FAILURE TO THRIVE
One of the better known consequences of obstructive sleep apnea in kids is the high risk of failure to thrive. Failure to thrive can exaggerate the other known morbidities of obstructive sleep apnea.
· One possible mechanism for failure to thrive as a result of obstructive sleep apnea is that dysphagia due to hypertrophic tonsils and adenoids may cause olfactory changes that contribute to decreased appetite, resulting in retardation of weight gain.
· Another hypothesis is that increased respiratory effort leads to increased metabolic expenditure.
· Or, that hormonal factors such as insulin growth factor-1 (IGF-1), binding factors for IGF-1 decrease appetite.
Indisputable is that early diagnosis and treatment of the kids’ apnea is mandated to avert serious morbid and irreversible consequences.
Failure to thrive as a symptom of obstructive sleep apnea is in direct contrast to another more prevalent form of kid’s apnea that is primarily associated with OBESITY.
In obese children the symptoms of apnea more closely resemble those of adults than those of kids’ apnea. Kids with failure to thrive usually have large tonsils and adenoids and surgical removal affects a major reduction in apneic events. Obese children usually do not display marked adenotonsillar hypertrophy and adenotonsillectomy does not usually achieve a desirable result. A greater rate of excessive daytime sleepiness, systemic hypertension and insulin resistance is found in the obese kids with apnea.