The Association Between Childhood Obesity and Severe Adolescent Obstructive Sleep Apnea - Retrospective Case Series

Introduction: To investigate the impact of childhood obesity (greater than or equal to 95th percentile BMI for ages 2-6 years old) on the severity of obstructive sleep apnea (OSA) in adolescents (14-18 years old).

Methods: Consecutive adolescents who underwent full-night polysomnography (PSG) were analyzed between January 2019 and February 2023. Patients were categorized into two independent groups based on childhood obesity and the presence of severe OSA (Apnea-Hypopnea-Index greater than 10) in adolescence. The association between BMI factors and adolescent OSA was assessed using multiple logistic regression.

Results: The study included 216 patients with a median age at PSG of 15.5 years, 62% male, 52% Hispanic, 51% with childhood obesity, and 28.7% with severe adolescent OSA. Adolescents with severe OSA had significantly higher BMI (42.76 vs 34.17, p less than 0.001), BMI percentile (154.97 vs 118.60, p less than 0.001), childhood BMI (20.84 vs 19.38, p=0.045) and prevalence of class 3 obesity (59.7% vs 29.2%, p less than 0.001). Childhood obesity resulted in a significantly higher rate of adolescent obesity (95.4% vs 60.7%, p less than 0.001) but not higher rates of severe OSA (31.2% vs 26.2%, p=0.414). Multiple logistic regression revealed that severe OSA was associated with BMI percentile (adjusted odds ratio [aOR]=1.036; 95% confidence interval [CI], 1.02-1.05; p less than 0.001) and change in BMI percentile (aOR=1.059, 95% CI=1.02–1.10, p=0.003) meaning that for every 1% increase in BMI percentile and change in BMI percentile, the odds of severe adolescent OSA increase by 3.6% and 5.9% respectively.

Conclusions: Childhood obesity significantly increases the likelihood of adolescent obesity but is not directly associated with higher rates of severe OSA. However, higher BMI percentile and changes in BMI percentile are significant predictors of severe adolescent OSA.