Association Between Severe Obesity and Pediatric Obstructive Apnea—A Retrospective Case Series

• DOI: 10.1002/ohn.1295
• Publication Date: 2025-05-14T11:35:11Z
• Authors: Tyler A. Durham; Basir S. Mansoor; Stephen R. Chorney; Ron B. Mitchell; Alex Najjar; Romaine F. Johnson

AbstractObjectiveTo investigate the impact of severe obesity on the severity of pediatric obstructive sleep apnea (OSA).Study DesignRetrospective case series.SettingTertiary stand‐alone pediatric hospital.MethodsConsecutive children with obesity (≥95th percentile body mass index [BMI]) who underwent full‐night polysomnography between January 2021 and December 2021 were analyzed. Patients were categorized into obesity (≥95th percentile BMI and <120% of the 95th percentile) and severe obesity (≥120% of the 95th percentile BMI). The association between severe obesity and severe OSA was assessed using multiple logistic regression.ResultsThe study included 282 patients with a median age of 9.2 years (interquartile range 5.9‐12.3), 63% male, and 65% Hispanic. In total, 53% were severely obese. Severely obese children had a higher prevalence of severe OSA (53% vs 33%, P < .001) and very severe OSA (apnea‐hypopnea index ≥ 24; 24% vs 11%, P = .006). Multiple logistic regression revealed that severe obesity was associated with severe OSA (adjusted odds ratio [aOR] = 3.44; 95% confidence interval [CI], 1.82‐6.53; P < .001) after adjusting for age, sex, and tonsillar hypertrophy. Among 170 patients who underwent posttonsillectomy polysomnography, 29% exhibited residual OSA, with 19% having residual severe OSA. Class 3 severe obesity was associated with residual OSA (aOR = 4.05, 95% CI = 1.09‐15.00).ConclusionChildren with severe obesity face substantial sleep disturbances and a heightened risk of residual OSA following adenotonsillectomy.