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Understanding how these traits vary by age and sex could provide insights into respiratory system development. This study aims to examine the association of age and sex with endotypic traits in children and adolescents with OSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Between April 2020 and September 2024, we prospectively enrolled 88 patients aged \u2264\u200918\u2009years who were referred to a single clinical sleep center in Taiwan for in\u2010laboratory diagnostic polysomnography. Patients with an apnea\u2010hypopnea index (AHI) \u2265\u20091\u2009h\n                      <jats:sup>\u22121<\/jats:sup>\n                      were included. Endotypic traits were estimated using polysomnographic signals. Linear regression analysis was performed to assess the associations of endotypic traits with AHI, age, and sex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Poor compensation, worse collapsibility, and high loop gain were associated with higher AHI, with compensation explaining the largest variance (12.85%) among all endotypic traits. Patients older than 12\u2009years exhibited a more compromised upper airway (\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>min<\/jats:sub>\n                      : 64.3 vs. 71.4% eupnea) and higher loop gain (LG\n                      <jats:sub>1<\/jats:sub>\n                      : 0.45 vs. 0.34) than younger patients, independent of AHI. No significant sex differences in endotypic traits were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In addition to upper airway collapsibility, inadequate compensatory activity of the dilator muscles significantly contributed to higher AHI in paediatric patients with OSA. The age\u2010related decrease in upper airway patency may result from the interplay between upper airway and craniofacial development.\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70128-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/resp.70128","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T08:51:27Z","timestamp":1757667087000},"page":"91-99","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pathological Endotypic Traits of Paediatric Obstructive Sleep Apnea: Age and Sex Differences"],"prefix":"10.1111","volume":"31","author":[{"given":"Chien\u2010Heng","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Pediatric Pulmonology and Critical Care Medicine China Medical University Children's Hospital  Taichung Taiwan"},{"name":"Department of Biomedical Imaging and Radiological Science, College of Health Care China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3237-5491","authenticated-orcid":false,"given":"Liang\u2010Wen","family":"Hang","sequence":"additional","affiliation":[{"name":"College of Medicine China Medical University  Taichung Taiwan"},{"name":"Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7396-0713","authenticated-orcid":false,"given":"Eysteinn","family":"Finnsson","sequence":"additional","affiliation":[{"name":"Nox Research, Nox Medical EHF  Reykjav\u00edk Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4309-6439","authenticated-orcid":false,"given":"J\u00f3n S.","family":"\u00c1g\u00fastsson","sequence":"additional","affiliation":[{"name":"Nox Research, Nox Medical EHF  Reykjav\u00edk Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3752-0328","authenticated-orcid":false,"given":"Scott A.","family":"Sands","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4510-7584","authenticated-orcid":false,"given":"Wan\u2010Ju","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Psychiatry China Medical University Hospital  Taichung Taiwan"},{"name":"Department of Public Health China Medical University  Taichung Taiwan"},{"name":"National Center for Geriatrics and Welfare Research National Health Research Institutes  Zhunan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200708-135MG"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2020.01.002"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2017.06.011"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000001119"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2014.08.001"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215881"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1203\/01.PDR.0000147565.74947.14"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsz130"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1998.84.6.1926"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3844"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00045.2008"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202203-271OC"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsae185"},{"key":"e_1_2_9_15_1","first-page":"487","article-title":"Gender Issues in Obstructive Sleep Apnea","volume":"94","author":"Geer J. 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