Short sleep and breathing issues increases obesity risk in children

A child's risk of obesity is increased by sleeping for short amounts of time and breathing issues while sleeping.

Too little sleep has officially been linked to an increased risk of obesity, particularly among young children. Recent findings published in The Journal of Pediatrics reveals a high connection between sleep-related breathing problems and obesity.

For the study, researchers analyzed data from 1,900 children in England and followed the participants for about 15 years. Study results showed that those who got the least amount of sleep between the ages 5 and 6 had between a 60 percent and 100 percent increased risk of obesity by age 15.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," said lead study author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Einstein, in a news release. "Sleep-disordered breathing, or SDB, which includes snoring and sleep apnea, is also a risk factor for obesity but receives less attention. These two risk factors had not been tracked together in children over time to determine their potential for independently influencing weight gain. Our study aimed to fill in that gap."

Furthermore, researchers found that children with the most severe sleep-disorder breathing (SDB) had the highest obesity risk. Children whose SDB levels peaked at around 5 to 6 years old still had a 60 to 80 percent increased risk of obesity, but fared better overall.

"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. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is oftentimes due to enlarged tonsils or adenoids, which can be removed with surgery if a problem occurs. Misalignment of jaws or teeth can also cause issues.

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Sleep disorders in children may be caused by winter viruses

Sleep disorders in children related to breathing during sleep may be due to winter viruses.

A good night's sleep is important to our children's development. But with the first day of school just passed, many children are at increased risk for sleep breathing disorders that can impair their mental and physical development and hurt their academic performance.

A study conducted in North America in 2011 showed that the frequency of sleep-disordered breathing increases in the winter and spring. Until now, researchers believed asthma, allergies and viral respiratory infections like the flu contributed to disorders that affect children's breathing during sleep.

Now, in a new study conducted at the Pediatric Sleep Center at the Tel Aviv Sourasky Medical Center and published in the journal Sleep Medicine, Riva Tauman and her fellow researchers of the Sackler Faculty of Medicine at Tel Aviv Univ. have shown that asthma and allergies do not contribute to pediatric sleep-disordered breathing. Viruses alone, they say, may be responsible for the seasonal variation seen in children.

The researchers say the study has broad implications for the treatment of sleep-breathing disorders in children, bolstering the idea that the time of year is relevant when treating children for sleep-disordered breathing in borderline cases.

Blowing hot and cold

"We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months," Tauman says. "What we didn't expect is that the trend has nothing to do with asthma or allergies."

"Sleep-disordered breathing" is a blanket term for a group of disorders. One of the common disorders is obstructive sleep apnea, in which the upper airway becomes blocked, usually by enlarged tonsils or adenoids, causing snoring and, in more severe cases, breathing pauses that lead to poor-quality and fragmented sleep and decreased oxygen and elevated carbon dioxide levels in the bloodstream.

In the long term, sleep-disordered breathing in children can cause stunted growth, heart disease and neurocognitive problems associated with diminished school performance, impaired language development and behavioral issues.

In their study, Tauman and her Sackler Faculty of Medicine colleagues Michal Greenfeld and Yakov Sivan statistically analyzed the cases of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010. Confirming earlier results of a 2011 study of five- to nine-year-olds, the researchers found that pediatric sleep-disordered breathing is worse in the winter — which in Israel they defined as from November to March — than in the summer. The seasonal variability is most apparent in children less than five years old, they found.

The researchers also found that wheezing and asthma do not contribute to the trend.

Based on their findings, the researchers speculate that viral respiratory infections — which are more prevalent in younger children and during colder months — are the major contributor to the seasonal variability seen in pediatric sleep-disordered breathing.

Taking the long view

If the sleep clinic tests had all been conducted in the winter, the researchers estimate that seven percent more children would have been diagnosed with sleep-disordered breathing. Seven percent fewer would have been diagnosed if all the tests had been done in the summer, they estimate.

"Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer," says Tauman. "But if he has only mild symptoms in the summer, I can assume they are more severe in the winter."

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Bedtimes help with obstructive sleep apnea

This article discusses obstructive sleep apnea and how adhering to a consistent bedtime helps with sleep apnea treatment.

Obstructive sleep apnea (OSA) occurs when the upper airway collapses during sleep. It is the most common type of sleep-disordered breathing, and chances of it occurring are greater in obese people. OSA is the second most prevalent sleep disorder among adults.

The first line of treatment for sleep apnea is a noninvasive, in-home treatment called CPAP -- continuous positive airway pressure therapy. However, if patients do not use the treatment consistently for the majority of sleep hours each night, it cannot help.

"It has been shown that routine is important for adherence when it comes to medication, and routine is also relevant to CPAP adherence," said Amy M. Sawyer, assistant professor ofnursing, who will report her results at SLEEP 2013, the annual meeting of the Associated Professional Sleep Societies, in Baltimore on June 5.

The researchers define CPAP adherence as using the treatment for at least four hours each night. They found that if a patient's bedtime was consistent within 45 minutes, they were significantly more likely to use the CPAP machine for at least four hours each night. A patient whose bedtime was inconsistent -- varying by an hour and five minutes or more -- was much less likely to adhere to treatment.

The researchers found that adults whose bedtime varied by more than 75 minutes or more per night, were 3.2 times more likely to use CPAP less than four hours per night after one month of treatment. For every 30-minute increase in bedtime variability, or inconsistency, the odds of nonadherence to CPAP treatment were 1.8 times greater.

Sawyer and her colleague Tonya King, professor of public health sciences, Penn State College of Medicine, are the first to study the consistency of bedtime and its correlation to treatment adherence.

The researchers asked 97 volunteers who were about to begin CPAP treatment to keep a sleep diary beginning seven days prior to starting treatment. The volunteers recorded the time they went to bed and the time they woke up each day for seven consecutive days.

Each CPAP machine had a microprocessor built in that sent CPAP-use information every 24 hours to the researchers. The microprocessor recorded the patient as using the CPAP machine when breathing through the CPAP mask was detected for longer than 20 minutes.

While the researchers found that regularity of bedtime before beginning CPAP use did not influence adherence during the first week of treatment, it did affect adherence for the first month.

"Unlike many other treatments, CPAP treatment adds new complexity to a person's daily routines," said Sawyer. She and King think that using CPAP is a learned behavior that needs to become a habit.

Sawyer indicated that next steps include figuring out ways to help patients incorporate CPAP use into their daily routine and also studying other consistencies or lack thereof in bedtime routine -- beyond what time a person goes to bed that may influence a person's ability to regularly use CPAP.

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Sleep Apnea in Children leads to Learning Complications

Obstructive sleep apnea in children leads to learning complications such as ADHD, behavioral problems, or learning problems.

New research confirms the relationship between obstructive sleep apnea in children and ADHD, as well as other behavioral and cognitive problems. Children with sleep apnea, a common type of disordered breathing during sleep, are more likely to have difficulties with learning and attention.

Obstructive sleep apnea, a type of sleep-disordered breathing (SDB), affects about 2 percent of children in the United States, according to the American Academy of Sleep Medicine. The link between obstructive sleep apnea in children and ADHD (attention-deficit hyperactivity disorder) has been previously established, but this is the first sleep study to use self-reports in assessing children's adaptive behavior, or ability to adapt to new situations.

The study, published in the April edition of the journal SLEEP, analyzed sleep and cognitive data from 263 Arizona children enrolled in the Tucson Children's Assessment of Sleep Apnea Study (TuCASA) over five years. The children, all between 6 and 11 years old, completed overnight sleep studies and standard series of neurobehavioral tests at the beginning and end of the 5-year period. Their parents also answered questionnaires about the children's behavior.

The sleep studies divided the children into four groups: those who never had sleep-disordered breathing, those who had it the first time but not the second, those who had it only the second time (new onset), and those who had it both times (persistent).

The results showed that children with new onset sleep apnea were at least four times as likely to have behavioral problems- the likelihood rose to six times higher if they had persistent sleep apnea.

The children with obstructive sleep apnea were more likely to have parents reporting problems with their hyperactivity, attention, communication abilities, self-care, and ability to adapt to new situations. They were also likely to be suffering academically, with grades of C or lower in school.

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Dr. Michelle Perfect, the study's lead author and assistant professor in psychology at the University of Arizona in Tucson.

Obstructive sleep apnea is a major cause of snoring, occurring when soft tissue in the back of the throat relaxes too much during sleep and collapses into the airway. This cuts off oxygen intake, and the temporary suffocation sends a signal to the brain to wake up immediately. When sleep apnea is especially severe, it can interrupt sleep hundreds of times throughout the night- depriving the brain of oxygen and causing exhaustion the next day.

Children with sleep-disordered breathing generally have larger tonsils and adenoids than other children their age, and most children with sleep apnea have a history of loud snoring. Effective treatment options for children include the surgical removal of the tonsils and adenoids or the use of continuous positive airway pressure (CPAP) therapy.

The Arizona researchers say in their study that most children with sleep apnea have larger tonsils and adenoids than those without it, and are much more likely to snore loudly. Tonsillectomies can provide effective sleep apnea treatment, and so can continuous positive airway pressure (CPAP therapy).

Perfect said in a statement that obstructive sleep apnea in children typically declines into adolescence, but that "taking a wait and see approach is risky" for parents who are worried about their children's cognitive and behavioral development.

"School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom."

The New York Times suggests that ADHD-related learning problems may often result from obstructive sleep apnea in children, and that the symptoms could be better treated with sleep improvements than with stimulant medications like Adderall and Ritalin, which can actually increase sleep deprivation.

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Higher risk of behavioral issues in children with sleep apnea

This article discusses how children with obstructive sleep apnea have more behavioral issues that can present as ADHD-type symptoms.

A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioral problems in children as well as other adaptive and learning problems.

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Michelle Perfect, PhD, the study's lead author and assistant professor in the school psychology program in the department of disability and psychoeducational studies at the University of Arizona in Tucson. "School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom."

The five-year study, which appears in the April issue of the journalSLEEP, utilized data from a longitudinal cohort, the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). The TuCASA study prospectively examined Hispanic and Caucasian children between 6 and 11 years of age to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning. The study involved 263 children who completed an overnight sleep study and a neurobehavioral battery of assessments that included parent and youth reported rating scales.

Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the entire study. Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.

The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea. Compared to youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care. Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.

The authors report that this is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning in typically developing youth with and without SDB.

"Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments," said Perfect.

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