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A new study examined the genetic basis of enlarged tonsils in children with obstructive sleep apnea.
The study involved 18 children with OSA. They were compared with 18 children who had recurrent tonsillar infections. All of the children had surgery to remove their tonsils. Then the tonsil tissue from each child was analyzed.
"We found that in the tonsil tissues of children with OSA, certain genes and gene networks were over expressed," study co-author Dr. David Gozal said in a news release.
They found that children with OSA had higher levels of a protein called phosphoserine phosphatase (PSPH). This protein almost never appeared in the tonsils of the children who did not have OSA.
Then they experimented with a phosphatase inhibitor to block this protein. It reduced the cell proliferation and increased programmed cell death.
"Together, these observations suggest that PSPH is a logical therapeutic target in reversing adenotonsillar enlargement in pediatric OSA," said Gozal.
Recently Gozal reported that the urine concentrations of certain proteins were altered in children with OSA. The results suggested that a urine teat may be able to detect sleep apnea in children.
The AASM reports that about two percent of healthy young children have OSA. It occurs when soft tissue in the back of the throat collapses and blocks the airway during sleep.
Most children with OSA have a history of loud snoring. This may include obvious pauses in breathing and gasps for breath. Parents often notice that the child seems to be working hard to breathe during sleep.
Last year the Sleep Education Blog reported that the causes of sleep apnea in children are complex. Sleep apnea often occurs when a child has large tonsils and adenoids. But weight and nasal problems also can play a role.
Removing the tonsils is a common treatment for sleep apnea in children. But some children may continue to have OSA even after the procedure.
A study in the Aug. 1 issue of the journal Sleep examined obstructive sleep apnea among siblings; it found a high “sibling risk” of OSA in both boys and girls.
The study group consisted of siblings born between 1978 and 1986; follow-up data were gathered from 1997 to 2004. Hospital records were analyzed for the entire pediatric population in Sweden – 2.7 million children.
Children 18 years of age and younger were divided into sibling groups. The study determined which children had a hospital diagnosis of OSA during the follow-up period. Then children were noted as positive for sibling OSA if a brother or sister also had the disorder.
Results found a high risk of OSA in boys and girls who had at least one sibling with OSA. The standardized incidence ratio was 33.2 in boys and 40.5 in girls. A total of 854 boys and 627 girls were diagnosed with sleep apnea during the study period.
The study also examined the sibling risk of having enlarged tonsils and adenoids; this is an important risk factor for sleep apnea in children. The familial risk was elevated; but it wasn’t as high as in the group with OSA. The standardized incidence ratio was 4.53 for boys and 4.94 for girls.
But the problem was much more common than OSA; 13,656 boys and 11,648 girls were diagnosed with enlarged tonsils and adenoids during the study.
The authors report that these sibling risks could have a genetic or environmental basis. In either case, both parents and doctors should be aware of the sibling risk of OSA.
“Early diagnosis and treatment is important to avoid complications,” study author Dr. Danielle Friberg told the AASM.
The AASM reports that OSA can slow a child’s growth rate in early childhood. Cognitive and behavioral problems also are common in children with OSA.Learn more about obstructive sleep apnea in children on SleepEducation.com.
Excess body weight is a major risk factor for obstructive sleep apnea in adults. In children, sleep apnea often occurs when a child has large tonsils and adenoids.
But a new study in the journal Sleep shows that the causes of sleep apnea in children are complex. You can’t put all of the blame on the tonsils; weight and nasal problems also play a role in child sleep apnea.
The study involved 700 children between the ages of 5 and 12 years. They were randomly selected from 18 public elementary schools.
Results show that 1.2 percent of children had moderate sleep apnea; it was more common in older children between 9 and 12 years of age. Twenty-five percent of children had mild sleep apnea; 15.5 percent had primary snoring.
Body mass index (BMI) and waist size were significant and strong predictors of both snoring and all severity levels of sleep apnea. Nasal factors such as chronic sinusitis, rhinitis and nasal drain were significant predictors of mild sleep apnea. Black and Hispanic children were more likely to have primary snoring and mild sleep apnea.
And tonsil size? Surprisingly, it wasn’t a significant risk factor for snoring or for any severity level of sleep apnea.
This means that adenotonsillectomy may not always be the best treatment for sleep apnea in children. This surgery involves the removal of the adenoids and tonsils.
Study author Edward O. Bixler, PhD, said that other treatments may be better options for some children with sleep disordered breathing (SDB).
“Risk factors for SDB in children are complex,” Bixler told the AASM. “Treatment strategies should consider alternative options, such as weight loss and correction of nasal problems.”
Get help for child sleep apnea at an AASM-accredited sleep center near you; a board-certified sleep specialist will determine which treatment option is best for your child.Learn more about sleep apnea in children at SleepEducation.com.
A new study examined the genetic basis of enlarged tonsils in children with obstructive sleep apnea.
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