The obesity epidemic and disordered sleep during childhood and adolescence
Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, 5721 S. Maryland Avenue, MC 8000, Suite K-160, Chicago, IL 60637, USA.Adolescent medicine: state of the art reviews 12/2010; 21(3):480-90, viii-ix.
The obesity pandemic is claiming its presence even among youngest of children and is clearly on the rise. Although the extent and implications of this massive increase in the prevalence of overweight and obese children are unclear, they are anticipated to be deleterious to global health outcomes and life expectancy. The potential interrelationships between sleep and obesity have gained recent attention. In this chapter, we initially examine the critical evidence supporting or refuting such proposed associations. In addition, the potential reciprocal roles of obesity and obstructive sleep apnea in the facilitation of their pathophysiology are also reviewed, along with their amplificatory effects on their respective morbidities.
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- "Furthermore, although the majority of these children demonstrated resolution of the endothelial dysfunction following treatment with AT,60 a subgroup who also had a strong family history of cardiovascular disease did not show the anticipated improvements in endothelial function, suggesting that the effects of OSA in a genetically susceptible subset of children may persist for unknown periods of time, potentially into adulthood. As anticipated, in children with concurrent obesity and OSA, the magnitude of endothelial dysfunction was greater than when either condition was present in isolation, suggesting the convergence of the deleterious consequences of obesity and OSA.26,34,64–65 The evidence for severity-dependent alterations in endothelial function was confirmed in children with OSA, using pulse arterial tonometry to derive the reactive hyperemia index, whereby significant differences in evening-to-morning changes of endothelial function emerged in children with OSA, and such overnight changes in endothelial function were closely associated with the severity of the disease.62 "
ABSTRACT: Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment.
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- "This may be a contributory factor to the cognitive impairment noted in this group. Reduced sleep may alter hormones ghrelin and leptin that may in turn increase the risk of weight gain. Lack of breast feeding by the mother, irrespective of causes, has been demonstrated to be another risk factor for pediatric obesity. "
ABSTRACT: Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity.
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