Original article
Sleep-Disordered Breathing and the Metabolic Syndrome in Overweight and Obese Children and Adolescents

https://doi.org/10.1016/j.jpeds.2007.01.051Get rights and content

Objective

To assess whether sleep-disordered breathing (SDB) is a risk factor of the metabolic syndrome (MS) in children and adolescents who are overweight and to examine whether the severity of SDB was independently associated with glucose intolerance, insulin resistance, and/or dyslipidemia.

Study design

Consecutive subjects who were overweight or obese underwent polysomnography, fasting blood sample, and oral glucose tolerance test (for calculation of area under the curve [AUC]). SDB was defined as a respiratory disturbance index ≥2. MS was present when ≥3 of these factors were present: waist circumference ≥90th percentile; fasting glucose level ≥110 mg/dL; triglyceride level ≥110 mg/dL; high-density lipoprotein cholesterol level ≤40 mg/dL; blood pressure ≥90th percentile.

Results

A total of 104 subjects were included in the study (44% boys; 58% prepubertal; mean age, 11.1 ± 2.6 years; 69% obese). Mean SaO2 (odds ratio, 0.54) and SaO2nadir (odds ratio, 0.89) were independent, significant predictors of the presence of MS. Multiple regression showed significant associations between SaO2nadir and high-density lipoprotein cholesterol level, mean SaO2 and both AUC glucose and triglyceride levels, and between the percentage of total sleep time with SaO2 ≥ 95% and cholesterol level, while controlling for adiposity and sex, puberty, or both.

Conclusion

This study supports the hypothesis of an interaction between SDB and metabolic abnormalities, independent of estimates of body fat distribution, in children and adolescents who are overweight and obese.

Section snippets

Methods

Consecutive subjects aged 6 to 17 years who were overweight or obese were recruited between January 2001 and September 2006 at the Pediatric Obesity Clinic of the Antwerp University Hospital. Children were excluded when they had any chronic medical condition, any genetic, neuromuscular, or craniofacial syndromes, or were receiving medications that are known to affect glucose homeostasis or serum lipid levels. Patients were classified as prepubertal or pubertal on the basis of a combination of

Results

A total of 104 subjects were studied; 44% were boys, and 58% were prepubertal, with a mean age of 11.1 ± 2.6 years (range, 6.1-16.7 years). The mean BMI z-score was 2.3 ± 0.5 (range, 1.3-3.8); 32 subjects (31%) were overweight, and 72 subjects (69%) were obese. No subject had diabetes mellitus.

The MS was present in 34 of 93 subjects (37%). In 11 subjects, the diagnosis of the MS could not be made, because of laboratory errors. Subjects with the MS had a higher waist circumference (88.5 ± 12.6

Discussion

The features comprising the metabolic or insulin-resistance syndrome are hyperinsulinemia, dyslipidemia, central obesity, and hypertension.27 Several reports have documented the prevalence of the MS in pediatric obesity.28, 29 Furthermore, high fasting insulin levels and increased BMI during childhood are strong predictors of the MS in adulthood,30 and children with insulin resistance have an increased risk of future cardiovascular morbidity and mortality.31 By aggravating the obesity-related

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