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Diagnosis and Treatment of Obstructive Sleep Apnea in Adults

MINNEAPOLIS – Sleep is in short supply, thanks to our "24-hour society" in which trading sleep for work or play is commonplace and sleep deprivation is worn as a badge of honor, according to Dr. Michel Cramer Bornemann, codirector of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis.

Not only have we become accustomed to trading sleep for work, Dr. Cramer Bornemann said at the annual meeting of the Associated Professional Sleep Societies, "lack of sleep is synonymous with hard work or achievement, when really it can impede both."

In fact, the effects of insufficient shut-eye extend across multiple domains, according to a collection of independent studies presented at this year’s meeting. For example, sleep loss was linked to the development or exacerbation of symptoms of ADHD in early childhood, an individual’s genetic risk of obesity, inhibitory response to images of high-calorie foods, and even marital discontent.

ADHD and Sleep Loss

In a study designed to tease out the complex relationship between sleep problems – particularly falling asleep and staying asleep – and the development or worsening of inattention and hyperactivity and impulsivity in children and adolescents diagnosed with ADHD, Erika Gaylor, Ph.D., of SRI International in Menlo Park, Calif., and her colleagues analyzed data from the preschool and kindergarten waves of the Early Childhood Longitudinal Study-Birth Cohort. The cohort comprises a representative sample of approximately 6,860 children and their families living the United States.

The investigators calculated total nighttime sleep duration based on parent-reported bedtime and wake time, and assessed children’s behavior using brief measures of attention and task persistence, Dr. Gaylor reported.

"We performed two sets of regression analyses to identify whether sleep duration in preschool-age children predicts attention and hyperactivity at kindergarten entry and [whether] attention and hyperactivity symptoms at preschool predict sleep duration at kindergarten," she explained.

Controlling for the outcome of interest at the preschool time point, sex, ethnicity, and family income, researchers found that less sleep at preschool significantly predicted worse scores on parent-reported hyperactivity and attention at kindergarten, whereas parent-reported hyperactivity and attention at preschool did not predict sleep duration at kindergarten, Dr. Gaylor stated.

"These findings suggest that some children who are not getting adequate sleep may be at risk for developing behavioral problems manifested by hyperactivity, impulsivity, and problems sitting still and paying attention," she said. The results extend those of a previous study in which she and her colleagues determined that having a consistent bedtime was the most reliable predictor of positive developmental outcomes by age 4 years, she noted.

The Link Between Sleep and Obesity

In a twin study designed to look more closely at the previously reported link between short sleep duration and elevated body mass index, Dr. Nathaniel Watson of the University of Washington in Seattle and his colleagues determined that short sleep may potentiate an underlying genetic mechanism for obesity.

The investigators examined whether sleep duration modified genetic and environmental influences on BMI in 1,811 pairs of twins drawn from the population-based University of Washington Twin Registry. The mean age of the study participants was 36.6 years. The participants provided self-reported information on height and weight, which was used to calculate BMI, as well as on habitual sleep duration, Dr. Watson said. The mean BMI of the group was 25.4 kg/m², and the mean sleep duration was 7.18 hours, he said.