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Association between REM sleep and obstructive sleep apnea in obese and overweight adolescents

  • Orna Sever
  • Eric J. Kezirian
  • Emily Gillett
  • Sally L Davidson Ward
  • Michael Khoo
  • Iris A. PerezEmail author
Pediatrics • Original Article

Abstract

Purpose

Overweight and obese children have demonstrated reduced rapid eye movement (REM) sleep, affecting energy balance regulation and predisposition to weight gain. Obstructive sleep apnea (OSA) is a known cause of decreased REM sleep. The purpose of this study is to examine the association between the percentage of REM sleep, BMI z-score, and OSA severity in overweight and obese adolescents.

Methods

We performed a cross-sectional study of 92 (43% female) overweight and obese adolescents (13–17 years old) who underwent overnight polysomnography (PSG) at Children’s Hospital Los Angeles between 2010 and 2017.

Results

The average Body Mass Index (BMI) z-score was 2.27 ± 0.47, with 71% having BMI z-score ≥ 2. REM% during PSG was 15.6 ± 6.8, and obstructive apnea-hypopnea index was 17.1 ± 24.3. The distribution across categories of OSA severity was 27% none (≤ 1.5 events/h), 24% mild (> 1.5–5 events/h), 8% moderate (> 5–10 events/h), and 41% severe (> 10 events/h). REM% was not associated with BMI z-score, either on univariate or multivariate regression with adjustment for age, gender, and apnea-hypopnea index (AHI). When subdivided into OSA categories, a 1-unit increase in BMI z-score was associated with a 5.96 (p = 0.03) increase in REM% in mild OSA and an 8.86 (p = 0.02) decrease in REM% in severe OSA. There was no association between BMI z-score and REM% in none and moderate OSA.

Conclusion

Among overweight and obese adolescents, BMI z-score was associated with decreased REM% in severe OSA and unexpectedly increased REM% in mild OSA, but there was no association in none or moderate OSA.

Keywords

Adolescents Obesity Obstructive sleep apnea Rapid eye movement 

Abbreviations

AASM

American Academy of Sleep Medicine

BMI

body mass index

CDC

centers for disease control and prevention

NREM

non rapid eye movement

OAHI

obstructive apnea-hypopnea index

OSA

obstructive sleep apnea

PSG

polysomnography

REM

rapid eye movement

Notes

Funding

This work was supported in part by the National Institutes of Health (NIH) grants HL090451 and EB001978, University of Southern California Center for Transdisciplinary Research on Energetics and Cancer grant TREC U54 CA 116848, and grant M01 RR00047 and RO1-HL-105210 from Children’s Hospital Los Angeles General Clinical Research Center.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study was approved by the Children’s Hospital Los Angeles institutional review board.

Informed consent

Informed consent was waivered by the Children’s Hospital Los Angeles institutional review board for all individual participants included in the study.

References

  1. 1.
    Mathew JL, Narang I (2014) Sleeping too close together: obesity and obstructive sleep apnea in childhood and adolescence. Paediatr Respir Rev 15(3):211–218PubMedGoogle Scholar
  2. 2.
    Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1(1):11–25CrossRefGoogle Scholar
  3. 3.
    Bhattacharjee R, Kim J, Kheirandish-Gozal L, Gozal D (2011) Obesity and obstructive sleep apnea syndrome in children: a tale of inflammatory cascades. Pediatr Pulmonol 46(4):313–323CrossRefGoogle Scholar
  4. 4.
    Hakim F, Kheirandish-Gozal L, Gozal D (2015) Obesity and altered sleep: a pathway to metabolic derangements in children? Semin Pediatr Neurol 22(2):77–85CrossRefGoogle Scholar
  5. 5.
    Taheri S, Lin L, Austin D, Young T, Mignot E (2004) Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 1(3):e62CrossRefGoogle Scholar
  6. 6.
    Liu X, Forbes EE, Ryan ND, Rofey D, Hannon TS, Dahl RE (2008) Rapid eye movement sleep in relation to overweight in children and adolescents. Arch Gen Psychiatry 65(8):924–932CrossRefGoogle Scholar
  7. 7.
    Chamorro R, Algarín C, Garrido M, Causa L, Held C, Lozoff B, Peirano P (2014) Night time sleep macrostructure is altered in otherwise healthy 10-year-old overweight children. Int J Obes 38(8):1120–1125CrossRefGoogle Scholar
  8. 8.
    Olson CA, Hamilton NA, Somers VK (2016) Percentage of REM sleep is associated with overnight change in leptin. J Sleep Res 25(4):419–425CrossRefGoogle Scholar
  9. 9.
    Horne JA (2015) Human REM sleep: influence on feeding behaviour, with clinical implications. Sleep Med 16(8):910–916CrossRefGoogle Scholar
  10. 10.
    Gonnissen HK et al (2013) Effects of sleep fragmentation on appetite and related hormone concentrations over 24 h in healthy men. Br J Nutr 109(4):748–756CrossRefGoogle Scholar
  11. 11.
    McEown K, Takata Y, Cherasse Y, Nagata N, Aritake K, Lazarus M (2016) Chemogenetic inhibition of the medial prefrontal cortex reverses the effects of REM sleep loss on sucrose consumption. Elife.  https://doi.org/10.7554/eLife.20269
  12. 12.
    Venancio DP, Suchecki D (2015) Prolonged REM sleep restriction induces metabolic syndrome-related changes: mediation by pro-inflammatory cytokines. Brain Behav Immun 47:109–117CrossRefGoogle Scholar
  13. 13.
    Walter LM, Nixon GM, Davey MJ, O’Driscoll DM, Trinder J, Horne RSC (2011) Sleep disturbance in pre-school children with obstructive sleep apnoea syndrome. Sleep Med 12(9):880–886CrossRefGoogle Scholar
  14. 14.
    Tauman R, O'Brien LM, Holbrook CR, Gozal D (2004) Sleep pressure score: a new index of sleep disruption in snoring children. Sleep 27(2):274–278CrossRefGoogle Scholar
  15. 15.
    Roche J, Gillet V, Perret F, Mougin F (2018) Obstructive sleep apnea and sleep architecture in adolescents with severe obesity: effects of a 9-month lifestyle modification program based on regular exercise and a balanced diet. J Clin Sleep Med 14(6):967–976CrossRefGoogle Scholar
  16. 16.
    Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291(23):2847–2850CrossRefGoogle Scholar
  17. 17.
    Barlow SE, Expert C (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(Suppl 4):S164–S192CrossRefGoogle Scholar
  18. 18.
    Witmans MB, Keens TG, Ward SLD, Marcus CL (2003) Obstructive hypopneas in children and adolescents: normal values. Am J Respir Crit Care Med 168(12):1540CrossRefGoogle Scholar
  19. 19.
    Iber, C.a.t.A.A.o.S.M. (2007) The AASM manual for the scoring of sleep and assosiatied events: rules, terminology and technical significations. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  20. 20.
    Jalilolghadr S, Yazdi Z, Mahram M, Babaei F, Esmailzadehha N, Nozari H, Saffari F (2016) Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study. Sleep Breath 20(2):845–851CrossRefGoogle Scholar
  21. 21.
    Shechter A, O'Keeffe M, Roberts AL, Zammit GK, RoyChoudhury A, St-Onge MP (2012) Alterations in sleep architecture in response to experimental sleep curtailment are associated with signs of positive energy balance. Am J Phys Regul Integr Comp Phys 303(9):R883–R889Google Scholar
  22. 22.
    Durdik P, Sujanska A, Suroviakova S, Evangelisti M, Banovcin P, Villa MP (2018) Sleep architecture in children with common phenotype of obstructive sleep apnea. J Clin Sleep Med 14(1):9–14CrossRefGoogle Scholar
  23. 23.
    Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM (1996) Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol 21(3):176–183CrossRefGoogle Scholar
  24. 24.
    Verhulst SL, van Gaal L, de Backer W, Desager K (2008) The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev 12(5):339–346CrossRefGoogle Scholar
  25. 25.
    Goh DY, Galster P, Marcus CL (2000) Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med 162(2 Pt 1):682–686CrossRefGoogle Scholar
  26. 26.
    Watanabe M, Kikuchi H, Tanaka K, Takahashi M (2010) Association of short sleep duration with weight gain and obesity at 1-year follow-up: a large-scale prospective study. Sleep 33(2):161–167CrossRefGoogle Scholar
  27. 27.
    Koren D, Levitt Katz LE, Brar PC, Gallagher PR, Berkowitz RI, Brooks LJ (2011) Sleep architecture and glucose and insulin homeostasis in obese adolescents. Diabetes Care 34(11):2442–2447CrossRefGoogle Scholar
  28. 28.
    Van Cauter E, Knutson KL (2008) Sleep and the epidemic of obesity in children and adults. Eur J Endocrinol 159(Suppl 1):S59–S66CrossRefGoogle Scholar
  29. 29.
    Katz ES, Greene MG, Carson KA, Galster P, Loughlin GM, Carroll J, Marcus CL (2002) Night-to-night variability of polysomnography in children with suspected obstructive sleep apnea. J Pediatr 140(5):589–594CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Orna Sever
    • 1
    • 2
  • Eric J. Kezirian
    • 2
  • Emily Gillett
    • 1
    • 2
  • Sally L Davidson Ward
    • 1
    • 2
  • Michael Khoo
    • 3
  • Iris A. Perez
    • 1
    • 2
    Email author
  1. 1.Children’s Hospital Los AngelesLos AngelesUSA
  2. 2.Keck School of Medicine of USCLos AngelesUSA
  3. 3.Viterbi School of EngineeringUniversity of Southern CaliforniaLos AngelesUSA

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