OBJECTIVE: The clinical significance of continuous paradoxical breathing (CPB) during sleep in patients with obesity, and its relationship to upper airway obstruction versus altered chest wall mechanics is not well-studied. We evaluated the prevalence of CPB and its relationship to obstructive sleep apnea (OSA), BMI, sleep position, sleep stage, O RESULTS: A total of 196 children (125 males and 71 females) were included. The mean (SD) age was 12.8 (3.4) years. Median (interquartile range (IQR)) BMI was 39 (32.5-46.2) kg/m CONCLUSION: CPB is highly prevalent in symptomatic obese children and is likely related to chest wall mechanics and not related to OSA.