Marine Sourced Docosahexaenoic acid (DHA) Supplementation Improves Children’s Sleep1.

The first published study investigating the association between long chain polyunsaturated fatty acid (LC-PUFA) status and sleep, and the effect of DHA supplementation on sleep in healthy children has reported that children get almost an extra hour of sleep and had seven fewer waking episodes and shorter night-wakings per night while taking DHA. The authors of the study based at the Centre for Evidence-Based Intervention, University of Oxford, UK, stated that “the physical, mental and social benefits that would be expected to follow such an improvement are profound”.

 

This study was nested within the Docosahexaenoic acid Oxford Learning and Behaviour (DOLAB) trial that included two stages. Stage 1 was an epidemiological study of 395 healthy children aged 7-9 years from  mainstream UK schools where the association between blood fatty acid concentration and subjective sleep was determined using an age-standardized parent questionnaire called the Child Sleep Habits Questionnaire (CSHQ). Parents rated their child’s sleeping habits over a week on 45 items using a three point scale (3=usually, 2 = sometimes and 1 = rarely/never) for the         subscales:  bedtime resistance, sleep duration, parasomnias, sleep disturbed breathing, night waking, daytime sleepiness, sleep anxiety and sleep onset delay. Children with a total CSHQ score of >41 were considered to have clinical-level sleep problems.         

 

Stage 2 included 362 of the children from the Stage 1 study randomly assigned to take either 600 mg daily of algal source DHA or a corn/soybean oil placebo for 16 weeks.  The CSHQ was repeated following supplementation.  In a subsample of 43 children with clinical-level sleep problems as determined by the CSHQ, sleep was also assessed for 5 nights pre and post treatment using an objective measure (actigraphy) where the following variables were reported as average times/scores over 5 nights:  sleep onset and offset times, sleep duration in minutes, minutes awake between sleep onset and offset, sleep efficiency (total sleep time divided by time in bed), sleep latency (minutes taken to fall asleep), number of night wakings after sleep onset. Lastly, parents completed a diary detailing their child’s bedtime and rising time, any intervals when the actigraph was removed and their perception of the child’s periods of sleep.

 

Results showed that 40% of the 395 children in the epidemiological study had clinical-level sleep problems as assessment by the CSHQ.  Higher blood DHA was associated with significantly better sleep while a higher DHA:AA ratio was associated with fewer total sleep disturbances. Following DHA treatment, there were no significant effects on        subjective sleep measures in the 362 children tested.  However, in the group of 43 subjects who had clinical level sleep problems, DHA treatment significantly improved total sleep disturbance scores as measured subjectively and when tested for objective measures by actigraphy, DHA supplementation led to 7 fewer wake episodes and shorter night-wakings, and 58 minutes more sleep per night.

 

The importance of LC-PUFAs for sleep initiation and maintenance has been known for a long time. Arachidonic acid (AA) is required to make the sleep promoting prostaglandin D2 and DHA appears to be essential for sleep regulation. The relative amounts of DHA and AA in the pineal gland regulates melatonin production with higher levels of DHA relating to increased levels melatonin since DHA is needed by one of the enzymes which transforms serotonin into melatonin.

 

Population studies have found higher levels of omega-3 fatty acids are associated with fewer sleep problems in infants2 and adults3, and in children with ADHD4, and higher DHA is associated with less severe sleep apnea5.  Intervention trials have shown that omega-3 and omega-6 fatty acids combined with other nutrients improve sleep quality6, and reduce sleep disorders7among children with behavioural problems. In addition, DHA supplementation in pregnant women improved sleep patterns in their infants8.

 

The results of this study are exciting and warrant further investigation of the effects of  safe and well-tolerated DHA supplementation on child sleep problems.

 

References:

1.             Montgomery P, Burton J, Sewell R, Spreckelson T, Richardson A. Fatty acids and sleep         in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial. J Sleep Res 2014: DOI:10.1111/jsr.12135

2.             Cheruku, S. R., Montgomery-Downs, H. E., Farkas, S. L., Thoman, E. B. and Lammi-Keefe, C. J. Higher maternal plasma docosahexaenoic acid during pregnancy is associated with more mature neonatal sleep-state patterning. Am. J. Clin. Nutr., 2002, 76: 608–613.

3.             Papandreou, C. Independent associations between fatty acids and sleep quality among obese patients with obstructive sleep apnoea syndrome.   J. Sleep Res., 2013, 22: 569–572.

4.             Burgess, J. R., Stevens, L., Zhang, W. and Peck, L. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am. J. Clin. Nutr., 2000, 71(Suppl. 1): 327S–330S.

5.             Ladesich, J. B., Pottala, J. V., Romaker, A. and Harris, W. S. Membrane level of omega-3 docosahexaenoic acid is associated with severity of obstructive sleep apnea. J. Clin. Sleep Med., 2011, 7: 391–396.

6.             Yehuda, S., Rabinovitz-Shenkar, S. and Carasso, R. L. Effects of essential fatty acids in iron deficient and sleep-disturbed attention deficit hyperactivity disorder (ADHD) children. Eur. J. Clin. Nutr., 2011, 65: 1167–1169.

7.             Huss, M., Volp, A. and Stauss-Grabo, M. Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems—an observational cohort study. Lipids Health Dis., 2010, 9: 105.

8.             Judge, M. P., Cong, X., Harel, O., Courville, A. B. and Lammi-Keefe, C. J. Maternal consumption of a DHA-containing functional food                 benefits infant sleep patterning: an early neurodevelopmental measure. Early Hum. Dev., 2012, 88: 531–537.

 

NEWS FROM THE RESEARCH FRONT                    No 162 Mar 2014

 

 

Topics: Omega-3 fatty acids, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), long chain polyunsaturated fatty acids (LC-PUFAs), sleep, attention deficit hyperactivity disorder (ADHD), arachidonic acid (AA)
Background:  Children with sleep problems generally have poor health, and poor sleep is also linked to ADHD and other difficulties with behaviour and learning in children. Children with sleep problems have lower than normal blood levels of LC-PUFAs including DHA. The importance of LC-PUFAs for sleep initiation and maintenance has been known for a long time. To date, little is known about the relationship between LC-PUFA and sleep in healthy children.
Objective:

There were two objectives for this study:
1) to explore associations between child sleep and biochemical measures of blood fatty acid status and
2) to assess the effect of DHA supplementation on children’s sleep.
Method:     This was a nested study within the Docosahexaenoic acid Oxford Learning and Behaviour (DOLAB) study that included two stages.
STAGE 1 – an epidemiological study of 395 healthy children aged 7-9 years from mainstream UK schools where the association between blood fatty acid concentration
and

subjective sleep using an age-standardized parent questionnaire was used.
Inclusion Criteria: aged 7-9 years with no significant learning difficult but thought to  have below-average literacy skills according to national standardized tests at age 7
                                    Exclusion Criteria: visual or hearing impairment, first language other than English or if  the family/social circumstances would make inclusion inappropriate.
Assessments:
                                    1.         Fatty Acid Status – in whole blood collected via finger-stick method
                                    2.         Subjective Sleep – using the Child Sleep Habits Questionnaire (CSHQ)
where

parents rated their child’s sleeping habits over a week on 45 items using a   three-point scale (3=usually, 2 = sometimes and 1 = rarely/never) for the following subscales: bedtime resistance, sleep duration, parasomnias, sleep disturbed breathing, night waking, daytime sleepiness, sleep anxiety and sleep onset delay. Children with a total CSHQ score of >41 were considered to have clinical-level sleep problems.
take     

STAGE 2 – included 362 of the children from the Stage 1 study randomly assigned to take either 600 mg daily of algal source DHA or a corn/soybean oil placebo for 16 weeks. A subsample of 43 children with clinical-level sleep problems had their sleep objectively  tested using actigraphy.
Inclusion Criteria: underperforming in reading but otherwise healthy and not taking fatty acid supplements or eating fish more than twice a week.
Exclusion Criteria: if taking any medication thought to affect behaviour.
Assessments:
1.         Subjective Sleep – using the CSHQ following treatment (to be compared with the results collected in the Stage 1 study).  
2.         Objective Sleep (in 43 children) – for 5 nights pre and post treatment using actigraphy where the following variables were reported as average times/scores over 5 nights.
– Sleep onset and offset times
– Sleep duration in minutes
– Minutes awake between sleep onset and offset
– Sleep efficiency (total sleep time divided by time in bed)
– Sleep latency (minutes taken to fall asleep)
– Number of night wakings after sleep onset
3.         Sleep Diary (in 43 children) – Parents completed a diary detailing their child’s bedtime and rising time, any intervals when the actigraph was removed and  their perception of the child’s periods of sleep.

Findings:      Forty percent of the 395 children in the epidemiological study had clinical-level sleep  problems as assessment by the CSHQ.  Higher blood DHA was associated with significantly better sleep (P<0.026) while a higher DHA:AA ratio was associated with total sleep disturbances (P<0.009).  
fewer    No consistent associations were found between CSHQ scores and other fatty acids when controlling for demographic variables including age, gender, weight and SES.  Following treatment, there were no significant effects on subjective sleep measures in the 362 children tested.  However, in the group of 43 subjects who had clinical level sleep problems, DHA treatment significantly improved total sleep disturbance scores (P<0.05) as measured subjectively and when tested for
objective measures by actigraphy, DHA supplementation led to 7 fewer wake episodes and
shorter night-wakings, and 58 minutes more sleep per night.
Conclusion: Higher blood levels of DHA relate to better sleep as determined by parents. Objective measures of sleep using actigraphy indicate that DHA supplementation significantly  improves children sleep.
Relevance to Efalex, Efalex Concentrate
Reference : Montgomery P, Burton J, Sewell R, Spreckelson T, Richardson A. Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial. J Sleep Res 2014: DOI:10.1111/jsr.12135