Pediatric Obesity and Sleep Apnea

Is bariatric surgery for a teenager ever an appropriate treatment for obstructive sleep apnea?

It can be, said Brian Kaplan, MD, chairman of the department of otolaryngology at the Greater Baltimore Medical Center. “I had a 16- or 17-year-old patient who was morbidly obese,” he said. “The child had sleep apnea and was already on CPAP, but it was clear that CPAP was not going to be a long-term solution. We had the child evaluated, and he ended up getting gastric bypass surgery. Over the next six months, he lost about 50 pounds, and we were able to decrease the CPAP settings almost in half.”

Obesity is inextricably linked to obstructive sleep apnea (OSA). And as pediatric obesity numbers have climbed, so have the number of children with OSA. “There’s a whole multifactorial element when it comes to sleep apnea in the obese pediatric population,” Dr. Kaplan said. “You don’t just have big tonsils and adenoids taking up space, but you have collapse of the soft tissues of the throat. There are also different fat pads within the throat and in the neck that further narrow the airway. Pressure on the stomach and chest from fat collection also makes it harder to take a deep breath. And there’s probably some central element to obesity that we don’t totally understand yet, which also contributes to the development of apnea.”

An interdisciplinary approach is often required and, increasingly, pediatric sleep specialists and otolaryngologists are working closely with pediatric obesity experts to design treatment plans that tackle both OSA and obesity.

Start with Compassion

Obese children and their families are often the targets of criticism, and anti-fat attitudes can even exist within medical practices. Research has shown that it’s not uncommon for health professionals to perceive obese patients as “lazy,” “stupid” or “worthless” (Obes Res. 2003;11(9):1033-1039). Replacing such attitudes with compassionate concern is the first step toward effectively caring for overweight and obese children, said Stephen Pont, MD, MPH, medical director of the Texas Center for the Prevention and Treatment of Childhood Obesity in Austin. “Every touch point that the child and parent have with medical care is the opportunity to plant small seeds of change and encouragement for them,” said Dr. Pont. “If we step back and say, ‘What’s the most effective way to help someone get healthier?’ it’s not to guilt and blame them into it. Instead, you want to empower the parents and patient.”