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Glucose metabolism in sleep disordered breathing
  1. J Kohyama,
  2. T Hasegawa,
  3. J S Ohinata
  1. Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, Japan
  1. Correspondence to:
    Dr J Kohyama, Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan;
    jkohyama.ped{at}tmd.ac.jp

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An association between sleep disordered breathing (SDB) and impaired glucose tolerance has been reported in adults.1 Although SDB has been reported in diabetic children,2 no data are available on glucose metabolism in children with SDB. We used glycated haemoglobin (HbA1c) for the preliminary assessment of glucose metabolism in paediatric SDB patients.

HbA1c was measured in 12 children aged 26–116 months (mean 63) with suspected SDB owing to adenotonsillar hypertrophy. Informed consent was obtained from the guardians of each patient, and consent was obtained from the child if older than 5 years of age. Overnight polysomnographic studies were performed once for each patient by the standard method described elsewhere.3 The desaturation time (percentage of total sleep time with oxygen saturation <90%), minimum oxygen saturation level, and apnoea-hypopnoea index (AHI) were calculated. Complete blood count, blood gases, and blood chemistry (glucose, total protein, albumin, urea nitrogen, creatinine, uric acid, sodium, chloride, potassium, calcium, phosphate, lactic dehydrogenase, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, γ-glutamyl transpeptidase, alkaline phosphatase, total bilirubin, total cholesterol, and triglyceride) were also determined.

The patients had no respiratory failure, heart failure, or coma. None of their weights exceeded 120% of their ideal weight for their heights. Desaturation time clearly divided the patients into two groups: six patients whose desaturation time was 0 or 0.1 (mild SDB group); and six whose desaturation time exceeded 4.0 (severe SDB group). The average HbA1c value for the severe SDB group (5.0, SE 0.07) was significantly higher than that for the mild SDB group (4.6, SE 0.10) (p = 0.01), although the actual HbA1c values were all within normal range. No other items showed significant differences between the two groups.

The severity of respiratory disturbances during sleep in diabetic children has been known to correlate with the duration of diabetes and with the HbA1c value.2 Recently, SDB parameters were found to be associated with worsening insulin resistance independent of obesity in adults.4 The current study shows that serum HbA1c is increased in association with the degree of desaturation in non-obese paediatric SDB patients; HbA1c levels should, however, be monitored after treatment. SDB and glucose metabolism are hypothesised to be closely associated in children as well as adults.

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