Metabolic disregulation in obese adolescents with sleep‐disordered breathing before and after weight loss

Abstract

Objective: Sleep-disordered breathing (SDB) is prevalent in obesity. Weight loss is one of the most effective treatment options. The aim was to assess the association of SDB and metabolic disruption before and after weight loss. Design and Methods: Obese adolescents were included when entering an in-patient weight loss program. Fasting blood analysis was performed at baseline and after 4-6 months. Sleep screening was done at baseline and at follow-up in case of baseline SDB. Results: 224 obese adolescents were included. Median age was 15.5 years (10.1-18.0) and mean BMI zscore was 2.74 6 0.42. About 30% had SDB at baseline (N ¼ 68). High-density lipoprotein (HDL)-cholesterol was associated with mean nocturnal oxygen saturation (<SaO2>) (partial r ¼ 0.21; P ¼ 0.002). Aspartate aminotransferase (ASAT) and alanine aminotransferase were related with oxygen desaturation index (partial r ¼ À0.15; P ¼ 0.03 and partial r ¼ À0.15; P ¼ 0.02), but this became insignificant after correction for sex. After weight loss, 24% had residual SDB. Linear regression showed an association between ASAT and <SaO2> (partial r ¼ À0.34; P ¼ 0.002). There were no significant correlations between improvements in laboratory measurements and sleep parameters. HDL-cholesterol improved in relation with the decrease in BMI z-score. Conclusion: SDB at baseline was associated with higher levels of liver enzymes and lower HDLcholesterol concentration. Improvements in sleep parameters were not associated with improvements in laboratory measurements.

Change in obesity‐related metabolic abnormalities associated with body mass index improvement through life‐style intervention: A meta‐regression

“…In total, 68 studies reported metabolic measures and details of these are listed in Table , alongside the outcome(s) of interest from each study. While various glucose measures were reported, we focused on fasting‐glucose measurements for this article (56 studies), as fasting glucose is used clinically to identify prediabetes and diabetes.…”

“…Twenty studies provided data on ALT, with two omitted from analysis (one used geometric means for BMI‐SDS and there was uncertainty with the other whether range or IQR for ALT was reported). The remaining 18 studies yielded 28 subsets for analysis.…”

Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences

“…Not only is obesity emerging as an increasingly important risk factor for sleep-disordered breathing in children, 120 but obstructive sleep apnea may further exacerbate the inflammatory and metabolic consequences of both obesity and chronic sleep loss. 7,[121][122][123] Some evidence also suggests there may be gender differences in the strength of the association between obesity and sleep duration, with adolescent boys seeming to be at higher risk compared with girls in both cross-sectional and longitudinal studies using large data sets. 124 However, not all studies have identified gender differences; in 1 study of junior high school students, short sleep duration was significantly associated with overweight in girls only.…”

What Change in Body Mass Index Is Required to Improve Cardiovascular Outcomes in Childhood and Adolescent Obesity through Lifestyle Interventions: A Meta-Regression

“…115 Six studies (n = 11) reported medians and IQRs for the baseline and post-intervention results. 39,40,54,75,76,105 Twenty-five subsets reported mean and SDs of the changes in HDL and analysis based on those given in Appendix Fig. A2(A).…”

“…Thirty-six subsets reported TG in mmol/L; the remaining (n = 62) required their reported values to be multiplied by 0.01129 to convert them from mg/dL to mmol/L. 115 Nine subsets reported medians and IQRs, 39,40,48,54,71 and two subsets reported medians and ranges 76,105 for both the baseline and post-intervention results. For Ford et al (n = 4), who reported TG values as GMs and ranges, GMs were used to approximate the medians and the mean/SD was estimated from the medians/ranges.…”