Childhood Obesity and Obstructive Sleep Apnea - Research Paper Example

- College Childhood Obesity and Obstructive Sleep Apnea Introduction The World Health Organization has stated that “obesity” is rising up as one of the major health concerns across the world. “Children obesity” was predominantly seen in western countries, but developing countries are not far left behind anymore. This impact has been seen in all socio-economic groups. Every aspect of social media is throwing light on this issue of child obesity and trying to create more awareness in public. It is very vital to take actions in order to control obesity, as it is known to have serious consequences such as diabetes, hypertension etc. Many healthcare organizations are targeting high risk groups and setting plans to control further weight gain in overweight children. Obesity prevalence rate is increasing with higher pace in adults, as well as children. Modern urbanization, faulty dietary habits and sedentary life styles are the main culprits. It is a priority for every individual to understand the cause and effect of childhood obesity. This article will highlight the points related to children obesity and related co-morbid conditions and effective measures. Obesity is measured in terms of “body mass index” where in BMI is calculated by” weight in kilogram divided by height in meter square” (Flagal, Tabak, and Ogden 755-760). This formula is applicable to both adults, as well as children. In a case of children, BMI differs with the age. Hence BMI of particular child is calculated by comparing the BMI of group of kids having same age and Annals Academy of Medicine as “Body mass index > 85th/95th percentile for age and gender for those < 72 months”. It is also calculated as “% ideal body weight for height > 120 %/> 140% for gender for children aged 6 to 18 years” (Tang 714). Number of obese people has increased significantly across the world since few years. The statistical data forwarded by various research works are really disturbing. They demonstrate the fact that they deserve extra focus to handle obesity problem in children. Here are some statistical data about the child obesity from various literatures, 1) Almost 20 percent of U.S. children will be categorized as obese by 2010, according to the Department of Health and Human Services. 2) In 2008, the proportion of overweight and obese children in United States was 32% and had stopped climbing (Patty Neighmond, NPR). 3) In 2004, according to the Centre for Disease Control and Prevention, 65% of adults are obese. And, there is a 70-80% chance that an obese child will turn out an obese adult. 4) A Stanford study says one out five American children is obese. US government spends almost 6% of total healthcare expenditure on obesity related problems ("Stanford Prevention Research Center" 1). Obesity is likely to cause wide variety of health problems, such as diabetes, high blood pressure, cardiac disease, psychological problems, and respiratory trouble causing disturbed sleep patterns, renal impairment, gall bladder diseases, cancer and many other chronic conditions. Obesity is a chronic problem. It starts deteriorating all the systems of the body gradually. Considering such a high statistical data of obesity in adults and children, it becomes too crucial to understand the etiology behind its occurrence. There has been a significant amount of study conducted by various organizations to gain knowledge about the possible etiological factors of obesity. Weight gain is caused due to “imbalance in calories consumed and calories expended” (WHO). Following are the most possible causes of obesity in childhood posted in Child Obesity Survey by Kaiser Family Foundation (1-20) and The Future of Children (2006) – (Anderso, and Butcher 8-12): 1) Dietary Causes – Faulty and irregular dietary habits, excess fatty food consumption, frequent visits to restaurants and fast food centers, aerated drinks and fruit juices consumption which has added sugar, chips, popcorns, chocolates and similar junk food. ("Stanford Prevention Research Center" 1; Anderson and Butcher 8-12) 2) Lifestyle – Less of outdoor activities and increase availability of indoor games are making kids very inactive. Kids have tremendous affinity towards the television set and computer games. The sedentary lifestyle and the fast food consumption are the leading causes of weight gain in children. ("Stanford Prevention Research Center" 1) 3) Genetics – Family history of obesity. It has been observed that when the parents are obese, the child is likely to become obese. (Anderson and Butcher 8-12) 4) Medical Illness –Hypothyroidism, Nephrotic syndrome and Cushing’s syndrome are such diseases which can make the child obese. (Ponder and Anderson 150) 5) Medications- Glucocorticoids and use of antipsychotics are known to cause obesity. (Ponder and Anderson 150) 6) Psychological – Obese children have been seen to suffer from psychological or emotional problems like depression and low self esteem as well as are often targets of teasing by peers. The other way round is also sometime true – meaning, depression can sometime lead to overeating habits causing obesity among children. (Ponder and Anderson 150) Complications related to obesity Obesity brings out lot of complications and co-morbidity along with it. Complications can be minor but if are not attended proactively, they can potentially get converted into critical illnesses. Some of the risk factors associated with obesity in children described in Diabetes spectrum journal (Ponder and Anderson 149) are as follows: Endocrinal- e.g. insulin resistance syndrome which can lead to many other complications in future such as Type II diabetes, hyper insulin secretion, etc. Research says blood glucose levels should be estimated in regular intervals along with lipid profiles in high risk children right from the age of ten years or since at least puberty. (Ponder and Anderson 149) Gastrointestinal- Obesity is known to cause fatty liver. Fat deposition can affect metabolism causing gall bladder diseases, bile stones etc. (Ponder and Anderson 149) Respiratory- Excess subcutaneous fat and abdominal fat put lot of pressure on respiratory system producing asthmatic symptoms and obstructive sleep apnea syndrome. Consequences of severe apnea could be pulmonary hypertension with Cor Pulmonale. (Ponder and Anderson 149) Cardiovascular- Long term obesity leads to hypertension, increase in lipid titers such as cholesterol, triglycerides causing atheromatous changes in the heart vessels leading to ischemic heart disease. (Ponder and Anderson 149) Psychological- Obese children often feel tiredness, sluggishness, irritability, low motivation, sadness, depression, embarrassment to face the public due to obesity. (Ponder and Anderson 149) Orthopedic- Extra kilos of body weight induces joint pains, back pain, slipped discs, Coxa Vera, legs calves’ Perth diseases and Blount’s diseases. (Ponder and Anderson 149) Dermatological- Insulin resistance brings out erythematous rash on skin called as Acanthosis Nigricans. It also causes “Intertrigo” or “Furunculosis” etc. (Ponder and Anderson 149) Reproductive- Obesity often leads to hormonal imbalance in the body. Commonest trouble is cystic disease in ovaries, irregular menstrual cycles, painful menses, and early puberty. Excess androgen causes “Hirsutism”. Instead, boys may have delayed pubertal onset, decrease in male hormones (Androgen), etc. (Ponder and Anderson 149) Renal- Children with long term obesity do have symptoms of microalbuminuria, etc. (Ponder and Anderson 149) Malignancy- Breast cancer, colon cancer etc. Hence, if the obesity has not been controlled promptly, children will have to suffer from severe illnesses in future. Obesity is one of the principle causes for “Obstructive Sleep Apnea syndrome”. Obstructive sleep apnea or OSA is a commonest condition found in children of all ages. Most of the times the symptoms are of mild variety and subside as the age advances further. The commonest expressions OSA exhibit through snoring, upper airway resistance resulting in breathing through mouth etc. In severe conditions of apnea and other respiratory distresses child needs medical intervention. “Obstructive sleep apnea” is studied more often nowadays as its occurrence is getting more and more visible in children under 12 years of age and it has been getting linked up with obesity which is the another major health issue of the society. Obstructive sleep apnea or hyperpnoea syndrome (OSAHS) in children is defined as a “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns” (Tang 710). Etiological factors for Obstructive Sleep Apnea Child has to undergo physical examination in suspected OSA cases in order to evaluate the root cause of obstruction of upper airway. According to AAFP article (Chan, Edman, and Koltai 1148) the commonest factors responsible for OSA are as follows: Adenoids or tonsillar hypertrophy Neuromuscular diseases - loss of muscular tone Craniofacial abnormalities - anatomical defects in the air passage Obesity Laryngeal pathology Tonsils-Lingual In most of the findings “Adenotonsillar hypertrophy” is the leading cause of the obstructive air passages and often surgical removal is advised in severe cases. Also, in some cases there may be other possibilities apart from enlarged adenoids, i.e. loss of neuro-muscular tone (Chan, Edman, and Koltai 1148). There was a research study conducted in Singapore by targeting obese children of various age groups and ethnicity. This has been published in article of annals academy of medicine. This article has proved the relationship in between obesity and obstructive sleep apnea. Survey was performed among the school going kids in Singapore, 10-15 % children have been found suffering from “obesity”, whereas 0.7 to 3% children have been suffering from “Obstructive sleep apnea syndrome”. But the percentage of prevalence rate of obstructive sleep apnea syndrome in obese children is much higher varying from 13-66%. This indicates obesity is one of the primary causes of obstructive sleep apnea (Tang 710). First light on this relationship of obesity and OSA was thrown by Charles Dickens almost 100 years ago. Now the obesity problem is getting widened over the period, obesity and its complications are again coming up into research discussions. Patho-physiology of Obstructive Sleep Apnea Syndrome Patient experiences distress in breathing due to “Imbalance in upper airway” (Tang 711). This imbalance is caused due to following processes: Upper airway obstruction - When patient lies down in supine position, passage of upper airways gets occluded. Symptoms severity depends upon the extent of blockage whether it is partial or major. In obese patients, pharyngeal muscles are prone for fatty depositions putting pressure on pharyngeal wall to collapse. Also, sometimes subcutetaneous fat around the neck region pressurizes pharyngeal lumen forcing it to collapse causing obstruction in the air passage. Reduced lung volume - excessive abdominal fat puts lot of pressure over the chest wall, lungs and diaphragm especially in supine posture (lying down position). This induces reduction in lung volume and oxygen reserve capacity causing breathing difficulty. Metabolic derangement - Some studies have also shown that obesity induced metabolic disturbances cause depletion in respiratory stimulants and central chemoreceptor modulator resulting in apnea or hyperpnoea. Epidemiology and clinical features Prevalence of obstructive sleep apnea is almost same in males and females and also found in all ethnicity. Symptoms variations are seen as per different age groups, e.g. in children under five years of age (Chan, Edman, and Koltai 1148): Intermittent snoring is the commonest symptom Nasal airway obstruction causing breathing through mouth Disturbed sleep and frequent arousal from sleep Hard breathing at times. Infrequent apnoic spells in case of severe blockage. Diaphoresis In above 5 year age group, symptom picture slightly differ, apart from snoring child may have following complaints (Chan, Edman, and Koltai 1148): Excessive sleepiness during daytime Increase frequency of urination day and night Lack of concentration in studies affecting school performance Restlessness or hyperactive behavior due to disturbed sleep Diagnosis of Obstructive sleep apnea It is described in aafp article (Chan, Edman, and Koltai, p 1151-1152) as follows: 1) Polysomnography - This tool is essential for evaluating patient with structural anomaly such as “craniofacial syndrome” and to measure “degree of apnea” etc. This is a standard tool for the diagnosis of adult cases of severe apnea, but in case of children, apneas are not well documented. Hence the use of this tool is still doubtful. 2) Video photography - This method helps in recording frequency of apneic spells and arousal from sleep. Performance of this test again varies depending upon subjectivity. 3) Airway Fluoroscopy - This tool often helps in finding the extent of airway obstruction and evaluating air passage for general observation. 4) Nasopharyngoscopy - This is the most reliable and commonest test for viewing air passages. 5) Lateral neck radiography and CT scanning or Magnetic resonance imaging - Radiographic method often helps in viewing adenoid for their enlargement. This is the added benefit for the confirmation of diagnosis. CT scanning and MRI are advised in order to rule out the chances of Pharyngeal malignancy. 6) Pulse oximetry - This is the test to calculate oxygen saturation in children having OSA. Management of Obstructive Sleep Apnea Medical management includes dosage of steroids and antibiotics to conquer secondary infections in the air passage after obstructive pathology. “Continuous positive airway pressure” or CPAP is indicated when surgical removal of adenoids or tonsils is unsuccessful (Chan, Edman, and Koltai 1152). Surgical intervention - “Adenotonsillectomy” is often a treatment of choice. “Uvulopalatopharyngoplasty” can also be done in case of soft palate pathology. Tracheotomy is planned when other methods fail. In cases of structural anomalies, this the only preferred mode of treatment (Chan, Edman, and Koltai 1152). Complication of Obstructive Sleep Apnea Hyper somnolence - It means excessive sleepiness. Child suffering from obesity with OSA will have disturbed night sleep pattern and will be excessively sleepy throughout the day. This is the commonest expression of OSA. Frequent and short naps induce enuresis (Tang 711). Neurobehavioral problems - Obese children with OSA will have restless behavior. They might present aggressive behavior along with hyperactivity. They lack concentration in studies and fail to do well in school due to their impaired behavioral patterns (Tang 711). Cardiovascular trouble - Obstructive sleep apnea is known to have effects on cardiovascular system having disturbances in blood pressure regulatory system resulting in Systemic hypertension and cardiac myopathy. Reduced lung volume does result in pulmonary hypertension. Cardiac affection is commonly seen in adults but the fact is its prevalence is not so much proven in children with obesity and OSA. Some kids had been reported to have pulmonary hypertension with Cor-pulmonale (Tang 711). Endocrine complications - Along with Obesity, OSA is also associated to cause insulin resistance, metabolic disorders (Tang 712). General growth impairment - OSA kids will have excessive energy consumption due to breathing struggle. Hypertrophied tonsils and adenoid will cause dysphagia with reduced olfaction and deranged metabolic activities. Intermittent sleep patterns will alter growth hormone (Tang 712). Post operative complications - These are also evident at times in some children and often close monitoring are essential (Tang 712). Conclusion- Some of the key notes discussed above have proven the relation between obesity and obstructive sleep apnea. It is clearly visible through available studies that children obesity does have serious impact on health and other activities during childhood and the later part of life. Most of the conditions causing obesity are correctable. Slight deviation in the life style and habits can certainly bring major changes in the health status. Healthcare institute and pharma companies have already pulled up their socks in creating awareness about children obesity and educating common public. Families should also take part in weight management programmes proactively to change their habits for the betterment of their family. Work cited Anderson, Patricia, and Kristin Butcher. "Childhood Obesity." The Future of Children. 16.1 (2006): 8-12. Web. 11 Dec. 2011. . Chan, James, Jennifer Edman, and Peter Koltai. "Obstructive Sleep Apnea in Children." AAFP Foundation. American Academy of Family Physician, 01032004. Web. 10 Dec 2011. . "Childhood overweight and obesity." World Health Organization. (n.d.) Web. 8 Dec 2011. . "Childhood Obesity: A growing Problem." Stanford Prevention Research Center. (n.d.): 1. Web. 8 Dec. 2011. . "Designing to Reduce Childhood Obesity." Active Living Research. (Feb 2005): 1. Web. 8 Dec.2011. . Flagal, Katherine, Carolyn Tabak, and Cynthia Ogden. "Overweight in children: definitions and interpretation." Oxford Journals. 21.6 (2006): 755-760. Web. 11 Dec. 2011. . Kaiser Family Foundation. "Survey on Childhood Obesity." kff.org. The San Jose Mercury News, (2004). Web. 8 Dec 2011. . Neighmond, Patti. "U.S childhood Obesity Rates level off." NPR morning edition. (28 May 2008): n. page. Web. 11 Dec. 2011. . "Obesity and Overweight." World Health Organization. WHO, (March 2011). Web. 11 Dec 2011. . Ponder, Stephen, and Megan Anderson. "Childhood Obesity: Practical Considerations for Prevention." Diabetes Spectrum. 20.3 (2007): 148-153. Web. 10 Dec. 2011. . Strauss, Richard, and Harold Pollack. "Epidemic Increase in Childhood Overweight,." JAMA. 286.22 (2001): 2845-2848. Web. 8 Dec. 2011. . Tang, Jenny PL. "Obesity and Obstructive Sleep Apnea Hyperpnoea Syndrome in Singapore." Annals Academy of Medicine. (August 2008): 714. Web. 9 Dec. 2011. . Ponder Stephen, and Megan Anderson. "Childhood Obesity: Practical Considerations for Prevention." Diabetes Spectrum. 20.3 (2007): 148-153. Web. 10 Dec. 2011. . Read More