Obesity Rather Than Severity of Sleep-Disordered Breathing as the Major Determinant of Insulin Resistance and Altered Lipidemia in Snoring Children

Abstract

ABSTRACT. Objective. Sleep-disordered breathing (SDB) is associated with insulin resistance and dyslipidemia in adults and in obese children. However, the prevalence of such metabolic abnormalities among snoring children is unknown. This study was done to prospectively assess the relative contribution of SDB and obesity to metabolic disturbances in a large cohort of snoring children.Methods. Measurements of fasting serum glucose, insulin, and lipids were obtained after polysomnographic evaluation in 116 snoring children and in 19 control subjects. Insulin resistance was assessed using the insulin/glucose ratio (I/G ratio) and homeostasis model assessment (HOMA).Results. A total of 135 children (79 boys; mean age: 8.9 ؎ 3.5 years) were studied. Sixty-four children had moderate to severe SDB (AHI ‫؍‬ 5 per hour of total sleep time [TST]), 52 had mild SDB (AHI ‫؍‬ 1 but <5 per hour of TST), and 19 were control subjects (AHI <1 per hour of TST). Seventy of these children were obese. No significant correlations were found between AHI, lowest arterial oxygen saturation, or arousal index and serum insulin, serum glucose, I/G ratio, HOMA, or serum lipids for either the whole group or the obese children only. However, significant positive correlations were found between I/G ratio and relative BMI (relBMI; r ‫؍‬ 0.58), HOMA and relBMI (r ‫؍‬ 0.52), triglycerides and relBMI (r ‫؍‬ 0.30), and high-density lipoprotein and relBMI (r ‫؍‬ 0.50). No significant differences were found in relBMI, I/G ratio, and lipid levels between boys and girls.Conclusions. Among children with suspected SDB, insulin resistance and dyslipidemia seem to be determined primarily by the degree of body adiposity rather than by the severity of SDB. Pediatrics 2005;116:e66-e73. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-2527; metabolic syndrome, sleep apnea, pediatrics, obesity, diabetes.ABBREVIATIONS. SDB, sleep-disordered breathing; CPAP, continuous positive airway pressure; CRP, C-reactive protein; Spo 2 , arterial oxygen saturation; AHI, apnea hypopnea index; TST, total sleep time; relBMI, relative BMI; HOMA, homeostasis model assessment; I/G ratio, insulin/glucose ratio; HDL, high-density lipoprotein; TG, triglyceride.T he incidence of childhood obesity has been increasing steadily in Western countries. 1 Recent reports place the prevalence of obesity and overweight in children at levels ranging from 7% up to 22% in various countries, 2-9 and such elevated figures will undoubtedly impose major health implications, particularly on the development of insulin resistance, type 2 diabetes, and cardiovascular morbidity. [10][11][12] The term "metabolic syndrome" is a known risk factor for cardiovascular disease in adults and refers to the clustering of insulin resistance, dyslipidemia, hypertension, and obesity. Elevation of fasting insulin levels and increased BMI during childhood are the strongest predictors of the metabolic syndrome in adulthood, 13,14 possibly through the combination of altered insulin signaling and adrenocortical function, in...

Relationship between Sleep Apnea, Fat Distribution, and Insulin Resistance in Obese Children

“…The subjects in our study had a high level of inflammation, likely due to their severe obesity compared with other study populations. This is consistent with several other studies that found that the BMI, and not measures of OSA, were the primary determinants of insulin resistance 39 and inflammation. 40 Our study is limited by a small sample size.…”

Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents

“…However, an uncontrolled follow-up study from this group failed to confirm an independent association between SDB and fasting insulin levels, nor did it show consistent associations between treatment of SDB and improvement in metabolic indices (37). Two other reports from pediatric sleep laboratories of young, prepubertal children, including one study that excluded obese children (38), also did not show significant associations between fasting insulin levels and indices of SDB (38,39). In contrast, in our communitybased sample of predominantly postpubertal adolescents, we have demonstrated strong associations of SDB with MetS as well as with individual metabolic parameters commonly associated with MetS, including fasting insulin and the HOMA index.…”

Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children

“…14 In children, the association of OSA with IR and MetSyn has been inconsistent: some studies have found that OSA increases risk of IR 15 and dyslipidemia, 16 whereas others have found that IR and MetSyn are primarily determined by obesity. 17,18 Most studies have examined associations rather than causal relationships. However, the few interventional studies of metabolic outcome in children with OSA after adenotonsillectomy (T&A, the gold standard pediatric OSA treatment) have had similarly contradictory results.…”