Among children with obesity, health-related quality of life (HRQOL) was more strongly associated with subjective sleep quality compared with obstructive sleep apnea (OSA), researchers reported in the Journal of Clinical Sleep Medicine.
The researchers conducted a cross-sectional study sought to determine the independent association of OSA and sleep quality with HRQOL in children with obesity. Participants, who were prospectively recruited from 2 Canadian centers between 2015 and 2021, were children aged 8 to 17 years with obesity who were referred for evaluation of suspected sleep-disordered breathing.
HRQOL was assessed with use of the self-reported Pediatric Quality of Life Inventory (PedsQL generic version), and sleep quality was assessed with the self-reported Pittsburgh Sleep Quality Index (PSQI).
The analysis included 98 children (44% female), with a median age at polysomnogram (PSG) of 15.0 (interquartile range [IQR], 13.0-16.0) years. The children’s median body mass index z-score (BMIz) was 3.8 (IQR, 3.1-4.6). Of the cohort, 49 children (50%) reported poor sleep quality, and 41 (42%) had a diagnosis of OSA on a baseline PSG (obstructive apnea-hypopnea index ≥5/hour).
The participants had a mean (SD) PedsQL score of 67.5 (16.2) and 53% of the children reported impaired HRQOL.
The mean PedsQL score was 61.9 (SD 13.7) for children who had poor sleep quality and 73.1 (SD 16.8) in children with good sleep quality. Poor sleep quality had an independent association with total PedsQL score and psychosocial functioning after adjustment for age, sex, OSA, attention-deficit/hyperactivity disorder (ADHD), mood/anxiety disorder, and study site.
Poor sleep quality was associated with a reduction in total PedsQL score of 8.8 points (95% CI, 2.6-14.9; P =.006) and a 10.4-point reduction in psychosocial functioning score (95% CI, 3.9-16.9; P =.002). OSA was not associated with total PedsQL score, psychosocial functioning, or physical functioning.
Multivariable analysis showed that a 1-point increase in BMIz was associated with a 3.2-point decrease in physical functioning scores (95% CI, 0.2-6.3; P =.040).
ADHD was associated with a decrease in total PedsQL score in the univariate and multivariable analyses. Mood/anxiety disorders were associated with a decrease in total PedsQL scores in the univariate analysis, which approached statistical significance in the multivariable analysis. In the univariate and multivariable analyses, ADHD was associated with a decrease in psychosocial functioning, and mood/anxiety disorders were associated with a reduction in physical functioning.
Among several limitations, the small sample size was limited to children with obesity referred to a tertiary care academic center for the evaluation of sleep-disordered breathing and who may have had more medical comorbidities than a community-based population. Also, socioeconomic variables were not included in the multivariable regression model, and the assessment of sleep symptoms was limited to a 1-month period using the PSQI.
“Clinicians should assess and optimize sleep quality as part of the evaluation for OSA in children with obesity,” stated the study authors. “Longitudinal studies delineating the aspects of sleep quality that influence HRQOL and health outcomes in children may inform targeted management strategies for this population.”
This article originally appeared on Pulmonology Advisor
Xiao L, Voutsas G, Ryan CM, Katz SL, Narang I. The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity. J Clin Sleep Med. Published online July 6, 2023. doi:10.5664/jcsm.10706