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Sleep Apnea, Obesity and Asthma–A Pediatric Epidemic

By Dr. Larry Chiaramonte

A study presented at the recent American College of Allergy, Asthma and Immunology noted that “73 percent of obese children were diagnosed with sleep apnea/hypopnea syndrome (SAHS) while none of the adolescents at a healthy weight were diagnosed with SAHS.” Furthermore: “Children who are overweight are nearly 2-1/2 times more likely to have asthma than those who are not overweight.”

As someone who has long worried about the connection between obesity and asthma (click here, here, and here) and has had some sleep issues of my own, I must say that these findings are unsurprising but very alarming.

What is sleep apnea? Simply put, it is ceasing to breathe while you are asleep. Your airways relax when you slide into slumber and close off the passages where air is supposed to flow. If you have inflamed upper airways from allergic rhinitis the less space there is for air. If your throat is constricted because your neck is too big from overweight, the more likely you are to have apnea; professional football players have apnea rates several times normal for men their age, although their necks are often crowded with muscle rather than fat. Once your body slides into slumber, the tissue in your upper airways loses its tone and collapses, blocking the movement of air in and out. Did you ever sit with someone, say after a big holiday dinner, who falls asleep even momentarily? They may start to snore instantly as their airways relax, impeding the supply of air to the lungs (which in asthmatics are compromised to begin with, of course). When you elbow them back awake, they often look startled. That’s a mild version of what happens with apnea when you actually stop breathing and your body has to wake itself up.

When you can’t breathe at all, your body panics. It activates the “flight or fight” response. Your adrenalin level spikes along with your blood pressure and other stress hormones as you unconsciously jolt yourself awake. How often does this happen? In severe apnea, it’s hundreds of times a night. Imagine getting an EpiPen over and over throughout the night, or having the Heimlich maneuver performed again and again to unblock your throat. No wonder then that many heart attacks and strokes take place while people are sleeping early in the morning. They have spent the night panicking when they are supposed to be at rest.

Now, imagine that happening to your child. Not only is he at risk for all the complications of high blood pressure and other cardiovascular stress, it actually encourages further weight gain because of the hormonal response to stress. It means that he is going to be worn out and inattentive in school the next day from all that distress. This is a vicious cycle, one will take a severe toll both on quality and longevity of life.

Listen to your child sleep. Does he snore or make grunting noises? Does he wake up often to go to the bathroom? Sleep apnea stimulates frequent urination. If your child has allergic rhinitis and asthma, good control should encourage restful sleep. If she has asthma and weight problems, they compound one another. And if she has sleep apnea, too, the problems compound at an increasing rate. Sleep apnea is already at epidemic levels among adults. That it should be happening to children, too, is a scandal.

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