Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

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 (≥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 ≤five episodes per hour) at different ages (≤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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marcus CL, McColley SA, Carroll JL, Loughlin GM, Smith PL, Schwartz AR (1994) Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol 77:918–924

    PubMed  CAS  Google Scholar 

  2. Arens R, McDonough JM, Costarino AT, Mahboubi S, Tayag-Kier CE, Maislin G, Schwab RJ, Pack AI (2001) Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 164:698–703

    PubMed  CAS  Google Scholar 

  3. Arens R, McDonough JM, Corbin AM, Hernandez ME, Maislin G, Schwab RJ, Pack AI (2002) Linear dimensions of the upper airway structure during development: assessment by magnetic resonance imaging. Am J Respir Crit Care Med 165:117–122

    PubMed  Google Scholar 

  4. Arens R, Marcus CL (2004) Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 27:997–1019

    PubMed  Google Scholar 

  5. Kelly A, Marcus CL (2005) Childhood obesity, inflammation, and apnea: what is the future for our children? Am J Respir Crit Care Med 171:202–203

    Article  PubMed  Google Scholar 

  6. Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T (2005) Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 165:2408–2413

    Article  PubMed  Google Scholar 

  7. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G (1999) Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 159:1527–1532

    PubMed  CAS  Google Scholar 

  8. Wing YK, Hui SH, Pak WM, Ho CK, Cheung A, Li AM, Fok TF (2003) A controlled study of sleep related disordered breathing in obese children. Arch Dis Child 88:1043–1047

    Article  PubMed  CAS  Google Scholar 

  9. Lam YY, Chan EY, Ng DK, Chan CH, Cheung JM, Leung SY, Chow PY, Kwok KL (2006) The correlation among obesity, apnea-hypopnea index, and tonsil size in children. Chest 130:1751–1756

    Article  PubMed  Google Scholar 

  10. Graw-Panzer K, Jambhekar SK, Rothshteyn Y, Friedman P, Vohra R, Malviya G, Mina I, Muzumdar HV, Rao M (2005) Effect of increasing body mass index on obstructive sleep apnea. Proc Am Thorac Soc 2:A895

    Google Scholar 

  11. O’Brien LM, Sitha S, Baur LA, Waters KA (2006) Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol 70:1555–1560

    Article  PubMed  Google Scholar 

  12. Tauman R, Gulliver TE, Krishna J, Montgomery-Downs HE, O’Brien LM, Ivanenko A, Gozal D (2006) Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 149:803–808

    Article  PubMed  Google Scholar 

  13. Shine NP, Lannigan FJ, Coates HL, Wilson A (2006) Adenotonsillectomy for obstructive sleep apnea in obese children: effects on respiratory parameters and clinical outcome. Arch Otolaryngol Head Neck Surg 132:1123–1127

    Article  PubMed  Google Scholar 

  14. Mitchell RB, Kelly J (2004) Adenotonsillectomy for obstructive sleep apnea in obese children. Otolaryngol Head Neck Surg 131:104–108

    Article  PubMed  Google Scholar 

  15. Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin North Am 36:1551–1569

    PubMed  CAS  Google Scholar 

  16. Rechtschaffen A, Kales A (1968) A manual of standardized terminology: techniques and scoring systems for sleep stages of human subjects. UCLA Brain Information Service/Brain Research Institute, Los Angeles

  17. American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–184

    Google Scholar 

  18. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60

    Article  PubMed  Google Scholar 

  19. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH (2003) Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 157:821–827

    Article  PubMed  Google Scholar 

  20. Tauman R, Gozal D (2006) Obesity and obstructive sleep apnea in children. Paediatr Respir Rev 7:247–259

    Article  PubMed  Google Scholar 

  21. McCullagh P, Nelder JA (1989) Generalized linear models. Chapman & Hall, London

    Google Scholar 

  22. Arens R, McDonough JM, Corbin AM, Rubin NK, Carroll ME, Pack AI, Liu J, Udupa JK (2003) Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 167:65–70

    Article  PubMed  Google Scholar 

  23. Arens R, Sin S, McDonough JM, Palmer JM, Dominguez T, Meyer H, Wootton DM, Pack AI (2005) Changes in upper airway size during tidal breathing in children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 171:1298–1304

    Article  PubMed  Google Scholar 

  24. Fregosi RF, Quan SF, Kaemingk KL, Morgan WJ, Goodwin JL, Cabrera R, Gmitro A (2003) Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Physiol 95:2030–2038

    PubMed  CAS  Google Scholar 

  25. Haapaniemi JJ (1995) Adenoids in school-aged children. J Laryngol Otol 109:196–202

    Article  PubMed  CAS  Google Scholar 

  26. Everett AD, Koch WC, Saulsbury FT (1987) Failure to thrive due to obstructive sleep apnea. Clin Pediatr (Phila) 26:90–92

    Article  CAS  Google Scholar 

  27. Freezer NJ, Bucens IK, Robertson CF (1995) Obstructive sleep apnoea presenting as failure to thrive in infancy. J Paediatr Child Health 31:172–175

    PubMed  CAS  Google Scholar 

  28. Sardon O, Perez-Yarza EG, Aldasoro A, Bordoy A, Mintegui J, Emparanza JI (2006) Obstructive sleep apnea-hypopnea syndrome in children is not associated with obesity. Arch Bronconeumol 42:583–587

    Article  PubMed  Google Scholar 

  29. Rosen CL, Larkin EK, Kirchner HL, Emancipator JL, Bivins SF, Surovec SA, Martin RJ, Redline S (2003) Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr 142:383–389

    Article  PubMed  Google Scholar 

  30. Ievers-Landis CE, Redline S (2007) Pediatric sleep apnea: implications of the epidemic of childhood overweight. Am J Respir Crit Care Med 175:436–441

    Article  PubMed  Google Scholar 

  31. Shine NP, Coates HL, Lannigan FJ (2005) Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: a review of the literature. Int J Pediatr Otorhinolaryngol 69:1475–1482

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Thessaly School of Medicine, Larissa, Greece

    Athanasios G. Kaditis, Emmanouel I. Alexopoulos, Fotini Hatzi, Ioanna Karadonta & George A. Syrogiannopoulos

  2. Sleep Disorders Laboratory, University of Thessaly School of Medicine, Larissa, Greece

    Athanasios G. Kaditis, Emmanouel I. Alexopoulos, Fotini Hatzi, Ioanna Karadonta, Konstantinos Chaidas & Konstantinos Gourgoulianis

  3. Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece

    Elias Zintzaras

  4. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Elias Zintzaras

  5. Department of Pediatrics, Larissa University Hospital, P.O. Box 1425, Larissa, 41110, Greece

    Athanasios G. Kaditis

Authors
  1. Athanasios G. Kaditis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmanouel I. Alexopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fotini Hatzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ioanna Karadonta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Konstantinos Chaidas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Konstantinos Gourgoulianis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elias Zintzaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. George A. Syrogiannopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Athanasios G. Kaditis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaditis, A.G., Alexopoulos, E.I., Hatzi, F. et al. Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring. Sleep Breath 12, 25–31 (2008). https://doi.org/10.1007/s11325-007-0132-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-007-0132-z

Keywords

Search

Navigation