Tuesday, July 10, 2012

Sleep 101: Sleep and Weight Status in Children

From Medscape Education Diabetes & Endocrinology 

In summary, a large and growing body of evidence suggests that short sleep duration in childhood is associated with both concurrent and future risk of overweight and obesity. Findings suggest that younger children and males may be at particular risk for the effects of short sleep duration on obesity status. 
Studies also demonstrate that other variables, including sleep timing and variability, may influence this risk. Experimental studies have begun to provide evidence that short sleep duration may influence key behaviors -- namely eating and activity behaviors -- that can lead to weight gain over time. 
However, experimental findings have largely focused on adults and have not always found the hypothesized effect of short sleep duration on eating and activity behaviors. 
Thus, although sufficient sleep in childhood is essential for optimal functioning and well-being, additional work is needed before clinicians can prescribe changes in children's sleep to combat the pediatric obesity epidemic. It will be particularly important to determine whether changes in children's sleep are associated with changes in eating and activity behaviors and weight status over time.
Medscape: What should clinicians caring for obese children do with this information? Should they routinely evaluate the sleep of overweight and obese children? Does enhancing children's sleep hold any promise for preventing and treating childhood obesity?
Dr Gozal: An ounce of prevention is worth a pound of cure, so what should pediatricians or family practitioners or anyone involved in primary care look for? A simple set of questions can help determine a child's quality and duration of sleep. If a child is sleeping enough, he or she will wake up without prompting in time to get up for the day's activities.
 Clinicians can ask parents, "Does your child wake up on his or her own every day?" An answer of "no" indicates that the child is not getting enough sleep or is getting poor-quality sleep. Further questions such as "Does your child have very restless sleep?" and "Does your child snore?" can help identify whether the child has a sleep disorder rather than sleep insufficiency.
Clinicians can ask parents questions about sleep routines. "What time does your child go to bed?" "How long does your child take to fall asleep?" "Would you consider modifying your child's sleep routine in order to increase the duration and quality of your child's sleep?"
We don't know whether interventions to improve sleep will modify the risk of obesity -- those studies have yet to be done and they need to be done. Whether modifying sleep in obese children will help achieve better results in obesity interventions is a different question. Studies conducted in Belgium at a residential facility for obese children where strict diet and exercise regimens were instituted have shown that obese children with sleep apnea whose sleep disorder was treated responded better to interventions for obesity than did children whose sleep apnea was not treated, suggesting that treating a sleep perturbation may lead to a better response to an intervention aimed at reducing the obesity state. By inference from those limited studies, it is likely that improving the duration, quality, and regularity of sleep in an obese cohort of children -- in addition to other measures such as diet and exercise -- might lead to improved outcomes compared with interventions that do not address sleep.
Sleep is one of our bodily functions that is essential for life, and it's probably the most forgotten life-sustaining function. We don't forget about eating; we don't forget about drinking. But we forget about sleep and treat it as a tradable commodity. We should start respecting sleep when we raise our children, and if we do we should see a change in the overall risk factors that are emerging in our society

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