Copyright 2015 by ESPGHAN and NASPGHAN. Unauthorized reproduction of this article is prohibited. Short Sleep Duration Is Related to Emerging Cardiovascular Risk Factors in Obese Children  Marı ´a Navarro-Solera, y Joaquı ´n Carrasco-Luna, z Gonzalo Pin-Arboledas,  Rebeca Gonza ´lez-Carrascosa, § Jose ´ M. Soriano, and jj Pilar Codon ˜er-Franch ABSTRACT Objective: The aim of the present study was to evaluate the inﬂuence of sleep duration on cardiovascular risk factors in obese children. Methods: Cross-sectional analysis of 90 obese children ages 7 to 16 years. Anthropometric and clinical evaluation with speciﬁcation of dietary and lifestyle habits was carried out during an ofﬁce visit. Sleep duration was evaluated by the BEARS (B ¼ bedtime issues, E ¼ excessive daytime sleepiness, A ¼ night awakening, R ¼ regularity and duration of sleep, S ¼ snoring) questionnaire on children’s sleep characteristics. Sleep time adequacy by age was assessed according to the criteria of the National Sleep Foundation. Biochemical blood variables indicative of metabolic risk (glucose, lipid proﬁle, and insulin) were obtained. Emergent new factors of metabolic risk, including high-sensitive C-reactive protein, g-glutamyltranspeptidase, homocysteine, retinol-binding protein 4 (RBP4), thyroid-stimulating hormone (TSH), inﬂammatory markers, and the adipokines leptin, adiponectin, and ghrelin were also evaluated. The relations between the duration of sleep and these variables were analyzed by general lineal model analysis. Signiﬁcant variables were introduced in logistic regression analysis to determine the odds ratio (OR) and 95% conﬁdence interval (CI) of cardiometabolic factors with respect to sleep. Results: Children who slept for short duration were signiﬁcantly more at risk of severe central obesity. In the regression model, the mean arterial pressure (odds ratio [OR] 1.10, 95% conﬁdence interval [CI] 1.02–1.17, P ¼ 0.008), homocysteine (OR 1.41, 95% CI 1.08–1.84, P ¼ 0.013), RBP4 (OR 1.78, 95% CI 1.15–2.78, P ¼ 0.010), and TSH (OR 2.01, 95% CI 1.21–3.34, P ¼ 0.007) remain as signiﬁcant independent predictors related to short sleep duration. We did not ﬁnd any association between sleep duration and inﬂammatory markers or adipokines. Conclusions: Short sleep duration increases the severity of obesity and is related to cardiovascular risk factors in children. Key Words: cardiovascular risk, homocysteine, obesity, retinol-binding protein, sleep duration (JPGN 2015;61: 571–576) What Is Known  Sleep is an important factor related to obesity and cardiovascular risk, primarily in situations of obstruc- tive sleep apnea.  Short sleep duration has been correlated with meta- bolic risk factors in adults.  A definite relation between sleep duration and child- hood obesity has not yet been established. What Is New  Obesity, abdominal adiposity, and blood pressure are related to reduced sleep duration.  Levels of homocysteine, retinol-binding protein 4, and thyroid-stimulating hormone are associated with short sleep duration.  Short sleep duration is associated with cardiovascular risk factors in childhood. O besity results from the combination of genetic and environ- mental factors. Among the lifestyle factors affecting obesity, the quality and quantity of sleep has been recognized as an important factor in recent years. It has been proven that short sleep duration results in increased body mass index (BMI) in children (1) and adults (2), although other authors have not found any relation between sleep duration and a major prevalence of obesity (3,4). The effect of sleep could be because of alterations in endocrine and metabolic control, lipid intake, thermoregulation, and decrease in physical activity, which are present in subjects with short sleeping hours (5,6). In turn, body fat mass could be an independent predictor of greater influence of sleep latency (7). In children, the impact of disturbed and inadequate sleep can be noticeable. During sleep, there is a peak in the secretion of growth hormone. Sleep duration also affects learning, mood regulation and behavior, dietary habits, and quality of life (8), each of which can be involved in obesity. Short sleep duration has been correlated with an increase in metabolic risk factors and can predict the metabolic syndrome in adults (9). Furthermore, short sleep duration is associated with decreased insulin sensitivity, lipid profile abnormalities, and high blood pressure (BP) in adolescents (10–12). Likewise, this associ- ation can also affect the emergent new factors of metabolic risk, including the inflammatory markers C-reactive protein, tumor necrosis factor a, and interleukin 6 (13). In childhood, primarily in obese children, to identify the presence of cardiovascular risk should be a priority because atherogenesis can precede its clinical manifestations by many years, and preventive measures can be Received February 28, 2015; accepted May 15, 2015. From the  Department of Pediatrics, Obstetrics, and Gynecology, University of Valencia, the y Department of Experimental Science, School Catholic University of Valencia, the z Sleep Unit, Hospital Quiro ´n, the § Department of Preventive Medicine and Public Health, University of Valencia, and the jj Department of Pediatrics, Dr Peset University Hospital, Valencia, Spain. Address correspondence and reprint requests to Pilar Codon ˜er-Franch, Department of Pediatrics, Dr Peset University Hospital, Avenida Gaspar Aguilar 90, 46017 Valencia, Spain (e-mail: pilar.codoner@ uv.es). The authors report no conﬂicts of interest. Copyright # 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000000868 ORIGINAL ARTICLE:NUTRITION JPGN  Volume 61, Number 5, November 2015 571