title: Behavior and obstructive sleep apnea in children: is obesity a factor?
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA. emilyrudnick@yahoo.com
authors.forename: Emily F
authors.initials: EF
authors.lastname: Rudnick
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D032763:Behavior Control / Q000379:methods; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications* / Q000523:psychology; D017286:Polysomnography; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000523:psychology; D014068:Tonsillectomy