Obstructive sleep apnea in childhood and adolescence

There is limited study data about the natural course of obstructive sleep apnea (OSA) in children. This study looked at OSA incidence and remission from middle childhood (ages 8-11 years) through late adolescence (ages 16-19 years). It also studied if risk factors for OSA that were present in middle childhood remained in adolescence. This was a retrospective study from a larger sleep and health study.

Of note, OSA in children is typically defined as full or partial collapse of the airway at least 1 time an hour. In this study, the authors used a more conservative measure of 5 or more airway collapses per hour. The results showed OSA was present in 4.7% of middle childhood aged kids and in 4.3% of adolescents. And only 8.7% of those with OSA in middle childhood still had OSA in adolescence - meaning almost 91% of cases of OSA resolved between middle childhood and adolescence. And of those whose OSA had remitted by adolescence, only 24% had had tonsillectomy, the treatment of choice for OSA in children. So in 3 out of 4 cases, the OSA went away on it's own, without surgical intervention. Of the children without OSA, only 4% went on to be diagnosed with OSA in adolescence.

Unlike OSA, habitual snoring was much more persistent from middle childhood to adolescence. Half of the snorers in middle childhood were still snoring in adolescence, yet most of them did not go on to develop OSA as adolescents. However, when the study authors lowered the threshold for diagnosing OSA, 32% of middle childhood snorers went on to develop OSA in adolescence.

Risk factors for middle childhood OSA were African American race, preterm status, and neighborhood distress. However, these were not risk factors for OSA in adolescents. Instead, the risk factors were male sex and history of tonsillectomy or adenoidectomy. Finally, adolescents with OSA had a higher body-mass index (marker for obesity) compared to adolescents and middle childhood kids without OSA. The authors speculated that the changing risk factors may reflect the fact that upper airway changes occur from middle childhood to adolescence, especially regression of tonsils. Thus, other factors like male gender and obesity would be more important in adolescents. The authors go on to explain that the risk factor of prior tonsillectomy in adolescents with OSA may be due to other risk factors that reflect a predisposition for upper airway collapse in sleep.

The authors concluded that screening for OSA could be age specific given the different risk factors present at the different ages. Also, the cutoff values for OSA may need to be altered given the child's age - using a more liberal cutoff for younger children and a more conservative one for older children. This is already being done at many sleep centers, where the sleep physician can use adult criteria or pediatric criteria cutoff values for children aged 13 and older.

Weight gain after tonsil removal for obstructive sleep apnea

Children with obstructive sleep apnea (OSA) can have reduced growth rates. The primary treatment of OSA in children is removing the tonsils adenoids, referred to as an adenotonsillectomy. After this procedure, studies have shown an increase in weight. However, some kids that are overweight before adenotonsillectomy put on even more weight after the surgery.

This study looked at two groups of children, ages 5-10 years old, who had OSA. One group got adenotonsillectomy and the other group received no treatment - just watchful waiting. Sleep studies and height / weight measurements were repeated 7 months later. Results showed that body weight and body mass index (BMI) increased in both groups of patients. This may be because the sleep apnea severity improved in both groups. It's unclear why that happened, especially with the weight gain. I would think that would make the sleep apnea severity worse in the untreated group.

What was remarkable about the study, however, was that after adjusting for baseline weight and other variables, the weight gain experienced by those that had the adenotonsillectomy was significantly greater than the group that received no treatment. In those children who were already overweight at the start of the study, 52% became obese after adenotonsillectomy vs 21% in the group that did not receive treatment. The researchers proposed several mechanisms for weight gain after adenotonsillectomy: increased calories consumed, unhealthy food choices, decreased energy burned due to reduced work of breathing, improvement in blood oxygen levels, and increased growth hormone secretion.

The authors recommend monitoring weight, nutritional counseling, and encouragement of physical activity after adenotonsillectomy for OSA in children.

Ten percent of young children have sleep-disordered breathing

This article describes a Finnish study that demonstrates that one in ten children, aged 6-8 years old, have sleep-disordered breathing. Hopefully, the word is getting out to parents and pediatricians to increase screening, especially by asking about snoring.

Removing tonsils and adenoids improves obstructive sleep apnea and bed-wetting

This article discusses research showing that removing tonsils and adenoids in children can resolve obstructive sleep apnea (OSA) and bed-wetting.

Obstructive sleep apnea, sleeping problems, and special education

This article discusses research showing that children with obstructive sleep apnea or sleeping problems are more likely to need special education classes.

Obstructive sleep apnea is linked to decreased insulin resistance.

This article describes research showing that children with obstructive sleep apnea have decreased sensitivity to insulin. Decreased sensitivity to insulin can be seen in diabetes. The researchers hypothesized that oxygen level decreases seen in obstructive sleep apnea could be responsible for the decreased sensitivity to insulin. Results of this study suggest that it is important to screen patients with diabetes or who are prediabetic for obstructive sleep apnea.

New recommendations for pediatric snoring and sleep apnea

The American Academy of Pediatrics recently release new guidelines for children who snore. This is helpful information, as we are seeing more children with sleep-disordered breathing. I limit my practice just to adults, but I am very fortunate to have Dr. James Roy as one of my partners. He is a pediatrician and board certified sleep specialist, one of the few in the country.

Reversing Brain Abnormalities in Childhood Obstructive Sleep Apnea

Here is a news brief about childhood obstructive sleep apnea (OSA). In kids, untreated OSA can cause learning, attention, and behavioral problems. In fact, some kids with OSA are incorrectly diagnosed as attention deficit disorder. It is thought that OSA can actually damage kids' brains. A new study shows that treating OSA can reverse some of the brain damage done and improve kids' learning, attention, and behavior.