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Background <p>Adolescent obesity is a major public health challenge. While obstructive sleep apnea (OSA) is a recognized complication, focusing solely on respiratory events offers an incomplete picture of sleep health.</p> Aim <p>This study evaluated the spectrum of subjective sleep quality in adolescent boys with and without diagnosed obesity and assessed the potential effect of the BMI z-score on the expression and structure of sleep disturbances using a matched multi-level design.</p> Patients and Methods <p>A case-control study included 40 age-matched pairs of adolescent boys (12–17 years) with diagnosed obesity (ICD-10 E66.0) and healthy controls. Subjective sleep quality across five behavioral dimensions was assessed using the 28-item self-report Adolescent Sleep Wake Scale (ASWS). Data were analyzed using a linear mixed-effects model (LMM).</p> Results <p>The LMM analysis demonstrated that the lowest subjective sleep quality scores occurred consistently on the “Awakening” and “Going to bed” scales. Including the continuous BMI z-score as a covariate significantly improved model fit, showing a significant negative association with sleep scores (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\:F\left(\text{1,64.0}\right)=4.46,p=0.039\)</EquationSource> </InlineEquation>). Each 1-unit increase in the BMI z-score was associated with a 0.12-point decrease in sleep dimension scores. Crucially, the interaction term was non-significant, indicating that the fundamental structural spectrum of sleep complaints does not change with obesity severity.</p> Conclusion <p>A core set of sleep initiation and awakening problems exists in adolescents, and these problems are uniformly intensified, rather than structurally altered, with increasing obesity severity. Clinical evaluations must move beyond sleep-disordered breathing to prioritize comprehensive assessment of difficulties in sleep initiation and wakefulness.</p>

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Subjective Sleep Quality and BMI z-Score in Adolescent Boys: A Case-Control Study

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Igor A. Kelmanson

摘要

Background

Adolescent obesity is a major public health challenge. While obstructive sleep apnea (OSA) is a recognized complication, focusing solely on respiratory events offers an incomplete picture of sleep health.

Aim

This study evaluated the spectrum of subjective sleep quality in adolescent boys with and without diagnosed obesity and assessed the potential effect of the BMI z-score on the expression and structure of sleep disturbances using a matched multi-level design.

Patients and Methods

A case-control study included 40 age-matched pairs of adolescent boys (12–17 years) with diagnosed obesity (ICD-10 E66.0) and healthy controls. Subjective sleep quality across five behavioral dimensions was assessed using the 28-item self-report Adolescent Sleep Wake Scale (ASWS). Data were analyzed using a linear mixed-effects model (LMM).

Results

The LMM analysis demonstrated that the lowest subjective sleep quality scores occurred consistently on the “Awakening” and “Going to bed” scales. Including the continuous BMI z-score as a covariate significantly improved model fit, showing a significant negative association with sleep scores ( \(\:F\left(\text{1,64.0}\right)=4.46,p=0.039\) ). Each 1-unit increase in the BMI z-score was associated with a 0.12-point decrease in sleep dimension scores. Crucially, the interaction term was non-significant, indicating that the fundamental structural spectrum of sleep complaints does not change with obesity severity.

Conclusion

A core set of sleep initiation and awakening problems exists in adolescents, and these problems are uniformly intensified, rather than structurally altered, with increasing obesity severity. Clinical evaluations must move beyond sleep-disordered breathing to prioritize comprehensive assessment of difficulties in sleep initiation and wakefulness.