Neurobehavioral functioning in adolescents with and without obesity and obstructive sleep apnea

Sleep. 2015 Mar 1;38(3):401-10. doi: 10.5665/sleep.4498.


Study objectives: Children and adults with obstructive sleep apnea syndrome (OSAS) exhibit neurobehavioral abnormalities, but few studies have evaluated the transitional stage of adolescence. Obesity is also associated with neurobehavioral abnormalities, and many patients with OSAS are obese. However, the confounding effect of obesity on neurobehavioral abnormalities in adolescents with OSAS has not been evaluated. We hypothesized that obese adolescents with OSAS would exhibit more neurobehavioral abnormalities than obese and lean adolescents without OSAS.

Design: Cross-sectional, case control.

Setting: Sleep Center and community.

Participants: Obese adolescents with OSAS compared to (1) nonsnoring, obese controls without OSAS, and (2) nonobese, nonsnoring controls.

Interventions: Neurobehavioral evaluation.

Measurements and results: Obese adolescents with OSAS had significantly worse executive function and attention compared to both obese (P < 0.001) and lean (P < 0.001) controls, and more depression (P = 0.004) and externalizing symptoms than lean controls (P = 0.008). A higher percentage of participants in the OSAS group scored in the clinically abnormal range on executive functioning, attention, sleepiness, and behavioral functioning than lean controls. Mediation analyses indicated that level of sleep apnea significantly mediated the effect of body mass on executive functioning, attention, and behavior.

Conclusions: Obese adolescents with OSAS show impaired executive and behavioral function compared to obese and lean controls, and are more likely to score in the clinically abnormal range on measures of neurobehavioral functioning. These results are especially concerning given that the frontal lobe is still developing during this critical age period. We speculate that untreated OSAS during adolescence may lead to significant neurobehavioral deficits in adulthood.

Keywords: children; cognition; sleep disordered breathing.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attention / physiology
  • Body Weight
  • Case-Control Studies
  • Child
  • Cross-Sectional Studies
  • Depression / complications
  • Depression / physiopathology
  • Executive Function / physiology*
  • Female
  • Humans
  • Male
  • Obesity / complications*
  • Obesity / physiopathology
  • Obesity / psychology*
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / physiopathology*
  • Sleep Apnea, Obstructive / psychology*
  • Sleep Stages / physiology
  • Thinness / complications
  • Thinness / physiopathology
  • Thinness / psychology