August 25, 2014

Children and Sleep Apnea

This study found overweight kids who had surgery were more likely to become obese within seven months. Tonsillectomies are commonly done to relieve sleep apnea in children, but a new study confirms that the treatment can speed kids' weight gain -- especially if they're already overweight. This is often the problem and many surgeons will not tell the family that this happens and urge them to exercise with their children to prevent this from happening.

The researchers did say that it is a concern, because obesity is a risk factor for a range of health problems, including sleep apnea. They are not advising against tonsillectomy for the children who need it. They are saying that doctors (plus surgeons) and parents should be taught that a healthy diet and exercise become even more important after the children have surgery. The researchers state that the surgery does create a 'certainty' that weight gain is an effect of the surgery.

That's because children in the study were randomly assigned to have surgery or to "watchful waiting" -- putting off surgery and staying with other options, such as medications to better control any nasal allergies or asthma symptoms. Altogether, 204 children aged 5 to 9 were assigned to have surgery right away, while 192 stuck with watchful waiting. It was found that over seven months, children who underwent surgery showed a quicker average weight gain, versus kids in the comparison group.

It was a small difference overall. And for children who were normal weight, there was no major effect. It was not making normal-weight children obese. It was alarming that of those children that were overweight before surgery, 52 percent had become officially obese seven months after surgery. 21 percent of overweight children in the watchful-waiting group were obese.

Sleep apnea also causes metabolic changes. The growth hormone is released at night, and sleep apnea can interfere with that. The body may adapt metabolism in an effort to maintain a child's growth. Then when sleep apnea is managed, the children are set up for rapid weight gain. Now, with childhood obesity on the rise, many kids with sleep apnea are already overweight or obese. If they rapidly put on pounds, their sleep apnea might return in six months to a year.

Diet and exercise are key for children with sleep apnea. Many can do well without surgery using CPAP, proper nutrition, and exercise. This reminds me of blogs from February and March 2012 when I was sending articles to a set of parents in another state that were trying to avoid surgery on their son. Their insurance and I agreed that surgery should be the last resort and they are very happy this was possible. Their sleep doctor emphasized proper nutrition and exercise with the CPAP use and the entire family has responded very positively.

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