Pediatr Res. 2026 Jun 10. doi: 10.1038/s41390-026-05079-0. Online ahead of print.
ABSTRACT
BACKGROUND: Pediatric obstructive sleep apnea (OSA) is associated with autonomic dysfunction and impaired quality-of-life (QoL). This study investigated whether weight status modifies the impact of OSA severity on heart rate variability (HRV) and disease-specific QoL.
METHODS: This retrospective cohort study included 115 children with OSA who underwent overnight polysomnography and HRV assessment. Participants were categorized by body mass index z-score into normal-weight, overweight, and obesity groups. Hierarchical multiple regression tested the moderating effect of weight status on the relationship between the apnea-hypopnea index (AHI) and both the low-frequency/high-frequency (LF/HF) ratio and total OSA-18 score.
RESULTS: Compared to normal-weight peers (56.5%), children with overweight (21.7%) and obesity (21.7%) exhibited significantly higher AHI and impaired autonomic regulation, including elevated LF/HF ratios (q < 0.05). Hierarchical regression revealed that both overweight (p = 0.02) and obesity (p = 0.02) significantly modified the impact of AHI on the LF/HF ratio, indicating exacerbated sympathetic dominance. However, weight status did not interact with AHI to affect QoL.
CONCLUSION: While AHI uniformly correlates the subjective QoL burden regardless of adiposity, weight status fundamentally modifies the autonomic response. Heavier children exhibit heightened cardiovascular vulnerability to sleep-disordered breathing, underscoring the need for targeted weight management to mitigate cardiometabolic risk in pediatric OSA.
IMPACT: Overweight and obesity significantly exacerbate autonomic dysfunction in children with obstructive sleep apnea (OSA), driving a reduction in total heart rate variability (HRV) and a marked increase in the low-frequency/high-frequency ratio, even when disease-specific quality-of-life scores remain comparable across weight groups. This study is among the first to demonstrate that weight status structurally modifies the autonomic response to sleep-disordered breathing, amplifying sympathetic predominance in response to respiratory severity. HRV analysis may serve as a critical, non-invasive tool to stratify cardiovascular risk in pediatric OSA, guiding clinicians toward more targeted, individualized interventions and early weight management.
PMID:42270809 | DOI:10.1038/s41390-026-05079-0