Clinical and polygraphic evolution of sleep-related breathing disorders in adolescents

Childhood obesity, weight loss and developmental trajectories predict the persistence and remission of childhood sleep-disordered breathing

BACKGROUND

Obesity has been recognized as a risk factor for childhood sleep-disordered breathing (SDB), yet it remains unclear how obesity and weight change predict the course of childhood SDB.

OBJECTIVE

The objective of the study is to investigate the role of body weight, upper airway abnormalities and developmental trajectories on the persistence and remission of childhood SDB in the transition to adolescence.

METHODS

The Penn State Child Cohort is a representative population sample of 700 children (5-12 years), of whom 421 were followed up as adolescents (12-23 years). Participants underwent a clinical history, physical examination and polysomnography at both time points.

RESULTS

Obesity and enlarged tonsils were cross-sectionally associated with childhood SDB. Longitudinally, baseline obesity predicted the persistence of childhood SDB (OR = 3.75, 95% CI = 2.00-7.05), while weight loss predicted its remission (OR = 1.67, 95% CI = 1.11-2.50). Children with enlarged tonsils who remitted from SDB had not experienced significant weight loss and only 4.4% had undergone adeno/tonsillectomy. Body fat distribution/composition at follow-up was similar in those who had remitted from childhood SDB as compared with those who had never experienced SDB, while those who persisted with childhood SDB showed significant android distribution and visceral adiposity at follow-up.

CONCLUSIONS

Our data support a causal role for obesity and weight loss in the chronicity and remission, respectively, of childhood SDB in the transition to adolescence and suggest that remission of SDB is related to developmental trajectories of the upper airway in a significant proportion of children. Thus, targeting childhood obesity and weight gain should be a priority in the prevention and treatment of SDB during this critical developmental period.

[Sleep-Disordered Breathing in Childhood]

Sleep-Disordered Breathing in Childhood Abstract. One out of ten healthy children is a habitual snorer, and one fourth of snoring children suffer from obstructive sleep apnea syndrome (OSAS). While OSAS is widely recognized as a relevant social and health problem due to its negative impact on behavior and neurocognitive development, the medical significance of habitual snoring remains debated. Sleep-disordered breathing remains underestimated and underdiagnosed in childhood, in part due to the variability of clinical manifestations. This is particularly true for children with an underlying syndromal morbidity such as Down syndrome or Prader-Willi syndrome. This review summarizes the essential key points of Sleep-Disordered Breathing (SDB) in childhood.

Associations of Overweight, Obesity and Related Factors with Sleep-Related Breathing Disorders and Snoring in Adolescents: A Cross-Sectional Survey

Background: Sleep-related breathing disorders (SRBD) have been identified as a major public health problem closely related to adolescent obesity. We aimed to estimate the prevalences of SRBD and snoring in adolescents in Changchun City, Northeastern China, and to evaluate the associated factors in this population. Methods: In total, 1955 adolescents aged 11–18 years were recruited in Changchun City using stratified cluster sampling. Parents and caretakers of children completed the questionnaires, which included demographic characteristics, anthropometric parameters and a pediatric sleep questionnaire (SRBD scale). Logistic regression was used to analyze the relationship between SRBD, snoring and other factors. Results: The prevalences of SRBD and snoring in our population were 3.7% and 3.3%, respectively, and the prevalences of overweight and obesity were 12.6% and 4.9%. Multivariate logistic regression showed that urban residence (OR = 2.356, 95%CI: 1.251–4.435) and post-term birth (OR = 3.275, 95%CI: 1.396–7.683) were significantly associated with SRBD. Preterm birth (OR = 2.255, 95%CI: 1.021–4.980) and parental education level of university and above (OR = 0.265, 95%CI: 0.083–0.850) were significantly associated with snoring. Overweight (OR = 2.063, 95%CI: 1.062–4.006) was also related to snoring. Conclusions: The prevalences of SRBD and snoring were similar to those reported in previous studies. Urban residence and post-term birth were important influencing factors for SRBD; overweight, highest parental education level (university and above) and preterm birth were key factors affecting snoring in adolescents.

Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence

STUDY OBJECTIVE

To study the incidence, remission, and prediction of obstructive sleep apnea (OSA) from middle childhood to late adolescence.

DESIGN

Longitudinal analysis.

SETTING

The Cleveland Children's Sleep and Health Study, an ethnically mixed, urban, community-based cohort, followed 8 y.

PARTICIPANTS

There were 490 participants with overnight polysomnography data available at ages 8-11 and 16-19 y.

MEASUREMENTS AND RESULTS

Baseline participant characteristics and health history were ascertained from parent report and US census data. OSA was defined as an obstructive apnea- hypopnea index ≥ 5 or an obstructive apnea index ≥ 1. OSA prevalence was approximately 4% at each examination, but OSA largely did not persist from middle childhood to late adolescence. Habitual snoring and obesity predicted OSA in cross-sectional analyses at each time point. Residence in a disadvantaged neighborhood, African-American race, and premature birth also predicted OSA in middle childhood, whereas male sex, high body mass index, and history of tonsillectomy or adenoidectomy were risk factors among adolescents. Obesity, but not habitual snoring, in middle childhood predicted adolescent OSA.

CONCLUSIONS

Because OSA in middle childhood usually remitted by adolescence and most adolescent cases were incident cases, criteria other than concern alone over OSA persistence or incidence should be used when making treatment decisions for pediatric OSA. Moreover, OSA's distinct risk factors at each time point underscore the need for alternative risk-factor assessments across pediatric ages. The greater importance of middle childhood obesity compared to snoring in predicting adolescent OSA provides support for screening, preventing, and treating obesity in childhood.