Weight-neutral approach and later sleep midpoint in adolescents with “emerging polycystic ovary syndrome phenotype” as vehicles for sustainable weight loss

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ObjectiveIncorporate sleep into a novel lifestyle intervention strategy in adolescents with emerging symptoms of Polycystic Ovary Syndrome (E-PCOS). DesignA Single Center Cohort Study. SettingsUniversity Hospital-based Clinic for adolescents with PCOS. PatientsForty-three girls ages between 10 and 18 years presenting with E-PCOS between March 2015-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. Interventions (s)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:1) Anti-insulin approach with metformin; 2) Anti-Androgen approach with oral contraceptive and spironolactone; and 3) Surveillance. Main Outcome MeasuresBody Mass Index (BMI) Z-score over time.Alanine Transaminase (ALT) levels as a risk factor for nonalcoholic fatty liver. ResultsAverage number of return visits was four with 58% percent having more than 4 return visits. Testosterone levels were correlated with ALT (r=0.68, p<0.001). Weeknight sleep duration was less than age-apporpriate recommendations for 63% of participants. Sleep midpoint correlated with ALT levels (r=0.48, p=0.006). Despite the weight neutral approach, regression models all demonstrated significant weight loss (p=0.0003) regardless of menarche status, metformin use, number of visits and high versus low ALT groups. Those with the latest sleep midpoint at baseline benefitted the most, with BMI Z-score dropping significantly (interaction of time and baseline sleep midpoint from first visit on school night of p=0.04). ConclusionA 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.