The influence of obesity on the risk and severity of obstructive sleep apnea in referred prepubescent children

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Objectives: To evaluate the influence of obesity on the presence and severity of obstructive sleep apnea (OSA) in prepubertal children (boys < 9, girls < 8 years old). Methods: Retrospective study of children referred for suspected OSA. Children with craniofacial malformations, neuromuscular diseases, or conditions that could independently affect weight or growth were excluded. Data on BMI z-score (obese > 2 sd), tonsil hypertrophy, asthma, and rhinitis were recorded. Respiratory polygraphy in the sleep unit was performed. Non-parametric statistical analyses, odds ratio (OR), and logistic regression were applied by age groups (1-2, 3-5, > 6 years). Results: 642 children (median age 4 years) were included, with 17% obese, 13.2% overweight, and 70.9% with OSA. A positive correlation was observed between the apnea-hypopnea index (AHI) and BMI z-score in the 1-2-year-old group (r=0.265, p=0.016). Logistic regression showed obesity (OR 6.90; CI 3.70-12.85; p<0.001) and overweight (OR 4.81; CI 2.39-9.73; p < 0.001) as risk factors for severe OSA (AHI>10) with ROC of 0.75 (CI 0.69-0.1, p<0.01). Obesity was a risk factor for severe OSA in the 1-2-year-old group (OR 5.55, CI 1.61-19.12; p= 0.007, ROC 0.73, CI 0.58-0.88; p=0.002) and in the > 6-year-old group (OR 6.11; CI 1.94-19.28, p=0.002, ROC 0.72, CI 0.57-0.88, p=0.004). In the 3-5-year-old group, obesity (OR 6.58, CI 2.69-16.11, p< 0.001) and overweight (OR 6.56, CI 2.62-16.41, p<0.001) were risk factors for severe OSA with ROC of 0.77 (CI 0.70-0.85, p<0.001). Conclusions: In prepubertal children with suspected OSA, obesity is a risk factor for severe OSA. Sleep studies should be prioritized in these children.

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