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Hermes FN, Nunes EEM, Melo CMD. Sleep, nutritional status and eating behavior in children: a review study. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2020479. [PMID: 36102411 PMCID: PMC9462407 DOI: 10.1590/1984-0462/2022/40/2020479in] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review the current literature on the relationship between sleep, nutritional status and eating behavior, as well as mechanisms associated with these elements in children. DATA SOURCE The literature research was conducted in the PubMed, LILACS and Scopus databases, using the following terms: "Child"; "Nutritional status"; "Sleep"; "Physical activity OR Physical activities OR Exercise". The articles included were those that met the research objective. Review articles, letters to authors, or guidelines were excluded. DATA SYNTHESIS 402 articles were initially found in the literature search. After careful analyses of the title and abstract, and application of inclusion criteria, only 24 studies were included in the present review. Most studies (n=13) suggest that short sleep duration (<9-10 hours/night) is associated with overweight/obesity in children. Only three studies did not show associations between overweight/obesity and sleep variables. Short sleep duration is also associated with poor food quality, higher intake of soft drinks and stimulant beverages before bedtime, as well as micronutrient deficiency. CONCLUSIONS Sleep duration is related to overweight and obesity development in infants. Changes in dietary pattern are also related to sleep debt, being one of the mechanisms that contribute to excessive weight gain. It is necessary that health professionals understand the importance of sleep quality in the nutritional status maintenance in children.
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Hermes FN, Nunes EEM, Melo CMD. Sono, estado nutricional e hábitos alimentares em crianças: um estudo de revisão. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
RESUMO Objetivo: Fazer uma revisão da literatura sobre a relação entre sono, estado nutricional e padrão alimentar, bem como mecanismos associados, na população infantil. Fontes de dados: Foram realizadas buscas bibliográficas nas bases PubMed, LILACS e Scopus, usando os seguintes descritores: “Child”; “Nutritional status”; “Sleep”; “Physical activity OR Physical activities OR Exercise”. Os artigos que atenderam ao objetivo da pesquisa foram incluídos. Excluíram-se estudos de revisão, cartas para autores ou diretrizes. Síntese dos dados: Inicialmente, 402 artigos foram encontrados na pesquisa. Após análise dos títulos e abstracts e a aplicação dos critérios de exclusão, 24 estudos foram selecionados para a revisão. A maioria dos estudos (n=13) sugere que sono de curta duração (<9-10 horas/noite) está associado com sobrepeso/obesidade na população infantil. Apenas três artigos não reportaram associações entre variáveis do sono e estado nutricional. Curta duração do sono também foi associada a hábitos alimentares ruins, maior consumo de refrigerantes e bebidas estimulantes antes de deitar, bem como deficiência de micronutrientes. Conclusões: A duração do sono tem relação com sobrepeso e obesidade na população infantil. Alterações no padrão alimentar também têm relação com débito de sono, sendo um dos mecanismos que contribuem para o ganho de peso excessivo. É necessário que os profissionais de saúde tomem conhecimento da importância da qualidade do sono para a manutenção do estado nutricional em crianças.
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Migueis DP, Lopes MC, Ignacio PSD, Thuler LCS, Araujo-Melo MH, Spruyt K, Lacerda GCB. A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan. Sleep Med 2021; 85:25-37. [PMID: 34271180 DOI: 10.1016/j.sleep.2021.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.
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Affiliation(s)
- D P Migueis
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Antonio Pedro University Hospital / Fluminense Federal University, Niterói, Brazil.
| | - M C Lopes
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - P S D Ignacio
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L C S Thuler
- National Cancer Institute, Rio de Janeiro, Brazil
| | - M H Araujo-Melo
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K Spruyt
- INSERM, Université de Paris, NeuroDiderot, France
| | - G C B Lacerda
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Saidi O, Rochette E, Doré É, Maso F, Raoux J, Andrieux F, Fantini ML, Merlin E, Pereira B, Walrand S, Duché P. Randomized Double-Blind Controlled Trial on the Effect of Proteins with Different Tryptophan/Large Neutral Amino Acid Ratios on Sleep in Adolescents: The PROTMORPHEUS Study. Nutrients 2020; 12:nu12061885. [PMID: 32599773 PMCID: PMC7353359 DOI: 10.3390/nu12061885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/06/2020] [Accepted: 06/16/2020] [Indexed: 12/26/2022] Open
Abstract
Disturbed sleep is common in adolescents. Ingested nutrients help regulate the internal clock and influence sleep quality. The purpose of this clinical trial is to assess the effect of protein tryptophan (Trp)/large neutral amino acids (LNAAs) ratio on sleep and circadian rhythm. Ingested Trp is involved in the regulation of the sleep/wake cycle and improvement of sleep quality. Since Trp transport through the blood-brain barrier is competing with LNAAs, protein with higher Trp/LNAAs were expected to increase sleep efficiency. This randomized double-blind controlled trial will enroll two samples of male adolescents predisposed to sleep disturbances: elite rugby players (n = 24) and youths with obesity (n = 24). They will take part randomly in three sessions each held over a week. They will undergo a washout period, when dietary intake will be calibrated (three days), followed by an intervention period (three days), when their diet will be supplemented with three proteins with different Trp/LNAAs ratios. Physical, cognitive, dietary intake, appetite, and sleepiness evaluations will be made on the last day of each session. The primary outcome is sleep efficiency measured through in-home electroencephalogram recordings. Secondary outcomes include sleep staging, circadian phase, and sleep-, food intake-, metabolism-, and inflammation-related biochemical markers. A fuller understanding of the effect of protein Trp/LNAAs ratio on sleep could help in developing nutritional strategies addressing sleep disturbances.
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Affiliation(s)
- Oussama Saidi
- Clermont Auvergne University, Laboratory of Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), 63000 Clermont-Ferrand, France; (O.S.); (E.D.)
- Center for Research in Human Nutrition Auvergne, 63000 Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Department of Pediatrics, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (E.R.); (E.M.)
- Clermont Auvergne University, INSERM, CIC 1405, CRECHE unit, 63000 Clermont-Ferrand, France
- Toulon University, Laboratory of the Impact of Physical Activity on Health (IAPS), 83000 Toulon, France
| | - Éric Doré
- Clermont Auvergne University, Laboratory of Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), 63000 Clermont-Ferrand, France; (O.S.); (E.D.)
- Center for Research in Human Nutrition Auvergne, 63000 Clermont-Ferrand, France
| | - Freddy Maso
- Rugby Training Center of the Sportive Association Montferrandaise, 63000 Clermont-Ferrand, France;
| | - Julien Raoux
- OXSITIS LAB-NUTRITION, Chrono-Nutrition Food Supplements, 63110 Clermont-Ferrand, France; (J.R.); (F.A.)
| | - Fabien Andrieux
- OXSITIS LAB-NUTRITION, Chrono-Nutrition Food Supplements, 63110 Clermont-Ferrand, France; (J.R.); (F.A.)
| | - Maria Livia Fantini
- Neurophysiology Unit, Neurology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France;
- NPsy-Sydo (EA 7280), Clermont Auvergne University, 63000 Clermont-Ferrand, France
| | - Etienne Merlin
- Department of Pediatrics, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (E.R.); (E.M.)
- Clermont Auvergne University, INSERM, CIC 1405, CRECHE unit, 63000 Clermont-Ferrand, France
- Clermont Auvergne University, INRA, UMR 1019 UNH, ECREIN, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France;
| | - Stéphane Walrand
- Clermont Auvergne University, Clermont-Ferrand University Hospital, INRAE, UNH, F-63000 Clermont–Ferrand, France;
| | - Pascale Duché
- Toulon University, Laboratory of the Impact of Physical Activity on Health (IAPS), 83000 Toulon, France
- Correspondence: ; Tel.: +33-(0)652-1838-91
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Elrokhsi SH, Bluez GP, Chin CN, Wheeler MD, Silva GE, Perfect MM. Differences in sleep architecture according to body mass index in children with type 1 diabetes. Pediatr Diabetes 2020; 21:98-105. [PMID: 31498940 DOI: 10.1111/pedi.12918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
Slow wave sleep (SWS), or deep sleep, is thought to be the most restorative stage of sleep and may be of a particular interest in the pathophysiology of obesity. The aim of this study was to investigate differences in sleep architecture based on body mass index (BMI) among a pediatric population with type 1 diabetes mellitus (T1DM). We hypothesized that children with T1DM who are obese would have less SWS than those who are not obese. Of 105 children with T1DM (mean age 13.54 years, 49.5% females) in this study, 19% were obese, 22% were overweight, and 59% had a normal BMI (81% non-obese). The overall SWS% among the participants was 13.2%. In contrast to our hypothesis, there was no significant difference in SWS% between obese and non-obese participants. However, the percent of time spent in rapid eye movement (REM) sleep among obese participants was significantly lower than those who were not obese (P = .022), which remained after adjusting the result for multiple covariates. While we found no significant association between the SWS time and BMI, obese adolescents with T1DM spent less time in REM sleep than those who were not obese. This study adds to the growing body of evidence supporting the importance of addressing sleep in clinical care of youth with T1DM.
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Affiliation(s)
- Salaheddin H Elrokhsi
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Grai P Bluez
- Disability and Psychoeducational Studies, University of Arizona, Tucson, Arizona
| | - Cindy N Chin
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Mark D Wheeler
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | | | - Michelle M Perfect
- Disability and Psychoeducational Studies, University of Arizona, Tucson, Arizona
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Night-time cardiac autonomic modulation as a function of sleep-wake stages is modified in otherwise healthy overweight adolescents. Sleep Med 2019; 64:30-36. [PMID: 31655323 DOI: 10.1016/j.sleep.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Even though sympathetic dominance during the daytime period is well known, currently, scarce data exist on autonomic nervous system (ANS) regulation during sleep in pediatric obesity. We aimed to evaluate sleep cardiac ANS regulation in normal-weight (NW) and overweight and obese (OW) adolescents. PATIENTS/METHODS In this study, 60 healthy adolescents (15.7 ± 0.7 years) belonging to a birth cohort since infancy were classified based on body mass index percentiles criteria as: OW (N = 27) or NW (N = 33). Sleep was evaluated by polysomnography (PSG) during two consecutive in-lab overnight sessions. Non-rapid eye movement (non-REM) sleep stages (stages 1, 2, and slow-wave sleep [SWS]), rapid eye movement (REM) sleep, and wakefulness (Wake) were scored. R-waves were detected automatically in the electrocardiographic (ECG) signal. An all-night heart rate variability analysis was conducted in the ECG signal, with several time- and frequency-domain measures calculated for each sleep-wake stage. Sleep time was divided into thirds (T1, T2, T3). The analysis was performed using a mixed-effects linear regression model. RESULTS Sleep organization was comparable except for reduced REM sleep percentage in the OW group (p < 0.04). Shorter R-R intervals were found for all sleep stages in the OW group; time-domain measured standard deviation of all R-R intervals (RRSD) was lower during stage 2, SWS and REM sleep (all p < 0.05). The square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD) was also lower only during wake after sleep onset (WASO) in T1 and T3 (p < 0.05). The OW group had increased very low- and low-frequency (LF) power during WASO (in T1 and T2), and LF power during stage 2 and REM sleep (in T2). During WASO in the OW group, high-frequency (HF) power was lower (in T1 and T2), and LF/HF ratio was higher (in T2, p < 0.007). CONCLUSIONS Several sleep-stage-dependent changes in cardiac autonomic regulation characterized the OW group. As sleep-related ANS balance was disturbed in the absence of concomitant metabolic alterations in this sample of otherwise healthy OW adolescents, their relevance for pediatric obesity should be further explored throughout development.
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Cyclic alternating pattern in infants with congenital hypothyroidism. Brain Dev 2019; 41:66-71. [PMID: 30037585 DOI: 10.1016/j.braindev.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022]
Abstract
Congenital hypothyroidism is defined as thyroid hormone deficiency present at birth which is crucial for brain development. Recently, the cyclic alternating pattern, a rhythm present in electroencephalography recordings in non-Rapid eye movement sleep, has been related to brain development and cognition in different pediatric conditions. Therefore, we evaluated the cyclic alternating pattern rate in infants with congenital hypothyroidism, thyroxine supplementation, and healthy controls. The parameters of the cyclic alternating pattern were evaluated in 19 healthy infants (10 female, mean age 25.5 ± 15.5 months) and 21 infants diagnosed with congenital hypothyroidism (19 female, mean age 24.3 ± 19.0 months). We considered the transient electro-cortical activations (phase A of the cycle) in non-Rapid eye movement sleep and the subdivisions of the A phase in: A1, A2 and A3, based on their frequency content. All subjects were subjected to polysomnography recording in a standard laboratory setting. Sleep data were stored computer following the International 10-20 System. Data showed that congenital hypothyroidism infants exhibited higher frequency of central apnea, hypopnea, and arousals in comparison to controls. Particularly, central apnea index decreased with age in the control group but not in congenital hypothyroidism group. Regarding to cyclic alternating pattern measurements, congenital hypothyroidism infants exhibit a higher frequency in the percentage of A3 subtype (electroencephalographic desynchrony) and conversely a lower percentage of A1 subtype (electroencephalographic synchrony), than healthy infants. An important finding of this study is the positive correlation between A1 mean duration and age, which is bigger in control group than in congenital hypothyroidism group (time duration in control group (0.52 s/month) versus congenital hypothyroidism group (0.1 s/month). Infants with congenital hypothyroidism showed an increase of A3 subtype, of central apnea, and of arousals. The reduction of percentage and mean duration of A1 subtype could be a valuable indicator of sleep development in patients with congenital hypothyroidism and healthy infants.
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Shaw ND, McHill AW, Schiavon M, Kangarloo T, Mankowski PW, Cobelli C, Klerman EB, Hall JE. Effect of Slow Wave Sleep Disruption on Metabolic Parameters in Adolescents. Sleep 2016; 39:1591-9. [PMID: 27166229 DOI: 10.5665/sleep.6028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/28/2016] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Cross-sectional studies report a correlation between slow wave sleep (SWS) duration and insulin sensitivity (SI) in children and adults. Suppression of SWS causes insulin resistance in adults but effects in children are unknown. This study was designed to determine the effect of SWS fragmentation on SI in children. METHODS Fourteen pubertal children (11.3-14.1 y, body mass index 29(th) to 97(th) percentile) were randomized to sleep studies and mixed meal (MM) tolerance tests with and without SWS disruption. Beta-cell responsiveness (Φ) and SI were determined using oral minimal modeling. RESULTS During the disruption night, auditory stimuli (68.1 ± 10.7/night; mean ± standard error) decreased SWS by 40.0 ± 8.0%. SWS fragmentation did not affect fasting glucose (non-disrupted 76.9 ± 2.3 versus disrupted 80.6 ± 2.1 mg/dL), insulin (9.2 ± 1.6 versus 10.4 ± 2.0 μIU/mL), or C-peptide (1.9 ± 0.2 versus 1.9 ± 0.1 ng/mL) levels and did not impair SI (12.9 ± 2.3 versus 10.1 ± 1.6 10(-4) dL/kg/min per μIU/mL) or Φ (73.4 ± 7.8 versus 74.4 ± 8.4 10(-9) min(-1)) to a MM challenge. Only the subjects in the most insulin-sensitive tertile demonstrated a consistent decrease in SI after SWS disruption. CONCLUSION Pubertal children across a range of body mass indices may be resistant to the adverse metabolic effects of acute SWS disruption. Only those subjects with high SI (i.e., having the greatest "metabolic reserve") demonstrated a consistent decrease in SI. These results suggest that adolescents may have a unique ability to adapt to metabolic stressors, such as acute SWS disruption, to maintain euglycemia. Additional studies are necessary to confirm that this resiliency is maintained in settings of chronic SWS disruption.
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Affiliation(s)
- Natalie D Shaw
- Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC
| | - Andrew W McHill
- Division of Sleep and Circadian Disorders, The Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston MA
| | - Michele Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Tairmae Kangarloo
- Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Piotr W Mankowski
- Division of Sleep and Circadian Disorders, The Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston MA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, The Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston MA
| | - Janet E Hall
- Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC
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