Obstructive Sleep Apnea: Differences between Normal-Weight, Overweight, Obese, and Morbidly Obese Children

Introduction The severity of obstructive sleep apnea in children determines perioperative management and is an indication for postoperative polysomnography. The relationship between increasing weight and sleep apnea severity in children remains unclear. Objectives To compare demographic, clinical, and polysomnography parameters in normal-weight, overweight, obese, and morbidly obese children, as well as identify demographic factors that predict sleep apnea severity. Study Design Case series with chart review. Setting Academic children's hospital. Methods A retrospective chart review of 290 children aged 2 to 18 years who underwent polysomnography at an academic children's hospital was performed. Demographics, clinical findings, and polysomnographic parameters were recorded. Children were categorized as normal weight, overweight, obese, or morbidly obese. Differences were assessed using linear and logistical regression models. Significance was set at P <.05. Results Morbidly obese were older than normal-weight children (mean, 8.0 ± 0.5 years vs 5.8 ± 0.3 years; P <.001) and less likely to have a normal polysomnogram (16% vs 48%; P =.02). There were no differences in sex, ethnicity, birth status (term or preterm), or tonsil size between normal-weight, overweight, obese, and morbidly obese children. Sleep efficiency and percentage of time in rapid eye movement were decreased in morbidly obese compared with other children (P <.05). The apnea-hypopnea index was positively correlated with increasing body mass index z score only as a function of increasing age (P <.001). Conclusion Obstructive sleep apnea severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe obstructive sleep apnea.