HJAR Mar/Apr 2021

HEALTHCARE JOURNAL OF ARKANSAS  I  MAR / APR 2021 41 who present with difficulty sleeping and/or daytime symptoms that suggest inadequate sleep (e.g., tiredness, sleepiness, inattention, poor school performance, mood disturbances) should have a detailed sleep history obtained to evaluate sleep quantity and quality. Children and adolescents with obesity, especially those with OSAsymptoms or children with other sleep problems (i.e., difficulty initiating sleep, very disturbed sleep on a regular basis, excessive daytime sleepiness) should be referred to a pediatric sleep disorders center for further evaluation and possible sleep study. n REFERENCES 1 Tähkämö, L., Partonen, T., & Pesonen, A. (2018). Sys- tematic review of light exposure impact on human circadian rhythm. Chronobiology International, 36(2), 151-170. doi:10.1080/07420528.2018.1527773 2 Benarroch, E. E. & Benarroch, E. E. (2008). Supra- chiasmatic nucleus and melatonin. Neurology, 71(8), 594-598. doi:10.1212/01.wnl.0000324283.57261.37 3 Foerster, M., Henneke, A., Chetty-Mhlanga, S., & Röösli, M. (2019). Impact of Adolescents’ Screen Time and Nocturnal Mobile Phone-Related Awakenings on Sleep and General Health Symptoms: A Prospective Cohort Study. International Journal of Environmental Research and Public Health, 16(3), 518. doi:10.3390/ ijerph16030518 4 Becker, S. P., Langberg, J. M., Eadeh, H., Isaacson, P. A., & Bourchtein, E. (2019). Sleep and daytime sleepiness in adolescents with and without ADHD: Differences across ratings, daily diary, and actig- raphy. Journal of Child Psychology and Psychiatry. doi:10.1111/jcpp.13061 5 Beccuti, G., & Pannain, S. (2011). Sleep and obesity. Currentopinion inclinicalnutritionandmetaboliccare, 14(4), 402–412. doi:10.1097/MCO.0b013e3283479109 Supriya Jambhekar, MD, is a Professor of Pedi- atrics at the University of Arkansas for Medical Sciences (UAMS) and Arkansas Children’s Hospital (ACH). She serves as medical director of the Arkansas Children’s Hospital Sleep Disorders Center. Jambhekar is currently board-certified in general pediatrics, pediatric pulmonology, and pediatric sleep medicine. She is currently a member of the American Academy of Pediatrics, American Thoracic Society, American College of Chest Physicians and the American Academy of Sleep Medicine. Jay White, DNP, APRN, is a certified pediatric nurse practitioner in the Arkansas Children’s Hospital Sleep Disorders Center. She is currently a member of the National Association of Pediatric Nurse Practitioners, the Association of Pulmonary Advanced Practice Providers and the American Academy of Sleep Medicine. sleep, symptoms of obstructive sleep apnea and restlessness to ensure they are getting good quantity and quality of sleep. Obesity and Obstructive Sleep Apnea Obesity has become more prevalent in the United States today, especially among children and adolescents. Some health risks associated with obesity include hypertension, diabetes and obstructive sleep apnea (OSA). Uncontrolled OSA, in turn, can increase the risk of getting hypertension and diabetes and may also prevent the ability to lose weight, even when trying. 5 During sleep, secretion of appetite regulation hormones leptin and ghrelin is regulated. ghrelin signals hunger, and leptin signals satiety or fullness. Inadequate sleep can cause ghrelin to increase and leptin to decrease, making it difficult for the brain to receive the “all full, stop eating”message. 5 Poor sleep is known to increase the appetite for starchy and sweet foods and to worsen obesity. The amygdala, which is the brain’s deep emotional center that regulates positive and negative emotions, and the prefrontal cortex, which manages impulse control, are affected by sleep. Without adequate sleep, the amygdala has shown to increase positive responses to unhealthy foods and the prefrontal cortex to decrease the ability to control impulses, increasing the risk of consuming simple sugars and carbohydrates for energy and pleasure. 5 In Summary, Sleep Does the Body Good Health care providers caring for children and adolescents must take extra time to evaluate their sleep and educate them regarding the importance of adequate sleep. Children and adolescents Jay White, DNP, APRN, CPNP-AC Pediatric Nurse Practitioner Arkansas Children’s Hospital Sleep Disorders Center Learning, Concentration and Behavior Children and adolescents use electronic devices for long periods on a daily basis. Nighttime usage of electronic devices within one hour before bedtime shifts the circadian rhythm forward, making it difficult to fall asleep at regular times. The wake-up times are equally shifted, but most children have to wake up at specific times to get to school or work, thus causing sleep deprivation and decreased rapid eye movement (REM) sleep. These sleep disruptions can lead to difficulty with learning and concentration, hyperactivity, obesity and other serious health concerns seen among children and adolescents today. Therefore, while following children and adolescents for a routine visit, it is important to confirm that their consistent bedtime routine includes no electronics one hour before bedtime and bright light exposure during the day. 3 Children and adolescents who are not getting sufficient, restful sleep are tired during the day, making it difficult to concentrate and learn. Also, the things learned during the day are moved from short-termmemory to long-termmemory during certain sleep stages.With decreased quality and quantity of sleep, the ability to remember what is learned from day to day can be affected. These, in turn, may lead to hyperactivity, poor academic performance and/or mood disturbances, including irritability. When this occurs, ADHD, behavioral problems or academic inadequacy may be inappropriately diagnosed in a child. 4 Therefore, before making these diagnoses, a detailed sleep history should be obtained. This should include bedtime routine, electronic device use, bedroom environment, amount of