May 17, 2011

Obesity, Asthma Can Lead To Sleepiness In Kids

Children who are obese, asthmatic, anxious or depressed are more likely to experience excessive daytime sleepiness (EDS), according to researchers at Penn State College of Medicine.

EDS is the inability to stay awake during daytime hours and often occurs along with other sleep disorders such as sleep apnea -- characterized by pauses in breathing.

"Although EDS in children is commonly assumed by physicians and the public to be the result of sleep-disordered breathing or inadequate sleep, our data suggest that EDS in young children is more strongly associated with obesity and mood issues as it is in adults," said Edward Bixler, Ph.D., professor of psychiatry and vice chair of research at Sleep Research and Treatment Center, and one of the study authors.

"EDS may interfere with daytime functioning in children, including academic performance," Bixler said in a statement. "Although excessive daytime sleepiness in adults has been the focus of extensive research, studies on the risk factors associated with EDS in children have been limited."

The Penn State sleep research team studied 508 children and found that 15 percent of them had EDS.

"Our study indicates that EDS is highly prevalent in children, a symptom that may adversely affect daytime functioning," said Bixler.

The study was conducted in two phases. In the first phase, researchers used a screening questionnaire to identify children at high risk for sleep-disordered breathing. They sent the survey to parents of every student in kindergarten through fifth grade in four different school districts. The questionnaire asked parents for general information about sleep and behavioral patterns in their kids.

In the second phase, the team of researchers randomly selected 200 children each year for five years based on grade, gender and risk for sleep-disordered breathing. In all, 508 children were chosen for the study, including those with medical problems and mental health disorders.

The researchers recorded height, weight, body mass index (BMI), and waist circumference of each child. All children spent one night in a sleep lab and were screened for sleep apnea. Sleep apnea is defined as a pause in breathing of at least five seconds while sleeping.

To assess whether children had EDS, researchers had parents complete a sleep questionnaire. If parents answered yes on one or both of the questions asked, the researchers classified the children as having EDS.

The two questions were: "Does your child have a problem with sleepiness during the day?" and "Has a teacher or other supervisor commented that your child appears sleepy during the day?"

Seventy-seven of the 508 children in the study were classified as having EDS. They ranged in age from 5 to 12 years old. Twenty-five percent were minority, and 51.8 percent were boys.

The team found that waist circumference, asthma, and use of asthma medication, heartburn, and parent-reported symptoms of anxiety and/or depression and sleep difficulty were greatly linked to EDS.

Waist circumference alone contributed to the independent prediction of EDS, suggesting that metabolic factors may play a contributing role in the mechanisms of EDS.

"Primary lines of treatment might include weight loss if the child is overweight, treatment for underlying depressive and anxious symptoms, and implementation of nocturnal asthma prevention methods if the child is diagnosed with asthma," said Bixler.

The study was published in the journal Sleep.


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