Kasa-Vubu Josephine Z, Waisanen Alexandra, Sturza Julie, Padmanabhan Vasantha, O'Brien Louise M
Division of Pediatric Endocrinology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan.
Division of Pediatric Endocrinology, Department of Pediatrics, Nutrition Services, Michigan Medicine, Ann Arbor, Michigan.
F S Rep. 2024 Sep 6;5(4):402-410. doi: 10.1016/j.xfre.2024.09.001. eCollection 2024 Dec.
Incorporate sleep into a novel lifestyle intervention strategy in adolescents with Emerging symptoms of polycystic ovary syndrome (E-PCOS).
A single-center cohort study.
University hospital-based clinic for adolescents with PCOS.
Forty-three girls at an age between 10 and 18 years presenting with E-PCOS between March 2015 and September 2017 with clinical signs of androgen excess and/or accelerated weight gain, acanthosis nigricans, irregular periods, or delayed menarche and followed every 6 months for a minimum of 4 visits, to October 2020.
All patients received nutritional counseling, with a goal of "zero weight gain," daily moderate physical activity goals of 45 minutes per day, and education regarding age-appropriate sleep duration. Three treatment strategies for E-PCOS symptoms were applied depending on the chief clinical complaint: anti-insulin approach with metformin; antiandrogen approach with oral contraceptive and spironolactone; and surveillance.
Body mass index (BMI) Z-score over time. Alanine Transaminase (ALT) levels as a risk factor for nonalcoholic fatty liver.
Average number of return visits was 4 with 58% having >4 return visits. Testosterone levels were correlated with ALT ( = 0.68). Weeknight sleep duration was less than age-appropriate recommendations for 63% of participants. Sleep midpoint correlated with ALT levels ( = 0.48). Despite the weight-neutral approach, regression models all demonstrated significant weight loss regardless of menarche status, metformin use, number of visits, and high vs. low ALT groups. Those with the latest sleep midpoint at baseline benefited the most, with BMI Z-score dropping significantly (interaction of time and baseline sleep midpoint from the first visit on school night).
A novel approach for adolescent girls with E-PCOS that focuses on metabolic endpoints and includes sleep duration and timing as specific targets, led to significant weight loss irrespective of treatment group.
将睡眠纳入针对多囊卵巢综合征初发症状（E-PCOS）青少年的新型生活方式干预策略中。
单中心队列研究。
大学医院的PCOS青少年诊所。
2015年3月至2017年9月期间，43名年龄在10至18岁之间的女孩，表现出E-PCOS，伴有雄激素过多和/或体重加速增加、黑棘皮病、月经不规律或初潮延迟等临床症状，并每6个月随访一次，至少随访4次，直至2020年10月。
所有患者均接受营养咨询，目标是“体重不增加”，每日适度体育活动目标为每天45分钟，并接受关于适合年龄的睡眠时间的教育。根据主要临床症状，应用三种治疗E-PCOS症状的策略：使用二甲双胍的抗胰岛素方法；使用口服避孕药和螺内酯的抗雄激素方法；以及监测。
随时间变化的体重指数（BMI）Z评分。丙氨酸转氨酶（ALT）水平作为非酒精性脂肪肝的危险因素。
平均复诊次数为4次，58%的患者复诊次数超过4次。睾酮水平与ALT相关（=0.68）。63%的参与者工作日睡眠时间少于适合其年龄的建议时间。睡眠中点与ALT水平相关（=0.48）。尽管采取了体重中性方法，但回归模型均显示，无论初潮状态、二甲双胍使用情况、就诊次数以及ALT高低分组如何，体重均显著下降。基线时睡眠中点最晚的患者获益最大，BMI Z评分显著下降（从上学日晚上首次就诊起，时间与基线睡眠中点的相互作用）。
一种针对E-PCOS青春期女孩的新型方法，专注于代谢终点，将睡眠时间和时间点作为特定目标，无论治疗组如何均导致显著体重减轻。
