Obstructive Sleep Apnea: Differences between Normal-Weight, Overweight, Obese, and Morbidly Obese Children

Area of Science:

• Pediatric Sleep Medicine
• Obesity and Health
• Respiratory Disorders

Background:

• Obstructive sleep apnea (OSA) severity in children dictates perioperative management and the need for postoperative polysomnography.
• The correlation between increasing weight and OSA severity in pediatric populations is not well-defined.

Purpose of the Study:

• To compare demographic, clinical, and polysomnography parameters across weight categories (normal, overweight, obese, morbidly obese) in children.
• To identify demographic factors that predict OSA severity in children.

Main Methods:

• Retrospective chart review of 290 children (aged 2-18 years) who underwent polysomnography.
• Children were classified into normal weight, overweight, obese, and morbidly obese groups.
• Statistical analysis included linear and logistical regression models, with significance set at P < .05.

Main Results:

• Morbidly obese children were older (mean 8.0 years) than normal-weight children (mean 5.8 years) and less likely to have normal polysomnograms (16% vs. 48%).
• Sleep efficiency and REM sleep percentage were reduced in morbidly obese children.
• The apnea-hypopnea index showed a positive correlation with increasing BMI z-score, but only in conjunction with increasing age (P < .001).

Conclusions:

• Pediatric OSA severity is associated with the combined effect of increasing age and weight, not either factor alone.
• Obese and morbidly obese children, particularly older ones, are at the greatest risk for severe obstructive sleep apnea.