Association Between Childhood Obesity and Obstructive Sleep Apnea Severity

Abstract

Background: Childhood obesity is an increasingly important risk factor for obstructive sleep apnea (OSA). Although adenotonsillar hypertrophy remains a common cause of pediatric OSA, excess adiposity may worsen upper airway collapsibility and increase disease severity.

Objective: To determine the association between childhood obesity and the severity of obstructive sleep apnea among children undergoing polysomnographic evaluation.

Material and Methods: This cross-sectional analytical study was conducted at a Tertiary Care Hospital in Pakistan from April 2023 to September 2023 and included 135 children aged 5–17 years who presented with symptoms suggestive of sleep-disordered breathing. Anthropometric measurements were recorded, and obesity was defined as body mass index-for-age at or above the 95th percentile. All participants underwent overnight polysomnography. OSA severity was classified using obstructive apnea-hypopnea index (OAHI): no OSA/minimal disease <1 event/hour, mild OSA 1–4.9 events/hour, moderate OSA 5–9.9 events/hour, and severe OSA ≥10 events/hour. The association between obesity and moderate-to-severe OSA was analyzed using chi-square testing and multivariable logistic regression.

Results: Of 135 children, 57 (42.2%) were obese and 78 (57.8%) were non-obese. The mean age was 11.1 +/- 3.3 years, and 78 (57.8%) were male. Moderate-to-severe OSA was observed in 37 obese children (64.9%) compared with 26 non-obese children (33.3%). Severe OSA was more frequent among obese children than non-obese children, 35.1% versus 12.8%, respectively. Median OAHI was significantly higher in obese children than non-obese children, 9.6 events/hour versus 3.8 events/hour. Obesity was significantly associated with moderate-to-severe OSA on unadjusted analysis (odds ratio 3.70; 95% CI 1.80-7.60; p<0.001). After adjustment for age, sex, and tonsillar hypertrophy, obesity remained an independent predictor of moderate-to-severe OSA (adjusted odds ratio 3.12; 95% CI 1.48-6.59; p=0.003).

Conclusion: Childhood obesity was significantly associated with greater OSA severity. Obese children had higher OAHI values, lower oxygen saturation nadirs, and greater odds of moderate-to-severe OSA. Routine assessment of obesity status should be incorporated into the evaluation and risk stratification of children with suspected OSA.

Keywords: Childhood obesity; obstructive sleep apnea; pediatric sleep-disordered breathing; apnea-hypopnea index; polysomnography; BMI percentile.