Citation

Frye SS, Fernandez-Mendoza J, Calhoun SL, Gaines J, Sawyer MD, He F, Liao D, Vgontzas AN, Bixler EO. Int. J. Obes. (NPG) 2018; 42(1): 95-101.

Affiliation

Sleep Research &Treatment Center, Penn State Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA.

Copyright

(Copyright © 2018, International Association for the Study of Obesity, Publisher Nature Publishing Group)

DOI

10.1038/ijo.2017.229

PMID

28924264

Abstract

BACKGROUND/OBJECTIVES: Sleep disordered breathing (SDB) has been associated with neurocognitive and behavioral problems in young children; however, this association is less studied in adolescents. Evidence suggests that obesity plays a key role in the development of SDB, although its relative association with neurobehavioral functioning remains unclear. We examined whether SDB and obesity are associated with neurocognitive and behavior problems in adolescents. SUBJECTS/METHODS: 421 adolescents (17.0±2.2y, 53.9% male) from the Penn State Child Cohort, a general population sample, underwent a 9-hour polysomnography, clinical history, physical examination, neurocognitive evaluation, and Dual-energy X-ray Absorptiometry (DXA) scan, and completed the Child or Adult Behavior Checklist. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI)⩾2, primary snoring (PS) as AHI<2+snoring, and no-SDB as AHI<2 without snoring. Body weight measures included body mass index (BMI) percentile, waist circumference (WC), and DXA-measured total adipose tissue (TAT).

RESULTS: WC and TAT were significantly associated with impaired vigilance, processing speed, working memory, and control interference and greater internalizing and externalizing behaviors, while BMI percentile was marginally associated. SDB per se (PS, AHI, or OSA) was not significantly associated with impaired neurocognitive outcomes or greater behavioral problems. However, TAT was significantly associated with impaired vigilance and greater internalizing and externalizing behaviors and, to a lesser extent, slower processing speed and greater control interference, only in adolescents with OSA.

CONCLUSIONS: Central obesity, an etiopathogenic mechanism of OSA, is more strongly associated with neurocognitive and behavioral problems in adolescents than SDB alone. Deficits in low-order (vigilance) and high-order (executive) functions and behavioral problems observed in adolescents with OSA are primarily associated with increased central adiposity, a finding not entirely captured with less precise measures of obesity. These data support that OSA and its associated neurocognitive and behavioral morbidity are related to underlying metabolic dysfunction as early as adolescence.International Journal of Obesity accepted article preview online, 19 September 2017. doi:10.1038/ijo.2017.229.

Language: en