Original Articles
Metabolic correlates with obstructive sleep apnea in obese subjects,☆☆

https://doi.org/10.1067/mpd.2002.123765Get rights and content

Abstract

Objective: To examine links between obstructive sleep apnea (OSA), insulin resistance, and dyslipidemia. Study design: Obese (body mass index [BMI] >95th percentile for age and gender) children who snored (n = 62, 46 males, age 10.89 [5-16 years] underwent polysomnography and metabolic studies. Results: Respiratory disturbance index (RDI) was 9.23 (0-95), with 23 children (39%) recommended for treatment. Fasting insulin levels were 154.6 pmol/L ± 79.8 (52-486), and fasting glucose levels were high in 7 children (11%). Fasting insulin levels correlated with sleep variables, including log transformed RDI (log10RDI) (P =.01), desaturation events (P =.05), arousal index (P =.01), and sleep-time with oxygen saturation in arterial blood <90% (P =.03) (adjusted r 2 = 0.21, F = 3.9, P =.005), but not with age, or BMI Z score. Log10RDI correlated with fasting insulin (P =.001) and BMI Z score (P =.03) (adjusted r 2 = 0.12, F = 3.9, P =.005), but not age or other metabolic variables. The correlation between log10RDI and fasting insulin persisted in models combining sleep and metabolic variables: log10RDI, adjusted r 2 = 0.75, F = 35.2, P <.001, and for fasting insulin, adjusted r 2 = 0.42, F = 6.1, and P <.001. Conclusions: The severity of OSA (log10RDI) correlated with fasting insulin levels, independent of BMI. Insulin levels may be further elevated as a consequence of OSA in obese children. (J Pediatr 2002;140:654-9)

Section snippets

Patients and methods

Obese children with a history of snoring were eligible for the study. Obesity was defined as a body mass index (BMI; weight/height2) >95th percentile for age and sex reference values.20 Children were excluded from the study if they had an intercurrent respiratory tract infection, a neuromuscular disorder, or they were being treated with anticonvulsant or sedative medication. Children were recruited from a range of hospitals and private clinics, as well as primary referrals to the 2 major

Patient characteristics

Obese children (n = 62, 46 males) aged 5 years to 16 years (mean ± SD, 10.9 ± 3.2) were recruited (Table I).

. Characteristics of the study population

Empty CellMean ± SDRange
Age (y)10.89 ± 3.145-16
Males, n (%)46 (74%)
Weight (kg)72.6 ± 29.426.5-150.0
Height (cm)150.6 ± 19.7104-200
Height (percentile)74.6 ± 29.04-100
BMI (kg/m2)31.2 ± 7.019.7-54.8
BMI (Z score)3.5 ±1.91.7-11.8
The mean Z score for the BMI was 3.48 ± 1.88 kg/m2 (range, 1.7-11.8) indicating morbid obesity in the majority.

Mean fasting insulin levels

Discussion

This study evaluated the association between OSA and insulin resistance in children; studies have shown similar perturbations in adult populations. We have demonstrated that the severity of OSA relates to fasting insulin levels in obese children. The severity of OSA was independently correlated with fasting insulin levels, after accounting for age and BMI. Stoohs et al10 showed that the association between insulin resistance and OSA was BMI-dependent in adults. The BMI range (15-39 kg/m2) shows

Acknowledgements

We thank the parents and children for their particpation in the study, Ms Kellie Tinworth for her assistance in preparation of the manuscript, and Assistant Professor Jennifer Peat for her advice on statistical analyses.

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    Supported by the Children's Hospital Fund and by an Astra Australian Lung Foundation Career Development Award (to K. A. W.).

    ☆☆

    Reprint requests: Karen A. Waters, MD, Dept of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.

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