Association between sleep duration,weight gain,and obesity for long period

BackgroundAlthough previous studies showed the long-term effects of sleep duration on risk of weight gain, Western tends to gain weight irrespective of sleep duration over a long period. Conversely, it is showed that body mass index (BMI) decreases during a long period in Japanese and thus, the long-term effect of sleep duration on weight gain and obesity is still unclear in Asia.MethodsWe followed up 13,629 participants aged 40–79 years and prospectively collected data from 1995 to 2006. We divided the participants into five groups according to their self-reported sleep duration: ⩽5 h (short sleep), 6 h, 7 h (reference), 8 h, and ⩾9 h (long sleep). The main outcome was ⩾5 kg weight gain or BMI ⩾ 25 kg/m² (obesity). We used logistic regression analyses to derive odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for several confounding factors.ResultsWe observed no association between sleep duration and risk of ⩾5 kg weight gain and obesity. After stratification by BMI, long sleepers had a significantly increased risk of ⩾5 kg weight gain (OR: 1.36, 95%CI: 1.09–1.70) in obese participants.ConclusionsAmong community-dwelling Japanese, only obese long sleepers have a significantly increased long-term risk of ⩾5 kg weight gain.     

Gender differences in nighttime sleep and daytime napping as predictors of mortality in older adults: The Rancho Bernardo Study

ObjectiveMany studies suggest optimal sleep duration for survival is 7–8 h/night. We report the gender-specific independent association of all-cause mortality with nighttime sleep and daytime nap duration in older adults who were followed for up to 19 years.MethodsBetween 1984 and 1987, 2001 community-dwelling, mostly retired, adults (1112 women), age 60–96 years, answered questions about health, mood, medications, life-style, daytime napping, and nighttime sleep duration. Vital status was confirmed for 96% through July 2001.ResultsAt baseline, men reported significantly longer nighttime sleep and daytime napping than women. In both men and women, nighttime sleep <6 h was associated with depressed mood and sleep-related medication, and ⩾9 h was associated with more alcohol consumption. Napping ⩾30 min was associated with prevalent depressed mood, coronary heart disease, and cancer. Of the group, 61% died over the next 19 years, at an average age of 85.6 years. Mortality risk was lowest among those sleeping 7–7.9 h/night in both men and women. Multiple-adjusted analyses showed that increased mortality was associated with nighttime sleep ⩾9 h in women (HR 1.51: 95% CI = 1.05–2.18), and with daytime napping ⩾30 min in men (HR 1.28: 95% CI, 1.00–1.64).ConclusionsMechanisms for these differences are unknown.     

Prevalence of excessive daytime sleepiness in a sample of the Australian adult population

ObjectivesExcessive daytime sleepiness (EDS) is associated with significant personal and medical burden. However, there is little indication of the impact of these symptoms in the broader population.Participants and methodsWe studied 946 men ages 24–92 years (median age, 59.4 [interquartile range {IQR}, 45–73 years]) and 1104 women ages 20–94 years (median age, 50 [IQR, 34–65 years]) who resided in the Barwon Statistical Division, South-Eastern Australia, and participated in the Geelong Osteoporosis Study (GOS) between the years of 2001 and 2008. EDS was defined as an Epworth Sleepiness Scale (ESS) score of ⩾10. Lifestyle factors, history of medical conditions, and medication history were documented by self-report.ResultsFor men, the age-specific prevalence of EDS was 5.1% (ages 20–29 years), 6.4% (ages 30–39 years), 9.8% (ages 40–49 years), 15.5% (ages 50–59 years), 12.0% (ages 60–69 years), 12.0% (ages 70–79 years), and 29.0% (ages ⩾80 years). For women, the age-specific prevalence of EDS was 14.7% (ages 20–29 years), 8.7% (ages 30–39 years), 15.0% (ages 40–49 years), 16.0% (ages 50–59 years), 12.6% (ages 60–69 years), 13.2% (ages 70–79 years), and 17.0% (ages ⩾80 years). Overall standardized prevalence of EDS was 10.4% (95% confidence interval, 9.7–11.2) for men and 13.6% (95% confidence interval, 12.8–14.4) for women.ConclusionsThe prevalence of EDS increased with age, affecting approximately one-third of those aged ⩾80 years. Because EDS has been associated with poorer health outcomes in the older age strata, these findings suggest that routine screening may be beneficial in ongoing health assessments for these individuals. Overall, more than one-tenth of the Australian adult population has EDS, which is indicative of possible underlying sleep pathology.     

Sleep–wake habits in Spanish primary school children

IntroductionSleep deficit in children has been associated with psychological and behavioral health alterations as well as an increased incidence of obesity and accidents. Several studies have assessed the effects of poor sleep patterns on adolescents and young adults; however few studies have been conducted in children and pre-teenagers. The main objective of this study was to examine sleep habits in primary school children.MethodsThe parents of primary school children in Alcoy (Spain) kept a sleep diary for their children for 1 week. Parents were asked to record the time their children went to bed, woke up and got out of bed, as well as sleep latency and total sleep time on schooldays and weekends. The data were analyzed and differences according to grade and gender were noted.ResultsThree hundred twenty-one sleep diaries were studied; 53% were from boys and 47% from girls. As grade increased, children went to bed later and slept less (p < 0.001). Children slept more hours on weekend than during the week. There was a substantial gender difference at the highest grade level: girls slept 23 min more than boys on weekends (p < 0.001). Sleep latency was greater than 20 min in 19% of children, primarily in girls 10–12 years of age. There were a considerable percentage of children in each group who slept less than average for their age.ConclusionSleep patterns in primary school children have been underreported. There appears to be insufficient sleep and delayed sleep-phase patterns among pre-teenagers.     

Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series

ObjectiveTo provide a 16-year update from the authors’ 1996 report documenting a 38% conversion from idiopathic rapid eye movement sleep behavior disorder (iRBD) to a parkinsonian disorder at a mean interval of nearly 13 years after the onset of iRBD in a series of 29 males ⩾50 years old.MethodsThe methods of evaluation, diagnosis and follow-up were previously described in the 1996 report. All patients had video-polysomnography (vPSG) confirmed RBD.Results80.8% (21/26) of patients who were initially diagnosed with iRBD eventually developed parkinsonism/dementia (three of the original 29 patients were lost to follow-up). The distribution of diagnoses was as follows: n = 13, Parkinson’s disease (PD); n = 3, dementia with Lewy bodies (DLB); n = 1, dementia (unspecified; profound); n = 2, multiple system atrophy (MSA); n = 2, clinically diagnosed Alzheimer’s Disease (AD) with autopsy-confirmed combined AD plus Lewy body disease pathology. Among the 21 iRBD “converters,” the mean age (±SD) of iRBD onset was 57.7 ± 7.7 years; mean age (±SD) of parkinsonism/dementia onset was 71.9 ± 6.6 years; and mean interval (±SD) from iRBD onset to parkinsonism/dementia onset was 14.2 ± 6.2 years (range: 5–29 years).ConclusionThe vast majority of men ⩾50 years old initially diagnosed with iRBD in this study eventually developed a parkinsonian disorder/dementia, often after a prolonged interval from onset of iRBD, with the mean interval being 14 years while the range extended to 29 years. Also, the specificity of iRBD converting to parkinsonism/dementia is striking. These findings carry important clinical and research implications in the convergent fields of sleep medicine, neurology, and neuroscience, and identify an optimal clinical group for conducting prospective research studies utilizing putative neuroprotective agents to delay the emergence of, or halt the progression to, parkinsonism and/or cognitive impairment as manifestations of either PD, DLB or MSA.     

Trilevel adaptive servoventilation for the treatment of central and mixed sleep apnea in chronic heart failure patients

BackgroundSleep-disordered breathing (SDB) in patients with heart failure (HF) is of major prognostic impact, though treatment of simultaneously occurring central and mixed apnea events is challenging. The objective was to examine long-term effects of a new trilevel adaptive servoventilation (ASV) therapy in patients with systolic or diastolic HF.MethodsA total of 45 consecutive patients with a history of HF, elevated N-terminal prohormone of brain natriuretic peptide levels, objective signs of cardiac dysfunction, and moderate to severe SDB (apnea-hypopnea index [AHI] ⩾15/h) with combined central and mixed respiratory events were included in this study and ASV therapy (SOMNOvent CR, Weinmann) was offered.ResultsIn 38 patients (84%), ASV therapy was successfully initiated, with 23 (51%) patients showing appropriate compliance (device use ⩾4 h/night for ⩾5 d/w) after 3.6 ± 1.2 months. In these patients ASV therapy and HF status were re-evaluated. A sustained reduction was achieved in AHI (42.8 ± 17.5/h vs 8.9 ± 5.8/h; p < 0.001) and oxygen saturation. Improvements also were recorded in New York Heart Association (NYHA) functional class (2.4 ± 0.5–1.9 ± 0.4; p < 0.001) and oxygen uptake during cardiopulmonary exercise testing (VO₂ peak, 13.64 ± 3.5–15.8 ± 5.8 ml/kg/min; p < 0.002).ConclusionIn selected HF patients, trilevel ASV therapy is able to treat SDB with combined central and mixed respiratory events. This treatment is associated with an improvement in HF symptoms and objective cardiopulmonary performance.     

Religiosity is a protective factor against self-injurious thoughts and behaviors in Jewish adolescents: Findings from a nationally representative survey

PurposeFew studies have investigated the association between religiosity and self-injurious thoughts and behaviors specifically in adolescents, yielding inconsistent results. To date, no study has examined this relationship in a Jewish adolescent cohort.MethodsSelf-injurious thoughts and behaviors, as well as depression, were assessed in a nationally representative sample of Jewish adolescents (n = 620) and their mothers, using the Development and Well-Being Assessment Inventory (DAWBA) structured interview. Degree of religiosity was obtained by a self-report measure.ResultsUsing multivariate analysis, level of religiosity was inversely associated with self-injurious thoughts and behaviors (Wald χ² = 3.95, P = 0.047), decreasing the likelihood of occurrence by 55% (OR = 0.45, 95% CI 0.2–0.99), after adjusting for depression and socio-demographic factors. This model (adjusted R² = 0.164; likelihood ratio χ² = 7.59; df = 1; P < 0.047) was able to correctly classify 95.6% of the patients as belonging either to the high or low risk groups.ConclusionThis is the first study demonstrating religiosity to have a direct independent protective effect against self-injurious thoughts and behaviors in Jewish adolescents. This finding has clinical implications regarding risk assessment and suicide prevention. Further research can potentially elucidate the complex relationship between religiosity, self-injury and suicide in this population.     

The association between short sleep and obesity after controlling for demographic,lifestyle, work and health related factors

ObjectiveThe relationship between short sleep and obesity remains unclear, and a possible explanation is that many studies have not included sufficient control variables in the analyses. We examined the association between sleep and being overweight or obese after adjusting for the confounding contributions of 17 variables.MethodsA random sample of 1162 Australian adults from three regional cities in central Queensland, Australia, participated in a telephone survey. A series of increasingly complex multinomial logistic regression models were employed to assess the association between short sleep (⩽6 h) being overweight (body mass index [BMI] 25–29.99 kg/m²) and obesity (BMI, ⩾30 kg/m²), while controlling for several demographic, lifestyle, work, and health-related variables.ResultsThe results suggested obesity was significantly associated with short sleep, age, male gender, lower education level, less physical activity, more sitting time, working longer hours, drinking more alcohol, having diabetes mellitus (DM), and having hypertension. Being overweight was significantly associated with age, male gender, smoking, and working more than 43 hours per week.ConclusionsAfter adjustment of several confounding variables, a significant association between short sleep and obesity was obtained, but there was no association between short sleep and being overweight. Additional studies applying comprehensive analytic models and stronger research designs are needed to confirm our findings.     

Sleep duration and obesity in a population-based study

BackgroundPrevious studies have demonstrated an association between sleep duration and obesity, but few population-based studies have examined the association. We examined the relationship between recent and usual lifetime sleep duration with the odds of obesity in 5549 women that participated in a population-based telephone survey.MethodsThe structured telephone interview included questions on usual sleep duration in adult life and the recent past, as well as height and weight and other demographic and lifestyle characteristics. We examined odds of overweight (BMI: 25–29.9 kg/m²), obesity (BMI: 30–39.9 kg/m²) and extreme obesity (BMI: ?40 kg/m²) according to reported sleep duration.ResultsCompared to women who slept 7–7.9 h per night, women who slept an average of <6 h per night in the recent past had significantly greater odds of obesity (Odds Ratio [OR]: 1.89; 95% Confidence Interval [CI]: 1.45–2.47) and extreme obesity (OR: 3.12; CI: 1.70–5.75), adjusting for potential confounding factors. Weaker associations were noted for short lifetime sleep duration. Current short sleep (<7 h) was associated with greater odds of obesity (?30 kg/m²) in those reporting less than 7 h (OR: 1.59; 95% CI: 0.93–2.78) and in those reporting 8 or more hours (OR: 1.75; 95% CI: 1.33–2.32) of sleep throughout adult life.ConclusionsCurrent short sleepers were more likely to be obese regardless of their usual sleep duration earlier in life. These findings do not support the hypothesis that sleep duration is a causal factor in obesity.     

The sleep macroarchitecture of children at risk for depression recruited in sleep centers

ObjectiveThe primary aim of this study was to compare the sleep macroarchitecture of children and adolescents whose mothers have a history of depression with children and adolescents whose mothers do not.MethodPolysomnography (PSG) and Holter electroencephalogram (EEG) were used to compare the sleep architecture of 35 children whose mothers had at least one previous depressive episode (19 boys, aged 4–18 years, “high-risk” group) and 25 controls (13 males, aged 4–18 years, “low-risk” group) whose mothers had never had a depressive episode. The total sleep time, wakefulness after sleep onset (WASO), sleep latency, sleep efficiency, number of awakenings per hour of sleep, percentages of time spent in each sleep stage, rapid eye movement (REM) latency and the depressive symptoms of participants were measured.ResultsIn children (4–12 years old), the high-risk group exhibited significantly more depressive symptoms than controls (P = 0.02). However, PSG parameters were not significantly different between high-risk children and controls. In adolescents (13–18 years old), the high-risk subjects presented with significantly more depressive symptoms (P = 0.003), a significant increase in WASO (P = 0.019) and a significant decrease in sleep efficiency compared to controls (P = 0.009).ConclusionThis study shows that children and adolescents born from mothers with a history of at least one depressive episode had significantly more depressive symptoms than controls. However, only high-risk adolescents presented with concurrent alterations of sleep macroarchitecture.     

Clinical significance of sleep-disordered breathing induced by sedatives during ablation of atrial fibrillation

BackgroundSleep-disordered breathing (SDB) frequently is induced by sedation during ablation of atrial fibrillation (AF). We tested whether or not sedative-induced SDB is associated with clinical sleep apnea syndrome (SAS).MethodsWe examined SDB observed during intra-ablation sedation with a novel portable respiratory monitor (PM), SD-101, in 140 patients undergoing AF ablation without any known SAS. A sleep study was repeated the next night of the ablation with the simultaneous use of the SD-101 and type 3 PM, APNOMONITOR V.ResultsThe respiratory disturbance index (RDI) during sedation (20.0 ± 7.8 events/h) was significantly correlated with the RDI measured by the SD-101 during the night (15.8 ± 13.7 events/h; r = 0.50) and the RDI assessed by the APNOMONITOR V during the night (12.7 ± 12.3 events/h; r = 0.55). An excellent agreement was found between the RDIs simultaneously measured with the 2 PMs (intraclass correlation coefficient, 0.84), especially for an RDI of ⩾30 events/h (κ statistic value, 0.82). The area under the receiver-operating characteristic curve for the RDI with the use of the SD-101 during sedation to identify the patients with an RDI of ⩾30 events/h by both PMs during the night was 0.92. A left atrial diameter of >40 mm (odds ratio [OR], 4.10) and an RDI during sedation of >20 events/h (OR, 17.75) were independently associated with having an RDI of ⩾30 events/h with both PMs during the night.ConclusionsFrequent episodes of sedative-induced SDB may have a diagnostic value for SAS in patients with AF.     

Sleep bruxism,snoring, and headaches in adolescents: short-term effects of a mandibular advancement appliance

ObjectivesSleep bruxism (SB) frequently is associated with other sleep disorders and pain concerns. Our study assesses the efficacy of a mandibular advancement appliance (MAA) for SB management in adolescents reporting snoring and headache (HA).MethodsSixteen adolescents (mean age, 14.9 ± 0.5) reporting SB, HA (>1 d/wk), or snoring underwent four ambulatory polysomnographies for baseline (BSL) and while wearing MAA during sleep. MAA was worn in three positions (free splints [FS], neutral position [NP], and advanced to 50% of maximum protrusion [A50]) for 1 week each in random order (FS–NP–A50 or NP–A50–FS; titration order, NP–A50). Reports of HA were assessed with pain questionnaires.ResultsOverall, sleep variables did not differ across the four nights. SB index decreased up to 60% with MAA in A50 (P = .004; analysis of variance). Snoring was measured as the percentage of sleep time spent snoring. The subgroup of snorers (n = 8) showed significant improvement with MAA (−93%; P = .002). Initial HA intensity was reported at 42.7 ± 5/100 mm, showing a decreasing trend with MAA (−21% to −51%; P = .07).ConclusionShort-term use of an MAA appears to reduce SB, snoring, and reports of HA. However, interactions between SB, breathing during sleep, and HA as well as the long-term effectiveness and safety of MAA in adolescents need further investigation.     

Sleep duration and abnormal serum lipids: the China Health and Nutrition Survey

ObjectiveTo examine the associations between sleep duration and total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), and lipoprotein (a) [Lp(a)].MethodsThe present study analyzed 8574 adults from the China Health and Nutrition Survey (2009). Sleep duration was classified into ⩽6, 7, 8, 9, and ⩾10 h. Age, education, occupation, current smoking, current drinking, physical activity, body mass index, hypertension, and diabetes were adjusted as confounders in gender-stratified multiple logistic regression models.ResultsCompared with women reporting 8 h sleep duration, the odds ratios (ORs) and 95% confidence intervals (CIs) of high TC for those with ⩽6, 7, 9, and ⩾10 h were 1.65 (1.32–2.06), 1.19 (1.00–1.43), 1.11 (0.89–1.39), and 1.27 (1.02–1.60) after adjusting for confounders. Likewise, the ORs (95% CIs) of high LDL-C were 1.71 (1.28–2.29), 1.36 (1.05–1.76), 1.04 (0.74–1.46), and 1.09 (0.78–1.53), whereas those of high ApoB were 1.80 (1.34–2.42), 1.15 (0.88–1.52), 0.95 (0.66–1.35), and 1.00 (0.70–1.43) for women with ⩽6, 7, 9, and ⩾10 h sleep duration, respectively. These associations were not statistically significant in men.ConclusionsBoth shorter and longer sleep durations were associated with higher risks of abnormal serum lipid profiles in women but not in men.     

An epidemological study of obsessive compulsive disorder in adolescents from India

ObjectivesThere is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12–18 years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse.Method7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule–Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2 weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment.ResultsIn the sample, 50.3% were males with a mean age of 15.2 years (range of 12–18 years). The response rate was 97.3% (7380 valid responses). 0.8% (n = 61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p = 0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p < 0.01) suicide attempts (24.6 vs. 3.8%, p < 0.01), ADHD (28 vs. 4%, p < 0.001), sexual abuse (24.6 vs. 4.2%, p < 0.01), and tobacco use (23 vs. 6.8%, p = 0.01). They also reported greater psychological distress and poorer academic performance.ConclusionsOCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.     

Continuity and discontinuity of trouble sleeping behaviors from early childhood to young adulthood in a large Australian community-based-birth cohort study

ObjectiveTo examine the continuity and discontinuity of trouble sleeping behaviors (TSB) from childhood to adolescence and young adulthood in a community-based prospective birth cohort study.MethodsThe original study comprised 7223 mother–offspring pairs who were followed prospectively at pregnancy, 6 months, 5, 14 and 21 years post-delivery. Participant numbers differ by follow-up stages. There were 3184 offspring for whom we have consistently collected information on TSB retrospectively at 2–4 years, and prospectively at 14 and 21 years of age.ResultsThese comprised maternal-reported offspring TSB at 2–4 years and 14 years, and offspring-reported trouble sleeping at 14 and 21 years. One in two children had persistent trouble sleeping from 2–4 to 14 years and two-thirds from 14 to 21 years. In the adjusted analysis, compared with 2–4-years-old children with no trouble sleeping, those who experienced trouble sleeping were 1.20 (95% CI: 1.00, 1.44) times more likely to have trouble sleeping at 21 years. Similarly, adolescents who experienced trouble sleeping were 1.94 (95% CI: 1.66, 2.27) times more likely to experience trouble sleeping at 21 years.ConclusionsThere is a continuity of TSB from early childhood through adolescence and young adulthood, although the persistence of TSB is strongest from adolescence to young adulthood. Interventions improving sleep in young children may prevent longer term difficulties in adolescents and young adults.     

Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic

BackgroundObstructive sleep apnea/hypopnea syndrome (OSAHS) is a major cause of morbidity and mortality. Different clinical models and questionnaires have been used to evaluate patients with the highest OSAHS probability.ObjectivesTo evaluate the clinical utility of five different questionnaires – STOP, STOPBang (SB), Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS), and 4-Variable Screening Tool (4-V) – in a sleep clinic in order to identify patients at risk for OSAHS and to assess the best possible combination of these tools.Methods1853 (74.4% males) patients (mean age 52 ± 14 years; mean body mass index 32.8 ± 7 kg/m²) visiting a sleep clinic were studied retrospectively.ResultsSB had the highest sensitivity (97.6%), the largest area under the receiver operating characteristics curve (AUC) (0.73; 95% CI, 0.7–0.76) and best OR (5.9; 95% CI, 3.6–9.5), but the lowest specificity (12.7%) for AHI ⩾15. The 4-V ⩾14 had the highest specificity (74.4%) followed by ESS (67%). BQ had good sensitivity (87%), worse specificity (33%) than 4-V and ESS but better than STOP (13%) and SB (12.7%). The combination of questionnaires did not improve their predictive value.ConclusionsSB had the highest sensitivity, OR, and AUC, but rather low specificity, and 4-V the highest specificity. The combination of different questionnaires did not improve their predictive value.     

Verbal school bullying and life satisfaction among Brazilian adolescents: Profiles of the aggressor and the victim

BackgroundBullying is a common occurrence in adolescence that may damage the physical and emotional health.ObjectiveThe purpose of the present cross-sectional study was to analyze the profile of the adolescent aggressor only, aggressor/victim, victim only, and those not involved in verbal school bullying, and to associate their profiles with life satisfaction and familial characteristics evaluated through socioeconomic status.Subjects and methodsA cross-sectional study was carried out with 366 Brazilian adolescents between 13 and 15 years. Verbal school bullying was identified using the Brazilian National School-Based Adolescent Health Survey (PeNSE) questionnaire. The life satisfaction of the adolescents was assessed using the Multidimensional Life Satisfaction Scale for Adolescents (MLSSA). Statistical analyses involved the chi-square test, Fisher's exact test and the Poisson regression with robust variance.ResultsSixty-six adolescents (18%) were aggressors, 5.5% were victims, 2.7% were both aggressor and victim, and 73.8% were not involved in verbal school bullying. Most aggressors were male (PR = 1.97, 95% CI: 1.23–3.14) and were satisfied with their family life (PR = 2.13, 95% CI: 1.18–3.8). Victims of verbal school bullying exhibited a low prevalence of non-violence (PR = 0.24, 95% CI: 0.09–0.64). Those who were both aggressors and victims were associated with factors of family support (PR = 0.25, 95% CI: 0.07–0.89) and self-efficacy (PR = 6.29, 95% CI: 1.54–25.6). Most of the adolescents who were not involved in verbal school bullying were female (PR = 1.32, 95% CI: 1.16–1.51).ConclusionsBoys tend to be aggressors and girls tend not to get involved in verbal school bullying. Family satisfaction, self-esteem, self-efficacy, and levels of violence are important factors that can influence the profile of adolescents in relation to verbal school bullying.     

The influence of patient,caregiver, and family factors on symptoms of anxiety and depression in children and adolescents with intractable epilepsy

ObjectiveThe objective was to evaluate the association of caregiver and family factors with symptoms of anxiety and depression in children and adolescents with medically refractory localization-related epilepsy (i.e., failed at least two epilepsy medications).MethodForty-four children (ages 6–11 years) and 65 adolescents (ages 12–18 years) and their parents participated in this multicentered, observational, cross-sectional study. Univariable and multivariable linear regressions were used to evaluate the influence of multiple patient, caregiver, and family characteristics on self-reported symptoms of anxiety and depression in the children and adolescents.ResultsAmong children, depressive symptoms were associated with a lower proportion of life with seizures (β = .344, p = .022), caregiver depression (β = .462, p = .002), poorer family relationships (β = .384, p = .010), and poorer family mastery and social support (β = .337, p = .025); in multivariable analysis, proportion of life with epilepsy and parental depression remained significant. No significant predictors of anxiety were found among children. Among adolescents, depressive symptoms were associated with caregiver unemployment (β = .345, p = .005) and anxiety (β = .359, p = .003), low household income (β = .321, p = .012), poorer family mastery and social support (β = .334, p = .007), and greater family demands (β = .326, p = .008); in multivariable analysis, caregiver unemployment and anxiety remained significant. Greater anxiety symptoms among adolescents were associated with females (β = .320, p = .009) and caregiver depression (β = .246, p = .048) and anxiety (β = .392, p = .001) and poorer family mastery and social support (β = .247, p = .047); in multivariable analysis, female sex and caregiver anxiety remained significant.SignificanceThese findings highlight the central role of caregiver psychopathology, which is amenable to intervention, on children and adolescents' symptoms of anxiety and depression. Addressing caregiver psychopathology may improve children and adolescents' quality of life even if seizure control is not attained.     

Airflow limitations in pregnant women suspected of sleep-disordered breathing

Background and aimPregnancy physiology may predispose women to the development of airflow limitations during sleep. The goal of this study was to evaluate whether pregnant women suspected of sleep-disordered breathing (SDB) are more likely to have airflow limitations compared to non-pregnant controls.MethodsWe recruited pregnant women referred for polysomnography for a diagnosis of SDB. Non-pregnant female controls matched for age, body mass index (BMI), and apnoea–hypopnoea index (AHI) were identified from a database. We examined airflow tracings for changes in amplitude and shape. We classified airflow limitation by (a) amplitude criteria defined as decreased airflow of ⩾10 s without desaturation or arousal (FL 10), or decreased airflow of any duration combined with either 1–2% desaturation or arousal, (FL 1–2%); and (b) shape criteria defined as the presence of flattening or oscillations of the inspiratory flow curve.ResultsWe identified 25 case-control pairs. Mean BMI was 44.0 ± 6.9 in cases and 44.1 ± 7.3 in controls. Using shape criteria, pregnant women had significantly more flow-limited breaths throughout total sleep time (32.4 ± 35.8 vs. 9.4 ± 17.9, p < 0.0001) and in each stage of sleep (p < 0.0001) than non-pregnant controls. In a subgroup analysis, pregnant women without a diagnosis of obstructive sleep apnoea (OSA) who had an AHI <5 had similar findings (p < 0.0001). There was no difference in airflow limitation by amplitude criteria between pregnant women and controls (p = 0.22).ConclusionsPregnant women suspected of OSA have more frequent shape-defined airflow limitations than non-pregnant controls, even when they do not meet polysomnographic OSA criteria.     

Low-level lead exposure and autistic behaviors in school-age children

IntroductionThe association between lead exposure and autism spectrum disorder is inconclusive. We hypothesized an association between higher blood lead concentrations and more autistic behaviors, including impaired social interactions and communication, stereotypical behaviors, and restricted interests, among school-age children.MethodsData from 2473 Korean children aged 7–8 years who had no prior history of developmental disorders were analyzed. Two follow-up surveys were conducted biennially until the children reached 11–12 years of age. Blood lead concentrations were measured at every survey, and autistic behaviors were evaluated at 11–12 years of age using the Autism Spectrum Screening Questionnaire (ASSQ) and Social Responsiveness Scale (SRS). The associations of blood lead concentration with ASSQ and SRS scores were analyzed using negative binomial, logistic, and linear regression models.ResultsBlood lead concentrations at 7–8 years of age (geometric mean: 1.64 μg/dL), but not at 9–10 and 11–12 years of age, were associated with more autistic behaviors at 11–12 years of age, according to the ASSQ (β = 0.151; 95% confidence interval [CI]: 0.061, 0.242) and SRS (β = 2.489; 95% CI: 1.378, 3.600). SRS subscale analysis also revealed associations between blood lead concentrations and social awareness, cognition, communication, motivation, and mannerisms.ConclusionEven low blood lead concentrations at 7–8 years of age are associated with more autistic behaviors at 11–12 years of age, underscoring the need for continued efforts to reduce lead exposure.