Dietary behavior and its association with sleep-disordered breathing symptoms in Taiwanese children.

BACKGROUND

Sleep-disordered breathing (SDB) is highly prevalent in children and is associated with significant cognitive, metabolic, and quality-of-life (QOL) impairments. While obesity is a primary risk factor, the role of specific dietary behaviors as independent, modifiable contributors to SDB symptom severity remains underexplored.

PURPOSE: We aimed to (1) examine the association between dietary intake and SDB symptom severity in children, and (2) develop and validate a dietary-based prediction model for moderate-to-severe SDB (msSDB).

METHODS

This cross-sectional study analyzed baseline data from 406 children (aged 5.0-12.9 years) with and without SDB symptoms. Caregivers completed a validated 25-item Short Food Frequency Questionnaire to assess dietary intake. SDB symptom severity was measured using the obstructive sleep apnea (OSA)-18 questionnaire, with a total score ≥ 60 defining msSDB. Multivariable regression models were used to identify dietary associations. A dietary prediction score was developed and its performance assessed using receiver operating characteristic (ROC) analysis, followed by external validation in a separate cohort (n = 24).

RESULTS

Among 406 participants (mean [SD] age, 8.0 [2.1] years; 174 girls [42.9%]), 80 children (19.7%) had msSDB. Higher intake of orange juice, sweets, chocolate, rice, and processed meats was significantly associated with greater total OSA-18 scores and worse subscale scores across domains. Conversely, fish for dinner and savory snacks were inversely associated with symptom burden. A dietary prediction model demonstrated acceptable discrimination for msSDB (area under the ROC curve [AUC] = 0.78; 95% CI, 0.72-0.84). The model showed 79.6% accuracy, 56.3% sensitivity, and 85.3% specificity, with comparable performance in the validation cohort.

CONCLUSIONS

Specific dietary behaviors are associated with SDB symptom severity in children. A simple dietary-based score can help identify children at risk for clinically significant SDB, supporting the investigation of dietary interventions in pediatric SDB management.