# A Scientometric Review of Obstructive Sleep Apnea and Obesity
## 4 Discussion
### Cluster #5: Childhood Obesity and OSA and Cluster #4: Pediatric Obstructive Sleep Apnea  
Cluster #5 and cluster #4 will be discussed together in this section as they both address OSA in childhood. However, they do so under a different light. On the one hand, documents in cluster #5 discuss the occurrence and the clinical manifestations of OSA in childhood. On the other hand, documents in cluster #4 were interested in the treatment and management of OSA in children. The major citing articles in cluster #5 \"Childhood obesity and OSA\" were authored by [PERSON] and [PERSON] [115], with a coverage of 15 articles and a GCS of 138; [PERSON] and [PERSON] [54], with a coverage of 14 articles and a GCS of 146; and [PERSON] and [PERSON] [116], with a coverage of 14 articles and a GCS of 56. The main theme of the cluster appears to be the occurrence of OSA with a focus on the population of children with obesity. This is not surprising, due to research on this relation in obese adults as well as the surging childhood obesity rates across the world. Notably, the occurrence of OSA seems to be the prevalent clinical presentation in children with obesity [115] where some studies have reported a prevalence of up to 45% in children with obesity [117]. The majority of citing articles focus on obesity and OSA in children (e.g., [118; 119; 120; 121; 122; 123; 124]) including the major citing articles mentioned above [54; 115; 116]. Similarly, the cited references are mainly studies on the effects and clinical outcomes of children with OSA such as increased inflammation levels (e.g., [125; 126; 127; 128; 129]), negative cardiovascular consequences such as hypertension (e.g., [130; 131; 132; 133; 134]) and metabolic consequences (e.g., [135; 136]). Interestingly, in the cluster, [PERSON] and [PERSON] [137] proposed a developmental perspective in framing the pathophysiology of upper airway obstruction which leads to OSA. In their developmental perspective, the authors consider that overall OSA is caused by a restriction in the anatomic airway and atypical upper airway neuromotor tone combined. On the one hand, as the authors argue, a reduction in the anatomic airway is typically observed independently from the age of the patient with OSA. On the other hand, upper airway neuromotor tone and reflexes during sleep vary throughout the lifespan and are superior in typical children as compared to adults to compensate for their smaller airway. It is noteworthy that upper airway neuromotor tone and reflexes during sleep are attenuated in children with OSA. The major citing articles in cluster #4 \"Pediatric obstructive sleep apnea\" were authored by [PERSON] et al. [138], with a coverage of 14 articles and a GCS of 31; [PERSON] and [PERSON] [139], with a coverage of 14 articles and a GCS of 21; and [PERSON] et al. [127], with a coverage of 13 articles and a GCS of 21. Cluster #4 appears to be a rapidly emerging cluster indicating the direction of attention towards the clinical presentation, treatment, and management of OSA in children as indicated by the citing articles [140; 141; 142; 143] and cited references [144; 145; 146; 62; 119]. Particularly, [PERSON] and [PERSON] [139] wrote a comprehensive review outlining the evaluation and management of children with complex medical comorbidities. In particular, the authors propose that all children should be screened for OSA and that referral to sleep expert or paediatric otolaryngologist and polysomnography, cardiology, and endocrinology evaluations should be conducted especially for those considered to be high-risk. In the cluster, there seems to be a number of studies concerned with the prognosis and post-operation outcomes relating to tonsillectomy and adenotonsillectomy in both the citing articles [147; 148; 149] and cited references [150; 58; 151], which is most likely due to the fact that adenotonsillectomy is one of the most commonly conducted surgical procedures in children for OSA treatment [152].