Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea.

STUDY OBJECTIVES
The association between obstructive sleep apnea (OSA) and lifestyle habits in children with obesity is largely unknown. This study aimed to determine whether there was an association between lifestyle patterns (sleep quality, physical activity, recreational screen time, and substance use) and OSA presence and severity in children with obesity.


METHODS
This cross-sectional study recruited children with obesity, aged 8-17 years, who were referred to undergo polysomnography. Children completed questionnaires on sleep quality, physical activity, recreational screen time, and substance use. Children also had a diagnostic polysomnography. The association between questionnaire scores and OSA severity, after adjusting for BMI z-score, age, and sex, was evaluated using negative binomial multiple regression. Correlations were conducted between sleep quality, physical activity, screen time, substance use, and OSA severity.


RESULTS
100 children were included in the analysis (mean age: 14.3 ± 2.6 years; 44% female; mean BMI z-score: 2.5 ± 0.4; 65% with OSA). In the adjusted regression analysis, each additional substance use behavior was associated with a 17% (CI: 1%, 36%) increase in OSA severity. Correlations were identified between poorer sleep quality and lower physical activity (r=-0.42), poorer sleep quality and more substance use behaviors (r=0.40), and greater physical activity and less substance use behaviors (r=-0.26).


CONCLUSIONS
In children with obesity, more substance use behaviors was independently associated with greater OSA severity. As there are complex, bi-directional relationships between lifestyle behaviors and OSA severity, interventions need to be comprehensive and multi-factorial to ensure successful treatment of OSA and its sequelae in children.