Sleep quality and obesity in young subjects: a meta-analysis

Influence of health-related behaviors patterns on obesity among primary and secondary school students: A latent profile analysis

OBJECTIVE

To analyze the co-existing patterns of health-related behaviors among children and adolescents at different education stages and the association with obesity.

DESIGN

Cross-sectional study.

SAMPLE

A total of 5651 primary and secondary school students were drawn from the National Student Physical Health Survey in 2014 with an average age of 13.53 ± 2.87 years.

MEASUREMENTS

Physical measurements and questionnaires were completed, which concluded height, weight, and health-related behaviors (sleep, physical activity, dietary, and screen behavior et al.). Latent profile analysis (LPA) was conducted using Mplus 8.3 and SPSS 26.0 was used for other statistical analysis.

RESULTS

Three latent classes of health-related behaviors were fitted for each of the education stages. After adjustment for age, gender, and region, the high-screen behavior group were 2.217 (95%CI = 1.030-4.772, p = .042) times more likely to be obesity than the health-behavior group in primary school, and the poor-diet group and poor-diet and high-screen behavior group were 2.101 (95%CI = 1.396-3.396, p < .001) and 1.788 (95%CI = 1.003-3.190, p = .049) times more likely to be overweight than the health-behavior group in junior middle school respectively.

CONCLUSION

Obesity is mainly influenced by screen behavior and dietary patterns among children and adolescents. Health-related behavior patterns should be accurately identified and comprehensive joint interventions should be carried out to prevent obesity.

Prevalence and factors of sleep problems among Japanese children: a population-based study

Background

High prevalence of sleep problems in not only children with neurodevelopmental disorders (NDS) but also non NDS has been established. However, there are few studies that have looked into population-based and age-specific prevalence of sleep problems of children. Moreover, there are even fewer studies that have investigated the correlation of demographic and lifestyle-related factors affecting sleep problems in children. Considering these, the purpose of this study is to assess the correlation of the prevalence of sleep problems and selected socio-demographic and lifestyle-related factors in 5-year-old Japanese children in population-based study.

Methods

Study children (SC) were recruited from two cohorts of the Hirosaki City 5-Year-Old Child Developmental Health Checkup Study. The first cohort consisted of 281 (162 males, 119 females) children recruited from 2014 to 2015, and the second cohort consisted of 2055 (1,068 males, 987 females) children from 2018 to 2019. In total there were 2,336 SC participants (1,230 males and 1,106 females). To determine the prevalence of sleep problems the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) was utilized, and sleep problems are defined by a total score of ≥86. To determine socio-demographic and lifestyle-related factors affecting sleep, 10 factors (NDS diagnosis, birth month, childcare place, income, number of siblings, bedtime, waking time, sleeping hours, sleep onset delay, and screen time) were selected. Finally, to determine the correlation between prevalence of sleep problems and the selected demographic and lifestyle-related factors, data was analyzed using chi-square test.

Results

The prevalence rate of sleep problems in 5-year-olds was 18% (369/2,055). Further, the prevalence of sleep problems was high in participants with ASD (50.4%), ADHD (39.8%), <2 million yen of income (30.5%), no siblings (24.2%), >22:00 of bedtime (30.7%), >7:30 of waking time (30.7%), <9 h of sleeping hours (25.3%), >30 min of sleep onset delay (35.3%), and ≥2 h of screen time (21.1%).

Conclusion

The findings report 18% prevalence rate of sleep problems in 5-year-old children. Further, the findings establish a significant correlation of sleep problems and NDS, specific socio-demographic, and lifestyle-related factors. In considering the identified modifiable lifestyle-related factors contributing to sleep problems among the participants (i.e., bed/waking times and screen times), sleep programs to address these concerns are suggested.

Role of dietary fiber and lifestyle modification in gut health and sleep quality

Dietary fiber has an immense role in the gut microbiome by modulating juvenile growth, immune system maturation, glucose, and lipid metabolism. Lifestyle changes might disrupt gut microbiota symbiosis, leading to various chronic diseases with underlying inflammatory conditions, obesity, and its associated pathologies. An interventional study of 16 weeks examined the impact of psyllium husk fiber with and without lifestyle modification on gut health and sleep quality in people with central obesity (men = 60 and women = 60), those aged from 40 to 60 years, those having WC ≥ 90 cm (men) and WC ≥ 80 cm (women), and no history of any chronic disease or regular medication. The participants were subgrouped into three intervention groups, namely, the psyllium husk fiber (PSH) group, the lifestyle modification (LSM) group, and the LSM&PSH group and control group with equal gender bifurcation (men = 15 and women = 15). A 24-h dietary recall, gastrointestinal tract (GIT) symptoms, and sleep quality analysis data were collected on validated questionnaires. The analyses of variance and covariance were used for baseline and post-intervention, respectively. Student's t-test was applied for pre- and post-intervention changes on the variable of interest. The intervention effect on GIT health was highly significant (P < 0.001). The mean GIT scores of the LSM, PSH, and LSM&PSH groups were 2.99 ± 0.14, 2.49 ± 0.14, and 2.71 ± 0.14, respectively, compared to the mean GIT scores of the control group. No significant (P = 0.205) effect of either intervention was observed on sleep quality. The study concluded that psyllium husk fiber significantly improved the GIT symptoms, while no significant effect of the intervention was observed on sleep quality analysis.

Self-reported neighborhood stressors and sleep quality among Puerto Rican young adults

OBJECTIVE

To examine the association between changes in self-reported neighborhood stressors and sleep quality and determine whether this varied by sociocultural context among Puerto Rican young adults.

METHODS

Data come from the Boricua Youth Study Health Assessment, a sample of Puerto Rican young adults from San Juan, Puerto Rico, and South Bronx, New York (n = 818; mean age=22.9years). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Neighborhood social stressors (disorder, social cohesion, and safety) were parent-reported in childhood and self-reported in young adulthood and categorized into: low in childhood/young adulthood (reference group), high in childhood/low in young adulthood, low in childhood/high in young adulthood, and high in childhood/young adulthood. Sociocultural context was based on participant residence during childhood (San Juan vs. South Bronx).

RESULTS

Adjusting for sociodemographic factors, living with high neighborhood stressors in both childhood and young adulthood (prevalence ratios=1.30, 95% CI: 1.01, 1.66) was associated with overall poor sleep (PSQI score >5). Among PSQI components, living with high neighborhood stressors in young adulthood only or in both time periods was associated with worse subjective sleep quality and daytime dysfunction. Additionally, there were various associations between the neighborhood stressor measures and PSQI components. Results did not differ by sociocultural context.

CONCLUSION

Findings suggest that living with high levels of neighborhood stressors during childhood and young adulthood may have a cumulative adverse impact on sleep quality in young adulthood.

Associations of actigraphy-assessed sleep variables with adiposity and serum cardiometabolic outcomes in emerging adults

This study assessed associations of actigraphy-assessed sleep with adiposity and serum cardiometabolic outcomes in emerging adults, and whether sex and race modified these associations. Data on 147 emerging adults (age = 19.4 ± 1.3 years; body mass index = 26.4 ± 7.0 kg m-2 ; 59% female; 65% White) from RIGHT Track Health were used. Actigraphy-based sleep measures included sleep duration, sleep efficiency, sleep timing midpoint, day-to-day sleep duration and sleep timing midpoint variability. Combined sleep duration and sleep timing behaviours were also derived (early-bed/late-rise, early-bed/early-rise, late-bed/late-rise, late-bed/early-rise). Outcomes included body mass index and BodPod-assessed fat mass index, fasting serum leptin, C-reactive protein, and homeostatic model assessment-insulin resistance. Sleep duration was 5.4 h per night. We noted an inverse association between sleep duration and homeostatic model assessment-insulin resistance. The early-bed/early-rise group had greater body mass index, C-reactive protein and homeostatic model assessment-insulin resistance compared with the early-bed/late-rise group (referent). Sex modified associations of sleep efficiency with C-reactive protein; stratified results revealed positive association between sleep efficiency and C-reactive protein in males, but not females. Race modified associations of sleep duration with body mass index and leptin, and of sleep duration variability with C-reactive protein. Stratified analyses revealed inverse associations between sleep duration with body mass index and leptin in Black, multiracial/other race individuals only. Positive association between sleep duration variability and C-reactive protein was noted in White individuals only. Shorter sleep duration, particularly when combined with earlier sleep timing, is associated with greater adiposity and serum cardiometabolic outcomes. Additional studies are needed to assess individual- and contextual-level factors that may contribute to sex and race differences in sleep health and cardiometabolic risk in emerging adults.

The interrelationship between sleep disturbance symptoms and aggression before and after the campus closure of the COVID-19 pandemic: insight from a cross-lagged panel network model

Background

The COVID-19 pandemic is detrimental to sleep quality and increases aggression among college students. Nevertheless, relevant studies were rare. Hence, we collected longitudinal data during and post-campus closure in the current study to investigate the relationship between sleep disturbance and aggression.

Methods

Data from 665 college students (59.2% females, Meanage = 19.01, SD age = 1.25) were collected before (wave 1) and after (wave 2) the campus closure of COVID-19. All participants were asked to fill out the Buss-Perry Aggression Questionnaire and the Youth Self-Rating Insomnia Scale. Two symptom networks and a cross-lagged panel network were formed and tested.

Results

Hostility has the highest centrality in the symptom network both in waves 1 and 2, and it bridges sleep disturbance and aggression. "Easily be woken" - "wake up too early" and "wake up with tired" - "function hindrance" are two important symptom associations in networks of waves 1 and 2. All symptoms except "difficulty in falling asleep" and "easily be woken" ameliorated after closure. Moreover, "physical aggression" and "hostility" can trigger other symptoms in wave 2.

Conclusion

As the first study about aggression and sleep disturbance in the background of COVID-19, we provide valuable information about the relationship between sleep disturbance and aggression on the symptom dimension.

High levels of sleep disturbance across early childhood increases cardiometabolic disease risk index in early adolescence: longitudinal sleep analysis using the Health Outcomes and Measures of the Environment study

STUDY OBJECTIVES

This study examines the impact of sleep duration, bedtime, and sleep disturbance during early childhood on the risk of cardiometabolic disorder (CMD) in early adolescence.

METHODS

Within the Health Outcomes and Measures of Environment Study, we examined sleep patterns of 330 children from ages 2 to 8 years and the relationship of these sleep patterns with cardiometabolic risk measures at age 12 (N = 220). We used a group-based semi-parametric mixture model to identify distinct trajectories in sleep duration, bedtime timing, and sleep disturbance for the entire sample. We then examined the associations between sleep trajectories and CMD risk measures using general linear models using both an unadjusted model (no covariates) and an adjusted model (adjusting for child pubertal stage, child sex, duration of breastfeeding, household income, maternal education, and maternal serum cotinine).

RESULTS

In the unadjusted and adjusted models, we found significant differences in CMD risk scores by trajectories of sleep disturbance. Children in the "high" disturbance trajectory had higher CMD risk scores than those in the 'low' disturbance trajectory (p's = 0.002 and 0.039, respectively). No significant differences in CMD risk were observed for bedtime timing or total sleep time trajectories in the unadjusted or adjusted models.

CONCLUSIONS

In this cohort, caregiver-reported sleep disturbance in early childhood was associated with more adverse cardiometabolic profiles in early adolescence. Our findings suggest that trials to reduce CMD risk via sleep interventions-which have been conducted in adolescents and adults-may be implemented too late.

Association between nighttime sleep duration and quality with knee osteoarthritis in middle-aged and older Chinese: A longitudinal cohort study

BACKGROUND

The association between nighttime sleep duration and sleep quality with the risk of knee osteoarthritis (OA) remains unclear. This study aimed to examine the longitudinal association among middle-aged and older adults in China.

METHODS

The data used in this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS) surveys conducted in 2011 and 2015. Nighttime sleep duration was categorized into five groups: <6 h, 6 to <7 h, 7 to <8 h, 8 to <9 h, and ≥9 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression models were used to assess the association between sleep duration and quality with incident knee OA.

RESULTS

A total of 11,114 participants who did not have knee OA at baseline were enrolled in this study. After 4 years of follow-up, the overall incidence of knee OA was 8.07 %. Compared to 7 to <8 h of sleep duration, short sleep duration (<6 h/night) was associated with a significantly increased risk of incident knee OA in the fully adjusted model [odds ratio (OR) =1.73, 95 % confidence interval (CI): 1.33-2.25]. Additionally, participants with 5-7 sleep restless days/week were associated with significantly increased risk of incident knee OA (OR = 1.88, 95 % CI: 1.48-2.38).

CONCLUSIONS

Short nighttime sleep duration and poor sleep quality are associated with increased risk of incident knee OA.

Modifiable dietary factors in adolescent sleep: A systematic review and meta-analysis

OBJECTIVE

Sleep problems are prevalent during adolescence, and modifying dietary factors may contribute to better sleep outcomes in adolescents. This systematic review and meta-analysis aimed to evaluate the impact of modifiable dietary factors on sleep health among adolescents.

METHODS

A systematic search of records from six databases including MEDLINE, PubMed, Embase, Scopus, CINAHL, and the CENTRAL from inception up to November 2023, identified 33 peer-reviewed publications that assessed the relationship between modifiable dietary factors and sleep outcomes in adolescents aged 12-18 years. The NIH Quality Assessment Tools were used to assess the quality of the included studies. Meta-analysis was performed on a sub-group of studies (n = 6) to ascertain the effect of dietary factors on sleep health.

RESULTS

Although the included studies were predominantly cross-sectional and exhibited heterogeneity, relying mainly on self-reported measures, it was observed that consumption of healthy foods was consistently linked with improved sleep outcomes among adolescents, whereas higher intake of fat-rich or sugar-rich foods and red meats or processed food was associated with poorer sleep features. The meta-analysis further substantiated that adolescents with higher caffeine intake faced increased odds of sleep problems (OR = 1.67, 95% CI: 1.28-2.17), while alcohol consumption was significantly associated with insomnia (OR = 1.17, 95% CI: 1.07-1.27).

CONCLUSION

Overall, despite high heterogeneity among studies, this systematic review underscores the promising role of healthy dietary factors in enhancing both the quality and quantity of sleep in adolescents. The meta-analysis results also highlight that reducing caffeine and alcohol intake holds potential for supporting better sleep in this population. However, further validation through intervention studies is warranted.

Investigation of obesity and its related factors among Chinese medical staff: a cross-sectional pilot study

BACKGROUND

Many studies have covered the prevalence of obesity in different populations. However, studies on the prevalence and predictors of obesity among medical staff are lacking. The aim of our study is to investigate the prevalence of obesity among medical staff and to identify the related predictors.

METHODS

Using a snowballing recruitment strategy in the form of an electronic questionnaire, a cross-sectional survey was conducted among 1201 medical staff from cooperative hospitals between January and March 2022. We designed a questionnaire to investigate the participants' demographic, lifestyle, diet, physical activity, and work status.

RESULTS

The overall prevalence of obesity was 8.5%, with males (13.7%) having a greater incidence than females (5.7%) (p < 0.001). Multiple logistic regression analyses showed that alcohol drinking (OR, 2.34; 95% CI 1.23-4.42, p = 0.01), sugar-sweetened beverages consumed > 3/week (OR, 2.50; 95% CI 1.02-6.15, p = 0.046), and working a night shift > 1/week (OR, 2.17; 95% CI 1.02-4.61, p = 0.043) were independent predictive factors for obesity in men. For women, having midnight snack having midnight snack (OR, 2.93;95% CI 1.24-6.96, p = 0.015), good sleep quality (OR, 4.47; 95% CI 1.10-21.70, p = 0.038), and working a night shift > 1/week (OR, 3.62; 95% CI 1.73-7.57, p = 0.001) were independently associated with obesity.

CONCLUSIONS

Obesity presented a low prevalence among medical staff. Alcohol drinking, drinking sugar-sweetened beverages > 3/week, and night shift > 1/week predicted a higher risk of obesity in males. In females, having midnight snack, good sleep quality, and night shift > 1/week were independently associated with obesity.

LEVEL OF EVIDENCE

V, descriptive study.

The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review

Sleep is an involuntary behaviour, biologically fundamental to survival and wellbeing. However, sleep is increasingly neglected, with significant health implications. Recent research has identified associations between sleep duration, quality, timing and risk of overweight/obesity in children and adults. The aim of this review was to systematically identify and examine research that investigates the relationships between multiple objective and subjective sleep outcomes and objective adiposity measures in adolescents. A systematic review of literature, published to December 2022, was conducted using ten bibliographic databases. Search terms included objective and subjective sleep/circadian rhythm outcomes, objective adiposity measurements, and adolescents aged 8-18 years. Eighty-nine studies were included in the final review. Sleep outcomes were synthesized into three sleep domains: pre-sleep, during sleep and post-sleep outcomes. In summary, pre-sleep outcomes (including poor sleep hygiene, later chronotype and increased variability and later sleep timings) and increased sleep disturbance are consistently significantly associated with increased obesity and adiposity in adolescents. The relationship between during-sleep outcomes (sleep quality and efficiency) with adiposity and obesity measures was mixed. These findings suggest that adapting an individual's schedule to best suit chronotype preference and improving sleep hygiene, including a consistent bedtime routine, could reduce adiposity and obesity in adolescents.

The efficacy of sleep lifestyle interventions for the management of overweight or obesity in children: a systematic review and meta-analysis

BACKGROUND

Childhood obesity remains a significant public health concern. Sleep duration and quality among children and youth are suboptimal worldwide. Accumulating evidence suggests an association between inadequate sleep and obesity risk, yet it is unclear whether this relationship is causal. This systematic review examines the efficacy of sleep interventions alone or as a part of lifestyle interventions for the management of overweight or obesity among children and adolescents.

METHODS

A keyword/reference search was performed twice, in January 2021 and May 2022 in MEDLINE/PubMed, EMBASE/Ovid, PsycINFO/EBSCO, The Cochrane Library, Web of Science Core Collection/Web of Science, SciELO/Web of Science, and CINAHL/EBSCO. Study eligibility criteria included youth with overweight or obesity between 5 and 17, were RCTs or quasi-randomized, and focused on the treatment of overweight and obesity with a sleep behavior intervention component. Risk of bias was assessed using the Cochrane Risk of Bias assessment tool (RoB2). A Meta-analysis was conducted to estimate the effect of interventions with a sleep component on BMI. The study protocol was registered in PROSPERO (CRD42021233329).

RESULTS

A total of 8 studies (2 quasi-experiments, 6 RCTs) met inclusion criteria and accounted for 2,231 participants across 7 countries. Only one study design isolated the effect of sleep in the intervention and reported statistically significant decreases in weight and waist circumference compared to control, though we rated it at high risk of bias. Our meta-analysis showed no significant overall effect on children's BMI as a result of participation in an intervention with a sleep component (Cohen's d = 0.18, 95% CI= -0.04, 0.40, Z = 1.56, P = .11), though caution is warranted due to substantial heterogeneity observed across studies (Tau2 = 0.08; X2 = 23.05, df = 7; I2 = 83.73%).

CONCLUSIONS

There were mixed results on the effect of sleep interventions across included studies on BMI, other weight-related outcomes, diet, physical activity, and sleep. Except for one study at low risk of bias, three were rated as 'some concerns' and four 'high risk of bias'. Findings from this study highlight the need for additional RCTs isolating sleep as a component, focusing on children and adolescents living with overweight and obesity.

Association between Beverage Consumption and Sleep Quality in Adolescents

The objective of this study was to verify if the consumption of different beverages (such as water, 100% pure fruit juice, and sugar-sweetened beverages (SSBs)) is associated with adolescents' sleep quality. French-speaking adolescents were recruited in person and online throughout the province of Québec (Canada) from the end of March to early July 2023. Beverage consumption and sleep quality were measured using French versions of validated questionnaires specifically designed for adolescents. A total of 218 adolescents (14-17 years; 55.5% female) completed the online survey. Among caffeinated SSBs, energy drink (rs = -0.16; p = 0.0197) and sugar-sweetened coffee (rs = -0.33; p < 0.0001) intake was correlated with adolescents' sleep quality. Energy drink consumption (β = -0.0048; p = 0.0005) and being male (β = 0.6033; p < 0.0001) were associated with adolescents' sleep quality. There was an interaction between sugar-sweetened coffee intake and biological sex that was associated with adolescents' sleep quality (p = 0.0053). Sugar-sweetened coffee consumption was correlated with adolescent girls' abilities to go to bed (rs = -0.21; p = 0.0203) and fall asleep (rs = -0.28; p = 0.0020), while in boys, it was only significantly correlated with their abilities to go to bed (rs = -0.27; p = 0.0069). Public health interventions aimed at adolescent boys should primarily target lowering energy drink consumption, while those aimed at girls should prioritize sugar-sweetened coffee intake to possibly improve their sleep quality.

Associations between social jetlag trajectories and body mass index among young adults

STUDY OBJECTIVES

This study employed longitudinal data collected repeatedly from individuals over the course of several years to examine the trajectories of social jetlag from ages 11 to 22 years and their associations with subsequent body mass index (BMI). Potential sex differences were also investigated.

METHODS

Data were obtained from two longitudinal studies conducted in Taiwan (N = 4287). Social jetlag was defined as ≥ 2 hours of absolute difference in sleep midpoint between weekdays and weekends. BMI was calculated using weight (kg)/height(m)2 and categorized as underweight (<18 kg/m2), normal weight (18 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese (≥27 kg/m2). Group-based trajectory modeling and multinomial logistic regression were applied to investigate study objectives.

RESULTS

Four distinct trajectories of social jetlag throughout the adolescent years were identified, with corresponding proportions as follows: low-stable (42%), moderate-decreasing (19%), low-increasing (22%), and chronic (17%) trajectories. Among males, the risk of being underweight (aOR, 1.96; 95% CI: 1.35 to 2.84) or obese (aOR, 1.40; 95% CI: 1.02 to 1.92) was higher in individuals with a low-increasing trajectory than in those with a low-stable trajectory. Among females, those with a low-increasing (aOR, 1.61; 95% CI: 1.02 to 2.54) or chronic (aOR, 2.04; 95% CI: 1.27 to 3.25) trajectory were at a higher risk of being obese relative to those with a low-stable trajectory.

CONCLUSIONS

Addressing the development of increasing or chronic social jetlag during adolescence can help prevent abnormal BMI in young adulthood. Practitioners should consider sex differences in treatment or consultation.

Sleep quality and executive function in a diverse sample of healthy young adults

Few studies examine the relationship between sleep and executive function in diverse samples of young adults. Our research aims to fill this gap by analyzing how self-reported sleep quality is related to informant-rated executive function as a whole and its working memory component in a diverse sample of 29 healthy college students. Using the self-report measure, the Pittsburgh Sleep Quality Index (PSQI), we divided our sample into two groups based on cutoff criteria (score ≥5: poor sleep): good sleep quality (n = 11) and poor sleep quality (n = 18). Participants were on average 20.86 years old. Informants rated participants' executive functioning and working memory using the Frontal Systems Behavior Scale (FrSBe) and Behavior Rating Inventory of Executive Function (BRIEF). Individuals in the poor sleep quality group were reported as having significantly worse executive function and working memory scores. Young adult college students who report less than 7 hours of sleep per night have lower scores on informant measures of working memory and executive function. This study raises awareness about how self-reported sleep experiences are related to other's observation of cognitive abilities in everyday life in a diverse young adult sample.

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention

Primary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016

STUDY OBJECTIVES

We aimed to identify the relationship between duration of categorized catch-up sleep on free days (CUS) and measured body mass index (BMI) in adults using the data from the seventh Korean National Health and Nutrition Examination Survey (KNHANES VII), 2016.

METHODS

CUS duration was classified as ≤ 0, > 0-1, > 1-2, and > 2 hours. Being overweight or obese was defined as having a BMI ≥ 25.0 kg/m2 or ≥ 30.0 kg/m2, respectively.

RESULTS

Of 6,382 participants aged 19-80 years in the KNHANES VII survey of 2016, 201 and 583 participants were excluded because of shift-working and insufficient data, respectively. Of 5,598 participants, CUS was observed in 2,274 (44.9%) participants, of which 3,324 (55.1%), 1,043 (19.4%), 724 (14.7%), and 507 (10.8%) had CUS of ≤ 0, > 0-1, > 1-2, and > 2 hours, respectively; the prevalence of obesity was 5.6%, 5.6%, 4.8%, and 6.1%, respectively. The association between BMI and CUS duration showed a significant negative association in the CUS ≤ 0 hours group (beta [95% confidence interval], -0.394 [-0.646, -0.143], P = .002); however, other CUS groups did not show any significant association with BMI (CUS > 0-1 hours: -0.196 [-1.258, 0.865], P = .716; CUS > 1-2 hours, -0.542 [-1.625, 0.541], P = .325; CUS > 2 hours, -0.113 [-0.459, 0.233], P = .519).

CONCLUSIONS

Our findings provide an understanding of the relationship between CUS and BMI and can serve as an instructive basis for the management of BMI.

CITATION

Lee HJ, Cho S, Lee SH, Kim SJ, Kim KM, Chu MK. Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016. J Clin Sleep Med. 2024;20(1):39-47.

Family income as a moderator of relations between sleep and physical health during adolescence

OBJECTIVES

Sleep duration, quality, and consistency are associated with overall physical health in adolescence, yet the effects of sleep on development may be not uniform because both sleep and physical health vary systematically along gradients of family income. To understand "for whom" sleep may be particularly beneficial, the present study tested family income as a moderator of relations between youth sleep and physical health.

METHODS

Three hundred twenty-three youth (M age=17.39years; 53% female; 41% Black, 59% White) wore wrist actigraphs for 1week at home. Four well-recognized sleep parameters were derived: minutes, efficiency, long wake episodes, and variability in minutes across the week. Parents reported family income, and mothers rated adolescents' physical health. In independent path models, physical health was regressed onto each indicator of sleep, family income, and Sleep × Family Income interactions to test potential moderation effects.

RESULTS

Associations between sleep and physical health were moderated by family income. Lower sleep efficiency, more long wake episodes, and more variability in sleep minutes were associated with poorer physical health among adolescents from lower-income families. At optimal levels of all sleep variables, income-based differences in physical health were mitigated. Youth from higher-income families tended to have better physical health regardless of their sleep.

CONCLUSIONS

Findings build evidence that sleep has relations with physical health for low-income youth in particular. Clinicians and other service providers working with youth might benefit from considering the role of sleep in prevention and interventions programs geared toward improving health.

Trends in weight change patterns across life course among US adults, 1988-2018: population-based study

BACKGROUND

To examine trends in weight change patterns from young adulthood through midlife to late adulthood and their sex and racial/ethnic disparities among US adults from 1988 to 2018.

METHODS

A total of 48,969 participants from the National Health and Nutrition Examination Survey 1988-1994 and 2001-2018 were included.

RESULTS

The age-adjusted prevalence of stable non-obesity between young adulthood and midlife declined significantly from 84.1% (95 CI, 82.9-85.3%) in 1988-1994 to 68.7% (67.1-70.2%) in 2013-2018, and between midlife and late adulthood from 71.2% (69.2-73.1%) to 52.4% (50.5-54.2%). The magnitude of increase in the prevalence of weight gain from young adulthood to midlife (from 10.8% [9.9-11.6%] in 1988-1994 to 21.2% [20-22.3%] in 2013-2018; P < 0.001 for trend) was greater than that from midlife to late adulthood (from 14.1% [12.9-15.3%] to 17.2% [16.2-18.1%]; P = 0.002 for trend). The magnitude of increase in the prevalence of stable obesity from young adulthood to midlife (from 3.9% [3.1-4.8%] in 1988-1994 to 9.2% [8.2-10.3%] in 2013-2018; P < 0.001 for trend) was smaller than that from midlife to late adulthood (from 11.2% [10.1-12.2%] to 24.8% [23.3-26.3%]; P < 0.001 for trend). The declining trends in the prevalence of stable non-obesity and increasing trends in the prevalence of weight gain and stable obesity from young adulthood through midlife to late adulthood were also observed for all sex and race/ethnicity subgroups. The magnitude of decrease in the prevalence of stable non-obesity, and the magnitude of increase in the prevalence of weight gain from young adulthood through midlife to late adulthood were greater in men than in women (all P for interaction < 0.01). Weight gain patterns for those aged ≥ 65 years were substantially different from the younger age groups.

CONCLUSIONS

More young people born in later years are encountering obesity and accumulate greater obesity exposure across their lives than young people born in earlier years.

Are 24-hour movement recommendations associated with obesity-related indicators in the young population? A meta-analysis

OBJECTIVE

This study aimed to determine the relationship between meeting all three 24-hour movement recommendations (i.e., physical activity, sleep duration, and screen time) and obesity-related indicators among young people.

METHODS

Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Library).

RESULTS

Meeting the 24-hour movement recommendations was cross-sectionally associated with lower overall obesity-related indicators (r = -0.09, 95% CI: -0.11 to -0.06), but no longitudinal association was found. Regarding each obesity-related indicator separately, meeting all three recommendations was related to lower odds of overweight/obesity (odds ratio = 0.65, 95% CI: 0.56 to 0.76) and obesity alone (odds ratio = 0.28, 95% CI: 0.16 to 0.50). An inverse relationship between meeting 24-hour movement recommendations and BMI, BMI z score, waist circumference, and body fat was also found. Regarding subgroup analysis, the association between 24-hour movement recommendations and overall obesity-related indicators was similar regardless of sex, comparison used (meeting all three vs. not meeting [i.e., those who met zero to two of the movement behaviors] or meeting all three vs. none), and type of measure to assess 24-hour movement recommendations (i.e., self-reported or accelerometer-based measures).

CONCLUSIONS

Meeting all 24-hour movement recommendations may be a crucial factor in maintaining a healthy weight status in the young population.

The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) and poor sleep quality are highly prevalent in children with obesity, but their individual associations with health-related quality of life (HRQOL) are unknown in this population. The primary objective was to describe the independent association of OSA and sleep quality with HRQOL in children with obesity.

METHODS

This was a cross-sectional study of children with obesity at 2 tertiary care centers. Sleep quality and HRQOL were measured with the Pittsburgh Sleep Quality Index and Pediatric Quality of Life Inventory questionnaires, respectively. Multivariable regression models were created to evaluate associations between OSA and sleep quality with HRQOL.

RESULTS

There were 98 children (median age 15.0 years, median body mass index z-score 3.8, 44% females). Among the study population, 49/98 (50%) children reported poor sleep quality, 41/98 (42%) children had OSA, and 52/98 (53%) children reported impaired HRQOL. Self-reported poor sleep quality was independently associated with reduced HRQOL, whereas the presence of OSA was not. Children with poor sleep quality had a reduced Pediatric Quality of Life Inventory score by 8.8 compared to children with good sleep quality (95% confidence interval, 2.6-14.9; P = .006), when adjusting for age, sex, body mass index z-score, attention-deficit/hyperactivity disorder, mood/anxiety disorder, and study site.

CONCLUSIONS

In the current study of children with obesity, we found that HRQOL was more strongly associated with the self-reported experience of sleep than the presence of OSA. Clinicians should assess and optimize sleep quality as part of the evaluation for OSA in children with obesity.

CITATION

Xiao L, Voutsas G, Ryan CM, Katz SL, Narang I. The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity. J Clin Sleep Med. 2023;19(11):1877-1883.

Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents

STUDY OBJECTIVES

We aimed to examine the association between self-rated and clinician-rated sleep disturbances and C-reactive protein (CRP), an objective marker of inflammation, in pediatric depression.

METHODS

Two hundred fifty-six children and adolescents (15.2 ± 1.6 y, 72.3% female) with moderate to severe symptoms of depression participated in the study. Sleep disturbances were assessed by self-reports (Insomnia Severity Index) and clinician ratings (Kiddie-Schedule for Affective Disorder and Schizophrenia), inflammation by plasma CRP levels.

RESULTS

Higher levels of CRP correlated positively with clinician-rated middle insomnia and hypersomnia. After adjusting for control variables (body mass index, tobacco, alcohol, stress, age, sex, antidepressants, sleep medication, depression severity), regression models confirmed the significant association of clinician-rated hypersomnia and middle insomnia symptoms with elevated CRP levels. In the adjusted regression models, other clinician-rated manifestations of sleep disturbance (eg, initial insomnia) and insomnia self-ratings were not significantly associated with CRP. Body mass index correlated positively with CRP, but body mass index had no mediating effect on the associations between sleep disturbances and CRP. We did not find an association between depression severity, assessed by the Children's Depression Rating Scale-Revised, and CRP.

CONCLUSIONS

Results of the present study indicate a significant association of hypersomnia and middle insomnia symptoms with CRP in pediatric depression, not linked to alterations in the body mass index.

CITATION

Strumberger MA, Häberling I, Emery S, et al. Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents. J Clin Sleep Med. 2023;19(10):1775-1784.

Associations between sleep health and obesity and weight change in adults: The Daily24 Multisite Cohort Study

OBJECTIVES

To examine cross-sectional and longitudinal associations of individual sleep domains and multidimensional sleep health with current overweight or obesity and 5-year weight change in adults.

METHODS

We estimated sleep regularity, quality, timing, onset latency, sleep interruptions, duration, and napping using validated questionnaires. We calculated multidimensional sleep health using a composite score (total number of "good" sleep health indicators) and sleep phenotypes derived from latent class analysis. Logistic regression was used to examine associations between sleep and overweight or obesity. Multinomial regression was used to examine associations between sleep and weight change (gain, loss, or maintenance) over a median of 1.66 years.

RESULTS

The sample included 1016 participants with a median age of 52 (IQR = 37-65), who primarily identified as female (78%), White (79%), and college-educated (74%). We identified 3 phenotypes: good, moderate, and poor sleep. More regularity of sleep, sleep quality, and shorter sleep onset latency were associated with 37%, 38%, and 45% lower odds of overweight or obesity, respectively. The addition of each good sleep health dimension was associated with 16% lower adjusted odds of having overweight or obesity. The adjusted odds of overweight or obesity were similar between sleep phenotypes. Sleep, individual or multidimensional sleep health, was not associated with weight change.

CONCLUSIONS

Multidimensional sleep health showed cross-sectional, but not longitudinal, associations with overweight or obesity. Future research should advance our understanding of how to assess multidimensional sleep health to understand the relationship between all aspects of sleep health and weight over time.

Sleep duration and its association with adiposity markers in adolescence: a cross-sectional and longitudinal study

AIMS

Large studies linking adolescents' objectively measured sleep duration and adiposity markers are lacking. We characterized sleep duration and its cross-sectional and longitudinal associations with adiposity markers in adolescence.

METHODS AND RESULTS

Seven-day accelerometry was performed in a cohort of adolescents enrolled in the SI! Program for Secondary Schools trial in Spain at approximately ages 12 (1216 adolescents, 49.6% girls), 14 (1026 adolescents, 51.3% girls), and 16 (872 adolescents, 51.7% girls) years. Participants were classified as very short sleepers (VSS; <7 h), short sleepers (SS; 7-<8 h), or recommended-time sleepers (RTS; 8-10 h). Adjusted associations between sleep duration and adiposity markers were analysed using generalized linear and Poisson models. At ∼12 years, 33.7% of adolescents met sleep recommendations, and this percentage decreased with advancing age (22.6% at ∼14 and 18.7% at ∼16 years). Compared with RTS, overweight/obesity prevalence ratios at ∼12, 14, and 16 years among SS were 1.19 [95% confidence interval (CI): 1.09-1.30], 1.41 (95% CI: 1.34-1.48), and 0.99 (95% CI: 0.77-1.26) and among VSS were 1.30 (95% CI: 1.28-1.32), 1.93 (95% CI: 1.41-2.64), and 1.32 (95% CI: 1.26-1.37). Compared with adolescents who always met sleep recommendations, the prevalence of overweight/obesity was ∼5 times higher in those never meeting recommendations or meeting them only once. Similar trends were observed for the waist-to-height ratio (P = 0.010) and fat mass index (P = 0.024).

CONCLUSION

Most adolescents did not meet sleep recommendations. Shorter sleep duration was independently associated with unfavourable adiposity markers, and such adverse impact was cumulative. Health promotion programmes should emphasize the importance of good sleep habits.

Sleep duration, sleep quality and the risk of being obese: Evidence from the Australian panel survey

BACKGROUND

Sleep difficulty is an unmet public health concern affecting a vast proportion of the world's population. Poor sleep duration (short or long sleep length) and quality affect more than half of older people. Sleep difficulty is associated with negative health outcomes such as obesity and reduced longevity. We aimed to assess whether poor sleep duration and quality are significant risk factors for obesity in adults aged 15 and over in Australia by examining a nationally representative panel data.

METHODS

We used three waves (waves 13, 17, and 21) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey data. The study applied generalized estimating equations (GEE) logistic regression model to assess the relationship between sleep duration and quality with obesity.

RESULTS

The study found that the odds of being obese was significantly higher amongst the study participants with poor sleep duration (adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.16-1.32) and poor sleep quality (aOR: 1.29, 95% CI: 1.02-1.38) compared with their counterparts who had good sleep duration and quality, respectively.

CONCLUSION

Having short or long sleep at night and poor sleep quality are associated with an increased risk of obesity. Obesity poses a significant threat to the health of Australian adults. Enacting policies that raise public awareness of the significance of good sleep hygiene and encouraging healthy sleeping habits should be considered to address the alarming rise in the obesity rate.

The effect of lavender on mothers sleep quality in the postpartum period: a systematic review and meta-analysis

Poor sleep quality in the postpartum period can have various negative effects on the health of mothers and infants such as anxiety, depression, low breastfeeding self-efficacy and disrupted child-mother attachment. Accordingly, intervention seems necessary to improve sleep quality. Given the probable effect of lavender on sleep problems, the present research intended to determine its effects on mothers' sleep quality during postpartum period. The PubMed, Embase, Cochrane Library, Scopus databases and the Persian language databases (Magiran and SID) were searched for all the articles they included at the end of February 2021. The risk of bias of the included studies was assessed using the Cochrane tool. The results of the meta-analysis were reported as the standardized mean difference (SMD). Heterogeneity of the studies was investigated using the I-squared test (I2). Three out of the 292 obtained studies entered the meta-analysis. The results indicated that sleep quality in the group receiving lavender improved compared to the control group, (SMD = -0.61; 95% CI: -1.07 to -015 p = 0.01) whereas the heterogeneity was higher. (I2 = 75%; Tau2 = 012; Chi2 = 7.905, p = 0.02). According to the results of this systematic review, use of lavender can improve postpartum maternal sleep quality. However, further randomized controlled trials using identical methodology, larger sample sizes and longer follow-up periods are needed.

Associations between Birth Weight and Adult Sleep Characteristics: A Cross-Sectional Analysis from the UAEHFS

Abnormal birth weight, particularly low birth weight (LBW), is known to have long-term adverse health consequences in adulthood, with disrupted sleep being suggested as a mediator or modifier of this link. We thus aimed to assess the associations between birth weight and self-reported adult sleep characteristics: sleep duration, difficulty waking up in the morning, daily nap frequency, sleep problems at night, snoring, daytime tiredness or sleepiness, and ever-stop breathing during sleep. This cross-sectional analysis used the United Arab Emirates Healthy Future Study data collected from February 2016 to March 2023 involving 2124 Emiratis aged 18-61 years. We performed a Poisson regression under unadjusted and age-sex-and-BMI-adjusted models to obtain the risk ratio and its 95% confidence interval for our analysis of the association between birth weight and each adult sleep characteristics, compared to individuals with normal birth weight (≥2.5 kg). Those with LBW had significantly a 17% increased risk of difficulty waking up in the morning, compared to those with normal birth weight. In addition, females with LBW history were also at an increased risk of reporting difficulty waking up in the morning. Studies with objective sleep assessments that include measurements of more confounding factors are recommended to confirm these risks.

Disordered Eating and Eating Disorders in Pediatric Obesity: Assessment and Next Steps

While the exact prevalence of disordered eating in youth who are overweight and have obesity has not been determined, studies show that the odds of a young adult (18-24 years) with obesity engaging in disordered eating behaviors is 2.45 times more likely to occur than in young adults with Body Mass Indexes (BMI) in the normative range. The purpose of this review is to highlight the role that disordered eating and eating disorders may play in pediatric obesity and the importance of screening for these conditions. The ability to identify and assess disordered eating alters the course of treatment. Without an understanding of the intersection of obesity and disordered eating, medical providers may continue treatment-as-usual. Doing so may inadvertently contribute to internalized weight bias in patients with obesity and exacerbate their disordered eating symptoms and behaviors. In addition, understanding the spectrum of disordered eating in pediatric patients with obesity allows providers to tailor treatments, discuss food and physical activity differently, and know when to refer patients to eating-disorder-specific providers for continued treatment.

Association between Mediterranean dietary pattern with sleep duration, sleep quality and brain derived neurotrophic factor (BDNF) in Iranian adults

Data on the association between Mediterranean diet, sleep and brain-derived neurotrophic factor (BDNF) were limited in Middle Eastern populations. We examined the association between Mediterranean dietary pattern with sleep quality/quantity, and serum BDNF in Iranian adults. This cross-sectional study was performed among 535 middle-aged adults (54% men), selected by multistage cluster random sampling method. The Pittsburgh sleep quality index and a validated food frequency questionnaire were used to assess sleep quality, sleep quantity, and Mediterranean diet score (MDS). Twelve-hour fasting blood samples were taken to evaluate serum BDNF values. Participants in the highest tertile of MDS, in comparison to those in the lowest tertile, had lower odds of having short sleep (OR = 0.44, 95%CI: 0.21-0.91) and poor sleep quality (OR = 0.48, 95%CI: 0.22-0.96), after adjustment for potential confounders. Among specific domains of sleep quality, lower odds of subjective sleep quality, sleep latency, and daytime dysfunction were associated with increased MDS. Higher adherence to MDS among individuals with overweight or obesity reduced the odds of having short sleep; this relation was not seen among individuals with normal weight. In contrast, the association between sleep quality and the MDS was significant in individuals with normal weight, but not those with overweight or obesity. Participants with higher adherence to MDS had lower odds for low BDNF values; however, this relation was not statistically significant. Overall, Iranian adults with a higher adherence to MDS had considerably lower odds of having short sleep and poor sleep quality. BDNF would not be an intermediate molecule for this connection.

Neuroprotection in metabolic syndrome by environmental enrichment. A lifespan perspective

Metabolic syndrome (MetS) is defined by the concurrence of different metabolic conditions: obesity, hypertension, dyslipidemia, and hyperglycemia. Its incidence has been increasingly rising over the past decades and has become a global health problem. MetS has deleterious consequences on the central nervous system (CNS) and neurological development. MetS can last several years or be lifelong, affecting the CNS in different ways and treatments can help manage condition, though there is no known cure. The early childhood years are extremely important in neurodevelopment, which extends beyond, encompassing a lifetime. Neuroplastic changes take place all life through - childhood, adolescence, adulthood, and old age - are highly sensitive to environmental input. Environmental factors have an important role in the etiopathogenesis and treatment of MetS, so environmental enrichment (EE) stands as a promising non-invasive therapeutic approach. While the EE paradigm has been designed for animal housing, its principles can be and actually are applied in cognitive, sensory, social, and physical stimulation programs for humans. Here, we briefly review the central milestones in neurodevelopment at each life stage, along with the research studies carried out on how MetS affects neurodevelopment at each life stage and the contributions that EE models can provide to improve health over the lifespan.

An Examination of the Associations between Nutritional Composition, Social Jet Lag and Temporal Sleep Variability in Young Adults

While dietary intake has previously been related to various indices of poor sleep (e.g., short sleep duration, poor sleep quality), to date, few studies have examined chrononutrition from the perspectives of the relationship between dietary intake and social jet lag and temporal sleep variability. Moreover, recently it has been suggested that previous methods of measuring social jet lag have the potential to lead to large overestimations. Together, this precludes a clear understanding of the role of nutritional composition in the pathophysiology of poor sleep, via social jet lag and temporal sleep variability, or vice versa. The aim of the present study was to determine the relationships between nutrient intake and social jet lag (using a revised index, taking account of intention to sleep and sleep onset and offset difficulties), and temporal sleep variability. Using a cross-sectional survey, 657 healthy participants (mean age 26.7 ± 6.1 years), without sleep disorders, were recruited via an online platform and completed measures of weekly dietary intake, social jet lag, temporal sleep variability, stress/sleep reactivity and mood. Results showed limited associations between nutritional composition and social jet lag. However, levels of temporal sleep variability were predicted by consumption of polyunsaturated fats, sodium, chloride and total energy intake. The results suggest further examinations of specific nutrients are warranted in a first step to tailoring interventions to manage diet and temporal variabilities in sleep patterns.

Obstructive sleep apnea and orofacial myofunctional aspects in obesity

PURPOSE

This study aimed to evaluate the quality of sleep, presence of obstructive sleep apnea (OSA), and its relationship with the presence of snoring, cephalometric characteristics, degree of collapse of the upper airways, and orofacial myofunctional profile in obese and overweight individuals.

METHODS

All participants completed polysomnography, as well as sleep and snoring questionnaires. We further performed orofacial, otorhinolaryngological, and anthropometric evaluations on all participants.

RESULTS

A total of 102 adults, comprising 29 obese, 21 overweight, and 52 eutrophic individuals of both sexes participated in this study. We observed a high prevalence of snoring in both obese and overweight (100%), and in 65% of eutrophic individuals. Among the obese subjects 58% had a severe degree of OSA, whereas 4% of eutrophic subjects presented a risk for OSA development. Sleep quality was related to body mass index (BMI) and cervical and abdominal circumference. All obese and overweight individuals presented with orofacial myofunctional alterations such as facial asymmetry, alteration of the maxilla-jaw relationship, inadequate tongue posture, changes in masticatory pattern and swallowing, and inadequate general orofacial myofunctional condition. Airway obstructions at the retropalatal and retrolingual levels > 75% were observed in at least 48% of the individuals.

CONCLUSION

Obese and overweight individuals presented a higher risk for the development of OSA compared with eutrophic patients, and obese individuals presented a greater severity of OSA. The higher the BMI and greater the cervical and abdominal circumferences, the higher the prevalence of OSA, worse the quality of sleep, and more serious orofacial myofunctional characteristics in this population.

The Longitudinal Interplay between Sleep, Anthropometric Indices, Eating Behaviors, and Nutritional Aspects: A Systematic Review and Meta-Analysis

Sleep is fundamental for adolescents' healthy development but undergoes dramatic changes in quantity and quality due to the conflict between biological and social rhythms. Insufficient sleep has been associated with worse physical health status and irregular eating behaviors in adolescents. This review aims to systematically synthesize the longitudinal associations between adolescents' sleep dimensions (i.e., duration, timing, quality, and insomnia symptoms) and physical health indicators (i.e., anthropometric indices, fat percentage, and risk of obesity), eating behaviors, and nutritional aspects (i.e., type of diet related to the intake of specific foods and nutrients, amount and timing of food consumption, energy expenditure). A total of 28 longitudinal studies were included. The meta-analytic results showed that longer sleep duration, better sleep quality, and lower insomnia symptoms were associated with lower BMI and fat percentage and that shorter sleep duration (<7 h) and lower sleep quality were associated with a higher risk of obesity. Conversely, anthropometric indices were not related to sleep over time. Limited literature examined the bidirectional association between adolescents' sleep and their eating behaviors and nutritional aspects. Such knowledge sheds new light on the role of sleep for adolescents' health, highlighting the need to examine further the interplay between these variables.

Association between hemoglobin adducts of ethylene oxide levels and the risk of short sleep duration in the general population: an analysis based on the National Health and Nutrition Examination Survey

This study aimed to evaluate the association between blood ethylene oxide (HbEtO) levels and short sleep duration (SSD). Data of 3438 participants aged 20 years or older in this study were collected from the National Health and Nutrition Examination Survey (NHANES). The ethylene oxide (EtO) biomarker (HbEtO) was quantified in blood using a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method. SSD was defined as sleep time equal to or less than 6 h. The analyses utilized weighted logistic regression models and restricted cubic spline. There was a significant non-linear relationship between HbEtO levels and the risk of SSD (P for-nonlinearity = 0.035). After the full adjustment for confounders, compared with the lowest quantile, the odds ratios (ORs) with 95% confidence intervals (CIs) of SSD across the quantiles of ethylene oxide levels were 1.54(1.09-2.18), 1.15(0.87-1.53), and 1.80(1.11-2.92), respectively (P for trend < 0.05). In subgroup analysis, people who were female, who were non-Hispanic Black, who never engaged in physical activity, who consumed alcohol ≤ 14 g/day, who were normal weight or obese had a significantly higher risk of SSD when they had highest quartiles of HbEtO levels than those had lowest (p < 0.05). Our study indicated that HbEtO levels, an indicator for EtO exposure, were associated with SSD in general adult populations.

Use of melatonin in children and adolescents with idiopathic chronic insomnia: a systematic review, meta-analysis, and clinical recommendation

Background

Melatonin prescriptions for children and adolescents have increased substantially during the last decade. Existing clinical recommendations focus on melatonin as a treatment for insomnia related to neurodevelopmental disorders. To help guide clinical decision-making, we aimed to construct a recommendation on the use of melatonin in children and adolescents aged 5-20 years with idiopathic chronic insomnia.

Methods

A systematic search for guidelines, systematic reviews and randomised controlled trials (RCT) were performed in Medline, Embase, Cochrane Library, PsycInfo, Cinahl, Guidelines International Network, Trip Database, Canadian Agency for Drugs and Technologies in Health, American Academy of Sleep Medicine, European Sleep Research Society and Scandinavian Health Authorities databases. A search for adverse events in otherwise healthy children and adolescents was also performed. The latest search for guidelines, systematic reviews, and adverse events was performed on March 18, 2023. The latest search for RCTs was performed on to February 6, 2023. The language was restricted to English, Danish, Norwegian, and Swedish. Eligible participants were children and adolescents (5-20 years of age) with idiopathic chronic insomnia, in whom sleep hygiene practices have been inadequate and melatonin was tested. There were no restrictions on dosage, duration of treatment, time of consumption, or release formula. Primary outcomes were quality of sleep, daytime functioning and serious adverse events. Secondary outcomes included total sleep time, sleep latency, awakenings, drowsiness, quality of life, all-cause dropouts, and non-serious adverse events. Outcomes were assessed at different time points to assess short-term and long-term effects. Meta-analysis was performed using inverse variance random-effects model and risk of bias was assessed using Cochrane risk of bias tool. If possible, funnel plots would be constructed to investigate publication bias. Heterogeneity was calculated via I² statistics. A multidisciplinary guideline panel formulated the recommendation according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The certainty of evidence was considered either high, moderate, low or very low depending on the extent of risk of bias, inconsistency, imprecision, indirectness, or publication bias. The evidence-to-decision framework was subsequently used to discuss the feasibility and acceptance of the constructed recommendation alongside the impact on resources and equity. The protocol is registered with the Danish Health Authority.

Findings

We included eight RCTs with 419 children and adolescents with idiopathic chronic insomnia. Melatonin led to a moderate increase in total sleep time by 30.33 min (95% confidence interval (CI) 18.96-41.70, 4 studies, I² = 0%) and a moderate reduction in sleep latency by 18.03 min (95% CI -26.61 to -9.44, 3 studies, I² = 0%), both as assessed by sleep diary. No other beneficial effects were found. None of the studies provided information on serious adverse events, yet the number of participants experiencing non-serious adverse events was increased (Relative risk 3.44, 95% CI 1.25-9.42, 4 studies, I² = 0%). Funnel plots were not constructed due to the low number of studies. The certainty of evidence was very low on the quality of sleep and low for daytime functioning.

Interpretation

Evidence of very low certainty shows that benefits are limited and unwanted events are likely when melatonin is used to treat otherwise healthy children and adolescents with chronic insomnia. Melatonin should never be the first choice of treatment for this particular population, yet carefully monitored short-term use may be considered if sleep hygiene practices and non-pharmacological interventions have proven inadequate, and only if daytime function is compromised.

Funding

The Danish Health Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital supported by the Oak Foundation.

The impact of laparoscopic Roux-en-Y gastric bypass on sleep quality and duration after one year of follow-up

BACKGROUND AND AIMS

Several studies have shown the association between obesity and sleep. Roux-en-Y gastric bypass (RYGB) surgery may improve sleep disturbances in patients with obesity by influencing a variety of factors. This study aims to evaluate the impact of bariatric surgery on sleep quality.

METHODS

Patients with severe obesity referred to the obesity clinic of a center from September 2019 to October 2021 were collected. The patients were divided into two groups, depending on whether they underwent RYGB surgery. Medical comorbidities and self-report questionnaires regarding sleep quality, anxiety, and depression were collected at baseline and 1-year follow-up.

RESULTS

54 patients were included, including 25 in the bariatric surgery group and 29 in the control group. However, five patients in the RYGB surgery group and four patients in the control group were lost in the follow-up. Pittsburgh Sleep Quality Index (PSQI) was decreased from a mean of 7.7 to 3.8 in the bariatric surgery group (p-value<0.001). In contrast to the control group, the number of patients with obstructive sleep apnea was significantly reduced in the bariatric surgery group.

CONCLUSIONS

We showed a significant improvement in sleep quality following RYGB surgery. Obstructive sleep apnea, obesity/overweight, and depressive symptoms significantly improved in our study. There is a lack of a better understanding of the association between these factors and sleep quality following surgery. Therefore, further studies are recommended regarding this issue.

Impaired sleep quality in children with allergic conjunctivitis and their parents

OBJECTIVES

To investigate the sleep quality in children with allergic conjunctivitis (AC) and their parents.

METHODS

Prospective, case-controlled study. Zhongshan Ophthalmic Center, a tertiary referral centre. Participants comprised 73 children aged 4-12 years with AC and their parents, and 81 healthy, age-matched children who served as controls and their parents. General information was recorded and ocular manifestations of children with AC were scored. Sleep quality of the children and parents were assessed using Children's Sleep Habits Questionnaire (CSHQ) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Children with AC and their parents had reduced sleep quality (Children's CSHQ: 48.3 ± 6.55 vs. 38.8 ± 4.63; Parental PSQI: 5.62 ± 2.12 vs. 3.40 ± 1.90, both p < 0.001) and significantly higher prevalence of poor sleep quality (CSHQ ≥ 41 in Children: 89.0% vs. 23.5%; PSQI > 7 in Parents: 18.5% vs. 1.23%, both p < 0.001). Children with AC scored worse on subcomponents of CSHQ including sleep onset delay, sleep duration, parasomnia, sleep-disordered breathing, and daytime sleepiness. Parents scored worse on subscores of PSQI including sleep duration, sleep disturbances, use of sleeping medication, and daytime sleepiness. Poor sleep quality in children with AC was associated with follicle formation (OR:3.95; 95% CI: 1.88-8.31, p < 0.001) and keratitis (OR:6.03; 95% CI: 1.29-28.3, p = 0.028). Parental poor sleep quality was associated with follicle formation (OR:7.14; 95% CI: 2.06-24.8, p = 0.002) and keratitis (OR:4.49; 95% CI: 1.27-15.9, p = 0.020) in children.

CONCLUSIONS

AC has a negative association with sleep quality in children and their parents, especially in those children with severe follicle formation and keratitis.

STATE THE DETAILS OF CLINICAL TRIALS

Chictr.org.cn, https://www.chictr.org.cn/showproj.aspx?proj=43511 , ChiCTR1900027486.

STATEMENT OF SIGNIFICANCE

Allergic conjunctivitis is a frequently encountered problem diagnosed and managed by ophthalmologists, paediatricians, allergists, and primary care physicians and has become a major public health issue. Sleep is crucial for learning and effective development in children. Our study discovered a strong association between these two conditions. This is the first study to evaluate the association of allergic conjunctivitis and sleep quality in children and their parents. This case-controlled study found that allergic conjunctivitis had a negative impact on sleep quality not only for children but also for their parents. The findings of this study suggest a multifaceted impact of AC with sleep quality; detailed assessment of sleep quality for improved care of paediatric patients with allergic conjunctivitis would be useful.

Non-Classical Aspects of Obesity Pathogenesis and Their Relative Clinical Importance for Obesity Treatment

Obesity is a chronic disease and a major public health problem due to its association with non-communicable diseases and all-cause mortality. An increased energy intake and decreased physical activity have been long recognized as the classical parameters that contribute to the development of obesity. However, several other, non-classical factors have also been associated with obesity through various complex mechanisms. Some of them are diet related, such as diet quality, dietary habits and speed of eating. Other factors are non-dietary, such as endocrine-disrupting chemicals, sleep quality and quantity, psychotropic medications and light at night. The scope of the present narrative review is to address these non-classical factors that are implicated in the pathogenesis of obesity, to clarify their potential role in the management of obesity and, where possible, to provide some practical clinical recommendations.

The course of insomnia symptoms during the acute treatment of major depressive disorder: A CAN-BIND-1 report

Despite considerable efforts to study the relationship between insomnia and depression, there is minimal research investigating whether insomnia symptoms change over time during a course of antidepressant pharmacotherapy. This study investigated the course of insomnia symptoms during the acute treatment of major depressive disorder (MDD) using a secondary analysis of data from MDD patients (N = 180) who were treated with open-label escitalopram (10-20 mg/day) for 8-weeks. Montgomery-Asberg Depression Rating Scale without sleep item (modified-MADRS) assessed depression and Self-reported Quick Inventory Depressive Scale (QIDS-SR) measured subjective sleep-onset, mid-nocturnal, and early-morning insomnia throughout 8-weeks of treatment. Pittsburgh Sleep Quality Index (PSQI) was used to assess subjective sleep quality, duration, onset latency, and efficiency throughout 8-weeks of treatment. Remission of depression was defined as modified-MADRS ≤10 at week-8. Mixed model repeated measures (MMRMs) were conducted with remission status as an independent variable and each sleep variable as a dependent variable. MMRMs demonstrated that remitters had significantly lower QIDS-SR sleep-onset and mid-nocturnal insomnia scores as well as a significantly lower PSQI sleep quality score than non-remitters throughout 8-weeks of treatment. Monitoring subjective sleep-onset and mid-nocturnal insomnia during the course of treatment with serotonergic antidepressants may be useful for predicting acute remission of depression.

Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study

OBJECTIVES

In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients' demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status).

METHODS

A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m²; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients' sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients' mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months).

RESULTS

Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η²_p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1.

CONCLUSION

The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.

Associations between 24-h movement behaviours and BMI in Chinese primary- and middle- school students

Purposes

This cross-sectional study aimed to examine the associations between the 24-h movement behaviours and body mass index (BMI) of students from China by using compositional data analysis.

Methods

A total of 389 students aged 6-16 years participated in this study. Accelerometers were used to measure moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LPA), sedentary behaviour (SED), and sleep. Weight and height were objectively measured. The association between 24-h movement and BMI was analyzed by using compositional data analysis.

Results

Time reallocation using minutes and proportions created major differences to the results. Reallocating 10 min from other movement behaviours to MVPA was associated with decreased BMI z-score of 1.372 to 0.158 among primary-school students. Reallocating 10 min from sleep and SED to MVPA, and from sleep and SED to LPA were associated with decreased BMI z-score of 0.505 to 0.017 among middle-school students. Reallocating 10% of time from all other components to SED and sleep were associated with a higher BMI z-score by 0.148 (95%CI: 0.020; 0.276) and 0.125 (95%CI: 0.046; 0.204), while reallocating time to MVPA was associated with a decrease in BMI z-scores of 0.132 (95%CI: -0.193; -0.070) among primary-school students. Reallocating 10% of time from all other components to SED was associated with a higher BMI z-score of 0.254 (95%CI: 0.165; 0.345), whereas reallocating time to MVPA and LPA was associated with a decrease in BMI z-scores of 0.039 (95%CI: -0.073; -0.005) and 0.093 (95%CI: -0.153; -0.033) among middle-school students.

Conclusion

Research results of 10-min one-to-one reallocation may be treated cautiously due to uneven distribution of time in 24-h movement behaviours. Based on the results of 10% one-to-remaining reallocation, replacing SED with MVPA may be an appropriate target for adiposity intervention in primary-school students, while increasing MVPA or LPA at the expense of SED may be effective in controlling adiposity of middle-school students in China.

Factors associated with sleep quality in university students

To investigate factors associated with poor sleep quality. A cross-sectional study was conducted in 2019 with random sampling. Information on sleep was obtained using the Mini Sleep Questionnaire (MSQ). Independent variables included sociodemographic, behavioural, academic and psychological health characteristics. Adjusted analyzes were performed using Poisson regression. A total of 996 undergraduate students participated in the study. The poor sleep quality affected 23.1% of the sample (95%CI 20.5-25.9), ranging from 13.4% for those with little concern about violence in the neighbourhood to 36.5% for those with less social support. In the adjusted analysis, female sex [PR] 1.81; (95%CI 1.33-2.45), concern about violence in the neighbourhood [PR] 2.21; (95%CI 1.48-3.28), discrimination at university [PR] 1.42; (95%CI 1.08-1.86) and food insecurity [PR] 1.45; (95%CI 1.11-1.89) were associated with the presence of poor sleep quality, as well as having less social support and income and suffering psychological distress. The results highlight socioeconomic and mental health factors that affect sleep quality and demonstrate the need for reflection and interventions capable of minimizing this problem.

Sleep quality and mental health during COVID-19: the role of distress tolerance

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted psychological health for many. This study aimed to investigate if distress tolerance, an individual's perceived or actual 'capacity to withstand negative psychological states', helps to explain the relationship between sleep and mental health problems during the COVID-19 pandemic. College students (N = 187) completed questionnaires using an online survey platform between 6 April 2020, and 6 June 2020, during the COVID-19 pandemic. Hierarchical multiple regression analyses were used to examine the indirect effect of distress tolerance on the relationship between sleep quality and mental health. Distress tolerance partially accounted for the relationship between sleep quality and perceived stress but did not help to explain the association between sleep quality and depression or anxiety. Two components of distress tolerance, absorption and appraisal, helped to explain the relationship between sleep quality and all mental health outcomes. These findings help explain how distress tolerance relates to mental health when sleep is negatively impacted. Prospective designs replicating these findings are needed and future research may inform how psychological interventions could target distress tolerance in the context of poor sleep, especially during major stressors.

Effects of Socioeconomic Environment on Physical Activity Levels and Sleep Quality in Basque Schoolchildren

The socioeconomic and built environment of an area are interrelated with health data and have a direct influence on children’s development. There are facilitators and barriers for schools to promote physical activity depending on the socioeconomic status of the school. The aim of this study was to analyse the relationship between physical activity and sleep and the socioeconomic level of children in the Basque Country. The sample consisted of 1139 schoolchildren between the ages of six and seventeen (566 boys and 573 girls) from 75 schools (43 public and 32 private). Differences between groups were compared using the Mann–Whitney U test (two samples), Kruskal–Wallis one-factor ANOVA (k samples), and Spearman’s Rho correlation. There are sex differences in light (200.8 ± 62.5 vs. 215.9 ± 54.7) and moderate (69.0 ± 34.3 vs. 79.9 ± 32.1) physical activity in favour of the female group of higher socioeconomic status compared to male group of higher socioeconomic status. In the case of vigorous physical activity, the female group performed less than the male group across all socioeconomic statuses, which was statistically significant in the groups of high socioeconomic status (11.6 ± 9.3 vs. 6.9 ± 5.7) in group 2 and medium socioeconomic status (11.1 ± 9.3 vs. 7.7 ± 6.1) in group 3. There is an inverse relationship between sedentary behaviour and BMI, total bed time, total sleep time, and night-time awakenings. There is also an inverse relationship between all levels of physical activity performed with respect to BMI and total sleep efficiency. These data point towards notable inequalities in physical activity and daily sleep in Basque schoolchildren, which in turn may be marginalised in our current school system due to the effects of the socioeconomic environment.

Sleep Well, Study Well: A Systematic Review of Longitudinal Studies on the Interplay between Sleep and School Experience in Adolescence

Adolescents spend most of their daily time in school and performing school-related activities. Different aspects of their school experiences, such as school performance, psychological factors related to school, and structural factors, consistently impact adolescents' health and are likely to be intertwined with their sleep (i.e., quantity and quality, sleep disturbances). This systematic review aimed to comprehensively summarize the reciprocal and longitudinal associations between adolescents' sleep and multiple aspects of their school experience. Using multiple search strategies and applying a two-step selection process, 25 journal articles matched the eligibility criteria and were thus included in the review. The results highlighted the contribution of poor sleep quality and sleep disturbances in predicting longitudinal school experiences-related outcomes (i.e., decreasing school engagement and performance, and increasing school-related burnout, absenteeism, and bullying). At the same time, the results showed how experiences related to the school's psychological factors (e.g., high levels of school burnout and stressful environment) and structural characteristics (e.g., early school entrance time) affect youth sleep over time (i.e., decreasing sleep quality and quantity). These main findings provided novel insights into the bidirectional relationship between school experience and sleep health, highlighting the importance of more longitudinal research investigating all aspects of healthy sleep, including the size and direction of the association.

Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea

STUDY OBJECTIVES

The association between obstructive sleep apnea (OSA) and lifestyle habits in children with obesity is largely unknown. This study aimed to determine whether there was an association between lifestyle patterns (sleep quality, physical activity, recreational screen time, and substance use) and OSA presence and severity in children with obesity.

METHODS

This cross-sectional study recruited children with obesity, aged 8-17 years, who were referred to undergo polysomnography. Children completed questionnaires on sleep quality, physical activity, recreational screen time, and substance use. Children also had a diagnostic polysomnography. The association between questionnaire scores and OSA severity, after adjusting for body mass index z-score, age, and sex, was evaluated using negative binomial multiple regression. Correlations were conducted between sleep quality, physical activity, screen time, substance use, and OSA severity.

RESULTS

A total of 100 children were included in the analysis (mean age: 14.3 ± 2.6 years; 44% female; mean body mass index z-score: 2.5 ± 0.4; 65% with OSA). In the adjusted regression analysis, each additional substance-use behavior was associated with a 17% (95% confidence interval: 1%, 36%) increase in OSA severity. Correlations were identified between poorer sleep quality and lower physical activity (r = -.42), poorer sleep quality and more substance-use behaviors (r = .40), and greater physical activity and less substance-use behaviors (r = -.26).

CONCLUSIONS

In children with obesity, more substance-use behaviors were independently associated with greater OSA severity. As there are complex, bidirectional relationships between lifestyle behaviors and OSA severity, interventions need to be comprehensive and multifactorial to ensure successful treatment of OSA and its sequelae in children.

CITATION

Blinder H, Narang I, Chaput J-P, Katz SL; on behalf of the Canadian Sleep and Circadian Network. Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(3):511-518.

Association between poor sleep quality and emotional eating in US Latinx adults and the mediating role of negative emotions

INTRODUCTION

Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities.

OBJECTIVE

To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions.

METHODS

This cross-sectional analysis used data from the Latino Health and Well-being Study. Sleep quality was measured with the Pittsburgh Sleep Quality Index. EE was measured with the EE subscale of the Three Factor Eating Questionnaire R18-V2 (categorized as no EE, low EE, and high EE). Negative emotions were measured via a composite score that included depression, anxiety, and perceived stress. Poisson regression models with robust variance errors estimated prevalence ratios (PR) and 95% confidence intervals (CI). Mediation was evaluated with the Karlsson-Holm-Breen method.

RESULTS

More individuals with poor (vs. good) sleep quality experienced high EE (39.1% vs. 17.9%). Individuals with poor (vs. good) sleep quality were more likely to experience high EE vs. no EE (total effect = 1.74; 95% CI = 1.34, 2.26). Controlling for negative emotions, the effect of poor sleep on high EE was reduced to 1.23 (95% CI = 0.92, 1.65), leaving an indirect effect of 1.41 (95% CI = 1.25, 1.60); 62.6% of the effect was explained by negative emotions.

CONCLUSION

Poor sleep quality was associated with high EE in US Latinx adults and negative emotions partially mediated this relationship. Longitudinal studies are needed. Interventions and clinical programs should concomitantly address sleep quality and negative emotions to help prevent dysfunctional eating behaviors.

Sleep quality and sleep-related issues in industrial workers: a global meta-analysis

Objectives. Sleep-related issues are important health issues. This study aimed to investigate the global prevalence of sleep-related issues in industrial workers. Methods. A syntax of keywords was used to search the PubMed, Web of Science and Scopus databases. The search time was limited to articles published until September 2020, and the search range was in English. Events and samples were extracted for each study to calculate the prevalence. For all subgroups, events and samples were extracted to calculate the results of the subgroups. The random-effects method was used in the analysis. Heterogeneity was examined at the levels of all analyses. Results. Forty-eight articles were included in the analysis as eligible studies. Sleep-related issues have 30% prevalence in the 95% confidence interval (CI) [25, 35%]. The prevalence of sleep-related issues in men was 38%, 95% CI [31, 45%] and in women was 32%, 95% CI [14, 50%]. The prevalence of poor sleep quality, insomnia, sleep duration <7 h, snoring and sleepiness was 36, 22, 37, 29 and 10%, respectively. Conclusions. Sleep-related issues have a high prevalence in industrial workers, and the cause of these differences needs to be addressed and increasing insights provided to prevent and treat sleep disorders.

A systematic review with meta-analyses of the relationship between recurrent binge eating and sleep parameters

BACKGROUND

Sleep problems are known to compound the negative effects of other health issues, such as eating disorders and the associated behavior of binge eating. Previous studies suggested associations between binge eating and sleep problems, but the strength of the relationship is unknown.

METHODS

We conducted a systematic review with meta-analyses examining the relationship between binge eating and sleep parameters. We searched for studies in Scopus, PubMed, and PsycInfo. The quality of evidence, including risk of bias, was assessed with adaptations of the Newcastle-Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, depending on study design. Data was synthesized as the difference in sleep between people who did or did not have binge eating.

RESULTS

Thirty-one reports of studies met our eligibility criteria. Results are presented in 12 meta-analyses. In the 7 reports of studies (with 4448 participants) that assessed poor overall sleep quality, we found poorer overall sleep quality in people with binge eating compared to people without binge eating, with a standardized mean difference of 0.77 (95% confidence interval [CI] 0.61-0.92; P < 0.001), which is a large effect size. In addition, we found evidence that people with binge eating had significantly greater hypersomnia/daytime sleepiness (7 reports of studies with 4370 participants), insomnia (5 reports of studies with 12,733 participants), and difficulty falling asleep (3 reports of studies with 4089 participants) compared to people without binge eating, with moderate effect sizes (standardized mean differences of 0.57-0.66).

CONCLUSIONS

People with binge eating exhibit poorer overall sleep quality compared to people without binge eating, and may also exhibit greater hypersomnia/daytime sleepiness, insomnia, and difficulty falling asleep. It is recommended that healthcare professionals routinely screen for poor overall sleep quality when treating people with binge eating-and address sleep difficulties when present.