Original article
Association between Inadequate Sleep and Insulin Resistance in Obese Children

https://doi.org/10.1016/j.jpeds.2006.08.063Get rights and content

Objective

To analyze the relationships between sleep duration, obstructive sleep apnea syndrome (OSAS), and markers of insulin resistance in obese children.

Study design

Forty obese children were evaluated for sleep-related complaints. Each child underwent a polysomnogram, an oral glucose tolerance test (OGTT), and fasting lipid panel tests. Indices of insulin resistance (HOMA-IR and WBISI) and insulin secretion (IGI) were calculated based on the results of the OGTT. Markers of insulin resistance were compared among groups categorized according to polysomnogram results.

Results

Subjects with shorter sleep duration had higher fasting insulin, peak insulin, and HOMA-IR levels and lower WBISI levels, findings suggestive of insulin resistance. In contrast, differences in body mass index z scores were not observed. Subjects with OSAS (32 of 40 children) had higher triglyceride levels and HOMA-IR values than those without OSAS, but did not differ in sleep duration. Multiple linear regression analysis revealed that HOMA-IR was significantly correlated with age, sleep duration, and percentage of rapid-eye-movement sleep.

Conclusions

Insulin resistance in obese children is associated with short sleep duration and OSAS.

Section snippets

Methods

We reviewed the outpatient charts of 40 obese children (body mass index [BMI] > 95th percentile for age and sex) who had been followed in the Weight Management Center of the Section of Endocrinology and Diabetes at St Christopher’s Hospital for Children. Charts were included for review if patients were obese, had completed an oral glucose tolerance test (OGTT) and a fasting lipid panel, and, because of sleep-related complaints, had completed an overnight multichannel polysomnogram at the Sleep

Results

The charts of 40 obese children were reviewed (20 males; age range, 3.5 to 18.5 years; mean age, 12.3 years) (Table I). The mean total sleep duration measured was 373.4 ± 73 minutes. Fourteen subjects slept for < 6 hours. One subject slept for 15.5 minutes (parental termination of the sleep study); this subject’s data were not included in this analysis. When we divided our cohort into 2 groups according to sleep duration, we found higher fasting insulin (P = .02), peak insulin (P = .02), and

Discussion

Sleep loss is becoming increasingly prevalent in both adults and in children. The decline in sleep duration has paralleled a dramatic increase in the prevalence of obesity and diabetes. Recent data suggest that these two epidemics may have a mechanistic relationship. Our findings indicate a link between decreased sleep duration and increased insulin resistance in obese children. Children with short sleep duration have greater insulin resistance than children with normal sleep duration. In

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