Pediatric Research Update: Changes in Objectively Measured Sleep After a Multidisciplinary Lifestyle Intervention in Children with Abdominal Obesity: A Randomized Trial

Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update refers to a systematic review of changes in objectively measured sleep after a multidisciplinary lifestyle intervention in children with abdominal obesity.

Article Summary

Adequate and good quality sleep is essential for optimal health and plays a key role in managing obesity and metabolic disorders. A recent study demonstrates that lifestyle interventions for obesity can significantly improve sleep quality, reinforcing the interconnection between sleep and weight management.

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Article Review

Adequate and good quality sleep allows the body to fulfill many functions that would otherwise not have been possible during wakefulness. Certain endocrine, neurologic, and immunologic functions, among others, can only be performed during sleep. It is therefore not surprising that adequate and good quality sleep is vital for good health. It plays a key role in optimal metabolism and in the prevention and management of many metabolic disorders.

Sleep disorders and obesity have a bidirectional relationship. Sleep disorders can lead to unnecessary weight gain and metabolic complications, and therefore worsen obesity. Sleep disorders can also make obesity treatment plans less efficacious. On the other hand, the presence of obesity can disrupt sleep and can lead to or worsen sleep disorders.

Preventing and managing both disorders is paramount. Most interventions, especially pharmacotherapies, only target specific conditions in either group of disorders. Few pharmacotherapies have effects on both. Lifestyle interventions for weight management, on the other hand, can be an important tool for prevention and adjunct therapy for those already on anti-obesity medications. One would think they would also be good for sleep in general, but none have proven that concretely.

The journal article featured this month studied the effects of a lifestyle intervention for obesity on specific sleep parameters. It has several strengths. First, it is a randomized controlled trial, not merely a retrospective or descriptive study. Second, there were objective criteria for the lifestyle interventions used for obesity. Third, sleep was objectively evaluated using an accelerometer (Actigraphy™).

Patients were randomized into two groups, with the interventional group having a more intensive and structured follow-up. The program for follow-up was for two years. There were noted changes in anthropometric, clinical, and biochemical measurements between the two groups, though many were not statistically significant. It appears that insulin levels, leptin levels, and triglycerides were significant at some points.

The more significant finding in the study is that the lifestyle interventions improved certain objective measures of sleep, mainly wake after sleep onset (WASO), sleep latency, sleep efficiency, and duration of arousals. Of note, these are also metrics used in tracking insomnia. This study reinforced the theory that “good” sleep is essential in weight and obesity management, but it also provided objective evidence of that. It debunked the commonly held notion that “good sleep” is often just sufficient hours of sleep, especially for children. Quality of sleep plays an important role. Though not mentioned directly in the article, the authors also showed how lifestyle interventions can help improve aspects of sleep related to insomnia.

Sleep and obesity are much more closely tied together than many healthcare providers think. There is much more overlap between the two than just sleep apnea. Disorders in both areas should be addressed concurrently, and this study shows how an intervention for one condition can change certain metrics in the other.