Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents

Impact of School Start Time Delays and Learning Modality on Sleep Timing and Duration During COVID-19

OBJECTIVES

To assess the impact of a school start time (SST) delay on adolescent sleep health during the COVID-19 pandemic, and whether there were differences by learning modality.

METHODS

Data were collected from a longitudinal study evaluating sleep, education, and health among high school students in Georgia in 2020. Paired t-tests and multivariable linear regression analyses were conducted to examine changes in sleep duration and timing among 9th grade students (n = 134) and their association with the learning modality (remote vs. in-person learner).

RESULTS

Students' school day wake times were 1.5 hours later, school night sleep duration was 1.2 hours longer, and social jetlag was 0.9 hours shorter after the school start time delay (all P < .05). The learning modality was a significant predictor of changes in sleep timing but was not associated with changes in sleep duration.

CONCLUSIONS

Delayed school start time was associated with positive changes in adolescent sleep health during the COVID-19 pandemic. Sleep timing was affected by the learning modality, however in-person and virtual students had similar gains in sleep duration. Learning modality may be more beneficial for adolescents with early school start times to promote healthier sleep habits.

Sleep Efficiency and Sleep Onset Latency in One Saskatchewan First Nation

BACKGROUND

Sleep efficiency and sleep onset latency are two measures that can be used to assess sleep quality. Factors that are related to sleep quality include age, sex, sociodemographic factors, and physical and mental health status. This study examines factors related to sleep efficiency and sleep onset latency in one First Nation in Saskatchewan, Canada.

METHODS

A baseline survey of the First Nations Sleep Health project was completed between 2018 and 2019 in collaboration with two Cree First Nations. One-night actigraphy evaluations were completed within one of the two First Nations. Objective actigraphy evaluations included sleep efficiency and sleep onset latency. A total of 167 individuals participated, and of these, 156 observations were available for analysis. Statistical analysis was conducted using logistic and linear regression models.

RESULTS

More females (61%) than males participated in the actigraphy study, with the mean age being higher for females (39.6 years) than males (35.0 years). The mean sleep efficiency was 83.38%, and the mean sleep onset latency was 20.74 (SD = 27.25) minutes. Age, chronic pain, ever having high blood pressure, and smoking inside the house were associated with an increased risk of poor sleep efficiency in the multiple logistic regression model. Age, chronic pain, ever having anxiety, heart-related illness, and smoking inside the house were associated with longer sleep onset latency in the multiple linear regression model.

CONCLUSIONS

Sleep efficiency and sleep onset latency were associated with physical and environmental factors in this First Nation.

Relationships between sleep duration and health among U.S. adults with a history of household incarceration during childhood

The rate of incarceration in the United States has increased at an alarming rate in the past 30 years and thus so has the number of children having a household member incarcerated (referred to as household incarceration). Associations between experiencing household incarceration in childhood and later negative health and developmental outcomes are well-documented; however, the underlying mechanisms linking this childhood stressor and adult outcomes have been less well studied. Using state Behavioral Risk Factor Surveillance System survey data (N = 145,102), this study examines how experiencing household incarceration during childhood is associated with mental and physical health in adulthood and mediational pathways through suboptimal sleep (short or long sleep). Results indicate there were significant indirect effects of household incarceration to physical and mental distress through short sleep (≤ 6 hr per 24 hr) and long sleep (≥ 10 hr per 24 hr), and a significant indirect effect of household incarceration to body mass index through short sleep. Findings from the present study highlight indirect pathways through which household incarceration in childhood is linked with sleep health in adulthood and, in turn, to negative mental and physical health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective sleep and cardiometabolic biomarkers: results from the community of mine study

Study Objectives

Examining multiple dimensions of sleep health may better capture associations between sleep and health risks, including cardiometabolic disease (CMD). Hispanics have elevated risk for inadequate sleep and CMD biomarkers. Few studies have explored whether associations between sleep and CMD differ by Hispanic ethnicity.

Methods

Leveraging data from the Community of Mine (CoM) study, a cross-sectional investigation of 602 ethnically diverse participants, we derived accelerometer-measured sleep duration and efficiency, and self-reported sleep quality. Accelerometer-measured sleep exposures were analyzed both as continuous and categorical variables. Multivariate and quantile regression models were used to assess associations between sleep and CMD biomarkers (insulin resistance, systolic blood pressure, and low-density-lipoprotein cholesterol), controlling for age, sex, ethnicity, education, smoking status, and body mass index. We examined the potential effect modification of Hispanic ethnicity.

Results

We observed mixed results based on CMD biomarkers and sleep exposure. Increased sleep duration was significantly related to low-density lipoprotein cholesterol in adjusted models (estimate = 0.06; 95% CI: 0.02, 0.11). Poor sleep efficiency was associated with greater insulin resistance in the adjusted quantile (estimate = 0.20; 95% CI: 0.04, 0.36) model at the 90th percentile. Self-reported sleep quality was not associated with CMD outcomes. There was no evidence of effect modification by Hispanic ethnicity.

Conclusions

In this cohort, sleep health measures were found to have mixed and at times opposing effects on CMD outcomes. These effects did not demonstrate an interaction with Hispanic ethnicity.

Social jetlag is associated with adverse cardiometabolic latent traits in early adolescence: an observational study

Introduction

Adolescence is marked by physiological and social changes, such as puberty, increased responsibilities and earlier school start times. This often leads to insufficient sleep on school nights and the need to compensate for lost sleep on weekends, causing a misalignment between biological and social times, which has been termed social jetlag (SJL). SJL triggers stress responses and is associated with several negative health outcomes, including higher cardiometabolic risk in adults. In adolescence, however, SJL has only been consistently related to increases in adiposity but its association with other cardiometabolic indicators are unclear.

Method

In a sample of 278 healthy early adolescents (9-15 years of age; 168 girls) we investigated: 1) whether self-reported SJL is associated (using path analyses) with a cardiometabolic status latent factor obtained by testing the best fitting model via confirmatory factor analyses from an initial set of eight indicators [body mass index (BMI), waist/height ratio, triglyceride concentration, diastolic and systolic blood pressure, glycated hemoglobin, total cholesterol/high-density lipoprotein ratio (chol/HDL), and % body fat]; and 2) whether age and/or pubertal status influence the association between SJL and cardiometabolic status.

Result

We found that, for girls, higher SJL was associated with more adverse cardiometabolic latent scores (the shared variance of BMI, waist/height ratio, chol/HDL and systolic blood pressure, which had acceptable model fit indices). However, the role of age and pubertal status in this association was unclear for both sexes.

Discussion

SJL was associated with adverse cardiometabolic latent traits beyond increases in adiposity in this observational study in early female adolescents. Because disruptions of circadian rhythms are believed to lead to dysregulated energy homeostasis and not vice-versa, our findings highlight the need for sleep interventions in adolescence to help reduce the global burden of cardiometabolic ill health, especially in girls.

Sleep, 24-hour activity rhythms, and cardiometabolic risk factors in school-age children

STUDY OBJECTIVES

Disturbed sleep and 24-hour activity rhythms are linked to adverse cardiometabolic profiles in adults and adolescents, and these associations may originate in early life. We aimed to study associations of sleep and 24-hour rhythms with cardiometabolic risk factors in school-age children.

METHODS

This cross-sectional population-based study comprised 894 children aged 8-11 years from the Generation R Study. Sleep (duration, efficiency, number of awakenings, and time awake after sleep onset) and 24-hour activity rhythms (social jet lag, interdaily stability, and intradaily variability) were assessed using triaxial wrist actigraphy for 9 consecutive nights. Cardiometabolic risk factors included adiposity (body mass index Z-score, fat mass index using dual-energy X-ray absorptiometry, and visceral fat mass and liver fat fraction using magnetic resonance imaging), blood pressure, and blood markers (glucose, insulin, and lipids). We adjusted for season, age, sociodemographics, and lifestyle factors.

RESULTS

Each increase in interquartile range of nightly awakenings (2 times) was associated with -0.12 standard deviation (95% confidence interval: -0.21, -0.04) lower body mass index and 0.15 mmol/L (0.10, 0.21) higher glucose. Among boys, an increase in interquartile range of intradaily variability (0.12) was associated with higher fat mass index (+0.07 kg/m2; 95% confidence interval: 0.03, 0.11) and visceral FM (+0.08 g; 95% confidence interval: 0.02, 0.15). We observed no associations with blood pressure or clustering of cardiometabolic risk factors.

CONCLUSIONS

Already at school age, greater fragmentation of the 24-hour activity rhythm is associated with general and organ adiposity. In contrast, more nightly awakenings were associated with lower body mass index. Future research should bring clarity to these disparate observations in order to create potential targets for obesity prevention programs.

CITATION

Beunders VAA, Koopman-Verhoeff ME, Vermeulen MJ, et al. Sleep, 24-hour activity rhythms, and cardiometabolic risk factors in school-age children. J Clin Sleep Med. 2023;19(7):1219-1229.

Dietary profile of pediatric obstructive sleep apnea patients, effects of routine educational counseling, and predictors for outcomes

Background

Dietary behavior is a main contributing yet modifiable factor to the body weight status of children and may be involved in the pathophysiology of childhood obstructive sleep apnea (OSA). This study aimed to investigate the dietary profile of pediatric OSA patients, effects of educational counseling after adenotonsillectomy, and predictor for disease resolution.

Methods

This observational study included 50 pediatric OSA patients undergoing adenotonsillectomy with routine educational counseling (Group 1), 50 pediatric OSA patients undergoing adenotonsillectomy without formal educational counseling (Group 2), and 303 healthy children without OSA (Control). The three groups were matched by age. The consumption frequency of 25 food items/groups was assessed by the Short Food Frequency Questionnaire. Quality of life was evaluated by the OSA-18 questionnaire. Sleep architecture and OSA severity were measured by standard polysomnography. Between- and within-group comparisons were analyzed by non-parametric approaches and generalized estimating equations. Prediction of disease recovery was performed by multivariable logistic regression models.

Results

Group 1 children consumed fruit drinks with sugar, vegetables, sweets, chocolate, rice, and noodles more frequently than Control Group children. At baseline, the distributions of sex, weight status, OSA-18 scores, and polysomnographic variables were comparable between Group 1 and Group 2. After a 12-month follow-up, Group 1 had better improvements in physical suffering, caregiver concerns, sleep architecture, and mean peripheral oxygen saturation compared to Group 2. Furthermore, Group 1 no longer had excessive consumption of fruit drinks with sugar, chocolate, and noodles; however, food consumption frequencies did not change significantly. Notably, younger age and reduced intake of butter/margarine on bread and noodles were independent predictors of cured OSA in Group 1.

Conclusion

The present study preliminarily characterized an unhealthy dietary profile among pediatric OSA patients and suggested that routine educational counseling in addition to adenotonsillectomy yielded some clinical benefits. Certain items/groups of food frequencies may be associated with disease recovery and further investigations are warranted.

Life Course Cardiovascular Health: Risk Factors, Outcomes, and Interventions

Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.

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.

Circadian Misalignment Impacts the Association of Visceral Adiposity With Elevated Blood Pressure in Adolescents

BACKGROUND

Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents.

METHODS

We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break.

RESULTS

Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP (P interaction=0.007) and diastolic blood pressure (P interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP (P interaction=0.026) and diastolic blood pressure (P interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP (P interaction=0.034).

CONCLUSIONS

A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.

Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial

Objective

Determine the optimal combination of digital health intervention component settings that increase average sleep duration by ≥30 minutes per weeknight.

Methods

Optimization trial using a 25 factorial design. The trial included 2 week run-in, 7 week intervention, and 2 week follow-up periods. Typically developing children aged 9-12y, with weeknight sleep duration <8.5 hours were enrolled (N=97). All received sleep monitoring and performance feedback. The five candidate intervention components (with their settings to which participants were randomized) were: 1) sleep goal (guideline-based or personalized); 2) screen time reduction messaging (inactive or active); 3) daily routine establishing messaging (inactive or active); 4) child-directed loss-framed financial incentive (inactive or active); and 5) caregiver-directed loss-framed financial incentive (inactive or active). The primary outcome was weeknight sleep duration (hours per night). The optimization criterion was: ≥30 minutes average increase in sleep duration on weeknights.

Results

Average baseline sleep duration was 7.7 hours per night. The highest ranked combination included the core intervention plus the following intervention components: sleep goal (either setting was effective), caregiver-directed loss-framed incentive, messaging to reduce screen time, and messaging to establish daily routines. This combination increased weeknight sleep duration by an average of 39.6 (95% CI: 36.0, 43.1) minutes during the intervention period and by 33.2 (95% CI: 28.9, 37.4) minutes during the follow-up period.

Conclusions

Optimal combinations of digital health intervention component settings were identified that effectively increased weeknight sleep duration. This could be a valuable remote patient monitoring approach to treat insufficient sleep in the pediatric setting.

Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective

BACKGROUND

The latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective.

METHODS

A cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including "Expected influence" to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure.

RESULTS

A total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9-52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F_(1,1,008) = 17.45, P < 0.001). "Sleep maintenance" (ISI2), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) were the most central symptoms in the insomnia network model, while "Sleep dissatisfaction" (ISI4), "Interference with daytime functioning" (ISI5), and "Distress caused by the sleep difficulties" (ISI7) had the strongest negative associations with QoL.

CONCLUSION

The high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.

Changes in sleep duration and sleep difficulties from adolescence to young adulthood and the risk of obesity: Bidirectional evidence in the GINIplus and LISA studies

OBJECTIVE

This study aimed to assess the association of changes in sleep behaviors from adolescence to young adulthood with the risk of overweight/obesity, and the reverse relationship.

METHODS

Data of 1978 participants was obtained from the 15- and 20-year follow-ups of the GINIplus and LISA birth cohorts. Insufficient sleep was defined as reported sleep duration <8 h for adolescents, <7 h for adults, and sleep difficulties as reported having sleeping difficulties. Logistic regression models were used to assess bidirectional associations of changes in insufficient sleep and sleep difficulties with overweight/obesity. The polygenic risk scores (PRS) for body mass index (BMI) was tested in a sub-sample (n = 918).

RESULTS

Compared with sufficient sleep in both adolescence and young adulthood, insufficient sleep only in young adulthood was associated with an increased risk of overweight/obesity (odds ratio = 1.85, 95%confidence interval = [1.27-2.69]). Compared with no sleep difficulties at both time-points, only persistent sleep difficulties was associated with a higher risk of overweight/obesity (2.15 [1.22-3.77]). The PRS for BMI was associated with overweight/obesity (1.41 [1.17-1.70]), but no significant gene-sleep interaction effect was observed. Reversely, only persistent overweight/obesity was associated with increased risks of insufficient sleep (1.81 [1.21-2.70]), and sleep difficulties (1.77 [1.18-2.66]), respectively.

CONCLUSIONS

Insufficient sleep only presented a cross-sectional association with overweight/obesity in young adulthood, while long-term sleep difficulties from adolescence to young adulthood was associated with young adult overweight/obesity. Reversely, long-term overweight/obesity from adolescence to young adulthood was associated with insufficient sleep and sleep difficulties in young adulthood.

Effect of adiposity and physical fitness on cardiometabolic risk factors in adolescents: A 2-year longitudinal study

Although risk factors for cardiometabolic diseases begin to present in young people, the association between physical fitness and adiposity with traditional and novel risk factors for cardiometabolic diseases across adolescence remains relatively unknown. Following ethical approval, fifty-two adolescents (age 11.6 ± 0.6 years; 32 girls) were recruited for a 2-years longitudinal study. Adiposity was assessed based on sum of skinfolds, waist circumference and body mass index, and physical fitness as distance run on the multi-stage fitness test (MSFT). Risk factors for cardiometabolic diseases (pro- and anti-inflammatory cytokines, plasma insulin, Homeostatic Model Assessment of Insulin Resistance - HOMA-IR, blood pressure) were measured following an overnight fast. Relationships between independent and response variables were analysed using multi-level modelling (final combined models were created using the stepwise backward elimination method). Plasma insulin concentration and HOMA-IR were positively associated with adiposity and inversely associated with distance run on the MSFT (all p < 0.05). The final combined models for plasma insulin concentration and HOMA-IR contained main effects for age, skinfolds and distance run on the MSFT. Levels of the anti-inflammatory cytokine IL-10 were inversely related to the sum of skinfolds (p = 0.046), whereas there was a trend for levels of the pro-inflammatory cytokine TNF-α to be positively related to the sum of skinfolds (p = 0.056). Adiposity and physical fitness are important, independent, determinants of metabolic health in adolescents. Furthermore, adiposity influences levels of pro- and anti-inflammatory cytokines in adolescence, with greater adiposity associated with a poorer inflammatory profile. The present study demonstrates an independent effect of physical fitness on metabolic health longitudinally across adolescence. It is therefore recommended that future work develops therapeutic interventions that reduce adiposity and enhance physical fitness in adolescents, to promote lifelong health.

Sleep-related breathing disorders and cardiometabolic risk factors in pediatric kidney transplant recipients

BACKGROUND

SRBDs have been shown to increase the risk of cardiovascular disease, which is a significant cause of mortality in kidney transplant recipients. Few studies have investigated the association between SRBDs and cardiometabolic risk factors in pediatric kidney transplant recipients.

METHODS

This was a cross-sectional study of pediatric kidney transplant recipients using baseline cardiometabolic data from a previous clinical trial (NCT01007994). Parents/guardians of pediatric kidney transplant recipients filled out 22-item PSQ. A score greater than 33% was defined as a diagnosis of a SRBD. Fisher's exact test, Mann-Whitney U test, and regressions were used to determine associations.

RESULTS

Among the 58 transplant recipients enrolled, 14.80% (n = 8) of participants identified as Black and 40.7% (n = 22) were male. The median age was 13 (IQR 8.25, 17) years and median number of years post-transplant for participants was 2 (IQR 1, 4). The prevalence of SRBDs was 26% (n = 14). The presence of a SRBD was associated with abnormalities in multiple cardiometabolic risk factors including total cholesterol level (β = 23.63; 95% CI 3.58-43.67), LDL level (β = 24.94; 95% CI 6.37-43.50), triglyceride level (β = 54.62; 95% CI 8.74-100.50), and LVH (OR = 5.12; 95% CI 1.12-23.45) when adjusted for age, sex, and race.

CONCLUSIONS

Similar to associations reported in the general pediatric and general CKD populations, SRBD is associated with increased cardiometabolic risk in pediatric kidney transplant recipients.

Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature

Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.

Street-view greenspace exposure and objective sleep characteristics among children

Greenspace may benefit sleep by enhancing physical activity, reducing stress or air pollution exposure. Studies on greenspace and children's sleep are limited, and most use satellite-derived measures that do not capture ground-level exposures that may be important for sleep. We examined associations of street view imagery (SVI)-based greenspace with sleep in Project Viva, a Massachusetts pre-birth cohort. We used deep learning algorithms to derive novel metrics of greenspace (e.g., %trees, %grass) from SVI within 250m of participant residential addresses during 2007-2010 (mid-childhood, mean age 7.9 years) and 2012-2016 (early adolescence, 13.2y) (N = 533). In early adolescence, participants completed >5 days of wrist actigraphy. Sleep duration, efficiency, and time awake after sleep onset (WASO) were derived from actigraph data. We used linear regression to examine cross-sectional and prospective associations of mid-childhood and early adolescence greenspace exposure with early adolescence sleep, adjusting for confounders. We compared associations with satellite-based greenspace (Normalized Difference Vegetation Index, NDVI). In unadjusted models, mid-childhood SVI-based total greenspace and %trees (per interquartile range) were associated with longer sleep duration at early adolescence (9.4 min/day; 95%CI:3.2,15.7; 8.1; 95%CI:1.7,14.6 respectively). However, in fully adjusted models, only the association between %grass at mid-childhood and WASO was observed (4.1; 95%CI:0.2,7.9). No associations were observed between greenspace and sleep efficiency, nor in cross-sectional early adolescence models. The association between greenspace and sleep differed by racial and socioeconomic subgroups. For example, among Black participants, higher NDVI was associated with better sleep, in neighborhoods with low socio-economic status (SES), higher %grass was associated with worse sleep, and in neighborhoods with high SES, higher total greenspace and %grass were associated with better sleep time. SVI metrics may have the potential to identify specific features of greenspace that affect sleep.

Associations Between Sleep and Metabolic Outcomes in Preadolescent Children

Context

Growing evidence suggests an important role for sleep for the metabolic health of children.

Objective

We aimed to determine how sleep is related to insulin sensitivity, insulin secretion, beta-cell function, and adiposity (BMI z-scores, body fat %, waist to height ratio) using objectively measured sleep and oral glucose tolerance test (OGTT)-derived measures.

Methods

Sixty-two children aged 7-11 years, born at Kaiser Permanente Southern California, wore wrist accelerometers for 7 days to objectively measure sleep, completed an OGTT, and had anthropometric measures (height [cm], weight [kg], waist [cm], body fat [%]) collected. Using linear regression, associations between Matsuda insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), BMI z-score, waist to height ratio, and body fat % with sleep parameters [total sleep time (TST; min), sleep efficiency (SE; %), time in bed (TIB; min), wake after sleep onset (WASO; min), and sleep latency (SL; min)] were assessed. Body fat % was tested as a mediator of the relationship between TST and ISI.

Results

Longer TST was associated with better insulin sensitivity (P = 0.02), but not after adjusting for body fat %. Sleep parameters were not associated with IGI or DI. Longer TST was associated with lower % body fat (P = 0.01) and lower waist-to-height-ratios (P = 0.05). Body fat % explained 62% (P = 0.01) of the relationship between TST and ISI. Longer TIB was associated with lower adiposity measures (P < 0.05). There were no associations between SE, WASO, or SL and metabolic outcomes.

Conclusion

Objectively measured sleep duration was associated with lower adiposity, and the relationship between sleep duration and ISI appeared partly through adiposity levels in preadolescent children. Longer sleep duration may be important for metabolic health.

How Are the Sleep Problems of Children in the US Foster Care System Addressed?

OBJECTIVE

Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps.

METHODS

Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years ( M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well.

RESULTS

Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night.

CONCLUSION

Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.

Characteristic Sleep Patterns and Associated Obesity in Adolescents

Poor sleep adversely affects health and may cause obesity. Poor sleep includes short sleep duration, low quality of sleep, and sleep discrepancy. Although most studies have focused on the association between sleep duration and obesity, poor sleep is a significant risk factor for obesity. Adolescents have characteristic sleep patterns which correspond to poor sleep. Adolescents sleep late due to various biological and psychosocial factors; also, they wake up early to be on time for school. This causes them to sleep less. To make up for this sleep debt, adolescents sleep more on non-school days, which causes sleep discrepancies. Therefore, since adolescents have characteristic sleep patterns, an in-depth investigation is needed to identify whether poor sleep is a risk for obesity. This article presents an overview of the characteristic sleep patterns of adolescents, and reviews studies on the association of each sleep pattern with obesity.

Associations of chronotype and sleep patterns with metabolic syndrome in the Hispanic community health study/study of Latinos

Sleep duration, sleep efficiency, and sleep timing have been shown to have potential effects on metabolic functions relevant to circadian rhythms. It is not clear if the impact of sleep patterns on metabolic risk factors is through sociocultural and environmental factors or circadian misalignment. We investigated the associations of sleep patterns, chronotype, and social jet lag with metabolic syndrome among non-shift worker Hispanic/Latino adults. We used cross-sectional data from the Sueño Ancillary Study of The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data from a subsample of 2189 participants aged 18-64 years were used in the analysis. Mean nightly sleep duration, mean sleep onset time, mean sleep offset time, mean sleep midpoint time, sleep efficiency, sleep variability (standard deviation (SD) of sleep duration, and SD of sleep midpoint), and time spent above light exposure threshold (1000 lux) in a day were assessed by wrist actigraphy (Acti-watch Spectrum). Chronotype was determined by the reduced Morningness-Eveningness Questionnaire. Medical conditions including dyslipidemia, hypertension, and diabetes mellitus were determined from a fasting blood specimen and physical exam at the baseline visit. To determine whether sleep patterns, light levels, chronotype, and social jetlag are associated with metabolic syndrome, multivariable logistic regression models were fitted, including variables with P < .15 in the univariate analysis. The results of the multivariable analysis demonstrated that in participants older than 40 years, intermediate chronotype (vs early) was significantly associated with a higher risk of metabolic syndrome (Odds ratio (95%CI): 1.33 (1.04,1.7)), while later chronotype (vs. early) in participants younger than 40 years was significantly associated with a lower risk of metabolic syndrome (Odds ratio (95%CI): 0.37 (0.14, 0.96)). Also, higher sleep efficiency was significantly associated with decreased odds of metabolic syndrome (Odds ratio (95%CI): 0.98 (0.96, 0.99)). Nightly sleep duration was not significantly different between two groups of participants with and without metabolic syndrome in multivariable analyses. There was no significant association between social jet lag and metabolic syndrome in multivariable analysis (p = .286). Moreover, there was no significant association between chronotype and social jet lag in multivariable analysis. The association between metabolic syndrome and chronotype is age-dependent. While early chronotype is associated with metabolic syndrome in younger individuals, it tended to be associated with lower odds for metabolic syndrome in older individuals.

Sex differences in childhood sleep and health implications

CONTEXT

Sleep is critical for optimal childhood metabolic health and neurodevelopment. However, there is limited knowledge regarding childhood sex differences in sleep, including children with neurodevelopmental disorders, and the impact of such differences on metabolic health.

OBJECTIVE

To evaluate if sex differences in childhood sleep exist and if sleep associates with metabolic health outcomes equally by sex. Using autism spectrum disorder (ASD) as a case study, we also examine sleep sex differences in children with a neurodevelopmental disorder.

METHODS

A narrative review explored the literature focussing on sex differences in childhood sleep.

RESULTS

Sex differences in sleep were not detected among pre-adolescents. However, female adolescents were more likely to report impaired sleep than males. Childhood obesity is more common in males. Shorter sleep duration may be associated with obesity in male pre-adolescents/adolescents; although findings are mixed. ASD is male-predominant; yet, there was an indication that pre-adolescent female children with ASD had more impaired sleep.

CONCLUSION

Sex differences in sleep appear to emerge in adolescence with more impaired sleep in females. This trend was also observed among pre-adolescent female children with ASD. Further research is needed on sex differences in childhood sleep and metabolic health and the underlying mechanisms driving these differences.

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.

Adolescent sleep health and school start times: Setting the research agenda for California and beyond: A research summit summary: A research summit summary

In fall 2019, California passed and signed into law SB328, the first US statewide legislation explicitly designed to protect adolescent sleep health by requiring most California public school districts to start no earlier than 8:00 AM for middle schools and 8:30 AM for high schools. Recognizing the unique opportunity presented by the bill's 3-year implementation period, a group of experts in adolescent sleep and school start times held a virtual summit on January 22-23, 2021 to (1) summarize the research on adolescent sleep and school start time change; (2) develop recommendations for relevant, refined, and innovative research areas and research questions; (3) provide input regarding research design, methodology, and implementation; and (4) offer a forum for networking, exchanging ideas, and establishing interdisciplinary research collaborations. Participants represented a multidisciplinary range of academic backgrounds including sleep and circadian biology, neuroscience, education, medicine, public health, mental health, safety, public policy, economics, implementation science, criminology, diversity studies, and science communication. This paper summarizes summit presentations regarding current knowledge on adolescent sleep health and school start times and key research recommendations from small group workshops on topics including research design and tools, methodological issues, sleep health disparities, logistical challenges in conducting school-based research, public-health impact, and novel and expanded approaches to research.

Assessing Cardiometabolic Health Risk Among U.S. Children Living in Grandparent-Headed Households

PURPOSE

We evaluated children's cardiometabolic health (CMH) risk indicators and adverse childhood experiences (ACEs) stratified by family structure type (grandparent-headed, two-parent headed, and single-parent headed households). Separately, we assessed whether family structure type and number of ACEs were independently associated with the CMH risk indicators.

DESIGN AND METHODS

Utilizing data from the 2017-2018 National Survey of Children's Health, we evaluated five CMH risk indicators (obesity, physical activity, secondhand smoke exposure, sleep, and sports participation). We used multivariable logistic regressions to assess the association of CMH risk indicators with family structure type and ACEs. We controlled for sex, age, race/ethnicity, health insurance, household poverty level, and overall health status.

RESULTS

Among children aged 10-17 years (n = 24,885), we found the number of ACEs differed by family structure type (P < 0.001) and was independently associated with obesity, secondhand smoke exposure, sleep, and sports participation. Adjusting for all covariates except ACEs, family structure type was significantly associated with children's CMH risk; but after controlling for ACEs that association was attenuated - except for sleep (less adequate sleep in grandparent-headed households) and exposure to secondhand smoke (less exposure in single-parent headed households).

CONCLUSIONS

ACEs were highest among children living in grandparent-headed households and independently associated with a majority of the CMH risk indicators. Findings suggest that children living in grandparent-headed households may be at elevated risk for poor CMH, potentially due to higher risk for ACEs.

PRACTICE IMPLICATIONS

It is recommended to consider ACEs and family structure type when assessing CMH risk in children.

The translational neuroscience of sleep: A contextual framework

Sleep is entwined across many physiologic processes in the brain and periphery, thereby exerting tremendous influence on our well-being. Yet sleep exists in a social-environmental context. Contextualizing sleep health with respect to its determinants—from individual- to societal-level factors—would enable neuroscientists to more effectively translate sleep health into clinical practice. Key challenges and opportunities pertain to (i) recognizing and exploring sleep’s functional roles, (ii) clarifying causal mechanisms in relation to key outcomes, (iii) developing richer model systems, (iv) linking models to known contextual factors, and (v) leveraging advances in multisensory technology. Meeting these challenges and opportunities would help transcend disciplinary boundaries such that social-environmental considerations related to sleep would become an ever-greater presence in the clinic.

Sleep fragmentation and the risk of obesity: The Sleep Heart Health Study

OBJECTIVE

Sleep disturbances have been recognized as a risk factor for obesity. This study used polysomnography records to investigate associations between sleep fragmentation and obesity.

METHODS

Objectively measured sleep fragmentation data recorded by in-home polysomnography, including total arousal index (ArI-total), ArI in rapid eye movement (REM) sleep (ArI-REM), ArI in non-REM sleep (ArI-NREM), sleep fragmentation index, sleep efficiency (SE), and wake after sleep onset (WASO), were based on the Sleep Heart Health Study (2,835 men and 2,888 women with a mean [SD] age of 63.2 [11.2] years). Multivariable regression analyses were used to examine the relationship between sleep fragmentation and obesity.

RESULTS

Multinomial logistic regression showed that participants with obesity have a significantly higher ArI-total (odds ratio [OR] 1.018; 95% CI: 1.010-1.026, p < 0.001), ArI-REM (OR 1.010; 95% CI: 1.002-1.018, p = 0.009), ArI-NREM (OR 1.017; 95% CI: 1.009-1.024, p < 0.001), and WASO (OR 1.003; 95% CI: 1.001-1.005, p = 0.007) compared with those with normal weight. Furthermore, multiple linear regression analyses showed an obvious correlation between ArI-total, ArI-REM, ArI-NREM, SE, WASO, and BMI.

CONCLUSIONS

The results revealed that ArI-total, ArI-REM, ArI-NREM, SE, and WASO were associated with obesity. The improvement of sleep fragmentation may contribute to decreasing the risk of obesity.

High incidence of acute self-reported sleep disturbances in patients following arthroscopic-assisted knee surgery

OBJECTIVES

To evaluate the self-reported incidence of sleep disturbances, defined as ≤7 hours of sleep per 24-hour period, in patients undergoing arthroscopic-assisted knee surgery.

METHODS

Patients who underwent arthroscopic knee surgery over the course of a 4-month period were prospectively included. Patients were excluded if a history of insomnia or other sleep altering medical history was reported. Self-reported sleep metrics included average number of hours of sleep per night, average number of awakenings during sleep per night, perceived quality of sleep, average pain level during sleep and number of hours of physical activity/therapy per week. Data were collected at weeks 1, 3, and 6 postoperatively. Joint circumference was measured on postoperative day 1 and served as an indicator of a knee effusion. Paired t-tests were used to compare preoperative to postoperative hours of sleep. Simple and multiple linear regression were used to evaluate relationships between surgical variables and postoperative sleep metrics.

RESULTS

There were 123 patients who underwent arthroscopic knee surgery during the prospective enrolment period; 83 patients were included in the final analysis. The overall incidence of preoperative sleep disturbances was 20% (n=17). The overall incidence of self-reported postoperative sleep disturbances was 99%, 96% and 90% at weeks 1, 3 and 6, respectively. The average number of hours slept was significantly reduced at 1, 3 and 6 weeks postoperatively compared with the preinjury state (p<0.001). Knee joint circumference had a significantly negative correlation with average number of hours of sleep in the first 6 weeks postoperatively (R=-0.704; p=0.001). Surgical variables including severity of surgery, weekly postoperative pain level and weekly hours of postoperative physical therapy were not significant independent predictors of acute postoperative sleep disturbances (p>0.05).

CONCLUSION

Sleep disturbances were commonly reported in patients following arthroscopic knee surgery without correction of sleep metrics by 6 weeks postoperatively. The majority of sleep disturbances in this cohort correlated with an increased knee effusion. A multidisciplinary team approach is recommended to counsel patients regarding the potential for and problems with acute sleep disturbances following arthroscopic knee surgery.Level of evidence: 3.

Associations of the residential built environment with adolescent sleep outcomes

STUDY OBJECTIVES

Over 75% of US high school students obtain insufficient sleep, placing them at risk for adverse health outcomes. Identification of modifiable determinants of adolescent sleep is needed to inform prevention strategies, yet little is known about the influence of the built environment on adolescent sleep.

METHODS

In this prospective study, actigraphy was used to assess sleep outcomes among 110 adolescents for 14 days each in eighth and ninth grades: duration (hours/night), onset and offset, and sleeping ≥8 hours. Home addresses were linked to built environment exposures: sound levels, tree canopy cover, street density, intersection density, population density, and housing density. Mixed-effects regression estimated associations of built environment measures with sleep outcomes, adjusting for sex, race, parent education, household income, household size, grade, weeknight status, and neighborhood poverty.

RESULTS

A 1-standard deviation (SD) increase in neighborhood sound was associated with 16 minutes later sleep onset (β = 0.28; 95% confidence interval (CI): 0.06, 0.49) and 25% lower odds of sleeping for ≥8 hours (odds ratio (OR) = 0.75, 95% CI: 0.59, 0.96). A 1-SD increase in neighborhood tree canopy was associated with 18 minutes earlier sleep onset (β = -0.31, 95% CI: -0.49, -0.13) and 10 minutes earlier sleep offset (β= -0.17, 95% CI: -0.28, -0.05). No associations were observed for density-based exposures.

CONCLUSIONS

Higher neighborhood sound level was associated with lower odds of sufficient sleep, while higher tree canopy cover was associated with more favorable sleep timing. Neighborhood sound levels and tree canopy cover are potential targets for policies and interventions to support healthier sleep among adolescents.

Effect of an online healthy lifestyle psychoeducation programme to improve cardiometabolic outcomes and affective symptoms in youth receiving mental health care: study protocol for a pilot clinical trial

INTRODUCTION

Worsened cardiometabolic profiles in youth with mental ill health have been associated with a number of modifiable lifestyle risk factors. It is becoming increasingly evident that clinical interventions need to be multimodal in focus to improve mental health symptoms and the physical health symptoms in this already at-risk cohort.

METHODS AND ANALYSIS

This 12-week pilot clinical trial examines the efficacy, feasibility and acceptability of an adjunctive online psychoeducation programme for improving cardiometabolic risk parameters and affective symptoms in a transdiagnostic sample of at least 44 young people aged 16-25 years presenting for mental healthcare for mood and/or psychotic syndromes (including anxiety, depression, bipolar disorder and psychosis). Individuals will be invited to participate in a pilot clinical trial for a structured online psychoeducation programme incorporating nutritional, physical activity, sleep-wake and healthy lifestyle information, delivered fortnightly over six online modules. Participants will undergo a series of assessments including: (1) self-report and clinician administered assessments determining mental health symptomatology; (2) fasting blood tests to assess cardiometabolic markers (fasting insulin, fasting glucose and blood lipids); (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) sleep-wake behaviours and circadian rhythm assessments. Changes in scores for all cardiometabolic and affective measures will be assessed via paired samples t-tests, and correlations between change scores will be assessed via Pearson's or Spearman's correlations. Feasibility will be assessed via completion rates, and the acceptability of the programme will be assessed via programme satisfaction measures.

ETHICS AND DISSEMINATION

This pilot clinical trial has been approved by the Sydney Local Health District Research Ethics and Governance Office (X20-0228 & 2020/ETH01201). The results of this pilot clinical trial will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12620000772943, Date 28 August 2020.

Cross-sectional associations between objectively measured sleep characteristics and body mass index in European children and adolescents

BACKGROUND

Short sleep duration has been found to be associated with a higher risk for overweight and obesity. However, previous studies have mainly relied on subjective measures of sleep duration and other sleep characteristics (eg quality, timing) have often been neglected. Therefore, we aimed to investigate associations between several, mainly objectively measured sleep characteristics and body mass index (BMI). Further, we aimed to identify distinct sleep subtypes based on these sleep characteristics and to study their association with BMI.

METHODS

Children aged 9-16 years participating in the European I.Family study (N = 559, 51.2% girls, 32.9% overweight/obese) wore an accelerometer for one week on their wrist and recorded their daily wake-up and lights-off times in a sleep diary. Information on sleep duration, sleep efficiency and sleep latency was derived. To identify sleep subtypes, we conducted a latent class analysis using all five sleep variables. Associations between single sleep variables, sleep subtype and age- and sex-specific BMI z-score were investigated using linear mixed-effects regression models to accommodate clustering among siblings.

RESULTS

No statistically significant associations were observed between the single sleep variables (sleep duration, sleep efficiency, sleep latency, wake-up and lights-off times) and BMI z-score. Four sleep subtypes were identified and children were assigned to one of the groups based on their highest probability for latent group membership: "early birds" (17.5% of the sample), "short sleep duration" (14.7%), "optimal sleep" (47.6%) and "poor sleep quality" (20.2%). Sleep subtype was not associated with BMI z-score.

CONCLUSIONS

Using objective sleep data, we did not find convincing evidence for associations between the sleep variables under investigation and BMI.

Sleep, Growth, and Puberty After 2 Years of Prolonged-Release Melatonin in Children With Autism Spectrum Disorder

OBJECTIVE

A recent 3-month double-blind, placebo-controlled study demonstrated efficacy and safety of pediatric prolonged-release melatonin (PedPRM) for insomnia in children with autism spectrum disorder. This study examined the long-term effects of PedPRM treatment on sleep, growth, body mass index, and pubertal development.

METHOD

Eighty children and adolescents (2-17.5 years of age; 96% with autism spectrum disorder) who completed the double-blind, placebo-controlled trial were given 2 mg, 5 mg, or 10 mg PedPRM nightly up to 104 weeks, followed by a 2-week placebo period to assess withdrawal effects.

RESULTS

Improvements in child sleep disturbance and caregiver satisfaction with child sleep patterns, quality of sleep, and quality of life were maintained throughout the 104-week treatment period (p < .001 versus baseline for all). During the 2-week withdrawal placebo period, measures declined compared with the treatment period but were still improved compared with baseline. PedPRM was generally safe; the most frequent treatment-related adverse events were fatigue (6.3%), somnolence (6.3%), and mood swings (4.2%). Changes in mean weight, height, body mass index, and pubertal status (Tanner staging done by a physician) were within normal ranges for age with no evidence of delay in body mass index or pubertal development.

CONCLUSION

Nightly PedPRM at optimal dose (2, 5, or 10 mg nightly) is safe and effective for long-term treatment in children and adolescents with autism spectrum disorder and insomnia. There were no observed detrimental effects on children's growth and pubertal development and no withdrawal or safety issues related to the use or discontinuation of the drug.

CLINICAL TRIAL REGISTRATION INFORMATION

Efficacy and Safety of Circadin in the Treatment of Sleep Disturbances in Children With Neurodevelopment Disabilities; https://clinicaltrials.gov/; NCT01906866.

Hair Cortisol Concentration as a Biomarker of Sleep Quality and Related Disorders

Cortisol is the end product of the hypothalamic-pituitary-adrenal (HPA) axis, and its production is increased mainly in stressful situations or in chronic disorders accompanied by stress enhancement. Altered cortisol concentrations have been reported in a number of neuropsychiatric diseases and sleep disorders. Cortisol concentrations have been measured using several methods, and in several matrixes, such as blood, saliva, and urine. However, lately, hair cortisol, for several reasons, has emerged as a promising biomarker of long-term retrospective HPA activation. Several experimental approaches for cortisol measurement with the corresponding concentration reference ranges and a summary of findings from scientific literature on this field are presented. There is evidence of a close relationship between HPA functional alteration and the development of neuropsychiatric disorders. Sleep disorders are the most common manifestation in several neuropsychiatric conditions, and have also been associated to cortisol alterations in both adults and children. Many studies indicate that hair cortisol constitutes a valuable tool for further contributing to existing data on salivary, plasma, or urinary cortisol concentrations in patients with sleep disorders.

A Model of Adolescent Sleep Health and Risk for Type 2 Diabetes

PURPOSE OF REVIEW

This paper presents a review of the current literature in support of a model explaining the relationships between sleep health and risk for type 2 diabetes in adolescents.

RECENT FINDINGS

Short sleep duration is associated with risk of developing obesity in youth. Sleep restriction increases energy expenditure, but also increases hunger, appetite, and food intake, causing positive energy balance, impacting appetite-regulating hormones, and leading to increased eating late at night. Insufficient sleep may lead to reduced physical activity and greater sedentary behaviors. In addition, short sleep duration is associated with reduced insulin sensitivity. The cumulative negative consequences of insufficient sleep increase risk for type 2 diabetes. Applications to clinical care, public policy, and future research are discussed. Insufficient sleep in adolescence increases risk for type 2 diabetes directly through impact on insulin sensitivity and indirectly through increased dietary intake, sedentary activity, and weight gain.

Association between cardiometabolic health and objectively-measured, free-living sleep parameters: a pilot study in a rural African setting

Objectives

To investigate the relationship between objectively-measured, free-living sleep quantity and quality, and cardiometabolic health, in a rural African setting in 139 adults (≥40 years, female: n = 99, male: n = 40). Wrist-mounted, tri-axial accelerometry data was collected over 9 days. Measures of sleep quantity and quality, and physical activity were extracted from valid minute-by-minute data. Self-reported data included behavioural, health and socio-demographic variables. Biological data included body composition, resting blood pressure and fasting blood glucose, insulin and lipids. Logistic regression models were constructed with insulin resistance (IR) and cardiometabolic (CM) risk, as dependent variables, adjusting for socio-demographic, behavioural and biological factors.

Results

Nocturnal sleep time was longer in females (p = 0.054) and sleep quality was better in males (p ≤ 0.017). Few participants slept > 9 h/night (4–5%), and 46–50% slept < 7 h/night. IR and CM risk was higher in females (p ≤ 0.006). In adjusted models, sleep variables were independently associated with IR (p < 0.05). Sleep quantity was non-linearly associated with CM risk (p ≤ 0.0398), and linearly associated with IR (p ≤ 0.0444). Sleep quality was linearly related with CM risk and IR (p ≤ 0.0201). In several models, sleep quantity and sleep quality measures were concurrently and significantly associated with IR (p ≤ 0.044).

Circadian Melatonin Secretion In Obese Adolescents With Or Without Obstructive Sleep Apnea

Objective — To compare melatonin levels in saliva during a 24-hr day in order to identify the specificities of circadian melatonin secretion in obese adolescents with or without obstructive sleep apnea (OSA). Material and Methods — We examined 18 obese adolescents with OSA, 12 obese adolescents without OSA, and 15 healthy adolescents with a normal body weight, from whom saliva was sampled four time during the 24-hr day. Polysomnography was used to diagnose OSA. Saliva samples (n=180) were subjected to enzyme-linked immunosorbent assay. Results — Obese adolescents with OSA had higher evening melatonin levels than obese adolescents without OSA. For example, this indicator in OSA patients was 5.3 times higher than in participants without OSA, who had the lowest evening melatonin level among all groups. In both obese groups, nighttime melatonin levels were significantly lower than in the control group. A positive correlation was detected between the levels of morning and afternoon melatonin and body mass index only in obese adolescents without OSA (r=0.58; p=0.03 and r=0.68; p=0.01, respectively). It was found that evening melatonin correlated with minimum blood oxygen saturation (SaO2) in the entire sample of adolescents with OSA (r=-0.69; p=0.008), and it also correlated with time with SaO2 <90% in the group with clinical manifestations of OSA (r=0.76; p=0.003). Nighttime melatonin levels negatively correlated with the minimum SaO2 value solely in the group with clinical manifestations of OSA (r=-0.58; p=0.035). Conclusion — The circadian melatonin secretion in obese adolescents differed, depending on the presence or absence of OSA, and correlated with the level of oxygen desaturation in OSA patients, to a greater extent – in the presence of clinical manifestations.

Changes in Sleep Duration and Timing During the Middle-to-High School Transition

PURPOSE

The purpose of the study was to quantify changes in sleep during the middle-to-high school transition and determine if changes in sleep differ by sociodemographic characteristics.

METHODS

Adolescents were enrolled in eighth grade and followed into ninth grade (N = 110; 2,470 nights observed). The outcomes were actigraphy-estimated sleep duration, sleep onset, sleep offset, and sleep sufficiency (≥8 hours of sleep). The exposures were school grade (eighth or ninth), school night status (school or nonschool), sex (female or male), and race (white, black, or other).

RESULTS

On school nights, sleep duration declined by 25.8 minutes per night (p < .001) from eighth to ninth grade. There was no change in sleep duration on nonschool nights. Timing of sleep onset was 22.2 minutes later on school nights (p < .001) and 17.4 minutes later on nonschool nights (p < .001) in ninth grade. Timing of sleep offset did not change on school mornings but was 22.2 minutes later on nonschool mornings (p < .001) in ninth grade. The proportion of school nights (and nonschool nights) with sleep duration ≥8 hours was 9.4% (38.3%) in eighth grade and 5.7% (35.9%) in ninth grade. The odds of sleeping ≥8 hours per night was 42% lower in ninth grade, compared toeighth grade (odds ratio = .58; 95% confidence interval: .37, .91). Males were 59% less likely to sleep ≥8 hours per night. Black adolescents were 51% less likely to sleep ≥8 hours per night.

CONCLUSIONS

Insufficient sleep is highly prevalent, especially on school nights and among male and black adolescents, and this problem worsens with the transition to high school.

Obesity and sleep disorders: A nationwide study of 1.3 million Israeli adolescents

OBJECTIVES

To assess the association between sleep disorders prevalence and obesity in Israeli adolescents.

METHODS

A nationwide, population-based, cross-sectional study of 1,348,817 Israeli adolescents (57% males) who were medically examined prior to military service between 1997 and 2015; height and weight were measured along with assessment of medical status at age 17.3⬰±⬰0.4 years. The diagnosis of a sleep disorder was made based on objective diagnostic criteria. The prevalence and odds ratio (OR) for a sleep disorder were computed across BMI subgroups and were adjusted for socio-demographic confounders.

RESULTS

Overall sleep disorders prevalence was 1.8:1000 (males) and 0.45:1000 (females), with a total of 1601 cases. There was a gradual increase in the odds ratio for sleep disorders with increasing BMI. Multivariable-adjusted ORs for sleep disorders were 1.29 (95% CI 1.10⬜1.52), 1.44 (1.18⬜1.75), 3.03 (2.32⬜3.96) and 3.38 (1.98⬜5.75) for overweight, obese class I, II and III, respectively (5^th⬜49th BMI percentile was the reference). Results persisted in extensive sensitivity analyses including limiting the study sample to participants with unimpaired health.

CONCLUSIONS

We found a higher prevalence of sleep disorders in males and a dose-dependent association between sleep disorders and adolescent BMI in both sexes. Our findings warrant clinical awareness among healthcare providers, given the rise in obesity in teenagers, and particularly in light of the obesity epidemic that we are experiencing in this era. Sleep related complaints should be actively screened in adolescents who suffer obesity.

Sleep dissatisfaction and insufficient sleep duration in the Italian population

To investigate the prevalence and possible determinants of sleep quality and quantity, we used data from a cross-sectional study conducted in 2019 on a sample of 3120 subjects, representative of the general Italian adult population. Sleep dissatisfaction was reported by 14.2% and insufficient sleep (duration) by 29.5% of adults. Sleep dissatisfaction and insufficient sleep were directly related with age (p for trend < 0.001), and inversely related with socioeconomic class (p for trend < 0.001) and income (p for trend < 0.001). Sleep dissatisfaction was higher among women (odds ratio, OR 1.30; 95% confidence interval, CI 1.05–1.60). Insufficient sleep was inversely related to education (p for trend < 0.001) and more frequent in current compared to never smokers (OR 1.32; 95% CI 1.08–1.61). Sleep dissatisfaction was higher among divorced/separated compared with married subjects (OR 1.75; 95% CI 1.20–2.58) and lower among subjects living with children aged 0–14 years (OR 0.48, 95% CI 0.33–0.70). Pet owners more frequently had sleep dissatisfaction (OR 1.35, 95% CI 1.08–1.68) and insufficient sleep (OR 1.46, 95% CI 1.23–1.73). In Italy, self-perceived sleep problems appear to be increasing. Sleep problems can contribute to aggravating health disparities in the society. The unfavourable relationship with pets (and the favourable ones with children) should be confirmed by longitudinal studies.

Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group

Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2-day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long-term health. These changes demand a repositioning of existing evidence-based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.

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

BACKGROUND

The relationship between short sleep duration and metabolic syndrome (MetS) in children and adolescents has been inconsistent. This study aimed to examine the association between short sleep duration and MetS in Chinese children and adolescents.

METHODS

Data were from a cross-sectional survey conducted in Jinan, China between September 2013 and November 2014. A total of 1008 children and adolescents aged 6-17 years were included. Sleep duration was self-reported by participants and categorized as normal or short (<9 h in children aged 6-12 years or <8 h in adolescents aged 13-17 years) according to the recommendations of the American Academy of Sleep Medicine. MetS was defined based on the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III.

RESULTS

After adjusted for sex, age, parental education levels, and midpoint of sleep, compared with normal sleep duration, short sleep duration was associated with increased odds of MetS (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.09-2.95) and abdominal obesity (OR: 1.60, 95% CI: 1.14-2.25). In the subgroups stratified by age and sex, compared with normal sleep duration, short sleep duration was associated with increased odds of abdominal obesity (OR: 2.34, 95% CI: 1.07-5.13) in girls aged 6-12 years; short sleep duration was associated with increased odds of MetS (OR: 2.49, 95% CI: 1.06-5.84), abdominal obesity (OR: 2.30, 95% CI: 1.10-4.82), and high TG (OR: 2.63, 95% CI: 1.11-6.21) in boys aged 13-17 years.

CONCLUSIONS

Short sleep duration associated with higher odds for MetS in Chinese children and adolescents. Interventions to improve sleep duration could help prevent and control MetS among children and adolescents.

Association of sleep characteristics with adiposity markers in children

Background Accumulating evidence suggests a relationship between sleep alterations and overweight/obesity in children. Our aim was to investigate the association of sleep measures other than obstructive sleep apnea or sleep duration with overweight/obesity and metabolic function in children. Methods We conducted a prospective cohort study in school- aged children (aged 5 to 8 years, prepubertal, and 12 to 15 years, pubertal) with overweight/obesity and normal-weight children. All children underwent a standardized in-laboratory polysomnography followed by a fasting blood assessment for glucose and metabolic testing. Subjective sleep measures were investigated by a 7-day sleep diary and questionnaire. We analyzed prepubertal and pubertal groups separately using logistic regression and partial correlation analyses. Results A total of 151 participants were analyzed. Overweight/obese children had significantly higher odds for arousal index (prepubertal children: 1.28, Confidence interval (CI): 1.06, 1.67; pubertal children: 1.65, CI: 1.19, 2.29) than normal-weight children, independent of age and gender. In prepubertal children, arousal-index was positively associated with C-peptide (r=0.30, p=0.01), whereas Minimum O2 saturation was negatively associated with triglycerides (r=-0.34, p=0.005), adjusting for age and sex. However, associations were attenuated by further adjustment for body mass index standard deviation scores (BMI-SDS). In pubertal children, higher level of apnea-hypopnea-index and pCO2 predicted increased lipoprotein (a) levels (r=0.35, p=0.03 and r=0.40, p=0.01, respectively), independent of age, sex, and BMI-SDS. A negative association was found between pCO2 and high-density lipoprotein (HDL)-cholesterol (r=-0.40, p=0.01). Conclusions Overall, we report that sleep quality as measured by arousal index may be compromised by overweight and obesity in children and warrants attention in future intervention programs.

Associations between sleep duration and insulin resistance in European children and adolescents considering the mediating role of abdominal obesity

Background

Short sleep duration has been suggested to lead to insulin resistance both directly by altering glucose metabolism and indirectly through obesity. This study aims to investigate associations between nocturnal sleep duration and insulin resistance considering abdominal obesity as a mediator.

Methods

We analysed data of 3 900 children aged 2–15 years participating in the second (2009/10) and third (2013/14) examination wave of the European IDEFICS/I.Family study (hereafter referred to as baseline and follow-up). Information on nocturnal sleep duration was collected by questionnaires and age-standardised (SLEEP z-score). The homeostasis model assessment (HOMA) was calculated from fasting insulin and fasting glucose obtained from blood samples; waist circumference (WAIST) was measured with an inelastic tape. HOMA and WAIST were used as indicators for insulin resistance and abdominal obesity, respectively, and transformed to age- and sex-specific z-scores. Cross-sectional and longitudinal associations between SLEEP z-score and HOMA z-score were investigated based on a path model considering WAIST z-score as a mediator adjusting for relevant confounders.

Results

Cross-sectionally, baseline SLEEP z-score was negatively associated with baseline WAIST z-score (unstandardised effect estimate -0.120, 95% confidence interval [-0.167; -0.073]). We observed no direct effect of baseline SLEEP z-score on baseline HOMA z-score but a negative indirect effect through baseline WAIST z-score (-0.042 [-0.058; -0.025]). Longitudinally, there was no direct effect of baseline SLEEP z-score on HOMA z-score at follow-up but a negative indirect effect through both baseline WAIST z-score and WAIST z-score at follow-up (-0.028 [-0.040; -0.016]).

Conclusions

Our results do not support the hypothesis of an association between short sleep duration and insulin resistance independent of abdominal obesity. However, longer sleep duration may exert short and long term beneficial effects on insulin resistance through its beneficial effects on abdominal obesity.

Associations of sleep duration and social jetlag with cardiometabolic risk factors in the study of Latino youth

OBJECTIVE

We investigated associations of sleep duration and social jetlag with cardiometabolic outcomes.

PARTICIPANTS

Boys and girls aged 8-16 years from the Hispanic Community Health Study/Study of Latino Youth.

MEASUREMENTS

Participants (n = 1,208) completed a clinical examination where anthropometric characteristics, health behaviors, and health history were measured. Sleep duration was calculated as the weighted average of self-reported weekday and weekend bedtimes and wake times and categorized into age-specific cutoffs for short vs. normal sleep. "Social jetlag" was defined as the absolute difference in the midpoint of the sleep period between weekdays and weekends, measured continuously and dichotomized (≥2 hours), with higher values indicating more displacement of sleep timing across the week. Regression models tested the associations between sleep measures (separately) and cardiometabolic outcomes (e.g., healthy eating index [0-100], physical activity-minutes per week, obesity, diabetes, hypertension) after adjustment for covariates.

RESULTS

The average sleep duration was 9.5 hours (95% confidence interval: 9.3, 9.6) and the mean social jetlag was 2.5 (2.4, 2.7) hours. Participants with social jetlag reported more physical activity (β = 34.8 [13.14], P < .01), had a higher healthy eating index (β = 1.77 [0.87], P < .05] and lower odds of being overweight [OR = 0.66, (95% confidence interval 0.44, 0.99)]. Short sleep duration was associated with less physical activity but did not relate to other cardiometabolic outcomes.

CONCLUSIONS

Social jetlag was associated with healthier behaviors and a lower odds of being overweight. Given these mixed findings, future research should further evaluate how to best characterize sleep timing differences in youth to identify health consequences.

[Not Available]

OBJECTIVE:

To examine associations of hair cortisol concentration (HCC) in mid-childhood and change in HCC from mid-childhood to early adolescence (ΔHCC) with early adolescent adiposity and cardiometabolic biomarker measures.

METHODS:

In Project Viva, a pre-birth cohort of mothers and children, we measured HCC in 599 white children in mid-childhood and in 426 of these participants in early adolescence. We used multivariable linear regression to examine associations of mid-childhood HCC and ΔHCC with BMI-for-age-and-sex z-score, waist circumference, waist-height ratio, dual X-ray absorptiometry total and trunk fat mass, a metabolic risk z-score, adiponectin, HOMA-IR, high-density lipoprotein, C-reactive protein, interleukin-6, leptin, and systolic blood pressure.

RESULTS:

Over a mean (SD) follow-up of 5.2 (0.8) years, we did not find associations of mid-childhood HCC with BMI-for-age-and-sex z-score (β=0.00 per 1-interquartile range of HCC, 95% confidence interval [CI]: −0.08, 0.07), waist circumference (β=−0.04cm, 95% CI: −0.83, 0.74), metabolic risk z-score (β=0.04, 95% CI: −0.03, 0.11), or other cardiometabolic measures except for an increase in log-transformed HOMA-IR (β=0.10, 95% CI: 0.04, 0.17). ΔHCC was not associated with any outcome measures.

CONCLUSIONS:

We found that mid-childhood HCC was not associated with early adolescent adiposity or cardiometabolic biomarkers except for a slight increase in HOMA-IR.