Public Release:  Children with bigger neck sizes face an increased risk of a sleep-related breathing disorder

American Academy of Sleep Medicine

WESTCHESTER, Ill. - Children with bigger age-adjusted neck sizes may be at increased risk for a sleep-related breathing disorder, as well as increased severity of the disease, according to a research abstract that will be presented on Tuesday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

The study, authored by Pearl L. Yu, MD, of the University of Virginia, focused on 215 children between one-and-a-half to 18 years of age who were referred to a pediatric sleep center. Obese patients comprised 37.3 percent of this population, and had an increased frequency of snoring. Apnea-hypopnea index (AHI) and mean oxygen saturation values were used as indices of sleep-related breathing disorder severity. Neck size, measured in a sitting and neutral head position, was regressed against age, and the percent deviation was obtained from the predicted neck size for each patient.

According to the results, predicted neck size correlated with body mass index (BMI) and weight, and showed no significant correlation with height or age. In addition, predicted neck size showed a higher correlation with AHI than did BMI, weight or tonsil size. Further, predicted neck size showed a strong inverse correlation with mean oxygen saturation, and was a better predictor of mean oxygen saturation than BMI, weight or tonsil size.

"Children with bigger neck sizes for age should be queried about snoring, apnea, excessive sleepiness, and hyperactivity," said Dr. Yu. "Neck size should be considered in the clinical evaluation of children with a history of snoring and apnea."

Sleep-related breathing disorders are a group of disorders that affect our breathing while we are asleep, and are characterized by disruptions of normal breathing patterns that only occur during sleep.

The most common category of sleep-related breathing disorder is obstructive sleep apnea (OSA), which causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs.

OSA occurs in about two percent of young children. It can develop in children at any age, but it is most common in preschoolers. OSA often occurs between the ages of three and six years when the tonsils and adenoids are large compared to the throat. OSA appears to occur at the same rate in young boys and girls. How often it occurs in infants and teens is unknown. OSA also is common in children who are obese.

Symptoms of OSA tend to appear in the first few years of life. But OSA often remains undiagnosed until many years later. In early childhood OSA can slow a child's growth rate. Following treatment for OSA children tend to show gains in both height and weight. Untreated OSA also can lead to high blood pressure.

OSA is more likely to occur in a child who has a family member with OSA.

Most children with OSA have a history of snoring. It tends to be loud and may include obvious pauses in breathing and gasps for breath. Sometimes the snoring involves a continuous, partial obstruction without any obvious pauses or arousals. The child's body may move in response to the pauses in breathing. The rate of snoring in children is reported to be 10 to 12 percent.

It is recommended that adolescents get nine hours of nightly sleep and school-aged children between 10-11 hours.

The American Academy of Sleep Medicine (AASM) offers the following tips to adolescents on how to get a good night's sleep:

  • Follow a consistent bedtime routine.

  • Establish a relaxing setting at bedtime.

  • Get a full night's sleep every night.

  • Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.

  • Do not stay up all hours of the night to "cram" for an exam, do homework, etc. If after-school activities are proving to be too time-consuming, consider cutting back on these activities.

  • Keep computers and TVs out of the bedroom.

  • Do not go to bed hungry, but don't eat a big meal before bedtime either.

  • Avoid any rigorous exercise within six hours of your bedtime.

  • Make your bedroom quiet, dark and a little bit cool.

  • Get up at the same time every morning.

The AASM offers some tips to help your child sleep better:

  • Follow a consistent bedtime routine. Set aside 10 to 30 minutes to get your child ready to go to sleep each night.

  • Establish a relaxing setting at bedtime.

  • Interact with your child at bedtime. Don't let the TV, computer or video games take your place.

  • Keep your children from TV programs, movies, and video games that are not right for their age.

  • Do not let your child fall asleep while being held, rocked, fed a bottle, or while nursing.

  • At bedtime, do not allow your child to have foods or drinks that contain caffeine. This includes chocolate and sodas. Try not to give him or her any medicine that has a stimulant at bedtime. This includes cough medicines and decongestants.

It is important to make sure that your child gets enough sleep and sleeps well. The value of sleep can be measured by your child's smiling face, happy nature and natural energy. A tired child may have development or behavior problems. A child's sleep problems can also cause unnecessary stress for you and the other members of your family.

Those who suspect that they might be suffering from OSA, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist. Parents should consult with their child's pediatrician or a sleep specialist.

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More information about "children and sleep" is available from the AASM at http://www.SleepEducation.com/Topic.aspx?id=8, "child sleep apnea" at http://www.SleepEducation.com/Disorder.aspx?id=71, and "teens and sleep", including a new questionnaire that assesses the level of sleepiness in adolescents, at: http://www.SleepEducation.com/Topic.aspx?id=71.

The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

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