A study in the June 1 issue of the journal SLEEP found that waist circumference and body mass index (BMI) are consistent, independent risk factors for all severity levels of sleep disordered breathing (SDB) in children, suggesting that as with adult SDB, metabolic factors are important risk factors for childhood SDB.
Results indicate that BMI and waist circumference, but not neck circumference, were significant and strong predictors of SDB at all severity levels – primary snoring, mild SDB and moderate SDB. Nasal anatomic factors such as chronic sinusitis, rhinitis and nasal drain were significant predictors of mild SDB; minority status was associated with primary snoring and mild SDB. Tonsil size, assessed by visual inspection, was not a significant risk factor for any level of SDB. Overall, 1.2 percent of children had moderate SDB (an apnea/hypopnea index of five or more breathing pauses per hour of sleep), 25 percent had mild SDB (AHI of at least one but less than five) and 15.5 percent had primary snoring.
According to principal investigator Edward O. Bixler, PhD, of Penn State University College of Medicine in Hershey, Penn., it is often assumed that the primary mechanism of SDB in children is the presence of large tonsils or adenoids. The study suggests, however, that the causes of SDB in children are more complex, that there may be a systemic influence of obesity, and that adenotonsillectomy may not always be the most effective, first-line treatment.
"Risk factors for SDB in children are complex and include metabolic, inflammatory and anatomic factors," said Bixler. "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."