Sleep-related breathing disorder among adolescents and its association with obesity, sleep pattern and mood

Moutrisha M. Roy; Ruchi Singh; Anzar B. Alvi; Ankur Joshi; Sunil Chouhan; Nirendra K. Rai

doi:10.18203/2394-6040.ijcmph20251699

Authors

Moutrisha M. Roy Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
Ruchi Singh Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
Anzar B. Alvi Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
Ankur Joshi Department of CFM, AIIMS, Bhopal, Madhya Pradesh, India
Sunil Chouhan Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
Nirendra K. Rai Department of Neurology, AIIMS, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20251699

Keywords:

Sleep-related breathing disorder, Adolescent, Daytime sleepiness, Obstructive sleep apnea, Seep quality, Obesity

Abstract

Background: Sleep-related breathing disorders (SRBD) are widely prevalent among adolescents; however, are often undiagnosed, impacting their physical and psychological well-being. This study examined SRBD prevalence and its association with obesity, sleep patterns and mental health of adolescents.

Methods: Adolescents aged 10-19 years were enrolled after requisite permission of school authorities and necessary assent and consent for participation. Participants were explored for their sleep quality, daytime sleepiness, SRBD and mood changes using standardized questionnaires like Pittsburgh sleep quality index (PSQI), pediatric daytime sleepiness scale (PDSS), sleep related breathing disorder-pediatric sleep questionnaire (SRBD- PSQ) and depression anxiety stress scale-21 (DASS-21) respectively.

Results: SRBD was present in 18.05% (389) adolescents and 15.83% (341) were obese. Males, as well as older adolescents, had higher SRBD susceptibility with 56%; p=0.008 and 52.7%; p<0.001, respectively. Older adolescents had higher body mass index (p=0.017), shorter sleep durations (p<0.001), poorer sleep quality (p=0.006), increased daytime sleepiness (p<0.001), and elevated levels of depression, anxiety, and stress (p<0.001). Among SRBD-positive adolescents, 40.1% were obese, 32.1% were overweight, 82.5% experienced poor sleep quality (p<0.001) and 66.3% (258) were sleep deprived.

Conclusions: An increasing trend in sleep disturbances, reduction in sleep quality and duration, increase in obesity as well as SRBD was observed with age among adolescents, with Older adolescents exhibiting the highest scores for all the parameters, including compromised emotional health.

Metrics

Metrics Loading ...

References

Sateia MJ. International classification of sleep disorders. Chest. 2014;146:1387-94. DOI: https://doi.org/10.1378/chest.14-0970

Foldvary-Schaefer NR, Waters TE. Sleep-disordered breathing. Contin Lifelong Learn Neurol. 2017;23:1093-116. DOI: https://doi.org/10.1212/01.CON.0000522245.13784.f6

Halstead ME, Walter KD, Fitness C on SM and. Sport-related concussion in children and adolescents. Pediatrics. 2010;126:597-615. DOI: https://doi.org/10.1542/peds.2010-2005

Tiwari R, Sharma P, Sogi HPS, Jain M, Gambhir A. Sleep Disorders in Pediatric Dentistry: A Hidden Foe. Indian J Sleep Med. 2023;18:45-9. DOI: https://doi.org/10.5005/jp-journals-10069-0118

Jara SM, Benke JR, Lin SY, Ishman SL. The association between secondhand smoke and sleep‐disordered breathing in children: a systematic review. Laryngoscope. 2015;125:241-7. DOI: https://doi.org/10.1002/lary.24833

Seema S, Rohilla KK, Kalyani VC, Babbar P. Prevalence and contributing factors for adolescent obesity in present era: Cross-sectional Study. J Fam Med Prim Care. 2021;10:1890-4. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1524_20

Kohler MJ, van den Heuvel CJ. Is there a clear link between overweight/obesity and sleep disordered breathing in children? Sleep Med Rev. 2008;12:347-61. DOI: https://doi.org/10.1016/j.smrv.2008.04.008

Obesity I, Force T. Global Prevalence of Overweight and Obesity in Children and Adolescents A Systematic Review and Meta-Analysis. JAMA Pediatr. 2024;178:800-13. DOI: https://doi.org/10.1001/jamapediatrics.2024.1576

Sharma N, Sanjeevi RR, Balasubramanian K, Chahal A, Sharma A, Sidiq M. A Systematic Review on Prevalence of Overweight and Obesity among School Children and Adolescents in Indian Population. Indian J Endocrinol Metab. 2024;28(2):104-16. DOI: https://doi.org/10.4103/ijem.ijem_365_23

Smith DL, Gozal D, Hunter SJ, Kheirandish-Gozal L. Frequency of snoring, rather than apnea-hypopnea index, predicts both cognitive and behavioral problems in young children. Sleep Med. 2017;34:170-8. DOI: https://doi.org/10.1016/j.sleep.2017.02.028

Giordani B, Hodges EK, Guire KE, Ruzicka DL, Dillon JE, Weatherly RA, et al. Changes in neuropsychological and behavioral functioning in children with and without obstructive sleep apnea following Tonsillectomy. J Int Neuropsychol Soc. 2012;18:212-22. DOI: https://doi.org/10.1017/S1355617711001743

Howarth TP, Gentin N, Reyes-Chicuellar N, Jonas C, Williamson B, Blecher G, et al. Sleep quality and obstructive sleep apnoea in Indigenous and non-Indigenous Australian children. Sleep Med. 2022;98:68-78. DOI: https://doi.org/10.1016/j.sleep.2022.06.014

Wise MS, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, et al. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep. 2011;34:389-98. DOI: https://doi.org/10.1093/sleep/34.3.389

Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1:21-32. DOI: https://doi.org/10.1016/S1389-9457(99)00009-X

Liao Z, Chen Y, Wu L, Huang Y, Li S, Liu J, et al. Associations of Obstructive Sleep Apnea Risk with Obesity, Body Composition and Metabolic Abnormalities in School-Aged Children and Adolescents. Nutrients. 2024;16. DOI: https://doi.org/10.3390/nu16152419

Thomas AA, Prasad V, Jayakumar C. Sleep disorders in adolescent school children in Kochi: a cross sectional study. Int J Contemp Pediatr. 2021;8:1079. DOI: https://doi.org/10.18203/2349-3291.ijcp20212052

Kaushal R, Bhardwaj P, Goel AD, Shekhar S, Kumar P, Goyal JP. Prevalence of Asthma and Sleep-Related Breathing Disorder in School-Going Children. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2020;45:539-42. DOI: https://doi.org/10.4103/ijcm.IJCM_58_20

Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4

Drake C, Nickel C, Burduvali E, Roth T, Jefferson C, Badia P. The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcomes in middle-school children. Sleep. 2003;26:455-8. DOI: https://doi.org/10.1037/t02761-000

Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33:335-43. DOI: https://doi.org/10.1016/0005-7967(94)00075-U

de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660-7. DOI: https://doi.org/10.2471/BLT.07.043497

World Health Organisation. Adolescent and Young Adult Health. 2022. Available at: https://www.who. int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions. Accessed on 12 April 2025.

Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242-52. DOI: https://doi.org/10.1513/pats.200708-135MG

Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief. 2017;288:1-8.

Singh R, Roy MM, Chouhan S, Joshi A, Rai NK. Impact of school start time and sleep pattern of adolescents on their mood and sleep quality. J Fam Med Prim Care. 2023;12:2469-75. DOI: https://doi.org/10.4103/jfmpc.jfmpc_803_23

Singh R, Suri JC, Sharma R, Suri T, Adhikari T. Sleep pattern of adolescents in a school in Delhi, India: Impact on their mood and academic performance. Indian J Pediatr. 2018;85:841-8. DOI: https://doi.org/10.1007/s12098-018-2647-7

Goyal A, Pakhare AP, Bhatt GC, Choudhary B, Patil R. Association of pediatric obstructive sleep apnea with poor academic performance: a school-based study from India. Lung India Off Organ Indian Chest Soc. 2018;35:132. DOI: https://doi.org/10.4103/lungindia.lungindia_218_17

Cohen Y, Reiter J, Gileles-Hillel A. Sleep-related disorders in children: A narrative review. Pediatr Discov. 2024;2:e76. DOI: https://doi.org/10.1002/pdi3.76

Lee JH, Cho J. Sleep and Obesity. Sleep Med Clin. 2022;17:111-6. DOI: https://doi.org/10.1016/j.jsmc.2021.10.009

Zandieh SO, Cespedes A, Ciarleglio A, Bourgeois W, Rapoport DM, Bruzzese J-M. Asthma and subjective sleep disordered breathing in a large cohort of urban adolescents. J Asthma Off J Assoc Care Asthma. 2017;54:62-8. DOI: https://doi.org/10.1080/02770903.2016.1188942

Spilsbury JC, Storfer-Isser A, Rosen CL, Redline S. Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence. Sleep. 2015;38:23-9. DOI: https://doi.org/10.5665/sleep.4318

Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med. 2016;12:1549-61. DOI: https://doi.org/10.5664/jcsm.6288

Delasnerie-Laupretre N, Patois E, Valatx JL, Kauffmann F, Alperovitch A. Sleep, snoring and smoking in high school students. J Sleep Res. 1993;2:138-42. DOI: https://doi.org/10.1111/j.1365-2869.1993.tb00077.x

Miyahara LK, Stefanini R, Suguri VM, Wawginiak GH, de Andrade Balsalobre R, Haddad FLM. Evaluation of sleep quality and risk of obstructive sleep apnea in patients referred for aesthetic rhinoplasty. Sleep Sci. 2019;12:126. DOI: https://doi.org/10.5935/1984-0063.20190077

Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, et al. Obstructive sleep apnea and obesity: implications for public health. Sleep Med Disord Int J. 2017;1.

Beebe DW, Lewin D, Zeller M, McCabe M, MacLeod K, Daniels SR, et al. Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J Pediatr Psychol. 2007;32:69-79. DOI: https://doi.org/10.1093/jpepsy/jsj104

Wing YK, Hui SH, Pak WM, Ho CK, Cheung A, Li AM, et al. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child. 2003;88:1043-7. DOI: https://doi.org/10.1136/adc.88.12.1043

Park K-M, Kim S-Y, Sung D, Kim H, Kim B-N, Park S, et al. The relationship between risk of obstructive sleep apnea and other sleep problems, depression, and anxiety in adolescents from a community sample. Psychiatry Res. 2019;280:112504. DOI: https://doi.org/10.1016/j.psychres.2019.112504

Kim NH, Lee SK, Eun CR, Seo JA, Kim SG, Choi KM, et al. Short sleep duration combined with obstructive sleep apnea is associated with visceral obesity in Korean adults. Sleep. 2013;36:723-9. DOI: https://doi.org/10.5665/sleep.2636

Sivertsen B, Pallesen S, Sand L, Hysing M. Sleep and body mass index in adolescence: results from a large population-based study of Norwegian adolescents aged 16 to 19 years. BMC Pediatr. 2014;14:1-11. DOI: https://doi.org/10.1186/1471-2431-14-204

Calhoun SL, Vgontzas AN, Fernandez-Mendoza J, Mayes SD, Tsaoussoglou M, Basta M, et al. Prevalence and risk factors of excessive daytime sleepiness in a community sample of young children: the role of obesity, asthma, anxiety/depression, and sleep. Sleep. 2011;34:503-7. DOI: https://doi.org/10.1093/sleep/34.4.503

Verhulst SL, Van Gaal L, De Backer W, Desager K. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev. 2008;12:339-46. DOI: https://doi.org/10.1016/j.smrv.2007.11.002

Kalra M, Inge T, Garcia V, Daniels S, Lawson L, Curti R, et al. Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery. Obes Res. 2005;13:1175-9. DOI: https://doi.org/10.1038/oby.2005.139

Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016:125-46. DOI: https://doi.org/10.2147/AHMT.S101631

Kerner NA, Roose SP. Obstructive sleep apnea is linked to depression and cognitive impairment: evidence and potential mechanisms. Am J Geriatr Psychiatry. 2016;24:496-508. DOI: https://doi.org/10.1016/j.jagp.2016.01.134

Kjelsberg FN, Ruud EA, Stavem K. Predictors of symptoms of anxiety and depression in obstructive sleep apnea. Sleep Med. 2005;6:341-6. DOI: https://doi.org/10.1016/j.sleep.2005.02.004

Buckley TM, Schatzberg AF. On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab. 2005;90:3106-14. DOI: https://doi.org/10.1210/jc.2004-1056