0896 DO NOT WAIT FOR CHILD OBESITY: OVERWEIGHT LEADS TO SLEEP DISORDERED BREATHING AND WEIGHT LOSS TO ITS REMISSION IN PRE-PUBERTAL CHILDREN TRANSITIONING TO ADOLESCENCE

Abstract

Identifying the factors that predict the incidence, persistence, and remission of sleep disordered breathing (SDB) in the transition from childhood to adolescence is essential for its prevention. We investigated the role of body weight on the natural history of SDB in pre-pubertal children transitioning to adolescence. Data from the Penn State Child Cohort, a randomly- selected sample of 421 children (5-12y) followed-up as adolescents (12-23y) was used. Incidence, persistence and remission of SDB, including primary snoring and obstructive sleep apnea (OSA), was ascertained by in-lab, 9-hour polysomnography (PSG). Body mass index (BMI) percentile and its change from baseline to follow-up (∆BMI) was ascertained during the physical examination. Overweight children had 2.6-fold odds (95%CI 1.02–6.52) of developing OSA in adolescence and obese children had 3.4-fold odds (95%CI 1.55–7.23) of persisting with SDB in adolescence. In contrast, weight loss was significantly associated with remitting from SDB, particularly among children with normal tonsil or adenoid size (-12.0 ± 5.2 ∆BMI percentiles) but not among those with enlarged tonsils and/or adenopathy in childhood (-1.0 ± 4.3 ∆BMI percentiles). Only 4.4% of the remitted SDB cases had a history of adeno/tonsillectomy. These data support a causal role for overweight, obesity and weight loss in the development, chronicity and remission, respectively, of SDB in the transition from childhood to adolescence. Thus, weight loss should be pursued already in overweight children in order to prevent SDB. Importantly, neither weight loss nor adeno/tonsillectomy were predictive of the remission of SDB in a large proportion of children with a history of enlarged tonsils and/or adenopathy. These data support that the remission of SDB in these children is related to normal developmental trajectories of the upper airway and, thus, frequent watchful waiting may be indicated. National Institutes of Health R01 HL63772, R01 HL97165, UL1 TR000127, C06 RR16499