Published ahead of print on December 7, 2006, doi:10.1164/rccm.200606-790PP Am. J. Respir. Crit. Care Med., Volume 175, Number 5, March 2007, 436-441 A more recent version of this article appeared on March 1, 2007
Submitted on June 13, 2006 Pediatric Sleep Apnea: Implications of the Epidemic of Childhood OverweightCarolyn E Ievers-Lanids1 and Susan Redline2*1 Division of Behavioral Pediatrics and Psychology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA, 2 Division of Clinical Epidemiology, Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA * To whom correspondence should be addressed. E-mail: susan.redline{at}case.edu.
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 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 obstructive sleep apnea syndrome (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 Perspectives, the inter-relationships 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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