Risk factors for obstructive sleep apnoea in obese children: a systematic review and meta-analysis

Background: Obstructive sleep apnoea (OSA) is prevalent among children with obesity and is associated with long-term morbidity. 

Methods: We conducted a systematic review and meta-analysis of risk factors for OSA among children (0–18) who are overweight/obese. Risk factors reviewed included overall adiposity, regional fat distribution, adenotonsillar hypertrophy, sex, ethnicity, and airway neuromuscular tone. PubMed and Embase were searched in July 2025. Random-effects models were applied. 

Results: Forty-seven studies were included. Children with OSA had higher BMI z-scores (mean difference (MD) = 0.30), neck circumference (MD = 2.19 cm), and waist circumference (MD = 5.99 cm) compared to obese children without OSA. Adenotonsillar hypertrophy and male sex associated with higher OSA odds (adenoid odds ratio (OR) = 3.28, tonsil OR = 4.16, Male OR = 1.51). Studies also suggested airway neuromuscular tone and non-Caucasian ethnicity as risk factors, but further research is needed. 

Conclusion: OSA in obese children is likely to be multifactorial. Assessment accounting for multiple factors may improve screening accuracy and guide targeted interventions in this high-risk population.