Sleep Patterns with Obstructive Sleep Apnea in Middle Adolescence: A Cross-Sectional Study of Obese Patients

Olga Berdina, Irina Madaeva, Svetlana Bolshakova, Olga Bugun, Lyubov Rychkova

 
International Journal of Biomedicine. 2020;10(3):235-240.
DOI: 10.21103/Article10(3)_OA7
Originally published September 10, 2020

Abstract: 

Background: The aim of this study was to explore specific sleep patterns in obese adolescents aged 15-17 using polysomnography (PSG), whether or not obstructive sleep apnea (OSA) is present.

Methods and Results: Anthropometric measurements were taken of all participants, and outpatient PSGs were performed. After PSG, all obese participants were divided into two groups: non-OSA group (n=18) and OSA group (n=27). Fifteen lean adolescents were included in the control group. Apnea/hypopnea index, episodes of snoring, time with SpO2<90%, arousal index, sleep stages 1-2 were significantly higher; and lowest SpO2, sleep efficiency, slow wave sleep, rapid eye movement sleep were significantly lower in OSA patients than in both non-OSA groups. However, all PSG variables in the non-OSA obese group were comparable to lean controls.

Conclusion: Sleep characteristics are related to the presence of OSA, but not to the excess weight. Future research should evaluate sleep pattern changes following successful treatment of OSA in obese adolescents and longitudinal outcomes in adults. 

Keywords: 
obstructive sleep apnea • obesity • polysomnography • middle adolescence
References: 

1. Daniels SR. Complications of obesity in children and adolescents. Int J Obes (Lond). 2009;33 Suppl 1:S60-S65. doi:10.1038/ijo.2009.20
2. Arroyo-Johnson C, Mincey KD. Obesity Epidemiology Worldwide. Gastroenterol Clin North Am. 2016;45(4):571-579. doi:10.1016/j.gtc.2016.07.012
3. Darenskaya MA, Rychkova LV, Kolesnikov SI, Gavrilova OA, Kravtsova OV, Grebenkina LA, et al. Oxidative stress parameters in adolescent boys with exogenous-constitutional obesity. Free Radic. Biol. Med. 2017;112:129-130. doi: 10.1016/j.freeradbiomed.2017.10.195.
4. Hagman E, Danielsson P, Brandt L, Svensson V, Ekbom A, Marcus C. Childhood Obesity, Obesity Treatment Outcome, and Achieved Education: A Prospective Cohort Study. J Adolesc Health. 2017;61(4):508-513. doi:10.1016/j.jadohealth.2017.04.009
5. Pogodina A, Rychkova L, Kravtzova O, Klimkina J, Kosovtzeva A. Cardiometabolic Risk Factors and Health-Related Quality of Life in Adolescents with Obesity. Child Obes. 2017;13(6):499-506. doi:10.1089/chi.2016.0330
6. Chen X, Beydoun MA, Wang Y.  Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity (Silver Spring). 2008;16(2):265-274. doi:10.1038/oby.2007.63
7. Hart CN, Cairns A, Jelalian E. Sleep and obesity in children and adolescents. Pediatr Clin North Am. 2011;58(3):715-733. doi:10.1016/j.pcl.2011.03.007
8. Kreitsch KN, Chardon ML, Beebe DW, Janicke DM. Sleep and weight-related factors in youth: A systematic review of recent studies. Sleep Med Rev. 2019;46:87-96. doi:10.1016/j.smrv.2019.04.010
9. McHill AW, Wright KP Jr. Role of sleep and circadian disruption on energy expenditure and in metabolic predisposition to human obesity and metabolic disease. Obes Rev. 2017;18 Suppl 1:15-24. doi:10.1111/obr.12503
10. Qu XX, Esangbedo IC, Zhang XJ, Liu SJ, Li LX, Gao S, et al. Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing: data from Beijing Child and Adolescent Metabolic Syndrome Study [published correction appears in Chin Med J (Engl). 2015 Dec 20;128(24):3390]. Chin Med J (Engl). 2015;128(17):2278-2283. doi:10.4103/0366-6999.163394
11. Su M-S, Zhang H-L, Cai X-H, Lin Y, Liu PN, Zhang YB, et al. Obesity in children with different risk factors for obstructive sleep apnea: a community-based study. Eur J Pediatr. 2016;175(2):211-220. doi:10.1007/s00431-015-2613-6
12. Marcus CL, Brooks IJ, Ward SD, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714-e755. doi:10.1542/peds.2012-1672
13. Morsy NE, Farrag NS, Zaki NFW, Badawy AY, Abdelhafez SA, El-Gilany A-H, et al. Obstructive sleep apnea: personal, societal, public health, and legal implications. Rev Environ Health. 2019;34(2):153-169. doi:10.1515/reveh-2018-0068
14. Jackson ML, Tolson J, Bartlett D, Berlowitz DJ, Varma P, Barnes M. Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates. Sleep Med. 2019;62:22-28. doi:10.1016/j.sleep.2019.03.011
15. Gaete V. [Adolescent psychosocial development]. Rev Chil Pediatr. 2015;86(6):436-443. doi:10.1016/j.rchipe.2015.07.005. [Article in Spanish].
16. Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning in adolescents. Child Dev. 1998;69(4):875-887.
17. Hagenauer MH, Lee TM. Adolescent sleep patterns in humans and laboratory animals. Horm Behav. 2013;64(2):270-279. doi:10.1016/j.yhbeh.2013.01.013
18. Berdina O, Madaeva I, Bolshakova S, Tsykunova M, Bugun O, Rychkova L. Applying a Translated Version of the Adolescent Sleep Habits Survey in Russian High School Children with Obesity. International Journal of Biomedicine. 2020;10(1):61-65. doi: 10.21103/Article10(1)_OA10.
19. Beebe DW, Lewin D, Zeller M, McCabe M, MacLeod K, Daniels SR, et al. Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J Pediatr Psychol. 2007;32(1):69-79. doi:10.1093/jpepsy/jsj104
20. Hayes JF, Balantekin KN, Altman M, Wilfley DE, Taylor CB, Williams J. Sleep Patterns and Quality Are Associated with Severity of Obesity and Weight-Related Behaviors in Adolescents with Overweight and Obesity. Child Obes. 2018;14(1):11-17. doi:10.1089/chi.2017.0148
21. Verhulst SL, Van Gaal L, De Backer W, Desager K. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev. 2008;12(5):339-346. doi:10.1016/j.smrv.2007.11.002
22. Xanthopoulos MS, Gallagher PR, Berkowitz RI, Radcliffe J, Bradford R, Marcus CL. Neurobehavioral functioning in adolescents with and without obesity and obstructive sleep apnea. Sleep. 2015;38(3):401-410. Published 2015 Mar 1. doi:10.5665/sleep.4498
23. Rundo JV, Downey R 3rd. Polysomnography. Handb Clin Neurol. 2019;160:381-392. doi:10.1016/B978-0-444-64032-1.00025-4
24. World Health Organization. Growth reference 5-19 years. BMI-for-age (5-19 years). [Electronic resource]. https://www.who.int/growthref/who2007_bmi_for_age/en/.
25. Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. The AASM Manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Version 2.2. Darien, Illinois: American Academy of Sleep Medicine; 2015.
26. Kaditis AG, Alvarez MLA, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016;47(1):69-94. doi:10.1183/13993003.00385-2015
27. Senaratna CV, English DR, Currier D, Perret JL, Lowe A, Lodge C, et al. Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health. BMC Public Health. 2016;16(Suppl 3):1029. Published 2016 Oct 31. doi:10.1186/s12889-016-3703-8
28. Madaeva I, Berdina O, Kolesnikova L, Semenova N. Gender-related differences of sleep pattern characteristics in obstructive sleep apnea. Sleep Med. 2017;40(Suppl 1):e204-5. doi: 10.1016/j.sleep.2017.11.598.
29. Andersen IG, Holm, Homøe P.  Obstructive sleep apnea in children and adolescents with and without obesity. Eur Arch Otorhinolaryngol. 2019;276(3):871-878. doi:10.1007/s00405-019-05290-2
30. Kang KT, Lee PL, Weng WC, Hsu WC. Body weight status and obstructive sleep apnea in children. Int J Obes (Lond). 2012;36(7):920-924. doi:10.1038/ijo.2012.5
31. Evangelisti M, Shafiek H, Rabasco J, Forlani M, Montesano M, Barreto M, et al. Oximetry in obese children with sleep-disordered breathing. Sleep Med. 2016;27-28:86-91. doi:10.1016/j.sleep.2016.08.014
32. Lennon CJ, Wang RY, Wallace A, Chinnadurai S. Risk of failure of adenotonsillectomy for obstructive sleep apnea in obese pediatric patients. Int J Pediatr Otorhinolaryngol. 2017;92:7-10. doi:10.1016/j.ijporl.2016.09.026
33. Parmar A, Baker A, Narang I. Positive airway pressure in pediatric obstructive sleep apnea. Paediatr Respir Rev. 2019;31:43-51. doi:10.1016/j.prrv.2019.04.006
34. Scheffler P, Wolter NE, Narang I, Amin R, Holler T, Ishman SL, et al. Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;160(6):985-992. doi:10.1177/0194599819829415
35. Patinkin ZW, Feinn R, Santos M. Metabolic Consequences of Obstructive Sleep Apnea in Adolescents with Obesity: A Systematic Literature Review and Meta-Analysis. Child Obes. 2017;13(2):102-110. doi:10.1089/chi.2016.0248
36. Andersen IG, Holm JC, Homøe P.  Impact of weight-loss management on children and adolescents with obesity and obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2019;123:57-62. doi:10.1016/j.ijporl.2019.04.031
37. Donlea JM. Neuronal and molecular mechanisms of sleep homeostasis. Curr Opin Insect Sci. 2017;24:51-57. doi:10.1016/j.cois.2017.09.008
38. Olini N, Rothfuchs I, Azzinnari D, Pryce CR, Kurth S, Huber R. Chronic social stress leads to altered sleep homeostasis in mice. Behav Brain Res. 2017;327:167-173. doi:10.1016/j.bbr.2017.03.022
39. Miller AL, Lumeng JC, LeBourgeois MK. Sleep patterns and obesity in childhood. Curr Opin Endocrinol Diabetes Obes. 2015;22(1):41-47. doi:10.1097/MED.0000000000000125

Download Article
Received July 15, 2020.
Accepted August 17, 2020.
©2020 International Medical Research and Development Corporation.