A controlled study of sleep related disordered breathing in obese children

Wing, Yun Kwok; Hui, Shuk Yi Annie; Pak, W M; Ho, Crover Kwok Wah; Cheung, Asy; Li, A M; Fok, Tai Fai

doi:10.1136/adc.88.12.1043

Cited by 231 publications

(165 citation statements)

References 28 publications

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“…Obesity is also a strong risk factor for adult SDB. Although data in children are more equivocal, obesity has been reported to be a risk factor for snoring or SDB in samples of older children and adolescents (47,48). Our data are consistent with this and underscore the importance of overweight as an SDB risk factor in adolescents: 72% of children with SDB in our sample were overweight and 77% had an increased waist circumference.…”

Section: Discussionsupporting

confidence: 80%

Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents

Redline¹,

Storfer‐Isser²,

Rosen³

et al. 2007

Am J Respir Crit Care Med

263

174

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Rationale: Metabolic syndrome (MetS) affects 4 to 10% of adolescents. Risk factors include overweight, male sex, and Hispanic ethnicity. Although sleep-disordered breathing (SDB) has been implicated as a risk factor for MetS in adults, its association with SDB in adolescents is unknown. Objectives: To define the association of SDB with MetS in adolescents. Methods: Standardized measurements of SDB, anthropometry and bioassays, were made in 270 adolescents, aged 13.6 ؎ 0.7 years. MetS was identified if threshold levels were exceeded in three of five areas: waist circumference, blood pressure, triglyceride level, high-density lipoprotein cholesterol level, and glucose levels. Measurements and Main Results: Although 70% of children with SDB (apnea-hypopnea index у 5) were overweight and 59% had MetS, 16% of children without SDB had MetS. Twenty-five percent of those with MetS had SDB. After adjusting for age, race, sex, and preterm status, children with SDB had a 6.49 (95% confidence interval, 2.52, 16.70) increased odds of MetS compared with children without SDB. Indices of SDB stress associated with MetS included respiratory event frequency, degree of oxygen desaturation, and sleep efficiency. Analyses of individual metabolic parameters showed that, after adjustment for body mass index, SDB was associated with systolic and diastolic blood pressure, low-density lipoprotein cholesterol, and fasting insulin levels. Conclusions: A majority of adolescents with SDB are overweight and meet criteria for MetS. The close association between MetS and SDB and their putative interacting pathophysiologies suggests a need to develop screening, prevention, and treatment strategies for both disorders in high-risk, overweight adolescents.Keywords: sleep apnea; metabolic syndrome; obesity Metabolic syndrome (MetS) refers to a clustering of abnormalities in glucose and lipid metabolism, believed to result from insulin resistance and/or central obesity. MetS, defined according to criteria established by the Adult Treatment Panel III (ATP III), is estimated to affect more than 20% of United States' adults, who frequently progress to diabetes and are at increased risk for premature cardiovascular disease (1). Approximately 95% of adults with MetS are overweight or obese (2).MetS is also estimated to afflict 4 to 10% of adolescents (3, 4). Similar to adults, overweight children have greater degrees of metabolic dysfunction than normal-weight children, and such abnormalities appear to track over time and predict metabolic dysfunction and cardiovascular risk profiles in adulthood (5, 6). What This Study Adds to the FieldObesity and metabolic syndrome are prevalent in adolescents with modest sleep apnea. Associations of metabolic dysfunction with sleep apnea persisted after considering weight, suggesting that sleep apnea contributes to metabolic dysfunction in children.The rising prevalence of overweight among children and adolescents has been implicated in the 10-fold estimated increased rate of noninsulin diabetes in adolescents, and ha...

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Section: Discussionsupporting

confidence: 80%

Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents

Redline¹,

Storfer‐Isser²,

Rosen³

et al. 2007

Am J Respir Crit Care Med

263

174

View full text Add to dashboard Cite

show abstract

“…29 However, the etiology and incidence of childhood OSA are evolving to resemble adult disease with the increasing prevalence of childhood obesity. 1,[30][31][32][33] In adults, OSA is linked to obesity. [34][35][36][37][38] In a prospective evaluation of adults, NC corrected for height was actually a better predictor of OSA than symptoms or general obesity, as assessed by body mass index (BMI).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Significant complications of untreated OSA include learning difficulties. [4][5][6][7] behavioral problems, 8,9 failure to thrive, 10,11 pulmonary hypertension [12][13][14][15] and systemic hypertension.…”

Section: Introductionmentioning

confidence: 99%

Inter‐ and intra‐rater reliability of neck circumference measurements in children

LaBerge

Vaccani

Gow

et al. 2008

Pediatric Pulmonology

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Summary. Rationale: Increased neck circumference is a risk factor for obstructive sleep apnea in adults. With rising obesity prevalence in children, it may be an important identifier of obstructive sleep apnea in children. The reliability of measuring neck circumference in children has not been systematically evaluated. Objective: To determine the inter-and intra-rater reliability of neck circumference measurements in children aged 2-16 years. Methods: Children aged 2-16 years with limb fractures were recruited. Neck circumference was measured by three investigators each using two separate unmarked paper tapes in the 2-5 year age group (N ¼ 43), and three separate tapes in the 6-10 and 11-16 year age groups (N ¼ 18 and 40). Results: Neck circumference measurements showed excellent inter-rater reliability for children 6-10 and 11-16 years (ICC ¼ 0.952 and 0.989). Substantial variation was observed for the 2-5 year age group (ICC ¼ 0.701). Good intra-rater reliability was demonstrated for the three groups (ICC range: 0.776, 0.950). Repeatability coefficients were 2.5-3.4 cm in the youngest age group and were 1.2-1.4 cm in the 6-16 year age group. Conclusion: In children 6-16 years old, neck circumference shows very good inter and good intra-rater reliability. Multiple measurements are not required for precision and reliability.

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“…This condition is one of the most serious problems that can occur and is more common among children who are severely obese. Prevalence is higher among obese children 55,56 and may be Ն50% among adolescents with severe obesity. 57 Symptoms that parents may notice are loud snoring with pauses in breathing, restless sleep, and daytime somnolence.…”

Section: Sleep Problemsmentioning

confidence: 99%

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

2007

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To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child's obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient's age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.www.pediatrics.org/cgi

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A controlled study of sleep related disordered breathing in obese children

Cited by 231 publications

References 28 publications

Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents

Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents

Inter‐ and intra‐rater reliability of neck circumference measurements in children

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

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