Sleep apnea and severe maternal-infant morbidity/mortality in the United States - Five fold increase in mortality!

Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009.

Louis JM1, Mogos MF2, Salemi JL2, Redline S3, Salihu HM4.

Author information

Abstract

STUDY OBJECTIVES: 

A recent trend in increasing rates of severe maternal morbidity and mortality despite quality improvements has been noted. The goal of this study is to estimate the national prevalence of obstructive sleep apnea (OSA) in pregnant women and examine associations between OSA and pregnancy-related morbidities, including in-hospital maternal mortality.

DESIGN: 

A retrospective, cross-sectional analysis.

SETTING: 

A nationally representative sample of maternal hospital discharges from 1998-2009.

PATIENTS OR PARTICIPANTS: 

The analytic sample included 55,781,965 pregnancy-related inpatient hospital discharges.

INTERVENTIONS: 

N/A.

MEASUREMENTS AND RESULTS: 

The Nationwide Inpatient Sample (NIS) database was used to identify hospital stays for women who were pregnant or gave birth. Among these women, we determined length of hospital stay, in-hospital mortality, and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify OSA and other outcome measures. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between OSA and each outcome. The overall rate of OSA was 3.0 per 10,000; however, the rate climbed substantially from 0.7 in 1998 to 7.3 in 2009, with an average annual increase of 24%. After controlling for obesity and other potential confounders, OSA was associated with increased odds of pregnancy-related morbidities including preeclampsia (OR, 2.5; 95% CI, 2.2-2.9), eclampsia (OR, 5.4; 95% CI, 3.3-8.9), cardiomyopathy (OR, 9.0; 95% CI, 7.5-10.9), and pulmonary embolism (OR, 4.5; 95% CI, 2.3-8.9). Women with OSA experienced a more than fivefold increased odds of in-hospital mortality (95% CI, 2.4-11.5). The adverse effects of OSA on selected outcomes were exacerbated by obesity.

CONCLUSIONS: 

Obstructive sleep apnea is associated with severe maternal morbidity, cardiovascular morbidity, and in-hospital death. Targeted interventions may improve pregnancy outcomes in this group.

KEYWORDS: 

maternal mortality obstructive sleep apnea preeclampsia  pregnancy pulmonary embolus

Abstract HERE

How about some good news....Basketball players defend Kenosha cheerleader targeted by bully!

How about some news about what is good in kids today! JR

Basketball players defend Kenosha cheerleader targeted by bully

KENOSHA -- A student being bullied at a Lincoln Middle School basketball game caught the attention of the basketball players. They walked off the court to come to defend her. 

This is where it all happened for Desiree Andrews.  As she was being bullied from the stands, a few boys on the team said enough's enough, and that's where this bullying situation turned her life around.

 

Desiree Andrews no longer walks to class alone.  Students have been drawn to her after a situation that could have taken away this pretty smile.

 

"The kids in the audience were picking on Dee, So we all stepped forward," said Chase Vazquez, Lincoln Middle School basketball player.

 

Andrews has Down syndrome.  These three boys were in the middle of a game when they heard something upsetting directed at one of their cheerleaders, a girl who dances to her own beat.

 

“So when I heard they were talking about her like, it kind of like made me mad," said Miles Rodriguez, Lincoln Middle School basketball player.

Basketball players stepped to action, walked off the court, and told the bully to stop.

“It’s not fair when other people get treated wrong because we’re all the same. We’re all created the same. God made us the same way," said Scooter Terrien, Lincoln Middle School basketball player.

Dee and the boys are now eighth graders and last night, played their last game in the gymnasium that they have affectionately dedicated to their friend.

We asked Desiree Andrews: “Are they calling it something special?"

An Essential Audio and Written Article on Ataxia and Cerebellar Disorders.

This is a very important informative piece for anyone with ataxia or other cerebellar dysfunction...or living with or educating someone with ataxia...Thanks to Dr. Schmahmann from a specialist and a parent.

My favorite quotes:

"...the cerebellum really has just one job: It takes clumsy actions or functions and makes them more refined. "It doesn't make things. It makes things better," Schmahmann says.'

"But during that time doctors and developmental health experts still didn't know why Jonathan was having so much trouble. And that turned out to be a good thing, says his father, Richard. "Not knowing what the diagnosis was we said, 'Well, let's assume he can do everything,' " he says."

 JR

A Man's Incomplete Brain Reveals Cerebellum's Role In Thought And Emotion

Since his birth 33 years ago, Jonathan Keleher has been living without a cerebellum, a structure that usually contains about half the brain's neurons.

This exceedingly rare condition has left Jonathan with a distinctive way of speaking and a walk that is slightly awkward. He also lacks the balance to ride a bicycle.

But all that hasn't kept him from living on his own, holding down an office job and charming pretty much every person he meets.

"I've always been more into people than anything else," Jonathan tells me when I meet him at his parents' house in Concord, Mass., a suburb of Boston. "Why read a book or why do anything when you can be social and talk to people?"

Jonathan's Brain Scans

These are brain MRI scans of Jon Keleher (A,B) compared to a control person (C,D) of the same age.

Source: Massachusetts General Hospital

Credit: Courtesy of Jeremy Schmahmann

Jonathan is also making an important contribution to neuroscience. By allowing scientists to study him and his brain, he is helping to change some long-held misconceptions about what the cerebellum does. And that, in turn, could help the hundreds of thousands of people whose cerebellums have been damaged by a stroke, infection or disease.

For decades, the cerebellum has been the "Rodney Dangerfield of the brain," says Dr. Jeremy Schmahmann, a professor of neurology at Harvard and Massachusetts General Hospital. It gets no respect because most scientists only know about its role in balance and fine motor control.

You can learn a lot about that role by watching someone who's been pulled over for drunken driving, Schmahmann says. "The state trooper test is a test of cerebellar function. So the effect of alcohol on cerebellar function is identified by everybody who's ever done walking a straight line or touching their finger to the nose."

But Schmahmann and a small group of other scientists have spent decades building acase that the cerebellum does a lot more than let people pass a sobriety test.

Full article and audio here

Concussions detectable on the sidelines in children as young as 5

A vision test that can be done on sidelines to detect concussions was shown effective in children as young as 5 years old.

New research from the NYU Langone Concussion Center finds that a simple eye test, which can be administered in less than two minutes, can effectively diagnose a concussion and help determine whether a student athlete as young as 5 years old should return to a game.

The new study, published online in the Journal of Neuro-Ophthalmology, was conducted on 89 NCAA athletes and a younger subset of 243 youth athletes under age 17, and shows how the eye test, known as the King-Devick test, could help mitigate the problems that face concussion diagnosis in youth sports.

Study author Steven Galetta, MD, the Philip K. Moskowitz, MD Professor and Chair of Neurology at NYU Langone Medical Center, says the test can easily be administered on the sidelines by parents and non-health care professionals when athletic trainers and doctors are not available to monitor sidelines at youth sports games.

"Our findings in children and collegiate athletes show how a simple vision test can aid in diagnosis of concussion at all levels of sport," says Dr. Galetta, who is also a professor of ophthalmology at NYU Langone. "Adding the King-Devick test to the sideline assessment of student athletes following a head injury can eliminate the guesswork for coaches and parents when deciding whether or not a student should return to play."

As part of the King-Devick test, athletes read numbers off of three pieces of paper while being timed with a stopwatch. A worsened performance from a baseline reading suggests a concussion has occurred.

"Given that concussions may cause devastating short- and long-term cognitive effects, tools like vision testing that can objectively diagnose a concussion are critical," says Laura Balcer, MD, co-director of the NYU Langone Concussion Center, and a professor of neurology, ophthalmology and population health at NYU Langone.

Some sideline tests only measure cognition and balance, but visual testing is rarely performed, despite longstanding evidence that vision is commonly affected by concussion, according to a review article published by Dr. Galetta and Dr. Balcer in the March 3 print issue of Journal of Neuro-Ophthalmology. Previous research suggests about 50 percent of the brain's pathways are tied to vision.

The King-Devick test was developed in 1976 by optometrists Dr. Alan King and Steven Devick. Previous studies have looked at the test for neurological conditions that can affect vision like multiple sclerosis, before the researchers began testing it on athletes.

While earlier studies by the NYU Langone researchers looked at the King-Devick test on college athletes, this is the first to administer the test in children.

For the new study, researchers recruited 243 male and female athletes between the ages of 5 and 17 years old participating in a local youth hockey and lacrosse leagues, and 89 athletes who played these sports at the collegiate level. All of them underwent a baseline King-Devick test before the start of the sports season.

As part of the test, participants read numerical on cards from left to right as quickly as possible. Times for all three reading cards are added together, and then that number is compared with the baseline score: higher testing times suggest a worsening of performance consistent with a concussion.

All the student athletes were also given a brief cognitive test called the Standardized Assessment of Concussion (SAC) which measures memory, concentration and recall, and a Timed Tandem Gait Test, which is a timed walking trial.

Researchers determined 12 athletes sustained a concussion during the season. After matching them to control subjects of the same age and sport who did not experience a head injury, the study showed the King-Devick test outperformed the other two tests in distinguishing a concussed athlete versus an uninjured control subject with 92 percent accuracy (compared to 87 percent for Tandem Gait and 68 percent for SAC test).

Among concussed athletes, K-D scores worsened by an average of 5.2 seconds compared to baseline scores, while non-concussed athletes improved their times by 6.4 seconds compared with baseline.

Up to 3.9 million sports-related mild traumatic brain injuries, or concussions, occur annually in the United States, according to the Centers for Disease Control and Prevention, but researchers say that number is likely higher since the CDC only tracks emergency room visits.

Experiencing a concussion in a game increases an athlete's risk for sustaining a second condition in the same season by three times. Other complications include the dangerous second impact syndrome, or other short- and long-term side effects.

The group next plans to study the underlying mechanisms of the fast eye movements required for rapid number naming using electronic quantitative eye movement recordings in collaboration with Janet Rucker, MD, the Bernard A. and Charlotte Marden Associate Professor of Neurology and J.R. Rizzo, MD, director of the Visuomotor Integration Lab at Rusk Rehabilitation. According to Dr Balcer, these observations may permit more precise anatomical correlations of performance data and concussive symptoms.

Read more here

Increased stroke risk seen with people who sleep too much

Sleeping for more than 8 hours per day can increase a person's risk of having a stroke.

People who sleep for more than eight hours a day have an increased risk of stroke, according to a study by the University of Cambridge -- and this risk doubles for older people who persistently sleep longer than average. However, the researchers say it is unclear why this association exists and call for further research to explore the link.

Previous studies have already suggested a possible association between sleep and risk of stroke, but today's study, published in the journal Neurology, is the first to provide detailed information about the British population and to examine the relationship between a change in sleep duration over time and subsequent stroke risk.

Researchers from the Department of Public Health and Primary Care at the University of Cambridge followed just under 10,000 people aged 42-81 years of age from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort over 9.5 years. During 1998-2000 and then again four years later, they asked the cohort how many hours on average they slept in a day and whether they generally slept well. Almost seven out of ten participants reported sleeping between six and eight hours a day, whilst one in ten reported sleeping for over eight hours a day. Participants who slept for less than six hours or more than eight hours were more likely to be older, women and less active.

Over the almost ten year period of the study, 346 participants suffered a stroke, either non-fatal or fatal stroke. After adjusting for various factors including age and sex, the researchers found that people who slept longer than eight hours a day were at a 46% greater risk of stroke than average. People who slept less than six hours a day were at an 18% increased risk, but the small number of people falling in this category meant the association was not statistically significant*.

Participants who reported persistently long sleep -- in other words, they reported sleeping over eight hours when asked at both points of the study -- were at double the risk of stroke compared to those with persistently average sleep duration (between six and eight hours a day). This risk was even greater for those whose reported sleep increased from short to long over the four years -- their risk was close to four times that of people who maintained an average sleep duration.

In addition to studying the EPIC-Norfolk cohort, the researchers carried out a study of combined data from 11 other studies related to identify the association between sleep duration and patterns of stroke risk. Their final analysis, including 560,000 participants from seven countries, supported the findings from the EPIC-Norfolk cohort study.

Yue Leng, a PhD candidate at the University of Cambridge, says: "It's apparent both from our own participants and the wealth of international data that there's a link between sleeping longer than average and a greater risk of stroke. What is far less clear, however, is the direction of this link, whether longer sleep is a symptom, an early marker or a cause of cardiovascular problems."

While older people have less work and fewer social demands and therefore often have the option of sleeping longer, previous research has shown that in fact, they tend to sleep on average for shorter periods.

The researchers say it is unclear yet why the link between sleep and stroke risk should exist. Lack of sleep has been linked with factors such as disrupted metabolism and raised levels of the 'stress hormone' cortisol, all of which may lead to higher blood pressure and increased stroke risk. However, the current study suggests that the association between longer sleep duration and higher risk of stroke was independent of normal risk factors for cardiovascular disease.

Professor Kay-Tee Khaw, senior author on the study, adds: "We need to understand the reasons behind the link between sleep and stroke risk. What is happening in the body that causes this link? With further research, we may find that excessive sleep proves to be an early indicator of increased stroke risk, particularly among older people."

The study was supported by the Medical Research Council and Cancer Research UK.

*The absolute risk of stroke was 4.1% for less than six hours' sleep, 3.1% for six to eight hours, and 5.3% for over eight hours. Note: these figures are before adjustment for age, sex, etc. -- figures for after adjustment were not available.

Read more here

Persistent debunked autism fads

This study from Emory University discusses why debunked autism treatment fads continue to persist.

The communication struggles of children with autism spectrum disorder can drive parents and educators to try anything to understand their thoughts, needs and wants. Unfortunately, specialists in psychology and communication disorders do not always communicate the latest science so well.

These factors make the autism community especially vulnerable to interventions and "therapies" that have been thoroughly discredited, says Scott Lilienfeld, a psychologist at Emory University.

"Hope is a great thing, I'm a strong believer in it," Lilienfeld says. "But the false hope buoyed by discredited therapies can be cruel, and it may prevent people from trying an intervention that actually could deliver benefits."

Lilienfeld is lead author of a commentary, "The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example," recently published by the journal Evidence-Based Communication Assessment and Intervention. Co-authors of the commentary are Julia Marshall (also from Emory) and psychologists James Todd (from Eastern Michigan University), and Howard Shane (director of the Autism Language Program at Boston Children's Hospital).

The authors describe a litany of treatments for autism that have been attempted with little or no success over the years, including gluten- and casein-free diets, antifungal interventions, chelation therapy, magnetic shoe inserts, hyperbaric oxygen sessions, weighted vests, bleach enemas, sheep-stem-cell injections and many more.

As a case study, however, the article focuses on one intervention in particular: Facilitated Communication, or FC.

FC purports to allow previously nonverbal individuals with autism and related disorders to type by using a keyboard or letter pad. A facilitator offers support to the individual's arms, allowing him or her to type words and complete sentences.

Soon after its introduction into the United States in the early 1990s, however, FC was convincingly debunked. Studies overwhelmingly demonstrated that facilitators were unconsciously guiding the hands of individuals with autism toward the desired letters, much as individuals using a Ouija board unknowingly guide the planchette to certain numbers and letters.

"The emotional appeal of FC is very powerful and understandable," Lilienfeld says. "And no doubt the overwhelming majority of people who use FC are sincere and well-meaning. The problem is, it doesn't work."

In some cases, the authors note, FC has resurfaced with minor variations in the technique and a new name, such as "rapid prompting," or "supported typing."

By reviewing published surveys of practitioner use and canvassing the popular and academic literatures, Lilienfeld and his co-authors show that FC continues to be widely used and widely disseminated in much of the autism community despite its scientific refutation. They examine a number of potential reasons for the surprising persistence of FC and other autism fads. They note that the inherent difficulties in treating autism may give rise to an understandable desire for quick fixes of many kinds.

Lilienfeld and his colleagues underscore the pressing need for experts in the autism field to better educate the public about not only what works for the condition, but what does not.

Read more here

Village in Kazakhstan hit with mystery sleep disorder

A small village in Kazakhstan is being hit with a mysterious sleep disorder where people fall asleep for days at a time.

Residents of a Kazakhstan town are being affected by a sleep disorder in which some fall asleep suddenly and don't wake up for days.

Over 150 cases since March 2013 have hit the town of Kalachi in northern Kazakhstan. The cause of the incidents, which come in waves, are unknown. The ninth wave of the mysterious illness was reported this week.

"The disease is characterized by the fact that the sickness immerses himself in unusually long sleep, while to bring them into full consciousness is practically impossible on the first day," said Leonid Rikhvanov of Russia's Tomsk Polytechnic University, who has studied the area for four years.

"During hospitalization, people exposed to the disease were marked by identical complaints: dizziness, weakness, loss of coordination, unconsciousness or semiconscious state for up to three days. After passing the first symptoms, they get headaches, become confused, and suffer emotional instability and memory disorders, which can last up to several weeks. In some cases, hallucinations occur, particularly in children. Some repeatedly fall asleep."

Rikhvanov suspects a nearby abandoned uranium mine is emitting radon, a colorless gas which could be working as an anesthetic or providing a narcotic effect. Other theories involve possible carbon monoxide poisoning and mass hysteria.

About 100 of Kalachi's 680 residents have been relocated to other parts of Kazakhstan, local government leader Amanbek Kalzhanov said.

Read more here

Experts claim better concussion prevention is needed in youth sports

This article discusses an expert's claim that better preventative measures for concussions are needed in youth sports.

Dina Morrissey, M.D., M.P.H., research associate for The Injury Prevention Center at Hasbro Children's Hospital, recently led a study that found that while compliance with mandated provisions in youth sports concussion laws was high among Rhode Island Interscholastic League (RIIL) high schools, compliance with recommended concussion protocols was very limited. The study, recently published in the Journal of Trauma and Acute Care Surgery, suggests that more concussion related standards and protocols need to be written into law in order to raise compliance rates among youth sports groups.

"An estimated 7.7 million children and adolescents participate in organized sports each year and the Centers for Disease Control and Prevention estimates that they sustain between 1.6 and 3.8 million sports-related concussions annually," said Morrissey. "In response to this, the state of Rhode Island passed the School and Youth Programs Concussion Act (SYPCA) in July 2010. The law outlines both mandatory and recommended provisions in regard to managing student athletes with a suspected concussion. Our study assessed compliance with this law among Rhode Island high schools and community league organizations."

In a 2013 statewide assessment of Rhode Island concussion law compliance among RIIL member high schools, non-member high schools and selected community league sports organizations, the study team found nearly universal compliance with mandated elements of SYPCA.

All athletic directors surveyed reported that they require concussion information sheets to be signed by both student athletes and parents prior to the start of each sports season. The research team also found that all coaches and 93 percent of volunteers have completed annual concussion training.

One hundred percent of surveyed groups also reported that any student athlete with a suspected concussion is immediately removed from play, and 93 percent reported that those students cannot return to play until they receive written clearance from a licensed physician, all per the SYPCA mandates.

"These SYPCA laws only apply to schools that are RIIL members," said Michael Mello, M.D., M.P.H., director of the Injury Prevention Center and co-author of the study. "When we explored other non-RIIL schools and sports organizations where SYPCA is recommended but not required, and also any of the recommendations that are not legally required of RIIL members, we found a very different compliance rate."

Only a handful of schools require student athletes to complete any type of pre-season neurocognitive testing, and nearly 20 percent don't offer it to student athletes at all. Half of the surveyed groups reported developing a written return to play protocol.

"These compliance statistics show us that in order to best protect youth athletes in Rhode Island, all recommendations outlined in the SYPCA law should be made mandatory," said Mello. "Additionally, non-RIIL schools, as well as community sports organizations, should also be required to comply with the law."

Neha Raukar, M.D., director of the Center for Sports Medicine and a co-author of the study, sees many youth athletes in her clinic for concussion treatment. "If a concussion is not treated properly and student athletes return to play too soon, they are at high risk for prolonging their symptoms, meaning more time out of the classroom and on the bench. They are also at risk for experiencing a devastating post-concussion event, such as second impact syndrome, which can be fatal," said Raukar.

"We are only just beginning to understand the long-term consequences of sustaining repeated head trauma and concussions," said Raukar. "Physicians, coaches and school staff alike all need to know the importance of properly diagnosing concussions, as well as the criteria for when a student athlete can both return to school and return to sports."

But, Morrissey also urges that the public needs to play a role and ensure that their school or community sports organization follows all the recommendations in the concussion law. "One example of our community pushing for better concussion protection for our students can be seen in school nurse annual training," said Morrissey. "At the time of our survey, only one quarter of surveyed groups required school nurses to complete annual concussion training. But now there is a new law in place to try to correct this, and Rhode Island is one of only a handful of states to reach out to school nurses for training. This is a clear step in the right direction."

Read more here

Childhood sleep disorders could hurt a child's heath

When you think of sleep disorders in children, the first types likely to spring to mind are night terrors, nightmares and sleepwalking. These fall into a class of sleep disorders known as parasomnias.

It is estimated that up to 6.5% of children - particularly those aged 4-12 years - experience night terrors, defined as episodes of intense fear, screaming and flailing during sleep. Approximately 3% of preschool and school-aged children experience nightmares, while up to 15% of children aged 4-12 years sleepwalk.

Perhaps less associated with children and adolescents is insomnia and obstructive sleep apnea. In fact, insomnia, the inability to fall asleep or frequent awakening, is estimated to affect around 25% of children and teenagers. Obstructive sleep apnea - when an individual stops breathing for long periods during sleep - affects around 2-4% of children.

What are the causes and symptoms of childhood sleep disorders?

There are a number of factors that can cause childhood and adolescent sleep disorders.

Just like adults, children and teenagers can experience stress, which can interfere with sleep. Consumption of energy drinks - which contain caffeine - is also known to disrupt sleep, as is use of certain medications, such as antidepressants and corticosteroids.

Children and adolescents are also more likely to develop sleep disorders if they have a family history of such conditions, and poor sleep habits, or poor "sleep hygiene" - such as going to bed at irregular times or attempting to sleep in an inadequate environment - can negatively affect sleep quality.

Increasingly, researchers are pointing to the use of technology as a driver for sleep disorders. Last month,Medical News Today reported on a study published in BMJ Open that found children are 50% more likely to have problems getting to sleep if they spend 4 hours a day or more using media devices.

"In adolescents, with the increase in popularity of technology, many teens are staying up very late communicating with friends on smartphones and tablets. The stimulation and light exposure from these devices are associated with late bedtimes and insomnia," Dr. Neil Kline, a sleep physician and internist at the American Sleep Association, told MNT.

Although often harmless, snoring can be a major indicator for a sleep disorder in children and adolescents. It can be a sign of sleep apnea or disturbed sleep quality.

Other symptoms of sleep disorders to look out for include difficulty getting to sleep, daytime fatigue, poor memory, lack of concentration, reduced attention span, irritability and mood swings, hyperactivity and depression.

"If there is any concern for a sleep problem, such as a child taking longer than 20-30 minutes to fall asleep, not sleeping through the night after about age 1 year, or snoring, it is important to discuss this with the child's pediatrician, health care provider or a sleep doctor," Dr. Shalini Paruthi, a spokesperson for the American Academy of Sleep Medicine (AASM), told us.

Children and teenagers are not getting enough sleep

According to recently updated recommendations from the National Sleep Foundation (NSF), the number of hours sleep children and adolescents need is as follows:

Over the past 20 years, the number of hours teenagers sleep each night has fallen.

• Newborns (0-3 months): 14-17 hours a day
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5 years): 10-13 hours
• School-age (6-13 years): 9-11 hours
• Teenagers (14-17 years): 8-10 hours.

However, it seems many children and teenagers are failing to meet sleep recommendations.

A 2014 poll from the NSF, which asked parents to estimate how much sleep their child gets on a school night, found that children aged 6-10 are only getting around 8.9 hours sleep a night, while 13-14-year-olds are only getting around 7.7 hours sleep each night.

More recently, MNT reported on a study published in the journal Pediatrics revealing that the number of hours teenagers sleep each night has declined over the past 20 years.

The study, which involved more than 270,000 adolescents, found that 72% of 15-year-olds were getting at least 7 hours or sleep each night in 1991, but this fell to only 63% in 2012.

"Declines in self-reported adolescent sleep across the last 20 years are concerning and suggest that there is potentially a significant public health concern that warrants health education and literacy approaches," said lead study author Dr. Katherine W. Keyes, of Columbia University's Mailman School of Public Health.

But why is lack of sleep among children and adolescents a public health concern?

Sleep deprivation linked to obesity, diabetes and heart problems

Sleep deprivation can cause a number of health problems for children and adolescents, both in childhood and adulthood.

In 2011, a study published in The BMJ claimed that children who do not get enough sleep are at significantly higher risk of becoming overweight, compared with children who get sufficient sleep.

Another study published in The Journal of Pediatrics in December 2014 reported a similar finding, associating severe lack of sleep and sleep-disordered breathing in early childhood with increased risk of obesity.

The researchers found that children with the shortest sleep time at the ages of 5 and 6 years were at 60-100% increased risk of obesity by the age of 15, compared with children with sufficient sleep times.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented," commented lead study author Prof. Karen Bonuck, from the Albert Einstein College of Medicine of Yeshiva University in New York, NY.

In March last year, another study published in the same journal found that overweight adolescents who do not get enough sleep may be at increased risk of diabetes, heart disease and stroke.

Past studies have also associated sleep apnea in children with delayed growth and heart failure.

Lack of sleep 'makes it nearly impossible for children to reach their full potential'

It is widely accepted that sleep is important for learning and memory. In June 2014, MNT reported on a study that suggested as such. It found that sleep after learning boosts growth of connections between brain cells, helping them to communicate with each other.

A more recent study found that sleep is particularly important for infants' learning skills. Published in theProceedings of the National Academy of Sciences, the researchers revealed that infants aged 6-12 months who had at least one 30 minute nap within 4 hours of learning a new skill were much more likely to demonstrate the skills they learned once they awoke.

With findings such as these, it is no wonder that lack of sleep and poor sleep quality has been associated with poor learning and educational attainment among children and adolescents.

A 2013 study conducted by researchers from Boston College in the UK found that sleep deprivation was a major contributor to poor grades in numerous countries. While taking literacy tests, 76% of American 9-10-years-olds were identified as sleep-deprived, and these students were found to have poorer results.

"I think we underestimate the impact of sleep. Our data show that across countries internationally, on average, children who have more sleep achieve higher in maths, science and reading. That is exactly what our data show," study co-author Chad Minnich told BBC News.

Dr. Paruthi believes sufficient sleep is crucial for a child's overall health and development. She told MNT:

"Sleep disorders in children and teens can hinder them in school, in social situations, in development and nearly every other aspect of their lives, with the negative impact potentially extending into adulthood. Without healthy sleep, it will be nearly impossible for children to reach their full potential."

Parents should not assume children will 'grow out' of sleep disorders

It is possible that as a child or teenager gets older, symptoms of their sleep disorder may ease. This is most likely for parasomnias, such as sleepwalking and night terrors.

But in some cases, sleep disorders can persist well into adulthood. "For example, children who have sleep apnea are more likely to develop sleep apnea as adults," noted Dr. Kline.

As such, sleep physicians say parents should not ignore signs of sleep disorders in children with the assumption they will "grow out" of them.

"Parents should never assume that their child will grow out of a sleep disorder," Dr. Paruthi told us. "Parents should talk to their child's doctor about how their child sleeps and discuss any potential sleep problems. It is important for a doctor to monitor sleep problems during childhood, identify any underlying causes and prescribe appropriate treatment when necessary."

Depending on what form of sleep disorder a child has, there are a number of treatments available. Doctors may recommend a melatonin supplement, for example. Melatonin is a natural hormone made by the body that helps regulate sleep.

Cognitive behavioral therapy may also be useful, in which psychological approaches - rather than medication - are used to improve a child's sleep time and quality.

Tips to improve a child's sleep

But while there are a number of therapies that can help treat symptoms of sleep disorders, there are many things the NSF say parents can do to improve the likelihood of their child getting a good night's sleep:

The NSF say parents should ensure their child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep.

• Make sleep a primary health priority in your family
• Talk to your child about the importance of sleep for their health and well-being
• Set regular bedtimes for yourself and your children and stick to them
• Be aware of how your child is using media devices in the bedroom and set boundaries for use before bedtime
• Ensure you and your child are educated on how light from media devices may impair sleep
• Rather than watching TV, playing video games or browsing the Internet before bedtime, encourage your child to read a book or listen to music
• Ensure your child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep
• Talk to your child's teacher to find out about their alertness during the school day, and ask them to inform you if they fall asleep in lessons.

To find out more about how to improve your child's sleep, visit the NSF website. Our Knowledge Center articles provide more general information on specific sleep disorders, including obstructive sleep apneaand insomnia.

What should I know about sleep apnea?

This article gives information on the different types of sleep apnea and the available treatments.

Sleep apnea is a type of sleep disorder characterized by interruptions or pauses in breathing during sleep. These interruptions can be significant and can be potentially life threatening. Because of this, the disorder can have an important impact on quality of life as well as the health of a patient.

Kim LaJack, Director of the Sleep Disorders Center at Opelousas General Health System, says symptoms of sleep apnea might include loud snoring, excessive daytime sleepiness and feelings of exhaustion upon awakening, as if sleep had never taken place. Other symptoms include depression, irritability, morning headaches, loss of sex drive, lack of concentration and memory problems.

If untreated, sleep apnea can lead to accidents due to drowsy driving as well as health issues such as hypertension, heart attacks, diabetes and strokes, according to LaJack. 

The Three Types of Sleep Apnea 

1. Obstructive sleep apnea: OSA is essentially breathing that is interrupted by a physical block to airflow despite respiratory effort, causing complete or partial closure of the airway during sleep. The three causes for OSA are enlarged tonsils blocking the airway, an enlarged neck or a large tongue blocking the airway. 

2. Central sleep apnea: This type of sleep apnea occurs when the brain fails to send the appropriate signal to the muscles responsible for initiating breathing. “We see this with patients who have neuromuscular disorders or who are on a lot of pain medication,” LaJack explains. “Sometimes patients with heart failure also experience central sleep apnea.” 

3. Complex sleep apnea: This type of sleep apnea encompasses a combination of obstructive and central sleep apnea, with the airways closed off and breathing suspended. 

“While there are three different kinds of sleep apnea, the most frequently treated at Opelousas General is obstructive sleep apnea,” LaJack says. 

Diagnosis and Treatment

Giving the history of symptoms to a qualified physician is the only way to determine if a patient's experience requires a sleep study, says LaJack. Patients who have undergone initial evaluation spend an evening at the Sleep Disorders Center at Opelousas General Health System, where their sleep is closely monitored. 

“Monitoring involves obtaining information about sleep stages, including heart rate, respiratory effort and oxygen and carbon dioxide levels,” LaJack says. 

The treatment for sleep apnea varies depending on the cause. OSA in adults involves initiation of continuous positive airway pressure (CPAP) therapy. The CPAP machine delivers a pressure into the patient's airway by way of a mask and tubing, acting as a splint to hold the airway open. LaJack says OSA in children is generally treated with tonsillectomy. On occasion, children will need to be treated with CPAP, and with family support, it often is successful. In regards to central sleep apnea, PAP therapy involves an added element of delivering a breath during pauses in breathing. 

Dr. Joseph Y. Bordelon, Medical Director of the Sleep Disorders Center, emphasizes, “No matter the cause of the sleep apnea, the goal of therapy is to maintain an open airway so that the patient can have a more restful night of sleep, experience improved quality of life, and to prevent complications associated with untreated sleep disordered breathing. If we can delay someone's premature trip to the funeral home or nursing home, then we have been successful.”

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