Actions for Sleep, Physical Activity, and Executive Function in Obese Adolescents with and without Obstructive Sleep Apnea Syndrome : A Feasibility Study

Email RIS file
Bookmark
Report an Issue

Sleep, Physical Activity, and Executive Function in Obese Adolescents with and without Obstructive Sleep Apnea Syndrome : A Feasibility Study

Author
Watach, Alexa
Published
[University Park, Pennsylvania] : Pennsylvania State University, 2017.
Physical Description
1 electronic document
Additional Creators
Sawyer, Amy M.
Access Online

Availability

I Want It
I Want It

Finding items...

Graduate Program
Restrictions on Access
Open Access.
Summary
BACKGROUND: Adolescents with obesity and obstructive sleep apnea syndrome (OSAS) are at substantially higher risk for poor physical and cognitive health outcomes than healthy counterparts.PURPOSE: The purpose of this feasibility study was to acquire methodological and protocol insights for a subsequent, larger, study that will be fully powered to assess executive function in adolescents with obesity and OSAS and examine the effects of sleep duration and physical activity on executive function. The research questions were: (1) to determine the feasibility of recruiting and retaining a sample of obese adolescents (11-17 years of age) with and without-OSAS, (2) to pilot test a protocol that incorporates a 1-week measurement period for physical activity and sleep to assess for complete data rates and participant acceptability of instrumentation, (3) to explore executive function impairments as measured by the Global Executive Composite (i.e., overall summary score) and three subscales (i.e., Behavior Regulation Index, Emotion Regulation Index, and Cognitive Regulation Index), within groups, compared to published normative data, and explore differences in executive function impairments between groups (obese adolescents with and without-OSAS), and (4) to describe differences in activity levels (frequency, intensity, time) and sleep duration (major sleep bout total sleep time), measured by 1-week actigraphy (objective measure of rest/activity and sleep) and self-report, between obese adolescents with and without OSAS and explore the relationship between activity levels and sleep duration with executive function (Global Executive Composite scores).METHODS: A two-cohort, prospective study design was employed with a target population of adolescents with obesity (cohort 1) and obesity+OSAS (cohort 2). Participants were recruited, enrolled and consented/assented from an academic, tertiary medical centers sleep center and weight management clinic. Inclusion criteria were: age 11-17 years, BMI-for-age 95th percentile, presence or absence of OSAS determined by overnight PSG (diagnostic or split night study within the last year), apnea-hypopnea index 1.5 events/hour for clinically significant OSAS, parental consent and adolescent assent, reading level 5th grade, ability to read English, and anticipated performance of usual activities over a 1-week period after enrollment (e.g., no planned vacations, acute illnesses). Exclusion criteria were: age <11 or 18 years, BMI-for-age <95th percentile, overnight PSG >1 year ago, change in BMI greater than 2 kg/m2 since overnight PSG, acute or chronic physical injury or disability that impedes participation in physical activity, intellectual disabilities/learning disabilities that impact independent ability to respond to questionnaires, current treatment of OSAS, established diagnosis of other sleep-wake disorders that may disrupt sleep duration, including insomnia, restless legs syndrome, and narcolepsy, uncontrolled diabetes, disruptive behavioral disorders such as Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), established diagnosis of psychological disorders, including anxiety, schizophrenia, or personality disorders, or current use of psychotropic medications, uncontrolled mood disorders (depression, anxiety), and regular use (>3 days/week) of over the counter or prescribed medications that interfere with sleep. After baseline characteristic variables were collected by self-report questionnaire, one-week wrist-worn actigraphy and daily sleep and physical activity diaries were employed as measures of total nightly sleep time and physical activity including duration, frequency and intensity (tertiary outcomes). Executive function, the secondary outcome, was measured using the BRIEF2. Feasibility outcomes, primary, included rates of recruitment, enrollment, retention and complete data; an end of study questionnaire measured participant acceptability of study protocol and instrumentation. Descriptive statistical analysis and correlation tests were employed. Because of difficulty recruiting a group of obese adolescents without-OSAS, no tests for group differences were conducted. RESULTS: It was not feasible to recruit obese adolescents without-OSAS given the recruitment plan; the study sample therefore included only a single cohort, adolescents with OSAS+obesity (n=20). Participants were largely white (n=15, 75%), non-Hispanic (n=19, 90%), adolescent (median= 14 years) males (n=11, 55%), with moderate obstructive sleep apnea syndrome (AHI median= 5.85, IQR 9.60). Face-to-face recruitment resulted in higher enrollment rates than mailed initiation letters. Complete data rates for one-week measures ranged from 75-90%. Ninety-five percent of participants completed the protocol and 90% of participants were interested in participating in another similar study. Obese adolescents with OSAS (n=20) had significantly worse executive function (by self- and parent-report) than a normative sample (p0.003); up to 30% had impaired executive function at thresholds considered clinically significant. No relationship was identified between sleep duration or physical activity and executive function. Participants did not meet national recommendations for sleep duration or physical activity and there was relatively minimal variability across participants for sleep duration or physical activity.CONCLUSION: Alternative recruitment techniques are needed to obtain a sample of obese adolescents without-OSAS. Adolescents with obesity and OSAS have impaired executive function and do not meet recommended sleep or physical activity guidelines. Larger prospective studies are needed to determine if sleep duration and/or physical activity are associated with executive function in adolescents with OSAS and obesity.
Other Subject(s)
Genre(s)
Dissertation Note
Ph.D. Pennsylvania State University 2017.
Reproduction Note
Microfilm (positive). 1 reel ; 35 mm. (University Microfilms 10-666649)
Technical Details
The full text of the dissertation is available as an Adobe Acrobat .pdf file ; Adobe Acrobat Reader required to view the file.
View MARC record | catkey: 21318432