Sleep and Breathing

, Volume 18, Issue 3, pp 555–561 | Cite as

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

Original Article

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.

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

References

  1. 1.
    Ebbeling CB, Pawlak DB, Ludwig DS (2002) Childhood obesity: public-health crisis, common sense cure. Lancet 360:473–482PubMedCrossRefGoogle Scholar
  2. 2.
    Ogden CL, Lamb MM, Carroll MD, Flegal KM (2010) Obesity and socioeconomic status in children and adolescents: United States, 2005–2008. NCHS Data Brief:1–8Google Scholar
  3. 3.
    Strauss RS (2000) Childhood obesity and self-esteem. Pediatrics 105:e15PubMedCrossRefGoogle Scholar
  4. 4.
    Kiess W, Reich A, Muller G, Meyer K, Galler A, Bennek J, Kratzsch J (2001) Clinical aspects of obesity in childhood and adolescence—diagnosis, treatment and prevention. Int J Obes Relat Metab Disord 25(Suppl 1):S75–S79PubMedCrossRefGoogle Scholar
  5. 5.
    Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, Steer C, Sherriff A (2005) Early life risk factors for obesity in childhood: cohort study. BMJ 330:1357PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Taveras EM, Rifas-Shiman SL, Oken E, Gunderson EP, Gillman MW (2008) Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med 162:305–311PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Spilsbury JC, Storfer-Isser A, Drotar D, Rosen CL, Kirchner LH, Benham H, Redline S (2004) Sleep behavior in an urban US sample of school-aged children. Arch Pediatr Adolesc Med 158:988–994PubMedCrossRefGoogle Scholar
  8. 8.
    Dahl RE (1996) The impact of inadequate sleep on children’s daytime cognitive function. Semin Pediatr Neurol 3:44–50PubMedCrossRefGoogle Scholar
  9. 9.
    National Sleep Foundation (2006) Sleep in America Poll; Accessed 11 August 2012Google Scholar
  10. 10.
    Van Cauter E, Knutson KL (2008) Sleep and the epidemic of obesity in children and adults. Eur J Endocrinol 159(Suppl 1):S59–S66PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Morselli L, Leproult R, Balbo M, Spiegel K (2010) Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab 24:687–702PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Jiang F, Zhu S, Yan C, Jin X, Bandla H, Shen X (2009) Sleep and obesity in preschool children. J Pediatr 154:814–818PubMedCrossRefGoogle Scholar
  13. 13.
    Padez C, Mourao I, Moreira P, Rosado V (2009) Long sleep duration and childhood overweight/obesity and body fat. Am J Hum Biol 21:371–376PubMedCrossRefGoogle Scholar
  14. 14.
    Lumeng JC, Somashekar D, Appugliese D, Kaciroti N, Corwyn RF, Bradley RH (2007) Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years. Pediatrics 120:1020–1029PubMedCrossRefGoogle Scholar
  15. 15.
    Sekine M, Yamagami T, Handa K, Saito T, Nanri S, Kawaminami K, Tokui N, Yoshida K, Kagamimori S (2002) A dose–response relationship between short sleeping hours and childhood obesity: results of the Toyama Birth Cohort Study. Child Care Health Dev 28:163–170PubMedCrossRefGoogle Scholar
  16. 16.
    Chaput JP, Brunet M, Tremblay A (2006) Relationship between short sleeping hours and childhood overweight/obesity: results from the ‘Quebec en Forme’ Project. Int J Obes (Lond) 30:1080–1085CrossRefGoogle Scholar
  17. 17.
    Bayer O, Rosario AS, Wabitsch M, von Kries R (2009) Sleep duration and obesity in children: is the association dependent on age and choice of the outcome parameter? Sleep 32:1183–1189PubMedCentralPubMedGoogle Scholar
  18. 18.
    Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5:242–252PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    O’Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, Raffield TJ, Gozal D (2004) Neurobehavioral implications of habitual snoring in children. Pediatrics 114:44–49PubMedCrossRefGoogle Scholar
  20. 20.
    Chervin RD, Archbold KH, Dillon JE, Panahi P, Pituch KJ, Dahl RE, Guilleminault C (2002) Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 109:449–456PubMedCrossRefGoogle Scholar
  21. 21.
    Gozal D (2009) Sleep, sleep disorders and inflammation in children. Sleep Med 10(Suppl 1):S12–S16PubMedCrossRefGoogle Scholar
  22. 22.
    Redline S, Storfer-Isser A, Rosen CL, Johnson NL, Kirchner HL, Emancipator J, Kibler AM (2007) Association between metabolic syndrome and sleep-disordered breathing in adolescents. Am J Respir Crit Care Med 176:401–408PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Amin RS, Kimball TR, Kalra M, Jeffries JL, Carroll JL, Bean JA, Witt SA, Glascock BJ, Daniels SR (2005) Left ventricular function in children with sleep-disordered breathing. Am J Cardiol 95:801–804PubMedCrossRefGoogle Scholar
  24. 24.
    Vgontzas AN, Bixler EO, Chrousos GP (2003) Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med 254:32–44PubMedCrossRefGoogle Scholar
  25. 25.
    Barlow SE (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(Suppl 4):S164–S192PubMedCrossRefGoogle Scholar
  26. 26.
    Chervin RD, Hedger K, Dillon JE, Pituch KJ (2000) Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 1:21–32PubMedCrossRefGoogle Scholar
  27. 27.
    American Academy of Sleep Medicine (2007) The AASM manual for scoring of sleep and associated events: rules, terminology and technical specification. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  28. 28.
    Verhulst SL, Schrauwen N, Haentjens D, Suys B, Rooman RP, Van Gaal L, De Backer WA, Desager KN (2007) Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child 92:205–208PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Agras WS, Hammer LD, McNicholas F, Kraemer HC (2004) Risk factors for childhood overweight: a prospective study from birth to 9.5 years. J Pediatr 145:20–25PubMedCrossRefGoogle Scholar
  30. 30.
    Spiegel K, Leproult R, L’Hermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E (2004) Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 89:5762–5771PubMedCrossRefGoogle Scholar
  31. 31.
    Spiegel K, Leproult R, Van Cauter E (1999) Impact of sleep debt on metabolic and endocrine function. Lancet 354:1435–1439PubMedCrossRefGoogle Scholar
  32. 32.
    National Sleep Foundation www.sleepfoundation.org. Accessed 11 August 2012
  33. 33.
    Dayyat EA, Spruyt K, Molfese DL, Gozal D (2011) Sleep estimates in children: parental versus actigraphic assessments. Nat Sci Sleep 3:115–123PubMedCentralPubMedGoogle Scholar
  34. 34.
    Short MA, Gradisar M, Lack LC, Wright HR, Chatburn A (2013) Estimating adolescent sleep patterns: parent reports versus adolescent self-report surveys, sleep diaries, and actigraphy. Nat Sci Sleep 5:23–26PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Marta Moraleda-Cibrián
    • 1
    • 2
  • Louise M. O’Brien
    • 1
    • 2
    • 3
  1. 1.Sleep Disorders Center, Department of NeurologyUniversity of MichiganAnn ArborUSA
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity of MichiganAnn ArborUSA
  3. 3.Michael S. Aldrich Sleep Disorders LaboratoryAnn ArborUSA

Personalised recommendations