Behavior and obstructive sleep apnea in children: is obesity a factor?

Laryngoscope. 2007 Aug;117(8):1463-6. doi: 10.1097/MLG.0b013e318063e866.


Objectives: Children with obstructive sleep apnea (OSA) frequently exhibit behavioral and neurocognitive problems. There is a high prevalence of OSA among obese children. This study aims to evaluate the relationship between OSA and behavioral problems in obese children as compared with normal-weight children (controls).

Study design: Prospective, nonrandomized, controlled study of obese and normal-weight children with OSA presenting to a tertiary medical center for adenotonsillectomy.

Methods: All study participants underwent preoperative polysomnography to document OSA. Obesity was defined as age- and sex-adjusted body mass index at the 95th percentile or higher. Behavior was evaluated using the Behavior Assessment System for Children (BASC). Preoperatively, the Behavioral Symptoms Index (BSI), a global measure of behavior, and BASC scores for obese and normal-weight children were compared using an unpaired t test.

Results: The study population included 52 children, 18 (35%) of whom were obese. The mean age of obese children was 8.6 (range, 2.0-14.9) years. The mean age of normal-weight children was 6.4 (range, 2.1-12.9) years. Demographics were otherwise similar. The mean apnea-hypopnea index for obese children was 17.2 (5.0-38.0) and for normal-weight children was 15.7 (5.3-88.0). The BSI score was 55.3 (SD, 15.9) for obese and 55.9 (SD, 15.0) for normal-weight children. Seven (38.9%) obese and 12 (35.3%) normal-weight children had clinically significant or abnormal behavior. Similar results were seen for the BASC scales of atypicality, depression, hyperactivity, and somatization in both groups.

Conclusions: Behavioral problems are highly prevalent in children with OSA. However, these problems exist independently of whether children are obese or normal weight.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Behavior Control / methods
  • Body Mass Index
  • Child
  • Child Behavior*
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Obesity / complications*
  • Obesity / psychology
  • Polysomnography
  • Preoperative Care / methods
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Sleep Apnea, Obstructive / etiology*
  • Sleep Apnea, Obstructive / psychology
  • Tonsillectomy