Journal of the International Neuropsychological Society

Research Articles

Iowa Gambling Task Performance in Overweight Children and Adolescents at Risk for Obstructive Sleep Apnea

Kelly A. McNallya1 c1, Paula K. Sheara2, Sarah Tlustosa3, Raouf. S. Amina4a5 and Dean W. Beebea5a6

a1 Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio

a2 Department of Psychology, University of Cincinnati, Cincinnati, Ohio

a3 Department of Psychology, The Denver Children's Hospital, Denver, Colorado

a4 Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

a5 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

a6 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio


Obstructive sleep apnea (OSA) is a nocturnal respiratory disorder associated with cognitive and behavioral sequelae, including impairments in executive functioning (EF). Previous literature has focused on “cool” EF, meaning abilities such as working memory and planning that do not involve affective control requirements. Little is known about the impact OSA may have on “hot” EF that involves regulation of affect and risk-related decision-making, and that may be particularly salient during adolescence, when these skills are rapidly developing. This study examined performance on the Iowa Gambling Task (IGT), a task believed to assess aspects of “hot” EF, in overweight adolescents at risk for OSA. Consistent with hypotheses, individuals without OSA made more beneficial decisions on the IGT over time, but participants with OSA did not benefit from feedback and continued to make choices associated with higher initial rewards, but greater long-term losses. The relationship between developmental level and IGT performance was moderated by OSA status. Individuals with OSA did not demonstrate the expected developmental gains in performance during the IGT. This finding suggests that OSA may impact the development of critical aspects of EF, or at least the expression of these skills during the developmentally important period of adolescence. (JINS, 2012, 18, 481–489)

(Received October 13 2011)

(Revised December 29 2011)

(Accepted December 29 2011)


c1 Correspondence and reprint requests to: Kelly McNally, Department of Psychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205. E-mail: