Introduction
Obstructive sleep apnea (OSA) is defined as repeated partial or complete
obstructions of the upper airways during sleep. Hypertrophy of the
adenoids and/or the tonsils is the main cause of OSA in otherwise
healthy children (also called OSA-I) with a prevalence ranging from 0%
to 5.7% (1, 2). OSA-I is generally mild to moderate, with the majority
of children having a spontaneous favorable evolution over time or after
adenotonsillectomy (3). However, a minority of children may present
severe residual OSA after upper airway surgery. These children require
other therapeutic options in order to avoid the deleterious
neurocognitive and behavioral consequences of persistent OSA (4, 5).
Continuous positive airway pressure (CPAP), by maintaining airway
patency during the entire breathing cycle has shown its efficacy in
these children (5, 6).
The escalating global obesity epidemic represents one of the most
serious public health challenges, not only in adults but also in
children (7). Overweight and obese children have an increased risk of
OSA (also called OSA-II), with OSA being in general more severe than in
lean children, and associated with a greater risk of residual OSA after
adeno-tonsillectomy (8). If weight loss cannot be obtained, CPAP has
shown to be an efficient treatment for severe persistent OSA (5). As
adults, children with OSA-II are also at risk of obesity hypoventilation
syndrome (OHS), which may require noninvasive ventilation (NIV) if CPAP
is insufficient to correct nocturnal hypoventilation.
In France, children treated with long term NIV/CPAP at home are followed
within the French national paediatric NIV network. A survey performed by
the network showed that 1449 patients aged less than 20 years were
treated with NIV/CPAP for at least 3 months on June 2019 (9). The mean
age of the patients was 9.8 ± 5.8 years and the most frequent underlying
disorders were upper airway obstruction (46%), neuromuscular disease
(28%), and central nervous system disorder (13%). Within the context
of a growing number of children with obesity, we analysed the
characteristics of the subgroups of patients of the 2019 national survey
with OSA-II and compared them to patients with OSA-I.