title: Neurobehavioral functioning in adolescents with and without obesity and obstructive sleep apnea.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional, case control.
  
  
  METHODS
  Sleep Center and community.
  
  
  METHODS
  Obese adolescents with OSAS compared to (1) nonsnoring, obese controls without OSAS, and (2) nonobese, nonsnoring controls.
  
  
  METHODS
  Neurobehavioral evaluation.
  
  
  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.
authors.affiliation: 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.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Xanthopoulos
authors.affiliation: Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.affiliation: Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Berkowitz
authors.affiliation: Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jerilynn
authors.initials: J
authors.lastname: Radcliffe
authors.affiliation: Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bradford
authors.affiliation: Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D001288:Attention / Q000502:physiology; D001835:Body Weight; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000503:physiopathology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D012894:Sleep Stages / Q000502:physiology; D013851:Thinness / Q000150:complications / Q000503:physiopathology / Q000523:psychology
keywords: children; cognition; sleep disordered breathing