Obesity, Family History Potential Risk Factors of Pediatric OSA

A retrospective, single-center study found that obesity and family history were among several potential risk factors for pediatric obstructive sleep apnea (OSA).

Several risk factors that could help explain pediatric obstructive sleep apnea (OSA), including obesity, family passive smoking, family history of OSA, and asthma, were identified in a new study published in Frontiers in Pediatrics.

The 2012 American Academy of Pediatrics guidelines estimated that 11% of children in the United States aged 1 to 9 years snore and 2% to 3% had OSA. These rates were similar in Hong Kong, where the prevalence of pediatric OSA was estimated at 4.8%.

Pediatric patients who were admitted for snoring and/or open mouth breathing between June 2020 and January 2021 were enrolled in this study. Patients were included if they were aged 17 or younger, had undergone polysomnography (PSG) and electronic nasopharyngoscopy, and had a parent or guardian complete a questionnaire. The researchers designed a questionnaire to retrieve data on OSA-related risk factors. All patients included in the study underwent a physical examination, electronic nasopharyngoscopy, and PSG.

There were 1550 children who completed their questionnaire and were included in the final analysis. The OSA group had 852 children with a median (IQR) age of 5.0 (3.9-6.4) years; the primary snoring group had 698 patients with a median age of 5.1 (4.1-6.6) years.

A univariable logistic regression analysis demonstrated that potential risk factors for pediatric OSA were obesity, family passive smoking, family history of snoring, allergic rhinitis, asthma, adenoid hypertrophy, and tonsil hypertrophy. A multivariate logistic regression analysis demonstrated that adenoid hypertrophy (odds ratio [OR], 1.835; 95% CI, 1.482-2.271) and tonsil hypertrophy (OR, 1.283; 95% CI, 1.014-1.622) were independent risk factors of pediatric OSA, with 83.5% and 28.3%, respectively, greater associated risks.

The researchers also found 128.5% (OR, 2.285; 95% CI, 1.713-3.049), 200% (OR, 3.006; 95% CI, 2.140-4.221), and 255% (OR,3.554; 95% CI, 2.514-5.024 greater risks of grade II, III, and IV adenoid hypertrophy, respectively, relative to grade I. Risks of tonsillar hypertrophy were also increased, at 47.8% (OR, 1.478; 95% CI, 1.167-1.870) for grade II, 55% (OR, 1.551; 95% CI, 1.115-2.157) for grade III, and 63% (OR, 1.631; 95% CI, 1.174-2.267) for grade IV relative to grade I. These ORs suggest that the OSA incidence rose with increasing adenoid and tonsillar hypertrophy grades.

Adenoid hypertrophy was found to have a weak association with OSA severity and no other correlations between risk factors and OSA severity was found.

There were some limitations to this study. The study is susceptible to measurement bias, selection bias, and recall bias due to its retrospective, single-center analysis. The criteria for diagnosis of OSA is also specific to Chinese children so the results may not be generalizable to other populations.

The researchers concluded that the study identified important risk factors for pediatric and that adenoid hypertrophy and tonsil hypertrophy were independently associated with pediatric OSA risk.

“It is important that these risk factors be taken into consideration, with a particular focus on adenoid and tonsil hypertrophy, and appropriate active clinical interventions should be administered with attention being paid to patient tonsil and adenoid size…” the authors wrote.


Xiao L, Su S, Liang J, Jiang Y, Shu Y, Ding L. Analysis of the risk factors associated with obstructive sleep apnea syndrome in Chinese children. Front Pediatr. 2022;10:900216. doi:10.3389/fped.2022.900216

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