Original Article
Relationships among Obstructive Sleep Apnea, Anthropometric Measures, and Neurocognitive Functioning in Adolescents with Severe Obesity

https://doi.org/10.1016/j.jpeds.2011.10.029Get rights and content

Objective

To explore associations between measures of obstructive sleep apnea (OSA) and sleep quality, anthropometrics, and neurocognitive functioning in severely obese adolescents.

Study design

This was a cross-sectional pilot study performed at an academic medical center in 37 severely obese (body mass index [BMI] >97th percentile) adolescents. Study evaluations included polysomnography, BMI, waist circumference, and standardized neurocognitive tests to assess memory, executive functioning, psychomotor efficiency, academic achievement, and an approximation of full-scale IQ. Outcome data were evaluated categorically, based on clinical criteria for the diagnosis of OSA, and continuously to quantify associations between sleep parameters, anthropometrics, and neurocognitive test results.

Results

Sleep fragmentation and poorer sleep quality were associated with reduced psychomotor efficiency, poorer memory recall, and lower scores on standardized academic tests. Having evidence of OSA was associated with lower math scores, but not with other neurocognitive measures. BMI and waist circumference were negatively associated with oxygen saturation.

Conclusion

Our pilot study findings suggest that sleep fragmentation and poorer sleep quality have implications for neurocognitive functioning in obese adolescents. The epidemic of childhood obesity has dire implications, not only for increasing cardiometabolic pathology, but also for possibly promoting less readily apparent neurologic alterations associated with poor sleep quality.

Section snippets

Methods

The study was approved by the University of Pittsburgh’s Institutional Review Board and was performed in the Pediatric Clinical and Translational Research Center at Children’s Hospital of Pittsburgh. Patients referred for evaluation of obesity who met the study criteria were invited to participate. After obtaining informed assent/consent, we studied 37 severely obese (BMI >97th percentile), nondiabetic, otherwise healthy adolescents (eligible age range, 12-18 years; mean age, 14.5 ± 1.7 years;

Results

Mean total sleep time was 420 ± 5.3 minutes (range, 354-484 minutes). Thirty-three participants snored (90%). Twenty had no evidence of apnea/hypopnea (AHI <1.5), and 17 had some degree of OSA (9 with an AHI ≥1.5 to <5, 2 with an AHI ≥5 to <10, and 6 with an AHI ≥10). AHI was positively associated with the arousal index (r = 0.45; P = .005) and negatively associated with sleep time (r = −0.34; P = .039), sleep efficiency (r = −0.66; P < .001), and mean and minimum oxygen saturation (rmean = −0.73, P < .001 and r

Discussion

We report that in severely obese adolescents, sleep fragmentation is associated with reduced psychomotor efficiency and lower scores on standardized vocabulary testing, and poorer sleep efficiency is associated with poorer memory recall and lower spelling scores. These findings indicate that clinically unrecognized sleep disruption leading to poorer sleep quality has implications for the neurocognitive functioning of obese adolescents. Having evidence of OSA also appears to be associated with

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Supported by the Pittsburgh Foundation (grant M2007-0064, to T.H.), the Children’s Hospital of Pittsburgh Research Advisory Committee (to T.H.), a National Institutes of Health Postdoctoral Training Fellowship (T32-HD049354, to D.R.), a National Institutes of Health Career Development Award (K12-HD043441/K23HD061598, to D.R.), the State Tobacco Fund–Pittsburgh Mind-Body Center (HL076852/076858, to D.R.), the US Public Health Service (grants R03HD057532, to T.H.; K24-HD01357, to S.A.; and K12-DK063704, to T.H. and S.A.), and the Pediatric Clinical and Translational Research Center at Children’s Hospital of Pittsburgh (National Institutes of Health/National Center for Research Resources/Clinical and Translational Science Awards grant UL1-RR024153). The authors declare no conflicts of interest.

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