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Multicenter Study
. 2023 Mar 1;19(3):555-562.
doi: 10.5664/jcsm.10386.

Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence

Evelyn Constantin  1 , Joanna E MacLean  2 , Nicholas Barrowman  3 , Linda Horwood  1 , Glenda N Bendiak  4 , Valerie G Kirk  4 , Stasia Hadjiyannakis  5 , Laurent Legault  1 , Bethany J Foster  1 , Sherri L Katz  3   5
Affiliations
Multicenter Study

Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence

Evelyn Constantin et al. J Clin Sleep Med. .

Abstract

Study objectives: Behavioral characteristics and outcomes of positive airway pressure (PAP) therapy in children with obesity and moderate-severe sleep-disordered breathing (SDB) have not been reported. Our aims were to 1) determine baseline behavioral/emotional symptoms of this population and characterize changes over time with PAP, and 2) examine associations between baseline behavioral/emotional symptoms and PAP adherence.

Methods: This multicenter prospective cohort study of children with obesity prescribed PAP for moderate-severe SDB assessed PAP adherence (≥ 4 h/night, >50% of nights, usage diaries, downloads) and compared behavioral/emotional characteristics with parent- and child-reported Conners Rating Scale (Conners) and the Child Behavior Checklist (CBCL) at baseline and 1 year after PAP prescription between adherent and nonadherent participants; scores at baseline were compared retrospectively between adherence groups.

Results: Twenty-four children were included (median 14.1 years [IQR:12.4,16.0]; 87.5% males). Baseline Conners and CBCL scores were elevated (parent- and child-reported Conners inattention and hyperactivity subscales and CBCL subscales [total, internalizing, externalizing]). Baseline parent-reported Conners scores were significantly more elevated in the nonadherent than adherent group (inattention: 73.3 ± 8.5 vs 60.5 ± 14.6, P = .01; hyperactivity: 70.9 ± 11.1 vs 59.1 ± 16.0, P = .05). This difference was present 1 year later for inattention (P = .01) but not for hyperactivity (P = .09). Parent-reported CBCL scores improved over 1 year in adherent but not nonadherent participants.

Conclusions: We found that children with obesity and moderate-severe SDB have elevated symptoms of behavioral/emotional concerns on standardized testing. Parent-reported emotional characteristics improved in the adherent but not in the nonadherent group. Children with greater inattention/hyperactivity at baseline were less adherent to PAP, suggesting this may contribute to PAP nonadherence.

Citation: Constantin E, MacLean JE, Barrowman N, et al. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence. J Clin Sleep Med. 2023;19(3):555-562.

Keywords: adherence; behavior; externalizing behavior; hyperactivity; inattention; internalizing behavior; obesity; positive airway pressure; sleep; sleep-disordered breathing.

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Conflict of interest statement

All authors have seen and approved the manuscript. This work was conducted at Children’s Hospital of Eastern Ontario, Ottawa, Ontario; Montreal Children’s Hospital, Montreal, Quebec; Stollery Children’s Hospital, Edmonton, Alberta; and Alberta Children’s Hospital, Calgary, Alberta. Funding: Canadian Institutes of Health Research. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Baseline Conners Rating Scale parent-report T-scores for adherent vs nonadherent groups for (A) inattention and (B) hyperactivity subscales.
Figure 2
Figure 2. Baseline CBCL parent-report T-scores for adherent vs nonadherent groups: (A) total score, (B) internalizing, and (C) externalizing subscores.
CBCL = Child Behavior Checklist.
See this image and copyright information in PMC

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