P2.A007: Obstructive Sleep Apnea and Somatic Syndromes in Adolescents: The Utility of the Body Sensation Questionnaire

Background: Obstructive sleep apnea (OSA) and obesity, both associated with chronic stress and inflammation are thought to contribute strongly to increased sympathetic nervous system tone or somatic arousal. The Body Sensation Questionnaire (BSQ) is a 17-item questionnaire, assessing increased somatic arousal such as tremors, sweating, dry mouth. In a study in adults with OSA, higher BSQ scores were correlated with somatic syndromes, anxiety, and insomnia, but has not been studied in adolescents. We hypothesized that higher BSQ scores would be correlated with somatic syndromes, anxiety, depression, ADHD, headaches and use of psychotropic medications in adolescents with OSA, and that BSQ scores would differ in obese and non-obese adolescents.

Methods: A retrospective chart review included 30 obese and 30 non-obese adolescents 12-18 years old who answered the BSQ, Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS) as routine screening at our Sleep Disorders Center from January 2013 to December 2023. Obesity was defined as BMI >/= 95th%. Correlations between BSQ scores and somatic syndromes (anxiety, depression, ADHD, headaches, use of psychotropic medications) as well as the ESS and FSS were assessed using Wilcoxon rank-sum tests or Kruskal-Wallis tests for categorical variables, or Pearson’s correlation for continuous variables. A multiple linear regression model with adjustment was further constructed to compare the BSQ difference between obese and non-obese groups.

Results: Higher BSQ score was correlated with anxiety (p = 0.0166), depression (p = 0.0546) headaches/migraines (p = 0.0002) and psychotropic medication use (p = 0.0181). BSQ scores had a moderate linear correlation with the ESS (p < 0.0001, correlation coefficient 0.51) and a mild correlation with the FSS (p = 0.0151, correlation coefficient 0.36). BSQ scores between obese and non-obese adolescents were not statistically significant (p = 0.1953). After controlling for age, anxiety, headaches and psychotropic medications, there was a trend of difference in BSQ score between obese and non-obese groups (33.8 vs 28.49, p = 0.1272).

Conclusion: Higher BSQ scores were correlated with anxiety, depression, headaches/migraines, and use of psychotropic medications in adolescents with OSA, reproducing the findings reported in adults with OSA. The increased somatic arousal associated with sleepiness and fatigue based on the utility of the three questionnaires may be elucidated by future studies. These are useful screening tools to further explore the relation of OSA to anxiety and depression and may inform additional treatment options for this population. Lastly, although not statistically significant, we observe that obese adolescents had higher trending BSQ scores correlating with increased somatic arousal. Obesity, anxiety and depression are increasingly prevalent in adolescents. As we obtain more sleep referrals from psychiatry, future studies may evaluate the importance for collaborative care for adolescents.