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Sleep-associated breathing disorders in morbidly obese children and adolescents
G B Mallory1, D H Fiser, R Jackson
1Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock 72202.
Insights
Morbidly obese children and adolescents often have sleep-disordered breathing. While most polysomnography abnormalities are mild, some cases require clinical intervention, highlighting the need for screening.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Obesity Research
Background:
- Morbid obesity in children and adolescents is a growing concern.
- Sleep-disordered breathing (SDB) is common in obese adults, but less studied in pediatric populations.
- Prevalence of SDB in morbidly obese youth requires further investigation.
Purpose of the Study:
- To determine the incidence of sleep-associated breathing disorders in children and adolescents with morbid obesity.
- To assess the relationship between weight, age, and gender with polysomnographic findings.
- To evaluate the severity of polysomnographic abnormalities in this population.
Main Methods:
- Polysomnography was performed on 41 children and adolescents (mean age 10.3 years, mean 208% ideal body weight).
- Pulmonary function testing was conducted on 17 patients.
- Sleep history questionnaires were utilized to gather subjective data.
Main Results:
- All patients reported snoring; frank apnea was reported in 32%.
- Pulmonary function tests revealed restrictive defects in 18% and obstructive changes in 47%.
- Polysomnograms were abnormal in 37% of patients due to apnea, hypopnea, arousals, or gas exchange issues. No significant association was found between weight, age, or gender and polysomnogram measures. Most abnormalities were mild, but two cases required clinical intervention.
Conclusions:
- Children and adolescents with morbid obesity are at increased risk for sleep-associated breathing disorders.
- While polysomnographic abnormalities are typically mild, severe cases requiring intervention can occur.
- Screening for SDB in morbidly obese youth is warranted.
Abstract:
Forty-one children and adolescents with a history of breathing difficulty during sleep and morbid obesity, defined as greater than 150% ideal body weight, underwent polysomnography to determine the incidence of sleep-associated breathing disorders. Seventeen patients also performed pulmonary function testing. The mean patient age was 10.3 +/- 4.4 (SD) years, and mean percent of ideal body weight was 208 +/- 42.2. A sleep history questionnaire showed that all patients snored, but frank apnea was reported in only 32%. The pulmonary function tests showed 18% (3/17) with a restrictive defect and 47% (8/17) with obstructive changes. The polysomnograms in 37% (15/41) of the patients were abnormal because of apnea, hypopnea, excessive arousals, or abnormalities in gas exchange. Multiple regression analysis demonstrated no significant association between weight, age, or gender and any physiologic measure on the polysomnogram. Most of the abnormal polysomnograms (13/15) were mildly abnormal, but two showed sufficiently severe abnormalities to require clinical intervention. We conclude that children and adolescents with morbid obesity are at risk for sleep-associated breathing disorders; their polysomnographic abnormalities are usually mild but rarely may be severe enough to require clinical intervention.