Reduced Slow Wave Sleep Is Associated with Increased Risk of Short Stature in Children: A Cross-Sectional Study

Zhaohua Chen,1,2,* Yuan Shi,1,2,* Fei Lei,1,2 Xujun Feng,1– 3 Lu Tan,1,2 Taomei Li,1,2 Junying Zhou,1,2 Yuanfeng Sun,1,2 Jiamin Liao,1,2 Yun Li,4– 6 Zhoulong Yu,7 Jian Jiao,1,2 Yanyan Wang,8 Larry D Sanford,9 Michael V Vitiello,10 Ye Zhang,1,2 Rong Ren,1,2 Xiangdong Tang1,2 1Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, Department of Otolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2State Key Laboratory of Biotherapy, Sichuan University, Chengdu, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China; 4Department of Sleep Medicine, Mental Health Center of Shantou University, Shantou, People’s Republic of China; 5Sleep Medicine Center, Shantou University Medical College, Shantou, People’s Republic of China; 6Shantou University Medical College-Faculty of Medicine of University of Manitoba Joint Laboratory of Biological Psychiatry, Shantou, People’s Republic of China; 7National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, People’s Republic of China; 8Healthcare Innovation Research Laboratory, West China School of Nursing, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 9Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Biomedical and Translational Sciences, Eastern Virginia Medical School, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, USA; 10Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA*These authors contributed equally to this workCorrespondence: Yuan Shi, Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, Department of Otolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China, Tel +86 18582450627, Email shiyuanff@foxmail.com Xiangdong Tang, Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, Department of Otolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China, Tel +86 18980602059, Email 2372564613@qq.comObjective: Although growth hormone was shown to be specifically released during slow wave sleep (SWS), no population-based evidence has demonstrated the association between sleep quality and childhood height. To address this gap, our study aims to investigate the relationship between SWS and height of children.Methods: We analyzed polysomnography data and z-scores for height in 2527 suspected obstructive sleep apnea (OSA) children (537 non-OSA children and 1990 OSA children) collected over the past 16 years. Different grades of z-scores for height and SWS were classified by the quartile method, and the lowest z-scores for height quartile defined short stature as the main outcome. Logistic regression models were used to assess the relationship between SWS and short stature.Results: 1990 OSA children and 537 non-OSA children were included in analyses. The mean value of z-score for height from high to low were 0.80, 0.34, 0.23 and − 0.19 in non-OSA children, and 0.47, 0.10, 0.14 and 0.05 in OSA children. Fully adjusted logistic regression models showed that, compared to the highest SWS quartile, the lowest quartile had 4.85-fold higher odds (95% CI, 2.4– 9.4) of short stature in non-OSA children and 2.15-fold higher odds (95% CI, 1.5– 3.0) in OSA children. Subgroup analyses demonstrated that in both non-OSA and OSA children, the reduction of SWS was significantly related to short stature in prepubertal children. Linear regression models confirmed positive correlations between SWS and z-score for height.Conclusion: Our findings emphasize the crucial role of adequate sleep quality in childhood growth and development, supporting the inclusion of sleep assessments and improvements in pediatric growth monitoring programs.Keywords: sleep, slow wave sleep, sleep quality, height, short stature, pediatric

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