Obstructive sleep apnea syndrome in obese Singapore children

Chay, Oh Moh; Goh, Angela; Abisheganaden, John; Tang, Julian; Lim, Wonbong; Chan, Yoke Hwee; Wee, M.K.; Johan, A; John, Angela Beatriz; Cheng, H. K.; Lin, Meng‐Chih; Chee, T. S. G.; Rajan, U.; Wang, S.; Machin, David

doi:10.1002/(sici)1099-0496(200004)29:4<284::aid-ppul8>3.0.co;2-d

Cited by 110 publications

(66 citation statements)

References 34 publications

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“…In this group, BMI z-score was an independent determinant of OSA, as is true in children over a wider range of BMI. [3][4][5]30 One proposed mechanism for the association between obesity and OSA is narrowing of the upper airway due to fat deposition. 31 In children, sleep apnea may be caused by somewhat different mechanisms.…”

Section: Resultsmentioning

confidence: 99%

“…2 The risk of OSA is greatly increased by obesity in children, with an estimated prevalence of 36% in obese children. [3][4][5] The prevalence in obese patients with snoring or other signs of apnea is estimated to be much higher. 5 Interestingly, many severely obese children do not have OSA, indicating that different fat distribution phenotypes may exist.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

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Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

Canapari

Hoppin

Kinane

et al. 2011

Journal of Clinical Sleep Medicine

101

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Background:Obstructive sleep apnea (OSA) is associated with obesity, inflammation, and insulin resistance. The role of fat distribution in OSA pathogenesis has not been established in children. The objective of the study is to examine the relationship between fat distribution, OSA, and insulin resistance in an unselected population of obese children. Methods: All obese (BMI > 95th percentile) children (ages 5-18 y) seen at a pediatric obesity clinic were invited to participate. Subjects underwent polysomnography, and were tested for dyslipidemia, inflammation, and insulin resistance measured by the homeostasis model assessment (HOMA). In a subset of subjects, magnetic resonance (MRI) imaging was used to determine the abdominal visceral and subcutaneous adipose tissue areas and magnetic resonance spectroscopy (MRS) spectroscopy was used to intramyocellular lipids in leg muscles. Measurements and Main Results: 31 obese subjects enrolled and completed polysomnography and serum testing, and 19 subjects underwent MRI/MRS. The mean age was 12.6 ± 3.0 y and the mean body mass index (BMI) was 39.5 ± 11.2 kg/m 2 . Forty-eight percent had OSA (mean apnea hypopnea index [AHI] 6.26 ± 6.77 events/h) Subjects with OSA had significantly increased BMI, log HOMA, triglycerides, and leptin compared to those without OSA. In regression analysis, only BMI z-score was associated with log HOMA. In the subset of patients with imaging data, visceral fat area was strongly predictive of AHI (p = 0.003, r 2 = 0.556). BMI z-score, gender, and age were not predictive. Conclusions: Visceral fat distribution is independently predictive of OSA severity in obese children.

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Section: Resultsmentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

Canapari

Hoppin

Kinane

et al. 2011

Journal of Clinical Sleep Medicine

101

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“…Our study cohort consisted of an otherwise typical referral-based pediatric population that required clinical evaluation for suspected SDB, such that the large proportion of children with BMI Ͼ95% may have accounted for the higher risk for SDB in the context of obesity. [50][51][52] Indeed, we have observed progressively an increasing prevalence of obesity during the past decade among snoring children who presented at a large pediatric sleep center (Gozal D, unpublished observations, 2003), such that ϳ40% to 50% of the patients fulfill the criteria for obesity, as opposed to ϳ17% obesity prevalence in the metropolitan area of Louisville. This increased representation of obese children among symptomatic snoring children is not surprising considering the effect of excessive fat deposition on upper airway collapsibility 53 and the overall higher prevalence of SDB among obese children.…”

Section: Discussionmentioning

confidence: 99%

Obesity Rather Than Severity of Sleep-Disordered Breathing as the Major Determinant of Insulin Resistance and Altered Lipidemia in Snoring Children

et al. 2005

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ABSTRACT. Objective. Sleep-disordered breathing (SDB) is associated with insulin resistance and dyslipidemia in adults and in obese children. However, the prevalence of such metabolic abnormalities among snoring children is unknown. This study was done to prospectively assess the relative contribution of SDB and obesity to metabolic disturbances in a large cohort of snoring children.Methods. Measurements of fasting serum glucose, insulin, and lipids were obtained after polysomnographic evaluation in 116 snoring children and in 19 control subjects. Insulin resistance was assessed using the insulin/glucose ratio (I/G ratio) and homeostasis model assessment (HOMA).Results. A total of 135 children (79 boys; mean age: 8.9 ؎ 3.5 years) were studied. Sixty-four children had moderate to severe SDB (AHI ‫؍‬ 5 per hour of total sleep time [TST]), 52 had mild SDB (AHI ‫؍‬ 1 but <5 per hour of TST), and 19 were control subjects (AHI <1 per hour of TST). Seventy of these children were obese. No significant correlations were found between AHI, lowest arterial oxygen saturation, or arousal index and serum insulin, serum glucose, I/G ratio, HOMA, or serum lipids for either the whole group or the obese children only. However, significant positive correlations were found between I/G ratio and relative BMI (relBMI; r ‫؍‬ 0.58), HOMA and relBMI (r ‫؍‬ 0.52), triglycerides and relBMI (r ‫؍‬ 0.30), and high-density lipoprotein and relBMI (r ‫؍‬ 0.50). No significant differences were found in relBMI, I/G ratio, and lipid levels between boys and girls.Conclusions. Among children with suspected SDB, insulin resistance and dyslipidemia seem to be determined primarily by the degree of body adiposity rather than by the severity of SDB. Pediatrics 2005;116:e66-e73. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-2527; metabolic syndrome, sleep apnea, pediatrics, obesity, diabetes.ABBREVIATIONS. SDB, sleep-disordered breathing; CPAP, continuous positive airway pressure; CRP, C-reactive protein; Spo 2 , arterial oxygen saturation; AHI, apnea hypopnea index; TST, total sleep time; relBMI, relative BMI; HOMA, homeostasis model assessment; I/G ratio, insulin/glucose ratio; HDL, high-density lipoprotein; TG, triglyceride.T he incidence of childhood obesity has been increasing steadily in Western countries. 1 Recent reports place the prevalence of obesity and overweight in children at levels ranging from 7% up to 22% in various countries, 2-9 and such elevated figures will undoubtedly impose major health implications, particularly on the development of insulin resistance, type 2 diabetes, and cardiovascular morbidity. [10][11][12] The term "metabolic syndrome" is a known risk factor for cardiovascular disease in adults and refers to the clustering of insulin resistance, dyslipidemia, hypertension, and obesity. Elevation of fasting insulin levels and increased BMI during childhood are the strongest predictors of the metabolic syndrome in adulthood, 13,14 possibly through the combination of altered insulin signaling and adrenocortical function, in...

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“…The prevalence of adolescent obesity in the United States is currently 20.5% (2). Obesity is associated with an increased risk of OSAS throughout the age spectrum, from infancy through adulthood (38)(39)(40)(41)(42). It is unclear how obesity interacts with adenotonsillar hypertrophy, as well as with ventilatory drive and pulmonary mechanics, as a risk factor for OSAS.…”

Section: Original Articlementioning

confidence: 99%

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Schwab

Kim

Bagchi

et al. 2015

Am J Respir Crit Care Med

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Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children.Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI).Methods: Three groups of adolescents (age range: 12-16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50). Measurements and Main Results:We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation.Conclusions: Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.Keywords: adenoid; adolescents; MRI; obstructive sleep apnea syndrome; tonsils The obstructive sleep apnea syndrome (OSAS) is common in children and adults, but it has not been well studied in adolescents. In one study, researchers reported the prevalence of OSAS in adolescents to be 2% (1), but the prevalence is probably higher in the United States because of the adolescent obesity epidemic (2). OSAS in children is thought to be secondary to a combination of enlargement of the lymphoid tissue (tonsils and adenoid) (3) and, sometimes, obesity, as well as to reductions in neuromuscular tone (4). In adults, there are known anatomic risk factors for OSAS, including enlargement of the tongue, soft palate, parapharyngeal fat pads, and lateral pharyngeal walls (5) in conjunction with craniofacial restriction (retrognathia) (6). In addition to anatomic factors, physiologic mechanisms increase OSAS risk in both children and adults (7-12). Although these risk factors for OSAS have been well described in children and adults, few Supported by grants from the National Institutes of Health (R01 HL058585, R01 HL089447, and P01 HL094307).Author Contributions: Conception and design: R.J.S., R.M.B., S.H., and C.L...

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Obstructive sleep apnea syndrome in obese Singapore children

Cited by 110 publications

References 34 publications

Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

Obesity Rather Than Severity of Sleep-Disordered Breathing as the Major Determinant of Insulin Resistance and Altered Lipidemia in Snoring Children

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

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