Frye S S, Fernandez-Mendoza J, Calhoun S L, Gaines J, Vgontzas A N, Liao D, Bixler E O
Sleep Research & Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Pediatr Obes. 2019 Jan;14(1). doi: 10.1111/ijpo.12461. Epub 2018 Sep 6.
Obesity has been recognized as a risk factor for childhood sleep-disordered breathing (SDB), yet it remains unclear how obesity and weight change predict the course of childhood SDB.
The objective of the study is to investigate the role of body weight, upper airway abnormalities and developmental trajectories on the persistence and remission of childhood SDB in the transition to adolescence.
The Penn State Child Cohort is a representative population sample of 700 children (5-12 years), of whom 421 were followed up as adolescents (12-23 years). Participants underwent a clinical history, physical examination and polysomnography at both time points.
Obesity and enlarged tonsils were cross-sectionally associated with childhood SDB. Longitudinally, baseline obesity predicted the persistence of childhood SDB (OR = 3.75, 95% CI = 2.00-7.05), while weight loss predicted its remission (OR = 1.67, 95% CI = 1.11-2.50). Children with enlarged tonsils who remitted from SDB had not experienced significant weight loss and only 4.4% had undergone adeno/tonsillectomy. Body fat distribution/composition at follow-up was similar in those who had remitted from childhood SDB as compared with those who had never experienced SDB, while those who persisted with childhood SDB showed significant android distribution and visceral adiposity at follow-up.
Our data support a causal role for obesity and weight loss in the chronicity and remission, respectively, of childhood SDB in the transition to adolescence and suggest that remission of SDB is related to developmental trajectories of the upper airway in a significant proportion of children. Thus, targeting childhood obesity and weight gain should be a priority in the prevention and treatment of SDB during this critical developmental period.
肥胖已被公认为儿童睡眠呼吸障碍(SDB)的一个危险因素,但肥胖和体重变化如何预测儿童SDB的病程仍不清楚。
本研究的目的是探讨体重、上气道异常和发育轨迹在儿童SDB向青春期过渡过程中的持续存在和缓解方面所起的作用。
宾夕法尼亚州立大学儿童队列是一个由700名儿童(5 - 12岁)组成的代表性人群样本,其中421名儿童在青少年期(12 - 23岁)接受了随访。参与者在两个时间点均接受了临床病史、体格检查和多导睡眠图检查。
横断面研究显示,肥胖和扁桃体肿大与儿童SDB相关。纵向研究表明,基线肥胖可预测儿童SDB的持续存在(OR = 3.75,95% CI = 2.00 - 7.05),而体重减轻则可预测其缓解(OR = 1.67,95% CI = 1.11 - 2.50)。从SDB中缓解的扁桃体肿大儿童并未经历显著的体重减轻,且只有4.4%接受了腺样体/扁桃体切除术。与从未经历过SDB的儿童相比,从儿童SDB中缓解的儿童在随访时的体脂分布/组成相似,而持续存在儿童SDB的儿童在随访时显示出明显的向心性分布和内脏脂肪增多。
我们的数据分别支持肥胖和体重减轻在儿童SDB向青春期过渡过程中的慢性化和缓解中所起的因果作用,并表明在相当一部分儿童中,SDB的缓解与上气道的发育轨迹有关。因此,在这个关键的发育时期,针对儿童肥胖和体重增加应成为预防和治疗SDB的优先事项。