High levels of sleep disturbance across early childhood increases cardiometabolic disease risk index in early adolescence: longitudinal sleep analysis using the Health Outcomes and Measures of the Environment study

STUDY OBJECTIVES

This study examines the impact of sleep duration, bedtime, and sleep disturbance during early childhood on the risk of cardiometabolic disorder (CMD) in early adolescence.

METHODS

Within the Health Outcomes and Measures of Environment Study, we examined sleep patterns of 330 children from ages 2 to 8 years and the relationship of these sleep patterns with cardiometabolic risk measures at age 12 (N = 220). We used a group-based semi-parametric mixture model to identify distinct trajectories in sleep duration, bedtime timing, and sleep disturbance for the entire sample. We then examined the associations between sleep trajectories and CMD risk measures using general linear models using both an unadjusted model (no covariates) and an adjusted model (adjusting for child pubertal stage, child sex, duration of breastfeeding, household income, maternal education, and maternal serum cotinine).

RESULTS

In the unadjusted and adjusted models, we found significant differences in CMD risk scores by trajectories of sleep disturbance. Children in the "high" disturbance trajectory had higher CMD risk scores than those in the 'low' disturbance trajectory (p's = 0.002 and 0.039, respectively). No significant differences in CMD risk were observed for bedtime timing or total sleep time trajectories in the unadjusted or adjusted models.

CONCLUSIONS

In this cohort, caregiver-reported sleep disturbance in early childhood was associated with more adverse cardiometabolic profiles in early adolescence. Our findings suggest that trials to reduce CMD risk via sleep interventions-which have been conducted in adolescents and adults-may be implemented too late.

Factors affecting pediatric adherence to positive airway pressure: Patient- and caregiver-reported treatment barriers and sleep difficulties

OBJECTIVE/BACKGROUND

Adherence to positive airway pressure (PAP) treatment among children and adolescents is often suboptimal. Little is understood about modifiable determinants of PAP adherence. We evaluated whether patient and caregiver-perceived treatment barriers (across behavioral, environmental, emotional, and physical domains), as well as insomnia severity, were associated with PAP adherence among youth with sleep disordered breathing (SDB).

PATIENTS/METHODS

We conducted a retrospective review of 188 patients prescribed PAP, ages 2-19 years. At the clinical visit, PAP adherence was assessed via objective download/smartcard and patients and their caregivers completed validated standardized questionnaires on barriers to PAP adherence and sleep onset and maintenance difficulties. We tested predictors of PAP adherence using linear regression.

RESULTS

On average, patients wore their PAP 2/3 of nights for 5.3 ± 3.4 h. Patients reported more barriers overall compared to caregivers, and specifically more behavioral and emotional barriers (e.g., over a third of patients reported they just want to forget about sleep apnea). After controlling for demographic/treatment characteristics, patient-reported barriers accounted for a significant proportion of the variance in percent nights used (51%) and average nightly use (42%). Greater difficulties with sleep maintenance predicted poorer PAP adherence (percent nights and nightly duration).

CONCLUSIONS

Study findings suggest that assessment of both patient and caregiver-perceived barriers to PAP adherence, as well as evaluating for sleep maintenance concerns, may provide important treatment targets for promoting PAP adherence among youth. Results also support the potential benefit of a multi-disciplinary team-based approach to managing SDB and promoting PAP adherence.

Losing sleep by staying up late leads adolescents to consume more carbohydrates and a higher glycemic load

This study examined how short sleep impacts dietary consumption in adolescents by testing whether experimentally shortening sleep influences the amount, macronutrient content, food types, and timing of food consumed. Ninety-three adolescents completed a within-subjects crossover paradigm comparing five nights of short sleep (6.5-hour sleep opportunity) to five nights of Healthy Sleep (9.5-hour sleep opportunity). Within each condition, adolescents completed three multiple-pass dietary recalls that recorded the types, amount, and timing of food intake. The following outcomes were averaged across days of dietary recall within condition: kilocalories, grams of carbohydrates, fat, protein, and added sugars, glycemic load of foods, and servings of specific types of foods (low-calorie drinks, sweetened drinks, fruits/vegetables, meats/proteins, processed snacks, "fast food" entrees, grains, and sweets/desserts). Timing of consumption of kilocalorie and macronutrient outcomes were also examined across four noncumulative time bins: 06:00-10:59, 11:00-15:59, 16:00-20:59, and 21:00-01:00. Adolescents slept 2 h and 20 min longer in Healthy Sleep than in Short Sleep (p < .0001). While in Short Sleep, adolescents ate more grams of carbohydrates (p = .031) and added sugars (p = .047), foods higher in glycemic load (p = .013), and servings of sweet drinks (p = .023) and ate fewer servings of fruits/vegetables (p = .006) compared to Healthy Sleep. Differences in consumption of kilocalories, fat, and carbohydrates emerged after 9:00 pm (ps = .012, .043, .006, respectively). These experimental findings suggest that adolescents who have insufficient sleep exhibit dietary patterns that may increase the risk for negative weight and cardiometabolic outcomes. Future health promotion efforts should include promoting optimal sleep to increase healthy dietary habits.

Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample

STUDY OBJECTIVES

Children with overweight or obesity are more likely to experience sleep disorders, though the role of weight in pediatric insomnia treatment has not been examined. The current study examined the relationships of high body mass with pre-treatment insomnia severity and global sleep problems, and the potential moderating impact of weight on changes in insomnia severity following insomnia treatment.

METHODS

Participants included 1133 youth ages 2-18 years clinically referred for insomnia treatment. The Pediatric Insomnia Severity Index was collected at the initial assessment and throughout treatment as part of routine clinical care. Treatment status was coded as no treatment, early termination, and completed treatment. Secondary measures of global sleep problems at the initial assessment included the Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale, and Children's Sleep Habits Questionnaire. Medical chart review of visits within ± 3 months of baseline was used to obtain age- and sex-adjusted Body Mass Index (BMIz).

RESULTS

Among adolescents, regression analyses found that higher BMIz modestly predicted baseline insomnia severity (p=.021) and worse sleep hygiene (p<.001). For children, higher BMIz was modestly associated with baseline total sleep problems (p=.006) but not insomnia severity (p=.792). Across ages, BMIz predicted neither treatment status nor insomnia improvement (ps>.05). Findings were similar in categorical analyses comparing patients with overweight/obesity to healthy weight.

CONCLUSIONS

Although there is evidence that children of higher body mass present for insomnia treatment with greater sleep concerns, body mass does not predict treatment completion or insomnia improvement. Data suggest insomnia treatment is effective irrespective of weight status.

0271 Effects of Experimentally Shortened Sleep on Dietary Outcomes in Adolescents

Introduction

Adolescents who sleep less may consume more calories during the day; however, shortened sleep may have greater impact on the dietary quality of foods, particularly foods high in sugar content. This study examined the impact of shortened sleep on total caloric intake, macronutrients of food (fats, proteins, carbohydrates), added sugars consumed, and glycemic load/index of foods consumed.

Methods

110 adolescents (ages 14–17, M = 15.73(1.80); 63.6% female) underwent a within-subject counterbalanced experimental sleep manipulation, spending either 6.5 or 9.5 hours/night in bed for five nights. During each sleep period, adolescents completed three dietary recalls (reporting amounts and types of foods consumed over a 24-hour period) administered by dietary core study staff. We conducted a series of repeated-measure general linear models comparing averaged weekly dietary outcomes of interest by sleep condition. We also explored whether experimental order of the sleep conditions, family income, or adolescent gender, body mass index (BMI), or race moderated the main effects of sleep condition on dietary outcomes. Alpha was set at .05 for primary analyses and .01 for exploratory analyses.

Results

We observed a main effect of sleep on carbohydrates (p=.038) and added sugars (p=.009) consumed, as well as the glycemic index (p=.013) and glycemic load (p=.009) of foods consumed. We did not observe a main effect of sleep on total calories or total grams of fat or protein consumed. Exploratory analysis found no significant interactions of the moderators with sleep condition on dietary outcomes.

Conclusion

Adolescents are consuming more carbohydrates, added sugars, and foods higher in glycemic index and load when sleep restricted, compared to well-rested, despite eating comparable amounts of calories. Sleep restricted adolescents may be drawn to foods that provide quick releases of energy to counteract sleepiness experienced during the day.

Support

R01 HL120879