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We examined the association between BMI trajectories from childhood to middle age and adult OSA, 10\u2009years later.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five BMI trajectories were previously identified in the population\u2010based cohort Tasmanian Longitudinal Health Study (TAHS), using eight time\u2010point BMI from age 5 to 43\u2009years. The primary outcome was probable OSA at 53\u2009years, defined using STOP\u2010Bang questionnaire, with Berlin and OSA\u201050 questionnaires used to ensure consistency of findings. Clinically significant diagnosed OSA was defined as self\u2010reported medical diagnosis or mild OSA with symptoms or moderate\u2010to\u2010severe OSA, using type\u20104 sleep studies. Associations were examined using multivariable logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared with the <jats:italic>average<\/jats:italic> BMI trajectory, the <jats:italic>child average\u2010increasing<\/jats:italic> (aOR\u2009=\u20095.28, 95% CI 3.38\u20138.27) and persistently <jats:italic>high<\/jats:italic> trajectories (aOR\u2009=\u20093.73, 2.06\u20136.74) were associated with increased risk of probable OSA. These associations were consistent when using clinically significant diagnosed OSA (<jats:italic>child average\u2010increasing<\/jats:italic> trajectory: aOR\u2009=\u20092.95, 1.30\u20136.72; <jats:italic>high<\/jats:italic> trajectory: aOR\u2009=\u20092.23, 0.82\u20136.09). Individuals belonging to the <jats:italic>low<\/jats:italic> trajectory were less likely than the <jats:italic>average<\/jats:italic> trajectory to have OSA. Notably, the <jats:italic>child high\u2010decreasing<\/jats:italic> trajectory was not associated with OSA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Physicians and the public should be aware of the potential risk of OSA in middle\u2010aged adults when BMI is high or continuously increasing from childhood to mid\u201040s. Obese children who subsequently lose weight were not at higher risk of OSA in middle age\u2014a novel and key finding.<\/jats:p><jats:p>\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70002-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.70002","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T13:40:42Z","timestamp":1739281242000},"page":"435-445","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Early\u2010to\u2010Midlife Body Mass Index Trajectories and Obstructive Sleep Apnoea Risk 10\u2009Years Later"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-1869","authenticated-orcid":false,"given":"Yaoyao","family":"Qian","sequence":"first","affiliation":[{"name":"Allergy and Lung Health Unit, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7034-0615","authenticated-orcid":false,"given":"Jennifer L.","family":"Perret","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"},{"name":"The Institute for Breathing and Sleep (IBAS)  Melbourne Victoria Australia"},{"name":"Department of Respiratory and Sleep Medicine Austin Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1744-2839","authenticated-orcid":false,"given":"Garun S.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Monash Lung, Sleep, Allergy &amp; Immunology Monash Health  Melbourne Victoria Australia"},{"name":"School of Clinical Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9954-0538","authenticated-orcid":false,"given":"Michael J.","family":"Abramson","sequence":"additional","affiliation":[{"name":"School of Public Health &amp; Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline J.","family":"Lodge","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4388-784X","authenticated-orcid":false,"given":"Dinh S.","family":"Bui","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7376-9561","authenticated-orcid":false,"given":"Gulshan B.","family":"Ali","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anurika P.","family":"De Silva","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"},{"name":"Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Adams","sequence":"additional","affiliation":[{"name":"Adelaide Institute for Sleep Health (AISH) Flinders University  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-0652","authenticated-orcid":false,"given":"Bruce R.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Melbourne School of Health Science The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bircan","family":"Erbas","sequence":"additional","affiliation":[{"name":"School of Psychology &amp; 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