Reduced sleep duration has an almost linear correlation with excessive weight and obesity in the pediatric population. This is especially true for the youngest population, less so for adolescents, whereas later on, this relationship tends to become U-shaped in middle-aged subjects. The level of physical activity is a crucial determinant of this correlation, with sedentary life and low activity level supporting obesity and poor quality sleep. Quality of life, school achievement, and emotional regulation are highly impacted by the short sleep–excessive weight dyad, as well as cardiometabolic indexes. The latter include blood pressure, glucose metabolism, and lipid profile, which all appear to be negatively affected, albeit less consistently, and thus with low quality evidence as far as the latest meta-analytic reviews are concerned. Obstructive sleep apnea (OSA) in children is also associated with alteration of sleep structure and with sleep fragmentation rather than sleep time reduction. Pediatric OSA recognizes two main phenotypes, lean and obese, the latter mostly typical of older children/adolescents, mainly males, with a more severe impact on inflammatory and metabolic indexes and a scarce cure rate after therapeutic adenotonsillectomy. Expanding sleep time and limiting obesity with appropriate sleep hygiene, adequate exercise levels, salutary nutritional advice, and screen time reduction may represent viable preventive tools to avoid more serious physical and mental consequences later in adult life.

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