Clinical reviewThe prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents
Introduction
The prevalence of childhood obesity has reached epidemic proportions worldwide and is still increasing. Obesity in children and adolescents is now recognized as a major medical and public health problem that affects nearly every major organ system.1 Furthermore, the development of cardiovascular morbidity can begin in childhood and in adolescence, which stresses the importance of early prevention, diagnosis and treatment for obesity and its related complications.2, 3, 4 One of the obesity-related complications that has received increasing attention in recent years is sleep-disordered breathing (SDB). SDB in overweight children and adolescents has been independently associated with the metabolic syndrome and its components*5, 6; thus, SDB becomes a potential additional risk factor for the development of cardiovascular morbidity. Secondly, SDB in children also results in behavioral and neurocognitive complications.7 Therefore, remaining alert for the presence of SDB in this high-risk population and subsequently seeking appropriate management is important. In this review, we will examine the current understanding regarding the prevalence of SDB; the role of adenoids, tonsils and adiposity in the development of SDB; and the various treatment options for SDB in overweight children and adolescents.
Section snippets
Prevalence of sleep-disordered breathing: primary snoring and obstructive sleep apnea syndrome
The main component of obstructive types of SDB, obstructive sleep apnea syndrome (OSAS), is characterized by recurrent events of partial and/or complete upper airway obstruction resulting in a disruption of normal ventilation and sleep.8 Obstructive SDB is also considered an entire continuum, which also encompasses upper airway resistance syndrome (UARS), in which the increased resistance at the upper airway is sufficiently large, which causes sleep fragmentation in the absence of blunt apneas
Prevalence of sleep-disordered breathing: central sleep apnea
In contrast to the evidence of a higher prevalence of OSAS among obese children, limited data have been reported on the occurrence of other respiratory abnormalities during sleep, i.e. central apneas. Several studies have provided reference data on the occurrence of apneas during sleep in normal children and adolescents. These studies all agree that short-duration central apneas (<20 s) are a normal phenomenon in children. Furthermore, these central events are almost never accompanied by serious
Anatomical correlates
The classical-risk factor for obstructive SDB in normal-weight children is an enlargement of the adenoids and/or tonsils. In obese children, one can expect that both lymphoid hypertrophy and obesity could compromise the upper airway. Several studies which demonstrated a significant relation between the degree of adiposity and AHI*24, 46 have already been reported and discussed. Silvestri et al.22 found that subjects without any adenotonsillar hypertrophy had a milder spectrum of respiratory
Treatment
Several treatment options can be considered for the obese child with SDB, including adenotonsillectomy, weight loss and continuous positive airway pressure (CPAP). Several of the previously discussed studies anecdotally reported a decrease in SDB symptoms and/or a normalization of the respiratory abnormalities after one of these treatment options was pursued.*22, *23, *24 Secondly, various reports have systematically investigated the effect of adenotonsillectomy in obese children with
Conclusion
In this review, we have shown that childhood obesity is associated with an increased prevalence of all types of SDB, specifically PS, OSAS and central sleep apnea that was marked by serious oxygen desaturations following the central apnea episodes. In view of the many SDB-related complications, we suggest that obese children and adolescents should be screened for SDB. However, it has to be noted that valid screening instruments for SDB are still lacking.60 We have also documented that upper
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