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  • Pediatric Original Article
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Beyond sleep duration: distinct sleep dimensions are associated with obesity in children and adolescents

Abstract

Objective:

Short sleep duration is recognized as a significant risk factor in childhood obesity; however, the question as to how sleep contributes to the development of obesity remains largely unknown. The majority of pediatric studies have relied on sleep duration as the exclusive measure of sleep; this insular approach may be misleading given that sleep is a dynamic multidimensional construct beyond sleep duration, including sleep disturbances and patterns. Although these sleep dimensions partly overlap, it is necessary to determine their independent relation with obesity, which in turn, may inform a more comprehensive understanding of putative pathophysiological mechanisms linking sleep and obesity. The aim of the present study was to investigate whether sleep dimensions including sleep duration, disturbances, and patterns were individually associated with obesity, independent of multiple covariates. The second objective was to examine whether sleep disturbances and patterns were independently associated with obesity, after adjusting for sleep duration.

Methods:

Participants included 240 healthy children and adolescents (Mage=12.60, s.d.=1.98; 45.8% females). Anthropometric measures included measured waist and hip circumference, body mass index Z-score, and percent body fat. Subjective sleep measures included sleep duration, sleep disturbances, sleep quality, and sleep patterns from youth- and parental report.

Results:

Youth with larger adiposity and body composition measures reported poorer sleep quality (βavg=−0.14, P<0.01), more sleep disturbances (βavg=0.13, P<0.05), and showed a delayed sleep phase pattern (βavg=0.15, P<0.05), independent of age, sex, pubertal status, physical activity, screen time, socioeconomic status, and sleep duration. Shorter sleep duration was significantly associated with obesity; however, this link was attenuated after adjustment of covariates.

Conclusions:

The results suggest that sleep measures beyond duration may more precisely capture influences that drive the negative association between sleep and obesity, and thus, yield more robust associations. As such, future studies are needed to better understand how distinct sleep dimensions confer risk for childhood obesity.

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References

  1. Chen X, Beydoun MA, Wang Y . Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity 2008; 16: 265–274.

    Article  PubMed  Google Scholar 

  2. Nielsen LS, Danielsen KV, Sørensen TIA . Short sleep duration as a possible cause of obesity: Critical analysis of the epidemiological evidence. Obes Rev 2011; 12: 78–92.

    Article  CAS  PubMed  Google Scholar 

  3. Calamaro CJ, Park S, Mason TB, Marcus CL, Weaver TE, Pack A et al. Shortened sleep duration does not predict obesity in adolescents. J Sleep Res 2010; 19: 559–566.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Knutson KL . Sex differences in the association between sleep and body mass index in adolescents. J Pediatr 2005; 147: 830–834.

    Article  PubMed  Google Scholar 

  5. Storfer-Isser A, Patel SR, Babineau DC, Redline S . Relation between sleep duration and BMI varies by age and sex in youth age 8–19. Pediatr Obes 2012; 7: 53–64.

    Article  CAS  PubMed  Google Scholar 

  6. American Sleep Disorders Association. International Classification of Sleep Disorders: Diagnostic and Coding Manual. American Sleep Disorders Association: Rochester, 1990.

  7. Pannain S, Van Cauter E . Sleep loss, obesity and diabetes: Prevalence, association and emerging evidence for causation. Obes Metab 2008; 4: 28–41.

    Google Scholar 

  8. van Eekelen APJ, Varkevisser M, Kerkhof GA . Cardiac autonomic activity during human sleep: analysis of sleep stages and sleep cycles. Biol Rhythm Res 2003; 34: 493–502.

    Article  Google Scholar 

  9. Hanlon EC, Van Cauter E . Quantification of sleep behavior and of its impact on the cross-talk between the brain and peripheral metabolism. PNAS 2011; 108: 15609–15616.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Edinger JD, Fins AI, Glenn DM, Sullivan RJ, Bastian LA, Marsh GR et al. Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints? J Consult Clin Psychol 2000; 68: 586–593.

    Article  CAS  PubMed  Google Scholar 

  11. Janackova S, Sforza E . Neurobiology of sleep fragmentation: cortical and autonomic markers of sleep disorders. Curr Pharm Des 2008; 14: 3474–3480.

    Article  CAS  PubMed  Google Scholar 

  12. Ekstedt M, Åkerstedt T, Söderström M . Microarousals during sleep are associated with increased levels of lipids, cortisol, and blood pressure. Psychosom Med 2004; 66: 925–931.

    Article  CAS  PubMed  Google Scholar 

  13. Stamatakis KA, Punjabi NM . Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 2010; 137: 95–101.

    Article  CAS  PubMed  Google Scholar 

  14. Björntorp P . Do stress reactions cause abdominal obesity and comorbidities? Obes Rev 2001; 2: 73–86.

    Article  PubMed  Google Scholar 

  15. Drapeau V, Therrien F, Richard D, Tremblay A . Is visceral obesity a physiological adaptation to stress? Panminerva Med 2003; 45: 189–195.

    CAS  PubMed  Google Scholar 

  16. Daniels SR, Morrison JA, Sprencher DL, Khoury P, Kimball TR . Association of body fat distribution and cardiovascular risk factors in children and adolescents. Circulation 1999; 99: 541–545.

    Article  CAS  PubMed  Google Scholar 

  17. Pan X, Hussain MM . Clock is important for food and circadian regulation of macronutrient absorption in mice. J Lipid Res 2009; 50: 1800–1813.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Turek FW, Joshu C, Kohsaka A, Lin E, Ivanova G, McDearmon E et al. Obesity and metabolic syndrome in circadian clock mutant mice. Science 2005; 308: 1043–1045.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Laposky AD, Bass J, Kohsaka A, Turek FW . Sleep and circadian rhythms: key components in the regulation of energy metabolism. FEBS Lett 2008; 582: 142–151.

    Article  CAS  PubMed  Google Scholar 

  20. Strine TW, Chapman DP . Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med 2005; 6: 23–27.

    Article  PubMed  Google Scholar 

  21. Wheaton AG, Perry GS, Chapman DP, McKnight-Eily LR, Presley-Cantrell LR, Croft JB . Relationship between body mass index and perceived insufficient sleep among US adults: an analysis of 2008 BRFSS data. BMC Public Health 2011; 11: 295–312.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lyytikainen P, Lallukka T, Lahelma E, Rahkonen O . Sleep problems and major weight gain: a follow-up study. Int J Obes 2011; 35: 109–114.

    Article  CAS  Google Scholar 

  23. Lauderdale DS, Knutson KL, Rathouz PJ, Yan LL, Hulley SB, Liu K . Cross-sectional and longitudinal associations between objectively measured sleep duration and body mass index. Am J Epidemiol 2009; 170: 805–813.

    Article  PubMed  PubMed Central  Google Scholar 

  24. van den Berg JF, Neven AK, Tulen JHM, Hofman A, Witteman JCM, Miedema HME et al. Actigraphic sleep duration and fragmentation are related to obesity in the elderly: The Rotterdam Study. Int J Obes 2008; 32: 1083–1090.

    Article  CAS  Google Scholar 

  25. Di Lorenzo L, De Pergola G, Zocchetti C, L’Abbate N, Basso A, Pannacciulli N et al. Effect of shift work on body mass index: results of a study performed in 319 glucose-tolerant men working in a Southern Italian industry. Int J Obes 2003; 27: 1353–1358.

    Article  CAS  Google Scholar 

  26. Beebe DW, Lewin D, Zeller M, McCabe M, MacLeod K, Daniels SR et al. Sleep in overweight adolescents: Shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J Pediatr Psychol 2006; 32: 69–79.

    Article  PubMed  Google Scholar 

  27. Moore M, Kirchner HL, Drotar D, Johnson N, Rosen C, Redline S . Correlates of adolescent sleep time and variability in sleep time: the role of individual and health related characteristics. Sleep Med 2011; 12: 239–245.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Olds TS, Maher CA, Matricciani L . Sleep duration or bedtime? Exploring the relationship between sleep habits and weight status and activity patterns. Sleep 2011; 34: 1299–1307.

    Article  PubMed  PubMed Central  Google Scholar 

  29. de Onis M, Garza C, Onyango AW, Rolland-Cachera MF . WHO growth standards for infants and young children [in French]. Arch Pediatr 2009; 16: 47–53.

    Article  CAS  PubMed  Google Scholar 

  30. Pateyjohns IR, Brinkworth GD, Buckley JD, Noakes M, Clifton PM . Comparison of three bioelectrical impedance methods with DXA in overweight and obese men. Obesity 2006; 14: 2064–2207.

    Article  PubMed  Google Scholar 

  31. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R et al. Growth charts for the United States: improvements to the 1977 National Center for Health Statistics Version. Pediatrics 2002; 109: 45–60.

    Article  PubMed  Google Scholar 

  32. Wolfson AR, Carskadon MA, Acebo C, Seifer R, Fallone G, Labyak SE et al. Evidence for the validity of a sleep habits survey for adolescents. Sleep 2003; 2: 213–216.

    Article  Google Scholar 

  33. Owens JA, Spirito A, McGuinn M . The children’s sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 2000; 23: 1043–1051.

    Article  CAS  PubMed  Google Scholar 

  34. Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, Bo SM . The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med Rev 2010; 14: 179–189.

    Article  PubMed  Google Scholar 

  35. Smith CS, Reilly C, Midkiff KJ . Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. Appl Psychol 1989; 74: 728–738.

    Article  CAS  Google Scholar 

  36. Wolfson AR, Carskadon MA . Sleep schedules and daytime functioning in adolescents. Child Dev 1998; 69: 875–887.

    Article  CAS  PubMed  Google Scholar 

  37. Golding J, Pembrey M, Jones R . ALSPAC–the Avon Longitudinal Study of Parents and Children. I. Study methodology. Paediatr Perinat Epidemiol 2001; 15: 74–87.

    Article  CAS  PubMed  Google Scholar 

  38. Morris NM, Udry JR . Validation of a self-administered instrument to assess stage of adolescent development. J Youth Adolesc 1980; 9: 271–280.

    Article  CAS  PubMed  Google Scholar 

  39. Sallis JF, Strikmiller PK, Harsha DW, Feldman HA, Ehlinger S, Stone EJ et al. Validation of interviewer- and self-administered physical activity checklists for fifth grade students. Med Sci Sports Exerc 1996; 28: 840–851.

    Article  CAS  PubMed  Google Scholar 

  40. Prochaska JJ, Sallis JF, Griffith B, Douglas J . Physical activity levels of Barbadian youth and comparison to a US sample. Int J Behav Med 2002; 9: 360–372.

    Article  PubMed  Google Scholar 

  41. He M, Harris S, Piche L, Beynon C . Understanding screen- related sedentary behavior and its contributing factors among school-aged children: a social-ecologic exploration. Am J Health Promot 2009; 23: 299–308.

    Article  PubMed  Google Scholar 

  42. Al Mamun A, Lawlor DA, Cramb S, O’Callaghan M, Williams G, Najman J . Do childhood sleeping problems predict obesity in young adulthood? Evidence from a prospective birth cohort study. Am J Epidemiol 2002; 166: 1368–1373.

    Article  Google Scholar 

  43. Moore M, Allison D, Rosen CL . A review of pediatric nonrespiratory sleep disorders. Chest 2006; 130: 1252–1262.

    Article  PubMed  Google Scholar 

  44. Liao D, Li X, Rodriguez-Colon SM, Liu J, Vgontzas AN, Calhoun S et al. Sleep- disordered breathing and cardiac autonomic modulation in children. Sleep Med 2010; 11: 484–488.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Walter LM, Foster AM, Patterson RR, Anderson V, Davey MJ, Nixon GM et al. Cardiovascular variability during periodic leg movements in sleep in children. Sleep 2009; 32: 1093–1099.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bawazeer NM, Al-Daghri NM, Valsamakis G, Al-Rubeaan KA, Sabico SL, Huang TT et al. Sleep duration and quality associated with obesity among Arab children. Obesity 2009; 17: 2251–2253.

    Article  PubMed  Google Scholar 

  47. Javaheri S, Storfer-Isser A, Rosen CL, Redline S . Sleep quality and elevated blood pressure in adolescents. Circulation 2008; 118: 1034–1040.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Jennings JR, Muldoon MF, Hall M, Buysse DJ, Manuck SB . Self-reported sleep quality is associated with the metabolic syndrome. Sleep 2007; 30: 219–223.

    Article  PubMed  Google Scholar 

  49. Tasali E, Leproult R, Ehrmann DA, Van Cauter E . Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci USA 2008; 105: 1044–1049.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Rao MN, Blackwell T, Redline S, Stefanick ML, Ancoli-Israel S, Stone KL . Association between sleep architecture and measures of body composition. Sleep 2009; 32: 483–490.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Theorell-Haglöw J, Berne C, Janson C, Sahlin C, Lindberg E . Associations between short sleep duration and central obesity in women. Sleep 2010; 33: 593–598.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Scheer FA, Hilton MF, Mantzoros CS, Shea SA . Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci USA 2009; 106: 4453–4458.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Trakada G, Chrousos G, Pejovic S, Vgontzas A . Sleep apnea and its association with the stress system, inflammation, insulin resistance and visceral obesity. Sleep Med Clin 2007; 2: 251–261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Baumann CR, Bassetti CL . Hypocretins (orexins) and sleep-wake disorders. Lancet Neurol 2005; 4: 673–682.

    Article  CAS  PubMed  Google Scholar 

  55. Sakurai T . The neural circuit of orexin (hypocretin): maintaining sleep and wakefulness. Nat Rev Neurosci 2007; 8: 171–181.

    Article  CAS  PubMed  Google Scholar 

  56. van den Top M, Lee K, Whyment AD, Blanks AM, Spanswick D . Orexigen-sensitive NPY/AgRP pacemaker neurons in the hypothalamic arcuate nucleus. Nature Neurosci 2004; 7: 493–494.

    Article  CAS  PubMed  Google Scholar 

  57. Zheng H, Patterson LM, Berthoud H-R . Orexin-A projections to the caudal medulla and orexin-induced c-Fos expression, food intake, and autonomic function. J Comp Neurol 2005; 485: 127–142.

    Article  CAS  PubMed  Google Scholar 

  58. Lockley SW, Skene DJ, Butler LJ, Arendt J . Sleep and activity rhythms are related to circadian phase in the blind. Sleep 1999; 22: 616–623.

    Article  CAS  PubMed  Google Scholar 

  59. Tremblay MS, Katzmarzyk PT, Willms JD . Temporal trends in overweight and obesity in Canada, 1981–1996. Int J Obes 2002; 26: 538–543.

    Article  CAS  Google Scholar 

  60. Must A, Anderson SE . Establishing a standard definition for childhood overweight and obesity worldwide: international survey. Brit Med J 2000; 320: 1240–1245.

    Article  Google Scholar 

  61. Hale L, Berger LM . Sleep duration and childhood obesity: moving from research to practice. Sleep 2011; 34: 1153–1154.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to specially thank the participants of the Healthy Heart Project, the Pediatric Public Health Psychology Laboratory research assistants and study coordinators, Natasha Hunt and Sabrina Giovanniello. The data used in these analyses were drawn from the Healthy Heart Project. This work was made possible through funding support from the Canadian Institute of Health Research (CIHR; MOP89886; OCO79897) and the Fonds de la recherche en santé du Québec (FRSQ; 16965). JM holds a New Investigator Award from the Canadian Institute of Health Research. DJ holds the Fonds de la Recherche en Santé du Québec Doctoral Fellowship (FRSQ) and Health Professional Student Research Award. CD is the vice-chairman of the Board of Directors of the National Sleep Foundation.

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Correspondence to J J McGrath.

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Jarrin, D., McGrath, J. & Drake, C. Beyond sleep duration: distinct sleep dimensions are associated with obesity in children and adolescents. Int J Obes 37, 552–558 (2013). https://doi.org/10.1038/ijo.2013.4

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