Sleep Breath DOI 10.1007/s11325-013-0918-0

ORIGINAL ARTICLE

Sleep duration and body mass index in children and adolescents with and without obstructive sleep apnea Marta Moraleda-Cibrián & Louise M. O’Brien

Received: 20 June 2013 / Revised: 9 September 2013 / Accepted: 19 November 2013 # Springer-Verlag Berlin Heidelberg 2013

Abstract Purpose The prevalence of pediatric obesity and short sleep duration has simultaneously increased in recent decades. Sleep plays a critical role in metabolic and endocrine regulation and insufficient sleep has been shown to be associated with changes in metabolism. Obesity, a major risk factor for obstructive sleep apnea (OSA), has been also associated with metabolic dysregulation. Despite this, no study investigating short sleep and obesity has addressed the potential confounder of OSA. The aim of this study was to investigate the association between short sleep duration and obesity in children with and without OSA. Methods In this retrospective study, 306 children who underwent polysomnography between January and December 2010 were included. A diagnosis of OSA was made if the apnea/hypopnea index on polysomnography is ≥1. Typical sleep times were obtained by parental report. Short sleep duration was defined as a reduction of >1 h from the minimum total sleep time (TST) recommended for age from the National Sleep Foundation (NSF). Results Overall, 32 % were obese, 39.5 % had short sleep duration, and 78 % had OSA. Children with OSA had a similar frequency of short sleep duration than those without (39.6 vs. 42.4 %, p =0.950). In children with short sleep

duration, the odds ratio for obesity was 2.5 (95 % CI 1.3– 4.9; p =0.009) compared to children with TST within normal limits even after accounting for the presence of OSA. Conclusion A parental history of total sleep duration of only 1 h less than recommended per age by the NSF is associated with a higher risk for obesity in children independently of the presence of OSA.

M. Moraleda-Cibrián : L. M. O’Brien Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA

Introduction

M. Moraleda-Cibrián : L. M. O’Brien Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA L. M. O’Brien (*) Michael S. Aldrich Sleep Disorders Laboratory, C736 Med Inn, 1500 East Medical Center Drive, Box 5845, Ann Arbor, MI 48109-0845, USA e-mail: [email protected]

Keywords Obesity . Childhood . Sleep duration . Obstructive sleep apnea Abbreviations BMI Body mass index CDC Center for Disease Control and prevention NHANES National Health and Nutrition Examination Survey NSF National Sleep Foundation OSA Obstructive sleep apnea PSG Polysomnography PSQ Pediatric Sleep Questionnaire SDB Sleep-disordered breathing TST Total sleep time

The prevalence of childhood obesity has dramatically increased in the last 30 years and has been recognized as one of the most important public health problems in developed countries [1]. Results of the NHANES indicated that from 1980 to 2007–2008 obesity in school-aged children and adolescents has tripled [2]. Of concern, childhood obesity is associated with short- and long-term health problems such as dyslipidemia, hypertension, cardiovascular disease, hyperinsulinemia, insulin resistance, obstructive sleep apnea

Sleep Breath

(OSA), and substantial psychological problems [1, 3]. In addition, obese children are at high risk for remaining obese during adulthood [4], and consequently, for the first time, this generation might have a shorter life expectancy than the parents. Therefore, there is an urgent need to identify modifiable risk factors for childhood obesity [5, 6]. In parallel to the increased prevalence of obesity, the prevalence of short sleep duration has risen. Although the reasons for this are multifactorial, the 24-h lifestyle common in most Western countries plays a significant role. Later bedtimes, demanding after-school activities, television viewing, and use of electronic devices at bedtime are some of the factors that contribute to reduce sleep time [7]. This sleep curtailment could have a significant impact on daytime function in young and older children, for example, increased daytime sleepiness, fatigue, depressed mood, and cognitive impairment [8, 9]. Sleep plays a critical role in metabolic and endocrine regulation. Indeed, even partial chronic sleep restriction (sleep duration of 4 h per night) leads to changes in carbohydrate metabolism and homeostasis profiles in young adults [10]. These changes likely result in weight gain due to an upregulation of appetite and an increase in wake time [11]. In the last decade, multiple studies have investigated the association between sleep duration and obesity in children [12–17]. While the available data, in general, appear to be supportive of such an association, no study has addressed the potential confounder of sleep-disordered breathing (SDB). Sleep-disordered breathing describes a spectrum of breathing disturbances from habitual snoring at one end of the spectrum to OSA at the other. Habitual snoring occurs in approximately 10–12 % of children while objectively defined OSA affects approximately 1–4 % of children [18]. Robust relationships exist between SDB in children and neurobehavioral dysfunction [19, 20] and data suggest that SDB is also associated with cardiovascular dysfunction [21–23]. While obesity is a risk for SDB, SDB is also associated with the metabolic syndrome independently of obesity [24], suggesting a bidirectional relationship. In addition, SDB may be a risk factor for sleep disturbance and therefore contribute to sleep curtailment. Nevertheless, no study has investigated the association between short sleep duration, body mass index (BMI), and SDB. Therefore, the goal of this study was to investigate the relationship between short sleep duration, SDB, and overweight/obesity in children attending a pediatric sleep clinic.

Patients and methods Subjects In this retrospective study, consecutive subjects were eligible if they were aged between 3 and 17 years old and underwent

overnight polysomnography (PSG) at the University of Michigan between January and December 2010. Children with major medical problems, craniofacial malformations, and developmental delay were excluded. This study was approved by the Institutional Review Board at the University of Michigan.

Measurements Demographics and anthropometrics Demographic data collected from medical records included age, gender, and racial background. Weight and height were obtained at the time of the PSG and used to calculate BMI and BMI percentile (adjusted for age and sex). Obesity and overweight was defined according to BMI percentile thresholds for children over 2 years of age, as recommended by The American Academy of Pediatrics and CDC [25]. The sample was classified into four weight-groups: underweight (BMI

Sleep duration and body mass index in children and adolescents with and without obstructive sleep apnea.

The prevalence of pediatric obesity and short sleep duration has simultaneously increased in recent decades. Sleep plays a critical role in metabolic ...
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