Biggs Sarah N, Tamanyan Knarik, Walter Lisa M, Weichard Aidan J, Davey Margot J, Nixon Gillian M, Horne Rosemary S C
The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia.
The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia.
Sleep Med. 2017 Nov;39:62-69. doi: 10.1016/j.sleep.2017.09.001. Epub 2017 Sep 18.
This study aimed to determine whether overweight and obesity increased the detrimental effects of pediatric sleep-disordered breathing (SDB) on cognition, behavior, mood, and quality of life.
Children and adolescents (8-16 years) with clinically diagnosed SDB were categorized into two groups: healthy weight (Body Mass Index (BMI) z-score <1.04, N = 11) and overweight/obese (BMI z-score ≥ 1.04, N = 10). Age-matched healthy weight, non-snoring controls (N = 25) were recruited from the community. All participants underwent overnight laboratory polysomnography (PSG). Cognitive, behavioral, and quality of life assessments were conducted in the home following the PSG. Analysis of Covariance (ANCOVA) was used to assess group differences in cognitive outcomes, controlling for socio-economic status. Kruskal-Wallis ANOVA was used to determine group differences in behavior and quality of life. Where group differences were found, hierarchical linear regressions determined the effect of weight on outcomes.
Children with SDB had significantly poorer behavior and quality of life than controls, with overweight/obese children with SDB having the greatest dysfunction. No group differences were found in cognitive outcomes. The obstructive apnea hypopnea index (OAHI) was a significant predictor of withdrawn behavior (R = 0.42), inattention (R = 0.43), and aggressive behavior (R = 0.30). BMI z-score added significantly to aggressive behavior (R = 0.22) and was an independent predictor of externalizing behaviors (R = 0.26). The OAHI predicted school functioning (R = 0.30). BMI z-score predicted social functioning (R = 0.38) and significantly added to physical functioning over the OAHI (OAHI R = 30; BMI z-score R = 0.37).
Overweight and obesity comorbid with SDB increase the risk of externalizing behaviors such as aggression but do not affect other behavioral associates of SDB such as inattention and school functioning.
本研究旨在确定超重和肥胖是否会增加小儿睡眠呼吸障碍（SDB）对认知、行为、情绪和生活质量的有害影响。
将临床诊断为SDB的儿童和青少年（8 - 16岁）分为两组：健康体重组（体重指数（BMI）z评分<1.04，N = 11）和超重/肥胖组（BMI z评分≥1.04，N = 10）。从社区招募年龄匹配的健康体重、不打鼾的对照组（N = 25）。所有参与者均接受夜间实验室多导睡眠图（PSG）检查。PSG检查后，在家庭中进行认知、行为和生活质量评估。采用协方差分析（ANCOVA）评估认知结果的组间差异，并对社会经济地位进行控制。采用Kruskal - Wallis方差分析确定行为和生活质量的组间差异。当发现组间差异时，采用分层线性回归确定体重对结果的影响。
患有SDB的儿童的行为和生活质量明显比对照组差，超重/肥胖的SDB儿童功能障碍最为严重。在认知结果方面未发现组间差异。阻塞性呼吸暂停低通气指数（OAHI）是退缩行为（R = 0.42）、注意力不集中（R = 0.43）和攻击性行为（R = 0.30）的重要预测指标。BMI z评分对攻击性行为有显著影响（R = 0.22），是外化行为的独立预测指标（R = 0.26）。OAHI可预测学校功能（R = 0.30）。BMI z评分可预测社会功能（R = 0.38），并在OAHI基础上对身体功能有显著影响（OAHI的R = 0.30；BMI z评分的R = 0.37）。
与SDB合并存在的超重和肥胖会增加攻击性行为等外化行为的风险，但不会影响SDB的其他行为关联因素，如注意力不集中和学校功能。
