Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study

Abstract

The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m −2 , corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h −1 . Among group 1 children, 21.2% had an RDI ⩾3 events·h −1 at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82,).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up. @ERSpublications Age, RDI and obesity are risk factors for unfavourable OSAS treatment outcomes at follow-up

Searching for the happy medium in the therapeutic approach to childhood sleep disordered breathing

“…Remarkably, primary snoring and mild disease in childhood were poor predictors, whereas older age, obesity and male sex, the usual risk factors in adults, were independently associated with SDB in adolescence, as previously reported in recent studies [7,14]. This underscores the differences in pathophysiology across the growth stages and shows how adolescent SDB more closely resembles the sleep disorder found in adulthood than that found in childhood.…”

Focus on prevention and treatment of obstructive sleep disordered breathing in childhood

“…A limitation of the study by ALONSO-ÁLVAREZ et al [1] is that children with persistent OSAS did not undergo systematic evaluation for subtle craniofacial abnormalities using cephalometry, eventually followed by appropriate interventions such as application of orthodontic appliances for dental malocclusion or rapid maxillary expansion for narrow maxillae [17,18]. Thus, the contribution of craniofacial factors to persistent OSAS which are present in both obese and normal-weight children with SDB remains undefined.…”

“…Most importantly, each five-unit postoperative reduction in the apnoea−hypopnoea index (AHI), or 5 mmHg decrease in the peak end-tidal CO 2 , was accompanied by a mean drop in heart rate by 1 or 1.5 beats per minute, respectively, denoting less sympathetic nervous system activation [9]. apnoea−hypopnoea index, OAHI) with cut-off values ranging between 1 and 3 episodes per hour, according to different definitions used in the paediatric literature [1]. The main feature distinguishing RDI from ORDI and OAHI is the inclusion or exclusion of central events [10].…”

“…Nevertheless, the importance of central apnoeas in otherwise healthy children with OSAS is uncertain. They are associated with fluctuations in heart rate and blood pressure during sleep, and central apnoea index decreased after adenotonsillectomy in both a published Australian study and in the NANOS trial [1,11,12].…”

“…In this issue of the European Respiratory Journal, treatment outcomes of obstructive sleep apnoea syndrome (OSAS) in obese community-dwelling children are reported by ALONSO-ÁLVAREZ et al [1]. The results of the NANOS multicentre trial indicate that obese children have a high rate of persistent disease despite treatment with adenotonsillectomy, nutritional interventions or even nasal continuous positive airway pressure (CPAP).…”