Obesity and Sleep-disordered Breathing in Children: Obstructive Sleep Apnea and Its Impact on Ear, Nose, and Throat Health

Abstract

Introduction: Obstructive sleep apnea (OSA) in children is a respiratory disorder characterized by intermittent upper airway (UA) obstructions during sleep. Childhood obesity is a major risk factor, contributing to UA narrowing and increased respiratory resistance. Objective: To review the interconnection between obesity and OSA in children, emphasizing the impact of the disease on otorhinolaryngological (ENT) health, particularly on structures such as the ears, nose, and throat. Methods: Systematic and narrative literature review (PubMed, Scopus, SciELO) focusing on studies from 2015 to 2025 that addressed pathophysiology, clinical manifestations, ENT complications (otitis media, eustachian tube dysfunction, adenotonsillar hypertrophy), and therapeutic approaches in obese children with OSA. Results: Obesity significantly increases the severity of OSA and is a predictor of adenotonsillectomy failure, the standard treatment. Obese children show a higher prevalence of eustachian tube dysfunction and serous otitis media, as well as greater residual pharyngeal collapse after surgery (Table 1). Increased nasal resistance and systemic inflammation contribute to the disorder’s pathogenesis. Conclusion: Obesity plays a significant role in the severity and persistence of pediatric OSA, increasing the risk of hearing alterations and refractoriness to ENT surgical treatment. This highlights the need for a mandatory multidisciplinary approach integrating otorhinolaryngological (surgical or nonsurgical) treatment with aggressive weight and metabolic control strategies.