Obstructive Sleep Apnea is Difficult to Correct in Obese Children

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A new research study has raised serious concern about the special risks obese children face when they undergo surgery for obstructive sleep apnea.

In obstructive sleep apnea (OSA), the upper part of a person’s airway becomes partly or completed blocked for 10 to 30 seconds intermittently and repeatedly while they are asleep. When OSA occurs in children, it can usually be traced to blockage caused by the adenoids and tonsils.

Childhood Sleep Apnea

Clinicians first identified this problem in children in the 1970s. There are no precise figures on how many children suffer from obstructive sleep apnea, though estimates suggest that as many as 2 to 3 percent of all children may be affected. This may be conservative, however, since as many as 8 to 27 percent of kids snore, which is a prime symptom of OSA. It is probably still an under-diagnosed condition, and we can expect the reported incidence to continue to increase, in part because it has become less customary to remove childrens’ adenoids and tonsils.

Untreated, OSA in children can cause learning, behavioral and developmental problems, as well as hypertension and heart problems. The resulting excessive sleepiness during the day can interfere with school achievement. Nighttime symptoms of OSA include snoring, gasping breaths, extreme restlessness, bedwetting, sleepwalking, and severe night sweats. During the day, morning headaches, noisy breathing, mouth breathing, chronic runny nose, poor school performance, and excessive daytime sleepiness can be warning signs that a child is experiencing OSA.

Special Treatment Risks for Obese Children

Obstructive sleep apnea in children is generally treated by surgical removal of the tonsils and/or adenoids. For most children this is a low-risk procedure. However, a recent research report on “Respiratory morbidity in obese children’s adenotonsillectomy” presented at the 2009 Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation suggests that children who are obese are significantly more likely to experience complications following surgery to treat obstructive sleep apnea.

Using data from an Edmonton, Alberta, tertiary pediatric center, researchers Elaine Fung, M.D., Hamdy El-Hakim, M.D., Dominic Cave, and Manisha Witmans, M.D., compared the cases of 49 obese children who underwent adenotonsillectomy surgery with a non-obese control group. They analyzed and compared the length of hospital stays, where treatment occurred (e.g., primary vs. secondary inpatient recovery units), and the number and severity of breathing-related complications, including whether the children required hospital admission and intensive care treatment.

The researchers discovered that complications were three times as likely for the overweight children. Forty-seven out of the 49 obese children experienced minor respiratory complications following surgery, and seven of the obese children had major complications. Complications were much less frequent among the non-obese children—only one had a major complication and 16 had minor problems. The overweight children stayed in the hospital ten hours on average and were more likely to require hospital admission. They also experienced a significantly higher rate of continued airway obstruction than the control group. Complications were more frequent among male children, and more prevalent in kids with the highest body mass index—that is, the most overweight.

The researchers believe that these findings should be taken into account when weighing the risks and benefits of surgery for obese children with obstructive sleep apnea—“especially since the benefit of surgery for this group is limited, if not questionable.”

While obesity is very common in adult patients with sleep disordered breathing, it is fortunately less frequent among children with obstructive sleep apnea. Weight loss programs should be encouraged for obese children both as a primary approach to treating their apnea and to reduce the risks of surgery should that course be recommended.

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