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Introduction and objectivesChildhood obesity is an increasing problem leading to significant health concerns. Children are referred to our Tier 3 obesity service if they have BMI ≥3.5 standard deviations (SD) or BMI ≥3 SD with comorbidities. There are currently 120 children under the care of the service; 22 have severe sleep disordered breathing (SDB) requiring non-invasive ventilation (NIV) overnight. We sought to characterise the demographics of those with sleep disordered breathing, the extent of associated comorbidities and to assess adherence to NIV.MethodsA retrospective review of all data from patients under the care of the obesity service with SDB requiring NIV was undertaken. Adherence to NIV was assessed by patient and parent/guardian verbal report.ResultsThe median onset of obesity was <5 years of age. 45% of patients reported poor adherence to NIV. The majority of children had obstructive sleep apnoea (OSA) requiring CPAP. 45% of patients had also undergone adenotonsillectomy. Those requiring BiPAP support had evidence of hypoventilation. Further patient demographics and comorbidities are presented in Table 1. There were no patients with pulmonary hypertension although one had cardiomyopathy.Abstract P209 Table 1Demographics and comorbiditiesPATIENT DEMOGRAPHICSCOMORBIDITIES Gender (female)63Hypertension23 Age at referral (years)9.7(5–13.4)Lipid abnormalities45Current age (years)14.3(10.6–16.3)Type 2 diabetes14Age at commencing NIV (years)11.6(7–14.8)Insulin resistance50CPAP86Steatohepatitis18BiPAP14Vitamin D deficiency92Adenotonsillectomy45Asthma27Chromosomal abnormality23Pulmonary hypertension0Child protection register9CAMHS9Results are presented as%. For ages, results are median (interquartile range)CAMHS – Child and Adolescent Mental Health ServicesConclusionThere is a high level of associated comorbidities in our patient cohort – highlighting the severe medical complications already present in these young patients. This is important to note for respiratory paediatricians who may be looking after these children for SDB. Obesity services are fragmented throughout the UK and not all children will have access to an obesity service. Vitamin D deficiency is independently associated with obesity and our Results highlight the importance of screening for this. In addition a high level of non-adherence to NIV was reported, although probably underestimated. Although only 9% were known to mental health services, severe obesity is associated with mental health issues which are currently not adequately addressed by our service. NICE guidance states that Tier 3 obesity services should include a psychologist and social worker. Most services do not fulfil these requirements through lack of funding. We aim to recruit a psychologist to support this group of patients in weight loss management and NIV support.