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Obesity in children with different risk factors for obstructive sleep apnea: a community-based study

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Abstract

This study investigated the association between obesity and obstructive sleep apnea (OSA) in preschool and school-age children. Parents of obese and randomly chosen normal weight children completed a questionnaire on sleep-related symptoms, demography, family, and medical history. All subjects were invited to undergo polysomnography (PSG). OSA cases were defined as obstructive apnea hypopnea index (OAHI) ≥1. A total of 5930 children were studied with 9.5 % obese (11.9 % boys/6.1 % girls), 205/2680 preschool and 360/3250 school children. There were 1030 children (535 obese/495 normal weight) who underwent PSG. OSA was higher in obese children and obese school children had higher OAHI, arousal index, and shorter total sleep time. However, there was no positive correlation between OSA and body mass index (BMI). The main risk factors for OSA in preschool children were adenotonsillar hypertrophy and recurrent respiratory tract infection. The main cause for OSA in school children was a history of parental snoring and obesity. Mallampati scores and sleep-related symptoms were found to be associated with OSA in both preschool and school children.

Conclusion: We demonstrated differential risk factors for OSA in obese children, which suggest that a different mechanism may be involved in OSA development in preschool and school-age children.

What is Known:

Various risk factors have been reported in obese children with OSA owing to the different age and different study design.

• Obese children have a higher prevalence and severity of obstructive sleep apnea (OSA).

• OSA risk factors in obese children are affected by different ages and study designs.

What is New:

• A differential prevalence and risk factors for obese preschool and school-age children with OSA has been demonstrated.

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Abbreviations

BMI:

Body mass index

OAHI:

Obstructive apnea hypopnea index

OSA:

Obstructive sleep apnea

PSG:

Polysomnography

REM:

Rapid eye movement

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Acknowledgments

The authors thank all the staff at the Center for Disease Control and Prevention in Wenzhou City, Sleep Center of Hong Kong Chinese University for their logistic support, and the cooperation and participation of all the schools, children, and their parents.

Contributors

M-SS was the guarantor of integrity and conceived the study, participated in its design, carried out sleep studies, and prepared the manuscript; H-LZ participated in the literature research, performed the statistical analysis, and helped draft the manuscript; X-HC helped coordinate and design the study; YL participated in data acquisition and data analysis; P-NL selected the epidemiology survey and clinic data; Y-BZ and W-ZH carried out sleep questionnaire; C-CL and Y-FX were mentors for M-SS and helped the design, data analysis, and final revision of the manuscript. All authors read and approved the final manuscript.

Conflict of interest

The authors have no financial relationship with the organization that sponsored the research.

Funding

This study was supported by funding from the Natural Science Foundation of China (81172689), Zhejiang Province Health Department Project (2013RCA037), Science and Technology Department Project (2013 C33174), and Wenzhou City Science and Technology Bureau (Y 20140502).

Author information

Authors and Affiliations

  1. Department of Pediatrics, The 2nd Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shanxi Province, People’s Republic of China

    Miao-Shang Su, Hai-Lin Zhang, Pei-Ning Liu & Yan-Feng Xiao

  2. Department of Pediatrics, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China

    Miao-Shang Su, Hai-Lin Zhang, Xiao-Hong Cai, Pei-Ning Liu, Yuan-Bo Zhang, Wen-Zhen Hu & Chang-Chong Li

  3. Department of Public Health, Center for Disease Control and Prevention in Wenzhou, Zhejiang, People’s Republic of China

    Ying Lin

Authors
  1. Miao-Shang Su
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  4. Ying Lin
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  9. Yan-Feng Xiao
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Corresponding authors

Correspondence to Chang-Chong Li or Yan-Feng Xiao.

Additional information

Communicated by Peter de Winter

Appendix

Appendix

Table 7 Published studies on prevalence of obesity in children using IOTF definition
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Table 8 Published studies on prevalence of obesity in children using WHO definition
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Su, MS., Zhang, HL., Cai, XH. et al. Obesity in children with different risk factors for obstructive sleep apnea: a community-based study. Eur J Pediatr 175, 211–220 (2016). https://doi.org/10.1007/s00431-015-2613-6

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  • DOI: https://doi.org/10.1007/s00431-015-2613-6

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