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

International Journal of Obesity volume 42, pages 95–101 (2018)Cite this article

Subjects

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 behavioral problems in adolescents.

Subjects/Methods:

A total of 421 adolescents (17.0±2.2y, 53.9% male) from the Penn State Child Cohort, a general population sample, underwent a 9-h 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.

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Acknowledgements

This study was partially supported by US National Institutes of Health grants R01 HL63772, R01 HL97165, UL1 RR033184, C06 RR16499.

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Authors and Affiliations

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

    S S Frye, J Fernandez-Mendoza, S L Calhoun, J Gaines, A N Vgontzas & E O Bixler

  2. Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA

    M D Sawyer, F He & D Liao

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  1. S S Frye
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Correspondence to J Fernandez-Mendoza.

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Frye, S., Fernandez-Mendoza, J., Calhoun, S. et al. Neurocognitive and behavioral functioning in adolescents with sleep-disordered breathing: a population-based, dual-energy X-ray absorptiometry study. Int J Obes 42, 95–101 (2018). https://doi.org/10.1038/ijo.2017.229

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