0735 Longitudinal Association of the Natural Course of Childhood Overweight with Sleep Disordered Breathing in the Transition to Adolescence: The Penn State Child Cohort

Abstract

Introduction: Although being overweight is a known risk factor for sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), it remains unknown 1) whether childhood SDB predicts the incidence or persistence of overweight in the transition from childhood to adolescence and 2) whether the natural course of overweight predicts the incidence of SDB in adolescence. Methods: We studied the Penn State Child Cohort, a general population sample of 421 children (5-12y) at baseline followed-up as adolescents (12-23y, 46.1% female, 17.5% minority). Overweight was defined as a BMI percentile for sex-and-age ≥ 85 and four natural course groups were identified: normal weight and incident, persistent and remitted overweight. Apnea/hypopnea index (AHI) was obtained from 9-hour, in-lab polysomnography and was categorized as no SDB (AHI<2), SDB (2≤AHI<5) and OSA (AHI≥5). Multivariable statistical analyses adjusted for sex, race and age. Results: Neither AHI, SDB nor OSA in childhood predicted the incidence of overweight (e.g., OR =1.5, 95%CI=0.5-4.8, p=0.495) or the persistence vs. remission of childhood overweight (e.g., OR=0.5, 95%CI=0.2-1.3, p=0.151) in adolescence. Incident overweight in adolescence and persistent overweight since childhood showed a similar AHI (3.4±4.4 vs. 3.5±5.0) and significantly greater incidence of OSA (14.9% and 21.3%, p<0.005) in adolescence. Remitted overweight showed a similar AHI and incidence of OSA in adolescence (2.3±6.3 and 5.7%) when compared to those who had been normal weight since childhood (2.0±1.8 and 6.3%). Conclusion: This longitudinal study showed that overweight children with SDB are not more likely to persist as overweight into adolescence, while the remission of childhood overweight leads to improved SDB outcomes. Interestingly, the incidence of OSA in adolescence was similar whether the overweight had been persistent since childhood or new-onset. These data indicate that early prevention of SDB should focus on childhood overweight, while new-onset overweight in adolescence should not be regarded as a less severe form in terms of its increased risk of OSA.