OBJECTIVE To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and device-assessed sleep behaviors with behavioral and emotional functioning in pediatric overweight/obesity. STUDY DESIGN A total of 109 children with overweight/obesity (10.0±1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (i.e., wake time, sleep onset time, total time in bed, total sleep time and wakening after sleep onset) were estimated with wrist-worn accelerometers. We used the Behavior Assessment System for Children level-2 to assess behavioral and emotional functioning (i.e., clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat and somatization; and adaptative scale: adaptability, social skills and leadership). RESULTS SDB was positively associated with all clinical scale variables (all β>0.197, P≤0.041), and with lower adaptability and leadership (all β<-0.226, P<0.021). Specifically, PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety and retreat (all β>0.196, P≤0.045) and lower adaptability (β=-0.246, P=0.011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptative scales (all β>|0.192|, P≤0.046), except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. CONCLUSIONS Our study suggests that SDB symptoms, but not device-assessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, retreat, and lower adaptability.
Associations of Sleep-Related Outcomes with Behavioral and Emotional Functioning in Children with Overweight/Obesity.