Neurocognitive and behavioral functioning in adolescents with sleep-disordered breathing: a population-based, dual-energy X-ray absorptiometry study

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.

Weight Spectrum and Executive Function in Adolescents: The Moderating Role of Depression

“…We observed a signi cant association of abdominal, not overall, overweight with EF problems, particularly in the areas of inhibit, emotion control, shift, working memory, and monitor, which was consistent with two prior ndings indicating that waist circumstance or WHtR was more sensitive than BMI indicator when examining the weight-EF association [26,27]. Consistent with our ndings, prior studies also suggested overweight had pronounced effect on the de cits of inhibit control, working memory, cognitive exibility (i.e., shift in our study), as well as high-order EF (e.g., reason, problem-solve, and plan) [8].…”

Childhood obesity, weight loss and developmental trajectories predict the persistence and remission of childhood sleep‐disordered breathing

“…The presence of childhood OSA was determined if AHI was ≥2 events/hour. This cut-off was based on the recent CHAT study (7) and commensurate with our previous studies (9,19). The reference group was comprised of subjects without childhood SDB (i.e.…”

Neurobehavioral Outcomes in School-Aged Children with Primary Snoring

“…As a result, some of the included children may also have OSA in addition to snoring (Arman et al, 2005;Brockmann et al, 2012a;O'Brien et al, 2011). In some studies, PSG was performed to exclude OSA, but snoring was not verified (Beebe et al, 2010;Biggs et al, 2011;Bourke et al, 2011ab;Jackman et al, 2012;Morsbach Honaker et al, 2009;Smith et al, 2016;Smith et al, 2017) or the amount of snoring was not quantified (Ali et al, 1993;Blunden et al, 2000;Calhoun et al, 2009;Frye et al, 2018;Kennedy et al, 2004;Miano et al, 2011;O'Brien et al, 2004). To the best of our knowledge, snoring time has been quantified in only one previous study that reported that memory consolidation does not differ between children with PS and healthy subjects (Maski et al, 2017).…”