# The High Prevalence of Continuous Paradoxical Breathing During Sleep in Children With Obesity and Its Relationship With Obstructive Sleep Apnea

## TL;DR

This study finds that paradoxical breathing during sleep is common in obese children and not linked to sleep apnea, suggesting it may stem from chest wall mechanics.

## Contribution

The study is the first to show that paradoxical breathing in obese children is not associated with sleep apnea severity or BMI.

## Key findings

- CPB was found in 67.9% of obese children during sleep.
- CPB was not correlated with apnea-hypopnea index or BMI.
- Supine-only CPB was linked to sleep-related symptoms.

## Abstract

Objective: The clinical significance of continuous paradoxical breathing (CPB) during sleep in patients with obesity, and its relationship to upper airway obstruction versus altered chest wall mechanics is not well-studied. We evaluated the prevalence of CPB and its relationship to obstructive sleep apnea (OSA), BMI, sleep position, sleep stage, O2 saturation, and sleep-related symptoms in children with obesity.

Methods: All polysomnography (PSG) studies in children with obesity (BMI > 95th percentile) between 2016 and 2022 were evaluated. CPB was defined as complete opposition of chest and abdominal wall signals for at least 50% of rapid eye movement (REM) sleep and/or nonrapid eye movement (NREM) sleep. OSA was defined as an apnea-hypopnea index (AHI) of >1.5 events/hours of sleep. CPB was considered REM-only if present during REM sleep and supine-only if present in the supine position. Multivariate regression analysis was used to evaluate the determinants of CPB.

Results: A total of 196 children (125 males and 71 females) were included. The mean (SD) age was 12.8 (3.4) years. Median (interquartile range (IQR)) BMI was 39 (32.5-46.2) kg/m2. OSA was present in 117 patients with a prevalence rate of 59.7%. CPB was identified in 133 patients with a prevalence rate of 67.9%%. CPB was REM-only in 16 (10.9%) patients, and supine-only in 63 (43.2%) patients. There was no correlation between CPB and AHI (p = 0.96), and no correlation was found between CPB and BMI (p = 0.08). There was also no correlation between CPB and O2 saturation. However, there was a positive correlation between supine-only CPB and clinical symptoms (p = 0.05).

Conclusion: CPB is highly prevalent in symptomatic obese children and is likely related to chest wall mechanics and not related to OSA.