Comparison of Studies Investigating Obesity in Children and its Association with Upper Airway Obstruction

Author	Referral Source N (mean age ± SD)	Ethnicity	Definition of Obesity	Inclusion Criteria	% (n) Obese	% (n) Obese with OAHI ≥ 5	Relationship between obesity and apnea severity
Brooks et al.13	Hospital Clinic	64% (21/33) AA	Not reported	SDB	30% (5/16)	Not reported	Obesity correlated with RDI (r = 0.49)
	17 (4.4 ± 0.8 y) RDI < 5	36% (12/33) Caucasian
	16 (5.1 ± 1.0 y) RDI ≥ 5
Beebe et al.38	Obesity Clinic	55% (45/82) AA	BMI > 95th %ile	Obesity	73% (60/82)	13% (8/60)	OR Obesity to OAHI > 1 = 6.6
	22 (12.6 ± 1.7 y) Controls	41% (34/82) Caucasian
	60 (13.1 ± 1.8 y) Obese	4% (3/82) Other
Carroll et al.39	Hospital Clinic	68% (56/82) AA	BMI > 95th %ile	SDB	23% (19/83)	Not reported	Frequency of obesity same for OAHI < 1 – OAHI ≥ 1
	48 (5.6 ± 3.4 y) OAHI < 1	31% (25/82) Caucasian
	35 (4.3 ± 2.4 y) OAHI ≥ 1	1% (1/82)
Chay et al.14	Obesity Clinic	58% (85/146) Chinese	≥ 180% of IBW	Obesity or SDB	41% (60/146)	13% (8/60)	No significant association
	146 (6-18 y)	32% (47/146) Malay
		8% (12/146) Indian
		2% (2/146) Other
de la Eva et al.17	Hospital Clinic	80% (50) Caucasian	BMI > 95th %ile	Obesity and snoring	100% (62/62)	Not reported	No significant association
	62 (10.9 ± 3.1 y)	10% (6) Middle Eastern
		7% (4) Asian
		3% (2) Others
Dubern et al.40	Nutrition Clinic	67% (36/54) Caucasian	BMI z-score>3 SD over mean (severe obesity)	Obesity	100% (54/54)	15% (8/54) RDI>10	Severe obesity correlated with RDI (r = 0.30)
	54 (12.0 ± 2.6 y)	33% (18/54) Black
Goodwin et al.18	Community 239 (6-11 y)	49% (117/239) Caucasian	BMI > 95th %ile	Nil	12% (28/239)	Not reported	No significant association
		51% (122/329) Hispanic
Lam et al.15	Hospital Clinic	100% (482/482) Chinese	BMI Z score > 1.96	SDB	30% (111/371)	49.5% (55/111)	Obesity correlated with (ln)AHI (r = 0.16). OR obesity to OAHI > 1.5 = 2.3
	482 (median age = 6y; interquartile range 4–9 y)
Mallory et al.27	Obesity Clinic	Not reported	≥ 150% of IBW	Obesity and SDB	100% (41/41)	24% (10/41)	No significant association
	41 (10.3 ± 4.4 y)
Marcus et al.12	Hospital Clinic	91% (20/22) AA	> 120% of IBW or subscapular skinfold thickness > 85th %ile	Obesity	100% (22/22)	27% (6/22) obstructive apneas > 1/hr	Obesity correlated with obstructive apneas/h (r = 0.47)
	22 (10.0 ± 5.0 y)	9% (2/22) Caucasian
Reade et al.41	Hospital Clinic	64.4% (58/90) AA	BMI > 95th %ile	SDB	62.2% (56/90)	53% (30/56) apnea Index > 1	Obesity correlated with OAHI (r = 0.29)
	90 (10.7: 4-18 y)	34.4% (31/90) Caucasian
		1% (1/90) Hispanic
Rosen10	Hospital Clinic	38% (137/326) AA	≥ 120% of IBW or BMI > 95th %ile	SDB	28% (91/326)	26% (24/91)	No significant association
	326 (5.8 ± 3.0 y)	30% (98/326) Caucasian
		31% (101/326) Hispanic
Stepanski et al.20	Hospital Clinic	68% (133/196) AA	BMI > 95th ile	SDB	23% (47/198)	NR	Non-SDB BMI < SDB BMI (only for children > 8y)
	196 (5.9 ± 3.7y)	12% (24/196) Caucasian
		19% (37/196) Hispanic
		1% (2/196) Arabic
Verhulst et al. 8	Obesity Clinic	Not reported	BMI > 95th ile	Obesity	70% (64/91)	8% (5/64)	No significant association
	91 (11.2 ± 2.6 y)
Wing et al. 16	Obesity Clinic and Community	100% Chinese	≥ 120% of IBW	Obesity	51.1% (46/90)	15% (7/46)	OR Obesity to RDI ≥ 5 = 1.2
	46 Obese (10.8 ± 2.3y)
	44 Control (11.7 ± 2.1y)

To produce the table the terms “Obesity,” “Children,” and “Polysomnography” were entered as search terms in the PubMed database. From that search we identified 16 studies that report sufficient details to determine OAHI, ethnicity and frequency of obesity. Studies that used nonstandard polysomnographic protocols were excluded. Abbreviations: ADT = adenotonsillectomy, AA = African-American, BMI = body mass index, IBW = ideal body weight, SDB = sleep disordered breathing, RDI = respiratory disturbance index (total respiratory events per hour of sleep) and OR = Odds Ratio.