Background <p>Obstructive sleep apnea (OSA) may induce chronic systemic inflammation, which may serve as a potential mechanism contributing to multiple complications. The timely identification of high inflammatory status (HIS) in pediatric OSA is crucial for effective clinical diagnosis and management. This study aimed to evaluate influencing factors in hsCRP levels, and further investigated the risk factors associated with HIS in pediatric OSA patients.</p> Methods <p>Children aged 3 to 15 years who presented with snoring symptoms and underwent polysomnography (PSG) at the sleep center were included in this study. All participants completed a comprehensive questionnaire, a physical examination, nasopharyngeal X-ray imaging and a blood test. The physical examination included measurements of height, weight, and visual evaluation of tonsillar hypertrophy.</p> Results <p>A total of 1,171 children were enrolled, with 562 cases diagnosed with OSA. Utilizing threshold for hsCRP generated via ROC curve, 299 and 872 children exhibited HIS and Low Inflammatory Status, respectively. Compared to the control group, the hsCRP levels in the OSA group were significantly elevated. Pediatric OSA with HIS had higher BMI and a greater proportion of both overweight and obese. Logistic regression analysis demonstrated that HIS was independently positively correlated with BMI and mean time of obstructive apnea, and negatively associated with minimum SpO₂.</p> Conclusions <p>HsCRP in pediatric OSA patients were notably elevated, whilst identifying BMI, mean time of obstructive apnea, and minimum SpO₂ as independent factors leading to HIS. HsCRP may function as an effective blood index capable of identifying individuals exhibiting HIS linked to OSA.</p>