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Obesity, weight change may predict trajectory of childhood sleep-disordered breathing

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September 16, 2018

Children with obesity and sleep-disordered breathing are more likely to have persistent sleep conditions into adolescence vs. children without obesity, whereas children who lose weight are more likely to experience remission of sleep-disordered breathing symptoms, according to study findings published in Pediatric Obesity.

Julio Fernandez-Mendoza

Childhood sleep-disordered breathing, which includes primary snoring and obstructive sleep apnea, is viewed as a disorder caused by anatomic abnormalities of the upper airway, such as enlarged tonsils, and first-line treatment is typically adeno/tonsillectomy, Julio Fernandez-Mendoza, PhD, CBSM, associate professor, clinical psychologist and director of the Behavioral Sleep Medicine Program and Sleep Research and Treatment Center at Penn State College of Medicine in Hershey, Pennsylvania, and colleagues wrote in the study background. However, several recent studies have suggested that up to 70% of childhood sleep-disordered breathing is likely to remit over time, yet there is limited literature on the factors leading to such high remission rates.

“Pediatric obesity is a key determinant of the persistence of breathing-related sleep disorders in children, whereas weight loss is associated with the remission of such sleep-disordered breathing in the transition to adolescence,” Fernandez-Mendoza told Endocrine Today. “Also, in many children with enlarged tonsils and sleep-disordered breathing, the condition remits without having undergone adenotonsillectomy.”

Fernandez-Mendoza and colleagues analyzed data from 421 adolescents participating in the Penn State Child Cohort, a population-based study of children aged 5 to 12 years at baseline followed to determine the prevalence and risk factors associated with sleep-disordered breathing (mean follow-up time, 8 years). All children underwent a physical exam (including visual evaluation of the nose and throat) and sleep study with polysomnography at baseline and follow-up. Apnea-hypopnea index was calculated as the number of apneas and hypopnea per hour of sleep (childhood obstructive sleep apnea was defined as at least two apnea/hypopnea events per hour). Researchers also assessed objectively monitored snoring. Researchers used logistic regression analysis to examine the predictive value and relative independent contribution of childhood weight and change in weight with the natural history of sleep-disordered breathing.

Within the cohort, 95 children had persistent sleep-disordered breathing and 45 children had sleep-disordered breathing at baseline that remitted at follow-up, whereas 248 children had no sleep-disordered breathing.

The researchers observed that obesity and enlarged tonsils were cross-sectionally associated with childhood sleep-disordered breathing.

After adjustments for sex, race and age, researchers found that baseline weight was the best single predictor of persistent sleep-disordered breathing (OR = 2.09; 95% CI, 1.51-2.89) and change in weight was the single best predictor of remitted sleep-disordered breathing (OR = 0.55; 95% CI, 0.36-0.86) when compared with children without sleep-disordered breathing.


Children with obesity at baseline were nearly four times more likely to have persistent sleep-disordered breathing (OR = 3.75; 95% CI, 2-7.05) vs. children without baseline obesity, whereas weight loss predicted remission of sleep-disordered breathing (OR = 1.67; 95% CI, 1.11-2.5), according to the researchers.

About 43% of children with persistent sleep-disordered breathing had a history of enlarged tonsils at baseline, according to researchers; however, those with persistent sleep-disordered breathing experienced an increase in change in BMI percentage regardless of baseline tonsil size. Researchers also found that remission of sleep-disordered breathing was associated with a decrease in change in BMI percentage among children with normal-size tonsils (–10.06 percentile; P = .031), but this was not observed among children with enlarged tonsils (–0.03 percentile).

Sara Frye

The researchers noted that only 4.4% of children with remitted sleep-disordered breathing had a history of adeno/tonsillectomy, a figure markedly lower than those with persistent sleep-disordered breathing (21.1%; P = .023).

“Childhood obesity and weight gain should be a focus of our preventive strategies for sleep-disordered breathing,” Sara Frye, PhD, NCSP, assistant professor of research and licensed psychologist with the school psychology program at the University of Arizona, told Endocrine Today. “Our data also suggest that while some children may benefit from adenotonsillectomy, others, particularly nonobese children with minimal symptoms, may require watchful waiting as their upper away follows a normal developmental trajectory.” – by Regina Schaffer

For more information:

Julio Fernandez-Mendoza, PhD, CBSM, can be reached at the Sleep Research and Treatment Center, Penn State College of Medicine, 500 University Drive, Suite C5644A, Hershey, PA 17033; email:

Sara Frye, PhD, NCSP, can be reached at the University of Arizona, College of Education, 1430 East Second St., P.O. Box 210069, Tuscon, Arizona; email:

Disclosures: The NIH funded this study. The authors report no relevant financial disclosures.

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This study provides valuable new information about the role of body weight, upper airway abnormalities and developmental trajectories on the persistence and remission of childhood sleep-disordered breathing in the transition to adolescence. It was concluded that addressing childhood obesity should be a priority in the prevention and treatment of sleep-disordered breathing during this critical developmental period. Obesity is a complex, multi-factorial, and chronic disease for which we have no good treatment options at the moment. This is unfortunate given the high burden posed by obesity on the individuals affected by this condition. The problem with obesity is not inducing weight loss, but to keep the weight off in the long-term. Studies show that 95% of people who lose weight regain it at some point in time. Relapse is thus a normal expectation when dealing with obesity and the best treatment for obesity still remains its prevention in the first place. For those already affected by obesity, let’s hope that better treatment options will be available in the near future, because a focus on eating less and moving more at the individual level has proven to be unsuccessful for a large majority of individuals. Unless things change, the future is unlikely to be different than the past.


Jean-Philippe Chaput, PhD

Associate Professor of Pediatrics, Faculty of Medicine, Univesity of Ottawa
Research Scientist, Healthy Active Living and Obesity (HALO) research group
CHEO Research Institute

Disclosure: Chaput reports no relevant financial disclosures.