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Polysomnography in obese children with a history of sleep-associated breathing disorders
J M Silvestri1, D E Weese-Mayer, M T Bass
1Rush Medical College of Rush University, Rush-Presbyterian-St. Luke's Medical Center, Department of Pediatrics, Chicago, Illinois 60612.
Insights
Obese children with sleep-disordered breathing often have obstructive sleep apnea (OSA). Polysomnography is recommended for obese children, especially those with severe obesity and enlarged tonsils/adenoids, to diagnose OSA.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Obesity Research
Background:
- Obesity is a growing concern in children.
- Sleep-disordered breathing, including obstructive sleep apnea (OSA), is common in obese children.
- Symptoms like snoring and difficulty breathing during sleep are indicative of potential OSA.
Purpose of the Study:
- To investigate the prevalence of obstructive sleep apnea (OSA) in obese children with sleep-disordered breathing.
- To determine correlations between obesity severity, adenotonsillar size, and polysomnography (PSG) findings.
- To identify predictors for OSA in this population.
Main Methods:
- 32 obese children with suspected sleep-disordered breathing were evaluated.
- Methods included sleep history questionnaires, airway radiographs, electrocardiograms (ECG), and polysomnography (PSG).
- Body mass index (BMI) as % ideal body weight (%IBW) and adenotonsillar size were assessed.
Main Results:
- 100% of children snored; 59% had difficulty breathing during sleep.
- Obstructive sleep apnea (OSA) was diagnosed in 59% and partial OSA in 66% of participants.
- Elevated end-tidal CO2 (PetCO2) and hypoxemia (SaO2 < 90%) correlated with higher %IBW (> or = 200%) and adenotonsillar enlargement.
- Predictors like %IBW, adenotonsillar tissue, and symptom count could predict PSG abnormalities with 81% reliability.
Conclusions:
- Obese children with sleep-disordered breathing frequently exhibit obstructive sleep apnea (OSA).
- Children with %IBW > or = 200% and adenotonsillar hypertrophy are at higher risk.
- Polysomnography (PSG) is crucial for diagnosing OSA in these children.
Abstract:
We hypothesized that obese children with a history of breathing difficulty during sleep would demonstrate (1) evidence of complete and partial obstructive sleep apnea (OSA) with hypercarbia and/or hypoxemia; and (2) correlation between symptoms, degree of obesity, adenoid and tonsil size, and polysomnography (PSG) results. We evaluated 32 obese children [% ideal body weight (IBW), 196 +/- 45%] with a sleep history questionnaire, airway radiographs, electrocardiograms (ECG), and PSG. By history, we found snoring (100%), difficulty breathing (59%), sweating (44%), restlessness (53%), arousals (41%), apnea (50%), worsening with upper respiratory infection (URI) (81%), hypersomnolence (59%), and mouth breathing (59%). We found adenoid and/or tonsil enlargement on 75% of airway x-ray pictures. ECGs were abnormal in 5 patients. Among all patients, mean sleep study oxyhemoglobin saturation (SaO2) was 85 +/- 16% and mean end-tidal CO2 (PetCO2) was 51 +/- 7 torr; 84% had paradoxical inward movement of the chest on inspiration, 59% had OSA, and 66% had partial OSA. In those with > or = 200% IBW and adenotonsillar enlargement, elevated PetCO2 and the presence of hypoxemia (SaO2 < 90%) for > or = 5% of the total sleep time (TST) were correlated, unlike in patients of similar weight but without adenotonsillar enlargement. Individuals symptoms did not correlate with the severity of PSG abnormalities. By discriminant analysis, using three variables (IBW, presence of adenotonsillar tissue, and presence of > or = 5 symptoms), we could predict PSG abnormalities with up to 81% reliability. Our findings indicate that in obese children, particularly those with %IBW > or = 200 and adenotonsillar hypertrophy, with sleep-disordered breathing evaluation by polysomnography should be considered.