Related Experiment Videos
Determinants of growth in children with the obstructive sleep apnea syndrome
C L Marcus1, J L Carroll, C B Koerner
1Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland.
Insights
Childhood obstructive sleep apnea syndrome (OSAS) can cause failure to thrive. Treating OSAS improves weight gain by reducing sleep energy expenditure, suggesting breathing effort contributes to poor growth.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Metabolic Disorders
Background:
- Failure to thrive is a recognized complication in children with obstructive sleep apnea syndrome (OSAS).
- The precise mechanisms linking OSAS to impaired growth remain incompletely understood.
Purpose of the Study:
- To investigate the relationship between obstructive sleep apnea syndrome (OSAS) and energy expenditure during sleep (SEE) in children.
- To determine if resolving OSAS through surgery impacts growth and SEE.
Main Methods:
- Prospective study involving 14 children with OSAS undergoing polysomnography, dietary assessment, and SEE measurement before and after tonsillectomy and adenoidectomy.
- Analysis of weight changes (z scores), caloric intake, and SEE across different sleep stages pre- and post-intervention.
Main Results:
- Following surgery, OSAS resolved, leading to a significant increase in weight z scores (p < 0.005) without changes in caloric intake.
- Sleep energy expenditure (SEE) decreased significantly post-surgery (p < 0.005), particularly during REM sleep.
- Higher initial SEE correlated with lower weight z scores (r = -0.62, p < 0.05).
Conclusions:
- Resolution of obstructive sleep apnea syndrome (OSAS) in children leads to improved weight gain.
- Reduced sleep energy expenditure (SEE) post-OSAS treatment suggests increased work of breathing during sleep contributes to poor growth in affected children.
Abstract:
Failure to thrive is a common complication of childhood obstructive sleep apnea syndrome (OSAS). To further evaluate its cause, we obtained 3-day dietary records, anthropometric measurements, polysomnography, and measurements of energy expenditure during sleep (SEE) in children with OSAS before and after tonsillectomy and adenoidectomy. Fourteen children were studied (mean age, 4 +/- 1 (SD) years). During initial polysomnography, patients had 6 +/- 3 episodes of obstructive apnea/hr, an arterial oxygen saturation nadir of 85% +/- 8%, and peak end-tidal carbon dioxide tension of 52 +/- 6 mm Hg. After surgery, OSAS resolved in all patients. The standard deviation score (z score) for weight increased from -0.30 +/- 1.47 to 0.04 +/- 1.34 (p < 0.005), despite unaltered caloric intake (91 +/- 30 vs 90 +/- 27 kcal/kg per day; not significant). The initial SEE (averaged over all sleep states) was 51 +/- 6 kcal/kg per day; postoperatively, it decreased to 46 +/- 7 kcal/kg per day (p < 0.005). Although SEE decreased during all sleep stages, the greatest decrease occurred during rapid eye movement sleep. The patients with the highest SEE on initial study had the lowest z scores (r = -0.62; p < 0.05). We conclude that SEE decreases and weight improves after resolution of OSAS. We speculate that the poor growth seen in some children with OSAS is secondary to increased caloric expenditure caused by increased work of breathing during sleep.