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Liao Z, Chen Y, Wu L, Huang Y, Li S, Liu J, Zong X, Tai J, Chen F. Associations of Obstructive Sleep Apnea Risk with Obesity, Body Composition and Metabolic Abnormalities in School-Aged Children and Adolescents. Nutrients 2024; 16:2419. [PMID: 39125300 PMCID: PMC11313962 DOI: 10.3390/nu16152419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
The objective of this study is to explore the associations between obesity, body composition, and the self-reported risk of obstructive sleep apnea (OSA) and to examine whether the risk of OSA is related to metabolic abnormalities in children and adolescents aged 6-17 years. Utilizing data from the 2022 to 2023 Beijing Children and Adolescents Health Cohort baseline survey, 5000 school-aged participants were analyzed. OSA risk was assessed via the Pediatric Sleep Questionnaire, with anthropometric and body composition measurements taken. Metabolic markers included blood pressure, lipid levels, blood glucose, and uric acid. Associations were analyzed using logistic regression and generalized linear models. Results showed that 88.6% were low-risk and 11.4% were high-risk for OSA. Overweight (aOR 1.53, 95% CI 1.22-1.92), obesity (aOR 1.94, 95% CI 1.57-2.40), and abdominal obesity (aOR 1.59, 95% CI 1.31-1.93) significantly increased OSA risk. High fat mass was a critical factor, while muscle mass was not, especially in those who were overweight and obese. Associations of OSA risk with metabolic abnormalities were non-significant after adjusting for BMI. Our research highlights the significant associations of obesity and body composition with OSA risk, with child BMI influencing the relationship between OSA and metabolic abnormalities. Future research should explore causative relationships and the enduring impacts of OSA on metabolic health in children.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Tai
- Capital Institute of Pediatrics, Beijing 100020, China; (Z.L.); (Y.C.); (L.W.); (Y.H.); (S.L.); (J.L.); (X.Z.)
| | - Fangfang Chen
- Capital Institute of Pediatrics, Beijing 100020, China; (Z.L.); (Y.C.); (L.W.); (Y.H.); (S.L.); (J.L.); (X.Z.)
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Cheung EC, Nilsson A, Venter I, Kowalik G, Ribeiro C, Rodriguez J, Kuraoka K, Russo R, Escobar JB, Alber BR, Mendelowitz D, Kay MW, Schunke KJ. Sex differences in cardiac transcriptomic response to neonatal sleep apnea. Physiol Rep 2024; 12:e16110. [PMID: 38981849 PMCID: PMC11233197 DOI: 10.14814/phy2.16110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 07/11/2024] Open
Abstract
Pediatric obstructive sleep apnea poses a significant health risk, with potential long-term consequences on cardiovascular health. This study explores the dichotomous nature of neonatal cardiac response to chronic intermittent hypoxia (CIH) between males and females, aiming to fill a critical knowledge gap in the understanding of sex-specific cardiovascular consequences of sleep apnea in early life. Neonates were exposed to CIH until p28 and underwent comprehensive in vivo physiological assessments, including whole-body plethysmography, treadmill stress-tests, and echocardiography. Results indicated that male CIH rats weighed 13.7% less than age-matched control males (p = 0.0365), while females exhibited a mild yet significant increased respiratory drive during sleep (93.94 ± 0.84 vs. 95.31 ± 0.81;p = 0.02). Transcriptomic analysis of left ventricular tissue revealed a substantial sex-based difference in the cardiac response to CIH, with males demonstrating a more pronounced alteration in gene expression compared to females (5986 vs. 3174 genes). The dysregulated miRNAs in males target metabolic genes, potentially predisposing the heart to altered metabolism and substrate utilization. Furthermore, CIH in males was associated with thinner left ventricular walls and dysregulation of genes involved in the cardiac action potential, possibly predisposing males to CIH-related arrhythmia. These findings emphasize the importance of considering sex-specific responses in understanding the cardiovascular implications of pediatric sleep apnea.
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Affiliation(s)
- Emily C. Cheung
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Anna Nilsson
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
| | - Ian Venter
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
| | - Grant Kowalik
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Caitlin Ribeiro
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeannette Rodriguez
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Kiralee Kuraoka
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
| | - Rebekah Russo
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Joan B. Escobar
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Bridget R. Alber
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - David Mendelowitz
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Matthew W. Kay
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Kathryn J. Schunke
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
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Adeva-Andany MM, Domínguez-Montero A, Castro-Quintela E, Funcasta-Calderón R, Fernández-Fernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:231. [PMID: 39076340 PMCID: PMC11270082 DOI: 10.31083/j.rcm2506231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/31/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- γ ) downregulation. In human adipose tissue, PPAR- γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
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Costa M, Correia-Costa L, Santos AC, Azevedo I. Obstructive sleep related breathing disorders and cardiometabolic risk factors - A Portuguese birth cohort. Respir Med 2024; 222:107531. [PMID: 38246393 DOI: 10.1016/j.rmed.2024.107531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Pediatric obstructive sleep related breathing disorders (SRBD) are an important under-diagnosed health problem with associated cardiometabolic comorbidities, demonstrated with polysomnographic studies in selected samples. Our main goal was to assess the prevalence of SRBD in a population-based cohort and to analyze its association with cardiometabolic risk factors, in general and by sex. METHODS Pediatric Sleep Questionnaire (PSQ) was applied to parents of 7-years-old children evaluated in the birth cohort, Generation XXI. Sex, anthropometrics, blood pressure (BP), lipid profile, glucose, insulin, HOMA-IR, and high-sensitivity C-reactive protein were compared among children with/without SRBD, using Chi-square, Mann-Whitney tests and logistic regression models. RESULTS A total of 1931 children (51.2 % boys) were included; 17.5 % were overweight and 15.7 % obese. The prevalence of SRBD was 13.4 %, more frequent among boys (15.7 % vs.10.9 %, p = 0.002) and in overweight/obese children (22.0 % vs.13.6 % vs.11.3 % in obese, overweight and normal weight group, respectively, p < 0.001). Children with SRBD had higher systolic BP (107 ± 8 vs.105±9 mmHg; p = 0.001) and lower HDL-cholesterol levels (54 ± 11 vs.56 ± 11 mg/dL; p = 0.04) than children without SRBD. After adjustment for sex, age, birthweight-for-gestational age and maternal age, children with SRBD had higher BMI-z-score, systolic BP, insulin and HOMA-IR levels, and lower HDL-cholesterol, when compared to those without SRBD, but these associations were lost when adjusting to BMI z-score. Analyzing obese children with the same regression model, those with SRBD presented lower HDL-cholesterol than those without SRBD. CONCLUSIONS Our results identified a male predominance of SRBD in pre-pubertal children and highlighted the potential contribution of SRBD to cardiovascular risk in obese children.
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Affiliation(s)
- Mariana Costa
- Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar de Leiria, Portugal
| | - Liane Correia-Costa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.
| | - Ana Cristina Santos
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Inês Azevedo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
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Umano GR, Galderisi A, Aiello F, Martino M, Camponesco O, Di Sessa A, Marzuillo P, Alfonso P, Miraglia Del Giudice E. Obstructive sleep apnea (OSA) is associated with the impairment of beta-cell response to glucose in children and adolescents with obesity. Int J Obes (Lond) 2023; 47:257-262. [PMID: 36670156 PMCID: PMC10113157 DOI: 10.1038/s41366-023-01257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The main purpose of the study is to assess the association between obstructive sleep apnea (OSA) and insulin secretion in children with obesity. METHODS We enrolled children and adolescents who attended our pediatric clinic because of obesity and OSA. Glucose homeostasis was assessed through standard 2-h oral glucose tolerance test (OGTT). Nocturnal cardio-respiratory polygraphy was performed for OSA diagnosis. Twenty-two patients underwent a 3-h OGTT to investigate insulin secretion and sensitivity through the oral-minimal model. RESULTS seventy-seven children and adolescents were included in the study. Based on OSA severity, the cohort was divided into three groups (29 mild, 29 moderate, and 19 severe OSA). The group with mild OSA showed lower levels of 30-min glucose (p = 0.01) and 60-min glucose (p = 0.03), and lower prevalence of elevated 1-h glucose (10.4% versus 44.8% in moderate and 31.6% in severe OSA, p = 0.01). The odds for elevated 1-h plasma glucose was 6.2-fold (95%CI 1.6-23.4) higher in subjects with moderate and severe OSA compared to mild OSA (p = 0.007) independent of confounders. Spearman correlation test revealed a positive correlation between 30-min plasma glucose and apnea-hypopnea index (AHI, r = 0.31, p = 0.01), oxygen desaturation index (ODI, r = 0.31, p = 0.009), and mean desaturation (r = 0.25, p = 0.04). The 3-h OGTT study included 22 participants (7 mild, 9 moderate, and 6 severe OSA). The group with mild OSA showed a higher dynamic, static, and total insulin secretion compared to those with moderate and severe OSA (p < 0.0001, p = 0.007, p = 0.007, respectively). AHI was significantly correlated to dynamic insulin secretion (r = -0.48, p = 0.02). CONCLUSIONS OSA might impair beta-cell function reducing the pool of promptly releasable insulin in children and adolescents with obesity, in the absence of an effect on insulin sensitivity.
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Affiliation(s)
- Giuseppina Rosaria Umano
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Alfonso Galderisi
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | - Francesca Aiello
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mariangela Martino
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | - Ornella Camponesco
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Di Sessa
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pierluigi Marzuillo
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Papparella Alfonso
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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Vidmar AP, Cáceres NA, Schneider-Worthington CR, Shirazipour C, Buman MP, de la Haye K, Salvy SJ. Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth. Curr Obes Rep 2022; 11:236-253. [PMID: 36348216 PMCID: PMC9742346 DOI: 10.1007/s13679-022-00491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep. RECENT FINDINGS Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.
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Affiliation(s)
- Alaina P Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, 4650 Sunset Boulevard, Mailstop #61, Los Angeles, CA, 90027, USA.
| | - Nenette A Cáceres
- Cancer Research Center On Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | | | - Celina Shirazipour
- Cancer Research Center On Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Tempe, USA
| | - Kayla de la Haye
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Sarah-Jeanne Salvy
- Cancer Research Center On Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome. Eur J Pediatr 2022; 181:1689-1697. [PMID: 35006374 DOI: 10.1007/s00431-021-04366-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED Obstructive sleep apnea syndrome (OSAS) in childhood is a complex disease primarily due both to adenotonsillar hypertrophy and pediatric obesity. Notably, inflammation has been recognized as one of the most important shared pathogenic factor between obesity and OSAS resulting in an increased cardiometabolic risk for these patients. To date, evidence is still limited in non-obese population with OSAS. We aimed to evaluate the cardiometabolic risk profile of a pediatric population of non-obese subjects affected by OSAS. A total of 128 school-aged children (mean age 9.70 ± 3.43) diagnosed with OSAS and 213 non-OSAS children (mean age 9.52 ± 3.35) as control group were enrolled. All subjects underwent a complete clinical and biochemical assessment (including white blood cell count (WBC), platelet count (PLT), mean platelet volume (MPV), % of neutrophils (NEU%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), uric acid, fasting insulin, iron, ferritin, and transferrin levels). A significant association between inflammation markers (including WBC, PLT, MPV, NEU%, ferritin, CPR, and ESR) and OSAS was found (all p < 0.001). Children with OSAS also showed increased transaminase, glucose, uric acid, and insulin levels (all p < 0.001) compared to healthy controls. CONCLUSION Taken together, these findings suggested a worse cardiometabolic profile in non-obese children with OSAS. Given the pivotal pathogenic role of inflammation both for hypoxiemia and metabolic derangements, therapeutic strategies for OSAS might also counteract the increased cardiometabolic risk of these patients, by improving their long-term quality of life. WHAT IS KNOWN • Pediatric OSAS has shown a close relationship with obesity and its cardiometabolic comorbidities. • Inflammation represents the hallmark of both obesity and OSAS. WHAT IS NEW • Non obese children with OSAS presented with a worse cardiometabolic risk profile. • OSAS treatment might serve as an effective approach also for the increased cardiometabolic risk of these children.
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Siriwat R, Wang L, Shah V, Mehra R, Ibrahim S. Obstructive sleep apnea and insulin resistance in children with obesity. J Clin Sleep Med 2020; 16:1081-1090. [PMID: 32118578 DOI: 10.5664/jcsm.8414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVES Because existing data investigating obstructive sleep apnea (OSA) and insulin resistance (IR) are inconsistent, we examine OSA and IR in a pediatric obesity clinic. METHODS Children (2-18 years) in the obesity clinic (2013-2017) undergoing polysomnography (PSG), anthropometric measurements, and fasting laboratory tests were included. Linear regression assessed OSA defined by the obstructive apnea-hypopnea index (oAHI) with the homeostatic model assessment of insulin resistance (HOMA-IR). Secondary aims assessed oxygen desaturation index (ODI) and age interactions with HOMA-IR. Logistic regression models and receiver operating characteristic analysis were performed to investigate optimal oAHI and ODI cutoffs relative to HOMA-IR ≥ 3. RESULTS Eighty children were included (mean age, 11.4 ± 4.0 years; 56% female; 46% Caucasian; median body mass index [BMI], 34.6 kg/m² [interquartile ratio, 29.9-40.1], median BMI z-score, 2.5 [interquartile ratio, 2.3-2.8); 46% with oAHI ≥ 5 events/h. HOMA-IR was higher in the OSA group (oAHI ≥ 5 events/h): 5 vs 3.8 (P = .034). After adjustment for sex, race, and BMI z-score, oAHI ≥ 5 events/h retained significance with HOMA-IR (P = .041). HOMA-IR increased in older children (age ≥ 12 years) when adjusting for waist circumference z-score and waist-height ratio (statistical interaction, P = .020 and .034, respectively). Receiver operating characteristic showed optimal cut points of oAHI and ODI for predicting significant IR 4.9 (area under the curve, 0.70; 95% confidence interval, 0.57-0.83; sensitivity, 0.76; specificity, 0.66) and 4.6 (area under the curve, 0.68; 95% confidence interval, 0.55-0.80; sensitivity, 0.70; specificity, 0.67), respectively. CONCLUSIONS In a clinic-based pediatric cohort with obesity, OSA is associated with increased IR even after adjusting for confounders including obesity defined by the BMI z-score. Age ≥ 12 years was associated with AHI relative to IR after adjustment for waist circumference z-score and waist-height ratio. Significant IR could be discriminated by oAHI ≥ 4.9 with moderate sensitivity/specificity. Future studies are needed to verify these findings.
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Affiliation(s)
| | - Lu Wang
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Vaishal Shah
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Sally Ibrahim
- Division of Pulmonary, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital of University Hospitals, Cleveland, Ohio
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Objective sleep quality and metabolic risk in healthy weight children results from the randomized Childhood Adenotonsillectomy Trial (CHAT). Sleep Breath 2019; 23:1197-1208. [PMID: 30798410 DOI: 10.1007/s11325-019-01802-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesized that cardiopulmonary coupling (CPC) sleep quality reflects cardiovascular and cardiometabolic health, in healthy weight children. METHODS Retrospective signal analysis of existing ECG data utilizing CPC, FDA cleared, software as medical device (SaMD). ECG signals were extracted from baseline polysomnography studies in the prospective Childhood Adenotonsillectomy Trial database, multicenter, single-blind, randomized controlled trial of 5.0-9.9-year-old children identified with obstructive sleep apnea syndrome without severe hypoxemia. Healthy weight was defined as age- and gender-specific BMI in the 5th-85th percentile range and overweight above the 85th percentile. The cohort was stratified based on CPC sleep quality Index (SQI) defined as high sleep quality (SQI ≥ 80) or low sleep quality (SQI < 60). Cardiovascular, cardiometabolic, quality of life, and cognition were compared between the sleep quality groups. RESULTS Healthy weight children with low sleep quality had more fragmented sleep with significantly higher arousal index (10.0 ± 4.3 vs.7.2 ± 3.1; p = 0.00) and eLFCBB (12.4 ± 4.9 vs. 0.9 ± 1.0; p < 0.001) CPC indicator of sleep fragmentation, higher average heart rate during sleep (84.5 ± 10.6 vs. 79.4 ± 7.1; p = 0.03) and worse insulin/glucose ratio (1.7 ± 1.6 vs. 1.1 ± 1.1; p = 0.03) and fasting insulin levels (7.9 ± 7.2 vs.5.3 ± 5.5; p = 0.05) when compared to healthy weight children with high sleep quality. SQI significantly correlates with average heart rate during sleep, insulin and triglyceride levels; for a unit increase in SQI, there is 0.154 unit decrease in average heart rate during sleep, 0.109 unit in insulin levels and 0.332 unit in triglyceride levels, respectively. CONCLUSION CPC sleep quality offers insights into pediatric sleep and how it affects cardiovascular and cardiometabolic health. ECG is simple signal to collect, which makes this method practical for testing sleep, over multiple nights, and on multiple occasions providing information on sleep dynamics not possible before. TRIAL REGISTRATION NCT00560859.
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Katz SL, MacLean JE, Hoey L, Horwood L, Barrowman N, Foster B, Hadjiyannakis S, Legault L, Bendiak GN, Kirk VG, Constantin E. Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study. J Clin Sleep Med 2017; 13:1039-1047. [PMID: 28728620 DOI: 10.5664/jcsm.6718] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 06/12/2017] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVES There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB. METHODS A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP). RESULTS Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups. CONCLUSIONS In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth. COMMENTARY A commentary on this article appears in this issue on page 1025.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital/University of Alberta, Edmonton, Alberta, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Linda Horwood
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Bethany Foster
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
| | - Laurent Legault
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
| | - Glenda N Bendiak
- Alberta Children's Hospital/ University of Calgary, Calgary, Alberta, Canada
| | - Valerie G Kirk
- Alberta Children's Hospital/ University of Calgary, Calgary, Alberta, Canada
| | - Evelyn Constantin
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
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12
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Ye XH, Chen H, Yu Q, Zhu QL. Liver X Receptor Gene Expression is Enhanced in Children with Obstructive Sleep Apnea-Hyperpnoea Syndrome and Cyclooxygenase-2 (COX-2) is Correlated with Severity of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Med Sci Monit 2017; 23:3261-3268. [PMID: 28676625 PMCID: PMC5508877 DOI: 10.12659/msm.900947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 09/02/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver X receptor (LXR) is a nuclear receptor presenting in macrophages; it works indispensably in lipid metabolism control and also negatively regulates the expression of inflammatory genes in macrophages. There are many LXR-related studies in adults with metabolic syndrome but rare reports in obese children with obstructive sleep apnea-hypopnea syndrome (OSAHS). The aim of this study was to investigate the expression of LXR, cholesterol ester transfer protein (CETP), and cyclooxygenase-2 (COX-2) genes in obese children with OSAHS compared with obese children without OSAHS and non-obese children. MATERIAL AND METHODS Sleep monitoring was conducted in 80 obese children with sleep disorders. Fasting morning blood samples from the 80 obese children and 51 normal children were collected and separated, so that macrophages were obtained after culture. Fluorescence quantitative real-time PCR (RT-PCR) was used to detect expression levels of the LXR, CETP, and COX-2 genes. RESULTS LXR, COX-2, and CETP levels in the OSAHS group were higher than those in the other two groups (P<0.05), and the LXR levels in the group of obese children without OSAHS were higher than those in control group (P<0.05). COX-2 expression in the group with moderate to severe OSAHS was higher than that in the group with mild OSAHS (P<0.05). Meanwhile, there were no significant differences in the LXR and CETP levels between the moderate to severe OSAHS group and the mild OSAHS group (P>0.05). CONCLUSIONS LXR gene expression was significantly increased in obese children with OSAHS. The severity of OSAHS was positively correlated with COX-2 levels.
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Affiliation(s)
- Xin-Hua Ye
- Child Medical Care Center, The 1 Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Hong Chen
- Child Medical Care Center, The 1 Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Qin Yu
- Department of Respiratory Medicine, The 1 Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Qing-Ling Zhu
- Child Medical Care Center, The 1 Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
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13
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[Obesity and obstructive sleep apnea in children]. Arch Pediatr 2016; 24 Suppl 1:S34-S38. [PMID: 27769628 DOI: 10.1016/j.arcped.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/16/2016] [Indexed: 01/08/2023]
Abstract
Obesity, along with hypertrophy of the adenoids and the tonsils, represents one of the major risk factors for obstructive sleep apnea (OSA) in children. Obesity is associated with an increase in the prevalence and the severity of OSA and is a major factor in the persistence and aggravation of OSA over time. Neurocognitive dysfunction and abnormal behavior are the most important and frequent end-organ morbidities associated with OSA in children. Other deleterious consequences such as cardiovascular stress and metabolic syndrome are less common in children than in adults with OSA. Defining the exact role of obesity in OSA-associated end-organ morbidity in children is difficult because of the complex and multidimensional interactions between sleep in general, OSA, obesity, and metabolic dysregulation. This may explain why obesity itself has not been shown to be associated with a significant increase in OSA-associated end-organ morbidity. Obesity is linked to a decreased treatment efficacy and, in particular, of adenotonsillectomy. Peri- and postoperative complications are more common and more severe in obese children as compared with normal-weight controls. Continuous positive airway pressure (CPAP) is frequently needed, but compliance with CPAP is less optimal in obese children than in non-obese children. In conclusion, obesity represents a major public health problem worldwide; its prevention is one of the most efficient tools for decreasing the incidence and the morbidity associated with OSA in children.
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Abstract
Emerging evidence has assigned an important role to sleep as a modulator of metabolic homeostasis. The impact of variations in sleep duration, sleep-disordered breathing, and chronotype to cardiometabolic function encompasses a wide array of perturbations spanning from obesity, insulin resistance, type 2 diabetes, the metabolic syndrome, and cardiovascular disease risk and mortality in both adults and children. Here, we critically and extensively review the published literature on such important issues and provide a comprehensive overview of the most salient pathophysiologic pathways underlying the links between sleep, sleep disorders, and cardiometabolic functioning.
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Affiliation(s)
- Dorit Koren
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine
- Section of Pediatric Sleep Medicine
| | - Magdalena Dumin
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine
| | - David Gozal
- Section of Pediatric Sleep Medicine
- Section of Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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15
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Marrone O, Bonsignore MR. The puzzle of metabolic effects of obstructive sleep apnoea in children. Eur Respir J 2016; 47:1050-3. [PMID: 27037314 DOI: 10.1183/13993003.00115-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Oreste Marrone
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy DiBiMIS, University of Palermo, Italy
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16
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Gileles-Hillel A, Kheirandish-Gozal L, Gozal D. Biological plausibility linking sleep apnoea and metabolic dysfunction. Nat Rev Endocrinol 2016; 12:290-8. [PMID: 26939978 DOI: 10.1038/nrendo.2016.22] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnoea (OSA) is a very common disorder that affects 10-25% of the general population. In the past two decades, OSA has emerged as a cardiometabolic risk factor in both paediatric and adult populations. OSA-induced metabolic perturbations include dyslipidaemia, atherogenesis, liver dysfunction and abnormal glucose metabolism. The mainstay of treatment for OSA is adenotonsillectomy in children and continuous positive airway pressure therapy in adults. Although these therapies are effective at resolving the sleep-disordered breathing component of OSA, they do not always produce beneficial effects on metabolic function. Thus, a deeper understanding of the underlying mechanisms by which OSA influences metabolic dysfunction might yield improved therapeutic approaches and outcomes. In this Review, we summarize the evidence obtained from animal models and studies of patients with OSA of potential mechanistic pathways linking the hallmarks of OSA (intermittent hypoxia and sleep fragmentation) with metabolic dysfunction. Special emphasis is given to adipose tissue dysfunction induced by sleep apnoea, which bears a striking resemblance to adipose dysfunction resulting from obesity. In addition, important gaps in current knowledge and promising lines of future investigation are identified.
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Affiliation(s)
- Alex Gileles-Hillel
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 East 57th Street, Mailbox 4, Chicago, Illinois 60637-1470, USA
| | - Leila Kheirandish-Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 East 57th Street, Mailbox 4, Chicago, Illinois 60637-1470, USA
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 East 57th Street, Mailbox 4, Chicago, Illinois 60637-1470, USA
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17
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The Status of Pediatric Obstructive Sleep Apnea in 2015: Progress? YES!! More Questions? Definitely YES!! CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0033-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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Beydoun HA, Beydoun MA, Jeng HA, Zonderman AB, Eid SM. Bisphenol-A and Sleep Adequacy among Adults in the National Health and Nutrition Examination Surveys. Sleep 2016; 39:467-76. [PMID: 26446109 DOI: 10.5665/sleep.5466] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/14/2015] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES To evaluate bisphenol-A (BPA) level and its relationship to sleep adequacy in a nationally representative sample of U.S. adults. METHODS A population-based cross-sectional study was conducted using 2005-2010 National Health and Nutrition Examination Survey whereby data were collected using in-person interviews, physical examination and laboratory testing. BPA level was measured in urine samples and analyzed as loge-transformed variable and in quartiles (< 0.9 ng/mL; 0.9 to < 1.9 ng/mL; 1.9 to < 3.7 ng/mL; 3.7+ ng/mL). Sleep adequacy was operationalized with three questions: "How much sleep do you usually get at night on weekdays or workdays?", "Have you ever told a doctor or other health professionals that you have trouble sleeping?" and "Have you ever been told by a doctor or other health professional that you have a sleep disorder?" Sleep duration was further categorized as (< 6 h, ≥ 6 h); (< 7 h, 7-8 h, > 8 h); (< 5 h, 5-6 h, 7-8 h, ≥ 9 h). Linear, binary, and ordinal logistic regression models were constructed. RESULTS Loge-transformed BPA level was inversely related to sleep duration defined, in hours, as a continuous variable, a dichotomous variable (≥ 6, < 6), or an ordinal variable (≥ 9, 7-8, 5-6, < 5), after adjustment for confounders. Help-seeking behavior for sleep problems and diagnosis with sleep disorders were not significantly associated with loge-transformed BPA level in fully adjusted models. CONCLUSIONS Loge-transformed BPA level may be associated with fewer hours of sleep among U.S. adults, with implications for prevention. Further research involving diverse populations are needed to confirm these study findings.
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Affiliation(s)
- Hind A Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Hueiwang Anna Jeng
- Department of Community & Environmental Health, Old Dominion University, Norfolk, VA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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19
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Bennett KG, Robinson AB, Kasten SJ, Buchman SR, Vercler CJ. Velopharyngeal Dysfunction and Sleep Apnea-A Survey to Ascertain Surgical Practice Patterns. Cleft Palate Craniofac J 2016; 54:13-18. [PMID: 26752134 DOI: 10.1597/15-250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine if all cleft surgeons uniformly and adequately evaluate patients with cleft for obstructive sleep apnea (OSA) and consider OSA in treatment of velopharyngeal dysfunction (VPD). DESIGN A 22-question survey was administered via e-mail to 1117 surgeons who were members of the American Cleft Palate-Craniofacial Association. Logistic regression was used to determine if management was affected by years in practice, clinical volume, field of training, and region of practice. MAIN OUTCOME MEASURES We sought to determine if years in practice, clinical volume, region of practice, and surgical specialty affected surgeons' evaluation of OSA and their approaches to VPD. RESULTS A total of 231 surgeons responded (21% response rate), and 67% stated that they had trained in plastic surgery. With increasing years of practice, surgeons were less likely to refer patients for preoperative and postoperative sleep studies (P = .00 and P = .001, respectively), screen patients for sleep apnea (P = .008), or change their management based on a sleep study (P = .001). There were no significant differences in screening or testing for OSA based upon clinical volume. Among those surveyed, otolaryngologists were more likely to refer patients for postoperative sleep studies (P = .028). Surgeons in the Southeast were more likely to change their management based upon a sleep study (P = .038). CONCLUSIONS Statistically significant trends in screening and testing for OSA in the setting of VPD were identified by this survey. Notably, older surgeons were less likely to investigate OSA in their patients, and not all specialties equally refer for postoperative sleep studies.
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20
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Quante M, Wang R, Weng J, Rosen CL, Amin R, Garetz SL, Katz E, Paruthi S, Arens R, Muzumdar H, Marcus CL, Ellenberg S, Redline S. The Effect of Adenotonsillectomy for Childhood Sleep Apnea on Cardiometabolic Measures. Sleep 2015; 38:1395-403. [PMID: 25669177 DOI: 10.5665/sleep.4976] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/08/2014] [Indexed: 02/01/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea syndrome (OSAS) has been associated with cardiometabolic disease in adults. In children, this association is unclear. We evaluated the effect of early adenotonsillectomy (eAT) for treatment of OSAS on blood pressure, heart rate, lipids, glucose, insulin, and C-reactive protein. We also analyzed whether these parameters at baseline and changes at follow-up correlated with polysomnographic indices. DESIGN Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT). SETTING Clinical referral setting from multiple centers. PARTICIPANTS There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia. INTERVENTIONS Randomization to eAT or Watchful Waiting with Supportive Care (WWSC). MEASUREMENTS AND RESULTS There was no significant change of cardiometabolic parameters over the 7-mo interval in the eAT group compared to WWSC group. However, overnight heart rate was incrementally higher in association with baseline OSAS severity (average heart rate increase of 3 beats per minute [bpm] for apnea-hypopnea index [AHI] of 2 versus 10; [standard error = 0.60]). Each 5-unit improvement in AHI and 5 mmHg improvement in peak end-tidal CO2 were estimated to reduce heart rate by 1 and 1.5 bpm, respectively. An increase in N3 sleep also was associated with small reductions in systolic blood pressure percentile. CONCLUSIONS There is little variation in standard cardiometabolic parameters in children with obstructive sleep apnea syndrome (OSAS) but without severe hypoxemia at baseline or after intervention. Of all measures, overnight heart rate emerged as the most sensitive parameter of pediatric OSAS severity. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov (#NCT00560859).
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Affiliation(s)
- Mirja Quante
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Rui Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA
| | - Carol L Rosen
- Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals-Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Raouf Amin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Susan L Garetz
- Department of Otolaryngology, Head and Neck Surgery and Sleep Disorders Center, University of Michigan Medical Center, Ann Arbor, MI
| | - Eliot Katz
- Harvard Medical School, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Shalini Paruthi
- Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, St Louis, MO
| | - Raanan Arens
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Hiren Muzumdar
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Carole L Marcus
- Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Susan Ellenberg
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
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