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Is Sleep Apnea a Significant Problem in Sleepy Kids?

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.

Edmonton, Alberta

1 Comment

  1. Dr Sharma,here is an article I just read.I really believe in exercise but…
    Here is an article from Mark Sisson La Nutrition Examiner
    Despite years of advice that diet and exercise are necessary for weight loss, a study in a recent issue of the journal Obesity suggests that exercise is not as effective at peeling off the pounds as once thought.

    For the study, a team of researchers led by Loyola University Health System compared the weight, activity levels and diets of a group of African American women living in metropolitan Chicago with a group of women living in rural Nigeria. According to researchers, women in the Chicago cohort weighted an average of 184 lbs, while the cohort of women living in Nigeria weighed an average of 124 lbs.

    Looking first at activity levels, the researchers found no discernable difference in calories burned due to physical activity between the two groups of women. In an analysis of diet, however, the researchers found that Nigerian women typically follow a diet rich in fiber and carbohydrates. By contrast, the Chicago women’s diets were high in fat and processed foods.

    Based on these findings, the researchers conclude that diet is a more likely explanation for why women in the Chicago cohort weigh more than their Nigerian counterparts. As such, they suggest that dietary intake may be more important than energy expenditure in weight loss and that weight loss may be difficult to achieve without dietary restraint.

    While these findings are certainly interesting, the researchers note that they do conflict with several other studies suggesting that exercise is integral to weight loss, including a study of older Amish men that found that even those with a genetic predisposition towards obesity were able to stay slim on account of their high physical activity levels.

    Despite these conflicting studies, it is important to remember that exercise has more benefits than a smaller number on the scale. Specifically, physical activity is associated with increased muscle strength and bone density, lower blood pressure and cholesterol levels, improved mental health and mood, and a reduced risk of several chronic conditions – many of which could ultimately prove fatal – including diabetes, cardiovascular disease and cancer of the colon and breast.

    So, before you ditch your new year’s resolution to exercise regularly, remember that the key to good health is to follow a nutritious diet and hit the gym on a regular basis.

    Mark’s web site is
    Thnks for all your great work Dr Sharma
    Pierre Trudel from the THEE QUEST team of Pierre & Pierrette

    For more info:
    Yahoo! News: Study: Exercise Won’t Cure Obesity
    Mark’s Daily Apple: The Definitive Guide to the Primal Blueprint Eating Plan

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