The Pediatric Pandemic

• By Elisha Bury
• May 01, 2007

Respiratory providers looking for a way to grow their business might look to the rising epidemic of obesity among children for inspiration.

Ann Tisthammer, of ResMed, says that the overweight and obesity statistics for children and adolescents have doubled and tripled in some states since early 2000.

The prevalence will obviously have an impact on the asthma market, even as researchers work to discover the link between childhood obesity and the prevalence of asthma. Already, children are five times more prone than adults to developing the condition.

But asthma isn’t the only concern. Childhood sleep apnea is a condition that’s beginning to show up on the public’s radar.

“Seventy-seven percent of the morbidly obese population — people who have body mass index (BMI) greater than typically 35-40 — have sleep apnea,” says Tisthammer. “Though there is no hard data for the prevalence of sleep apnea in morbidly obese children, data for children in general shows that about 20 percent are occasional snorers and 10 percent are habitual snorers. However, uncovering sleep apnea in children often presents a challenge.”

One connection getting more attention with children and sleep apnea is the correlation between sleep-disordered breathing and hyperactivity and cognitive deficit. Simply put, children who experience the symptoms of sleep apnea are not growing physically as they should, have mental developmental issues and are exhibiting more energy, rather than less.

“What’s interesting is if you look at adult symptoms, they’re overweight, they typically snore and they’re very sluggish. They complain of excessive daytime sleepiness, fatigue; they’re not motivated; they don’t have any energy,” says Tisthammer. “You don’t necessarily see these symptoms in children. They certainly might be overweight; they may have snoring, but a lot of them are hyperactive. They’re not sluggish and fatigued. They just go, go, go, yet they can’t pay attention.”

Gretchen Jezerc, of Respironics, says a number of children with obstructive sleep apnea are actually being misdiagnosed as being hyperactive. “It’s counterintuitive but when children are really tired they actually tend to get hyper,” she says. “So, you have kids who are put on Ritalin when what they really need is to have their OSA treated. It’s very concerning.”

In addition to ADHD medications such as Ritalin to target hyperactivity, children who exhibit sleep apnea symptoms like snoring generally undergo tonsillectomies and adenoidectomies. But if these treatments don’t improve symptoms, CPAP might be prescribed to treat sleep apnea.

Children are also experiencing many of the co-morbidities generally associated with obesity and sleep apnea that adults do.

“Unfortunately, with kids getting heavier, they’re starting to develop Type 2 diabetes and all these different types of disorders that normally are not associated with children but are more associated with adults who have obesity,” says Sharon Baer, of Respironics. “They’re now seeing that maybe these kids who are obese, even though they have a tonsillectomy and an adenoidectomy, they still have residual sleep apnea events. And as a result, they end up going onto CPAP therapy or positive airway pressure therapy to help maintain their airway.”

Currently, ResMed has the only FDA-approved system to treat pediatric sleep apnea. The VPAP III ST-A, a bi-level device, targets ages 1-3 and allows providers to customize the treatment to the individual.

Depending on the child’s weight and age, however, a CPAP device might be the best option. Most devices on the market target children who weigh 40 pounds or more, says Baer.

“You may have a 10-year-old that weighs over 200 pounds; they may need a bi-level device,” says Tisthammer. “They may have obesity hypoventilation of a more adolescent nature, where they need one pressure to keep the upper airway open but they also need a bi-level to assist their adequacy of breath.”

Then again, another child might do well on a regular CPAP and even fit nicely into a small adult mask.

As this segment of the sleep market continues to blossom, Baer expects more people to stop thinking about sleep apnea as an adult-only disease and to start looking at children as well.

When that happens, the marketing strategies of sleep manufacturers and providers will also shift. Just as current asthma devices are marketed with educational packs, coloring books and child-friendly designs, sleep devices will also have to embrace the pediatric population.

“From an educational standpoint, the user manuals are written not only for the parents but also for the child,” says Baer. “So there is going to be additional support for children so that they understand why it’s important to use their interface or why it’s important to use their CPAP device (and) how to identify if the device is not working for them.”

The trend has already caught on with some sleep labs that recognize the need to ease a child into a CPAP mask.

“I know a lot of the great sleep labs would let the child take the mask and make it something that’s their own, so they become a pirate or they become a clown,” says Baer. “And they allow the child to draw on the mask to engage them, so they’re not afraid of it.”

This article originally appeared in the Respiratory Management May/June 2007 issue of HME Business.