Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: A review of the literature

Shine, Neville; Coates, Harvey; Lannigan, Francis J.

doi:10.1016/j.ijporl.2005.08.008

Cited by 75 publications

(57 citation statements)

References 54 publications

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“…Although both adenotonsillar hypertrophy and adiposity predispose children to obstructive SDB, the relative contribution of each of them is unknown [31]. In the controlled study by Wing et al [8], tonsillar enlargement had an odds ratio of 12.7 (95% level confidence interval 2.1-75.2) for SDB and obesity a ratio of only 1.2 (95% level confidence interval 1.1-1.3).…”

Section: Discussionmentioning

confidence: 99%

Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring

et al. 2007

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Correlation between obesity and obstructive sleep apnea has been documented in both adults and children. This investigation evaluated importance of body mass index (BMI) in relation to age as predictor of severity of obstructive sleep-disordered breathing (SDB). Children with habitual snoring referred for polysomnography were recruited. BMI Z score (> or =1.036 vs <1.036, i.e. at risk for overweight or overweight vs normal) was assessed as predictor of severity of SDB (apnea-hypopnea index [AHI] >five vs < or =five episodes per hour) at different ages (< or =6 vs >6 years). Two hundered eighty-four participants were recruited: 75 young children (4.6 +/- 1 years) with high BMI (1.9 +/- 0.7); 95 young subjects (4.5 +/- 1.1 years) with low BMI (-0.2 +/- 1.3); 55 older children (9.2 +/- 1.8 years) with high BMI (1.8 +/- 0.5); and 59 older participants (9.7 +/- 2.2 years) with low BMI (-0.2 +/- 1.1). Odds ratios for AHI >5 in young/high BMI children, young/low BMI subjects, and older/high BMI subjects relative to older/low BMI participants were: 6.5 (95% confidence interval 2.1-19.9), 7.3 (2.4-22) and 2 (0.6-7.3), respectively. Large tonsil size was associated with young age (odds ratio 1.97; 1.2-3.3). Among children with habitual snoring, adiposity does not predict severity of obstructive SDB in early childhood probably due to the prominent role of adenotonsillar hypertrophy. However, it may have a more important contribution to severity of SDB in older children.

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Section: Discussionmentioning

confidence: 99%

Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring

et al. 2007

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“…[83][84][85] Estimates of the prevalence among all children and adolescents are much lower at roughly 2% to 3%. [86][87][88] Obese children and adolescents with OSAS are more likely to have excessive daytime sleepiness. 89 Furthermore, OSAS is more likely to persist after treatment with adenotonsillectomy in obese youth than in normalweight youth.…”

Section: Other Comorbidities Obstructive Sleep Apnea Syndromementioning

confidence: 99%

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Kelly¹,

Barlow

Rao³

et al. 2013

Circulation

898

804

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espite recent data suggesting that the rate of increase of obesity among children and adolescents has slowed and overall prevalence has possibly begun to plateau, 1,2 a worrisome trend has emerged in the form of severe pediatric obesity. As the fastest-growing subcategory of obesity in children and adolescents, 1,3,4 severe obesity afflicts between 4% and 6% of all youth in the United States 3-7 and has both immediate and long-term health consequences. Recent data further Abstract-Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing.Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behaviorbased treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks. (Circulation. 2013;128:1689-1712.)

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“…Indeed, similar to adults, obese children are at increased risk for developing sleep-disordered breathing, and the severity of OSA is proportional to the degree of obesity [43][44][45][46], such that for every increment in BMI by 1 kg/m 2 beyond the mean BMI for age and gender, the risk of OSA will increase by 12%. Conversely, adenotonsillar hyperplasia/hypertrophy is not always the main contributing factor to the development of OSA in obese children (47)(48)(49). In fact, interactions between these 2 factors, namely BMI and tonsil/adenoid size have been independently implicated in the risk for OSA [50].…”

Section: Pathophysiology Of Osa: Tonsils/adenoids Vs Obesitymentioning

confidence: 99%

Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities?

Dayyat

Kheirandish‐Gozal

Gozal

2007

Sleep Medicine Clinics

210

114

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The spectrum of sleep disordered breathing (SDB) encompasses habitual snoring at the low end of severity all the way to frank obstructive sleep apnea (OSA), with upper airway resistance syndrome (UARS) and obstructive alveolar hypoventilation being considered as less severe variants of this condition. SDB occurs in children of all ages, from neonates to adolescents, and is characterized by repeated events of increased upper airway resistance as well as with either partial or complete upper airway obstruction during sleep, all of which may result in disruption of normal gas exchange and sleep integrity [1]. SDB was initially described over a century ago [2] and was then rediscovered in children by Guilleminault in 1976 [3]. However, this complex and relatively prevalent disorder is only now being recognized as a major public health problem. During the initial years since the seminal paper by Guilleminault et al [3], it became apparent that the classic clinical syndrome of OSA in children markedly differed from the OSA seen in adults, in particular with respect to gender distribution, clinical manifestations, polysomnographic findings, and treatment approaches [4,5]. However in more recent years, the epidemic of obesity that affects the pediatric population all over the world has led, in our opinion, to the emergence of a phenotypic variant of OSA in children that closely resembles that of adults with the disease. In this paper, we will review the pathophysiological mechanisms of OSA in children, delineate the clinical manifestations associated with the disease, and provide arguments for our novel and hopefully useful proposition that aims to define 2 types of OSA in children. For the sake of convenience, and in analogy with type I and type II diabetes, we propose to divide pediatric OSA as types I and II. Keywordsobstructive sleep apnea; adenotonsillar hypertrophy; obesity; inflammation; upper airway; snoring Epidemiology of Pediatric OSAHabitual snoring during sleep, the hallmark indicator of increased upper airway resistance, is an extremely frequent occurrence during childhood, with up to 27% of children being affected [6][7][8][9][10][11][12][13][14]. SDB is most common in young children (pre-school and early school years), with a peak prevalence around 2-8 years, and subsequent declines in frequency [15]. However, accurate prevalence information is missing, particularly in infants, since most epidemiological studies have to date concentrated on older children. Furthermore, the exact polygraphic Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. demarcation betwee...

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Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: A review of the literature

Cited by 75 publications

References 54 publications

Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring

Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities?

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