Association between short sleep duration and metabolic syndrome in Chinese children and adolescents

Machine learning approach to investigate pregnancy and childbirth risk factors of sleep problems in early adolescence: Evidence from two cohort studies

BACKGROUND

This study aimed to predict early adolescent sleep problems using pregnancy and childbirth risk factors through machine learning algorithms, and to evaluate model performance internally and externally.

METHODS

Data from the China Jintan Child Cohort study (CJCC; n=848) for model development and the US Healthy Brain and Behavior Study (HBBS; n=454) for external validation were employed. Maternal pregnancy histories, obstetric data, and adolescent sleep problems were collected. Several machine learning techniques were employed, including least absolute shrinkage and selection operator, logistic regression, random forest, naïve bayes, extreme gradient boosting, decision tree, and neural network. The area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, and root mean square of residuals were used to evaluate model performance.

RESULTS

Key predictors for CJCC adolescents' sleep problems include gestational age, birthweight, duration of delivery, and maternal happiness during pregnancy. In HBBS adolescents, the duration of postnatal depressive emotions was the primary perinatal predictor. The prediction models developed in the CJCC had good-to-excellent internal validation performance but poor performance in predicting the sleep problems in HBBS adolescents.

CONCLUSION

The identification of specific perinatal risk factors associated with adolescent sleep problems can inform targeted interventions during and after pregnancy to mitigate these risks. Health providers should consider integrating these predictive factors into routine pre- and postnatal assessments to identify at-risk populations. The variability in model performance across different cohorts highlights the need for context-specific models and the cautious application of predictive analytics across diverse populations. Future research should focus on refining predictive models to account for such variations, potentially through the incorporation of additional socio-cultural factors and genetic markers. This study emphasizes the importance of personalized and culturally sensitive approaches in the prediction and management of adolescent sleep problems, leveraging advanced computational methods to enhance maternal and child health outcomes.

Associations between adherence to 24-Hour Movement Guidelines with continuous metabolic syndrome score among Chinese children and adolescents

OBJECTIVES

The objective of this study was to evaluate the associations between adherence to 24-Hour Movement Guidelines (24-HMG) with continuous metabolic syndrome score (cMetS) among Chinese children.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a cross-sectional study among 4604 children aged 6-17 years from Shenzhen, China. The 24-HMG was constructed using the self-report information on moderate-to-vigorous physical activity (MVPA), screen time (ST), and sleep duration. The cMetS was calculated based on waist circumference, homoeostatic model assessment for insulin resistance, mean arterial blood pressure, high-density lipoprotein cholesterol, and triglyceride. Multivariate linear regression models were used to assess the associations between adherence to recommendations of 24-HMG and cMetS.

RESULTS

Among the participants, 563 (12.23%) students adhered to 3 recommendations of the 24-HMG. We found that adhering to more recommendations was negatively associated with cMetS (P for trend: <0.001). For specific combinations, meeting the ST + MVPA recommendations was negatively associated with cMetS (coefficients [β]: -0.686; 95% confidence interval [CI]: -1.148, -0.223). Individuals who adhered to all recommendations had a lower cMetS (β: -0.693; 95% CI: -1.147, -0.238) than those who met none of the recommendations.

CONCLUSIONS

Our study showed that adherence to more recommendations of the 24-HMG was associated with lower levels of cMetS in Chinese children and adolescents.

Accelerometry-assessed sleep clusters and cardiometabolic risk factors in adolescents

OBJECTIVE

This study aimed to identify sleep clusters based on objective multidimensional sleep characteristics and test their associations with adolescent cardiometabolic health.

METHODS

The authors included 1090 participants aged 14.3 to 16.4 years (mean = 15.2 years) who wore 7-day accelerometers during the 15-year follow-up of the German Infant Study on the influence of Nutrition Intervention PLUS environmental and genetic influences on allergy development (GINIplus) and the Influence of Lifestyle factors on the development of the Immune System and Allergies in East and West Germany (LISA) birth cohorts. K-means cluster analysis was performed across 12 sleep characteristics reflecting sleep quantity, quality, schedule, variability, and regularity. Cardiometabolic risk factors included fat mass index (FMI), blood pressure, triglycerides, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and insulin resistance (n = 505). Linear and logistic regression models were examined.

RESULTS

Five sleep clusters were identified: good sleep (n = 337); delayed sleep phase (n = 244); sleep irregularity and variability (n = 108); fragmented sleep (n = 313); and prolonged sleep latency (n = 88). The "prolonged sleep latency" cluster was associated with increased sex-scaled FMI (β = 0.39, 95% CI: 0.15-0.62) compared with the "good sleep" cluster. The "sleep irregularity and variability" cluster was associated with increased odds of high triglycerides only in male individuals (odds ratio: 9.50, 95% CI: 3.22-28.07), but this finding was not confirmed in linear models.

CONCLUSIONS

The prolonged sleep latency cluster was associated with higher FMI in adolescents, whereas the sleep irregularity and variability cluster was specifically linked to elevated triglycerides (≥1.7 mmol/L) in male individuals.

Sleep duration is associated with metabolic syndrome in adolescents and children: a systematic review and meta-analysis

STUDY OBJECTIVES

Studies on the associations between sleep duration and metabolic syndrome in adolescents and children have reported mixed results. To shed more light on this issue, we conducted this meta-analysis by synthesizing the results of previous studies.

METHODS

Studies were retrieved from PubMed, Ovid, Cochrane, and Embase from inception to October 2021. Fixed-effects models and random-effects models were used to analyze the effects of sleep time on metabolic syndrome in adolescents.

RESULTS

Data from 7 studies, including 13,305 adolescents and children, were meta-analyzed. Compared with the control group, short sleep durations were not associated with a high prevalence of metabolic syndrome in adolescents and children using a random-effects model (odds ratio = 0.92, 95% confidence interval = 0.48-1.37, I2 = 56.5%, P = .378). Using a fixed-effects model on long sleep duration, this association was statistically significant (odds ratio = 0.57, 95% confidence interval = 0.38-0.76, I2 = 0.0%, P < .001) as a protective factor compared with shorter sleep duration.

CONCLUSIONS

Long sleep duration, instead of short sleep duration, was significantly associated with a lower prevalence of metabolic syndrome among adolescents and children.

CITATION

Xu Y, Hua J, Wang J, Shen Y. Sleep duration is associated with metabolic syndrome in adolescents and children: a systematic review and meta-analysis. J Clin Sleep Med. 2023;19(10):1835-1843.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Sleep Duration and Metabolic Syndrome among Early Adolescents-A Cross-Sectional Study in Khartoum State, Sudan

Numerous studies have reported that sleep disorders are linked to poor health outcomes. However, studies on these associations in children and adolescents in an African context are limited. The aim of the present study was to analyze the relationship between sleep duration and the presence of metabolic syndrome among early adolescents in Sudan. Methods: A cross-sectional study was conducted on participants aged 10-15 years in Khartoum State, Sudan. Metabolic syndrome (MetS) was diagnosed by increased waist circumference and the presence of two or more metabolic abnormalities (triglycerides [TG], high-density lipoproteins [HDL-C], blood pressure [BP], and fasting plasma glucose [FBG]). Short sleep duration was defined based on National Sleep Foundation (NSF) classification. Data were collected by physical examinations, biochemical analyses, and self-developed standardized questionnaires. Data were analyzed with IBM SPSS Statistics Version 24. A generalized additive model (GAM) was used for the smoothing function between sleep duration and MetS. p < 0.05 was considered as significant. Results: The prevalence of MetS and short sleep among early adolescents aged 10-15 years in Sudan was 2.3% and 55.0%, respectively. A higher prevalence of short sleep was found among overweight and obese participants (p < 0.05). The prevalence of MetS among short sleepers was 2.8%. Binary logistic regression analysis showed that male short sleepers had higher odds of having MetS compared to female short sleepers. The relationship between short sleep and low HDL-C in boys and between short sleep and high TG in girls was statistically significant. The highest risk of MetS was observed at less than 6.5 h of sleep per night. Conclusions: Short sleep duration was significantly associated with overweight/obesity in the total population and with low HDL-C in boys and high triglycerides in girls. A nonlinear curve pattern was observed between sleep duration and prevalence of MetS. Longitudinal studies are needed to further determine the causal relationship between sleep habits and MetS and its components.

Sleep disturbances in individuals with down syndrome: An overview

Down Syndrome, or Trisomy 21, is one of the most common birth defects, with 6,000 babies born annually with Down Syndrome in the U.S. One of many health risk factors individuals with Down Syndrome experience is sleep issues, ranging from poor sleep quality to high prevalence of obstructive sleep apnea. This literature review aims to review these sleep challenges in this population and explore consequences and treatment options.

Relationship Between Sleep Duration and Metabolic Health in Adolescents

Purpose: This study analyzed the gender differences in the cross-sectional relationship between sleep duration and metabolic health in Korean adolescents. Materials and Methods: Adolescents (1234 males, 1073 females) aged 12-19 years who provided their metabolic syndrome score (MetZscore) and sleep duration were included from the Korea National Health and Nutrition Examination Survey 2016-2020 data. Waist circumference (WC), blood pressure (BP), glucose, triglycerides (TGs), and high-density lipoprotein cholesterol (HDL) were combined to create a standardized MetZscore. Gender-specific linear or quadratic relationships between sleep durations (weekday or difference between weekend and weekday sleep) and MetZscore were analyzed after adjusting for age, family affluence, and self-rated health. Results: Male adolescents displayed an inverse linear relationship between weekday sleep duration and MetZscore [B, -0.037 (confidence interval, 95% CI: -0.054 to -0.019)], whereas females showed a nonsignificant relationship. In male adolescents, the standardized scores of WC, BP, and TG decreased linearly as weekday sleep duration increased. In females, weekday sleep duration had an inverse linear association with WC score and a positive quadratic association with glucose score. MetZscore declined linearly as the difference in sleep durations between weekends and weekdays increased [B, -0.078 (95% CI: -0.123 to -0.034) in males; B, -0.042 (95% CI: -0.080 to -0.005) in females]. Although the scores of WC and HDL in males and the scores of WC and glucose in females had inverse linear relationships with the difference in sleep durations, the BP score in males had a positive quadratic association. Conclusions: According to this study, metabolic health benefited from longer weekend sleep durations than weekdays in both male and female adolescents and longer weekdays sleep durations in male adolescents.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Impact of objectively-measured sleep duration on cardiometabolic health: A systematic review of recent evidence

Cardiometabolic disease is a spectrum of diseases including, cardiovascular diseases, and metabolic syndrome. It is the leading cause of morbidity and mortality worldwide, with premature deaths being preventable. Currently, sleep has emerged as a potential target for cardiometabolic disease prevention. Several epidemiological studies have provided ample evidence that objectively measured short sleep duration increases the risk of cardiometabolic disease. However, the findings are inconsistent, and few studies measure sleep duration on cardiometabolic profiles objectively. Therefore, in this review, we focused on the recently published literature that explored the association between objectively measured sleep duration and cardiometabolic profiles (cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome), seeking more insights regarding the applicability and, in turn, the impact of objectively measured sleep duration on cardiometabolic health, which is relatively understudied. We retrieved the information manually from PubMed, Google Scholar, HINARI, and the Cochrane Library from 2015 to 2022 using appropriate search terms, we included 49 articles. In this review, we found a strong relationship between objectively measured sleep duration and the risk of cardiometabolic disease, indicating that objectively measured short sleep durations increase cardiometabolic risks. In general, the association between objectively measured sleep duration and increased cardiometabolic risks (CMR) has been well-documented in higher-income countries. Several studies found that longer sleep duration was associated with a more favorable cardiometabolic profile in early adolescence, independent of other risk factors. On the other hand, objectively measured short sleep duration is associated with adverse cardiometabolic health outcomes such as coronary heart disease, hypertension, type 2 diabetes mellitus, and metabolic syndrome.

Sex differences in metabolically healthy and metabolically unhealthy obesity among Chinese children and adolescents

OBJECTIVES

To analyze sex differences in the prevalence of obesity phenotypes and their risk factors among children and adolescents aged 7-18 years in China.

METHODS

We enrolled 15,114 children and adolescents aged 7-18 years into the final analysis. Obesity phenotypes were classified by body mass index (BMI) and metabolic status as metabolically healthy or unhealthy obesity. In addition, we collected four possible influencing factors on obesity phenotypes through questionnaires, including demographic, parental, early life, and lifestyle indicators. Multinomial logistic regression analysis in a generalized linear mixed model (GLMM) was selected to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for identifying risk factors and control the cluster effects of schools. More importantly, the interaction terms of sex and each indicator were established to demonstrate the sex differences.

RESULTS

The prevalence of metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), metabolically healthy overweight and obesity (MHOO), and metabolically unhealthy overweight and obesity (MUOO) were 3.5%, 5.6%, 11.1%, and 13.0% respectively, with higher prevalence in boys (5.3% vs. 1.6%, 7.9% vs. 3.1%, 14.3% vs. 7.7%, 15.6% vs. 10.1%). In addition, younger ages, single children, parental smoking, parental history of diseases (overweight, hypertension, diabetes), caesarean, premature, and delayed delivery time, high birth weight, insufficient sleep time, and excessive screen time were considered as important risk factors of MHO and MUO among children and adolescents (p < 0.05). More notably, boys were at higher risks of MUO when they were single children (boys: OR = 1.56, 95% CI: 1.24-1.96; girls: OR = 1.12, 95% CI: 0.82-1.54), while girls were more sensitive to MUO with parental smoking (girls: OR = 1.34, 95% CI: 1.02-1.76; boys: OR = 1.16, 95% CI: 0.97-1.39), premature delivery (girls: OR = 3.11, 95% CI: 1.59-6.07; boys: OR = 1.22, 95% CI: 0.67-2.22), high birth weight (girls: OR = 2.45, 95% CI: 1.63-3.69; boys: OR = 1.28, 95% CI: 0.96-1.70), and excessive screen time (girls: OR = 1.47, 95% CI: 1.06-2.04; boys: OR = 0.97, 95% CI: 0.79-1.20), with significant interaction term for sex difference (p_interaction < 0.05).

CONCLUSIONS

MHO and MUO are becoming prevalent among Chinese children and adolescents. Significant sex differences in the prevalence of obesity phenotypes as well as their environmental and genetic risk factors suggest it might be necessary to manage obesity phenotypes problems from a sex perspective.

Dietary Tryptophan and the Risk of Metabolic Syndrome: Total Effect and Mediation Effect of Sleep Duration

PURPOSE

Tryptophan affects energy homeostasis, glucose metabolism, blood pressure, and sleep. However, studies investigating the association between tryptophan and metabolic syndrome (MetSyn) are rare. We aimed to investigate the associations of dietary tryptophan with MetSyn incidence and potential mediation via sleep duration.

METHODS

Data of 7890 participants were obtained from the China Health and Nutrition Survey (1997-2011) (male: 49.9%; mean age=43.43 years;median follow-up=129.76 months; MetSyn incidence: 16.3%). A combination of individual 24-hour recall and household survey was used to assess dietary intake. In total, 6720 and 4474 participants who reported sleep duration and had blood samples taken, respectively, were incorporated into subgroup analyses. MetSyn was defined according to National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III criteria (2004), and tryptophan consumption and sleep duration were assessed by self-report in each survey. Multivariate Cox regression models were used to assess the associations between tertiles of tryptophan intake and MetSyn. Generalized linear regression models were used to evaluate the effect of tryptophan on sleep duration and plasma biomarkers.

RESULTS

Dietary tryptophan showed a protective effect on the risk of MetSyn. The hazard ratio (95% CI) of MetSyn was 0.77 (0.65-0.90) for individuals with a high tertile of tryptophan. Sleep duration was significantly higher, and HbA_1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (APO-B) were lower in the high tertile of tryptophan compared to the low tertile (P<0.05). In addition, mediation effects on the association between tryptophan intake and MetSyn risk were observed for sleep duration (estimated mediation percentage: 26.5%).

CONCLUSION

Our study demonstrated a negative association between dietary tryptophan and MetSyn incidence, and the mediation effect of sleep duration on this association, after adjusting for numerous confounders such as nutrients and food patterns. These findings may have important public health implications for the improvement of cardiometabolic health.

Associations Between Sleep Duration, Wake-Up Time, Bedtime, and Abdominal Obesity: Results From 9559 Chinese Children Aged 7-18 Years

OBJECTIVE

To investigate the associations of sleep duration, wake-up time, bedtime, and childhood abdominal obesity, and to test whether there is a weekday/weekend difference and the potential modifying role of sex.

METHODS

This cross-sectional study was based on the Students' Constitution and Health Survey and included 9559 students (4840 boys and 4719 girls) aged 7-18 years (7227 aged 7-12 years, 2332 aged 13-18 years). They were divided into two groups (control group and group with abdominal obesity). The physical measurements included children and youth body height, body weight, and waist circumference (WC). A parent-report questionnaire was used to collect the information about parent characteristics as well as lifestyle and sleep patterns (sleep duration, bedtime, and wake-up time of weekdays and weekends) of children and youth.

RESULTS

The prevalence of abdominal obesity was 30.57% and the percentages of sleep duration <9 hours/day, wake-up time before 07:00 am on weekdays and weekends, bedtime after 10:00 pm on weekends were significantly higher in the group with abdominal obesity. After adjusting for confounders, sleep duration <9 hours/day on weekends was inversely related to abdominal obesity in the overall subjects, regardless of their sex and age, while bedtime after 10:00 pm on weekends was inversely related to abdominal obesity only in the overall subjects, boys, and children aged 7-12 years. Logistic regression models in all subjects showed that shorter hours of weekends sleep duration were associated with greater risks of abdominal obesity, even after adjusting for all confounders, including wake-up time and bedtime. The adjusted odds ratios and 95% confidence intervals of abdominal obesity (with ≥10 hours/day as the reference group) for children with 9-10 hours/day, 8-9 hours/day, and <8 hours/day of weekend sleep duration were 1.23 (1.04-1.46), 1.59 (1.32-1.91) and 1.83 (1.42-2.36), respectively. Specifically, after stratification by sex and age, this phenomenon was only observed in boys and children aged 7-12 years.

CONCLUSIONS

Sleep duration and bedtime on weekends were independently associated with the risk of childhood abdominal obesity, particularly in boys and children aged 7-12 years.