Sleep in Overweight Adolescents: Shorter Sleep, Poorer Sleep Quality, Sleepiness, and Sleep-Disordered Breathing

Division of Behavioral Medicine and Clinical Psychology (MLC 3015), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 06/2006; 32(1):69-79. DOI: 10.1093/jpepsy/jsj104
Source: PubMed


To document the sleep of overweight adolescents and to explore the degree to which weight-related sleep pathology might account for diminished psychosocial outcome.
Sixty children aged 10-16.9 from a weight-management clinic were compared to 22 healthy controls using comprehensive actigraphic, polysomnographic, and parent- and self-report questionnaire assessments.
Overweight participants averaged more symptoms of sleep-disordered breathing, later sleep onset, shorter sleep time, and more disrupted sleep than controls. Although the groups did not differ in self-reported sleep habits, multiple concerns were reported by parents of overweight participants, including daytime sleepiness, parasomnias, and inadequate sleep. Group differences in academic grades and depressive symptoms were at least partially accounted for by short sleep and daytime sleepiness.
Excessive weight is associated with an increased risk of sleep problems. There is a need for further research in this area and for clinicians who work with overweight children to evaluate their sleep.

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Available from: Meg H Zeller, Mar 03, 2014
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    • "This pattern of inadequate sleep in children and adolescents is thought to be due to a combination of both intrinsic and extrinsic factors. Intrinsic factors include natural, developmental changes such as a shift in circadian rhythm during puberty [8], delayed sleep phase syndrome (estimated to occur in 7% of adolescents) [9], and sleep disordered breathing (SDB) such as obstructive sleep apnoea (OSA) [9,10]. However, insomnia type symptoms, such as difficulty falling asleep or staying asleep, seem to be the most prevalent cause of inadequate sleep with studies estimating insomnia type symptoms affecting up to 34% of adolescents [11,12]. "
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    ABSTRACT: The current study aimed to examine the changes following a sleep hygiene intervention on sleep hygiene practices, sleep quality, and daytime symptoms in youth. Participants aged 10–18 years with self-identified sleep problems completed our age-appropriate F.E.R.R.E.T (an acronym for the categories of Food, Emotions, Routine, Restrict, Environment and Timing) sleep hygiene programme; each category has three simple rules to encourage good sleep. Participants (and parents as appropriate) completed the Adolescent Sleep Hygiene Scale (ASHS), Pittsburgh Sleep Quality Index (PSQI), Sleep Disturbance Scale for Children (SDSC), Pediatric Daytime Sleepiness Scale (PDSS), and wore Actical® monitors twice before (1 and 2 weeks) and three times after (6, 12 and 20 weeks) the intervention. Anthropometric data were collected two weeks before and 20 weeks post-intervention. Thirty-three youths (mean age 12.9 years; M/F = 0.8) enrolled, and retention was 100%. ASHS scores significantly improved (p = 0.005) from a baseline mean (SD) of 4.70 (0.41) to 4.95 (0.31) post-intervention, as did PSQI scores [7.47 (2.43) to 4.47 (2.37); p < 0.001] and SDSC scores [53.4 (9.0) to 39.2 (9.2); p < 0.001]. PDSS scores improved from a baseline of 16.5 (6.0) to 11.3 (6.0) post- intervention (p < 0.001). BMI z-scores with a baseline of 0.79 (1.18) decreased significantly (p = 0.001) post-intervention to 0.66 (1.19). Despite these improvements, sleep duration as estimated by Actical accelerometry did not change. There was however a significant decrease in daytime sedentary/light energy expenditure. Our findings suggest the F.E.R.R.E.T sleep hygiene education programme might be effective in improving sleep in children and adolescents. However because this was a before and after study and a pilot study with several limitations, the findings need to be addressed with caution, and would need to be replicated within a randomised controlled trial to prove efficacy. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000649819
    BMC Pediatrics 12/2012; 12(1):189. DOI:10.1186/1471-2431-12-189 · 1.93 Impact Factor
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    • "Published studies have extended its use to children beyond this age range such as, 1.5–10 years [35], 2–5.5 years [36], 2–18 years [37], 4–12 years [38] and 10–16.9 years [39]. It compiles 33 items measuring sleep disturbances and three items collecting information about bedtime , wake-up time and sleep duration (nighttime sleep and daytime nap) over a ''typical'' recent week (weekday and weekend). "
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    ABSTRACT: Objective: The study aimed to (1) characterize sleep patterns and sleep disturbances among Chinese school-aged children, (2) determine the prevalence of their short sleep duration and sleep disturbances based on clinical cutoffs, and (3) examine possible factors (socio-demographic factors and emotional/behavioral problems) that are associated with sleep disturbances. Methods: A large representative sample of 912 children aged 6-14years was recruited from Shenzhen, China. Their parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Results: The mean bedtime was 9:45pm (SD=1h 11min), mean wake-up time was 7:03am (SD=31min), mean sleep duration was 9h 14min (SD=46min), and 23.8% of the children had sleep duration <9h. Overall, 69.3% of the children suffered from global sleep disturbances (CSHQ total score >41). Bedtime resistance (22.9%), sleep anxiety (22.1%), sleep duration (21%) and daytime sleepiness (20%) were the most prevalent sleep disturbances; followed by sleep disordered breathing (12.1%), parasomnias (9.4%), sleep onset delay (6.9%), and night waking (5.2%). The prevalence of specific sleep disturbances ranged from 3.2% (falling asleep while watching television) to 81.9% (awakening by others in the morning). Correlations between most domains of sleep disturbances and emotional/behavioral problems were statistically significant (p<0.05 or p<0.01). Hierarchical multiple regression analysis revealed that gender (β=0.10, p<0.01), school grade (β=-0.09, p<0.05), co-sleeping (β=0.25, p<0.01), emotional symptoms (β=0.24, p<0.01), conduct problems (β=0.09, p<0.05), and hyperactivity (β=0.17, p<0.01) accounted for significant variance in CSHQ total score. Conclusions: Short sleep duration and sleep disturbances are prevalent among Chinese school-aged children. Sleep disturbances are associated with gender, school grade, co-sleeping, emotional symptoms, conduct problems, and hyperactivity.
    Sleep Medicine 12/2012; 14(1). DOI:10.1016/j.sleep.2012.09.022 · 3.15 Impact Factor
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    • "Increased adipose tissue mass in the abdominal wall and cavity, as well as in the thorax, increases the global respiratory load and reduces intrathoracic diaphragm excursion, particularly during the supine position, leading to decreased lung volumes and oxygen reserve, and increased work of breathing during sleep. Furthermore, obesity can be accompanied by poor quality sleep, which, in turn, can perturb arousal mechanisms and, therefore, delay upper airway opening, thus exacerbating the duration of apnea.63 "
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    ABSTRACT: In modern life, children are unlikely to obtain sufficient or regular sleep and waking schedules. Inadequate sleep affects the regulation of homeostatic and hormonal systems underlying somatic growth, maturation, and bioenergetics. Therefore, assessments of the obesogenic lifestyle, including as dietary and physical activity, need to be coupled with accurate evaluation of sleep quality and quantity, and coexistence of sleep apnea. Inclusion of sleep as an integral component of research studies on childhood obesity should be done as part of the study planning process. Although parents and health professionals have quantified normal patterns of activities in children, sleep has been almost completely overlooked. As sleep duration in children appears to have declined, reciprocal obesity rates have increased. Also, increases in pediatric obesity rates have markedly increased the risk of obstructive sleep apnea syndrome (OSAS) in children. Obesity and OSAS share common pathways underlying end-organ morbidity, potentially leading to reciprocal amplificatory effects. The relative paucity of data on the topics covered in the perspective below should serve as a major incentive toward future research on these critically important concepts.
    Annals of the New York Academy of Sciences 08/2012; 1264(1):135-41. DOI:10.1111/j.1749-6632.2012.06723.x · 4.38 Impact Factor
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