Pediatric weight management experts are very aware of the link between obesity and sleep apnea and often refer their patients to sleep specialists or otolaryngologists as well. “Because of the known relationship between sleep apnea and obesity, at least one nearby obesity center sends all of their obese patients for sleep studies as part of their routine workup,” said Lewis Kass, MD, director of pediatric sleep medicine at Norwalk Hospital in Norwalk, Conn.
Dr. Kass initiates CPAP in approximately 95 percent of the children referred to him by the obesity clinic. “It may seem aggressive to try CPAP on a kid who only has mild sleep apnea, but I do it anyway,” he said. “With kids, it’s not about the severity of apnea; it’s about the presence or absence. If it’s there, it’s probably affecting the child’s metabolism and daytime functioning.”
Beginning CPAP may help address the obesity issue as well. “The most exciting science I’ve seen in the last five years has been findings that suggest that treatment for obstructive sleep apnea, all by itself, improves metabolism,” Dr. Kass said. “Fat calls secrete a peptide called leptin, and when they over-secrete leptin, we get leptin resistance, and leptin resistance leads to insulin resistance. When you treat obstructive sleep apnea, the leptin goes away.” One 2003 study found that insulin sensitivity in patients with OSA improved after just two days of CPAP and remained improved at three months (Am J Resp Crit Care Med. 2004;169:156-162).