Sleep Health

Child sleep apnea severity linked to obesity, finds new study

Researchers at UT Southwestern Medical Center and Children’s Health have discovered that obesity and older age are substantial predictors of the severity of obstructive sleep apnea (OSA) in children. The study, recently published in Laryngoscope Investigative Otolaryngology, underscores the essential role of obesity in paediatric OSA. This new finding contributes to the increasing recognition of the association between childhood obesity and various negative outcomes including cognitive deficits, impaired academic performance, behavioural issues, excessive daytime sleepiness, and potential long-term effects on cardiovascular health.

Obstructive sleep apnea is a sleep disorder characterised by repeated obstruction of the upper airway during sleep, leading to interruptions in both ventilation and sleep patterns. Diagnosis of OSA usually requires full-night polysomnography, an extensive sleep study that monitors brain waves, blood oxygen levels, and heart and breathing rates while the patient sleeps.

Traditionally, paediatric patients suffering from OSA have been treated with adenotonsillectomy, a surgical procedure involving the removal of the adenoids and tonsils. However, this surgery does not always resolve the problem, and some children continue to experience what is known as residual OSA after the procedure.

The study was led by Romaine F. Johnson, M.D., M.P.H., Professor of Otolaryngology – Head and Neck Surgery at UT Southwestern, who emphasised that “OSA is typically considered a condition that affects adults.” But Dr. Johnson pointed out that the growing epidemic of childhood obesity has led to an increase in the number of paediatric patients diagnosed with OSA. He explained that “higher levels of obesity and advancing age are key contributors to this issue,” and suggested that targeting childhood obesity could substantially enhance sleep quality and mitigate the detrimental consequences of both OSA and residual OSA.

Dr. Johnson and his research team initially embarked on the study to investigate the relationship between socioeconomic status (SES) and paediatric OSA. They examined the medical records of 249 children aged 18 or younger who underwent both polysomnogram and adenotonsillectomy at Children’s Health over a one-year span. To evaluate the influence of SES on paediatric OSA, the researchers utilised the area deprivation index (ADI), a metric defining neighbourhood-level disadvantages through various social determinants such as education, employment, and poverty.

Contrary to expectations, the study revealed that neighbourhood-level deprivation, as indicated by the ADI ranking, did not predict OSA severity or residual OSA after surgery. Instead, the team found that severe OSA was significantly associated with obesity, and residual OSA was more commonly linked with older age, particularly among adolescents.

While the research did not establish a direct link between SES and OSA severity, Dr. Johnson emphasised the need for further investigation into the relationship. He highlighted the critical nature of understanding how socioeconomic status intersects with paediatric OSA, stating that “social disadvantages can further affect the consequences of poor sleep quality.” He also noted that children who experience both OSA and social disadvantages might be at increased risk and may require specialised interventions.

The significance of this study lies in its identification of childhood obesity as a key factor in the severity of sleep apnea, thereby opening the door to potential interventions targeting weight management. Supported by the Beth and Marvin C. “Cub” Culbertson Professorship in Pediatric Otolaryngology, the research also emphasises the complex interplay between obesity, age, and sleep disorders in children, and calls attention to the need for a multifaceted approach to address these interconnected health challenges.

A good night’s sleep may make it easier to stick to exercise and diet goals, study finds

Preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023 suggests that people who get regular and uninterrupted sleep are more successful at sticking to their exercise and diet plans while trying to lose weight. 

The researchers found that good sleep health was associated with higher rates of attendance at group interval sessions, adherence to caloric intake goals and improvement in time spent performing moderate-vigorous physical activity. The researchers examined 125 adults with overweight or obesity over 12 months in a weight loss program that included measurements of sleep habits through patient questionnaires, sleep diaries and wrist-worn devices. 

They measured adherence to the program by percentage of group intervention sessions attended, percentage of days that participants ate between 85-115% of their recommended daily calories, and change in daily duration of moderate or vigorous physical activity. 

The study’s limitations include that it did not incorporate any intervention to help participants improve their sleep, that the study sample was not recruited based upon participants’ sleep health characteristics, and that the overall sample population had relatively good sleep health at baseline. Additionally, the sample was primarily white and female, so it is unclear whether these results are generalisable to different population groups.

Overall, the preliminary research suggests that sleep may play a key role in promoting self-control and making healthy choices, highlighting the need for public health efforts to promote healthy sleep habits and the importance of getting enough sleep for maintaining a healthy lifestyle.