Child obesity causing jump in sleep apnea cases, testing

More Canadian children are suffering from obstructive sleep apnea due to spiking rates of obesity, according to two Ontario sleep doctors.

"In the past we used to see predominantly preschool-age children who had large tonsils and large adenoids, that was the basis for their obstructive sleep apnea," said Dr. Sherri Katz, who is also a principal investigator for CHEO's Research Institute.

"As time goes on we are seeing a second wave of children with obstructive sleep apnea, predominantly over the age of eight, where obesity is the major factor contributing to their sleep disorder."

Sleep apnea is characterized by pauses in breathing during sleep and it has been linked to a range of chronic health issues when left untreated.

"Children can have trouble with high blood pressure, they can have impaired glucose tolerance … it can certainly impact on their quality of life," said Katz.

A Continuous Positive Airway Pressure (CPAP) system is one of the most common treatments for the disorder because the use of air pressure helps keep airways open.

"It's like a splint for the airway so it doesn't close when all the muscles relax and the tissues flap inward when you go to sleep," Katz said.

Katz says CHEO is currently leading a national study evaluating treatments for young people suffering from obstructive sleep apnea. She says children’s hospitals in Montreal, Calgary Edmonton and Winnipeg are also participating in the study.

The study recruits children with obesity, as well as obstructive sleep apnea, and follows them over the first year from the time of diagnosis through their treatment. Researchers are measuring blood sugar control and looking at blood pressure and quality of life, Katz said.

There are 1,000 children waiting for a diagnostic sleep study at CHEO's sleep laboratory, Katz said. Her lab can test about 400 to 500 patients a year, but she’s concerned about the increased pressures on the system.

"Rates of sleep apnea are about three to 10 times higher in children with obesity," said Katz. "There aren't sufficient pediatric sleep laboratory resources across the country to manage the growing demand."

Obesity is connected to sleep apnea. A major reason is because patients have a greater amount of fat around the neck, which can cause obstruction of the airway during sleep.

Some of the signs of sleep apnea include snoring, pauses in breath and struggling or gasping for air.

Dr. Indra Narang, the director of sleep medicine at The Hospital for Sick Children in Toronto, says obesity-related sleep apnea is the main reason children are referred to her department.

She calls the issue of obesity and sleep apnea a “public health issue.”

“We are inundated with referrals for obesity-related sleep apnea," said Narang. "We also believe that probably 60 to 70 per cent of obesity-related sleep apnea isn't even diagnosed because of a lack of an awareness of sleep apnea associated with obesity.”

Narang also says most people focus on other conditions associated with obesity, such as high blood pressure or diabetes, but they “forget or even neglect sleep apnea.”

But Narang says this problem has "immediate consequences" for the obese children who are suffering from it.

"I think the disaster is happening as we speak," she said. "Not only do they not sleep well at night, but these children are affected during the day. They are sleeping, they are tired, they don't learn as well, they don't do as well at school. They can't participate in physical activity.”

Doctors also worry children with obesity will become obese adults if they are not tested or treated for sleep apnea.

"Our concern is 75 per cent of obese children will become obese adults and will have untreated obstructive sleep apnea and what we will see is an epidemic of premature cardiovascular death because of obesity and because of related obstructive sleep apnea," said Narang.

She said there are warning signs parents should look out for. They include daytime fatigue and taking naps during the day.

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