Prevalence and Polysomnographic Features of Obstructive Sleep Apnea in Childhood Obesity

ABSTRACT Objectives To identify the prevalence and polysomnography (PSG) features of obstructive sleep apnea (OSA) in subcategories of children with obesity. Methods Children with obstructive sleep‐disordered breathing evaluated in pediatric otolaryngology clinic and referred for PSG between January 2023 and December 2023 were included. Children with a history of tonsillectomy and/or adenoidectomy were excluded. Collected data included demographics, comorbidities, PSG parameters, and BMI categories including underweight, healthy weight, overweight, and obesity (Class I, II, and III). The prevalence of OSA and PSG parameters were compared using the χ 2 test, logistic regression, multivariate analysis of variance, and linear regression models. p < 0.05 was considered significant. Results Out of 604 children (342 male, 262 female, age range: 2–18), 488 (81%) had OSA. Most children were healthy weight (46%) or had obesity (38%). Prevalence of OSA was significantly different across BMI categories ( p < 0.001), with highest odds of OSA in children with Class III Obesity (OR = 5.01, 95% CI [1.77, 21.04], p = 0.008). Compared to patients with healthy weight and no OSA, patients with Class II (OR = 2.67, 95% CI [1.16, 6.16], p = 0.02) and Class III Obesity (OR = 8.31, 95% CI [2.40, 28.81], p < 0.001) were more likely to have severe OSA (apnea‐hypopnea index > 10). PSG parameters including obstructive apnea‐hypopnea index, minimum SpO 2 , and mean CO 2 differed among BMI categories ( p < 0.001, p < 0.001, p = 0.003, respectively). Conclusion The prevalence of OSA varies among weight groups. The severity of obesity is associated with increased odds of OSA and OSA severity. Obesity has a significant effect on minimum SpO 2 saturation and mean CO 2 levels. The utility of these findings in decision‐making for PSG referral and surgical planning merits further investigation. Level of Evidence 4.