Overweight and obesity adds to behavioral problems in children with sleep disordered breathing

Publication date: Available online 17 September 2017
Source:Sleep Medicine
Author(s): Sarah N. Biggs, Knarik Tamanyan, Lisa M. Walter, Aidan J. Weichard, Margot J. Davey, Gillian M. Nixon, Rosemary SC. Horne
ObjectiveThis study aimed to determine whether overweight and obesity increased the detrimental effects of pediatric sleep disordered breathing (SDB) on cognition, behavior, mood and quality of life.MethodsChildren and adolescents (8-16y) with clinically diagnosed SDB were categorized into two groups: healthy weight (BMI z-score <1.04, N=11) and overweight/obese (BMI z-score ≥ 1.04, N=10). Age-matched healthy weight, non-snoring Controls (N=25) were recruited from the community. All participants underwent overnight laboratory polysomnography (PSG). Cognitive, behavioral, and quality of life assessments were conducted in the home following the PSG. ANCOVA assessed group differences in cognitive outcomes, controlling for socio-economic status. Kruskal-Wallis ANOVA determined group differences in behavior and quality of life. Where group differences were found, hierarchical linear regressions determined the effect of weight on outcomes.ResultsChildren with SDB had significantly poorer behavior and quality of life than Controls, with overweight/obese children with SDB having the greatest dysfunction. No group differences were found in cognitive outcomes. The obstructive apnea hypopnea index (OAHI) was a significant predictor of withdrawn behavior (R²=0.42), inattention (R²=0.43) and aggressive behavior (R²=0.30). BMI z-score added significantly to aggressive behavior (R²=0.22) and was an independent predictor of externalizing behaviors (R²=0.26). OAHI predicted school functioning (R²=0.30). BMI z-score predicted social functioning (R²=0.38) and significantly added to physical functioning over OAHI (OAHI R²=30; BMI z-score R²=0.37).ConclusionsOverweight and obesity comorbid with SDB increases the risk of externalizing behaviors such as aggression, but does not affect other behavioral associates of SDB such as inattention and school functioning.



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