celiac disease

Researchers investigated whether sleep quality in children with sleep apnea and celiac disease benefitted from a gluten-free diet.

Gluten is a common protein found in grains such as wheat. Celiac disease is a condition in which an individual’s sensitivity to gluten triggers a systemic immune response. Celiac disease is prevalent in approximately 1% of the population. The consumption of gluten in these individuals can cause symptoms such as damage to the small intestines and swelling of lymph nodes.  The most common treatment for celiac disease is the complete elimination of gluten from the diet.

Obstructive sleep apnea is characterized by an obstruction in the airflow within the upper airway during sleep. The incident of OSA in children is 3%, peaking in children from ages 2-8 years old. Symptoms include difficulty breathing, and sleeping. A reason for this can be attributed to swelling of lymph nodes.

How are Sleep Apnea and Celiac Disease Related?

Both celiac disease and obstructive sleep apnea share a common feature of inflammation and enlargement of the lymph nodes. A previous study showed that obstructive sleep apnea was more prevalent in patients with celiac disease, whose symptoms decreased once they began to consume a gluten-free diet. A recent study further investigating this relationship was conducted by researchers in Israel and was published in the journal BMC Pediatrics. They aimed to find out whether children with celiac disease were more likely to have OSA, and if a gluten-free diet would reduce the symptoms of OSA in these children.

The researchers recruited 34 children with celiac disease between the ages of 2-18 years old before being treated with a gluten-free diet. An additional 24 children were recruited as controls. The parents filled out questionnaires about the sleeping behaviours of their children at the start and end of the study. The questionnaires were used to determine whether the child had obstructive sleep apnea or not. The duration of the study was six months, during which the children ate gluten-free diets.

Sleep Apnea Improved Most in Children with Celiac Disease

The researchers found that symptoms of obstructive sleep apnea were less prevalent in children with celiac disease than controls, which contradicted the previous research. At the end of the study, both the control and celiac disease group showed improvements in obstructive sleep apnea symptoms. However, children with celiac disease showed a significantly higher improvement of obstructive-sleep-apnea-related symptoms compared to controls. The researchers could not pinpoint the exact reason for the improvement, as they did not directly measure the size of lymph nodes in the children.

These findings can influence the treatment options for children with celiac disease suffering from obstructive sleep apnea. Instead of surgery as the first line of treatment, a much less invasive gluten-free diet can be implemented. This can also create more conscious eating habits for the children with celiac disease. To further broaden the application of the study, the researchers suggest conducting a similar study with children suffering from obstructive sleep apnea only.

Written by Alena Kim, BSc

Reference: Yerushalmy-feler, A., Tauman, R., Derowe, A., Averbuch, E., Ben-tov, A., & Weintraub, Y. (2018). Gluten-free diet may improve obstructive sleep apnea-related symptoms in children with celiac disease. BMC Pediatrics, 18:35(2018), 1–55. https://doi.org/10.1186/s12887-018-1039-5

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