Changes in objectively measured sleep after a multidisciplinary lifestyle intervention in children with abdominal obesity: A randomized trial.

Ana Catalán-Lambán, Ana Ojeda-Rodríguez, Amelia Marti Del Moral, Cristina Azcona-Sanjulian

Journal: Sleep medicine 2023;109():252-260

PMID: 37487278

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Plain Language Summary

The main factors that contribute to obesity are genetics, excessive energy intake, decreased physical activity, and sedentarism. Sleep duration, sleep timing and chronotype have also recently been recognised as possible risk factors for obesity in children. The aim of this study was to assess the effectiveness of an intervention (usual care vs. intervention group) on sleep quality and its relationship with changes in biochemical and metabolic syndrome related anthropometric parameters. This study was a randomised controlled trial. The multidisciplinary intervention consisted of a two-year program that comprised a 2-month intensive phase with individual and group sessions and a follow-up period at 12 and 24 months. Subjects were randomly assigned to the usual care or intervention group at a ratio of 1:3. Results showed that a lifestyle intervention improved most sleep parameters in children and adolescents with abdominal obesity. In fact, the lifestyle intervention showed a reduction in anthropometric indexes and several biochemical parameters, and improved sleep quality at 2, 12, and 24 months of follow-up. Decreasing sleep latency, awakenings duration and wakefulness after sleep onset (WASO) also accompanied improved sleep efficiency. Authors conclude that their findings add to the growing body of research on the relationship between sleep and metabolic health outcomes in children, emphasizing the need to consider multiple dimensions of sleep beyond just sleep duration.

Abstract

BACKGROUND/OBJECTIVE

childhood obesity and sleep disorders have a well-established cross-sectional association, but lifestyle interventions' effects on sleep quality remain under-researched. This study aimed to evaluate the sleep quality of 122 participants (7-16 years) with abdominal obesity after a 2-year necessary lifestyle intervention.

PATIENTS/METHODS

participants were assigned to either the intervention group (moderate hypocaloric Mediterranean Diet) or the usual care group (standard recommendations on a healthy diet). Sleep was objectively assessed using triaxial accelerometry, and sleep parameters analyzed included latency, efficiency, wake after sleep onset, total time in bed, total sleep time, number of awakenings, and awakening duration.

RESULTS AND CONCLUSIONS

the results showed that the intervention group significantly improved sleep latency at 12 and 24 months and improved sleep efficiency at 2 and 12 months, compared to the usual care group. Wake after sleep onset and the number of awakenings were significantly reduced at 24 months in the intervention group. Wake after sleep onset and leptin levels were positively associated in all participants. Total time in bed was inversely associated with triglycerides and metabolic score, and total sleep time was inversely associated with leptin, triglycerides, and metabolic score after the 2-month intervention. Triglyceride levels were inversely associated with total time in bed and total sleep time at one year, while the metabolic score was directly associated with wake after sleep onset and the number of awakenings and inversely associated with efficiency. In conclusion, the multidisciplinary intervention in children and adolescents with abdominal obesity reduced anthropometric parameters and improved sleep habits.

Address: Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain.; Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, School of Pharmacy and Nutrition, University of Navarra, Spain; Lipids and Atherosclerosis Unit, Unidad de Gestión Clinica Medicina Interna, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Av. Menendez Pidal, S/N. 14004, Córdoba, Spain.; Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, School of Pharmacy and Nutrition, University of Navarra, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain; Institute of Research of Navarra (IdisNa), Pamplona, Spain.; Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain; Institute of Research of Navarra (IdisNa), Pamplona, Spain. Electronic address: [email protected].

DOI: 10.1016/j.sleep.2023.07.004