Obstructive sleep apnea (OSA) significantly impairs autonomic function and quality of life (QoL) in children, with overweight and obesity being notable risk factors. This retrospective cohort study examines the effects of weight status on sleep heart rate variability (HRV) and disease-specific QoL in 115 children, predominantly boys (77%), aged 7.4 ± 1.9 years. Supported by grants from the National Science and Technology Council, Taiwan (grant numbers: 109-2314-B-182-083-MY3, 111-2314-B-182-019-MY2), and the Chang Gung Medical Foundation, Taiwan (grant number CMRPG3F1091-3), the study included participants with a mean body mass index (BMI) z-score of 0.50 ± 1.82 and an apnea-hypopnea index (AHI) of 10.93 ± 13.21 events/hour, spanning from 2017 to 2024. Assessments involved standard in-laboratory polysomnography, sleep HRV measurements, and the OSA-18 QoL questionnaire. Analysis showed that overweight/obese children (BMI z-score ≥ 1, WHO guidelines; n = 50 [43%]) had significantly higher mean age, height, weight, blood pressure, AHI, and arousal index, yet similar total sleep time, sleep stages, and blood oxygen saturation as their normal-weight counterparts (n = 65 [57%]) (all p < 0.05). Importantly, HRV indicators—total power, ultra-low frequency power, and high frequency power—were significantly diminished in the overweight/obese group, with an increased low frequency/high frequency ratio. Multivariable

linear regression models with forward selection procedures demonstrated that body weight significantly impacted total power, ultra-low frequency power, and low frequency/high frequency ratio but did not affect OSA-related QoL. These findings suggest that weight status predominantly affects sleep HRV rather than disease-specific QoL in children with OSA. The results underscore the need for further research into how weight management might improve sleep autonomic functions in this population

Professor Li-Ang Lee is a distinguished Clinical Professor at the School of Medicine, Chang Gung University, Taoyuan, Taiwan, where he holds multiple esteemed positions across several institutions. He serves as the Vice Director at the School of Medicine, National Tsing Hua University, Hsinchu, Taiwan, and is deeply involved in the Division of Laryngology at the Department of Otorhinolaryngology, Head and Neck Surgery at the Linkou Chang Gung Memorial Hospital. Professor Lee's expertise spans a broad spectrum of areas including Otorhinolaryngology, Head and Neck Surgery, Sleep Medicine, and Medical Education. His academic career is complemented by significant editorial roles such as Associate Editor for Frontiers in Oncology, Reviewing Editor for Frontiers in Medicine, and

Editorial Board Member of Plos One. Noteworthy among his achievements are multiple awards from the International College of Surgeons, Taiwan Section, reflecting his substantial contributions to medical science and education. His extensive training includes a PhD in Brain Science from the National Yang Ming Chiao Tung University and a

Master's degree in Medical Education from Chang Gung University. Professor Lee's impressive academic and professional journey is documented by over 175 SCI publications and several key board certifications, underlining his profound impact on the fields of medicine and surgery