Sleep and Snoring, a Childhood Obesity Paradox

It is obvious that the duration and quality of their sleep are important to children in avoiding obesity. And yet, obesity itself is an obstacle to quality sleep. The youngsters who most need good sleep are likely to be already handicapped by disorders that interrupt and disturb sleep. So there is a vicious cycle. When a problem turns into a self-perpetuating feedback loop, the situation is serious.

There is in fact a whole spectrum of sleep-disordered breathing. In sleep apnea, the person stops breathing entirely for at least 10 seconds. Hypopnea is the partial loss of breath for at least that long. Typically, sufferers do not realize how many times each night they are awakened by erratic breathing, but it is still not good for them.

Obstructive sleep apnea (OSA) is classified as a potentially dangerous consequence, and a co-morbidity to childhood obesity. With the severity of the OSA, the intensity of snoring increases. OSA diagnosis is accomplished by polysomnography, which connects the patient with equipment to measure several bodily processes and come up with an AHI, or apnea/hypopnea index.

In 2010, the journal Chest published “Sleep-Disordered Breathing in Obese Children: The Southern Italy Experience,” which had eight authors, all with M.D. and/or Ph.D. credentials. Before researchers can attract support for attacking a problem, they have to first prove that it exists, and ScienceDaily‘s description sounds like an example of how that works, noting while obesity was commonly associated with sleep-disordered breathing, and snoring, in adults, the new Italian study confirmed the same association in children. The study stated that, at the time,

The lack of an accepted standard for AHI (apnea/hypopnea index) to indicate the severity of SDB (sleep-disordered breathing) in children has important implications and it makes difficult the comparison of research studies using different definitions.

That situation seems to have changed. According to a WebMD article,

The AHI is the number of times you have apnea or hypopnea during one night, divided by the hours of sleep.
Normal sleep: An AHI of fewer than five events, on average, per hour
Mild sleep apnea: An AHI of five to 14 events per hour
Moderate sleep apnea: An AHI of 15 to 29 events per hour
Severe sleep apnea: An AHI of 30 or more events per hour
A child typically needs treatment if their AHI is higher than 5.

A previous study from Singapore, for instance, had indicated that “21% of 86 obese children had an AHI of more than five episodes per hour.” The Italian study looked at 809 subjects, classified as NS (non-snorers) which made up 77.5%, OS (occasional snorers) accounting for 17%, and HS (habitual snorers), represented by 5.4%. The ScienceDaily article described what was learned:

Results showed that the incidence of snoring in obese children was three times (12.5 percent) that of normal weight children (4.6 percent) and more than two times that of overweight children (5.8 percent). In addition, the presence of obstructive sleep apnea in obese children was nearly two times that of normal and overweight children.

As is traditional, the study authors informed readers of several “ifs, ands, or buts.” For instance, “scoring of SDB events in this study was performed using data from thermistors, although their use it is not recommended as the primary flow monitor in children.” The authors also explain that while adenotonsillar hyperplasia/hypertrophy had been seen as the main factor causing SDB in obese kids, this is not invariably the case, because “Upper airway narrowing may also result from fatty infiltration of upper airway structures.”

The report goes on to explain in detail several other processes and relationships in the body that influence the effect of breathing on obesity, and vice versa.

Your responses and feedback are welcome!

Source: “Snoring incidence triples in obese children, study finds,”, 05/04/10
Source: “Apnea Hypopnea Index (AHI),”, 03/03/21
Source: “Sleep-Disordered Breathing in Obese Children: The Southern Italy Experience.”, May 2010
Image by Carlton Martinez/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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