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Vicious cycle of sleep apnea and obesity in kids
February 17th, 2012
03:20 PM ET

Vicious cycle of sleep apnea and obesity in kids

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

The classic pediatric sleep apnea patient is a skinny 6-year-old with chronic congestion and dark circles under his eyes.

We still see many kids in the sleep center who match this profile, but over the past 10 years, a new clinical picture has emerged. Coinciding with the dramatic rise in childhood obesity, there is a clear change in our younger patients.

We now see many overweight children in the sleep clinic who have obstructive sleep apnea that resembles the adult version.

The thin child with OSA does not usually act sleepy in the daytime. On the contrary, they often act hyperactive or inattentive. In fact, their symptoms can mimic attention deficit hyperactivity disorder.

Large tonsils and adenoids are the primary cause of OSA in thin children because these and surrounding tissues can relax during sleep and block the airflow to the lungs. In fact, 80 to 90% of such cases of pediatric OSA are cured by surgically removing the tonsils and adenoids.

Overweight or obese children are not such an easy fix. They usually present with loud snoring and significant daytime sleepiness. In obese children, the tonsils often become enlarged due to fatty tissues in the upper airway. Fat deposits in the neck and chest also add to the collapsibility of the upper airway during sleep.

Unfortunately, a tonsillectomy/adenoidectomy is curative in only about 50% of overweight kids who have OSA. The others are encouraged to try continuous positive airway pressure (CPAP) which is the most common treatment for severe OSA.

When adults have mild-to-moderate OSA, we offer them an alternative treatment called an oral appliance (also called a mandibular advancing device). However, we cannot use this treatment in children and teens whose mouth and jaw are still changing.

The important thing for pediatricians and parents to keep in mind is that the connection between weight and sleep is a two-way street.

It’s not just that excess weight increases the likelihood that kids have obstructive sleep apnea, but that having sleep apnea increases the risks of gaining weight.

Sleep deprivation due to poor sleep or too little sleep can cause hormonal havoc that leads to weight gain.

For example, when research subjects were allowed to sleep for only four hours per night, the hormones that control appetite got all out of whack. Leptin, which acts on the brain to make people feel full, was abnormally decreased and ghrelin, which makes people hungry, was unusually high.

These hormonal changes caused the research participants to be very hungry and eat more during the day.

Children and teens with sleep apnea might seem to be sleeping a lot, but their sleep is constantly disturbed by brief turbulence in their brain waves - what sleep experts call micro-arousals. In effect, these kids are as sleep deprived as people who only get four to five hours of sleep.

Not only do obese kids with OSA have a similar clinical presentation as adults, they unfortunately can have the same adverse outcomes if the sleep apnea is not treated. We are seeing pre-teens who have what we use to think of as adult diseases such as high blood pressure, pulmonary hypertension, heart disease and congestive heart failure.

If your child is overweight, please consult a doctor to find out if he or she has the symptoms of sleep apnea, such as snoring, rough breathing, daytime sleepiness, poor academic performance, behavior issues and depression.

OSA is easy to diagnose with an overnight sleep test and as I outlined above, there is more than one treatment option. Treating sleep apnea, if present, needs to be part of the weight loss program for everyone, including kids and teens.


soundoff (66 Responses)
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    Weight loss is simple when you learn the secret. If you have a stubborn insulin you hold fat and have a hard time losing weight. You can eat very little and the weight still does not come off. YOU HAVE STUBBORN INSULIN that holds fat and diets won’t work
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    February 17, 2012 at 19:10 | Report abuse | Reply
    • Patrick

      More snake oil.

      Eat right and exercise it’s not a secret.

      March 1, 2012 at 15:41 | Report abuse |
  2. Dani

    There are also people who, despite eating healthily and exercising, have naturally slower metabolisms.
    I had sleep apnea as a kid. The article isn't lying about removal of tonsils being curative. I ate ice cream and chocolate pudding for a week after surgery, and never had problems with sleep apnea again.

    February 17, 2012 at 20:06 | Report abuse | Reply
    • Patrick

      Your metabolism is sped up by exercising. The REAL issue is people that don’t lose weight are lying to themselves. So you took the stairs at work today…so what. That doesn’t mean you can have a donut now.

      March 1, 2012 at 15:44 | Report abuse |
  3. Joshua Rotenberg MD

    As a pediatrician/neurologist/sleep specialist, I have noted that the best pediatricians/Family docs in Texas recognize this link. It should be instinctive to refer a child or teen to a pediatric specialist for evaluation. Thank you for this article! Dr. Rotenberg, Houston, TX http://www.txmss.com

    February 18, 2012 at 14:04 | Report abuse | Reply
  4. thalakos

    now all u have to do is get the medical associations to convince insurance companies to pay for the CPAP machines. and possibly for one every year or two because as shocking as it sounds they're not cheap but they do break.

    February 20, 2012 at 03:43 | Report abuse | Reply
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  7. John O'Shea

    Thank You for the excellent information Dr. Shives; we at Huneo are doing some exciting work with Stanford University Research which we hope will have a most positive impact in child health in the areas of sleep apnea, obesity and head injuries. Keep up your good work.
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    Impossible to contact Dr. Lisa at her web site. Messages simply won't "send".

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    Weight is really a factor in having sleep disorders like sleep apnea. Thus. we really have to watch our food intake and make sure we only consume what we need. When we have kids, we have to look into their diet to ensure that they are not eating more than what they need.

    August 19, 2013 at 04:04 | Report abuse | Reply
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    Thank you Doc for this wonderful info... i wetted till i was 13 .. stopped wetting then was diagnosed with OSA at sixteen .. i would like to input the relation between coughing while urinating and how it interrupts the urine flow ..

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