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Wilson V. Managing type 1 diabetes in children and young people: challenges and solutions. Nurs Child Young People 2023; 35:e1465. [PMID: 37272192 DOI: 10.7748/ncyp.2023.e1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 06/06/2023]
Abstract
Type 1 diabetes is the most common form of diabetes in school-age children. Effective management and self-management at home and during school hours are essential to improve the quality of life of children and young people and reduce their risk of developing complications such as cardiovascular disease and kidney disease. There are, however, multiple barriers to effective management and self-management, notably in adolescence. Interventions, education and support based on clear psychoeducational principles improve the outcomes of children and young people. This article explores type 1 diabetes including its causes and risk factors, presentation and diagnosis, complications and comorbidities, and treatment and management. It focuses in particular on the role of nurses in supporting self-management and on the challenges of type 1 diabetes care in school.
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DeJarnette K, Frederick RM, Harris AJ, Bashir A, Wood J, Sheyn A. Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2022; 162:111256. [PMID: 35994833 DOI: 10.1016/j.ijporl.2022.111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 06/18/2022] [Accepted: 07/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Obstructive Sleep Apnea (OSA) affects 1-4% of the pediatric population in the U.S. Drug-Induced Sleep Endoscopy (DISE) is widely used to localize the level(s) of obstruction. The VOTE classification system is used to grade obstructions found at the velum, oropharynx, base of tongue, and epiglottis and has been validated in adults. This study aims to determine if the VOTE score has any predictive value in pediatric OSA postoperative outcomes. METHODS A retrospective chart review of 129 patients from January 7, 2016 to 05/30/2020 was performed. Included patients were between the ages of 2 and 17, undergoing DISE, and if they had preoperative and postoperative polysomnography (PSG) data. Excluded patients did not meet one of the above or had other comorbidities contributing to their sleep apnea. 53 patients were included. RESULTS Pearson's Correlation tests compared intraoperative VOTE score to postoperative BMI, AHI, and O2 nadir and their relationships. We found a weakly positive correlation between the VOTE and postoperative AHI with a coefficient of 0.35 and a p-value of 0.01. We found a relationship between postoperative O2 nadir and AHI, with a coefficient of -0.627 and a p-value <0.0001. Finally, a paired, two-tailed t-test compared the mean change between preoperative and postoperative BMIs (+1.6), oAHIs (-23.5), and O2 nadirs (+14), all with p-value <0.0001. CONCLUSION We demonstrated a correlation between VOTE and improved postoperative AHI and a relationship between improved postoperative AHI and postoperative O2 nadir. The validity of VOTE may be proven with larger sample size. Alternatively, a different scoring system may be required for pediatric OSA.
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Affiliation(s)
- Kaci DeJarnette
- University of Tennessee Health Science Center College of Medicine, 910 Madison Ave Ste. 1031, Memphis, TN, 38163, USA
| | - Robert M Frederick
- University of Tennessee Health Science Center College of Medicine, 910 Madison Ave Ste. 1031, Memphis, TN, 38163, USA
| | - Atia J Harris
- Division of Pulmonology and Sleep Medicine, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA
| | - Ahsan Bashir
- Division of Pulmonology and Sleep Medicine, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA
| | - Joshua Wood
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA; University of Tennessee Health Science Center Department of Otolaryngology, 910 Madison Ave Ste. 430, Memphis, TN, 38163, USA
| | - Anthony Sheyn
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA; University of Tennessee Health Science Center Department of Otolaryngology, 910 Madison Ave Ste. 430, Memphis, TN, 38163, USA.
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3
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Monzon AD, Patton SR, Koren D. Childhood diabetes and sleep. Pediatr Pulmonol 2022; 57:1835-1850. [PMID: 34506691 DOI: 10.1002/ppul.25651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.
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Affiliation(s)
- Alexandra D Monzon
- Department of Psychology and Applied Behavioral Science, Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Susana R Patton
- Department of Biomedical Research, Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dorit Koren
- Department of Pediatrics, Pediatric Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kang KT, Weng WC, Chiu SN, Lee PL, Hsu WC. Office Blood Pressure Monitoring in Children with Obesity and Obstructive Sleep Apnea. J Pediatr 2022; 246:138-144.e2. [PMID: 35314156 DOI: 10.1016/j.jpeds.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the relative contributions of obesity and obstructive sleep apnea (OSA) to unfavorable blood pressure in children. STUDY DESIGN Children aged 3-18 years with OSA-related symptoms were recruited. All children underwent office blood pressure (BP) monitoring and full-night polysomnography. Obesity was defined as a body mass index ≥95th percentile. OSA severity was divided into primary snoring (apnea-hypopnea index [AHI] <1), mild OSA (5> AHI ≥1), and moderate to severe OSA (AHI ≥5). Age- and sex-adjusted logistic regression analysis was performed to determine the associations among OSA, obesity, and elevated BP. RESULTS This cross-sectional study enrolled 1689 children (66% boys), with a mean age of 7.9 years. Compared with children with primary snoring, children with moderate to severe OSA had significantly higher systolic BP (108.1 mmHg vs 105.6 mmHg), diastolic BP (75.0 mmHg vs 70.4 mmHg), systolic BP percentile (75.0 vs 70.4), and diastolic BP percentile (74.0 vs 69.2). The rate of unfavorable BP (ie, elevated BP or hypertension level BP) also was significantly higher in children with more severe OSA. Children with obesity had higher BP and BP percentile. Logistic regression analysis revealed that children with obesity and moderate to severe OSA have a 3-fold greater risk of unfavorable BP compared with children without obesity and primary snoring. CONCLUSIONS We identified a 3-fold greater risk of unfavorable BP in children with obesity and moderate to severe OSA.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Stavrou VT, Vavougios GD, Boutlas S, Tourlakopoulos KN, Papayianni E, Astara K, Stavrou IT, Daniil Z, Gourgoulianis KI. Physical Fitness Differences, Amenable to Hypoxia-Driven and Sarcopenia Pathophysiology, between Sleep Apnea and COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:669. [PMID: 35055495 PMCID: PMC8775577 DOI: 10.3390/ijerph19020669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/26/2022]
Abstract
Handgrip strength is an indirect indicator of physical fitness that is used in medical rehabilitation for its potential prognostic value. An increasing number of studies indicate that COVID-19 survivors experience impaired physical fitness for months following hospitalization. The aim of our study was to assess physical fitness indicator differences with another prevalent and hypoxia-driven disease, Obstructive Sleep Apnea Syndrome (OSAS). Our findings showed differences between post-COVID-19 and OSAS groups in cardiovascular responses, with post-COVID-19 patients exhibiting higher values for heart rate and in mean arterial blood pressure. Oxygen saturation (SpO2) was lower in post-COVID-19 patients during a six-minute walking test (6MWT), whereas the ΔSpO2 (the difference between the baseline to end of the 6MWT) was higher compared to OSAS patients. In patients of both groups, statistically significant correlations were detected between handgrip strength and distance during the 6MWT, anthropometric characteristics, and body composition parameters. In our study, COVID-19 survivors demonstrated a long-term reduction in muscle strength compared to OSAS patients. Lower handgrip strength has been independently associated with a prior COVID-19 hospitalization. The differences in muscle strength and oxygenation could be attributed to the abrupt onset of the disorder, which does not allow compensatory mechanisms to act effectively. Targeted rehabilitation focusing on such residual impairments may thus be indispensable within the setting of post-COVID-19 syndrome.
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Affiliation(s)
- Vasileios T Stavrou
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - George D Vavougios
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Stylianos Boutlas
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Konstantinos N Tourlakopoulos
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Eirini Papayianni
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Kyriaki Astara
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Ilias T Stavrou
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Zoe Daniil
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
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Smith DF, Schuler CL, Hossain MM, Huang G, McConnell K, Urbina EM, Amin RS. Early Atherosclerotic Inflammatory Pathways in Children with Obstructive Sleep Apnea. J Pediatr 2021; 239:168-174. [PMID: 34450122 PMCID: PMC9020582 DOI: 10.1016/j.jpeds.2021.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate structural and functional carotid changes and inflammatory profiles in children with obstructive sleep apnea (OSA) and healthy controls. STUDY DESIGN Patients with OSA and matched controls (ages 5-13 years) were recruited. Proinflammatory cytokines and acute phase reactants were measured at 6:00 p.m. Common carotid artery measures were determined using ultrasound. Confirmatory factor analysis was used to determine subgroups of cytokines and their effects on carotid measures. RESULTS Ninety-six patients participated (53 healthy controls, 43 patients with OSA). OSA was associated with increased proinflammatory cytokines (cluster of differentiation-40 ligand [CD40-L], interleukin [IL]-6, and IL-8) and high sensitivity C-reactive protein (P < .05 for all). One cytokine subgroup (IL-6 and IL-8) was negatively associated with markers of carotid function, indicating reduced arterial distensibility and increased stiffness (P < .05 for 3 ultrasound measures); and tumor necrosis factor-α had an opposing effect on carotid function compared with this cytokine subgroup (P < .05 for 2 ultrasound measures). Linear regression demonstrated significant associations between and tumor necrosis factor- α and 2 measures of carotid function (P < .05 for each). Children with OSA did not have functional or structural carotid changes compared with controls. CONCLUSION OSA was not directly associated with structural and functional carotid changes but was associated with upregulation of key proinflammatory cytokines (sCD40-L, IL-6, and IL-8). Together, IL-6 and IL-8 were associated with changes in carotid function. Longitudinal studies are needed to demonstrate that the inflammatory milieu observed in our population is a precursor of atherosclerosis in children.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; The Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christine L Schuler
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Md M Hossain
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Keith McConnell
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Elaine M Urbina
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH.
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Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity. Rev Clin Esp 2021; 221:509-516. [PMID: 34752262 DOI: 10.1016/j.rceng.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS We obtained 599 responses. The respondents mean age was 44.4 ± 11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.
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The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art. CHILDREN-BASEL 2021; 8:children8100921. [PMID: 34682186 PMCID: PMC8535044 DOI: 10.3390/children8100921] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.
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Chen B, Gorantla S, Shah V. Acute lacunar infarct in an obese adolescent with obstructive sleep apnea. J Clin Sleep Med 2021; 17:1743-1747. [PMID: 33960295 DOI: 10.5664/jcsm.9390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Obstructive sleep apnea is associated with an increased risk of acute ischemic cerebrovascular accidents in adults. However, this association has not been well established in the pediatric population. We report a case of acute right internal capsule lacunar infarct manifesting as left-sided hemiplegia in an adolescent with severe obesity. Severe untreated obstructive sleep apnea was identified during the hospital stay. Positive airway pressure therapy, weight loss, and tonsillectomy eventually normalized sleep-disordered breathing. The patient recovered completely without any residual neurological deficits with multidisciplinary care. Lacunar infarcts due to hypertension-related cerebral vasculopathy are a well-known cause of stroke in adults. Untreated obstructive sleep apnea may cause hypertension and potentially predispose even the pediatric population to develop lacunar infarcts. Polysomnography needs to be considered as a part of the diagnostic algorithm in pediatric patients with stroke. CITATION Chen B, Gorantla S, Shah V. Acute lacunar infarct in an obese adolescent with obstructive sleep apnea. J Clin Sleep Med. 2021;17(8):1743-1747.
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Affiliation(s)
- Brian Chen
- Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sasikanth Gorantla
- Department of Neurology, University of Illinois College of Medicine at Peoria and OSF Healthcare Illinois Neurological Institute, Peoria, Illinois
| | - Vaishal Shah
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Chen W, Zhang X, Parmar C, Wang Y, Yang W, Pan J, Dong Z, Wang C. The Prevalence and Predictors of Obstructive Sleep Apnea in Chinese Bariatric Surgery Candidates: A Single-Center Study. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2021; 10:14-22. [PMID: 36687752 PMCID: PMC9847650 DOI: 10.17476/jmbs.2021.10.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 01/25/2023]
Abstract
Purpose The purpose of the study is to determine the prevalence and predictors of OSA in Chinese bariatric surgery candidates. Materials and Methods The clinical data were collected from 326 patients evaluated for bariatric surgery and referred for polysomnography. Multiple logistic regression was used for identifying independent predictors of presence of OSA and ROC curve analysis to determine the best cut-off value for continuous variable. Results Baseline BMI and age were 33.3±3.7 kg/m2 and 24.3±3.1 years. 62.9% of the patients fulfilled the diagnostic criteria for OSA; Of these, 22.7% had mild OSA; 11.3% had moderate OSA, and 28.8% had severe OSA. The prevalence was significantly higher in males (84.2%) than in females (47.3%) (P<0.001). The superobese patients and the obese patients aged older than 50 years that all of those were diagnosed with OSA. A multivariate logistic regression model displayed that increasing age, BMI and neck circumference together with presence of habitual snoring and male sex were identified as risk factors of OSA. The best cut-off values for the presence of OSA for age, BMI, neck circumference were 24.5 years, 39.45 kg/m2, 40.40 cm. Conclusion The prevalence of OSA is very prevalent (62.9%) in Chinese bariatric surgery candidates, especially in male patients (84%). Age, BMI and neck circumference together with presence of habitual snoring and male sex are independent predictors of OSA in these patients. As clinical predictors are not enough to be a properly screening for OSA, routine PSG testing should be recommended to bariatric surgery candidates.
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Affiliation(s)
- Wenhui Chen
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaotao Zhang
- Department of Respiratory and Sleep, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chetan Parmar
- Department of Bariatric Surgery, The Whittington Hospital NHS Trust, London, United Kingdom
| | - Yucheng Wang
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiyang Pan
- Department of Respiratory and Sleep, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Zapata JK, Catalán V, Rodríguez A, Ramírez B, Silva C, Escalada J, Salvador J, Calamita G, Azcona-Sanjulian MC, Frühbeck G, Gómez-Ambrosi J. Resting Energy Expenditure Is Not Altered in Children and Adolescents with Obesity. Effect of Age and Gender and Association with Serum Leptin Levels. Nutrients 2021; 13:1216. [PMID: 33917063 PMCID: PMC8067685 DOI: 10.3390/nu13041216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
In children and adolescents, obesity does not seem to depend on a reduction of resting energy expenditure (REE). Moreover, in this young population, the interactions between either age and obesity or between age and gender, or the role of leptin on REE are not clearly understood. To compare the levels of REE in children and adolescents we studied 181 Caucasian individuals (62% girls) classified on the basis of age- and sex-specific body mass index (BMI) percentile as healthy weight (n = 50), with overweight (n = 34), or with obesity (n = 97) and in different age groups: 8-10 (n = 38), 11-13 (n = 50), and 14-17 years (n = 93). REE was measured by indirect calorimetry and body composition by air displacement plethysmography. Statistically significant differences in REE/fat-free mass (FFM) regarding obesity or gender were not observed. Absolute REE increases with age (p < 0.001), but REE/FFM decreases (p < 0.001) and there is an interaction between gender and age (p < 0.001) on absolute REE showing that the age-related increase is more marked in boys than in girls, in line with a higher FFM. Interestingly, the effect of obesity on absolute REE is not observed in the 8-10 year-old group, in which serum leptin concentrations correlate with the REE/FFM (r = 0.48; p = 0.011). In conclusion, REE/FFM is not affected by obesity or gender, while the effect of age on absolute REE is gender-dependent and leptin may influence the REE/FFM in 8-10 year-olds.
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Affiliation(s)
- J. Karina Zapata
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (J.K.Z.); (C.S.); (J.E.); (J.S.)
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.C.); (A.R.); (B.R.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.C.); (A.R.); (B.R.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.C.); (A.R.); (B.R.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Camilo Silva
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (J.K.Z.); (C.S.); (J.E.); (J.S.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Javier Escalada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (J.K.Z.); (C.S.); (J.E.); (J.S.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Javier Salvador
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (J.K.Z.); (C.S.); (J.E.); (J.S.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Giuseppe Calamita
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari “Aldo Moro”, 70125 Bari, Italy;
| | - M. Cristina Azcona-Sanjulian
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
- Paediatric Endocrinology Unit, Department of Paediatrics, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (J.K.Z.); (C.S.); (J.E.); (J.S.)
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.C.); (A.R.); (B.R.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (V.C.); (A.R.); (B.R.)
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
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dos Santos LM, Gomes IC, Pinho JF, Neves-Alves CM, Magalhães GS, Campagnole-Santos MJ, Rodrigues-Machado MDG. Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents. Clinics (Sao Paulo) 2021; 76:e2350. [PMID: 33503191 PMCID: PMC7798126 DOI: 10.6061/clinics/2021/e2350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/29/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents. METHODS This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains). RESULTS The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%). CONCLUSION In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.
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Affiliation(s)
- Luzia Maria dos Santos
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Isabel Cristina Gomes
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - José Felippe Pinho
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Claudia Marotta Neves-Alves
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Giselle Santos Magalhães
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
| | - Maria José Campagnole-Santos
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR
| | - Maria da Glória Rodrigues-Machado
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, MG, BR
- *Corresponding author. E-mail:
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Carretero Gómez J, Ena J, Arévalo Lorido JC, Seguí Ripoll JM, Carrasco-Sánchez FJ, Gómez-Huelgas R, Pérez Soto MI, Delgado Lista J, Pérez Martínez P. Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity. Rev Clin Esp 2020; 221:S0014-2565(20)30180-6. [PMID: 32723530 DOI: 10.1016/j.rce.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS We obtained 599 responses. The respondents mean age was 44.4±11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.
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Affiliation(s)
| | - J Ena
- Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, España
| | | | - J M Seguí Ripoll
- Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante, Alicante, España
| | - F J Carrasco-Sánchez
- Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna. Hospital Regional Universitario de Málaga, Málaga. Instituto de Investigación Biomédica de Málaga Institute of Biomedical (IBIMA). CIBER Physiopathology of Obesity and Nutrition - CIBERobn
| | - M I Pérez Soto
- Servicio de Medicina Interna, Hospital Universitario de Vinalopó, Elche, Alicante, España
| | - J Delgado Lista
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía/Universidad de Córdoba/ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - P Pérez Martínez
- Unidad de Lípidos y Arterioesclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
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The cardiovascular risk in paediatrics: the paradigm of the obstructive sleep apnoea syndrome. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:217-225. [PMID: 32203011 DOI: 10.2450/2020.0283-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obstructive sleep apnoea syndrome (OSAS) describes a spectrum of abnormal breathing patterns during sleep characterised by snoring, increased upper airway resistance and pharyngeal collapsibility, with alteration of normal oxygenation and ventilation. Intermittent desaturations during sleep have multi-organ implications. Adults with OSAS have an increased risk of developing a dysfunctional endothelium that is characterised by greater adherence of inflammatory mediators to endothelial cells and hypercoagulability. There is increasing evidence to show that risk factors for comorbid cardiovascular disease (CVD) can develop during childhood and adolescence and are likely to continue over time. Risk factors for CVD include both modifiable factors and factors that cannot be changed. MATERIALS AND METHODS Using the MEDLINE® electronic database, we reviewed the scientific literature for published studies evaluating the association between sleep-disordered breathing and cardiovascular damage in children. RESULTS In this review, we show the role of blood markers in demonstrating the inflammation caused by intermitted oxygen desaturations during sleep in both healthy and obese children. Several instrumental techniques, in addition to serum biomarkers, can be used to assess vascular endothelial damage and its deterioration in the form of a pre-atherosclerotic condition. The confirmation of their role as markers of inflammation and vascular damage is supported by normalisation after resolution or improvement of the sleep-disordered breathing with surgery. DISCUSSION Great attention should be given to this condition in infants and children as it will significantly affect their present and future well-being as they grow into adulthood. Healthcare professionals, especially paediatricians, should be trained to recognise the signs and symptoms of the disease in order to send children forward for specialist care in centres dealing with sleep-disordered breathing.
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Kostrzewska M, Grabicki M, Piorunek T, Krauze T, Skrypnik D, Batura-Gabryel H, Trafas T, Bogdański P, Wykrętowicz A, Guzik P. Cardiovascular Function in Obstructive Sleep Apnea Patients with Controlled Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1271:99-106. [DOI: 10.1007/5584_2020_478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nguyen XL, Briffod J, Couloigner V, Darqué F, Kerbrat JB, Vecchierini MF. [Adolescent obstructive sleep apnoea syndrome: Characteristics and treatment]. Rev Mal Respir 2019; 36:697-706. [PMID: 31255317 DOI: 10.1016/j.rmr.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/29/2018] [Indexed: 12/28/2022]
Abstract
Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms.
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Affiliation(s)
- X-L Nguyen
- Unité somnologie et fonction respiratoire, hôpital St-Antoine, 75012 Paris, France
| | - J Briffod
- Centre médical spécialisé de l'enfant et de l'adolescent, 17, rue Froment, 75011 Paris, France
| | - V Couloigner
- Service d'ORL pédiatrique, hôpital Necker-Enfants Malades, université Paris Descartes, AP-HP, 75015 Paris, France
| | - F Darqué
- Unité d'orthopédie dento-faciale, hôpital Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - J-B Kerbrat
- Pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France
| | - M-F Vecchierini
- Centre du sommeil et de la vigilance, Hôtel-Dieu, 1, place du Parvis Notre-Dame, 75181 Paris cedex 04, France.
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Arlouskaya Y, Sawicka A, Głowala M, Giebułtowicz J, Korytowska N, Tałałaj M, Nowicka G, Wrzosek M. Asymmetric Dimethylarginine (ADMA) and Symmetric Dimethylarginine (SDMA) Concentrations in Patients with Obesity and the Risk of Obstructive Sleep Apnea (OSA). J Clin Med 2019; 8:jcm8060897. [PMID: 31234586 PMCID: PMC6616493 DOI: 10.3390/jcm8060897] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/25/2022] Open
Abstract
Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are endogenous inhibitors of nitric oxide (NO) synthesis, and play a critical role in the process of endothelial dysfunction, and are considered markers of oxidative stress. The aim of the present study was to explore relationships between ADMA and/or SDMA and the occurrence of OSA in obese patients as well as the effect of the endothelial nitric oxide synthase (eNOS) gene polymorphism, which may modify the influence of ADMA or SDMA on NO production. A total of 518 unrelated obese subjects were included in this study. Body weight, height and blood pressure were measured and data on self-reported smoking status were collected. Obstructive sleep apnea (OSA) was assessed by the apnea hypopnea index (AHI). Blood samples were collected to measure serum concentrations of glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, creatinine, HbA1c (%), folic acid, vitamin B12, C-reactive protein (CRP), aspartate aminotransferase (ASP), alanine aminotransferase (ALT) and IL-6 by routine methods. The NOS3 gene G894T and 4a/4b polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. ADMA, SDMA and arginine concentrations were assessed simultaneously using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method. Adjusted multivariate logistic regression analysis showed a significant association between the occurrence of OSA and high serum ADMA levels, BMI above 40, age > 43 years, hypertension and male sex. Heterozygotes for the G894T eNOS polymorphism have the lowest serum concentrations of ADMA and SDMA, while no effect of the 4a/4b variants was observed. The results indicate that OSA in obese individuals can coexist with high ADMA levels, which appear as a potential OSA predictor.
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Affiliation(s)
- Yana Arlouskaya
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy and Laboratory of Biochemistry and Clinical Chemistry at the Preclinical Research Center, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Ada Sawicka
- Department of Family Medicine, Internal Medicine and Metabolic Bone Diseases, Medical Centre of Postgraduate Education, 00-416 Warsaw, Poland.
| | - Marek Głowala
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy and Laboratory of Biochemistry and Clinical Chemistry at the Preclinical Research Center, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drug Analysis, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Natalia Korytowska
- Department of Bioanalysis and Drug Analysis, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Marek Tałałaj
- Department of Family Medicine, Internal Medicine and Metabolic Bone Diseases, Medical Centre of Postgraduate Education, 00-416 Warsaw, Poland.
| | - Grażyna Nowicka
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy and Laboratory of Biochemistry and Clinical Chemistry at the Preclinical Research Center, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Małgorzata Wrzosek
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy and Laboratory of Biochemistry and Clinical Chemistry at the Preclinical Research Center, Medical University of Warsaw, 02-097 Warsaw, Poland.
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Kang KT, Chiu SN, Lin CY, Weng WC, Lee PL, Hsu WC. Effect of Adenotonsillectomy on Ambulatory Blood Pressure in Pediatric Obstructive Sleep Apnea: 6-Month Follow-up Study. Otolaryngol Head Neck Surg 2019; 160:911-921. [DOI: 10.1177/0194599818825462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea. Study Design Prospective interventional study. Setting Tertiary medical hospital. Subjects and Methods Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight. The 24-hour ambulatory blood pressure was measured before and 6 months after surgery. Results The study cohort enrolled 124 children: mean (SD) age, 7.3 (3.1) years; 73% boys. After surgery, the apnea-hypopnea index significantly decreased from 13.3 (18.1) to 3.3 (7.2) events per hour ( P < .001). Overall systolic blood pressure and diastolic blood pressure were not significantly different following surgery, while daytime systolic blood pressure was slightly increased (114.3 to 117.3 mm Hg, P < .01) postoperatively. The hypertensive group (n = 43) exhibited significantly decreased levels of overall diastolic, nighttime systolic, and nighttime diastolic blood pressure ( P < .05), and 54% of hypertensive children became nonhypertensive after surgery. The nonhypertensive group (n = 81) showed slightly increased levels of nocturnal overall systolic, daytime systolic, and nighttime systolic blood pressure. A generalized linear mixed model revealed that children with hypertension had a greater decrease in systolic and diastolic ambulatory blood pressure during the daytime and nighttime (all P < .05) than those without hypertension. Conclusions Ambulatory blood pressure changes after adenotonsillectomy among children with obstructive sleep apnea are minimal. The decrease in ambulatory blood pressure after surgery is more prominent for hypertensive children than nonhypertensive children.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital and Children’s Hospital, Taipei, Taiwan
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, Taiwan
| | - Che-Yi Lin
- Department of Otolaryngology, National Taiwan University Hospital and Children’s Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital and Children’s Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
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Han Y, Liu Y, Zhao Z, Zhen S, Chen J, Ding N, Ma Y, Wen D. Does Physical Activity-Based Intervention Improve Systemic Proinflammatory Cytokine Levels in Overweight or Obese Children and Adolescents? Insights from a Meta-Analysis of Randomized Control Trials. Obes Facts 2019; 12:653-668. [PMID: 31645033 PMCID: PMC6940473 DOI: 10.1159/000501970] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this research was to conduct a meta-analysis of the role that physical activity (PA) plays in influencing the critical proinflammatory cytokine levels associated with overweight/obese children and adolescents to explore the effectiveness of exercise intervention within this population. METHODS With searches of the PubMed, EMBASE, and CENTRAL databases, we updated our meta-analysis up to November 2018. The randomized controlled trials (RCT) evaluated the ability of exercise training to increase the following factors in children and/or adolescents classified as obese or overweight: tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP). RESULTS Eleven RCT comprising 623 children and/or adolescents who were obese or overweight (i.e., 393 with PA and 230 controls) were suitable for use in this study. The meta-analysis showed that PA in general was associated with a significant reduction of CRP levels (mean difference = -0.45 mg/L, p = 0.02) in overweight/obese children and adolescents. Based on 115 overweight and obese youths, this study suggests that PA does not significantly mitigate IL-6 levels (mean difference = -0.39 pg/mL, p = 0.08), although there was a trend towards a reduction. Additionally, no close connection was observed between PA and TNF-α levels at 0.04 pg/mL (p = 0.78). Moreover, meta-regression analysis revealed a statistical association between CPR levels and changes in BMI or changes in adiponectin; likewise, IL-6 levels dramatically impacted the effect of exercise on changes in adiponectin. CONCLUSIONS PA was associated with significantly reduced CRP levels, whereas there was no significant association with IL-6 or TNF-α in overweight/obese children or adolescents; however, there was a trend towards a reduction of IL-6.
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Affiliation(s)
- Yanshuo Han
- Institute of Health Science, China Medical University, Shenyang, China
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Liu
- Institute of Health Science, China Medical University, Shenyang, China
| | - Zhongyi Zhao
- Institute of Health Science, China Medical University, Shenyang, China
| | - Shihan Zhen
- Institute of Health Science, China Medical University, Shenyang, China
| | - Jianhua Chen
- Institute of Health Science, China Medical University, Shenyang, China
- No. 2 Orthopedic Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ning Ding
- Research Center of Medical Education, China Medical University, Shenyang, China
| | - Yanan Ma
- Institute of Health Science, China Medical University, Shenyang, China
- School of Public Health, China Medical University, Shenyang, China
| | - Deliang Wen
- Institute of Health Science, China Medical University, Shenyang, China,
- Research Center of Medical Education, China Medical University, Shenyang, China,
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Han Y, Ma Y, Liu Y, Zhao Z, Zhen S, Yang X, Xu Z, Wen D. Plasma cholinesterase is associated with Chinese adolescent overweight or obesity and metabolic syndrome prediction. Diabetes Metab Syndr Obes 2019; 12:685-702. [PMID: 31190929 PMCID: PMC6526022 DOI: 10.2147/dmso.s201594] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/16/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose: To determine the plasma concentrations of butyrylcholinesterase (BChE), also known as pseudocholinesterase, in different weight categories of adolescents, and to explore the possible association between plasma BChE and overweight (OW), obesity, and metabolic syndrome (MetS) in Chinese adolescents. Patients and methods: This cross-sectional study included 1,236 Chinese adolescents (194 obese [OB], 188 OW, 732 normal weight [NW], and 122 underweight [UW]). The biochemical variables and anthropometric variables of the study participants were evaluated. Plasma BChE level was measured by DGKC method. Results: OB was associated with a higher prevalence of upper strata plasma BChE levels when compared with the BChE levels in UW, NW, and OW group. A logistic regression analysis showed that plasma BChE was positively associated with the OB group when compared with the NW group. Boys in the OW group, but not the OB group, had a significantly higher prevalence of upper stratum of BChE levels. Plasma triglyceride, total cholesterol, low-density lipoprotein-cholesterol, and ApoB levels were positively associated with the upper stratum of BChE levels when compared with lower stratum. MetS and most of its components were more prevalent among subjects with upper stratum rather than lower stratum BChE levels. Receiver operating characteristic curves for plasma BChE in subjects with MetS indicated that the AUC was 0.80 (95%CI:0.70-0.90,P<0.001) and 0.89 (95%CI:0.82-0.95,P<0.001) in girls and boys, respectively. After adjusting for age, the multivariate-adjusted odds ratio for MetS in the upper stratum of BChE levels was 8.73 (95%CI: 3.49-21.84) in the boys cohorts and also in the girls cohorts (OR=1.71, 95%CI: 1.35-21.70). Conclusion: This study confirmed an association between BChE levels and weight status in Chinese adolescents, and demonstrated that the upper strata of plasma BChE levels were associated with being OW, and even more highly associated with obesity. Plasma BChE levels were positively associated with MetS and its components and could be useful for identifying adolescents with MetS.
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Affiliation(s)
- Yanshuo Han
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yanan Ma
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
- Public Health Department, China Medical University, Shenyang, People’s Republic of China
| | - Yang Liu
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
| | - Zhongyi Zhao
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
| | - Shihan Zhen
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
| | - Xuelian Yang
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
| | - Zhiyong Xu
- Educational Research Centre of Huanggu District, Shenyang, People’s Republic of China
| | - Deliang Wen
- Institute of Health Science, China Medical University, Shenyang, People’s Republic of China
- Correspondence: Deliang WenInstitute of Health Science, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, People’s Republic of ChinaTel +86 024 3131 3333Email
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Qiao Y, Wang B, Yang JJ, Fan YF, Guo Q, Dou ZJ, Huang YQ, Feng TT, Wang SJ, An DD, Gao XL. Bone Metabolic Markers in Patients with Obstructive Sleep Apnea Syndrome. Chin Med J (Engl) 2018; 131:1898-1903. [PMID: 30082519 PMCID: PMC6085856 DOI: 10.4103/0366-6999.238149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Obstructive sleep apnea syndrome (OSAS) is prevalent in obesity and is associated with many metabolic abnormalities. The relationship between OSAS and bone metabolism is still unclear. The aim of this study was to investigate the relationship between the severity of OSAS and bone metabolic markers. Methods: A total of 119 obese males were enrolled in this study in spring months from 2015 to 2017. All candidates underwent polysomnography, and their bone mineral density (BMD) and the serum levels of total procollagen type 1 N-terminal propeptide (t-P1NP), N-terminal midfragment of osteocalcin (N-MID), β-C-terminal telopeptide of type 1 collagen (β-CTX), vitamin D (VD), and parathyroid hormone (PTH) were measured. The analysis of variance and Pearson correlation analysis were performed for data analyses. Results: No significant differences in the mean values of BMD were observed among the obesity, mild-to-moderate OSAS, and severe OSAS groups; and the serum levels of t-P1NP and β-CTX in the severe OSAS group were significantly higher than those in the obesity group (48.42 ± 23.78 ng/ml vs. 31.98 ± 9.85 ng/ml, P < 0.001; 0.53 ± 0.24 ng/ml vs. 0.41 ± 0.13 ng/ml, P = 0.011, respectively). The serum level of VD in the obesity group was significantly higher than those in the mild-to-moderate and severe OSAS groups (both P < 0.001), and decreased as the severity of OSAS increased (P < 0.001). The serum level of PTH in the severey and mild-to-moderate OSAS groups (both P < 0.001). The results of correlation analysis indicated that the level of apnea-hypopnea index (AHI) was correlated with the levels of t-P1NP (r = 0.396, P < 0.001), VD (r = –0.404, P < 0.001), and PTH (r = 0.400, P < 0.001), whereas the level of minimum O2 saturation (SaO2 min) was correlated with the levels of VD (r = 0.258, P = 0.016) and PTH (r = –0.376, P < 0.001). Conclusions: The levels of bone resorption and formation markers in patients with severe OSAS were significantly increased compared to obese men, and the severity of OSAS was correlated with the serum levels of t-P1NP, VD, and PTH.
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Affiliation(s)
- Yan Qiao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Bei Wang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Jiao-Jiao Yang
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Yan-Feng Fan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Qian Guo
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Zhan-Jun Dou
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Ya-Qiong Huang
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Ting-Ting Feng
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Shu-Juan Wang
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Dong-Dong An
- Department of the Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Xiao-Ling Gao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
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22
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24-Hour Ambulatory Blood Pressure after Adenotonsillectomy in Childhood Sleep Apnea. J Pediatr 2018; 199:112-117.e6. [PMID: 29753541 DOI: 10.1016/j.jpeds.2018.03.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/17/2018] [Accepted: 03/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the effects of adenotonsillectomy (T&A) on ambulatory blood pressure (ABP) in childhood obstructive sleep apnea (OSA). STUDY DESIGN From 2012 to 2017, children aged 4-16 years with symptoms and polysomnography-diagnosed OSA (apnea-hypopnea index [AHI] >1) underwent T&A. PSG studies and 24-hour ABP monitoring were performed before and at 3 months after surgery. RESULTS In total, 159 children were enrolled (mean age, 7.8 ± 3.3 years; 72% male). T&A significantly reduced the AHI from 12.4 ± 15.9 events/hour to 2.7 ± 5.7 events/hour (P < .001). A decrease was observed in the children's overall diastolic blood pressure (65.1 ± 6.1 mm Hg to 63.8 ± 7.4 mm Hg, P = .04) after surgery. In subgroup analysis, 100 (63%) patients were classified as nonhypertensive, and 59 (37%) were classified as hypertensive. Linear mixed model analysis revealed that compared with the children without hypertension, those with hypertension had superior improvement in systolic and diastolic blood pressure during daytime and nighttime (all P values < .01). The ABP changes after surgery were not correlated with the AHI changes. Finally, preoperative hypertension was an independent risk factor of postoperative hypertension among these children (OR 3.66; 95% CI 1.70-7.86). CONCLUSIONS Overall, in children with OSA, the 24-hour ABP change after T&A is small. However, among children with preoperative hypertension, there is significant BP improvement after T&A surgery.
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23
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Smith DF, Hossain MM, Hura A, Huang G, McConnell K, Ishman SL, Amin RS. Inflammatory Milieu and Cardiovascular Homeostasis in Children With Obstructive Sleep Apnea. Sleep 2017; 40:2991813. [PMID: 28204724 DOI: 10.1093/sleep/zsx022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Biomarkers of atherosclerosis (pro-inflammatory cytokines and acute phase reactants) are elevated in children with obstructive sleep apnea (OSA). However, their association with cardiovascular endpoints in children are not understood. We hypothesized that biomarkers of atherosclerosis in children with OSA correlate with pulse transit time (PTT), a surrogate measure of vascular stiffness, with some positively influencing and others negatively influencing PTT. Methods Children with OSA and matched controls were recruited to the study. Pro-inflammatory cytokines and acute phase reactants were measured at 6:00 pm and 6:00 am. Polysomnography with beat-to-beat blood pressure was performed. PTT during wakefulness and stage 2 sleep was calculated. Diurnal variation of biomarkers and their associations with PTT was estimated. Factor analysis was used to determine the effect of groups of cytokines on PTT. Results One hundred fifty-five children participated in the study; 90 were healthy controls and 65 had OSA. Children with OSA exhibited a different diurnal variation of biomarkers than healthy controls, with pro-inflammatory cytokines peaking in the morning and acute phase reactants peaking in the afternoon. Structural equation modeling demonstrated that interleukins 6 and 8, tumor necrosis factor-α, and sCD40L had a shortening effect, while serum amyloid A, C-reactive protein, and adiponectin had a prolonging effect on PTT. As a result, there was no difference in PTT between the two groups. Conclusion The differential relationships of acute phase reactants and pro-inflammatory cytokines with PTT suggest that in children with OSA, these mediators may have opposing actions to maintain cardiovascular homeostasis.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Md M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arjan Hura
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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24
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Patinkin ZW, Feinn R, Santos M. Metabolic Consequences of Obstructive Sleep Apnea in Adolescents with Obesity: A Systematic Literature Review and Meta-Analysis. Child Obes 2017; 13:102-110. [PMID: 27936906 DOI: 10.1089/chi.2016.0248] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adolescents who are obese are at high risk of developing obstructive sleep apnea (OSA). Although there is clear evidence associating OSA with metabolic dysfunction in adults, the evidence is less clear cut with adolescents. The purpose of this review was determine the association of sleep apnea with dyslipidemia, insulin resistance, cardiovascular disease risk, nonalcoholic fatty liver disease, and difficulty with weight loss in adolescents. METHODS A systematic literature review using PubMed, Scopus, CINAHL, Google Scholar, and PsycINFO was performed and articles were screened and reviewed with an a priori protocol. RESULTS Sixteen articles were included in qualitative synthesis and 10 were included in meta-analysis. Results from the meta-analysis indicate that OSA in adolescents is associated with greater risk of dyslipidemia, insulin resistance, and hypertension. CONCLUSIONS Although obesity leads to increased metabolic risk, OSA appears to independently increase metabolic impairment. Adolescents with obesity should be frequently screened for OSA to determine need for treatment and reduce this metabolic burden.
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Affiliation(s)
- Zachary W Patinkin
- 1 Frank H. Netter School of Medicine, Quinnipiac University , North Haven, CT
| | - Richard Feinn
- 1 Frank H. Netter School of Medicine, Quinnipiac University , North Haven, CT
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25
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Tan HL, Alonso Alvarez ML, Tsaoussoglou M, Weber S, Kaditis AG. When and why to treat the child who snores? Pediatr Pulmonol 2017; 52:399-412. [PMID: 28029756 DOI: 10.1002/ppul.23658] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/25/2016] [Accepted: 11/30/2016] [Indexed: 12/31/2022]
Abstract
Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui-Leng Tan
- Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, Sydney St., London SW3 6NP, United Kingdom
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Silke Weber
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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26
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea. J Pediatr 2017; 182:177-183.e2. [PMID: 27939257 DOI: 10.1016/j.jpeds.2016.11.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/05/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA). STUDY DESIGN Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses. RESULTS In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables. CONCLUSIONS Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.
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27
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Uncoupling of Vascular Nitric Oxide Synthase Caused by Intermittent Hypoxia. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:2354870. [PMID: 27840666 PMCID: PMC5093285 DOI: 10.1155/2016/2354870] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/03/2016] [Indexed: 12/15/2022]
Abstract
Objective. Obstructive sleep apnea (OSA), characterized by chronic intermittent hypoxia (CIH), is often present in diabetic (DB) patients. Both conditions are associated with endothelial dysfunction and cardiovascular disease. We hypothesized that diabetic endothelial dysfunction is further compromised by CIH. Methods. Adult male diabetic (BKS.Cg-Dock7m +/+ Leprdb/J) (db/db) mice (10 weeks old) and their heterozygote littermates were subjected to CIH or intermittent air (IA) for 8 weeks. Mice were separated into 4 groups: IA (intermittent air nondiabetic), IH (intermittent hypoxia nondiabetic), IADB (intermittent air diabetic), and IHDB (intermittent hypoxia diabetic) groups. Endothelium-dependent and endothelium-independent relaxation and modulation by basal nitric oxide (NO) were analyzed using wire myograph. Plasma 8-isoprostane, interleukin-6 (IL-6), and asymmetric dimethylarginine (ADMA) were measured using ELISA. Uncoupling of eNOS was measured using dihydroethidium (DHE) staining. Results. Endothelium-dependent vasodilation and basal NO production were significantly impaired in the IH and IADB group compared to IA group but was more pronounced in IHDB group. Levels of 8-isoprostane, IL-6, ADMA, and eNOS uncoupling were ≈2-fold higher in IH and IADB groups and were further increased in the IHDB group. Conclusion. Endothelial dysfunction is more pronounced in diabetic mice subjected to CIH compared to diabetic or CIH mice alone. Oxidative stress, ADMA, and eNOS uncoupling were exacerbated by CIH in diabetic mice.
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28
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Kheirandish-Gozal L, Gozal D. Pediatric OSA Syndrome Morbidity Biomarkers: The Hunt Is Finally On! Chest 2016; 151:500-506. [PMID: 27720883 DOI: 10.1016/j.chest.2016.09.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/12/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022] Open
Abstract
Since initial reports 40 years ago on pediatric OSA syndrome (OSAS) as a distinct and prevalent clinical entity, substantial advances have occurred in the delineation of diagnostic and treatment approaches. However, despite emerging and compelling evidence that OSAS increases the risk for cognitive, cardiovascular, and metabolic end-organ morbidities, routine assessment of such morbidities is seldom conducted in clinical practice. One of the major reasons for such discrepancies resides in the relatively labor-intensive and onerous steps that would be required to detect the presence of any of such morbidities, further adding to the already elevated cost of diagnosing the disorder. To circumvent these obstacles, the search for biomarker signatures of pediatric OSA and its cognitive and cardiometabolic consequences was launched, and considerable progress has occurred since then. Here, we review the current evidence for the presence of morbidity-related biomarkers among children with OSAS, and explore future opportunities in this promising arena.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL.
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL
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29
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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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30
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Hanis CL, Redline S, Cade BE, Bell GI, Cox NJ, Below JE, Brown EL, Aguilar D. Beyond type 2 diabetes, obesity and hypertension: an axis including sleep apnea, left ventricular hypertrophy, endothelial dysfunction, and aortic stiffness among Mexican Americans in Starr County, Texas. Cardiovasc Diabetol 2016; 15:86. [PMID: 27266869 PMCID: PMC4897940 DOI: 10.1186/s12933-016-0405-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing appreciation for a series of less traditional risk factors that should not be ignored when considering type 2 diabetes, obesity, hypertension, and cardiovascular disease. These include aortic stiffness, cardiac structure, impaired endothelial function and obstructive sleep apnea. They are associated to varying degrees with each disease categorization and with each other. It is not clear whether they represent additional complications, concomitants or antecedents of disease. Starr County, Texas, with its predominantly Mexican American population has been shown previously to bear a disproportionate burden of the major disease categories, but little is known about the distribution of these less traditional factors. METHODS Type 2 diabetes, obesity and hypertension frequencies were determined through a systematic survey of Starr County conducted from 2002 to 2006. Individuals from this examination and an enriched set with type 2 diabetes were re-examined from 2010 to 2014 including assessment of cardiac structure, sleep apnea, endothelial function and aortic stiffness. Individual and combined frequencies of these inter-related (i.e., axis) conditions were estimated and associations evaluated. RESULTS Household screening of 5230 individuals aged 20 years and above followed by direct physical assessment of 1610 identified 23.7 % of men and 26.7 % of women with type 2 diabetes, 46.2 and 49.5 % of men and women, respectively with obesity and 32.1 and 32.4 % with hypertension. Evaluation of pulse wave velocity, left ventricular mass, endothelial function and sleep apnea identified 22.3, 12.7, 48.6 and 45.2 % of men as having "at risk" values for each condition, respectively. Corresponding numbers in women were 16.0, 17.9, 23.6 and 28.8 %. Cumulatively, 88 % of the population has one or more of these while 50 % have three or more. CONCLUSIONS The full axis of conditions is high among Mexican Americans in Starr County, Texas. Individual and joint patterns suggest a genesis well before overt disease. Whether they are all mediated by common underlying factors or whether there exist multiple mechanisms remains to be seen.
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Affiliation(s)
- Craig L Hanis
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77225, USA.
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Beth Israel Hospital, Boston, MA, 02215, USA
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Graeme I Bell
- Departments of Medicine and Human Genetics, The University of Chicago, Chicago, IL, 60637, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Jennifer E Below
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77225, USA
| | - Eric L Brown
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77225, USA.,Center for Infectious Disease, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77225, USA
| | - David Aguilar
- Cardiology, Baylor College of Medicine, Houston, TX, 77030, USA
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31
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Koren D, Gozal D, Bhattacharjee R, Philby MF, Kheirandish-Gozal L. Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children. Chest 2016; 149:999-1010. [PMID: 26447773 PMCID: PMC4944784 DOI: 10.1378/chest.15-1543] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND OSA associates with insulin resistance (IR), hyperglycemia, and dyslipidemia consistently in adults, but inconsistently in children. We set out to quantify the impact of OSA treatment upon obesity and metabolic outcomes and thus assess causality. METHODS Sixty-nine children with OSA; mean age, 5.9 years (range, 3-12.6); 55% boys; and 68% nonobese (NOB) underwent baseline overnight polysomnography, anthropometric and metabolic measurements, adenotonsillectomy (T&A), and follow-up testing a mean 7.9 months (range, 2-20) later. RESULTS Fifty-three children (77% of study cohort; 91% of obese children) had residual OSA (apnea-hypopnea index > 1 event/h) post-T&A. Fasting plasma insulin (FPI, 14.4 ± 9.4 → 12.6 ± 9.7 μIU/mL, P = .008), homeostasis model assessment-IR (3.05 ± 2.13 → 2.62 ± 2.22, P = .005), and high-density lipoprotein (HDL) (51.0 ± 12.9 → 56.5 ± 14.4 mg/dL, P = .007) improved despite increased BMI z score (1.43 ± 0.78 → 1.52 ± 0.62, P = .001); changes did not differ significantly between sexes or NOB and obese participants; however, post-T&A BMI z score rather than apnea-hypopnea index was the main predictor of levels of follow-up FPI, HDL, and other metabolic parameters. Higher baseline FPI and BMI-z predicted likelihood of residual OSA; conversely, on regression analysis, follow-up IR, HDL, and triglycerides were predicted by BMI z score, not residual OSA. CONCLUSIONS T&A improved IR and HDL, and residual OSA is predicted by baseline FPI and BMI z score, indicating a causal relationship; however, following T&A, residual metabolic dysfunction related to underlying adiposity rather than remaining sleep-disordered breathing. Finally, T&A cured OSA in < 25% of all children and only 10% of obese children; post-T&A polysomnography is indicated to assess which children still require treatment.
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Affiliation(s)
- Dorit Koren
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL; Section of Endocrinology and Metabolism, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL; Section of Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Rakesh Bhattacharjee
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL; Section of Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Mona F Philby
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL; Section of Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL.
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32
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Blechner M, Williamson AA. Consequences of Obstructive Sleep Apnea in Children. Curr Probl Pediatr Adolesc Health Care 2016; 46:19-26. [PMID: 26631839 DOI: 10.1016/j.cppeds.2015.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) has various negative health and behavioral consequences in the pediatric population. As shown in adults, there are metabolic derangements such as obesity, insulin sensitivity, dyslipidemia, and metabolic syndrome, as well as cardiovascular derangements like hypertension, chronic inflammation, endothelial dysfunction, ventricular size/function abnormalities, and even elevated pulmonary arterial pressures, that can be seen in children with OSAS. The first two sections will discuss the metabolic and cardiovascular consequences on OSAS in children. The last section summarizes selected studies and reviews on the behavioral, neurocognitive and academic consequences of OSAS in children.
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Affiliation(s)
- Michael Blechner
- Division of Pulmonary Medicine, The Children׳s Hospital of Philadelphia, Philadelphia, PA.
| | - Ariel A Williamson
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE; Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children׳s Hospital of Philadelphia, Philadelphia, PA
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