The Role of Vitamin D in Sleep Disorders of Children and Adolescents: A Systematic Review.
Federica Prono,
Katerina Bernardi,
Raffaele Ferri,
Oliviero Bruni
Systematic Review
International journal of molecular sciences
2022
36 citations
PubMed
DOI
CC-BY
PDF
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Study Design
- Type d'étude
- Systematic Review
- Intervention
- The Role of Vitamin D in Sleep Disorders of Children and Adolescents: A Systematic Review. None
- Comparateur
- Placebo
- Direction de l'effet
- Positive
- Risque de biais
- Moderate
Abstract
This review investigates the association between vitamin D and sleep disorders. Vitamin D is an essential nutrient known to play an important role in the growth and bone health of the human body, but it also appears to play a role in sleep. The goal of our review is to examine the association between vitamin D and sleep disorders in children and adolescents. We summarize the evidence about the role and the mechanism of action of vitamin D in children and adolescents with sleep disorders such as insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and other sleep disorders. Systematic electronic database searches were conducted using Pubmed and Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The studies that met the established inclusion criteria were analyzed and compared. Results suggest a strict relationship between vitamin D deficiency in children and sleep disorders. There is evidence that vitamin D is implicated in the different neurochemical mechanisms involved in sleep regulation and mainly in the serotonergic and dopaminergic pathways. This might be responsible for the association of vitamin D deficiency and restless sleep, sleep hyperhidrosis, OSA, and RLS.
Full Text
Figures
Tables
Table 1
| Study | Objective | Design | Population | Methods | Results |
|---|---|---|---|---|---|
| Al-Shawwa et al. 2020 | Relationship between sleep architecture and vitD status. | Retrospective cohort study. | 39 children | PSG and pediatric sleep questionnaires. | 51 with vitD deficiency (25(OH)D < 30 ng/mL). Children with vitD deficiency: decreased TST and sleep efficiency, and later weekday and weekend bedtimes. |
| Deng et al., 2020 | Association between vit D in cord or venous blood and sleep–wake patterns at two years of age. | Prospective cohort study. | 29 children | 25(OH)D assessed in cord blood and venous blood at two years of age. Sleep–wake patterns measured with BISQ and Acti-Watch. | Venous but not cord blood 25(OH)D level at two years age positively associated with sleep duration. |
| Gong et al., 2018 | Association between 25(OH)D levels and sleep duration. | School-based prospective study. | 800 Chinese adolescents (8–14 years) | Anthropometric measured by trained research staff. Serum 25(OH)D and lipids measured in the laboratory. Sleep habits and health-related behaviors assessed by questionnaire. | 25(OH)D levels positively correlated with sleep duration. Insufficiency/deficiency of vitD (25(OH)D < 20 ng/mL) significantly associated with increased probability of short sleep. |
| Yong et al., 2019 | Association between cord-blood vitD levels at birth and night-sleep duration trajectories between 2 and 5–6 years old. | Cohort study. | 264 children | Cord-blood 25OHD determined by radio-immunoassay at birth, and night-sleep trajectories between 2 and 5–6 years obtained by group-based trajectory modeling method. Associations assessed by multinomial logistic regression adjusted for maternal and child characteristics. | Trajectories short sleep (<10.5 h) was found in 5%, medium–low sleep (10.5–11.0 h) in 46%, medium–high sleep (≈11.5 h) in 37%, long sleep (≥11.5 h) in 4% and changing sleep (decreased from ≥11.5 to 10.5–11.0 h) in 8%, respectively. The mean 25OHD level was 19, 12, 19, 14, and 16, respectively. On adjusted analysis, decrease in 25OHD level correlated with the odds of belonging to the shorter sleep trajectories. |
| Kheirandish-Gozal et al., 2014 | Association between OSA and plasma 25(OH)D and risk of metabolic dysfunction and systemic inflammation. | Observational cross-sectional study. | 176 obese and non-obese children with and without OSA | PSG and fasting blood draw the morning after. Lipid profile, homeostatic model of insulin resistance and high-sensitivity C-reactive protein assays and plasma 25(OH)D assessed. | 25(OH)D levels reduced in pediatric OSA (also in Afro American and in obese children); possible role in modulating the degree of insulin resistance and systemic inflammation. |
| Shin et al., 2018 | Relationship between vitD and associated factors in children ATH. | Retrospective cross-sectional study. | 88 children with sleep-disordered breathing | Four groups based on adenoidal and/or tonsillar hypertrophy. Demographic data, the sizes of tonsils and adenoids, serum 25(OH)D level, BMI, and allergen sensitization patterns. | Children with ATH had decreased 25(OH)D). Children with vitD deficiencies higher frequency of ATH. Inverse correlation between serum 25(OH)D levels and age, tonsil and adenoid size, and height. Tonsil and adenoid size, and BMI-z score associated with 25(OH)D levels, after controlling for age, sex, height, and mite sensitization. |
| Ekinci et al., 2017 | Serum vitB12 and vitD correlation with self-reported sleep quality of pediatric FMF patients. | Case-control study. | 63 children with FMF | Self-administered PSQI. The patients divided into subgroups depending on vitD concentrations (≥20 and <20 ng/mL) or to vitB12 concentration (≥200, <200 pg/mL). | vitB12 levels not correlated with PSQI scores. Significant correlation between vitD and total PSQI scores and daytime sleepiness. Total PSQI score, sleep disorders and daytime sleepiness sub-scores higher in patients with vitD < 20 ng/mL. vitD possibly protective against sleep disorders and poor sleep. |
| Zhao et al., 2021 | vitD status by demographic and lifestyle factors including dietary supplementation and physical activity. | Population based, cross-sectional, multicenter study. | 5289 children aged 0–5 years | Stratified cluster random-sampling method in 12 Children’s Health Care Centers from 10 cities in Jiangsu Province, China. | Prevalence of vitD deficiency 30.1%. Higher risk of vitD deficiency associated with: older age, girls, survey conducted in spring, location in southern Jiangsu province, residence in urban, outdoor activity < 2 h/day. Lower risk associated with: parity ≥ 2 times, vitD supplementation from birth to 6 months, vitD supplementation starting ≤ 1 month after birth, vitD and calcium supplementation in the last 3 months, and dose of vitD supplementation > 400 IU/day. Higher risk of vitD deficiency with preference for sweets, meat consumption > 150.0 g/day1, milk consumption < 250 mL/day, sleeping < 10 h/day. |
| Ozgurhan et al., 2016 | Risk of OSA in subjects with vitD deficiency. | Prospective and comparative study. | 176 obese and non-obese children with and without OSA | Two groups based on 25(OH)D levels: low level (<20 ng/mL) group (n = 120) and control (>20 ng/mL) group (n = 120). Risk of developing OSA assessed by Berlin Questionnaire. | No statistically significant differences between the low level and control groups in terms of gender, age, and BMI z-score distributions. 24 subjects with high risk of developing OSA (17 subjects in the low-level group and 7 subjects in the control group). Risk of developing OSA significantly higher in the low-level group. BMI z-score significantly higher in high-risk groups than low-risk groups. |
| Cui et al., 2021 | vitD in the treatment of children with OSA. | Case-control study. | 50 children: 30 with OSA, 20 controls | In all subjects: sex, age, triglyceride, total cholesterol, HDL, LDL, serum 25-OHD levels, and Conners’ parental scale were measured. In children with OSA: BMI, AHI, and minimum oxygen saturation. Children with OSA treated with Rocaltrol (0.25 g/QD) for 4 weeks and reanalyzing their triglycerides, total cholesterol, HDL, LDL, serum 25(OH)D levels, sleep AHI, minimum oxygen saturation, and Conners’ parental scale. | Children with OSA frequently obese, with dyslipidemia, and vitD deficiency, with behavioral and cognitive dysfunction. No significant changes in BMI, triglycerides, total cholesterol, HDL, LDL, sleep AHI, and minimum oxygen saturation after vitD treatment, but the serum 25-OHD level significantly improved, as well as conduct problems, learning problems, and hyperactivity index decreased. |
| Sung et al., 2020 | Factors associated with EDS and vitD level. | Case-control study. | 618 children: 111 with EDS and 507 healthy controls | Physical examination, acoustic rhinometry, and blood sampling. Parent-filled questionnaires. Korean version of Pediatric Daytime Sleepiness Scale (PDSS). | Children with low 25(OH)D3 (<20 ng/mL) and HDL-C (<40 mg/dL) levels with increased risk of EDS. 25(OH)D3 level, exercise, and BMI were over three. High levels of 25(OH)D3 and HDL cholesterol and performing regular exercise associated with decreased risk of EDS. |
| Valtuena et al., 2013 | Environmental, individual, and genetic factors associated with 25(OH)D levels. | Multi-center cross-sectional study. | 1006 children | Measures of body composition, biochemical markers, socioeconomic status, dietary intake, physical activity, fitness, sleep time, and vitamin D genetic polymorphism (rs1544410). | In males, 25(OH)D levels independently influenced by winter season, higher latitudes, BMI z-score and retinol concentration. In females, 25(OH)D levels independently influenced by winter season, sleep time, supplement intake, flexibility, body fat %, BMI z-score, higher latitudes, and handgrip strength. Season, latitude, fitness, adiposity, sleep time, and micronutrient supplementation were highly related to 25(OH)D concentrations. |
| Işıkay et al., 2018 | Prevalence and associated factors of RLS in children with CD. | Cross-sectional study: case-control study. | 494 children: 226 with CD and 268 controls | Demographic data, educational status and routine laboratory data of children including complete blood count, ferritin, vitB12, folate and 25(OH)D levels. RLS prevalence and associated symptoms by a 30-item questionnaire. | Prevalence of RLS not increased in children with CD. Age at onset of RLS symptoms significantly younger and more severe in CD. |
| Barceló et al., 2021 | Inter-relationship between serum 25(OH)D levels and metabolic profiles, sleep parameters, and paternal and maternal vitD status. | Familial longitudinal study. | 137 Caucasian families (children and their parents) | Measurement of serum 25(OH)D levels, serum glucose, lipids, liver enzymes, parathyroid hormone, insulin, and glycated hemoglobin and evaluation of overnight PSG. | VitD insufficiency (<30 ng/mL) and deficiency (<20 ng/mL) in 40.9% and 17.5%, respectively. Risk of vitD insufficiency increased by both paternal and maternal insufficiency. Serum 25(OH)D concentration associated with AHI and respiratory arousal index. |
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