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Positional obstructive sleep apnea in an obese pediatric population
Sarah Selvadurai1, Giorge Voutsas1,2, Colin Massicotte3
1Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada.
Insights
Positional obstructive sleep apnea (POSA) is common in children with obesity. Identifying POSA can help tailor positional therapies for better treatment outcomes in pediatric patients.
Area of Science:
- Pediatric Sleep Medicine
- Obesity and Sleep Disorders
- Respiratory Physiology
Background:
- Obstructive sleep apnea (OSA) is prevalent in children with obesity.
- Positional obstructive sleep apnea (POSA), where events occur mainly when supine, is a recognized phenotype.
- Limited data exists on POSA prevalence and associated factors in pediatric obesity.
Purpose of the Study:
- To determine the prevalence of POSA in children with obesity.
- To identify factors associated with POSA in this population.
Main Methods:
- Cross-sectional study of 112 children (aged 8-18) with obesity undergoing polysomnography (PSG).
- POSA defined by an overall apnea-hypopnea index (OAHI) ≥5 and a supine to nonsupine OAHI ratio ≥2.
- Demographic, anthropometric, and PSG data were collected and analyzed.
Main Results:
- 38% of children with obesity had OSA (43/112).
- Of those with OSA, 58% (25/43) had POSA.
- No significant differences in age, sex, or anthropometrics were found between POSA and non-POSA groups.
Conclusions:
- POSA is a frequent phenotype in children with obesity and OSA.
- Identifying POSA is crucial for developing targeted positional therapies.
- This finding supports individualized treatment strategies for pediatric sleep apnea.
Study Objectives:
Positional obstructive sleep apnea (POSA) is a phenotype of obstructive sleep apnea (OSA) where sleep-related obstructive events occur predominantly in the supine position. Limited knowledge exists regarding the presence of POSA in children with obesity. The study objective was to determine the prevalence of POSA while identifying factors associated with POSA in children with obesity.
Methods:
This was a cross-sectional study of children with obesity, aged 8 to 18 years, with a diagnostic polysomnogram (PSG) between 2012 to 2019, who were referred for the evaluation of sleep-related breathing. POSA was defined as an overall obstructive apnea-hypopnea index (OAHI) ≥5 events/h and a supine OAHI to nonsupine OAHI ratio of ≥2. Patient demographics, anthropometrics, and PSG data were recorded.
Results:
Of the 112 children with obesity with a diagnostic PSG, 43 (38%) had OSA. Among those with OSA, 25 of 43 (58%) had POSA (mean age: 14.6 ± 2.3 years; mean body mass index: 37.7 ± 7.6 kg/m²; 68% male) and 18 of 43 (42%) had non-POSA (mean age: 13.9 ± 2.8 years; mean body mass index: 37.9 ± 7.2 kg/m²; 78% male). Among those with POSA, 13 of 25 (52%) had mild OSA, 7 of 25 (28%) had moderate OSA, and 5 of 25 (20%) had severe OSA. No significant differences were found in age, sex, and anthropometric measures between POSA and non-POSA groups. Time spent in supine and nonsupine sleep did not differ significantly between groups.
Conclusions:
In children with obesity and OSA, POSA occurs frequently. Identifying POSA allows for potential targeted positional therapy for children with obesity.
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