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Obstructive sleep apnea syndrome in obese Singapore children
O M Chay1, A Goh, J Abisheganaden
1Respiratory Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.
Insights
Obstructive sleep apnea syndrome (OSAS) affects 0.7% of obese Singapore schoolchildren. Morbidly obese children face a higher risk, with 13.3% affected, highlighting the need for targeted screening.
Area of Science:
- Pediatrics
- Sleep Medicine
- Public Health
Background:
- Obesity is a growing concern in school-aged children.
- Obstructive sleep apnea syndrome (OSAS) is a serious condition linked to obesity.
- Limited data exists on OSAS prevalence in obese children in Singapore.
Purpose of the Study:
- To determine the prevalence of OSAS in obese Singaporean schoolchildren.
- To identify risk factors associated with OSAS in this population.
Main Methods:
- Prospective, three-phase study involving questionnaires, clinical visits, and polysomnography.
- Screened 3,671 obese children, with 146 undergoing polysomnography.
- Utilized discriminant analysis to estimate prevalence.
Main Results:
- Overall OSAS prevalence was 0.7% (26/3,671), rising to 5.7% with discriminant analysis.
- Morbidly obese children (percent ideal body weight >/=180) had a significantly higher prevalence of 13.3%.
- Sleeping sitting up was a significant clinical feature correlating with OSAS (P = 0.005).
- Adenotonsillar hypertrophy increased OSAS risk.
- 12.5% of affected children were asymptomatic, missed by questionnaires alone.
Conclusions:
- OSAS is present in obese Singaporean schoolchildren, with a higher prevalence in the morbidly obese.
- Screening beyond questionnaires is crucial, especially for morbidly obese children.
- Identifying risk factors like sleeping position and adenotonsillar hypertrophy aids in early detection.
Abstract:
We set out to determine the prevalence of obstructive sleep apnea syndrome (OSAS) among obese Singapore school children and identify risk factors for OSAS. This study was designed as a prospective study in three phases. Parents completed a questionnaire with regards to sleep and daytime symptoms in Phase 1. Children suspected to have OSAS based on the questionnaire and all with a percent ideal body weight (IBW) >/=180 were called for clinic visits in Phase 2. All whose percent IBW >/=180 and those in whom the physicians strongly suspected OSAS were subjected to a polysomnogram in phase 3. The children were recruited from the School Health Nutritional Clinic for obese children. The investigations were carried out at Tan Tock Seng Hospital. In all, 3,671 children were screened with the questionnaire. Of these, 146 were selected to undergo polysomnography. Twenty-six had abnormal sleep studies with apnea/hypoxia indices (AHIs) >5/hr. The significant clinical feature which correlated with OSAS was sleep sitting up (P = 0.005). The risk is higher in morbidly obese (IBW >/=180), with a prevalence of 13.3% (8/60), than in less obese children (IBW <180). One in eight (12.5%) of these children was asymptomatic and would have been missed based on the questionnaire. Presence of adenotonsillar hypertrophy led to increased risk of OSAS. The prevalence of OSAS was 0.7% (26/3,671) among the obese schoolchildren in Singapore, which is similar to the prevalence reported by others. Using discriminant analysis, the estimated prevalence increased to 5.7%. In the morbidly obese (IBW >/=180), the prevalence rate is higher at 13.3%.