Sleep and cardio-metabolic risk factors: a prospective study of adolescents

描述(申请人提供)：我们建议对700名青少年进行为期8年的跟踪调查。该队列的招募和基线检查是在他们5-12岁时进行的。我们的总体目标是评估儿童早期肥胖和睡眠问题的广泛风险因素及其亚临床和临床后果。具体地说，我们建议评估以下三个具体目标：1)儿童睡眠相关因素与青壮年肥胖之间的预期关系；2a)基线肥胖与心脏代谢、睡眠和神经行为结果之间的纵向联系；2b)肥胖与相关临床和亚临床心脏代谢和睡眠异常的横向联系；以及3)青春期的SDB是否与年龄相关。我们计划评估肥胖和睡眠领域的独立变量与涉及心脏代谢、睡眠和神经行为系统的三个相互关联的健康结果之间的独立关联。成人和儿童中的肥胖已经成为一种流行病，而且是一个主要的公共卫生问题，因为它与心血管疾病(死亡的主要原因)和其他代谢性疾病有关。然而，评估儿童肥胖症的风险因素和后果的数据有限。来自我们团队和其他人的最新数据支持对我们的假设进行系统的前瞻性调查，这些证据包括：(1)睡眠时间最近被确定为肥胖的一个新的危险因素，并且这种联系被年龄、性别、压力、体力活动和社会经济地位等因素所修正。在我们的数据中，我们观察到了睡眠时间和肥胖之间的横截面关联，这是基于主观但不是客观的报告；(2)经常受到压力的肥胖成年人患有轻度皮质醇亢进症，并面临应激诱导的内脏肥胖和代谢综合征的风险。我们来自儿童和成人样本的数据支持这一假设；(3)成人肥胖是心血管疾病的强烈风险因素。在我们的儿童样本中，我们已经报道肥胖和SDB是导致血压水平升高和心脏自主神经调节障碍的强烈和独立的危险因素；(4)在成年人中，假设肥胖通过代谢综合征途径导致更高的心血管疾病风险，并且越来越多的人关注肥胖儿童的代谢因素也会增加。我们和其他人已经报道，成人的SDB与代谢综合征的风险增加有关。在我们的儿童数据中，SDB与几种代谢异常的风险增加有关；(5)我们和其他人报告说，自主神经调节受损与心血管疾病的死亡率和发病率显著相关。在我们的儿童样本中，我们报告了SDB-HRV和肥胖-HRV在血压升高方面的显著协同作用，表明睡眠、肥胖和心脏代谢健康之间的复杂相互关系发生在生命早期。最后，在我们的儿童数据中，SDB的年龄分布表明青春期可能存在年龄依赖关系。

DESCRIPTION (provided by applicant): We propose to conduct an 8-year follow-up examination of a population-based sample of 700 young adolescents. The recruitment and baseline exam of this cohort was conducted when they were 5-12 years old. Our overall objective is to assess a wide range of risk factors for and subclinical and clinical consequences of early childhood obesity and sleep problems. Specifically, we propose to evaluate the following three specific aims: 1) the prospective relationships between childhood sleep related factors and obesity in young adulthood; 2a) the longitudinal association between baseline obesity and cardiometabolic, sleep and neurobehavioral outcomes at follow-up; 2b) cross-sectional association between obesity and relevant clinical and subclinical cardiometabolic and sleep abnormalities at follow-up; and 3) whether SDB in adolescence is age-dependent. We plan to assess the independent associations between independent variables in the obesity and sleep domains and three inter-related health outcomes involving cardiometabolic, sleep and neurobehavioral systems. Obesity both in adults and children has become epidemic and is a major public health problem given its association with CVD, the leading cause of death, and other metabolic diseases. However, there are limited data assessing the risk factors for, and outcomes of, childhood obesity. Recent data from our group and others are supportive of a systematic prospective investigation of our hypotheses, and these evidences include: (1) Sleep duration has been recently identified as a novel risk factor for obesity, and the association is modified by factors such as age, gender, stress, physical activity, and socioeconomic status. In our data, we observed a cross-sectional association between sleep duration and obesity based on subjective but not objective reports; (2) Obese adults that are stressed frequently have mild hypercorticolism and are at risk for stress-induced visceral obesity and metabolic syndrome. Our data, from the child and adult samples, support this hypothesis; (3) Obesity in adults is a strong risk factor for cardiovascular disease. In our child sample, we have reported that obesity and SDB are strong and independent risk factor for higher levels of BP and impairment of cardiac autonomic modulation; (4) In adults it is hypothesized that obesity leads to higher risk of CVD via metabolic syndrome pathway and there is increasing concern that metabolic factors are elevated in obese children as well. We and others have reported that SDB in adults is associated with increased risk of the metabolic syndrome. In our child data, SDB was cross-sectionally associated with an increased risk for several metabolic abnormalities; (5) We and others have reported that impaired autonomic modulation is significantly associated with CVD mortality and morbidity. In our children sample, we have reported significant synergistic interactions between SDB-HRV and obesity-HRV on elevated BP, indicative of complex inter-relationships between sleep, obesity, and cardiometabolic health occurring early in life. Finally, in our child data the age distribution of SDB suggested a possible age-dependent relationship within adolescence.