Exploring sleep-related breathing disorders in pediatric obesity and Prader-Willi syndrome.

Objective: To analyze the differences of clinical and diagnostic features of sleep related breathing disorders (SRBDs) between children with PWS and obese children, considering obesity as a unifying risk factor for sleep apnea.

Study Design: This retrospective cohort study included ≥2 years of age children who had obesity and genetically confirmed Prader-Willi syndrome (PWS) or were non-PWS obese children. Out of 267 children, 58 children met inclusion criteria. Clinical data and records of standard overnight polysomnography (PSG) were collected and compared between groups during the study.

Results: Obstructive sleep apnea (OSA) was identified in 97.2 % non-PWS obese children and 72.7 % PWS children (p = 0.072). Central sleep apnea (CSA) events were more commonly found in children with PWS (p = 0.035, OR 4.35, CI 95 % 1.05-18.03) as well as sleep-related hypoventilation (p = 0.016, OR 4.66, CI 95 % 1.26-17.34). Sleep efficiency was higher in PWS patients (p = 0.038). Sleep fragmentation was significantly associated with higher AHI only in non-PWS obese children (p = 0.027). In the PWS group patients, a moderate correlation was found between BMI and age (p = 0.025, r = 0.559, CI 95 % 0.087-0.826) as well as AHI and age (p = 0.003, r = 0.686, CI 95 % 0.232-0.895).

Conclusions: Non-PWS obese children, similar to those with PWS, exhibit a high risk of SRBDs. Although CSA and sleep-related hypoventilation may occur more frequently in patients with PWS, OSA remains the predominant disorder. Both patient groups are advised to undergo PSG due to the significant risk of SRBDs, particularly during adolescence.