The Relationship Between Obstructive Sleep Apnea and Pediatric Obesity: A Nationwide Analysis

Abstract

Objective: Pediatric obstructive sleep apnea (OSA) can have both acute and chronic consequences when untreated. We hypothesize that a link exists between childhood obesity and OSA at nationwide level, with race, gender, and socioeconomic status conferring their own risk for pediatric OSA. Methods: This study examined nationwide discharges in 2016 using the Kids’ Inpatient Database (KID). The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for obesity (E66.0) and OSA (G47.33) were used. Prevalence rates and odds ratios (ORs) were used to quantify associations between the obesity and OSA groups in the general pediatric inpatient population. Multiple binary logistic regression was utilized to compare cohorts of pediatric inpatient admissions. Results: There were 36 266 285 weighted discharges in the 2016 KID. Among patients included in our dataset, 0.426% (26 684) were diagnosed with obesity and 0.562% (35 242) had OSA. Obesity was independently associated with a significantly increased risk of OSA (OR = 22.89; 95% C.I. = 21.99-23.84). Within the OSA inpatient population, obesity was associated with non-Hispanic black race, Hispanic ethnicity, and Native American race/ethnicity (OR = 1.45, 1.32, 2.51; 95% C.I. = 1.33-1.58, 1.21-1.44, 1.73-3.63). Conclusions: Obesity is independently associated with OSA in children after controlling for adenotonsillar hypertrophy. Non-Hispanic black race and Hispanic ethnicity are independent risk factors for OSA and are associated with obesity in the OSA inpatient population, which suggests that obesity may play a role in the increased risk of OSA within these groups.

Analysis of the Risk Factors Associated With Obstructive Sleep Apnea Syndrome in Chinese Children

“…While some reports have found obesity to be independently related to the risk of OSAS ( 15 , 16 ), this finding was not replicated in the present study, and the relevance of these risk factors remains controversial. However, this study revealed a relationship between obesity and OSAS severity, suggesting that obesity may play a role in the increased risk of OSAS as reported by Bachrach et al ( 15 ). While obese individuals may not exhibit OSAS, obesity can nonetheless contribute to pre-vertebral soft tissue hyperplasia of the upper airway, pharyngeal airway stenosis, and increased airway closure resistance, aggravating extant OSAS.…”

“…Efforts to identify OSAS-related risk factors at an early time point are essential to improving patient outcomes. In prior reports, tonsillar hypertrophy and adenoid hypertrophy ( 7 , 10 , 11 ), as well as obesity ( 8 , 15 ), were identified as critical factors associated with the development of OSAS in children. Other risk factors including asthma ( 16 ), pre-term birth ( 17 , 18 ), being male ( 11 ), parental smoking ( 19 , 20 ), habitual snoring ( 21 ), and ethnicity ( 22 ) have also been reported to be associated with OSAS incidence, but these findings are somewhat controversial.…”

“…Several studies have emphasized the importance of obesity as a risk factor for OSAS (8,11,15,30), with some evidence suggesting that it is the primary factor related to the persistence and aggravation of childhood sleep disorders (31), consistent with an observed positive correlation between obesity and OSAS severity (32). While some reports have found obesity to be independently related to the risk of OSAS (15,16), this finding was not replicated in the present study, and the relevance of these risk factors remains controversial. However, this study revealed a relationship between obesity and OSAS severity, suggesting that obesity may play a role in the increased risk of OSAS as reported by Bachrach et al (15).…”

Evaluation and diagnosis of pediatric obstructive sleep apnea—An update

“…Additional metabolic markers have been assessed, given the increasing rates of pediatric obesity (Childhood Obesity Facts, 2022), and concomitant obesity in children with OSA (Bachrach et al, 2022). Comorbid diagnoses to obesity, such as insulin resistance and dyslipidemia, have been evaluated in pediatric OSA (Deboer et al, 2012;Zong et al, 2013;Bhushan et al, 2014;Amini et al, 2017;Siriwat et al, 2020).…”

The Association between Asthma and OSA in Children

“…Adenotonsillar hypertrophy and fat deposition in the lateral fat pads, uvula, and tongue are contributing anatomic factors to airway narrowing that can cause OSA. Obesity is an independent risk factor for OSA in children after controlling for adenotonsillar hypertrophy [ 12 , 26 ]. It is possible that the same mechanism involving a diet high in saturated fatty acids that increase neutrophil recruitment within the airway inflammation and increase macrophage activation can explain the same effect not only in the lower but also in the upper airway causing OSA in obese patients [ 23 ].…”