INTRODUCTIONObesity affects about 10% to 15% of our school-going population in Singapore and is a risk factor for development of obstructive sleep apnoea hypopnoea syndrome (OSAHS). This article reviews the prevalence, aetiology, pathophysiology, diagnosis, complications and treatment of obese children with OSAHS with particular reference to children in Singapore.

METHODSReview of articles or conference papers reporting data with regards to OSAHS in Singapore children.

RESULTSPrevalence of OSAHS was high in obese children in Singapore and was more common in males with no racial predisposition. Hypersomnolence as a presenting symptom was uncommon. Cognitive function, behaviour, attention and processing speed was affected and improved after intervention. Abnormalities of glucose metabolism were also found with the respiratory disturbance index (RDI) as an independent predictor of insulin resistance. Tonsillectomy and or adenoidectomy was efficacious as treatment and risk of complications was low. No significant increase in weight occurred post intervention in those enrolled in concurrent weight management programmes.

CONCLUSIONSPrevalence of OSAHS is high in obese Singapore children and many are 'asymptomatic'. A low threshold for evaluation is necessary for early diagnosis and intervention for prevention of morbidity. Tonsillectomy and/or adenoidectomy is safe and efficacious and remains the first-line treatment in most obese patients.

Adenoidectomy ; Child ; Diabetes Mellitus ; epidemiology ; Disorders of Excessive Somnolence ; epidemiology ; Humans ; Obesity ; epidemiology ; Prevalence ; Quality of Life ; Singapore ; epidemiology ; Sleep Apnea Syndromes ; epidemiology ; Sleep Apnea, Obstructive ; epidemiology ; physiopathology ; Tonsillectomy

Studies indicate that sleep problems in children and adolescents are highly prevalent, with prevalence rates ranging from 25% to 40%. They are even more common in special populations, especially children with psychiatric issues. Furthermore, sleep issues are often persistent. Unfortunately, sleep disturbances often do not receive the attention that they deserve, especially since they are often highly amenable to intervention. Sleep problems, in general, range from those that are physiologically-based, such as obstructive sleep apnoea and restless legs syndrome, to those that are behaviorally-based. The behaviourally-based sleep disorders are reviewed, including a discussion of assessment, prevalence and treatment. Non-pharmacologic approaches are usually the preferred treatment and have received the most empirical support in paediatric populations. It is strongly recommended that all paediatric healthcare providers consider sleep issues in their comprehensive assessment of all children and adolescents, especially those with psychiatric issues, and provide preventive education as part of their usual standard of care.
Adolescent ; Arousal ; Behavior Therapy ; Child ; Comorbidity ; Humans ; Medical History Taking ; Mental Disorders ; epidemiology ; Sleep Disorders, Circadian Rhythm ; epidemiology ; Sleep Initiation and Maintenance Disorders ; epidemiology ; Sleep Wake Disorders ; diagnosis ; epidemiology ; physiopathology ; therapy

OBJECTIVES: Obesity is currently an epidemic in Korea, and sleep duration is thought to be one of the risk factors for obesity. The objective of this study was to test the hypothesis that short sleep duration is associated with obesity in Korean adults. METHODS: The data from the 2001 Korean National Health and Nutrition Survey were used, and 6,174 subjects aged 18~80 years were included in the analysis. Sleep duration was measured using information obtained from self-reported questionnaires. Obesity, the main outcome variable, was measured according to body mass index. Multiple regression modeling was used to adjust for potential confounding variables. RESULTS: The study results revealed a negative association between sleep duration and body mass index among Korean adults. These associations persisted after controlling for the potential confounding variables. CONCLUSIONS: These findings support the hypothesis that sleep duration is associated with obesity in Korean adults. In addition, these observations support earlier experimental sleep studies and provide a basis for future studies on weight control intervention by increasing the amount of sleep.
Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Obesity/*epidemiology/etiology ; Questionnaires ; Risk Factors ; Sleep Disorders/*epidemiology/physiopathology

BACKGROUND/AIMS: Obstructive sleep apnea (OSA) is associated with an increased risk of obesity and non-alcoholic fatty liver disease (NAFLD), but it remains unclear whether the risk of NAFLD is independently related to OSA regardless of visceral obesity. Thus, the aim of the present study was to examine whether OSA alone or in combination with excessive daytime sleepiness (EDS) or short sleep duration was associated with NAFLD independent of visceral fat in Korean adults. METHODS: A total of 621 participants were selected from the Korean Genome and Epidemiology Study (KoGES). The abdominal visceral fat area (VFA) and hepatic fat components of the participants were assessed using computed tomography scans and they were then categorized into four groups depending on the presence of OSA and EDS. RESULTS: The proportions of NAFLD were 21.1%, 18.5%, 32.4%, and 46.7% in participants without OSA/EDS, with only EDS, with only OSA, and with both OSA and EDS, respectively. A combination of OSA and EDS increased the odds ratio (OR) for developing NAFLD (OR, 2.75; 95% confidence interval [CI], 1.21 to 6.28) compared to those without OSA/EDS, and this association remained significant (OR, 2.38; 95% CI, 1.01 to 5.59) even after adjusting for VFA. In short sleepers (< 5 hours) with OSA, the adjusted OR for NAFLD was 2.50 (95% CI, 1.08 to 5.75) compared to those sleeping longer than 5 hours without OSA. CONCLUSIONS: In the present study, OSA was closely associated with NAFLD in Korean adults. This association was particularly strong in those with EDS or short sleep duration regardless of VFA.
*Adiposity ; Aged ; Asian Continental Ancestry Group ; Chi-Square Distribution ; Disorders of Excessive Somnolence/diagnosis/*epidemiology/physiopathology ; Female ; Humans ; Intra-Abdominal Fat/*physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Non-alcoholic Fatty Liver Disease/diagnosis/*epidemiology/physiopathology ; Obesity, Abdominal/diagnosis/*epidemiology/physiopathology ; Odds Ratio ; Republic of Korea/epidemiology ; Risk Factors ; *Sleep ; Sleep Apnea, Obstructive/diagnosis/*epidemiology/physiopathology

BACKGROUND/AIMS: The aim of this study was to compare the sleep quality between rheumatoid arthritis (RA) patients and healthy controls; and to evaluate the relationship between RA disease activity and sleep quality in Korea. METHODS: A total of 130 RA patients and 67 age- and sex-matched healthy controls were enrolled in a comparative study of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Age, gender, concomitant medication, erythrocyte sedimentation rate, serum C-reactive protein, Beck Depression Inventory second edition (BDI-II), 28 joints disease activity score (DAS28), pain visual analog scale (VAS), and PSQI were analyzed as covariates. We also analyzed the sleep quality of RA patients according to the disease activity (DAS28 < or = 3.2, 3.2 < DAS28 < 5.1, and DAS28 > or = 5.1, respectively). RESULTS: The total PSQI score and the frequency of poor sleep quality, were higher in the RA patients (5.62 +/- 4.19, 38.5%) than in the control subjects (3.57 +/- 2.17, 13.4%). The patients with poor sleep quality (PSQI > 5) were older and had a higher BDI-II and VAS score than the patients without sleep disturbance (PSQI < or = 5). The score in subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction, total PSQI, and frequency of poor sleep quality were increased when RA activity was high. CONCLUSIONS: Sleep disturbance was observed in RA patients (38.5%), and high RA disease activity was associated with poor sleep quality in Korea.
Adult ; Aged ; Aged, 80 and over ; Arthritis, Rheumatoid/diagnosis/ethnology/*physiopathology ; Asian Continental Ancestry Group ; Case-Control Studies ; Cross-Sectional Studies ; Depression/diagnosis/ethnology ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index ; *Sleep ; Sleep Wake Disorders/diagnosis/ethnology/*physiopathology ; Surveys and Questionnaires ; Young Adult