ESPE2021 ePoster Category 2 Fat, metabolism and obesity (59 abstracts)
“Sleep Properly, Reduce Intake, aNd Get Stepping” (SPRINGS): a multidisciplinary approach to managing paediatric morbid obesity with severe obstructive sleep apnoea
Katherine Hawton 1 , uliette Oakley 1 , Kathryn Welsh 1 , Kate Kilpin 1 , Cal McLean 1 , Shelley Easter 1 , Simon C Langton Hewer 1,2 , Julian P Hamilton Shield 3,1 & Dinesh Giri 1,2
1Bristol Royal Hospital for Children, Bristol, United Kingdom; 2University of Bristol, Bristol, United Kingdom; 3NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
Introduction: Paediatric morbid obesity (BMI >99.6th centile for age) causes severe obstructive sleep apnoea (OSA) requiring respiratory support. Patient prognosis is poor and requires urgent intervention. Four patients with morbid obesity and severe OSA were admitted for multidisciplinary team (MDT) intensive weight management and continuous positive airway pressure (CPAP) initiation.
Methods: The patients (3 male, 1 female; ages 9-16 years) had BMIs >99.6th centile (>3 SDS). Two had developmental delay. One patient was taking metformin prior to admission, another taking orlistat was also commenced on liraglutide. During an inpatient admission (between 10-33 days), all patients/families received specialist input from obesity and respiratory MDTs including clinical nurse specialists, dietetics, and a psychologist. All patients had overnight sleep studies performed due to clinical concerns of OSA. The choice of study was determined by availability and patient tolerance, including in some a cardio-respiratory study. All patients started a calorie-restricted diet and personalised exercise plans were provided to all except one patient with global developmental delay, with target goals set by the MDT and families in collaboration.
Results: All patients had severe obstructive sleep apnoea (median oxygen desaturation index (ODI): 36.5 events/hour; range: 34-98) and suboptimal minimum oxygen saturations (median: 73.5%; range 39-80%). When measured, maximum CO2 was between 6-10.5kPa. All were successfully initiated on overnight CPAP in hospital. Sleep parameters rapidly improved in all following overnight CPAP initiation; including a reduction in ODI (median ODI: 13.9 events/hour; range: 9.7-14.3) and reduction in median minimum oxygen saturations (median: 80.5%; range: 77-85%). All patients have continued overnight CPAP. Weight loss and BMI-SDS improvement during the admission continued up to 12-months following discharge (Table 1).
| Patient | |||||
| A | B | C | D | ||
| Admission weight (kg) | 184.5 | 86 | 155.8 | 83.4 | |
| Weight loss (kg) | At Discharge | -4.9 | -8.4 | -7.6 | -3.4 |
| 3 months | -14.5 | -14.7 | -20.4 | -10.7 | |
| 6 months | -29.5 | -20.0 | -29.6 | -14.4 | |
| 12 months | -45.3 | -23.0 | |||
| BMI-SDS change | At Discharge | -0.05 | -0.15 | -0.13 | -0.13 |
| 3 months | -0.14 | -0.36 | -0.41 | -0.44 | |
| 6 months | -0.34 | -0.54 | -0.71 | -0.70 | |
| 12 months | -0.62 | -0.88 |
Discussion: The mechanisms for weight loss may be due to a range of factors, including a lifestyle shift following an intensive MDT intervention, improved sleep quality through CPAP enhancing weight loss and medication for weight reduction. This approach may benefit a range of patients with morbid obesity and severe OSA.
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