Identifying Obstructive Sleep Apnea in At-Risk Youth: An Exploratory Cross-Sectional Study in Adolescents Living With Obesity

Obstructive sleep apnea (OSA) is one of the most common sleep disorders, affecting 1-10 % of children. A key risk factor is elevated body mass index (BMI). This exploratory study aimed to assess OSA prevalence and severity in adolescents living with obesity and explore associations with clinical and metabolic parameters. Adolescents with obesity aged 10-15 years hospitalized for weight management were enrolled. Participants underwent examination including anthropometry, blood pressure, and lipid profile. BMI was evaluated using WHO BMI-for-age z-scores and an internal standard deviation score (SDS). Sleep-disordered breathing was assessed using cardiorespiratory polygraphy. OSA severity was classified by pediatric AASM criteria using the apnea-hypopnea index (AHI). Among 26 adolescents, OSA occurred in 25 (96.2 %). Median AHI was 9.6 (IQR 5.3-19.1); 44 % had severe, 40 % moderate, and 16 % mild OSA. Severe OSA was more frequently observed in boys (p=0.045), who also showed significantly higher BMI z-score, ODI3 and T90 values; (p<0.05). Adolescents with severe OSA had higher body weight and BMI z-scores; (p<0.05). In regression models using BMI SDS, male sex emerged as a borderline predictor of higher AHI (β=9.07; p=0.051), while age and BMI metrics were not significant. Spearman analysis further revealed a moderate positive correlation between BMI z-score and T90 (ρ=0.51, p=0.02). In this exploratory study, OSA was detected in the majority of adolescents living with obesity, though results should be interpreted with caution. Early recognition may support interventions to limit adverse outcomes. Larger polysomnographic studies with control groups are required to confirm prevalence and clarify risk factors.