Risk factors and treatment for obstructive sleep apnea amongst obese children and adults

Abstract

In view of recent findings, a direct association between body mass and upper airway obstruction should be viewed with caution. Obesity may play a more significant role in the predisposition to OSA amongst particular subgroups of the population, such as adults, and those with particular craniofacial and upper airway morphology. Healthcare prioritization and requirements may be more substantial for such groups. Further, commonly used treatment methods for OSA (such as adenotonsillectomy for children and continuous positive airway pressure for adults) may be less effective for obese individuals. Weight-reduction strategies appear important for an optimal outcome, and such strategies may be more or less invasive depending on the severity of obesity, OSA or both, and other patient complications.

A clinical risk matrix for obstructive sleep apnea using Bayesian network approaches

“…We obtained a proportion of normal results in 66 patients (34%), revealing a large number of unnecessary exams that are performed every day in Vila Nova de Gaia/Espinho hospital center, with the possibility of this result being generalized to the different hospital centers in the country. Male gender was more prevalent (63%), agreeing with the literature [1,10,16,[20][21][22]27,30,36,[42][43][44][45]. Possible explanations are the higher prevalence of craniofacial and upperairway abnormalities (21%), and also snoring (90%).…”

“…Recommendations from the American Academy of Sleep Medicine state that OSA is present when AHI ≥ 5. It can be classified as mild (AHI: 5-15), moderate (AHI: [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], or severe (AHI ≥ 30) [6,7,13,22]. Approximately 30% of the general public is affected by a significant sleep problem, often of long standing [39].…”

“…Reported risk factors for developing OSA include different groups of variables, such as demographic, clinical history, comorbidities and even factors collected during the consultation, for example, male gender [1,10,16,20-22, 27,30,36,42-45], aging [1,16,[20][21][22]27,30,36,[42][43][44][45], obesity [1,10,12,16,[20][21][22]30,36,42,43,45], history of smoking [1,10,12,22,30,45], increased neck [1,10,16,[20][21][22]27,30,36,43,45] and abdominal [30,45] circumferences, arterial [1,12,16,20,22,…”

Sleep-disordered breathing, behavior, and academic performance in Taiwan schoolchildren

“…Several hypotheses also have been proposed for explaining why obese children are at risk of SDB, including reduction of the intrathoracic volume causing lower oxygen reserves [29], impaired ventilatory responses to hypoxia and hypercapnia, hypoventilation because of leptin resistance [30], and central apnea followed by narrowing or collapse of the upper airway [31]. In practice, an important concern is that obese children may have adenotonsillar hypertrophy [32,33], which may reduce the cross-sectional diameter of the upper airway [34]. However, the effect of adenotonsillar hypertrophy was not evaluated in our study.…”

Influence of snoring on microalbuminuria in diabetic patients

“…These results suggest that snoring is independently associated with an elevated risk for type 2 diabetes. Obesity, age, and menopause are known risk factors for OSA [20]. In the AHEAD study [12], waist circumference is found to be the only significant predictor of the presence of OSA (AHI≥5) in diabetics.…”