Obstructive Sleep Apnea in Underweight Children

Otolaryngol Head Neck Surg. 2022 Sep;167(3):566-572. doi: 10.1177/01945998211058722. Epub 2021 Nov 16.


Objectives: To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA.

Study design: Case-control study.

Setting: University of Texas Southwestern Medical Center and Children's Medical Center of Dallas.

Methods: Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P < .05.

Results: An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA.

Conclusion: Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.

Keywords: allergic rhinitis; obstructive sleep apnea; polysomnogram; tonsillar hypertrophy; underweight children.

MeSH terms

  • Case-Control Studies
  • Child
  • Female
  • Humans
  • Hypertrophy
  • Male
  • Retrospective Studies
  • Rhinitis, Allergic*
  • Sleep Apnea, Obstructive* / complications
  • Sleep Apnea, Obstructive* / diagnosis
  • Sleep Apnea, Obstructive* / epidemiology
  • Thinness / complications
  • Thinness / epidemiology