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Weight status, heart rate variability and quality-of-life in children with obstructive sleep apnea

Li-Ang Lee1,2,3, Wan-Ni Lin1,2, Li-Jen Hsin1,2

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.

Pediatric Research
|June 10, 2026
PubMed

Insights

Overweight and obese children with obstructive sleep apnea (OSA) show worse autonomic dysfunction. Weight status worsens the impact of OSA severity on heart rate variability (HRV), highlighting the need for weight management.

Area of Science:

  • Cardiology
  • Pediatrics
  • Sleep Medicine

Background:

  • Pediatric obstructive sleep apnea (OSA) is linked to autonomic dysfunction and reduced quality of life (QoL).
  • The influence of weight status on OSA's impact on autonomic function and QoL in children is not fully understood.

Purpose of the Study:

  • To investigate if weight status modifies the association between OSA severity and heart rate variability (HRV).
  • To determine if weight status alters the relationship between OSA severity and disease-specific QoL in children.

Main Methods:

  • Retrospective cohort study of 115 children with OSA.
  • Assessment of apnea-hypopnea index (AHI), HRV (LF/HF ratio), and OSA-18 QoL scores.
  • Categorization of participants into normal-weight, overweight, and obesity groups based on BMI z-score.
  • Hierarchical multiple regression to test for moderation by weight status.

Main Results:

  • Overweight and obese children had significantly higher AHI and elevated LF/HF ratios, indicating impaired autonomic regulation.
  • Weight status (overweight/obesity) significantly moderated the relationship between AHI and LF/HF ratio, showing increased sympathetic dominance.
  • No significant interaction was found between AHI and weight status concerning QoL scores.

Conclusions:

  • Weight status significantly exacerbates autonomic dysfunction in pediatric OSA, independent of QoL impact.
  • Heavier children exhibit greater cardiovascular vulnerability to sleep-disordered breathing.
  • Targeted weight management is crucial for mitigating cardiometabolic risk in pediatric OSA.
Abstract

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