Sleep-Disordered Breathing Symptoms and Central Adiposity in Children with Adenotonsillar Hypertrophy

Background/Objectives: Children with adenotonsillar hypertrophy (ATH) and sleep-disordered breathing (SDB) may have altered body composition. The roles of anatomical upper airway obstruction and functional respiratory impairment in the risk of body composition remain poorly understood. This study assessed nutritional status in children. It also examined how nasopharyngeal obstruction (NP) due to ATH and SDB symptoms affects adiposity and fat distribution. Methods: This cross-sectional study included 106 children (57 boys, 49 girls; mean age 6.1 ± 2.0 years) who were scheduled for surgical treatment. Flexible nasopharyngolaryngoscopy was used to measure the size of the adenoid and palatine tonsils and combined grades of adenoid and tonsillar hypertrophy were used to determine NP obstruction. Parents filled out a questionnaire to assess SDB symptoms. Anthropometric measures (height, weight, BMI, skinfold thicknesses, body circumferences) were expressed as age- and sex-standardised scores. General linear models (GLMs) were used to examine associations between disease factors and body composition. Results: About 21% of participants were classified as overweight or obese. In contrast, 10% were undernourished. Severe NP obstruction was present in 57% of children. SDB symptoms appeared in 28% of children. Despite normal linear growth, children with ATH showed greater adiposity than reference values. In univariate analyses, severe NP obstruction was associated with higher body weight, BMI, triceps and subscapular skinfold thicknesses, waist circumference, and waist-to-height ratio (WHtR). However, after adjustment for BMI, these associations were no longer significant. In contrast, SDB symptoms were independently associated with increased subcutaneous adiposity, as indicated by greater subscapular and abdominal skinfold thicknesses, greater mid-upper arm fat area, and higher WHtR. The pattern showed a more central distribution of fat. Conclusion: Children with ATH and SDB symptoms reported by a parent had increased subcutaneous and central adiposity, independent of BMI or the anatomical severity of nasopharyngeal obstruction. Longitudinal studies incorporating objective assessment of SDB are warranted to further clarify the mechanisms underlying these associations.