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Pathological Endotypic Traits of Paediatric Obstructive Sleep Apnea: Age and Sex Differences

Chien-Heng Lin1,2, Liang-Wen Hang3,4, Eysteinn Finnsson5

  • 1Department of Pediatric Pulmonology and Critical Care Medicine, China Medical University Children's Hospital, Taichung, Taiwan.

Respirology (Carlton, Vic.)
|September 12, 2025
PubMed

Insights

In children with obstructive sleep apnea (OSA), poor airway compensation and collapsibility contribute to higher apnea-hypopnea index (AHI). Older children show reduced upper airway function, independent of AHI severity.

Area of Science:

  • Pediatric Sleep Medicine
  • Respiratory Physiology
  • Otolaryngology

Background:

  • Pediatric obstructive sleep apnea (OSA) has unique characteristics compared to adult OSA.
  • Endotypic traits in children with OSA are not well-documented.
  • Understanding age and sex variations in OSA endotypes can inform respiratory development insights.

Purpose of the Study:

  • To investigate the association between age and sex with endotypic traits in pediatric OSA.
  • To identify key endotypic drivers of OSA severity in children.

Main Methods:

  • Prospective enrollment of 88 pediatric patients (≤18 years) with OSA (AHI ≥ 1/h).
  • In-laboratory polysomnography to assess endotypic traits.
  • Linear regression analysis to correlate endotypes with AHI, age, and sex.

Main Results:

  • Poor compensation and worse upper airway collapsibility were linked to higher AHI.
  • Compensation explained the largest variance (12.85%) in AHI.
  • Older children (>12 years) had compromised upper airway function and higher loop gain, irrespective of AHI.
  • No significant sex-based differences in endotypic traits were found.

Conclusions:

  • Inadequate dilator muscle compensatory activity and upper airway collapsibility are significant contributors to pediatric OSA severity.
  • Age-related decline in upper airway patency may involve craniofacial and airway development interactions.
Abstract

Keywords:
arousal thresholdchemoreflexchildrencompensationloop gainupper airway

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