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Published ahead of print on December 7, 2006, doi:10.1164/rccm.200606-790PP
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American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 436-441, (2007)
© 2007 American Thoracic Society
doi: 10.1164/rccm.200606-790PP

Pulmonary Perspective

Pediatric Sleep Apnea

Implications of the Epidemic of Childhood Overweight

Carolyn E. Ievers-Landis1 and Susan Redline2

1 Division of Behavioral Pediatrics and Psychology and 2 Division of Clinical Epidemiology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio

Correspondence and requests for reprints should be addressed to Susan Redline, M.D., M.P.H., Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106-6003. E-mail: susan.redline{at}case.edu

ABSTRACT

Over the last 30 years, the prevalence of overweight across all pediatric age groups and ethnicities has increased substantially, with the current prevalence of overweight among adolescents estimated to be approximately 30%. Current evidence suggests that overweight is modestly associated with obstructive sleep apnea syndrome (OSAS) among young children, but strongly associated with OSAS in older children and adolescents. The rising incidence of pediatric overweight likely will impact the prevalence, presentation, and treatment of childhood OSAS. The subgroup of children who may be especially susceptible include ethnic minorities and those from households with caregivers from low socioeconomic groups. OSAS, by exposing children to recurrent intermittent hypoxemia or oxidative stress, may amplify the adverse effects of adiposity on systemic inflammation and metabolic perturbations associated with vascular disease and diabetes. When these conditions manifest early in life, they have the potential to alter physiology at critical developmental stages, or, if persistent, provide cumulative exposures that may powerfully alter long-term health profiles. An increased prevalence of overweight also may impact the response to adenotonsillectomy as a primary treatment for childhood OSAS. The high and anticipated increased prevalence of pediatric OSAS mandates assessment of optimal approaches for preventing and treating both OSAS and overweight across the pediatric age range. In this Pulmonary Perspective, the interrelationships between pediatric OSAS and overweight are reviewed, and the implications of the overweight epidemic on childhood OSAS are discussed.

Key Words: sleep apnea • childhood obesity • childhood overweight




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