NEW YORK (Reuters Health) – Waist size and body mass index are independently associated with sleep disordered breathing (SDB) in school-age children, according to research in the June issue of Sleep.

The authors suggest that, as in adults, metabolic and inflammatory factors may be implicated in the development of snoring and obstructive sleep apnea in children.

Dr. Edward O. Bixler and associates at Penn State University College of Medicine in Hershey, Pennsylvania, examined the prevalence of and risk factors for SDB “based on the largest population-based sample of elementary school-aged children available to date.”

Parents of 5740 children in kindergarten through grade 5 completed questionnaires regarding their children’s sleep and behavioral patterns. A random selection of 700 children, stratified by grade, gender, and risk for SDB, underwent physical evaluations and 9-hour overnight polysomnography.

Severity levels were classified as primary snoring with an apnea/hypopnea index (AHI) less than 1, mild SDB (AHI of 1 or higher but less than 5), or moderate SDP (AHI of 5 or higher). Prevalence rates were 15.5% for primary snore, 25.0% for mild SDB, and 1.5% for moderate SDB. The maximum AHI was 24.6.

In stepwise logistic regression analysis, waist size was a significant predictor at all three levels of severity. By contrast, tonsil size was not a significant independent risk factor at any degree of severity, “suggesting that adenotonsillectomy may not always be the best first-line treatment.”

In children with primary snoring, there was also a negative association with increasing age, and a positive association with cervical adenopathy and minority status (Black or Hispanic as opposed to Caucasian).

For mild SDB, nasal abnormalities, including chronic sinusitis/rhinitis and turbinate hypertrophy, and minority status were also significant predictors.

Aside from waist size, long soft palate was the only identified risk factor for moderate SDB.

“Factors that were clearly not associated with SDB included middle ear effusion, abnormal uvula, macroglossia, retrognathia, chronic cough, or wheeze,” the authors note.

“Risk factors for SDB in children are complex and include metabolic, inflammatory and anatomic factors,” Dr. Bixler remarked in a prepared statement. “Because SDB in children is not just the outcome of anatomical abnormalities, treatment strategies should consider alternative options, such as weight loss and correction of nasal problems.”

Reference:
Sleep 2009;32:731-736.