Is there a clear link between overweight/obesity and sleep disordered breathing in children?

Risk factors and treatment for obstructive sleep apnea amongst obese children and adults

PURPOSE OF REVIEW

The purpose of this review is to summarize the evidence for the association between obesity and obstructive sleep apnea (OSA), as well as predisposing risk factors and treatment strategies for OSA amongst obese patients.

RECENT FINDINGS

Recent findings highlight a number of factors including sex, age, upper airway structure and ethnicity, which may predispose patients to OSA when obese. Both invasive and noninvasive weight-reduction strategies also show positive signs of being an effective means to reduce or remediate OSA amongst obese adults and children.

SUMMARY

In view of recent findings, a direct association between body mass and upper airway obstruction should be viewed with caution. Obesity may play a more significant role in the predisposition to OSA amongst particular subgroups of the population, such as adults, and those with particular craniofacial and upper airway morphology. Healthcare prioritization and requirements may be more substantial for such groups. Further, commonly used treatment methods for OSA (such as adenotonsillectomy for children and continuous positive airway pressure for adults) may be less effective for obese individuals. Weight-reduction strategies appear important for an optimal outcome, and such strategies may be more or less invasive depending on the severity of obesity, OSA or both, and other patient complications.

Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy

BACKGROUND

The obesity epidemic has prompted remarkable changes in the proportion of obese children who are referred for habitual snoring. However, the contribution of obesity to adenotonsillar hypertrophy remains undefined.

METHODS

In our study, 206 nonobese habitually snoring children with polysomnographically diagnosed obstructive sleep apnea (OSA) were matched for age, gender, ethnicity, and obstructive apnea-hypopnea index (OAHI) to 206 obese children. Size estimates of tonsils and adenoids, and Mallampati class scores were obtained, and allowed for the assessment of potential relationships between anatomic factors and obesity in pediatric OSA.

RESULTS

The mean OAHI for the two groups was approximately 10.0 episodes/h total sleep time. There was a modest association between adenotonsillar size and OAHI in nonobese children (r = 0.22; p < 0.001) but not in obese children. The mean (+/- SEM) adenotonsillar size was larger in nonobese children (3.85 +/- 0.16 vs 3.01 +/- 0.14, respectively; p < 0.0001), and conversely Mallampati class scores were significantly higher in obese children (p < 0.0001).

CONCLUSION

The magnitude of adenotonsillar hypertrophy required for any given magnitude of OAHI is more likely to be smaller in obese children compared to nonobese children. Increased Mallampati scores in obese children suggest that soft-tissue changes and potentially fat deposition in the upper airway may play a significant role in the global differences in tonsillar and adenoidal size among obese and nonobese children with OSA.