# Cross-Sectional Assessment of Sleep-Disordered Breathing Prevalence in Pediatric Population with Obesity

## TL;DR

More than a third of obese children in Saudi Arabia show signs of sleep-disordered breathing, with neck circumference being a key predictor.

## Contribution

The study identifies neck circumference as a critical mediator linking obesity severity to sleep-disordered breathing risk in children.

## Key findings

- 37.7% of obese children aged 6–12 years screened positive for sleep-disordered breathing.
- Neck circumference mediates the relationship between BMI and sleep-disordered breathing risk.
- Simple anthropometric measures can aid in early identification of sleep-disordered breathing in obese children.

## Abstract

What are the main findings?
More than one-third of children with obesity screened positive for sleep-disordered breathing, indicating a substantial hidden burden in pediatric obesity clinics.Neck circumference emerged as a key anatomical predictor and a mediator linking overall obesity severity to sleep-disordered breathing risk.

More than one-third of children with obesity screened positive for sleep-disordered breathing, indicating a substantial hidden burden in pediatric obesity clinics.

Neck circumference emerged as a key anatomical predictor and a mediator linking overall obesity severity to sleep-disordered breathing risk.

What are the implications of the main findings?
Simple anthropometric measures, particularly neck circumference, can enhance early identification of sleep-disordered breathing in obese children.Integrating routine sleep screening into pediatric obesity care may enable earlier intervention and improve long-term cardiometabolic and neurocognitive outcomes.

Simple anthropometric measures, particularly neck circumference, can enhance early identification of sleep-disordered breathing in obese children.

Integrating routine sleep screening into pediatric obesity care may enable earlier intervention and improve long-term cardiometabolic and neurocognitive outcomes.

Background: Childhood obesity is a growing public health concern globally and is associated with a wide spectrum of comorbidities, including sleep-disordered breathing (SDB). SDB remains under-recognized in pediatric population with obesity, particularly in Middle Eastern settings, despite its significant impact on cognitive, behavioral, and metabolic health. Objectives: To assess the prevalence of SDB among children with obesity aged 6–12 years attending King Faisal University polyclinics in Saudi Arabia and to identify key demographic and anthropometric predictors, with particular emphasis on the mediating role of neck circumference. Methods: A cross-sectional study was conducted involving 130 children with obesity aged 6–12 years. Data collection included sociodemographic characteristics, anthropometric measurements (BMI percentile, neck and waist circumference), and screening for SDB using the validated Arabic version of the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder (PSQ-SRBD) scale. Logistic regression and mediation analyses were performed to examine associations and pathways between obesity parameters and SDB risk. Results: Of the 130 participants, 37.7% screened positive for SDB risk. SDB prevalence was higher among males and older children. Neck circumference and BMI percentile were independently associated with SDB risk, with neck circumference mediating the relationship between BMI and SDB. The mediation model indicated that increased BMI contributes to SDB risk both directly and indirectly through increased neck circumference. Conclusions: SDB is highly prevalent among obese Saudi children, and neck circumference is a significant mediator of risk. Incorporating SDB screening and neck circumference measurements into routine pediatric obesity care can facilitate early detection and management. These findings support the need for integrated, multidisciplinary approaches to improve pediatric health outcomes.