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The High Prevalence of Continuous Paradoxical Breathing During Sleep in Children With Obesity and Its Relationship

Amal R Al-Naimi1, Nadine Asir1, Antonisamy Belavendra2

  • 1Pediatric Pulmonology, Sidra Medicine, Doha, QAT.

Cureus
|February 17, 2025
PubMed

Insights

Continuous paradoxical breathing (CPB) is common in symptomatic obese children, affecting over 67% of those studied. This breathing pattern appears linked to chest wall mechanics, not obstructive sleep apnea (OSA).

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Obesity Research

Background:

  • Continuous paradoxical breathing (CPB) during sleep is not well-understood in obese children.
  • Its relationship to upper airway obstruction (like obstructive sleep apnea - OSA) versus chest wall mechanics requires further investigation.
  • Obesity significantly impacts respiratory function during sleep.

Purpose of the Study:

  • To evaluate the prevalence of CPB in children with obesity.
  • To determine the relationship between CPB and obstructive sleep apnea (OSA), BMI, sleep position, sleep stage, oxygen saturation, and sleep-related symptoms.
  • To investigate the underlying causes of CPB in this population.

Main Methods:

  • Retrospective analysis of polysomnography (PSG) studies in obese children (BMI > 95th percentile) from 2016-2022.
  • CPB defined as opposing chest and abdominal wall signals for ≥50% of REM and/or NREM sleep.
  • OSA defined as apnea-hypopnea index (AHI) > 1.5 events/hour; multivariate regression used to identify CPB determinants.

Main Results:

  • 196 obese children (mean age 12.8 years, median BMI 39 kg/m²) were analyzed.
  • CPB prevalence was high (67.9%), identified in 133 children.
  • No significant correlation found between CPB and OSA (AHI) or BMI, but supine-only CPB correlated with clinical symptoms (p=0.05).

Conclusions:

  • Continuous paradoxical breathing (CPB) is highly prevalent in symptomatic obese children.
  • CPB in this population is likely associated with chest wall mechanics rather than obstructive sleep apnea (OSA).
  • Further research into chest wall mechanics is warranted to understand CPB in obese children.
Abstract

Keywords:
asynchronous breathingobesityobstructive sleep apneaparadoxical breathingpolysomnographysleep disorder breathing

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