Abstract P249: Incident Sleep-Disordered Breathing is Associated with Obesity: Penn State Child Cohort

Objectives: To study the epidemiology of sleep-disordered breathing (SDB) in adolescents, which has received little attention. Methods: The Penn State Child Cohort (PSCC) is a representative general population sample of 700 children aged 5-12 years. Our preliminary results are based on an average 8 year follow up of the initial 300 prospective subjects (~43%) from this ongoing cohort study. A logistic regression was used to assess the association between potential risk factors and incident SDB. Results: The mean age at the 8-year follow up examination was 17.2 ± 0.1 years, with an average BMI percentile of 66.6 ± 1.6 and 56.5% boys. At baseline 1.5% of this subsample had SDB, defined by Apnea Hypopnia Index (AHI > 5 /hour). Surprisingly, there was no persistence of SDB. Eight-year incident SDB was 10.5%. The average AHI in those with incident SDB was 12.7 with a maximum of 92.4. Incident SDB was similar for girls (7.8%) and boys (12.7%). Those with SDB were older than those without (18.7 vs 17.0 years, P<0.001) and girls with SDB were older than boys with SDB (20.0 vs 18.0 years, P=0.002). Those with incident SDB tended to have a greater change in BMI percentile (8.2 vs 1.8, P = 0.143) during the follow up and slightly higher minority representation (25.8% vs 21.9%, P=0.655). A logistic regression model identified three variables that were associated with incident SDB, controlling for baseline AHI: age (OR = 1.5 (1.3, 1.9) P<0.001), male (OR= 2.5 (1.11,10.00) P=0.021), and [[Unable to Display Character: ∆]]BMIPCT (OR=1.2(1.02, 1.5) P=0.032). Conclusion: In this population based sample of adolescents, the 8-year incidence of SDB was high (10.5%), whereas childhood SDB did not persist into adolescence. Further, the results indicate that risk factors for incident SDB in adolescents are age, male and the development of obesity.

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Abstract MP84: Incident Sleep-Disordered Breathing is Associated with Higher Blood Pressure and its Reactivity: Penn State Child Cohort

Circulation ◽

10.1161/circ.127.suppl_12.amp84 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Edward O Bixler ◽

Duanping Liao ◽

Alexandros N Vgontzas ◽

Fan He ◽

Sol M Rodriguez-Colon ◽

...

Keyword(s):

Blood Pressure ◽

Sleep Disordered Breathing ◽

Vascular Reactivity ◽

Population Based ◽

Increased Risk ◽

Penn State ◽

State Child ◽

The Difference ◽

Disordered Breathing

Objectives: To examine the association between incident sleep-disordered breathing (SDB) and blood pressure and blood pressure reactivity in a population based sample of adolescents. Methods: The Penn State Child Cohort is a general population based sample of 700 children aged 5-12 years at the baseline examination (2000-2005). Currently, 300 participants have completed their 8-year follow up examination. Blood pressure was assessed at follow up in the evening using an automated device prior to the sleep recording in three positions. Three assessments in the seated position were completed after 5 minutes of rest. This was followed by 3 assessments in the supine position after 5 minutes of rest. The averages of the 2 nd and 3 rd readings for both positions are reported. Finally the subject was asked to stand as fast as possible and 2 additional readings were completed immediately upon their foot hitting the floor. These two standing readings were averaged. The difference between standing and supine BP was used as measures of vascular reactivity. The age, gender and height adjusted mean level of BP measures comparing individuals with and without incident SDB (defined as Apnea Hypopnia Index, AHI>5/hr) after excluding individuals with baseline SDB were calculated. Results: We observed no significant differences in diastolic blood pressure across the three positions. However, systolic blood pressure across all three positions and vascular reactivity were significantly elevated in those with incident SDB, as summarized in Table 1. Conclusion: In an 8-year followup of this population based sample of children, there was no persistence of SDB from baseline. Incident SDB (about 11%) was significantly associated with elevated systolic BP across all three positions. Further, SDB was associated with increased systolic BP reactivity, which has been associated with increased risk of CVD and the development of hypertension in adults.

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0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort

SLEEP ◽

10.1093/sleep/zsaa056.886 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A339-A339

Author(s):

J Fernandez-Mendoza ◽

Z Gao ◽

K Brandt ◽

L Houser ◽

S L Calhoun ◽

...

Keyword(s):

Young Adults ◽

Endothelial Dysfunction ◽

Young Adulthood ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Penn State ◽

State Child ◽

Disordered Breathing

Abstract Introduction Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups. Methods The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood. Results SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p<0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p<0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively). Conclusion SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

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Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

Otolaryngology ◽

10.1177/0194599821993383 ◽

2021 ◽

pp. 019459982199338

Author(s):

Flora Yan ◽

Dylan A. Levy ◽

Chun-Che Wen ◽

Cathy L. Melvin ◽

Marvella E. Ford ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Sleep Disordered Breathing ◽

Healthy Children ◽

Loss To Follow Up ◽

Cox Regression Analysis ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

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Risk factors associated with habitual snoring and sleep-disordered breathing in a multi-ethnic Asian population: a population-based study

Respiratory Medicine ◽

10.1016/j.rmed.2003.11.017 ◽

2004 ◽

Vol 98 (6) ◽

pp. 557-566 ◽

Cited By ~ 32

Author(s):

See M Khoo ◽

Wan C Tan ◽

Tze P Ng ◽

C.H Ho

Keyword(s):

Risk Factors ◽

Sleep Disordered Breathing ◽

Asian Population ◽

Population Based ◽

Population Based Study ◽

Factors Associated ◽

Habitual Snoring ◽

Disordered Breathing

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Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: Results of over 15 years of follow-up.

10.21203/rs.3.rs-24011/v2 ◽

2020 ◽

Author(s):

Seyyed Saeed Moazzeni ◽

Hossein Toreyhi ◽

Samaneh Asgari ◽

Fereidoun Azizi ◽

Fahimeh Ramezani Tehrani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Live Birth ◽

Middle Eastern ◽

Population Based ◽

P Value ◽

Cvd Risk ◽

Live Births ◽

Potential Risk Factors

Abstract Background: Most previous studies, conducted in non-Middle Eastern populations, have suggested that increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women. Methods: In this population-based cohort study, included 3929 women and 2571 men aged ≥ 30 years, Data for number of parity/live birth(s) were obtained by standard questionnaire. Participants were then annually followed for CVD events. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HRs), and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors. Results: During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with 2 live births. Among women in multivariate analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01-1.10) and having ≥4 parity was associated with a HR of 1.86 (0.97-3.56, p-value=0.061). Among men, in comparison with participants who had 1 child, multivariate HRs of having 2, 3 and ≥4 children were 1.97 (1.24-3.12), 2.08 (1.31-3.31) and 2.08 (1.30-3.34), respectively. Conclusion: To the best of our knowledge, the current study is the first report of this issue in the Middle East and North Africa region, a region with high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors.

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Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: Results of over 15 years of follow-up.

10.21203/rs.3.rs-24011/v3 ◽

2020 ◽

Author(s):

Seyyed Saeed Moazzeni ◽

Hossein Toreyhi ◽

Samaneh Asgari ◽

Fereidoun Azizi ◽

Fahimeh Ramezani Tehrani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Live Birth ◽

Middle Eastern ◽

Population Based ◽

P Value ◽

Cvd Risk ◽

Live Births ◽

Potential Risk Factors

Abstract Background: Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women.Methods: In this population-based cohort study, which included 3929 women and 2571 men aged ≥ 30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors.Results: During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariate analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01-1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97-3.56, p-value=0.061). Among men, in comparison with participants who had 1 child, multivariate HRs of having 2, 3, and ≥4 children were 1.97 (1.24-3.12), 2.08 (1.31-3.31), and 2.08 (1.30-3.34), respectively.Conclusion: To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors.

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0735 Longitudinal Association of the Natural Course of Childhood Overweight with Sleep Disordered Breathing in the Transition to Adolescence: The Penn State Child Cohort

SLEEP ◽

10.1093/sleep/zsz067.733 ◽

2019 ◽

Vol 42 (Supplement_1) ◽

pp. A295-A295

Author(s):

Jacqueline M Danisi ◽

Julio Fernandez-Mendoza ◽

Susan L Calhoun ◽

Fan He ◽

Kristina Puzino ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Childhood Overweight ◽

Natural Course ◽

Transition To Adolescence ◽

Penn State ◽

Longitudinal Association ◽

State Child ◽

Disordered Breathing

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Natural history of insomnia symptoms in the transition from childhood to adolescence: population rates, health disparities, and risk factors

SLEEP ◽

10.1093/sleep/zsaa187 ◽

2020 ◽

Author(s):

Julio Fernandez-Mendoza ◽

Elizaveta Bourchtein ◽

Susan Calhoun ◽

Kristina Puzino ◽

Cynthia K Snyder ◽

...

Keyword(s):

Risk Factors ◽

Low Socioeconomic Status ◽

Clinical History ◽

Population Based ◽

Self Report ◽

Full Remission ◽

Penn State ◽

Racial Ethnic ◽

Insomnia Symptoms

Abstract Study Objectives To determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence. Methods The Penn State Child Cohort is a random, population-based sample of 700 children (5–12 years at baseline), of whom 421 were followed-up as adolescents (12–23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep. Results The 421 subjects with baseline (Mage = 8.8 years) and follow-up (Mage = 17 years) data were 53.9% male and 21.9% racial/ethnic minorities. The persistence of childhood insomnia symptoms (CIS) was 56% (95% CI = 46.5–65.4), with only 30.3% (95% CI = 21.5–39.0) fully remitting. The incidence of adolescent insomnia symptoms was 31.1% (95% CI = 25.9–36.3). Female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms. Conclusions CIS are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic-, and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of CIS versus their incidence in adolescence. CIS should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.

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Risk Factors for Snoring in Two Canadian First Nations Communities

Clocks & Sleep ◽

10.3390/clockssleep1010011 ◽

2019 ◽

Vol 1 (1) ◽

pp. 117-125

Author(s):

James Dosman ◽

Chandima Karunanayake ◽

Kathleen McMullin ◽

Sylvia Abonyi ◽

Donna Rennie ◽

...

Keyword(s):

Risk Factors ◽

First Nations ◽

Sleep Disordered Breathing ◽

Respiratory Health ◽

Smoking Status ◽

Excess Body Weight ◽

Potential Risk Factors ◽

Contextual Determinants ◽

First Nations People ◽

Disordered Breathing

Snoring may be an important predictor of sleep-disordered breathing. Factors related to snoring among First Nations people are not well understood in a population with high rates of smoking and excess body weight. An interviewer-administered survey was conducted among 874 individual participants from 406 households in 2012 and 2013 in two Canadian First Nations communities. The survey collected information on demographic variables, individual and contextual determinants of respiratory health and snoring (classified as present versus absent) and self-reported height and weight. Multiple logistic regression analyses were conducted to examine relationships between snoring and potential risk factors adjusting for age and sex. Snoring was present in 46.2% men and 47.0% women. Considering body mass index, 259 people (30.3%) were overweight and 311 (36.4%) were considered obese. The combined current/former smoking rate was 90.2%. Being overweight, obesity, sinus trouble, current smoking status and former smoking were significantly associated with snoring. Exposure to home dampness and mold were suggestive of an association with snoring. To the degree that snoring may be a predictor of possible sleep-disordered breathing, these results indicate that environmental conditions such as smoking and home exposures may be important factors in the pathogenesis of these conditions.

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