Obstructive Sleep Apnea in Extremely Overweight Adolescents undergoing Bariatric Surgery

Kalra, Maninder; Inge, Thomas H.; Garcia, Victor F.; Daniels, Stephen R.; Lawson, Louise; Curti, Rebecca; Cohen, Aliza P.; Amin, Raouf S.

doi:10.1038/oby.2005.139

Cited by 238 publications

(125 citation statements)

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“…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. On physical examination, children may have tonsillar hypertrophy, although obstructive sleep apnea can occur in the absence of tonsillar hypertrophy or after removal of tonsils and adenoids.…”

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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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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“…In the pediatric population, the risk for developing SDB is fourfold greater in obese children than in children who are not obese (2). Although the prevalence of SDB in all children is believed to range from 2 to 3% (3)(4)(5), the prevalence in adolescents who are morbidly obese exceeds 50% (6,7). Obesity is therefore strongly associated with abnormal upper airway control during sleep across all age groups.…”

mentioning

confidence: 99%

Growth Velocity Predicts Recurrence of Sleep-disordered Breathing 1 Year after Adenotonsillectomy

Amin

Anthony

Somers³

et al. 2008

Am J Respir Crit Care Med

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165

125

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Rationale: Adenotonsillectomy, the first line of treatment of sleepdisordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified. Objectives: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy. Methods: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year. Measurements and Main Results: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence. Conclusions: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension. Keywords: growth velocity; adenotonsillectomy; sleep-disordered breathingOne of the most frequently encountered conditions associated with obesity is sleep-disordered breathing (SDB). In adults, the risk of SDB increases by 1.14 for every unit increase in body mass index (BMI) (1). In the pediatric population, the risk for developing SDB is fourfold greater in obese children than in children who are not obese (2). Although the prevalence of SDB in all children is believed to range from 2 to 3% (3-5), the prevalence in adolescents who are morbidly obese exceeds 50% (6, 7). Obesity is therefore strongly associated with abnormal upper airway control during sleep across all age groups.Adenotonsillectomy, the first line of treatment in the management of childhood SDB, is the most commonly performed surgical procedure in children. The annual rate of adenotonsillectomy in children aged 0 to 14 years ranges from 19 per 10,000 in Canada to 115 per 10,000 in the Netherlands (8). At least half of these procedures are performed to relieve symptoms of SDB. In the first few weeks after adenotonsillectomy, obese children with SDB have a less favorable response to surgery than lean children. However, neither the long-term outcome nor the factors that contribute to recurrence of the disorder after adenotonsillectomy are clearly understood. Moreover, the impact of recurrence of SDB on important cardiovascular risk factors, such as blood pressure (BP), has never been examined.Research investigating the relationship between adiposity and SDB h...

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“…Silvestri and coworkers reported that 59% of children referred to a sleep clinic and evaluated with polysomnography had OSAHS [13]. Kalra and coworkers described 55% of obese adolescents selected for bariatric surgery that underwent polysomnography had OSAHS [14]. Redline and coworkers made one of the few population-based studies which included 399 children between 2 -18 years old, and found obesity as the principal risk factor for OSAHS with an odds ratio (OR) of 4.5 (95% confidence interval 1.58 -13.3) [15].…”

Section: Discussionmentioning

confidence: 99%

Frequency and severity of OSAHS in Mexican adolescents. The role of BMI and neck circumference

Partida-Gaytán¹,

Berber²,

Río-Navarro³

et al. 2013

Health

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Background: Overweight and obesity are major public-health issues in Mexico. Sleep breathing disorders directly impact the health of affected subjects. The aim of this study was to describe the frequency and severity of obstructive sleep apnea/hypopnea syndrome (OSAHS) in Mexican adolescents grouped by weight status. Secondary objectives were to describe the influence of body mass index (BMI) and neck circumference (NC) as predictive factors of OSAH. Method: Somatometric, demographic data and full-night polysomnography were done. Linear and logistic regression models described the relationship between BMI and NC with OSAHS presence and severity. Receiver-Operating-Characteristics (ROC) curves showed different sensitivity and specificity performances of BMI and NC cutoff-values. Results: OSAHS frequency and severity were significantly greater in obese and extremelyobese adolescents (8% vs 22% vs 67%; p < 0.001). Linear regression showed an AHI increase of 0.940 events/hour for every centimeter-increase in NC and 0.696 events/hour for every 1 kg/m 2 -increase in BMI. Logistic-regression showed extreme-obesity as the main risk factor (OR 9.9) for diagnosis of OSAHS. ROC curves showed an area under the curve (AUC) of 0.83 for BMI defined cutoff-values, and of 0.80 for BMI percentile-for-age cutoff-values. The AUC of NC ROC curve was 0.8043. Conclusion: This is the largest study made on Latin-American population evaluating the frequency and severity of OSAHS with full-night polysomnography. We showed that obese and extremelyobese Mexican-adolescents are at highest risk for OSAHS. Increasing BMI and NC showed positive correlation with AHI. Different BMI cut-off values showed similar diagnostic performance. Extreme-obesity increases 8 times the risk association for OSAHS.

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Obstructive Sleep Apnea in Extremely Overweight Adolescents undergoing Bariatric Surgery

Cited by 238 publications

References 31 publications

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

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

Growth Velocity Predicts Recurrence of Sleep-disordered Breathing 1 Year after Adenotonsillectomy

Frequency and severity of OSAHS in Mexican adolescents. The role of BMI and neck circumference

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