Sleep-Disordered Breathing and Uric Acid in Overweight and Obese Children and Adolescents

Verhulst, Stijn; Hoeck, Koen Van; Schrauwen, Nancy; Haentjens, Dominique; Rooman, Raoul; Gaal, Luc Van; Backer, Wilfried A. De; Desager, Kristine

doi:10.1378/chest.06-2930

Cited by 60 publications

(48 citation statements)

References 27 publications

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“…In the current study, both short and long sleep durations may contribute to poor self-rated health by increasing fatigue. 46 Previous studies report that both short and long sleep duration are related to a number of adverse physiological changes, including impaired glucose tolerance, 47 inflammation, 48 and high uric acid levels, 49 which increase the risk of chronic diseases such as diabetes, obesity, and hypertension. 17 Conversely, short and long sleep duration could be a result of poor self-rated health.…”

Section: Discussionmentioning

confidence: 99%

The Association between Sleep Duration and Self-Rated Health in the Korean General Population

Kim

Cho

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep duration is recognized as one of the most common issues in modern society. Self-rated health is a commonly used subjective health measure based on a single question asking individuals to rate their general health on a four-or fi ve-point scale. However, few studies have examined the relationship between sleep duration and self-rated health. Here, we examined the association between sleep duration and poor self-rated health, using a large representative sample of the general Korean adult population. Design: We conducted a cross-sectional study of 15,252 participants in the Korea National Health and Nutrition Examination Survey IV (2007)(2008)(2009)) who were aged 19 years and older. Sleep duration was categorized as ≤ 5, 6, 7, 8, or ≥ 9 hours. The main outcome of interest was poor self-rated health (n = 3,705, 19.7%). Multiple logistic regression analysis was performed to examine the association between sleep duration and self-rated health. Results: We found both short (≤ 5 h) and long (≥ 9 h) sleep duration to be associated with poor self-rated health independent of sociodemographic, health risk, and health status variables. Compared with 7-h sleep duration, the multivariate odds of poor self-rated health were 1.358 times higher (95% CI 1.167-1.580) with short sleep duration and 1.322 times higher (95% CI 1.091-1.601) with long sleep duration. This association persisted in subgroup analyses of gender, body mass index, and age by gender. Conclusions:In a large representative sample of the Korean general adult population, compared with sleep duration of 7 hours, we found a positive association between short and long sleep duration and poor self-rated health in Korean adults. Furthermore, the association between sleep duration and poor self-rated health was consistently present in subgroups divided by gender, age, and BMI. Keywords: Sleep, sleep duration, self-rated health, gender, age, body mass index (BMI), KNHANES Citation: Kim JH; Kim KR; Cho KH; Yoo KB; Kwon JA; Park EC. The association between sleep duration and self-rated health in the Korean general population.

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Section: Discussionmentioning

confidence: 99%

The Association between Sleep Duration and Self-Rated Health in the Korean General Population

Kim

Cho

et al. 2013

Journal of Clinical Sleep Medicine

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“…[15][16][17][18] Visceral fat has been proposed as a potential mediator of the relationship, because both OSA and insulin resistance are more closely associated with the size of visceral fat deposits than with BMI alone. [19][20][21] Previous studies examining the relationship between fat distribution and OSA relied on measurements of waist/hip ratios and total body fat, 13,22,23 and have not found a clear cut relationship between fat distribution and OSA. In children, both visceral adiposity and intramyocellular lipid content, a measure of fat accumulation at the cellular level determined by spectroscopy, has been shown to be a strong predictor of insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

Canapari

Hoppin

Kinane

et al. 2011

Journal of Clinical Sleep Medicine

103

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Background:Obstructive sleep apnea (OSA) is associated with obesity, inflammation, and insulin resistance. The role of fat distribution in OSA pathogenesis has not been established in children. The objective of the study is to examine the relationship between fat distribution, OSA, and insulin resistance in an unselected population of obese children. Methods: All obese (BMI > 95th percentile) children (ages 5-18 y) seen at a pediatric obesity clinic were invited to participate. Subjects underwent polysomnography, and were tested for dyslipidemia, inflammation, and insulin resistance measured by the homeostasis model assessment (HOMA). In a subset of subjects, magnetic resonance (MRI) imaging was used to determine the abdominal visceral and subcutaneous adipose tissue areas and magnetic resonance spectroscopy (MRS) spectroscopy was used to intramyocellular lipids in leg muscles. Measurements and Main Results: 31 obese subjects enrolled and completed polysomnography and serum testing, and 19 subjects underwent MRI/MRS. The mean age was 12.6 ± 3.0 y and the mean body mass index (BMI) was 39.5 ± 11.2 kg/m 2 . Forty-eight percent had OSA (mean apnea hypopnea index [AHI] 6.26 ± 6.77 events/h) Subjects with OSA had significantly increased BMI, log HOMA, triglycerides, and leptin compared to those without OSA. In regression analysis, only BMI z-score was associated with log HOMA. In the subset of patients with imaging data, visceral fat area was strongly predictive of AHI (p = 0.003, r 2 = 0.556). BMI z-score, gender, and age were not predictive. Conclusions: Visceral fat distribution is independently predictive of OSA severity in obese children.

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“…KheirandishGozal et al 185 found elevated alanine transaminase (a marker for fatty liver) in a large sample of obese children who had OSAS (level IV). Verhulst et al 186 found elevated serum uric acid (a marker of oxidative stress) in 62 overweight children who had OSAS, with a significant relationship between the severity of OSAS and serum uric acid independent of abdominal adiposity (P = .01) (level IV They reported that the obese group had later bedtimes (P < .05), shorter (P < .01) and more disrupted sleep (P < .05), more symptoms of OSAS (P < .001), sleepiness (P = .009), parasomnias (P = .007), higher AHI (P < .01), and poorer school performance. Another study by Beebe et al 190 of 263 overweight subjects enrolled in a hospital-based weightmanagement program found a negative relationship between the severity of OSAS and school performance and parent-and teacher-reported behaviors that persisted with adjustment for gender, race, SES, sleep duration, and BMI (level IV).…”

Section: Predictors Of Obesity-related Sdbmentioning

confidence: 99%

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Marcus¹,

Brooks²,

Ward³

et al. 2012

Pediatrics

1,502

1,504

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OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS: The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.

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Sleep-Disordered Breathing and Uric Acid in Overweight and Obese Children and Adolescents

Cited by 60 publications

References 27 publications

The Association between Sleep Duration and Self-Rated Health in the Korean General Population

The Association between Sleep Duration and Self-Rated Health in the Korean General Population

Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

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