Childhood obesity, weight loss and developmental trajectories predict the persistence and remission of childhood sleep-disordered breathing.

BACKGROUND: Obesity has been recognized as a risk factor for childhood sleep-disordered breathing (SDB), yet it remains unclear how obesity and weight change predict the course of childhood SDB. OBJECTIVE: The objective of the study is to investigate the role of body weight, upper airway abnormalities and developmental trajectories on the persistence and remission of childhood SDB in the transition to adolescence. METHODS: The Penn State Child Cohort is a representative population sample of 700 children (5-12 years), of whom 421 were followed up as adolescents (12-23 years). Participants underwent a clinical history, physical examination and polysomnography at both time points. RESULTS: Obesity and enlarged tonsils were cross-sectionally associated with childhood SDB. Longitudinally, baseline obesity predicted the persistence of childhood SDB (OR = 3.75, 95% CI = 2.00-7.05), while weight loss predicted its remission (OR = 1.67, 95% CI = 1.11-2.50). Children with enlarged tonsils who remitted from SDB had not experienced significant weight loss and only 4.4% had undergone adeno/tonsillectomy. Body fat distribution/composition at follow-up was similar in those who had remitted from childhood SDB as compared with those who had never experienced SDB, while those who persisted with childhood SDB showed significant android distribution and visceral adiposity at follow-up. CONCLUSIONS: Our data support a causal role for obesity and weight loss in the chronicity and remission, respectively, of childhood SDB in the transition to adolescence and suggest that remission of SDB is related to developmental trajectories of the upper airway in a significant proportion of children. Thus, targeting childhood obesity and weight gain should be a priority in the prevention and treatment of SDB during this critical developmental period.

Neurocognitive and behavioral functioning in adolescents with sleep-disordered breathing: a population-based, dual-energy X-ray absorptiometry study.

BACKGROUND/OBJECTIVES: Sleep-disordered breathing (SDB) has been associated with neurocognitive and behavioral problems in young children; however, this association is less studied in adolescents. Evidence suggests that obesity plays a key role in the development of SDB, although its relative association with neurobehavioral functioning remains unclear. We examined whether SDB and obesity are associated with neurocognitive and behavioral problems in adolescents. SUBJECTS/METHODS: A total of 421 adolescents (17.0±2.2y, 53.9% male) from the Penn State Child Cohort, a general population sample, underwent a 9-h polysomnography, clinical history, physical examination, neurocognitive evaluation and Dual-energy X-ray Absorptiometry (DXA) scan, and completed the Child or Adult Behavior Checklist. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI)⩾2, primary snoring (PS) as AHI<2+snoring and no-SDB as AHI<2 without snoring. Body weight measures included body mass index (BMI) percentile, waist circumference (WC) and DXA-measured total adipose tissue (TAT). RESULTS: WC and TAT were significantly associated with impaired vigilance, processing speed, working memory, and control interference and greater internalizing and externalizing behaviors, while BMI percentile was marginally associated. SDB per se (PS, AHI or OSA) was not significantly associated with impaired neurocognitive outcomes or greater behavioral problems. However, TAT was significantly associated with impaired vigilance and greater internalizing and externalizing behaviors and, to a lesser extent, slower processing speed and greater control interference, only in adolescents with OSA. CONCLUSIONS: Central obesity, an etiopathogenic mechanism of OSA, is more strongly associated with neurocognitive and behavioral problems in adolescents than SDB alone. Deficits in low-order (vigilance) and high-order (executive) functions and behavioral problems observed in adolescents with OSA are primarily associated with increased central adiposity, a finding not entirely captured with less precise measures of obesity. These data support that OSA and its associated neurocognitive and behavioral morbidity are related to underlying metabolic dysfunction as early as adolescence.

The relative association of obstructive sleep apnea, obesity and excessive daytime sleepiness with incident depression: a longitudinal, population-based study.

BACKGROUND: It is postulated that obstructive sleep apnea (OSA) is a risk factor for the development of depression. However, obesity and excessive daytime sleepiness (EDS) are associated with both OSA and depression. The goal of this study was to examine the relative contribution of OSA, obesity and EDS to incident depression. METHODS: A representative random sample of 1137 adults without depression from the Penn State Adult Cohort was followed up after 7.5 years. All subjects underwent a full medical examination and polysomnography at baseline. OSA was defined as an apnea/hypopnea index (AHI) ⩾5, overweight as a body mass index (BMI) of 25-29.9 kg m(-)(2), obesity as a BMI⩾30 kg m(-)(2) and EDS as moderate-to-severe drowsiness/sleepiness and/or irresistible sleep attacks. RESULTS: Overweight, obesity and EDS were associated with incident depression, whereas OSA alone was not. Overweight was associated with incident depression in women, while obesity and EDS were associated with incident depression in both genders. The association of overweight and obesity with incident depression was independent of premorbid emotional distress, while that of EDS was not. The association between BMI and EDS with incident depression was stronger in women 20-40 years old. The severity of EDS predicted incident depression in those with OSA, while AHI or oxygen desaturation did not. CONCLUSIONS: Overweight, obesity and EDS are the main predictors of incident depression. Obesity may be linked to depression through psychobiological mechanisms, while EDS may be an early sign of depression. Obesity should be a target of our preventative strategies for depression.

Unveiling the longitudinal association between short sleep duration and the incidence of obesity: the Penn State Cohort.

OBJECTIVE: Several epidemiologic, longitudinal studies have reported that short sleep duration is a risk factor for the incidence of obesity. However, the vast majority of these studies used self-reported measures of sleep duration and did not examine the role of objective short sleep duration, subjective sleep disturbances and emotional stress. DESIGN: Longitudinal, population-based study. SUBJECTS: We studied a random sample of 815 non-obese adults from the Penn State Cohort in the sleep laboratory for one night using polysomnography (PSG) and followed them up for a mean of 7.5 years. Subjective and objective measures of sleep as well as emotional stress were obtained at baseline. Obesity was defined as a body mass index (BMI) ≥30 kg/ m(-2). RESULTS: The incidence of obesity was 15% and it was significantly higher in women and in individuals who reported sleep disturbances, shorter sleep duration and higher emotional stress. Significant mediating effects showed that individuals with subjective sleep disturbances who developed obesity reported the shortest sleep duration and the highest emotional stress, and that subjective sleep disturbances and emotional stress were independent predictors of incident obesity. Further analyses revealed that the association between short sleep duration, subjective sleep disturbances and emotional stress with incident obesity was stronger in young and middle-age adults. Objective short sleep duration was not associated with a significantly increased risk of incident obesity. CONCLUSION: Self-reported short sleep duration in non-obese individuals at risk of developing obesity is a surrogate marker of emotional stress and subjective sleep disturbances. Objective short sleep duration is not associated with a significant increased risk of incident obesity. The detection and treatment of sleep disturbances and emotional stress should become a target of our preventive strategies against obesity.

Insomnio y calidad del sueño en médicos de atención primaria: una perspectiva de género / Insomnia and quality of sleep among primary care pshycians: A gender perspective

Objetivo. Se trata de explorar la prevalencia del insomnio y la calidad del sueño en una muestra de médicos de atención primaria desde una perspectiva de género. Sujetos y métodos. Se seleccionó una muestra representativa compuesta por 240 médicos de 70 centros de atención primaria de la Comunidad de Madrid. La tasa de respuesta fue del 71,6%. El cuestionarioincluía información sociodemográfica, síntomas de insomnio según los criterios del Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV) y el índice de calidad del sueño de Pittsburgh (ICSP). Resultados. El 18,8% del total de a muestra cumplió los criterios diagnósticos de insomnio del DSM-IV, con una mayor frecuencia en las mujeres (23%) comparadascon los hombres (9,6%). El mismo patrón apareció en el despertar antes de lo deseado y en el malestar diurno. La relación entre género e insomnio se confirmó mediante análisis de regresión binaria, controlando las variables sociodemográficas. Además, los resultados indicaron que las mujeres obtuvieron puntuaciones significativamente mayores que las de los hombres en el índice ICSP y en sus componentes. Una puntuación global igual o mayor de 5 en el ICSP resulta un criterio válido desde el punto de vista clínico para discriminar entre buenos y malos durmientes. Mediante este criterio, puede considerarseque el 35,4% de los médicos encuestados era mal durmiente, y es significativamente mayor el porcentaje de mujeres que cumplía dicho criterio (el 40% frente al 25,3%). Conclusiones. Los datos indican una elevada prevalencia de las alteraciones del sueño en médicos de atención primaria, especialmente entre las mujeres

Aim. To assess insomnia and sleep quality in primary care physicians from a gender perspective. Subjects and methods. A representative sample of 240 physicians was drawn from 70 medical centers from the Madrid Autonomous region. The participation rate was 71.6%. The questionnaire included sociodemographic data, insomnia symptomatology using DSM-IVcriteria and the Pittsburgh Sleep Quality Index (PSQI). Results. 18.8% of the total sample met DSM-IV criteria for insomnia diagnosis, with higher frequency among women (23%) compared to men (9.6%). The same pattern appeared for early morning awakening and daytime impairment.Results of logistic regression analyses showed that, after controlling for sociodemographic variables, this relationship between gender and insomnia remained significant. Furthermore, the results indicate that women scored significantly higher than men on global sleep quality and on its components. A PSQI global score= or > 5 is an optimal cut-off score for distinguishing good sleepers from subjects with clinical sleep problems. Following this criteria, 35.4% of physicians had sleep problems, with a significant higher prevalence among women (40% vs. 25.3%).Conclusions. The data indicates that the prevalence of sleep disturbances is high among primary care physicians, especially among women

[Insomnia and quality of sleep among primary care physicians: a gender perspective]. / Insomnio y calidad del sueño en médicos de atención primaria: una perspectiva de género.

AIM: To assess insomnia and sleep quality in primary care physicians from a gender perspective. SUBJECTS AND METHODS: A representative sample of 240 physicians was drawn from 70 medical centers from the Madrid Autonomous region. The participation rate was 71.6%. The questionnaire included sociodemographic data, insomnia symptomatology using DSM-IV criteria and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: 18.8% of the total sample met DSM-IV criteria for insomnia diagnosis, with higher frequency among women (23%) compared to men (9.6%). The same pattern appeared for early morning awakening and daytime impairment. Results of logistic regression analyses showed that, after controlling for sociodemographic variables, this relationship between gender and insomnia remained significant. Furthermore, the results indicate that women scored significantly higher than men on global sleep quality and on its components. A PSQI global score = or > 5 is an optimal cut-off score for distinguishing good sleepers from subjects with clinical sleep problems. Following this criteria, 35.4% of physicians had sleep problems, with a significant higher prevalence among women (40% vs. 25.3%). CONCLUSIONS: The data indicates that the prevalence of sleep disturbances is high among primary care physicians, especially among women.