The metabolic consequences of obstructive sleep apnoea in children

Educational aims

1. To define the metabolic syndrome in the paediatric population.

2. To describe the long-term morbidity of paediatric metabolic syndrome in early adulthood.

3. To investigate the relationship between OSA and metabolic syndrome during childhood, across age ranges and across different degrees of obesity.

4. To identify future areas of research.

Summary The metabolic syndrome is defined as the clustering of hyperinsulinaemia, obesity, hypertension and hyperlipidaemia. Its prevalence in the paediatric population in the US is estimated at ∼4%, but this can rise to 20–50% in obese children. The presence of aspects of the metabolic syndrome in childhood is closely linked to factors such as obesity, insulin resistance and early signs of cardiovascular disease in young adulthood.

While in adults there is a strong relationship between sleep-disordered breathing and obesity, and hence with other factors associated with the metabolic syndrome, the evidence in children has not been as clear-cut, although factors such as arterial oxygen saturation (Sa,O2) and apnoea–hypopnoea index (AHI) have been shown to correlate with aspects of the metabolic syndrome.

Intervention studies in sleep-disordered breathing with metabolic syndrome, using adenotonsillectomy, continuous positive airway pressure (CPAP) and weight loss, have produced mixed results, and the optimum treatment remains unclear. Randomised controlled trials of these treatments, along with larger-scale and longitudinal studies to tease out the associations between sleep-disordered breathing, obesity and the metabolic syndrome in a paediatric context, are needed.