Obstructive sleep apnea in obese adolescents referred for bariatric surgery: association with metabolic and cardiovascular variables

Talib, Ali; Roebroek, Yvonne G. M.; Waardenburg, Dick A. van; Grinten, C.P.M. van der; Winkens, Björn; Bouvy, Nicole D.; Heurn, Ernst L. W. E. van

doi:10.1016/j.sleep.2020.02.026

Cited by 6 publications

(10 citation statements)

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“…Regression coefficients remained significant, also after further correction for age and gender. Importantly, OSA is highly prevalent in severely obese adolescents, with 86.9% of our patients having an AHI ≥ 1 and 39.5% having an AHI ≥ 5, corresponding to mild and moderate-severe OSA, respectively [56]. Our findings support the notion that OSA is an important pathogenic factor in obesity-related LVH and indicate the importance of early recognition and treatment of this serious comorbidity.…”

Section: Discussionsupporting

confidence: 80%

Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications

et al. 2020

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Left ventricular hypertrophy (LVH) is independently associated with a higher risk of cardiovascular morbidity and mortality in adults. Adiposity is a risk factor for LVH, independent of blood pressure. Potential causes of this nonhemodynamic pathogenesis identified in adults include adverse body fat distribution, insulin resistance, dyslipidemia, and obstructive sleep apnea syndrome (OSA). In severely obese adolescents, the determinants of obesity-induced changes in left ventricular structure are poorly characterized. Cardiac ultrasonographic, demographic, anthropometric, and comorbidity-related data were prospectively collected in adolescents with severe obesity refractory to conservative treatment who presented for surgical therapy. Differences between adolescents with LVH and without LVH were evaluated using independent samples t, chi-square, or Fisher’s exact test. Multivariable linear regression analysis was performed to evaluate associations with left ventricular structural changes, corrected for body mass index (BMI) z score. Forty-three patients entered analysis, of whom 24 (55.8%) showed LVH. The most common geometrical change was eccentric LVH (eLVH), occurring in 21 subjects (48.8%). Demographic and anthropometric variables did not differ between patients with and without LVH. Independent of BMI z score, left ventricular mass index was significantly associated with apnea–hypopnea index (AHI) (regression parameter B = 0.8; 95% CI 0.3 to 1.2). Interventricular septum thickness (IVST) was significantly associated with HOMA-IR values (B = 0.1; 95% CI 0.04 to 0.2), HDL-cholesterol (B = − 1.2; 95% CI − 2.2 to 0.1), and triglyceride levels (B = 0.5; 95% CI 0.001 to 0.9). LVH, especially eLVH, is highly prevalent amongst severely obese adolescents. Adverse changes in cardiac structure, increased IVST in particular, are independently associated with several nonhemodynamic comorbidities that are common in this population, namely OSA, insulin resistance, and dyslipidemia.

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Section: Discussionsupporting

confidence: 80%

Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications

et al. 2020

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“…Our findings are in agreement with earlier studies showing significant OSA prevalence ranging from 37.7% up to 55%. [12][13][14] It is possible that differences between studies in the prevalence of moderate/severe OSA are partly related to the differences in BMI between them. In our study, the average BMI was 49, and moderate/severe OSA was found in 45.5% of our adolescents.…”

Section: Discussionmentioning

confidence: 99%

“…We grouped our patients as no/mild OSA (i.e., AHI 0-4.9, events/h) or moderate/ severe OSA (AHI ≥ 5.0, events/h). 13,14,18…”

Section: Sleep Studymentioning

confidence: 99%

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Obstructive sleep apnea and metabolic disorders in morbidly obese adolescents

Haim

Daniel

Hershkovitz

et al. 2021

Pediatric Pulmonology

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Background Little known about the prevalence of obstructive sleep apnea (OSA) in morbid obese adolescents and the association between OSA and comorbid factors. Aim To examine the association between apnea–hypopnea index (AHI, a measure for OSA severity) and metabolic morbidity among morbidly obese adolescents. Methods We performed a population‐based retrospective cohort study by reviewing sleep study, metabolic indices, and comorbidity‐related data of a cohort (n = 106) of adolescents referred to a bariatric surgery clinic. We compared subjects with moderate/severe OSA (AHI ≥ 5) versus no/mild OSA (AHI < 5) OSA and three groups of subjects with increasing body mass index (BMI) concerning sleep‐study and metabolic indices using univariate analyses. To assess the link between AHI and ferritin levels a multivariate linear regression (adjusted for BMI and mean cell volume) was preformed. Results A total of 71 patients met the inclusion criteria. Subjects with moderate/severe OSA (n = 32, 45%) had higher BMI, cholesterol, cholesterol/high‐density lipoprotein (HDL) ratio, hemoglobin A1c, and serum ferritin levels (p < .05). AHI significantly increased across BMI strata (p = .02). Multivariate linear regression indicated that moderate/severe OSA was associated with higher levels of ferritin, unstandardized β = 49.1 (nIU/ml) (p = .025). Conclusions Morbidly obese adolescents with moderate/severe OSA versus no/mild OSA have a higher risk for metabolic complications. Therefore, OSA management should be considered in adolescents with morbid obesity, in addition to weight loss.

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“…Moreover, prematurity, genetic syndromes and neuromuscular abnormalities were found to lead to severe paediatric OSAHS. 11 However, compared with studies on comorbidities associated with other diseases, studies on paediatric OSAHS have the following defects: the focus is usually on only a single pattern or class of comorbidities (Down syndrome, [12][13][14][15][16] obesity, 17 neurological diseases, 18 type 1 narcolepsy, 19 etc), and relevant guidelines are not well outlined. Therefore, existing studies lack descriptions of comorbidity distributions and characteristics in paediatric OSAHS patients across a wide age range, causing great inconvenience in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Comorbidity patterns and associated characteristics in children with obstructive sleep apnoea–hypopnoea syndrome in Shanghai, China: a cross-sectional study

Gao

Chen

et al. 2021

BMJ Open

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ObjectivesPaediatric obstructive sleep apnoea–hypopnoea syndrome (OSAHS), which usually cooccurs with various diseases, significantly impacts health and social resources. Domestic paediatric OSAHS studies have not included comorbidity patterns or distribution characteristics. Thus, we investigated the comorbid characteristics of paediatric OSAHS in Shanghai, China.DesignLarge hospital-based cross-sectional study.SettingPaediatric ward medical data from the Pudong New Area, Shanghai, China from 2013 to 2016.Participants4045 Chinese children aged 0–18 years.Primary and secondary outcome measuresPaediatric OSAHS was diagnosed using the Paediatric Sleep Questionnaire with a cut-off score of 8 points. The outcomes were comorbidity patterns and their characteristics. χ2 tests were performed to compare differences among the top comorbidity patterns.ResultsMajor comorbidities were otolaryngological morbidities. Among one-comorbidity patterns, OSAHS+chronic rhinitis (37.53%) and OSAHS+allergic rhinitis (28.13%) were most common. Among two-comorbidity patterns, OSAHS+chronic rhinitis +chronic exudative otitis media (10.88%), OSAHS+allergic rhinitis +chronic exudative otitis media (7.94%), OSAHS+allergic rhinitis +chronic tonsillitis (4.43%) and OSAHS+chronic rhinitis +chronic tonsillitis (4.23%) were most common. Males predominated in all comorbidity groups. Age differences for the top five patterns in both the one-comorbidity (p=0.035) and two comorbidities (p<0.001) groups were statistically significant. In the one-comorbidity group, patients were more likely to have one operation (p<0.001), and in the two comorbidities group, patterns of ‘OSAHS+chronic rhinitis +chronic exudative otitis media’ and ‘OSAHS+allergic rhinitis +chronic exudative otitis media’ were more common in the ≥2 operations group (p<0.001). Notably, the top five patterns of the 2-comorbidities group were significantly associated with the length of stay (LOS) (p<0.001), while those in the one-comorbidity group were not.ConclusionOSAHS+rhinitis (chronic rhinitis or allergic rhinitis) was the most common diagnosis. Age, number of operations, and LOS are significantly associated with the patterns. This emphasises the importance of better understanding complex otolaryngological comorbidity diagnoses and treatments in paediatric OSAHS to reverse clinical outcomes and save health resources.

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Obstructive sleep apnea in obese adolescents referred for bariatric surgery: association with metabolic and cardiovascular variables

Cited by 6 publications

References 32 publications

Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications

Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications

Obstructive sleep apnea and metabolic disorders in morbidly obese adolescents

Comorbidity patterns and associated characteristics in children with obstructive sleep apnoea–hypopnoea syndrome in Shanghai, China: a cross-sectional study

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