The obesity epidemic and disordered sleep during childhood and adolescence.
ABSTRACT The obesity pandemic is claiming its presence even among youngest of children and is clearly on the rise. Although the extent and implications of this massive increase in the prevalence of overweight and obese children are unclear, they are anticipated to be deleterious to global health outcomes and life expectancy. The potential interrelationships between sleep and obesity have gained recent attention. In this chapter, we initially examine the critical evidence supporting or refuting such proposed associations. In addition, the potential reciprocal roles of obesity and obstructive sleep apnea in the facilitation of their pathophysiology are also reviewed, along with their amplificatory effects on their respective morbidities.
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ABSTRACT: The syndrome of obstructive sleep apnea (OSA) has emerged over the last decades as an important risk factor for heart and metabolic disease, and also, for neurocognitive dysfunction. The four major components of this condition are intermittent hypoxia, hypercapnia, intrathoracic pressure changes and sleep fragmentation. Several pathophysiological mechanisms are likely to be involved, such as increased oxidative stress, systemic inflammation and endothelial and autonomic dysfunction. Surgical treatment for OSA has been shown to be effective at normalizing endothelial function, reducing levels of inflammatory markers, and to improve the apnea-hypopnea index and sleep fragmentation, but this effect is smaller in obese children. The high prevalence of childhood obesity has changed the phenotypic expression of the disease, aggravating the problem and creating the need for effective interventions for this high-risk population. The aim of this study is to describe in detail the consequences of OSA on pediatric populations.Revista chilena de pediatría 04/2013; 84(2):128-137. DOI:10.4067/S0370-41062013000200002
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ABSTRACT: Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment.Nature and Science of Sleep 09/2013; 5:109-123. DOI:10.2147/NSS.S51907