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Obstructive sleep apnea in children and adolescents with and without obesity

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Abstract

Purpose

To investigate the prevalence of obstructive sleep apnea (OSA) in children referred for obesity treatment, and to compare the prevalence with that of a normal-weight group. Moreover, we examined the association between Body Mass Index Standard Deviation Score (BMI SDS) and the Apnea–Hypopnea Index (AHI).

Methods

This cross-sectional study included 139 children aged 7–18 years with overweight/obesity (BMI SDS >1.28) recruited from an obesity treatment clinic. The normal-weight group consisted of 33 children (BMI SDS ≤ 1.28) aged 7–18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor (Nox T3). OSA was defined as AHI ≥ 2. Height and weight were measured and the tonsillar size was clinically estimated using the Brodsky scale.

Results

The OSA prevalence was 44.6% in children with overweight/obesity compared with 9.1% in the normal-weight group (p = 0.0002), and the relative risk of OSA was 4.9 (95% CI 1.6–14.7). In a logistic regression, a one-unit increase in the BMI SDS increased the odds of having OSA by a factor of 1.92 independent of age, sex, tonsillar hypertrophy, and asthma (95% CI 1.33–2.76, p = 0.0005). A generalized linear regression adjusted for the same variables revealed an association between BMI SDS and AHI (a one-unit increase in the BMI SDS equaled an average increase in the AHI of 35% (95% CI 19–53%, p < 0.0001)).

Conclusions

In this study, children with overweight/obesity had a significantly higher prevalence of OSA compared with a normal-weight group. Increased BMI SDS was associated with increased AHI.

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References

  1. Marcus CL, Brooks LJ, Draper KA et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130:e714–e755. https://doi.org/10.1542/peds.2012-1672

    Article  PubMed  Google Scholar 

  2. Kang K-T, Chou C-H, Weng W-C et al (2013) Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One 8:e78666. https://doi.org/10.1371/journal.pone.0078666

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Mitchell RB, Kelly J (2007) Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 137:43–48. https://doi.org/10.1016/j.otohns.2007.03.028

    Article  PubMed  Google Scholar 

  4. O’Brien LM, Sitha S, Baur LA, Waters KA (2006) Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol 70:1555–1560. https://doi.org/10.1016/j.ijporl.2006.04.003

    Article  PubMed  Google Scholar 

  5. Marcus CL, Moore RH, Rosen CL et al (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368:2366–2376. https://doi.org/10.1056/NEJMoa1215881

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Verhulst SL, Franckx H, Van Gaal L et al (2009) The effect of weight loss on sleep-disordered breathing in obese teenagers. Obesity (Silver Spring) 17:1178–1183. https://doi.org/10.1038/oby.2008.673

    Article  Google Scholar 

  7. Siegfried W, Siegfried A, Rabenbauer M, Hebebrand J (1999) Snoring and sleep apnea in obese adolescents: effect of long-term weight loss-rehabilitation. Sleep Breath 3:83–88. https://doi.org/10.1007/s11325-999-0083-7

    Article  PubMed  Google Scholar 

  8. Van Hoorenbeeck K, Franckx H, Debode P et al (2012) Weight loss and sleep-disordered breathing in childhood obesity: effects on inflammation and uric acid. Obesity 20:172–177. https://doi.org/10.1038/oby.2011.282

    Article  PubMed  CAS  Google Scholar 

  9. Arens R, Sin S, Nandalike K et al (2011) Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 183:782–787. https://doi.org/10.1164/rccm.201008-1249OC

    Article  PubMed  Google Scholar 

  10. Koenig SM (2001) Pulmonary complications of obesity. Am J Med Sci 321:249–279

    Article  PubMed  CAS  Google Scholar 

  11. Rosen CL, Larkin EK, Kirchner HL et al (2003) Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr 142:383–389. https://doi.org/10.1067/mpd.2003.28

    Article  PubMed  Google Scholar 

  12. Spilsbury JC, Storfer-Isser A, Rosen CL, Redline S (2015) Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence. Sleep 38:23–29. https://doi.org/10.5665/sleep.4318

    Article  PubMed  PubMed Central  Google Scholar 

  13. Redline S, Tishler PV, Schluchter M et al (1999) Risk factors for sleep-disordered breathing in children. Am J Respir Crit Care Med 159:1527–1532. https://doi.org/10.1164/ajrccm.159.5.9809079

    Article  PubMed  CAS  Google Scholar 

  14. Cakirer B, Hans MG, Graham G et al (2001) The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African–Americans. Am J Respir Crit Care Med 163:947–950. https://doi.org/10.1164/ajrccm.163.4.2005136

    Article  PubMed  CAS  Google Scholar 

  15. Wing YK, Hui SH, Pak WM et al (2003) A controlled study of sleep related disordered breathing in obese children. Arch Dis Child 88:1043–1047

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Beebe DW, Lewin D, Zeller M et al (2007) Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J Pediatr Psychol 32:69–79. https://doi.org/10.1093/jpepsy/jsj104

    Article  PubMed  Google Scholar 

  17. Xu Z, Jiaqing A, Yuchuan L, Shen K (2008) A case-control study of obstructive sleep apnea–hypopnea syndrome in obese and nonobese Chinese children. Chest 133:684–689. https://doi.org/10.1378/chest.07-1611

    Article  PubMed  Google Scholar 

  18. Su M-S, Zhang H-L, Cai X-H et al (2016) Obesity in children with different risk factors for obstructive sleep apnea: a community-based study. Eur J Pediatr 175:211–220. https://doi.org/10.1007/s00431-015-2613-6

    Article  PubMed  Google Scholar 

  19. Ng M, Fleming T, Robinson M et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781. https://doi.org/10.1016/S0140-6736(14)60460-8

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pearson S, Olsen LW, Hansen B, Sørensen TIA (2005) [Increase in overweight and obesity amongst Copenhagen schoolchildren, 1947–2003]. Ugeskr Laeger 167:158–162

    PubMed  Google Scholar 

  21. Nysom K, Mølgaard C, Hutchings B, Michaelsen KF (2001) Body mass index of 0 to 45-year-old Danes: reference values and comparison with published European reference values. Int J Obes Relat Metab Disord 25:177–184. https://doi.org/10.1038/sj.ijo.0801515

    Article  PubMed  CAS  Google Scholar 

  22. Cole T, Green P (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319

    Article  PubMed  CAS  Google Scholar 

  23. Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin North Am 36:1551–1569

    Article  PubMed  CAS  Google Scholar 

  24. Berry R, Brooks R, Gamaldo C et al (2014) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.1. American Academy of Sleep Medicine, Darien

    Google Scholar 

  25. American Academy of Sleep Medicine (2014) international classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien

    Google Scholar 

  26. Andersen IG, Holm J-C, Homøe P (2016) Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment—a systematic review. Int J Pediatr Otorhinolaryngol 87:190–197. https://doi.org/10.1016/j.ijporl.2016.06.017

    Article  PubMed  Google Scholar 

  27. Kohler M, Lushington K, Couper R et al (2008) Obesity and risk of sleep related upper airway obstruction in caucasian children. J Clin Sleep Med 4:129–136

    PubMed  PubMed Central  Google Scholar 

  28. Marcus CL, Fernandes Do Prado LB, Lutz J et al (2004) Developmental changes in upper airway dynamics. J Appl Physiol 97:98–108. https://doi.org/10.1152/japplphysiol.00462.2003

    Article  PubMed  Google Scholar 

  29. Kohler MJ, van den Heuvel CJ (2008) Is there a clear link between overweight/obesity and sleep disordered breathing in children? Sleep Med Rev 12:347–361. https://doi.org/10.1016/j.smrv.2008.04.008

    Article  PubMed  Google Scholar 

  30. Scholle S, Scholle HC, Kemper A et al (2003) First night effect in children and adolescents undergoing polysomnography for sleep-disordered breathing. Clin Neurophysiol 114:2138–2145. https://doi.org/10.1016/S1388-2457(03)00209-8

    Article  PubMed  CAS  Google Scholar 

  31. Cairns A, Wickwire E, Schaefer E, Nyanjom D (2014) A pilot validation study for the NOX T3TM portable monitor for the detection of OSA. Sleep Breath 18:609–614. https://doi.org/10.1007/s11325-013-0924-2

    Article  PubMed  Google Scholar 

  32. Certal V, Camacho M, Winck JC et al (2015) Unattended sleep studies in pediatric OSA: a systematic review and meta-analysis. Laryngoscope 125:255–262. https://doi.org/10.1002/lary.24662

    Article  PubMed  Google Scholar 

  33. Kaditis AG, Alonso Alvarez ML, Boudewyns A et al (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47:69–94. https://doi.org/10.1183/13993003.00385-2015

    Article  PubMed  Google Scholar 

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Acknowledgements

Thank you to the staff in the Children’s Obesity Clinic, Holbæk University Hospital, and to the staff in the Sleep Clinic, Zealand University Hospital, for the support.

Funding

This study was funded by Region Zealand and Region Zealand Health Scientific Research Foundation (Grant nos. 15–000342, 180886). It was supported by a grant from Toyota-Fonden, Denmark (grant no. KJ/BG8866) and from ResMed Maribo, Denmark, (2700€ study-related funding). The funding sources had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Lykkebaekvej 1, 4600, Køge, Denmark

    Ida Gillberg Andersen & Preben Homøe

  2. Department of Pediatrics, The Children’s Obesity Clinic, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Denmark

    Ida Gillberg Andersen & Jens-Christian Holm

  3. The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen, Denmark

    Jens-Christian Holm

  4. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark

    Preben Homøe

Authors
  1. Ida Gillberg Andersen
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Contributions

IGA, PH, and JCH designed the study. IGA collected and analyzed the data and drafted the manuscript. PH and JCH critically revised and approved the manuscript.

Corresponding author

Correspondence to Ida Gillberg Andersen.

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Conflict of interest

Author IGA received a study-related grant from ResMed Maribo, Denmark. Author JCH declares he has no conflict of interest. Author PH declares he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Approvals were obtained from the Regional Danish Ethics Committee (Protocol ID SJ-404) and the Danish Data Protection Agency (ID no. REG-111-2014). The study was registered in Clinicaltrials.gov (ID no.: NCT02463201).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Andersen, I.G., Holm, JC. & Homøe, P. Obstructive sleep apnea in children and adolescents with and without obesity. Eur Arch Otorhinolaryngol 276, 871–878 (2019). https://doi.org/10.1007/s00405-019-05290-2

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  • DOI: https://doi.org/10.1007/s00405-019-05290-2

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