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.