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Poor sleep quality and its associated neurocognitive function in children with obesity with or without obstructive
Chun Ting Au1, Giorge Voutsas1,2, Sherri Lynne Katz3,4,5
1Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Poor sleep quality and daytime sleepiness in children with obesity are linked to executive functioning and behavioral issues. Obstructive sleep apnea severity and snoring did not show significant associations with these cognitive outcomes.
Area of Science:
- Pediatric Sleep Medicine
- Neuropsychology
- Childhood Obesity Research
Background:
- Obstructive sleep apnea (OSA) is prevalent in children with obesity, potentially impacting cognitive function.
- Executive functions are crucial for behavior regulation and academic success in children.
- The relationship between OSA, sleep quality, sleepiness, and executive function in obese children requires further elucidation.
Purpose of the Study:
- To investigate the associations between OSA severity, snoring, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity.
- To differentiate the impact of OSA presence and severity versus subjective sleep experiences on cognitive outcomes.
Main Methods:
- Cross-sectional study including 85 children (aged 8-18 years) with obesity and suspected OSA.
- Participants underwent polysomnography and completed validated questionnaires: Pediatric Sleep Questionnaire (SRBD-PSQ), Pittsburgh Sleep Quality Index (PSQI), Behavior Rating Inventory of Executive Function (BRIEF), and Conners-3 Parent Short Form.
- Multiple linear regression analyses were used to assess associations, controlling for covariates.
Main Results:
- Poor subjective sleep quality and greater daytime sleepiness were independently associated with poorer executive functioning (behavioral regulation, metacognition, global executive composite) and increased inattention/hyperactivity symptoms.
- Specifically, poor sleep quality correlated with higher BRIEF and Conners-3 executive functioning/inattention scores, while sleepiness correlated with higher Conners-3 learning problem scores.
- Obstructive sleep apnea severity (mild, moderate-severe) and snoring symptoms were not significantly associated with any of the assessed executive functioning or behavioral outcomes.
Conclusions:
- Subjective sleep quality and daytime sleepiness are significant independent predictors of executive functioning deficits and behavioral problems in children with obesity.
- OSA severity and snoring alone do not appear to be directly linked to these cognitive and behavioral impairments in this population.
- Interventions targeting sleep quality and daytime sleepiness may be beneficial for improving executive function in obese children.
Objective:
To evaluate the associations of OSA severity, snoring symptoms, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity.
Methods:
This was a cross-sectional study of children aged 8-18 years with obesity and symptoms suggestive of OSA. All participants underwent an overnight polysomnography and completed a set of questionnaires to assess their sleep-related breathing disordered (SRBD) symptoms [Pediatric Sleep Questionnaire (SRBD-PSQ)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], executive function [Behavior Rating Inventory of Executive Function (BRIEF)], and inattention and hyperactivity symptoms (Conners-3 Parent Short Form).
Results:
A total of 85 children (62% male, mean age: 13.9 ± 3.0 years) were included in this analysis, of whom 36, 16, and 33 were categorized into the non-OSA (obstructive apnea hypopnea index, OAHI < 1.5/h), mild OSA (OAHI 1.5-5/h), and moderate-severe OSA (OAHI ≥ 5/h) groups, respectively. Of 85 participants, 27 (32%) were classified with poor sleep quality (PSQI composite score ≥ 8). From multiple linear regression analyses, poor sleep quality and sleepiness were both independently associated with higher BRIEF behavioral regulation T-score, metacognition T-score, and global executive composite T-score in the fully adjusted model. In addition, poor sleep quality was also independently associated with higher Conners-3 inattention and executive functioning T-scores, while greater sleepiness was also associated with a higher learning problem T-score. The presence of OSA and snoring were not associated with any cognitive outcomes.
Conclusions:
Subjective sleep quality and daytime sleepiness, but not OSA severity and snoring symptoms, were independently associated with executive functioning and behavioral problems in children with obesity.
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