Excess weight and sleep-disordered breathing

Excess weight is a well-established predictor of sleep-disordered breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consistently shown a graded increase in the prevalence of SDB as body mass index, neck girth, or other measures of body habitus increases. Clinical studies of weight loss and longitudinal population studies provide strong support for a causal association. The role of excess body weight, a modifiable risk factor, with SDB raises many questions relevant to clinical practice and public health. The topic takes on added importance with the alarming rate of weight gain in children as well as adults in industrialized nations. Among adults ages 30–69 yr, averaging over the estimated United States 2003 age, sex, and BMI distributions, we estimate that ∼17% of adults have mild or worse SDB (apnea-hypopnea index ≥ 5) and that 41% of those adults have SDB “attributable” to having a body mass index of ≥25 kg/m2. Similarly, we estimate that ∼5.7% of adults have moderate or worse SDB (apnea-hypopnea index ≥ 15) and that 58% of those adults have SDB attributable to excess weight. Clearly, if the expanding epidemic of obesity seen in the United States continues, the prevalence of SDB will almost certainly increase, along with the proportion of SDB attributable to obesity.

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Orthopedic Problems in Overweight and Obese Children

Integrative Pediatrics and Child Care ◽

10.18314/ipcc.v1i1.1102 ◽

2018 ◽

Vol 1 (1) ◽

pp. 05-07

Author(s):

GL Di Gennaro

Keyword(s):

United States ◽

Coronary Artery Disease ◽

Body Mass Index ◽

Childhood Obesity ◽

Body Mass ◽

The United States ◽

Obese Children ◽

The World ◽

Prevalence Of Obesity ◽

Artery Disease

According to the data published by Haslam and James, about 10% of the world populations aged up to 18 areoverweight or obese [1]. In Europe, there are about 20% children with excessive body mass, 5% of whom sufferfrom obesity [2,3]. Childhood obesity is an ongoing epidemic in the United States [4,5]. The most recent data fromthe US indicate that 16.9% of children and adolescents are obese, defined as a body mass index (BMI) for age >95thpercentile [6,7] and there is evidence that the prevalence of obesity among children will reach 30% by 2030 [8].Childhood obesity is a risk factor for greater morbidity later in life, including diabetes, coronary artery disease andincreased mortality [4,5,9,10].

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Clinical Staging for Sleep-Disordered Breathing

Otolaryngology ◽

10.1067/mhn.2002.126477 ◽

2002 ◽

Vol 127 (1) ◽

pp. 13-21 ◽

Cited By ~ 315

Author(s):

Michael Friedman ◽

Hani Ibrahim ◽

Lee Bass

Keyword(s):

Body Mass Index ◽

Success Rate ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Staging System ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Clinical Staging ◽

Disordered Breathing

OBJECTIVE: The purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep-disordered breathing (SDB) versus those destined to fail. STUDY DESIGN: We retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage. SETTING: Academically affiliated tertiary care referral center. RESULTS: Stage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%. CONCLUSION: A clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.

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