Associations of Sleep-Related Outcomes with Behavioral and Emotional Functioning in Children with Overweight/Obesity

Lucia V Torres-Lopez,Cristina Cadenas-Sanchez,Jairo H Migueles,Pontus Henriksson,Marie Löf,Francisco B Ortega

doi:10.1016/j.jpeds.2022.03.006

Lucia V Torres-Lopez, Cristina Cadenas-Sanchez + Show 4 more

Open Access

https://doi.org/10.1016/j.jpeds.2022.03.006

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Abstract

To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and device-assessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/obesity. A total of 109 children with overweight/obesity (mean age, 10.0±1.1years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). SDB was positively associated with all clinical scale variables (all β>0.197, P≤.041) and with lower adaptability and leadership (all β<-0.226, P<.021). Specifically, the PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat (all β>0.196, P≤.045) and lower adaptability (β=-0.246, P=.011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all β>|0.192|, P≤.046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. Our study suggests that SDB symptoms, but not device-assessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability.

Highlights

Study design A total of 109 children with overweight/obesity were included in this cross-sectional study
The Pediatric Sleep Questionnaire (PSQ) subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat and lower adaptability (b = À0.246, P = .011)
Our study suggests that sleep-disordered breathing (SDB) symptoms, but not device

Summary

Introduction

Study design A total of 109 children with overweight/obesity (mean age, 10.0 Æ 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership)

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