The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity

Lena Xiao; Giorge Voutsas; Clodagh M Ryan; Sherri Lynne Katz; Indra Narang; Canadian Sleep and Circadian Network; Najib Ayas; Julie Carrier; Patrick Hanly; John Peever; Sachin Pendharkar; Roberto Skomro; Indra Narang

doi:10.5664/jcsm.10706

The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity

J Clin Sleep Med. 2023 Nov 1;19(11):1877-1883. doi: 10.5664/jcsm.10706.

Authors

Lena Xiao^{1

2}, Giorge Voutsas^{1

3}, Clodagh M Ryan^{4

5}, Sherri Lynne Katz^{6

7

8}, Indra Narang^{1

2}; Canadian Sleep and Circadian Network; Najib Ayas, Julie Carrier, Patrick Hanly, John Peever, Sachin Pendharkar, Roberto Skomro, Indra Narang

Affiliations

¹ Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
³ Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Respirology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
⁶ Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
⁷ Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.

Abstract

Study objectives: Obstructive sleep apnea (OSA) and poor sleep quality are highly prevalent in children with obesity, but their individual associations with health-related quality of life (HRQOL) are unknown in this population. The primary objective was to describe the independent association of OSA and sleep quality with HRQOL in children with obesity.

Methods: This was a cross-sectional study of children with obesity at 2 tertiary care centers. Sleep quality and HRQOL were measured with the Pittsburgh Sleep Quality Index and Pediatric Quality of Life Inventory questionnaires, respectively. Multivariable regression models were created to evaluate associations between OSA and sleep quality with HRQOL.

Results: There were 98 children (median age 15.0 years, median body mass index z-score 3.8, 44% females). Among the study population, 49/98 (50%) children reported poor sleep quality, 41/98 (42%) children had OSA, and 52/98 (53%) children reported impaired HRQOL. Self-reported poor sleep quality was independently associated with reduced HRQOL, whereas the presence of OSA was not. Children with poor sleep quality had a reduced Pediatric Quality of Life Inventory score by 8.8 compared to children with good sleep quality (95% confidence interval, 2.6-14.9; P = .006), when adjusting for age, sex, body mass index z-score, attention-deficit/hyperactivity disorder, mood/anxiety disorder, and study site.

Conclusions: In the current study of children with obesity, we found that HRQOL was more strongly associated with the self-reported experience of sleep than the presence of OSA. Clinicians should assess and optimize sleep quality as part of the evaluation for OSA in children with obesity.

Citation: 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. 2023;19(11):1877-1883.

Keywords: children; health-related quality of life; insomnia; obesity; obstructive sleep apnea.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Cross-Sectional Studies
Female
Humans
Male
Obesity / complications
Obesity / epidemiology
Polysomnography
Quality of Life
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology
Sleep Initiation and Maintenance Disorders* / complications
Sleep Quality