Differences in the association between obesity and obstructive sleep apnea among children and adolescents.
OBJECTIVE
Overweight and obesity are thought to increase the risk of obstructive sleep apnea syndrome (OSAS) among children. However, previous results have been inconsistent and appear to be confounded by both ethnicity and the different ages of children studied. To determine whether the association between excess weight and OSAS varies with age across childhood, we assessed polysomnographic data from a series of Caucasian children and adolescents referred for clinical evaluation of snoring.


METHODS
Sleep and OSAS severity were assessed using polysomnography in 234 children aged 2.0 to 18.0 years. All children were referred for overnight evaluation of suspected OSAS. Severity of OSAS as a function of body mass and age were then evaluated.


RESULTS
Risk of OSAS among adolescents (age > or =12 years) was increased 3.5 fold with each standard-deviation increase in body mass index z-score. Risk of OSAS was not significantly increased with increasing body mass among younger children.


CONCLUSIONS
Similar to adults, adolescent children show an increased risk for having OSAS in association with overweight and obesity. For Caucasian children, overweight and obesity should be considered a significant risk for OSAS among adolescents or from age 12 years, especially when in combination with other established risk factors, including snoring and adenotonsillar hypertrophy.
Kohler
Mark J
MJ
Discipline of Paediatrics, University of Adelaide, Adelaide, Australia. mark.kohler@adelaide.edu.au
Thormaehlen
Swetlana
S
Kennedy
J Declan
JD
Pamula
Yvonne
Y
van den Heuvel
Cameron J
CJ
Lushington
Kurt
K
Martin
A James
AJ
D000293:Adolescent; D017677:Age Distribution; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*
J Clin Sleep Med. 2008 Apr 15;4(2):129-36
18468311
Am J Respir Crit Care Med. 2008 Mar 15;177(6):654-9
18174542
Aust Fam Physician. 2004 Jan-Feb;33(1-2):33-6
14988958
N Engl J Med. 1993 Apr 29;328(17):1230-5
8464434
Otolaryngol Head Neck Surg. 2007 Jul;137(1):43-8
17599563
Int J Pediatr Otorhinolaryngol. 2006 Sep;70(9):1555-60
16820218
Sleep Med Rev. 2008 Oct;12(5):339-46
18406637
Sleep. 2002 Aug 1;25(5):499-506
12150315
Proc Am Thorac Soc. 2008 Feb 15;5(2):242-52
18250218
JAMA. 2000 Dec 20;284(23):3015-21
11122588
Psychiatry Clin Neurosci. 2001 Jun;55(3):305-10
11422885
J Appl Physiol (1985). 2004 Jul;97(1):98-108
14990559
Sleep Med Rev. 2008 Oct;12(5):347-61; discussion 363-4
18790410
Ann Acad Med Singap. 2008 Aug;37(8):715-21
18797568
Sleep. 2008 Apr;31(4):534-41
18457241
Am J Respir Crit Care Med. 1997 Jan;155(1):186-92
9001310
Curr Opin Obstet Gynecol. 2006 Oct;18(5):487-91
16932041
Sleep. 2002 Jun 15;25(4):412-9
12071542
Chest. 2003 May;123(5):1544-50
12740272
Chest. 2009 Jul;136(1):137-144
19225059
Am J Clin Nutr. 1999 Jul;70(1):173S-5S
10419424
Paediatr Anaesth. 2007 May;17(5):426-30
17474948
Sleep Breath. 2008 Mar;12(1):25-31
17684780
Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1527-32
10228121
Obes Res. 2005 Jul;13(7):1175-9
16076986
Am J Respir Crit Care Med. 1996 Feb;153(2):866-78
8564147
Lancet. 2002 Aug 10;360(9331):473-82
12241736
Arch Otolaryngol Head Neck Surg. 2006 Oct;132(10):1123-7
17043263
Pediatr Pulmonol. 1999 Jun;27(6):403-9
10380092
Sleep. 2004 Aug 1;27(5):997-1019
15453561
Sleep. 2006 Sep;29(9):1115-34
17040000
Arch Otolaryngol Head Neck Surg. 1995 May;121(5):525-30
7727086
Int J Fertil Womens Med. 1997 May-Jun;42(3):184-97
9222803
Iran J Allergy Asthma Immunol. 2006 Sep;5(3):127-32
17237564
Obes Surg. 2008 Jun;18(6):675-9
18350342
J Pediatr. 2006 Sep;149(3):342-7
16939744
J Sleep Res. 1999 Mar;8(1):65-70
10188138
Sleep. 1992 Apr;15(2):173-84
11032543
Sleep. 2001 Nov 1;24(7):823-9
11683485
J Pediatr. 2006 Dec;149(6):803-8
17137896