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Review
. 2010 Feb;108(2):436-44.
doi: 10.1152/japplphysiol.00689.2009. Epub 2009 Oct 29.

Childhood obesity and obstructive sleep apnea syndrome

Raanan Arens  1 , Hiren Muzumdar
Affiliations
Review

Childhood obesity and obstructive sleep apnea syndrome

Raanan Arens et al. J Appl Physiol (1985). 2010 Feb.

Abstract

The increasing prevalence of obesity in children seems to be associated with an increased prevalence of obstructive sleep apnea syndrome (OSAS) in children. Possible pathophysiological mechanisms contributing to this association include the following: adenotonsillar hypertrophy due to increased somatic growth, increased critical airway closing pressure, altered chest wall mechanics, and abnormalities of ventilatory control. However, the details of these mechanisms and their interactions have not been elucidated. In addition, obesity and OSAS are both associated with metabolic syndrome, which is a constellation of features such as hypertension, insulin resistance, dyslipidemia, abdominal obesity, and prothrombotic and proinflammatory states. There is some evidence that OSAS may contribute to the progression of metabolic syndrome with a potential for significant morbidity. The treatment of OSAS in obese children has not been standardized. Adenotonsillectomy is considered the primary intervention followed by continuous positive airway pressure treatment if OSAS persists. Other methods such as oral appliances, surgery, positional therapy, and weight loss may be beneficial for individual subjects. The present review discusses these issues and suggests an approach to the management of obese children with snoring and possible OSAS.

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Figures

Fig. 1.
Fig. 1.
Diagram demonstrating the possible associations among obesity, obstructive sleep apnea syndrome (OSAS), and metabolic syndrome. Gray arrows indicate associations among obesity, OSAS, and metabolic syndrome; white arrows indicate associations among OSAS, metabolic syndrome, and obesity; and black arrows indicate associations among metabolic syndrome and atherosclerosis.
Fig. 2.
Fig. 2.
Suggested approaches to the treatment of the obese child with snoring. Note that dietary modification, exercise, and lifestyle changes to achieve weight loss are essential for all children with obesity. CPAP, continuous positive airway pressure; UPPP, uvulopalatopharynoplasty.
See this image and copyright information in PMC

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