Human sleep and growth.2 ppt
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Transcript of Human sleep and growth.2 ppt
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Human Sleep and Growth!
Dr. Ahmed Elshebiny , MDDr. Ahmed Elshebiny , MDLecturer of Internal MedicineLecturer of Internal Medicine
Faculty of Medicine, Menoufyia UniversityFaculty of Medicine, Menoufyia University
Former Clinical Research FellowFormer Clinical Research Fellow,,Joslin Diabetes Center, Harvard UniversityJoslin Diabetes Center, Harvard University
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Sleep for growth
Sleep is no less important than food for growth
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Key message Sleep pattern differs by age Sleep and hormones are interrelated GH is secreted preferentially in the SW sleep Sleep disorders can retard growth Treatment of sleep disorders can lead to catch – up Bidirectional inter-relation between somatotropic
system and sleep GH, GHRH , prolactin & somatostatin promote sleep
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Intra-uterineGrowth
PostnatalGrowth
GrowthGrowth
Nutrition
GHGonadal
steroids and GH
(Sam & Meeran Lecture notes Endocrinology& Diabetes, 2009)
InfantilePhase
ChildhoodPhase
Pubertal Phase
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Rate of Growth
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Growth failureCauses Some are constitutional, some are genetic,
nutritional, psychological, are due to chronic illnesses, and some are the result of hormonal disorders or may be idiopathic.
Many primary care physicians do not include sleep OSA as a cause of Growth retardation
Bonuck, et al, International Journal of Pediatric Otorhinolaryngology (2005)
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Prevalence of Growth failure Among children under 2 years of age,
a population-based screening program in England identified 3% with GF
(Wright et al BMJ, 1998)
In US children aged 24—71months who are < 5th percentile range between ( 2.7-5.2 %)
( Third report on nutrition monitoring in US, 1995)
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What happened to our sleep ?
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Sleep is an active process Sleep is not merely the absence of waking. On the contrary, it is a state during which
specialized physiological activities occur in the brain and throughout the body.
It is an active process in which metabolism, tissue restoration, memory consolidation, and general homeostatic balance is maintained
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Newborns – 100%
Six-month-olds – 20-30%
Up to four years: one in three continues to awaken during the night and require intervention by a parent to return to sleep.
Frequency of Night – Waking
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Sleep Center? Recently VLPO of hypothalamus Sleep active neurons GABA inhibition to arousal systems
( Gaus et al, Neuroscience , 2002)
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Sleep disorders in Children 25 % of children experience some type of
sleep disturbance Instead of appearing sleepy, the overtired
child may appear overactive & inattentive.
Wake up America, A National Sleep Alert January, 1993
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Prevalence of Insomnia by age group
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GH secretion during sleep Growth hormone (GH) is preferentially secreted
during slow-wave sleep . In normal adult men , sleep onset GH pulse
represents 60-70% of the total daily secretion of the hormone
There is a quantitative correlation between the amount of GH secretion during sleep and the duration of SW sleep
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GH secretion during sleep
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GH secretion during sleep deprivation and daytime sleep
Van Cauter et al, 2000
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Effect of interrupted sleep on GH secretory pattern
(Y. TAKAHASHI, et al)
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SW sleep and nocturnal GH patterns through adult life
Van Cauter et al, 1998 , American Academy of Sleep Medicine
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GHRHGH
SW sleep
Bidirectional Interactions between GH &sleep
REM sleepGhrelin
Somatostatin
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Sleep & Feeding problems co-exist Problematic sleep and feeding behaviors tend
to coexist in early childhood. Increased awareness of this coexistence may
improve outcome.
(Pediatrics 2011;127:e615-e621 )
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Sleep deprivation & appetite Total sleep deprivation in humans has been
associated with hyperphagia Leptin & ghrelin – hormones associated the central
regulation of food intake
Van Cauter E et al 2004
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Sleep and intra-uterine growth
In a study of pregnant women in Sri Lanka , sleeping for less than or equal to 8 h during 2nd or 3rd or both trimesters is a risk factor for small for gestational age baby.
(Abeysena, et al., Australian & New Zealand Journal of Obstetrics & Gynaecology. 49(4):382-7, 2009 )
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SDB in children Sleep disordered breathing is
relatively common in children
While the exact prevalence of SDB in children is unknown, snoring may occur in 3—12%, while OSA may occur in 1—10%
Bonuck, et al, International Journal of Pediatric Otorhinolaryngology (2005)
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Sleep disordered breathing and Growth failure
SDB, secondary to adenotonsillar hypertrophy increases the risk of growth failure in children.
Just 20% of pediatricians screen for SDB OSA peaks at 2—6 years of age, because of the relative adenotonsillar hypertrophy found at this time
Bonuck, et al, International Journal of Pediatric Otorhinolaryngology (2006)
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Potential pathways for the effect of OSA Increased energy expenditure Nocturnal hypoxemia Metabolic alkalosis Impaired growth hormone secretion Feeding problems
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Effect of Adenotonsillectomy on growth
Studies found that otherwise healthy children experiencing GF show significant catch up following T&A( Tonsillectomy and adenoidectomy).
The American Academy of Pediatrics identifies GF as a serious complication of untreated obstructive apnea
Bonuck, et al, International Journal of Pediatric Otorhinolaryngology (2005)
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Sleep disturbance, cortisol and growth hormones
Sleep disturbance has a stimulatory effect on the HPA axis and a suppressive effect on the GH axis.
There is an observed hypocortisolism in idiopathic hypersomnia and HPA axis relative activation in chronic insomnia.
Vogontzas et al., Clin Endocrinol (Oxf). 1999 Aug;51(2):205-15.
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GHRHGH
SW sleep
Bidirectional Interactions between GH &sleep
REM sleepGhrelin
Somatostatin
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Central effects of GH High density of GH binding sites has been
demonstrated in pituitary, hypothalamus and hippocampus.
The binding sites are also abundant in choroid plexus
(Lai et al., 1991)
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GH deficiency and sleep GHD is associated with impaired sleep
quality
(Bjo¨rk et al., 1989).
The analysis of sleep microstructure by means of CAP (cyclic alternating pattern) , in children with GHD, showed a reduction of transient EEG amplitude oscillations.
Verrillo et al., Neuroendocrinology. 2011 Apr 5. (online)
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Effects of GH, GHRH , Prolactin, and somatostatin on sleep
GH, PRL & Somatostatin possess REM sleep-promoting activity.
(Danguir J. Brain Res 367, 26-30 -1986)
GHRH by itself promotes non-REM sleep.
Krueger JM and ObaÂl Jr F. FASEB J 7, 645-652 (1993).
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Potential for novel therapeutic approaches
Pharmacological approaches that stimulate SW sleep may act as GH secretagogues e.g oral GHB ( investigational drug for narcolepsy) and ritanserin( 5HT2 antagonist)
Aging effects on GH and SW sleep? Improvements of lifestyle indices in GH
deficient adults after treatment with GH may be related to improvement of sleep quality
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Take home message1. Normal sleep is important to the survival,
growth and development of children.
2. Primary care physicians, parents, and even teachers, to some extent, should be aware of sleep disorders that effect children.
3. Appropriate diagnosis and management of these disorders can significantly improve the lives of children and their families.
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