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Introduction: Obesity and obstructive sleep apnea syndrome in children have been strongly and independently associated with metabolic and cardiovascular morbidities. Aim: To evaluate the presence of metabolic alterations among obese children recruited from the community. Methods: A cross-sectional, prospective multicenter study of Spanish children aged 3 – 14 years-old with a body mass index (BMI)≥ 95th percentile for age and sex were randomly selected in the first phase of this study. Four groups were obtained for follow-up:(1) No treatment; (2) Dietary intervention; (3) surgical treatment of OSA; (4) CPAP treatment of OSA. We performed fasting blood tests at baseline (T0) and ∼1-year follow-up after the intervention (T1). Results: 113 obese children with a mean age of 11.3±2.9 years completed T0 and T1 assessments within 11.8±4.1 months. Their mean BMI at T0 was 27.6±4.7 kg/m2, and mean respiratory disturbance index was 8.56±12.97 at T0 and 3.29 ± 3.99/hr TST at T1. Significant univariate associations between BMI and C reactive protein (CRP), insulin and HOMA emerged at both T0 and T1 for the whole cohort. To assess potential metabolic characteristics that independently associated with OSA incidence, OSA persistence, or residual OSA, stepwise logisitc regression models were performed, but did not reach statistical significance. However, HOMA index was a predictor of incident (OR: 1.97) and persistent OSA (OR:1.10), while CRP emerged as a predictor of residual OSA (OR:1.41). Conclusions: (1) Concurrent obesity and OSA promotes metabolic and inflammatory alterations. (2) Specific metabolic alterations appear to behave as predictors of incident, persistent and residual OSA in obese children. Funded by SEPAR.