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.

Public Health Relevance

Obesity in childhood has become an epidemic and a major public health problem. This prospective study will assess a wide range of novel risk factors for and subclinical and clinical consequences of early childhood obesity and sleep problems. The knowledge gained from this study will better position our intervention strategies to reduce the public health burden of childhood obesity.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Cardiovascular and Sleep Epidemiology (CASE)
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Twery, Michael
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Pennsylvania State University
Schools of Medicine
United States
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Gaines, Jordan; Vgontzas, Alexandros N; Fernandez-Mendoza, Julio et al. (2018) Obstructive sleep apnea and the metabolic syndrome: The road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment. Sleep Med Rev 42:211-219
Fernandez-Mendoza, Julio; Li, Yun; Fang, Jidong et al. (2018) Childhood high-frequency EEG activity during sleep is associated with incident insomnia symptoms in adolescence. J Child Psychol Psychiatry :
Frye, S S; Fernandez-Mendoza, J; Calhoun, S L et al. (2018) Neurocognitive and behavioral functioning in adolescents with sleep-disordered breathing: a population-based, dual-energy X-ray absorptiometry study. Int J Obes (Lond) 42:95-101
Fernandez-Mendoza, Julio; Baker, Joshua H; Vgontzas, Alexandros N et al. (2017) Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents. Brain Behav Immun 61:110-116
Fernandez-Mendoza, Julio; Calhoun, Susan L; Vgontzas, Alexandros N et al. (2016) Insomnia Phenotypes Based on Objective Sleep Duration in Adolescents: Depression Risk and Differential Behavioral Profiles. Brain Sci 6:
Gaines, Jordan; Vgontzas, Alexandros N; Fernandez-Mendoza, Julio et al. (2016) Inflammation mediates the association between visceral adiposity and obstructive sleep apnea in adolescents. Am J Physiol Endocrinol Metab 311:E851-E858
Fernandez-Mendoza, Julio; Li, Yun; Vgontzas, Alexandros N et al. (2016) Insomnia is Associated with Cortical Hyperarousal as Early as Adolescence. Sleep 39:1029-36
He, Fan; Bixler, Edward O; Liao, Jiangang et al. (2015) Habitual sleep variability, mediated by nutrition intake, is associated with abdominal obesity in adolescents. Sleep Med 16:1489-94
He, Fan; Rodriguez-Colon, Sol; Fernandez-Mendoza, Julio et al. (2015) Abdominal obesity and metabolic syndrome burden in adolescents--Penn State Children Cohort study. J Clin Densitom 18:30-6
He, Fan; Bixler, Edward O; Berg, Arthur et al. (2015) Habitual sleep variability, not sleep duration, is associated with caloric intake in adolescents. Sleep Med 16:856-61

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