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Abstract
Introduction: In adult populations, the pathology of obstructive sleep apnea syndrome (OSAS) is mainly related to obesity. In contrast, early studies in pediatric populations suggested adenoid and tonsillar hypertrophy (ATH) to be the main causes of OSAS in children, making adenotonsillectomy the first line of treatment. Early consensus was that, in contrast to adults, pediatric OSAS patients often present with inadequate weight gain and even failure to thrive. In fact, the past three decades have witnessed a 2-3-fold increase in the prevalence of childhood obesity. This fact sparked a shift in the pediatric OSAS paradigm towards combing obesity and ATH as the main causes of the disease. This represents a major change from the traditional view that ATH alone was the primary cause. Thus, further research on the pathology and outcomes of pediatric OSAS is needed. Especially given the increased prevalence of childhood obesity.
Methods: Correlations between patients' sleep apnea severity, indicated by apnea hypopnea index (AHI) score, and patients' body weight, indicated by the body mass index Z-score (BMI Z-score) were studied in a pediatric population from Seattle Children's Hospital Sleep Center (n=500). Analysis was carried out in the overall group and then stratified by body weight.
Results: Nearly half of the study subjects were overweight or obese. There was a significant association between AHI scores and the BMI Z-scores in the non-underweight group (n=480). This association remained significant after adjusting for sociodemographic and comorbidity factors. No significant association was found between AHI scores and the BMI Z-scores in the all-subject group (n=500) or in the underweight group (n=20).
Conclusion: Obesity has become another major risk factor and potential cause for OSAS in the pediatric population. Weight management should become an important first line of treatments for OSAS patients in addition to the traditional surgical approach.
