Obstructive sleep apnea in children and adolescents with and without obesity
To investigate the prevalence of obstructive sleep apnea (OSA) in children referred for obesity treatment, and to compare the prevalence with that of a normal-weight group. Moreover, we examined the association between Body Mass Index Standard Deviation Score (BMI SDS) and the Apnea–Hypopnea Index (AHI).
This cross-sectional study included 139 children aged 7–18 years with overweight/obesity (BMI SDS >1.28) recruited from an obesity treatment clinic. The normal-weight group consisted of 33 children (BMI SDS ≤ 1.28) aged 7–18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor (Nox T3). OSA was defined as AHI ≥ 2. Height and weight were measured and the tonsillar size was clinically estimated using the Brodsky scale.
The OSA prevalence was 44.6% in children with overweight/obesity compared with 9.1% in the normal-weight group (p = 0.0002), and the relative risk of OSA was 4.9 (95% CI 1.6–14.7). In a logistic regression, a one-unit increase in the BMI SDS increased the odds of having OSA by a factor of 1.92 independent of age, sex, tonsillar hypertrophy, and asthma (95% CI 1.33–2.76, p = 0.0005). A generalized linear regression adjusted for the same variables revealed an association between BMI SDS and AHI (a one-unit increase in the BMI SDS equaled an average increase in the AHI of 35% (95% CI 19–53%, p < 0.0001)).
In this study, children with overweight/obesity had a significantly higher prevalence of OSA compared with a normal-weight group. Increased BMI SDS was associated with increased AHI.
KeywordsAdolescent Child Normal weight Obesity Obstructive sleep apnea
Thank you to the staff in the Children’s Obesity Clinic, Holbæk University Hospital, and to the staff in the Sleep Clinic, Zealand University Hospital, for the support.
IGA, PH, and JCH designed the study. IGA collected and analyzed the data and drafted the manuscript. PH and JCH critically revised and approved the manuscript.
This study was funded by Region Zealand and Region Zealand Health Scientific Research Foundation (Grant nos. 15–000342, 180886). It was supported by a grant from Toyota-Fonden, Denmark (grant no. KJ/BG8866) and from ResMed Maribo, Denmark, (2700€ study-related funding). The funding sources had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit the article for publication.
Compliance with ethical standards
Conflict of interest
Author IGA received a study-related grant from ResMed Maribo, Denmark. Author JCH declares he has no conflict of interest. Author PH declares he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Approvals were obtained from the Regional Danish Ethics Committee (Protocol ID SJ-404) and the Danish Data Protection Agency (ID no. REG-111-2014). The study was registered in Clinicaltrials.gov (ID no.: NCT02463201).
Informed consent was obtained from all individual participants included in the study.
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