The influence of obesity on the risk and severity of obstructive sleep apnea in referred prepubescent children

Abstract

Childhood obesity is a growing global concern linked to obstructive sleep apnea (OSA). Though adenotonsillar hypertrophy is a risk factor, obesity's independent role in prepubertal OSA severity is understudied. The aim of this study was to evaluate the association between obesity and the presence and severity of OSA in a cohort of prepubescent children referred for sleep-disordered breathing symptoms. We conducted a retrospective observational study of children referred to a pediatric sleep clinic. OSA was diagnosed using supervised nocturnal respiratory polygraphy and OSA severity was classified according to apnea-hypopnea index (AHI). BMI-z was calculated and categorized. A total of 645 children (17% obese, 13.2% overweight) were included with 70.9% having OSA. Obesity was significantly associated with severe OSA (OR = 6.90; 95% CI 3.70-12.85; p < 0.001), independent of tonsillar hypertrophy. A significant, dose-dependent correlation between BMI-z and AHI was observed across all age groups. In multivariate analysis, obesity was a significant predictor of severe OSA across all age strata: 1-2 years (OR 5.55), 3-5 years (OR 6.58), and ≥ 6 years (OR 6.11). Overweight status also conferred a significant risk (OR = 4.82; 95% CI 2.39-9.73; p < 0.001), particularly in the 3-5-year age group (OR 6.60) and in children with concurrent tonsillar hypertrophy. The predictive model for severe OSA achieved an AUC of 0.75.

Conclusion: Obesity and overweight are associated with severe OSA in prepubertal children referred for sleep-disordered breathing symptoms.

What is known: • Obesity is a recognized risk factor for pediatric obstructive sleep apnea, but its specific influence on disease severity in prepubertal children remains incompletely defined.

What is new: • In a large cohort of prepubertal children referred for sleep-disordered breathing symptoms, obesity and overweightwere associated with severe OSA.

Keywords: Apnea–hypopnea index; BMI-z score; Childhood obesity; OSA severity; Pediatric sleep apnea; Prepubertal children; Respiratory polygraphy; Tonsillar hypertrophy.