Yesterday, I again hosted a Bariatric Forum, broadcasted via TeleHealth across Alberta and beyond. My guest was Dr. Justin Sebastian, Edmonton pulmonologist and sleep specialist, and the topic was obstructive sleep apnea.
The leading symptoms of this problem, snoring and excessive daytime sleepiness, are commonly associated with excess weight and can often pose an important barrier to, as well as an indication for, obesity treatment. Although we did not touch on the issue of sleep apnea in kids, this may well be an increasing problem, even in perpubertal children with excess weight.
Thus, in a study by David Gozal and colleague from the University of Louisville, KY, just out in Pediatrics, for the same level of sleep-related airway obstruction, obese children were more likely to demonstrate daytime sleepiness than normal weight kids.
Fifty consecutive, nonobese, habitually snoring, otherwise-healthy children (age range: 6-9 years) and 50 age-, gender-, and ethnicity-matched obese children (BMI z score: >1.67) underwent an overnight polysomnographic evaluation, followed by a multiple sleep latency test the following day.
Although there was no difference in the mean obstructive apnea/hypopnea index values between the two groups, obese children had significantly shorter sleep latency times (time taken to fall asleep) than the nonobese kids (12 vs. 18 mins). Although there was a significant association between various measures of sleep-disordered breathing across the groups, the relationships were consistently greater in the obese children.
Overall the study suggests that for any given level of sleep apnea, obese children are more likely to experience excessive daytime sleepiness, a pattern not so different from that seen in obese adults.
Given the importance of restorative sleep for intellectual and physical functioning, and the increasing reports on the relationship between poor sleep and obesity risk, careful assessment of sleep history should be an essential part of any evaluation of overweight and obese children.
Excessive daytime sleepiness, even in very young overweight and obese children, especially if associated with snoring and not readily explained by sleep deprivation for other reasons (e.g. excessive late-evening TV watching), should prompt investigations for sleep apnea.