ESPE Abstracts

Introduction: Childhood obesity is associated with several complications, involving many systems. The prevalence of respiratory problems, such as obstructive sleep apnea syndrome (OSAS), is higher in obese children and adolescents. In fact, OSAS affects 13–59% of obese children and the severity is strongly associated with weight excess. Although overnight pulse oximetry (PO) can be used for diagnosing OSAS, a complete night polysomnography (PSG), which records peripheral oxygen saturation, heart rate, respiratory airflow and effort during sleep providing information about the sleep stages, is the gold standard for Sleep Disorders of Breathing (SDB) diagnosis.

Aim: An observational study to evaluate differences in SDB between obese and non-obese children and adolescents referred snoring.

Patients and methods: 77 subjects, aged between 2 months and 17 years were enrolled. All the subjects underwent a PO and a complete night PSG, and all the parameters for apnea/hypopnea and quality of sleep were analyzed. Parents of all the subjects enrolled filled out OSAS18 questionnaire for evaluation of the quality of life. For obese subjects, metabolic parameters were collected.

Results and discussion: 22 obese (14M) and 45 Non-obese subjects (33M) were recruited, with a mean age of 10.5±2.8 and 4.8±2.5 respectively (P < 0.0001). All the obese children resulted affected by OSAS. At PO: obese children have lower both Oxyhemoglobin Desaturation Index (ODI), P = 0.02, and McGill oximetry scoring system (MOS), P = 0.002, as expression of more prolonged desaturations in obese subjects compared to the shorter, but deeper, and organized in cluster desaturations of non-obese children with OSAS. At PSG: Obese children presented a higher apnea/hypopnea index (AHI), P = 0.03, revealing more severe OSAS. Obstructive-AHI (index of peripheral apnea) was not different in the 2 groups, confirming that obese subjects had both prolonged obstructive apneas and alterations in the drive trigger for breathing. No differences in neither sleep efficacy nor %REM phase (in our experience, as non-obese children with OSAS were much younger, they were more habitual and less adaptive to fall asleep in a different setting such as the hospital).

Conclusions: OSAS is a frequent and early complication in obese children with snoring. OSAS is more severe in young children with obesity, as documented by PSG (more sensible than PO). The type of desaturations are both obstructive and central. In a hospital setting, no differences were found in sleep quality between obese and non-obese subjects, maybe because of the different age of the 2 groups.