0871 Does Severity of Pediatric Obesity Predict Children Most at Risk for Severe Obstructive Sleep Apnea?

Abstract Introduction Severe pediatric obesity has emerged as a major public health crisis. Obstructive sleep apnea (OSA) is present in up to 60% of obese children and adolescents. In the adult population, OSA screening tools incorporate body mass index (BMI); however, such tools do not exist for the pediatric population. We hypothesize pediatric patients with severe obesity, defined as BMI 140th percentile of the 95th percentile, will have a significantly higher apnea-hypopnea index (AHI) 15 when compared to patients with normal BMI (5th to 85th percentile). Methods We performed a retrospective chart review from January 2014 to December 2023 for all children, aged 6-18 years, who had a polysomnography (PSG) performed at Children’s Wisconsin with an AHI 15. Patients with craniofacial abnormalities, chromosomal disorders, chronic lung disorders, and neuromuscular diseases were excluded. For analysis, patients were divided into an obese BMI group and normal BMI group. Statistical analysis was performed using Fisher’s exact test and Mann-Whitney test with p-value 0.05 for significance level. Results We had 264 patients, 71% male, with a median (IQR) age of 12.9 (9.5-16.0) years at the time of sleep study. There were 23 (9%) patients with a normal BMI and 241 (91%) with an obese BMI with 52% of those with Class III obesity. The AHI ranged between 15.0-231.4. There was a trend towards a higher AHI with a higher class of obesity, p=0.052. Tonsillar size was not a significant factor in leading to severe OSA. The higher the obesity class, the lower the national Child Opportunity Index (COI), p=0.007 which indicates less access to quality resources affecting health outcomes. Conclusion This study demonstrates that as BMI increases, there is a trend towards severe OSA given the increased number of patients with Class III Obesity in our study population. When considering severe OSA, the presence or absence of tonsillar hypertrophy does not carry as much significance. There was a significant difference in COI scores between patients with higher BMIs and normal BMIs. The findings of this study may have clinical applications regarding patient education, determining need for split night PSG, and the urgency of testing. Support (if any)