Xanthopoulos Melissa S, Gallagher Paul R, Berkowitz Robert I, Radcliffe Jerilynn, Bradford Ruth, Marcus Carole L
Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA.
Sleep. 2015 Mar 1;38(3):401-10. doi: 10.5665/sleep.4498.
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.
Cross-sectional, case control.
Sleep Center and community.
Obese adolescents with OSAS compared to (1) nonsnoring, obese controls without OSAS, and (2) nonobese, nonsnoring controls.
Neurobehavioral evaluation.
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.
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.
患有阻塞性睡眠呼吸暂停综合征（OSAS）的儿童和成人存在神经行为异常，但很少有研究评估青春期这一过渡阶段。肥胖也与神经行为异常有关，许多OSAS患者都肥胖。然而，肥胖对OSAS青少年神经行为异常的混杂影响尚未得到评估。我们假设，患有OSAS的肥胖青少年比没有OSAS的肥胖和瘦青少年表现出更多的神经行为异常。
横断面病例对照研究。
睡眠中心和社区。
患有OSAS的肥胖青少年与（1）不打鼾的肥胖OSAS对照组，以及（2）非肥胖、不打鼾的对照组进行比较。
神经行为评估。
与肥胖（P < 0.001）和瘦（P < 0.001）对照组相比，患有OSAS的肥胖青少年的执行功能和注意力明显更差，且比瘦对照组有更多的抑郁（P = 0.004）和外化症状（P = 0.008）。OSAS组中在执行功能、注意力、嗜睡和行为功能方面临床异常范围内得分的参与者比例高于瘦对照组。中介分析表明，睡眠呼吸暂停程度显著介导了体重对执行功能、注意力和行为的影响。
与肥胖和瘦对照组相比患有OSAS的肥胖青少年表现出执行和行为功能受损，并且在神经行为功能测量中更有可能在临床异常范围内得分。鉴于在这个关键年龄阶段额叶仍在发育，这些结果尤其令人担忧。我们推测青春期未经治疗的OSAS可能导致成年期出现明显的神经行为缺陷。
