Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity

Study Objectives: Obesity and regional fat distribution, measured by neck fat mass percentage using dual-energy X-ray absorptiometry (DXA), correlate with obstructive sleep apnea (OSA) severity in adults. In obese children, neck-to-waist-circumference ratio predicts OSA. This study examined associations between body fat percentage and distribution and sleep-disordered breathing (SDB) severity in obese youth, measured with DXA. Methods: Cross-sectional retrospective study conducted at a tertiary children's hospital. Participants were aged 6 to 18 years with obesity (body mass index [BMI] >99th percentile [BMI z-score 2.35] or >95th percentile with comorbidity). They underwent polysomnography and DXA to quantify body fat percentage and distribution ratios (neck-to-abdominal fat percentage [NAF % ratio]). SDB was defined as apnea-hypopnea index (AHI) >5 and OSA as obstructive AHI (OAHI) >1 event/h. Relationships of BMI z-score and NAF % ratio to log AHI and log OAHI were evaluated. Results: Thirty individuals participated; 18 male; median age 14.1 years. Twenty-four individuals had BMI z-scores >2.35. Ten had AHI >5 events/h. NAF % ratio was significantly associated with log AHI in males and with log OAHI in all, whereas total fat mass percent was not. The association between log OAHI and NAF % ratio was significant in males, but not females. NAF % ratio was significantly associated with log OAHI in those with BMI z-score above 2.35. Conclusions: NAF % ratio was associated with OSA severity in males and youth with BMI >99th percentile; however, total fat mass percentage was not, suggesting that body fat distribution is associated with OSA risk in youth.