Sleep disorders in children with ENT pathology are a predictor of overweight and obesity

Introduction. A decrease in sleep duration, its significant variability and sleep breathing disorders (obstructive sleep apnea syndrome — OSA) are factors in the formation of obesity in children. The main cause of OSA in children is chronic pathology of the ENT organs, when combined with overweight and obesity, its most severe forms are recorded. The aim: to determine the features of sleep disorders and their association with obesity in children with chronic pathology of ENT organs.

Materials and methods. One hundred twenty seven children (75 boys and 52 girls) aged of 4–12 years (median 6 years) with chronic pathology of ENT organs were examined during 2016–2024. All children were examined with night polysomnography (PSG) using the Embla 7000 system (USA). A statistical analysis of quantitative PSG data was performed and their relationship to age, gender, and SDS index of the of body mass index (BMI) was determined.

Results. Snoring, shortness of breath, and sleep disorders in children with chronic forms of ENT pathology are closely related to the indices of apnea/hypopnea (IAG) and desaturation (ID), which indicates the risk of developing chronic non-communicable diseases. In preschool children (4–6 years old), complaints of breathing disorders during sleep and objective signs of sleep disorders prevail. In these patients, despite severe forms of pathology of the ENT organs, overweight, obesity, and less pronounced forms of OSA are less often detected. Overweight and obesity are significantly more common in school-age children (7–12 years) with chronic pathology of the ENT organs, as well as their close correlations with complaints and objective PSG data indicating more pronounced sleep breathing disorders than in preschoolers.

Conclusion. In school-age children with chronic pathology of the ENT organs, objective signs of respiratory disorders during sleep are registered more often, are more pronounced and are associated with a frequently detected increased BMI, which requires an integrated approach in the treatment of children, taking into account behavioral factors, one of which is the child’s sleep.

Contribution:
Kozhevnikova O.V., Makarova S.G. — the concept and design of the study;
Tikhonovsky P.A., Lebedev V.V., Blazhievskaya T.O., Abashidze E.A. — collection and processing of the material;
Gordeeva I.G., Kustova E.A. — statistical analysis;
Kozhevnikova O.V., Tikhonovsky P.A., Rodionova A.M. — writing the text;
Fisenko A.P., Makarova S.G., Komarova O.V. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 16, 2025
Accepted: November 27, 2025
Published: December 25, 2025

1. Primack C. Obesity and sleep. Nurs. Clin. North Am. 2021; 56(4): 565–72. https://doi.org/10.1016/j.cnur.2021.07.012

2. Antza C., Kostopoulos G., Mostafa S., Nirantharakumar K., Tahrani A. The links between sleep duration, obesity and type 2 diabetes mellitus. J. Endocrinol. 2021; 252(2): 125–41. https://doi.org/10.1530/JOE-21-0155

3. Figorilli M., Velluzzi F., Redolfi S. Obesity and sleep disorders: A bidirectional relationship. Nutr. Metab. Cardiovasc. Dis. 2025; 35(6): 104014. https://doi.org/10.1016/j.numecd.2025.104014

4. Styne D.M., Arslanian S.A., Connor E.L., Farooqi I.S., Murad M.H. Silverstein J.H., et al. Pediatric obesity-assessment, treatment, and prevention. J. Clin. Endocrinol Metab. 2017; 102(3): 709–57. https://doi.org/10.1210/jc.2016-2573

5. Herkenrath S.D., Treml M., Hagmeyer L., Matthes S., Randerath W.J. Severity stages of obesity-related breathing disorders – a cross-sectional cohort study. Sleep Med. 2022; 90: 9–16. https://doi.org/10.1016/j.sleep.2021.12.015

6. Blüher M. An overview of obesity-related complications: The epidemiological evidence linking body weight and other markers of obesity to adverse health outcomes. Diabetes Obes. Metab. 2025; 27(Suppl. 2): 3–19. https://doi.org/10.1111/dom.16263

7. Tuomilehto H., Seppä J., Uusitupa M. Obesity and obstructive sleep apnea – clinical significance of weight loss. Sleep Med. Rev. 2013; 17(5): 321–9. https://doi.org/10.1016/j.smrv.2012.08.002

8. Leproult R., Van Cauter E. Role of sleep and sleep loss in hormonal release and metabolism. Endocr. Dev. 2010; 17: 11–21. https://doi.org/10.1159/000262524

9. Duan D., Kim L.J., Jun J.C., Polotsky V.Y. Connecting insufficient sleep and insomnia with metabolic dysfunction. Ann. N. Y. Acad. Sci. 2023; 1519(1): 94–117. https://doi.org/10.1111/nyas.14926

10. Pham L.V., Jun J., Polotsky V.Y. Obstructive sleep apnea. Handb. Clin. Neurol. 2022; 189: 105–36. https://doi.org/10.1016/B978-0-323-91532-8.00017-3

11. Huang W., Zhong A., Xu H., Xu C., Wang A., Wang F., et al. Metabolomics analysis on obesity-related obstructive sleep apnea after weight loss management: a preliminary study. Front. Endocrinol. (Lausanne). 2022; 12: 761547. https://doi.org/10.3389/fendo.2021.761547

12. Meyer E.J., Wittert G.A. Approach the patient with obstructive sleep apnea and obesity. J. Clin. Endocrinol Metab. 2024; 109(3): e1267–79. https://doi.org/10.1210/clinem/dgad572

13. Hopps E., Caimi G. Obstructive sleep apnea syndrome: links betwen pathophysiology and cardiovascular complications. Clin. Invest. Med. 2015; 38(6): E362–70. https://doi.org/10.25011/cim.v38i6.26199

14. Bosi M., De Vito A., Kotecha B., Viglietta L., Braghiroli A., Steier J., et al. Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature. Sleep Breath. 2018; 22(3): 579–92. https://doi.org/10.1007/s11325-017-1613-3

15. Doğru Yuvarlakbaş S., Boyan N., Kuleci S., Balli H.T. Anatomic changes of patients with obstructive sleep apnea syndrome at different stages. J. Craniofac. Surg. 2025; 36(4): 1254–7. https://doi.org/10.1097/SCS.0000000000011053

16. Yeşildağ M., Duksal F. Comorbidities and anthropometric parameters in obstructive sleep apnea syndrome: a phenotype-based study. Clin. Exp. Hypertens. 2025; 47(1): 2512136. https://doi.org/10.1080/10641963.2025.2512136

17. Xue Z., Yao B., Yang Y., Yin L. Tonsillectomy and/or adenoidectomy improves macular microcirculation in children with obstructive sleep apnea. Sci. Rep. 2025; 15(1): 31033. https://doi.org/10.1038/s41598-025-16476-6

18. Villa M.P., Piro S., Dotta A., Bonci E., Scola P., Paggi B., et al. Validation of automated sleep analysis in normal children. Eur. Respir. J. 1998; 11(2): 458–61. https://doi.org/10.1183/09031936.98.11020458

19. Vendrame M., Kaleyias J., Valencia I., Legido A., Kothare S.V. Polysomnographic findings in children with headaches. Pediatr. Neurol. 2008; 39(1): 6–11. https://doi.org/10.1016/j.pediatrneurol.2008.03.007

20. DelRosso L.M., Jackson C.V., Trotter K., Bruni O., Ferri R. Video-polysomnographic characterization of sleep movements in children with restless sleep disorder. Sleep. 2019; 42(4): zsy269. https://doi.org/10.1093/sleep/zsy269

21. Jo J.H., Kim S.H., Jang J.H., Park J.W., Chung J.W. Comparison of polysomnographic and cephalometric parameters based on positional and rapid eye movement sleep dependency in obstructive sleep apnea. Sci. Rep. 2022; 12(1): 9828. https://doi.org/10.1038/s41598-022-13850-6

22. Ohayon M.M., Guilleminault C., Zulley J., Palombini L., Raab H. Validation of the sleep-EVAL system against clinical assessments of sleep disorders and polysomnographic data. Sleep. 1999; 22(7): 925–30. https://doi.org/10.1093/sleep/22.7.925

23. Wakai M., Nishikage H., Goshima K., Yamamoto J. Polysomnographic features of idiopathic central sleep apnea. Psychiatry Clin. Neurosci. 2002; 56(3): 323–4. https://doi.org/10.1046/j.1440-1819.2002.01000.x

24. Tasali E., Pamidi S., Covassin N., Somers V.K. Obstructive sleep apnea and cardiometabolic disease: obesity, hypertension, and diabetes. Circ. Res. 2025; 137(5): 764–787. https://doi.org/10.1161/Circresaha.125.325676

25. Wu K., Gan Q., Pi Y., Wu Y., Zou W., Su X., et al. Obstructive sleep apnea and structural and functional brain alterations: a brain-wide investigation from clinical association to genetic causality. BMC Med. 2025; 23(1): 42. https://doi.org/10.1186/s12916-025-03876-8

26. Henning R.J., Anderson W.M. Sleep apnea is a common and dangerous cardiovascular risk factor. Curr. Probl. Cardiol. 2025; 50(1): 102838. https://doi.org/10.1016/j.cpcardiol.2024.102838

27. Antonaglia C., Passuti G. Obstructive sleep apnea syndrome in non-obese patients. Sleep Breath. 2022; 26(2): 513–8. https://doi.org/10.1007/s11325-021-02412-1

28. Badran M., Gozal D. Intermittent hypoxia as a model of obstructive sleep apnea: present and future. Sleep Med. Clin. 2025; 20(1): 93–102. https://doi.org/10.1016/j.jsmc.2024.10.009

29. Chen Y.F., Hang L.W., Huang C.S., Liang S.J., Chung W.S. Polysomnographic predictors of persistent continuous positive airway pressure adherence in patients with moderate and severe obstructive sleep apnea. Kaohsiung J. Med. Sci. 2015; 31(2): 83–9. https://doi.org/10.1016/j.kjms.2014.11.004

30. Shine N.P., Coates H.L., Lannigan F.J. Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: a review of the literature. Int. J. Pediatr. Otorhinolaryngol. 2005; 69(11): 1475–82. https://doi.org/10.1016/j.ijporl.2005.08.008

31. Anderson N., Tran P. Obstructive sleep apnea. Prim. Care. 2025; 52(1): 47–59. https://doi.org/10.1016/j.pop.2024.09.007

32. Keenan B.T., Ye L., Pien G.W., Magalang U.J., Benediktsdottir B., Gislason T., et al. Symptom subtypes of obstructive sleep apnea 10 years later: past, present, and future. Sleep. 2025; 48(7): zsaf082. https://doi.org/10.1093/sleep/zsaf082

33. Gaspar L.S., Pyakurel S., Xu N., D’Souza S.P., Koritala B.S.C. Circadian biology in obstructive sleep apnea-associated cardiovascular disease. J. Mol. Cell Cardiol. 2025; 202: 116–32. https://doi.org/10.1016/j.yjmcc.2025.03.008

34. Kashaninasab F., Khoozan M., Ghalebandi M.F., Alavi K. Comparison of subjective and objective sleep quality in patients with obstructive sleep apnea syndrome. Brain Behav. 2025; 15(8): e70759. https://doi.org/10.1002/brb3.70759

35. Testone G., Fernandes M., Carpi M., Lupo C., Mercuri N.B., Liguori C. Obstructive sleep apnea may induce sleep-wake cycle dysregulation: An actigraphic study. J. Sleep Res. 2025; 34(1): e14273. https://doi.org/10.1111/jsr.14273

36. Haim A., Daniel S., Hershkovitz E., Goldbart A.D., Tarasiuk A. Obstructive sleep apnea and metabolic disorders in morbidly obese adolescents. Pediatr Pulmonol. 2021; 56(12): 3983–90. https://doi.org/10.1002/ppul.25652

37. Altree T.J., Bartlett D.J., Marshall N.S., Hoyos C.M., Phillips C.L., Birks C., et al. Predictors of weight loss in obese patients with obstructive sleep apnea. Sleep Breath. 2022; 26(2): 753–62. https://doi.org/10.1007/s11325-021-02455-4

38. Day K., Nguo K., Edwards B., O’Driscoll D., Young A., Haines T., et al. Body composition changes and their relationship with obstructive sleep apnoea symptoms, severity: The Sleeping Well Trial. Clin. Nutr. 2023; 42(9): 1661–70. https://doi.org/10.1016/j.clnu.2023.07.006

39. Yook S., Park H.R., Seo D., Joo E.Y., Kim H. Obstructive sleep apnea subtyping based on apnea and hypopnea specific hypoxic burden is associated with brain aging and cardiometabolic syndrome. Comput. Biol. Med. 2025; 185: 109604. https://doi.org/10.1016/j.compbiomed.2024.109604