TO THE EDITOR: I would like to mak...

TO THE EDITOR: I would like to make notes on a few points raised by the agency of the authors of "Obstructive nap Apnea in Children," (1) in American Family Physician. First, they state that "in children, an apnea-hypopnea index greater than 1 is considered abnormal." (1) This is incorrect: the studious mood (2) the authors cited clearly states that the commended normal value of apnea index (not apnea-hypopnea index) is les than or equal to 1 The normal value of apnea-hypopnea index has not been established for children flat though hypopnea is as important as apnea. Apnea-hypopnea index values of 5 10 15 20 and 30 were used as definitions of obstructive repose apnea in children. (3) Using an apnea-hypopnea index greater than 1 as the definition of obstructive rest apnea is not supported by way of the current evidence. The authors (1) remarked that adenotonsillectomy has been shown to improve weight enigmas This is certainly true for failure to thrive, further not for obesity. It has been well documented that obesity frequently worsens after adenotonsillectomy. (4,5) Hence, dietary and exercise advice is an essential composing in managing children who are obese and have obstructive rest apnea. One study6 reported resolution of nap apnea after weight loss in five children who were morbidly obese.

DANIEL K NG FHKAM(PAED)

Kwong Wah Hospital Department of Paediatrics 25 Waterloo Rd Kowloon

HONG KONG

REFERENCES

(1) Chan J Edman JC Koltai PJ Obstructive be dead apnea in children. Am Fam Physician 2004;69:1147-54

(2) Marcus CL Omlin KJ Basinki DJ Bailey SL Rachal AB, Von Pechmann W et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992;146(5 pt 1):1235-9

(3) Redline s Sanders M. Hypopnea, a floating metric: implications for prevalence, morbidity estimates, and case findings. rest 1997;20:1209-17.

(4.) Marcus CL Carroll JL Koerner CB Hamer A, Lutz J Loughlin GM Determinants of produce in children with the obstructive rest apnea syndrome. J Pediatr 1994;125:556-62

(5) Soultan Z Wadowski s Rao M, Kravath RE. drift of treating obstructive sleep apnea by the agency of tonsillectomy and/or adenoidectomy on obesity in children. Arch Pediatr Adolesc M 1999;153:33-7

(6) Willi SM Oexmann MJ Wright NM slice NA, Key LL Jr. The consequences of a high-protein, low-fat, ketogenic diet forward adolescents with morbid obesity: corpse composition, blood chemistries, and slumber abnormalities. Pediatrics 1998;101(1 pt 1):61-7

IN REPLY: As seen in previous studies, (12) episodes of perfect airway obstruction in children are relatively out of the way Obstructive sleep apnea may manifest mainly as hypopneas and continuous hypoventilation with partial cessation of airflow. Therefore, incorporating information about hypopneas may be as important as data upon apneas. Hopefully, further research in this area will lead to clearer guidelines regarding hypopneas and apneas.

We agree that adenotonsillectomy has been shown to be effective in improving weight in children with failure to thrive and not in children with obesity. (34) It is stated in several places in our article5 that medical management of obesity may benefit the overweight child and potentially disentangle their obstructive sleep apnea. (56)

JAMES CHAN, MD

JENNIFER EDMAN, MD

PETER KOLTAI, MD

Cleveland Clinic Foundation A71 9500 Euclid Ave. Cleveland, OH 44195

REFERENCES

(1) Marcus CL Omlin KJ Basinki DJ Bailey SL Rachal AB, Von Pechmann W et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992;146(5 pt 1):1235-9

(2) Uliel s Tauman R, Greenfeld M, Sivan Y Normal polysomnographic respiratory values in children and adolescents. Chest 2004;125:872-8

(3) Mitchell RB and Kelly J Adenotonsillectomy for obstructive be dead apnea in obese children. Otolaryngol Head Neck Surg 2004;131:104-8

(4) Soultan Z Wadowski s Rao M, Kravath RE. drift of treating obstructive sleep apnea by the agency of tonsillectomy and/or adenoidectomy on obesity in children. Arch Pediatr Adolesc M 1999;153:33-7

(5) Chan J Edman JC Koltai PJ Obstructive be motionless apnea in children. Am Fam Physician 2004;69:1147-54

(6) Willi SM Oexmann MJ Wright NM slice NA, Key LL Jr. The consequences of a high-protein, low-fat, ketogenic diet in succession adolescents with morbid obesity: material substance composition, blood chemistries, and be dead abnormalities. Pediatrics 1998;101(1 pt 1):61-7

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