Overweight and obesity add to behavioral problems in children with sleep-disordered breathing

Objective 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. Methods 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. Results 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 The obstructive apnea hypopnea index (OAHI) was a significant predictor of withdrawn behavior (R² = 0.42), inattention (R² = 0.43), and aggressive behavior (R² = 0.30). BMI z-score added significantly to aggressive behavior (R² = 0.22) and was an independent predictor of externalizing behaviors (R² = 0.26). The OAHI predicted school functioning (R² = 0.30). BMI z-score predicted social functioning (R² = 0.38) and significantly added to physical functioning over the OAHI (OAHI R² = 30; BMI z-score R² = 0.37). Conclusions 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.