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Obesity and Sleep

  • Edward O. BixlerEmail author
  • Alexandros N. Vgontzas
  • Marina Tsaoussoglou
  • Susan L. Calhoun
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

Over the past 15 years, many studies in adults suggest that obesity via inflammation, insulin resistance, visceral adiposity, and central neural mechanisms (e.g., hypofunctioning hypothalamic CRH) play a role in the pathogenesis of sleep apnea, sleepiness, and the associated cardiovascular comorbidities. In contrast to adults, in children, until recently, the predominant belief was that anatomic rather than metabolic factors were primary in the development of sleep-disordered breathing (SDB). Adenotonsillectomy is the first line of treatment while the potential role of obesity has been overlooked. However, in the Penn State Child Cohort, obesity was the strongest risk factor for mild and moderate SDB. This chapter reviews studies that show that SDB in obese children shares many similarities with SDB in obese adults. Both SDB and obesity appear to be associated with increased excessive daytime sleepiness (EDS), inflammatory markers, and leptin and a decrease in adiponectin.

Keywords

Obstructive Sleep Apnea Waist Circumference Sleep Apnea Obese Child Daytime Sleepiness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Schwab RJ. Pro: sleep apnea is an anatomic disorder. Am J Respir Crit Care Med. 2003;168(3):270–1. discussion 273.PubMedCrossRefGoogle Scholar
  2. 2.
    Strohl KP. Con: sleep apnea is not an anatomic disorder. Am J Respir Crit Care Med. 2003;168(3):271–2. discussion 272–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K, Chrousos GP. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab. 1997;82(5):1313–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Shinohara E, Kihara S, Yamashita S, et al. Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J Intern Med. 1997;241(1):11–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85(3): 1151–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001;86(2):517–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2003;167(9):1181–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Shahar E, Redline S, Young T, et al. Hormone replacement therapy and sleep-disordered breathing. Am J Respir Crit Care Med. 2003;167(9):1186–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Vgontzas AN, Zoumakis E, Bixler EO, et al. Selective effects of CPAP on sleep apnoea-associated manifestations. Eur J Clin Invest. 2008;38(8):585–95.PubMedCrossRefGoogle Scholar
  10. 10.
    Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23): 3015–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Johansson K, Neovius M, Lagerros YT, et al. Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ. 2009;339:b4609.PubMedCrossRefGoogle Scholar
  12. 12.
    Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP. Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab. 2004;89(9):4409–13.PubMedCrossRefGoogle Scholar
  13. 13.
    Basta M, Lin HM, Pejovic S, Sarrigiannidis A, Bixler E, Vgontzas AN. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med. 2008;4(1):19–25.PubMedGoogle Scholar
  14. 14.
    Polotsky VY, Smaldone MC, Scharf MT, et al. Impact of interrupted leptin pathways on ventilatory control. J Appl Physiol. 2004;96(3):991–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Vgontzas AN, Pejovic S, Zoumakis E, et al. Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: effects of continuous positive airway pressure therapy. J Clin Endocrinol Metab. 2007;92(11):4199–207.PubMedCrossRefGoogle Scholar
  16. 16.
    Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1527–32.PubMedGoogle Scholar
  17. 17.
    Marcus CL, Omlin KJ, Basinki DJ, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992;146(5 Pt 1):1235–9.PubMedGoogle Scholar
  18. 18.
    Lofstrand-Tidestrom B, Thilander B, Ahlqvist-Rastad J, Jakobsson O, Hultcrantz E. Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children. Eur J Orthod. 1999;21(4): 323–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Brunetti L, Rana S, Lospalluti ML, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest. 2001;120(6):1930–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Bixler EO, Vgontzas AN, Lin HM, et al. Sleep-disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32(6):731–6.PubMedGoogle Scholar
  21. 21.
    Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149(6):803–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol. 1996;21(3):176–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Gozal D, Wang M, Pope Jr DW. Objective sleepiness measures in pediatric obstructive sleep apnea. Pediatrics. 2001;108(3):693–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Lim J, McKean M. Adenotonsillectomy for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2003(1):CD003136.Google Scholar
  25. 25.
    Brietzke SE, Gallagher D. The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg. 2006;134(6):979–84.PubMedCrossRefGoogle Scholar
  26. 26.
    van Staaij BK, van den Akker EH, Rovers MM, Hordijk GJ, Hoes AW, Schilder AG. Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial. BMJ. 2004;329(7467):651.PubMedCrossRefGoogle Scholar
  27. 27.
    Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev. 2003;7(1):61–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005;90(8):4510–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Vgontzas AN, Bixler EO, Tan TL, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med. 1998;158(12):1333–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Gozal D, Kheirandish-Gozal L. Neurocognitive and behavioral morbidity in children with sleep disorders. Curr Opin Pulm Med. 2007;13(6):505–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998;102(3 Pt 1):616–20.PubMedCrossRefGoogle Scholar
  32. 32.
    Bixler EO, Vgontzas AN, Lin HM, et al. Blood pressure associated with sleep-disordered breathing in a population sample of children. Hypertension. 2008;52(5):841–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics. 2004;114(3):768–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Gozal D, Kheirandish-Gozal L. Obesity and excessive daytime sleepiness in prepubertal children with obstructive sleep apnea. Pediatrics. 2009;123(1):13–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Tsaoussoglou M, Bixler EO, Calhoun S, Chrousos GP, Sauder K, Vgontzas AN. Sleep-disordered breathing in obese children is associated with prevalent excessive daytime sleepiness, inflammation, and metabolic abnormalities. J Clin Endocrinol Metab. 2010;95(1):143–50.PubMedCrossRefGoogle Scholar
  36. 36.
    Mayes SD, Calhoun SL, Bixler EO, et al. ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. J Pediatr Psychol. 2009;34:328–37.PubMedCrossRefGoogle Scholar
  37. 37.
    Vgontzas AN. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem. 2008;114(4):211–23.PubMedCrossRefGoogle Scholar
  38. 38.
    Ronchetti R, Villa MP, Matricardi PM, et al. Association of asthma with extra-respiratory symptoms in schoolchildren: two cross-sectional studies 6 years apart. Pediatr Allergy Immunol. 2002;13(2): 113–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Desager KN, Nelen V, Weyler JJ, De Backer WA. Sleep disturbance and daytime symptoms in wheezing school-aged children. J Sleep Res. 2005;14(1): 77–82.PubMedCrossRefGoogle Scholar
  40. 40.
    Tauman R, O’Brien LM, Gozal D. Hypoxemia and obesity modulate plasma C-reactive protein and interleukin-6 levels in sleep-disordered breathing. Sleep Breath. 2007;11(2):77–84.PubMedCrossRefGoogle Scholar
  41. 41.
    Larkin EK, Rosen CL, Kirchner HL, et al. Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation. 2005;111(15):1978–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Tam CS, Wong M, McBain R, Bailey S, Waters KA. Inflammatory measures in children with obstructive sleep apnoea. J Paediatr Child Health. 2006;42(5):277–82.PubMedCrossRefGoogle Scholar
  43. 43.
    Kaditis AG, Alexopoulos EI, Kalampouka E, et al. Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing. Am J Respir Crit Care Med. 2005;171(3):282–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259(5091):87–91.PubMedCrossRefGoogle Scholar
  45. 45.
    Reid MB, Lannergren J, Westerblad H. Respiratory and limb muscle weakness induced by tumor necrosis factor-alpha: involvement of muscle myofilaments. Am J Respir Crit Care Med. 2002;166(4):479–84.PubMedCrossRefGoogle Scholar
  46. 46.
    Wilcox PG, Wakai Y, Walley KR, Cooper DJ, Road J. Tumor necrosis factor alpha decreases in vivo diaphragm contractility in dogs. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1368–73.PubMedGoogle Scholar
  47. 47.
    Wilcox P, Milliken C, Bressler B. High-dose tumor necrosis factor alpha produces an impairment of hamster diaphragm contractility. Attenuation with a prostaglandin inhibitor. Am J Respir Crit Care Med. 1996;153(5):1611–5.PubMedGoogle Scholar
  48. 48.
    Li X, Moody MR, Engel D, et al. Cardiac-specific overexpression of tumor necrosis factor-alpha causes oxidative stress and contractile dysfunction in mouse diaphragm. Circulation. 2000;102(14):1690–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Tauman R, Ivanenko A, O’Brien LM, Gozal D. Plasma C-reactive protein levels among children with sleep-disordered breathing. Pediatrics. 2004;113: e564–9.PubMedCrossRefGoogle Scholar
  50. 50.
    O’Brien LM, Serpero LD, Tauman R, Gozal D. Plasma adhesion molecules in children with sleep-disordered breathing. Chest. 2006;129(4):947–53.PubMedCrossRefGoogle Scholar
  51. 51.
    Shamsuzzaman AS, Winnicki M, Wolk R, et al. Independent association between plasma leptin and C-reactive protein in healthy humans. Circulation. 2004;109(18):2181–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Leyva F, Godsland IF, Ghatei M, et al. Hyperleptinemia as a component of a metabolic syndrome of cardiovascular risk. Arterioscler Thromb Vasc Biol. 1998;18(6):928–33.PubMedCrossRefGoogle Scholar
  53. 53.
    Tauman R, Serpero LD, Capdevila OS, et al. Adipokines in children with sleep-disordered breathing. Sleep. 2007;30(4):443–9.PubMedGoogle Scholar
  54. 54.
    Gilardini L, McTernan PG, Girola A, et al. Adiponectin is a candidate marker of metabolic syndrome in obese children and adolescents. Atherosclerosis. 2006; 189(2):401–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Cruz M, Garcia-Macedo R, Garcia-Valerio Y, et al. Low adiponectin levels predict type 2 diabetes in Mexican children. Diabetes Care. 2004;27(6):1451–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Spranger J, Kroke A, Mohlig M, et al. Adiponectin and protection against type 2 diabetes mellitus. Lancet. 2003;361(9353):226–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Verhulst SL, Rooman R, Van Gaal L, De Backer W, Desager K. Is sleep-disordered breathing an additional risk factor for the metabolic syndrome in obese ­children and adolescents? Int J Obes (Lond). 2009; 33(1): 8–13.CrossRefGoogle Scholar
  58. 58.
    Hannon TS, Lee S, Chakravorty S, Lin Y, Arslanian SA. Sleep-disordered breathing in obese adolescents is associated with visceral adiposity and markers of insulin resistance. Int J Pediatr Obes. 2011;6:157–60.PubMedCrossRefGoogle Scholar
  59. 59.
    Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev. 2005;9(3):211–24.PubMedCrossRefGoogle Scholar
  60. 60.
    Calhoun SL, Vgontzas AN, Mayes SD, et al. Prenatal and perinatal complications: is it the link between race, SES and childhood sleep-disordered breathing? J Clin Sleep Med. 2010;6:264–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Edward O. Bixler
    • 1
    Email author
  • Alexandros N. Vgontzas
    • 1
  • Marina Tsaoussoglou
    • 1
  • Susan L. Calhoun
    • 1
  1. 1.Sleep Research and Treatment Center, Department of PsychiatryPennsylvania State University College of MedicineHersheyUSA

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