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Lei L, Zhang X, Wang B, Lei F, Dai L, Sun X, Zhao Y, Zhu P, Zou J. Effects of sleep-disordered breathing on serum lipid levels in children:a case control study. BMC Pediatr 2024; 24:220. [PMID: 38561714 PMCID: PMC10983664 DOI: 10.1186/s12887-024-04577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) during childhood is common and includes a range of breathing abnormalities that range from primary snoring (PS) to obstructive sleep apnea syndrome (OSAS).Studies have shown that not only OSAS, but also PS, which is originally considered harmless, could cause cardiovascular, cognitive, behavioral, and psychosocial problems. Many researches are focused on the relation of OSA and serum lipid levels. However, little studies are focused on PS and serum lipid levels in children.We evaluated whether serum lipid (total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C)) concentrations were associated with specific components of SDB, including indices of oxygen reduction index, lowest oxygen saturation, mean oxygen saturation. And we explored whether serum lipid levels were associated with different degree sleep disordered (PS and OSA group) and obese. METHODS This was a cross-sectional study. Children who were complained by their guardians with habitual snoring and(or) mouth breathing were collected in the SDB group. Normal children without sleep problem were matched in the control group. Subjects in the SDB group underwent polysomnography. The serum lipid profiles of all the children included TC, TG, HDL-C and LDL-C concentrations were measured by appropriate enzymatic assays. RESULTS A total of 241 with Apnea/Hypopnea Index ≥ 5 (AHI) were assigned to the OSAS group and the remaining 155 with normal AHI were assigned to the PS group. The values of TC, TG, LDL-C and LDL/HDL were significantly higher in the OSAS group than in the PS group, and the values in the PS group were significantly higher than the control group. Multiple regression analysis revealed serum TG only correlated negatively with lowest oxygen saturation. Body mass index-z score has a positive effect on TG in all the 1310 children (P = 0.031) and in SDB 396 children(P = 0.012). The level of serum TG in obese group was significantly higher than that in non-obese group. CONCLUSIONS SDB had a very obvious effect on blood lipids, whereas PS without apnea and hypoxia. Obese only affects the aggregation of TG. TRIAL REGISTRATION ChiCTR1900026807(2019.10.23).
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Affiliation(s)
- Lei Lei
- Department of Otorhinolaryngology, Head&Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - XiaoYun Zhang
- Department of Otorhinolaryngology, Head&Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Binbin Wang
- Department of Otorhinolaryngology, Head&Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Fei Lei
- Department of Sleep Medical Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Li Dai
- West China Medical School, Sichuan University, Sichuan, China
| | - Xiaoru Sun
- Department of Otorhinolaryngology, Head&Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology, Head&Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Ping Zhu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Sichuan, China
| | - Jian Zou
- Department of Otorhinolaryngology, Head&Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China.
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Armañac-Julián P, Martín-Montero A, Lázaro J, Hornero R, Laguna P, Kheirandish-Gozal L, Gozal D, Gil E, Bailón R, Gutiérrez-Tobal G. Persistent sleep-disordered breathing independently contributes to metabolic syndrome in prepubertal children. Pediatr Pulmonol 2024; 59:111-120. [PMID: 37850730 DOI: 10.1002/ppul.26720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor for metabolic syndrome (MetS) in adults, but its association in prepubertal children is still questionable due to the relatively limited cardiometabolic data available and the phenotypic heterogeneity. OBJECTIVE To identify the role of OSA as a potential mediator of MetS in prepubertal children. METHODS A total of 255 prepubertal children from the Childhood Adenotonsillectomy Trial were included, with standardized measurements taken before OSA treatment and 7 months later. MetS was defined if three or more of the following criteria were present: adiposity, high blood pressure, elevated glycemia, and dyslipidemia. A causal mediation analysis was conducted to assess the effect of OSA treatment on MetS. RESULTS OSA treatment significantly impacted MetS, with the apnea-hypopnea index emerging as mediator (p = .02). This mediation role was not detected for any of the individual risk factors that define MetS. We further found that the relationship between MetS and OSA is ascribable to respiratory disturbance caused by the apnea episodes, while systemic inflammation as measured by C-reactive protein, is mediated by desaturation events and fragmented sleep. In terms of evolution, patients with MetS were significantly more likely to recover after OSA treatment (odds ratio = 2.56, 95% confidence interval [CI] 1.20-5.46; risk ratio = 2.06, 95% CI 1.19-3.54) than the opposite, patients without MetS to develop it. CONCLUSION The findings point to a causal role of OSA in the development of metabolic dysfunction, suggesting that persistent OSA may increase the risk of MetS in prepubertal children. This mediation role implies a need for developing screening for MetS in children presenting OSA symptoms.
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Affiliation(s)
- Pablo Armañac-Julián
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Adrián Martín-Montero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Jesús Lázaro
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Roberto Hornero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Pablo Laguna
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Leila Kheirandish-Gozal
- Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri, United States
| | - David Gozal
- Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, Virginia, United States
| | - Eduardo Gil
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Raquel Bailón
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Gonzalo Gutiérrez-Tobal
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
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3
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Sistla SK, Lahane V. OSA 18 Questionnaire: Tool to Evaluate Quality of Life and Efficacy of Treatment Modalities in Pediatric Sleep Disordered Breathing Due to Adenotonsillar Hypertrophy. Indian J Otolaryngol Head Neck Surg 2022; 74:6406-6413. [PMID: 36742702 PMCID: PMC9895508 DOI: 10.1007/s12070-019-01757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/02/2019] [Indexed: 02/07/2023] Open
Abstract
Aims to evaluate quality of life in paediatric SDB due to adenotonsillar hypertrophy and efficacy of treatment modalities (medical and surgical) by using OSA-18 questionnaire. Prospective study, conducted from April 2019 to June 2019, including 42 patients with clinical features suggestive of SDB due to adenotonsillar hypertrophy, in age group of 3-15 years. Nasopharyngoscopy was done to grade adenoid hypertrophy. OSA-18 QOL questionnaire was recorded in all patients and depending upon the severity of impact of QOL and grades of adenoid hypertrophy, patients were categorized into two groups. Group 1 received medical treatment and group 2 underwent adenotonsillectomy. Questionnaire was again recorded after 4 weeks. Pretreatment and post-treatment total mean and individual domain scores were compared. Paired t tests was used to evaluate results. Group 1 included 16 children with mild to moderate impact and received medical management. Pretreatment mean OSA-18 score of 70.31 was improved to 33.5. Group 2 enrolled 26 patients with severe impact, were subjected to adenotonsillectomy. Pretreatment and post-treatment mean score were 95.88 and 24.92 respectively. Both groups showed statistically significant improvement in all individual domains and total mean OSA-18 scores indicating improvement in QOL after treatment and efficacy of medical management for mild-moderate SDB and surgery for severe cases. OSA-18 questionnaire is self-administered and disease specific screening tool for early diagnosis and evaluation of QOL before and after treatment. It also helps to categorize patients for advocating appropriate treatment and to evaluate efficacy of treatment modalities.
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Affiliation(s)
- Srinivas Kishore Sistla
- Department of ENT and Head Neck Surgery, Star Hospital, B Block, Banjara Hill Road No 10, Hyderabad, Telengana India
| | - Vaibhav Lahane
- Department of ENT and Head Neck Surgery, Star Hospital, B Block, Banjara Hill Road No 10, Hyderabad, Telengana India
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Huang YC, Huang SH, Chung RJ, Wang BL, Chung CH, Chien WC, Sun CA, Yu PC, Lu CH. Obese Patients Experience More Severe CSA than Non-Obese Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031289. [PMID: 35162313 PMCID: PMC8835470 DOI: 10.3390/ijerph19031289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Objective: To investigate whether central sleep apnea (CSA) is associated with an increased risk of obesity. Materials and methods: From 1 January 2000 to 31 December 2015, we screened 24,363 obese patients from the 2005 longitudinal health insurance database, which is part of the Taiwan National Health Insurance Research Database. From the same database, 97,452 non-obese patients were also screened out. Age, gender, and index dates were matched. Multiple logistic regression was used to analyze the previous exposure risk of obese and CSA patients. A p-value of <0.05 was considered significant. Results: Obese patients were more likely to be exposed to CSA than non-obese patients would (AOR = 2.234, 95% CI = 1.483–4.380, p < 0.001). In addition, the closeness of the exposure time to the index time is positively correlated with the severity of obesity and has a dose–response effect (CSA exposure < 1 year, AOR = 2.386; CSA exposure ≥ 1 year and <5 years, AOR = 1.725; CSA exposure time ≥ 5 years, AOR = 1.422). The CSA exposure time of obese patients was 1.693 times that of non-obese patients. Longer exposure time is associated with more severe obesity and has a dose-response effect (CSA exposure < 1 year, AOR = 1.420; CSA exposure ≥ 1 year and <5 years, AOR = 2.240; CSA ≥ 5 years, AOR = 2.863). Conclusions: In this case-control study, patients with CSA had a significantly increased risk of obesity. Long-term exposure to CSA and obesity is more likely and has a dose-response effect.
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Affiliation(s)
- Yao-Ching Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (C.-H.L.)
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Big Data Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Pi-Ching Yu
- Graduate Institute of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
- Cardiovascular Intersive Care Unit, Department of Critical Care Medicine, Far-Eastern Memorial Hospital, New Taipei City 10602, Taiwan
| | - Chieh-Hua Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (C.-H.L.)
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5
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Ribot C, Morell-Garcia D, Piérola J, Peña-Zarza JA, Sanchís P, Muñiz J, de la Peña M, Alonso-Fernández A, Barceló A. Surfactant protein D concentration in a pediatric population with suspected sleep disorder. Pediatr Pulmonol 2022; 57:285-292. [PMID: 34559461 DOI: 10.1002/ppul.25697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/06/2022]
Abstract
Obstructive sleep apnea (OSA) affects between 2% and 4% in children and there is a search for new biomarkers that can be useful both in the diagnosis and in the evolution of the disease. The surfactant protein D (SP-D) is a collection that is part of the innate immune system exerting an anti-inflammatory and antimicrobial effect. Thus, the objective of this study was to evaluate the concentration of SP-D in the suspect OSA pediatric population. A total of 178 children were recruited in this prospective study. Blood samples, sleep parameters, feeding habits, anthropometric, sociodemographic, and family data were collected. Specific biochemical determinations were made, and the plasmatic concentrations of SP-D were measured by enzyme-linked immunosorbent assay. We found no statistical correlation between the SP-D concentration and the apnea-hypopnea index (AHI) from the data. Nevertheless, the changes in SP-D levels could be correlated to a large extent by the arousals that often go along with hypopneas (r = -0.258, p = 0.011 unadjusted; r = -0.258, p = 0.014 adjusted by age and body mass inded [BMI] Z-score). Intermittent hypoxia was correlated with C-reactive protein levels (r = 0.547, p < 0.001 unadjusted; r = 0.542, p < 0.001 adjusted by age and BMI Z-score). Although AHI and SP-D did not appear to correlate, a secondary analysis suggests that sleep fragmentation, which is produced by arousals, may do, and further research is needed to determine the mechanisms by which changes in SP-D occur in OSA.
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Affiliation(s)
- Caterina Ribot
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Javier Piérola
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - José A Peña-Zarza
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,Department of Pediatrics, Sleep Unit, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Pilar Sanchís
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Jesús Muñiz
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Mónica de la Peña
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Alberto Alonso-Fernández
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonia Barceló
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.,CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain
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6
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Vermeiren E, Bruyndonckx L, De Winter B, Verhulst S, Van Eyck A, Van Hoorenbeeck K. The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies. Nutr Metab Cardiovasc Dis 2021; 31:2575-2586. [PMID: 34172320 DOI: 10.1016/j.numecd.2021.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/19/2023]
Abstract
AIMS Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint. DATA SYNTHESIS A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved. CONCLUSION Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.
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Affiliation(s)
- Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium.
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
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7
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Kang EK, Jang MJ, Kim KD, Ahn YM. The association of obstructive sleep apnea with dyslipidemia in Korean children and adolescents: a single-center, cross-sectional study. J Clin Sleep Med 2021; 17:1599-1605. [PMID: 33739258 DOI: 10.5664/jcsm.9258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES To evaluate whether obstructive sleep apnea (OSA) and its severity are related to dyslipidemia and alanine transaminase elevation as a marker of nonalcoholic fatty liver disease in children. METHODS The data collected from polysomnography, laboratory measurements (lipid profile and liver enzyme), and body mass index in children aged 0-18 years who visited the pediatric department between 2012 and 2018 were retrospectively analyzed. RESULTS There were a total of 273 participants in the study (ages 0-6 years, 7-12 years, and 13-18 years: 61.9%, 26.4%, and 11.7%, respectively). In the ages 7-12 and 13-18 years groups, obesity was strongly associated with OSA severity (Cramer's V = 0.498, P < .001). High-density lipoprotein cholesterol levels were significantly lower in the OSA group than in the non-OSA group, irrespective of the presence of obesity. In addition, high-density lipoprotein cholesterol levels were significantly different between the OSA severity groups after adjusting for body mass index (P = .000). In participants who were obese, moderate and severe OSA were associated with alanine transaminase elevation (P = .023 and P = .045, respectively). CONCLUSIONS This study suggests that OSA may be an independent risk factor for dyslipidemia and that OSA and obesity have a synergistic effect on alanine transaminase elevation. Early diagnosis and treatment of OSA from childhood, especially in obese children, will reduce metabolic complications. CITATION Kang EK, Jang MJ, Kim KD, Ahn YM. The association of obstructive sleep apnea with dyslipidemia in Korean children and adolescents: a single-center, cross-sectional study. J Clin Sleep Med. 2021;17(8):1599-1605.
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Affiliation(s)
- Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Min Jeong Jang
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ki Duk Kim
- School of Medicine, Eulji University, Daejeon, Korea
| | - Young Min Ahn
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.,School of Medicine, Eulji University, Daejeon, Korea
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Nathan K, Livnat G, Feraru L, Pillar G. Improvement in BMI z-score following adenotonsillectomy in adolescents aged 12-18 years: a retrospective cohort study. BMC Pediatr 2021; 21:184. [PMID: 33879120 PMCID: PMC8056500 DOI: 10.1186/s12887-021-02634-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Characteristics of obstructive sleep apnea (OSA) changes with age. Infants, toddlers and prepubertal children with OSA are usually underweight and may suffer from failure to thrive (FTT). Adenotonsillectomy (T&A) is the first line of treatment for OSA in childhood. In adults OSA is commonly associated with obesity and the metabolic syndrome. The change in body mass index (BMI) in adolescents with OSA following T&A was only sporadically studied. Thus, we peruse to examine the BMI z-score change following T&A in adolescents. METHODS Clalit Health Services is the largest health care organization in Israel with the largest patient registry (more than 50% of the population). Two hundred and forty two adolescents aged 12-18 who underwent T&A between 2006 and 2015 were identified in the Clalit registry and their characteristics including height and weight were retrieved. The BMI z-score of these adolescents at baseline (up to 3 months prior to T&A) and during the consecutive 3 years after T&A were analyzed and compared. RESULTS Changes in BMI Z-score were observed to all directions following T&A with overall small increase, not statistically significant (P = 0.26) from a median of 0.79 prior to T&A to a median of 0.835 after it. There was a minimal trend toward BMI z-score reduction in overweight children (n = 74) from 1.508 to 1.48 following T&A (p = NS), and in obese children (n = 33) from 2.288 to 2.000 (P = 0.06, 2 tailed). Interestingly thin individuals (n = 6) increased their BMI z-score following T&A from - 2.4 to - 0.59 (p = 0.046). CONCLUSIONS Adolescents show variable changes in their BMI z-score following T&A. In this aspect their BMI z-score change is closer to the change seen in adults treated for OSA and not that of young children. The changes observed show a trend toward normalization of the BMI z-score such that overweight children tend to decrease their BMI z-score while thin individuals tend to increase it.
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Affiliation(s)
- Keren Nathan
- Department of Pediatrics, Carmel Hospital and Technion Faculty of Medicine, Haifa, Israel.
| | - Galit Livnat
- Pediatric Pulmonary Unit & CF Center, Carmel Medical Center, Haifa, Israel
| | - Liat Feraru
- Department of Pediatrics, Carmel Hospital and Technion Faculty of Medicine, Haifa, Israel
| | - Giora Pillar
- Department of Pediatrics, Carmel Hospital and Technion Faculty of Medicine, Haifa, Israel.,Sleep Clinic, Carmel Hospital and Technion Faculty of Medicine, Haifa, Israel
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9
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Volkov SI, Ginter OV, Covantev S, Corlateanu A. Adenoid Hypertrophy, Craniofacial Growth and Obstructive Sleep Apnea: A Crucial Triad in Children. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201202122440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Age-related (physiological) AH is an important problem in pediatric otorhinolaryngology.
Since the beginning of the 70s, there has been an increase in the proportion of children with
pharyngeal tonsil hypertrophy. Functional disorders of the oropharynx in children occupy the second
place based on their incidence (after disorders of the musculoskeletal system). In previous
years, there has been an increase in the incidence and prevalence of obstructive sleep apnea syndrome
(OSAS) among children. In most cases of pediatric OSAS, upper airway obstruction occurs
from the nasopharynx to the oropharynx, caused by upper airway stenosis. Consequences of untreated
OSAS in children can be inattention and behavioral problems, daytime sleepiness, and in
more severe cases are associated with a variety of comorbidities. The current review discusses the
links between hypertrophied adenoids, craniofacial development and OSAS in children taking into
account physiological and pathophysiological aspects as well as clinical evaluation of the problem.
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Affiliation(s)
- Stanislav I. Volkov
- Department of Endocrinology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Olga V. Ginter
- Department of Neurology, Schon Klinik, Bad Aibling, Germany
| | - Serghei Covantev
- Department of General Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State Medical and Pharmaceutical University of “N. Testimetanu”, Chisinau, Moldova, Republic of
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Gerdung C, Rodriguez-Lopez S, Palkowski S, Keto-Lambert D, Sebastianski M, Castro Codesal ML. Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol. BMJ Open 2020; 10:e039655. [PMID: 32830118 PMCID: PMC7445331 DOI: 10.1136/bmjopen-2020-039655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA. METHODS AND ANALYSIS A systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed. ETHICS AND DISSEMINATION There are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.
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Affiliation(s)
- Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sara Rodriguez-Lopez
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Maria Luisa Castro Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
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11
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The immune-sleep crosstalk in inflammatory bowel disease. Sleep Med 2020; 73:38-46. [PMID: 32769031 DOI: 10.1016/j.sleep.2020.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
Sleep disorders are progressively common and sometimes are associated with aberrant regulation of the adaptive and innate immune responses. Sleep interruption can increase the inflammatory burden by enhancing the pro-inflammatory cytokines particularly in patients with chronic diseases such as inflammatory bowel disease (IBD). IBD is a chronic inflammatory disease characterized by immune dysregulation, dysbiosis of gut microbiome, and poor-quality life. Therefore, this review highlights the crosstalk between sleep and immune responses during the progression of IBD.
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Roche J, Corgosinho FC, Dâmaso AR, Isacco L, Miguet M, Fillon A, Guyon A, Moreira GA, Pradella-Hallinan M, Tufik S, Túlio de Mello M, Gillet V, Pereira B, Duclos M, Boirie Y, Masurier J, Franco P, Thivel D, Mougin F. Sleep-disordered breathing in adolescents with obesity: When does it start to affect cardiometabolic health? Nutr Metab Cardiovasc Dis 2020; 30:683-693. [PMID: 32008915 DOI: 10.1016/j.numecd.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Pediatric obesity and sleep-disordered breathing (SDB) are associated with cardiometabolic risk (CMR), but the degree of severity at which SDB affects cardiometabolic health is unknown. We assessed the relationship between the CMR and the apnea-hypopnea index (AHI), to identify a threshold of AHI from which an increase in the CMR is observed, in adolescents with obesity. We also compared the clinical, cardiometabolic and sleep characteristics between adolescents presenting a high (CMR+) and low CMR (CMR-), according to the threshold of AHI. METHODS AND RESULTS 114 adolescents with obesity were recruited from three institutions specialized in obesity management. Sleep and SDB as assessed by polysomnography, anthropometric parameters, fat mass (FM), glucose and lipid profiles, and blood pressure (BP) were measured at admission. Continuous (MetScoreFM) and dichotomous (metabolic syndrome, MetS) CMR were determined. Associations between MetScoreFM and AHI adjusted for BMI, sex and age were assessed by multivariable analyses. Data of 82 adolescents were analyzed. Multivariable analyses enabled us to identify a threshold of AHI = 2 above which we observed a strong and significant association between CMR and AHI (Cohen's d effect-size = 0.57 [0.11; 1.02] p = 0.02). Adolescents with CMR+ exhibited higher MetScoreFM (p < 0.05), insulin resistance (p < 0.05), systolic BP (p < 0.001), sleep fragmentation (p < 0.01) and intermittent hypoxia than CMR- group (p < 0.0001). MetS was found in 90.9% of adolescents with CMR+, versus 69.4% in the CMR- group (p < 0.05). CONCLUSIONS The identification of a threshold of AHI ≥ 2 corresponding to the cardiometabolic alterations highlights the need for the early management of SDB and obesity in adolescents, to prevent cardiometabolic diseases. CLINICAL TRIALS NCT03466359, NCT02588469 and NCT01358773.
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Affiliation(s)
- Johanna Roche
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France; Sleep and Health Medicine Center Ellipse, Franois, France; Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Flavia C Corgosinho
- Universidade Federal de Goiás - Faculdade de Nutrição - Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil
| | - Ana R Dâmaso
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil
| | - Laurie Isacco
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France
| | - Maud Miguet
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France
| | - Alicia Fillon
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France
| | - Aurore Guyon
- Sleep Pediatric Unit, Woman Mother Child Hospital, Hospices Civils de Lyon, Lyon1 University, F-69500, France; Physiology of Brain Arousal System Research Laboratory, CRNL, INSERM-U1028, CNRS UMR5292, Lyon1 University, Lyon, France
| | - Gustavo A Moreira
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Marcia Pradella-Hallinan
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Marco Túlio de Mello
- Universidade Federal de Minas Gerais - Programa de Pós-Graduação em Educação Física - Minas Gerais, Brazil
| | - Valérie Gillet
- Sleep and Health Medicine Center Ellipse, Franois, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
| | - Martine Duclos
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR, 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France
| | - Yves Boirie
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR, 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Human Nutrition, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France
| | - Julie Masurier
- UGECAM Nutrition Obesity Ambulatory Hospital, Clermont-Ferrand, France
| | - Patricia Franco
- Sleep Pediatric Unit, Woman Mother Child Hospital, Hospices Civils de Lyon, Lyon1 University, F-69500, France; Physiology of Brain Arousal System Research Laboratory, CRNL, INSERM-U1028, CNRS UMR5292, Lyon1 University, Lyon, France
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France
| | - Fabienne Mougin
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France
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Caro P, Guerra X, Canals A, Weisstaub G, Sandaña C. Is neck circumference an appropriate tool to predict cardiovascular risk in clinical practice? A cross-sectional study in Chilean population. BMJ Open 2019; 9:e028305. [PMID: 31699715 PMCID: PMC6858176 DOI: 10.1136/bmjopen-2018-028305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Neck circumference has emerged as a predictor of obesity and metabolic syndrome, but its clinical usefulness for different groups of population is not clearly defined. The aim is to evaluate the predictive capacity of neck circumference in order to detect cardiovascular risks (CVRs) on the Chilean population and to compare it with waist circumference performance. DESIGN Cross-sectional study. SETTING General Chilean population. PARTICIPANTS Data of 4607 adults aged 18 and over from the Chilean National Health Survey 2009-2010 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Anthropometrics measures included neck and waist circumference, height and weight. CVR was identified according to the Framingham tables adapted for the Chilean population. Receiver operating characteristics curves and logistic regression models were made to evaluate the performance of neck circumference to predict a moderate/high CVR, comparing it to waist circumference. RESULTS Almost 10% of the sample had a moderate or high CVR. The probability of having a moderate/high cardiovascular risk increase with cervical obesity (OR 1.95, 95% CI 1.04 to 3.68) and central obesity (OR 4.5, 95% CI 2.47 to 8.22). The area under the curves were high for cervical obesity (AUC 81.4%, 95% CI 78.8% to 84.0%) and central obesity (AUC 82.2%, 95% CI 79.7% to 84.7%) and not statistically different (p=0.152). CONCLUSIONS Neck obesity has a high capacity to predict moderate/high CVR in the Chilean population. Its good performance appears as an opportunity to use it in clinical practice when waist circumference measurement is difficult to measure and eventually replace the waist circumference measurement as the technique is easier.
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Affiliation(s)
- Patricia Caro
- School of Public Health, Faculty of Sciences, Universidad Mayor, Santiago, Chile
- School of Nutrition and Dietetics, Universidad Tecnológica de Chile Sede Apoquindo, Santiago, Chile
| | - Ximena Guerra
- School of Nutrition and Dietetics, Universidad Tecnológica de Chile Sede Apoquindo, Santiago, Chile
| | - Andrea Canals
- Academic Direction, Clínica Santa María, Santiago, Chile
- Biostatistics Department, School of Public Health, Universidad de Chile, Santiago, Chile
| | - Gerardo Weisstaub
- Public Nutrition Department, Instituto de Nutrición y Tecnología de los Alimentos Universidad de Chile, Santiago, Chile
| | - Carlos Sandaña
- School of Public Health, Faculty of Sciences, Universidad Mayor, Santiago, Chile
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Naets T, Vervoort L, Ysebaert M, Van Eyck A, Verhulst S, Bruyndonckx L, De Winter B, Van Hoorenbeeck K, Tanghe A, Braet C. WELCOME: improving WEight controL and CO-Morbidities in children with obesity via Executive function training: study protocol for a randomized controlled trial. BMC Public Health 2018; 18:1075. [PMID: 30157826 PMCID: PMC6116429 DOI: 10.1186/s12889-018-5950-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/09/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current "Multidisciplinary Obesity Treatments" (MOT) already provide significant weight loss, but still leave room for more long-lasting improvements. In this protocol paper, we outline the research goals of the WELCOME trial, based on a substantial proof of concept. METHODS In this Randomized Controlled Trial (RCT) - conducted in both an inpatient and two outpatient treatment settings - existing MOT will be supplemented with an Executive Function (EF) training and compare effects on various parameters in an experimental versus an active control group of obese youngsters (8-18 years old). WELCOME aims to (a) train youngsters' executive functions to facilitate effects on weight loss, psychological and medical comorbidities, (b) to enhance the long-term effects by continuing the training in the daily home context with booster sessions, and (c) to investigate its effects until a 6-month follow-up. In comparison to the active control group, better progress is expected in the experimental group on following variables: weight, psychological comorbidities (unhealthy eating behavior, internalizing symptoms, impaired self-esteem) and medical comorbidities (metabolic syndromes, endothelia dysfunction, tonsillar hypertrophy and sleep obstruction). DISCUSSION It is stated that this EF-training for enhancing self-control abilities is necessary for a long-lasting effect of childhood obesity treatment interventions. TRIAL REGISTRATION The Study Procotol was registered on 10/05/2017 (n° ISRCTN14722584 ).
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Affiliation(s)
- Tiffany Naets
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Marijke Ysebaert
- Department of Pediatrics, Antwerp University and University Hospital Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Department of Pediatrics, Antwerp University and University Hospital Antwerp, Antwerp, Belgium
| | - Stijn Verhulst
- Department of Pediatrics, Antwerp University and University Hospital Antwerp, Antwerp, Belgium
| | - Luc Bruyndonckx
- Department of Pediatrics, Antwerp University and University Hospital Antwerp, Antwerp, Belgium
| | - Benedicte De Winter
- Department of Pediatrics, Antwerp University and University Hospital Antwerp, Antwerp, Belgium
| | - Kim Van Hoorenbeeck
- Department of Pediatrics, Antwerp University and University Hospital Antwerp, Antwerp, Belgium
| | | | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
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Leptin and Leptin Resistance in the Pathogenesis of Obstructive Sleep Apnea: A Possible Link to Oxidative Stress and Cardiovascular Complications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:5137947. [PMID: 29675134 PMCID: PMC5841044 DOI: 10.1155/2018/5137947] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 12/17/2022]
Abstract
Obesity-related sleep breathing disorders such as obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) cause intermittent hypoxia (IH) during sleep, a powerful trigger of oxidative stress. Obesity also leads to dramatic increases in circulating levels of leptin, a hormone produced in adipose tissue. Leptin acts in the hypothalamus to suppress food intake and increase metabolic rate. However, obese individuals are resistant to metabolic effects of leptin. Leptin also activates the sympathetic nervous system without any evidence of resistance, possibly because these effects occur peripherally without a need to penetrate the blood-brain barrier. IH is a potent stimulator of leptin expression and release from adipose tissue. Hyperleptinemia and leptin resistance may upregulate generation of reactive oxygen species, increasing oxidative stress and promoting inflammation. The current review summarizes recent data on a possible link between leptin and oxidative stress in the pathogenesis of sleep breathing disorders.
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Hannon TS, Watson SE, Jalou HE, Chakravorty S, Mather KJ, Arslanian SA. Characteristics of Obstructive Sleep Apnea Across the Spectrum of Glucose Tolerance in Obese Adolescents. Front Endocrinol (Lausanne) 2018; 9:281. [PMID: 29910773 PMCID: PMC5992282 DOI: 10.3389/fendo.2018.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/14/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND It is not known if dysglycemia and sleep-disordered breathing are linked in adolescents, as in adults. OBJECTIVE To perform a pilot study evaluating measures of sleep-disordered breathing across the spectrum of glucose tolerance in obese adolescents. We hypothesized that dysglycemia would be associated with sleep-disordered breathing. PARTICIPANTS/METHODS This was a prospective, cross-sectional clinical pilot study that included 57 adolescents [body mass index (BMI) 38.9 ± 8.4 kg/m2] aged 12-18 years (14.5 ± 1.6) with normal glucose tolerance (NGT), or dysglycemia [impaired glucose tolerance (IGT) or type 2 diabetes (T2D)]. MEASURES Anthropometrics, overnight polysomnogram, and oral glucose tolerance tests were performed. Participant characteristics and outcome measures were compared by glucose tolerance status. Correlational analyses were conducted to assess the associations between variables of interest. RESULTS Participants with dysglycemia (n = 21) were not different from those with NGT (n = 36) for BMI, waist circumference, body fat, or sleep characteristics. Nocturnal oxygen desaturation was associated with higher BMI (r = -0.334, p = 0.012). The apnea-hypopnea index (AHI) was not associated with physical and metabolic parameters. Although participants with dysglycemia tended to have higher AHIs (median 3.2, 2.2, and 1.6 events/h for T2D, IGT, and NGT, respectively), there was not a linear relationship between measures of glycemia and AHI. CONCLUSION Further study with a larger proportion of youth with prediabetes and T2D is necessary to determine whether evaluation for sleep-disordered breathing is uniformly warranted.
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Affiliation(s)
- Tamara S. Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Tamara S. Hannon,
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Hasnaa E. Jalou
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sangeeta Chakravorty
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kieren J. Mather
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Silva A. Arslanian
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Bruyndonckx L, Vrints CJ. Editorial: Assessing cardiovascular risk - should physicians start measuring neck circumference? Eur J Prev Cardiol 2017; 24:1774-1775. [PMID: 29053014 DOI: 10.1177/2047487317737630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Luc Bruyndonckx
- 1 Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Belgium.,2 Department of Paediatrics, University Hospital Antwerp, Belgium
| | - Christiaan J Vrints
- 3 Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp, Belgium.,4 Department of Cardiology, University Hospital Antwerp, Belgium
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18
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Alonso-Álvarez ML, Terán-Santos J, Gonzalez Martinez M, Cordero-Guevara JA, Jurado-Luque MJ, Corral-Peñafiel J, Duran-Cantolla J, Ordax Carbajo E, MasaJimenez F, Kheirandish-Gozal L, Gozal D. Metabolic biomarkers in community obese children: effect of obstructive sleep apnea and its treatment. Sleep Med 2017; 37:1-9. [DOI: 10.1016/j.sleep.2017.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022]
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Um YH, Hong SC, Jeong JH. Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:9-18. [PMID: 28138105 PMCID: PMC5290714 DOI: 10.9758/cpn.2017.15.1.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/06/2016] [Accepted: 09/11/2016] [Indexed: 01/11/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is notorious for its debilitating consequences and early age of onset. The need for early diagnosis and intervention has frequently been underscored. Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. Genetic-phenotypic differences across individuals regarding the aforementioned sleep problems have been elucidated along with the possible use of these characteristics for early prediction of ADHD. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD, with novel treatment approaches ranging from melatonin and light therapy to myofunctional therapy and adjustments of the time point at which school starts.
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Affiliation(s)
- Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Joosten KF, Larramona H, Miano S, Van Waardenburg D, Kaditis AG, Vandenbussche N, Ersu R. How do we recognize the child with OSAS? Pediatr Pulmonol 2017; 52:260-271. [PMID: 27865065 DOI: 10.1002/ppul.23639] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/12/2016] [Accepted: 10/30/2016] [Indexed: 12/29/2022]
Abstract
Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Koen F Joosten
- Erasmus MC, Pediatric Intensive Care, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Department of Pediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Dick Van Waardenburg
- Pediatric Intensive Care Unit, Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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21
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Isacco L, Roche J, Quinart S, Thivel D, Gillet V, Nègre V, Mougin F. Cardiometabolic risk is associated with the severity of sleep-disordered breathing in children with obesity. Physiol Behav 2016; 170:62-67. [PMID: 27993515 DOI: 10.1016/j.physbeh.2016.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity. METHODS Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScoreBMI and MetScoreWC). RESULTS Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScoreBMI and MetScoreWC (p<0.05) in obese children. There is no association between SDB and PAL. CONCLUSIONS In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.
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Affiliation(s)
- Laurie Isacco
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France.
| | - Johanna Roche
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France; Sleep and Health Medicine Center, Franois, France, Ellipse. 9 chemin des quatre Journaux, 25770 Franois, France.
| | - Sylvain Quinart
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Pediatric Obesity Prevention and Rehabilitation Department, Besançon, France, RéPPOP-FC-CHRU St Jacques, 2 place St Jacques, F-25000, Besançon cedex, France.
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, Campus Universitaire des Cézeaux, 5 impasse Amélie Murat, 63178 Aubière cedex, France; Auvergne Research Center for Human Nutrition (CRNH), 58 Rue Montalembert, 63009 Clermont-Ferrand, France.
| | - Valérie Gillet
- Sleep and Health Medicine Center, Franois, France, Ellipse. 9 chemin des quatre Journaux, 25770 Franois, France.
| | - Véronique Nègre
- Pediatric Obesity Prevention and Rehabilitation Department, Besançon, France, RéPPOP-FC-CHRU St Jacques, 2 place St Jacques, F-25000, Besançon cedex, France.
| | - Fabienne Mougin
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France.
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Abstract
Emerging evidence has assigned an important role to sleep as a modulator of metabolic homeostasis. The impact of variations in sleep duration, sleep-disordered breathing, and chronotype to cardiometabolic function encompasses a wide array of perturbations spanning from obesity, insulin resistance, type 2 diabetes, the metabolic syndrome, and cardiovascular disease risk and mortality in both adults and children. Here, we critically and extensively review the published literature on such important issues and provide a comprehensive overview of the most salient pathophysiologic pathways underlying the links between sleep, sleep disorders, and cardiometabolic functioning.
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Affiliation(s)
- Dorit Koren
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine
- Section of Pediatric Sleep Medicine
| | - Magdalena Dumin
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine
| | - David Gozal
- Section of Pediatric Sleep Medicine
- Section of Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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Marrone O, Bonsignore MR. The puzzle of metabolic effects of obstructive sleep apnoea in children. Eur Respir J 2016; 47:1050-3. [PMID: 27037314 DOI: 10.1183/13993003.00115-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Oreste Marrone
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy DiBiMIS, University of Palermo, Italy
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Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment - A systematic review. Int J Pediatr Otorhinolaryngol 2016; 87:190-7. [PMID: 27368470 DOI: 10.1016/j.ijporl.2016.06.017] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To systematically review and discuss the outcome of treating obstructive sleep apnea (OSA) in obese children and adolescents. METHODS In February 2016 Pub Med was searched using a predetermined string to retrieve all relevant articles. The search identified 518 publications. In total 16 articles were included for review using the selected inclusion and exclusion criteria. The PRISMA guidelines was used. RESULTS OSA was significantly more likely to persist in obese children after adenotonsillectomy. The prevalence of persistent OSA ranged from 33 to 76% in obese children and from 15 to 37% in non-obese children depending on the definition of OSA, the degree of obesity and the age of the study population. The few studies that investigated the effect of weight loss found that OSA improved significantly after intervention and that the prevalence of persistent OSA varied between 10 and 38%. Positive airway pressure was effective for treating OSA, but the mean nightly use was <4 h in two out of three available studies. CONCLUSION Obese children benefit less from adenotonsillectomy than normal-weight children. Weight loss improve OSA significantly, but more research is needed to clarify the role of weight loss as treatment for OSA. Positive airway pressure is effective for treating OSA; however, adherence is a challenge.
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Metabolic consequences of snoring in adolescents and younger adults: a population study in Chile. Int J Obes (Lond) 2016; 40:1510-1514. [PMID: 27478923 DOI: 10.1038/ijo.2016.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/09/2016] [Accepted: 06/25/2016] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES To investigate the potential association between snoring and other symptoms indicative of sleep-disordered breathing and metabolic syndrome (MetS) in Hispanic adolescents and younger adults using a large population-based survey. METHODS Sleep-related information, anthropometric measurements and fasting blood samples markers of MetS were obtained from subjects aged 15-40 years collected through the 2nd Chilean Health Survey. Regression models were constructed to evaluate the associations of snoring with MetS, hypertension and serum cholesterol levels. The modulating effect of sleep duration was accounted for in the models. RESULTS A total of 2147 subjects (42% males, mean age 27.9±7.6 years) were included. Snoring and short sleep duration were present in 43.5 and 25% of the entire population, respectively. MetS was detected in 19.5% of the subjects. In the adjusted regression model, the odds of MetS among snoring subjects were 2.13 times higher (95% confidence interval (CI): 1.52-2.99; P<0.01), and 1.53-fold higher odds of elevated cholesterol also emerged (95% CI: 1.12-2.10; P<0.01). However, the odds of hypertension were not increased by the presence of snoring after adjusting for confounders. In addition, snoring was associated with an increase of 7.26 and 6.56 mg dl-1 for total and low-density lipoprotein cholesterol, respectively, even after adjusting for age, sex and body mass index. Short sleep duration was associated with a small albeit significant risk increase for high systolic blood pressure. CONCLUSIONS In this large population-based sample of young Hispanic adults and adolescents, snoring, but not sleep duration, emerged as an independent risk factor for dyslipidemia and MetS, but not for hypertension.
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GONZAGA NC, SENA ASS, COURA AS, DANTAS FG, OLIVEIRA RC, MEDEIROS CCM. Sleep quality and metabolic syndrome in overweight or obese children and adolescents. REV NUTR 2016. [DOI: 10.1590/1678-98652016000300008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Objective To assess sleep quality and its association with metabolic syndrome and its components. Methods This cross-sectional study was conducted from June 2011 to March 2012 at the Childhood Obesity Center, Campina Grande, Paraíba , Brazil, with 135 overweight or obese children and adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Metabolic syndrome diagnosis was based on abdominal circumference, blood pressure, glycemia, high density lipoprotein-cholesterol, and triglycerides. The data were treated by the software Statistical Package for the Social Sciences version 22.0 at a significance level of 5%. Results The prevalence of poor sleep quality or sleep disorder according to the Pittsburgh Sleep Quality Index was 40.7%, and females had higher mean global Pittsburgh Sleep Quality Index score. Metabolic syndrome prevalence was 63.0%. Females also had higher daytime dysfunction. Poor sleep quality was associated with high diastolic blood pressure (OR=2.6; p =0.015) and waist circumference (OR=3.17; p =0.024) after adjusting for sex and age. Conclusion Girls had higher global Pittsburgh Sleep Quality Index score, which was associated with daytime dysfunction. Poor sleep quality was a predictor of high diastolic blood pressure in the study sample.
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Constantin E, Low NCP, Dugas E, Karp I, O'Loughlin J. Association Between Childhood Sleep-Disordered Breathing and Disruptive Behavior Disorders in Childhood and Adolescence. Behav Sleep Med 2016; 13:442-54. [PMID: 25102357 DOI: 10.1080/15402002.2014.940106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examined the association between sleep-disordered breathing (SDB) and disruptive behavior disorders in 605 children participating in a population-based cohort study. Nineteen percent of children snored (sometimes or often) and 10% had obstructive sleep apnea (OSA) symptoms. Thirteen percent had an ADHD diagnosis or symptoms and 5-9% had behavioral problems or a conduct disorder. Snoring or OSA symptoms were associated with a twofold difference in the odds of ADHD diagnosis or symptoms. OSA symptoms were associated with a threefold to fourfold difference in the odds of behavioral problems or conduct disorder. Clinicians should consider inquiring about SDB in children with disruptive behavior disorders and should also consider disruptive behavior disorders as potential sequelae of SDB.
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Affiliation(s)
| | | | - Erika Dugas
- c Centre de Recherche du Centre Hospitalier de l'Université de Montréal
| | - Igor Karp
- c Centre de Recherche du Centre Hospitalier de l'Université de Montréal.,d Department of Social and Preventive Medicine University of Montréal
| | - Jennifer O'Loughlin
- c Centre de Recherche du Centre Hospitalier de l'Université de Montréal.,d Department of Social and Preventive Medicine University of Montréal.,e Institut national de santé publique du Québec
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Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study. Sleep Breath 2015; 20:845-51. [PMID: 26711131 DOI: 10.1007/s11325-015-1291-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/29/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Obesity and biochemical parameters of metabolic disorders are both closely related to obstructive sleep apnea (OSA). The aim of this study was to compare sleep architecture and OSA in obese children with and without metabolic syndrome. METHODS Forty-two children with metabolic syndrome were selected as case group and 38 children without metabolic syndrome were matched for age, sex, and BMI as control group. The standardized Persian version of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring (BEARS) and Children's Sleep Habits Questionnaires were completed, and polysomnography (PSG) was performed for all study subjects. Scoring was performed using the manual of American Academy of Sleep Medicine for children. Data were analyzed using chi-square test, T test, Mann-Whitney U test, and logistic regression analysis. RESULTS Non-rapid eye movement (NREM) sleep and N1 stage in the case group were significantly longer than the control group, while REM sleep was significantly shorter. Waking after sleep onset (WASO) was significantly different between two groups. Severe OSA was more frequent in the control group. Multivariate logistic regression analysis showed that severe OSA (OR 21.478, 95 % CI 2.160-213.600; P = 0.009) and REM sleep (OR 0.856, 95 % CI 0.737-0.994; P = 0.041) had independent association with metabolic syndrome. CONCLUSIONS Obese children with metabolic syndrome had increased WASO, N1 sleep stage, and severe OSA. But the results regarding sleep architecture are most likely a direct result of OSA severity. More longitudinal studies are needed to confirm the association of metabolic syndrome and OSA.
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Van Eyck A, Van Hoorenbeeck K, De Winter BY, Van Gaal L, De Backer W, Verhulst SL. Sleep-disordered breathing, systemic adipokine secretion, and metabolic dysregulation in overweight and obese children and adolescents. Sleep Med 2015; 30:52-56. [PMID: 28215263 DOI: 10.1016/j.sleep.2015.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/10/2015] [Accepted: 11/14/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is common among overweight and obese children, and it is an independent risk factor for developing metabolic syndrome. However, the mechanisms linking OSA and metabolic syndrome are still unclear, but a role for adipose tissue dysfunction caused by intermittent hypoxia has been suggested. Therefore, the goal of this study was to investigate the relationship between OSA and systemic adipokine concentrations in overweight and obese children. METHODS We included 164 overweight and obese children in a tertiary center and distributed them in groups based on their obstructive apnea-hypopnea index (111 controls, 28 mild OSA, 25 moderate-to-severe OSA). All subjects underwent polysomnography and a blood sample was taken to determine leptin, adiponectin, tumor necrosis factor alpha, and interleukin-6 levels. RESULTS No significant differences were found in adipokine levels between subjects with or without OSA. Leptin correlated with oxygen desaturation index (r = -0.17, p = 0.03), adiponectin correlated with mean oxygen saturation (r = 0.24, p = 0.002) and with the percentage of sleep time with an oxygen saturation >95% (r = 0.25, p = 0.001). However, these associations did not persist after correction for adiposity. No correlations between interleukin-6 and tumor necrosis factor alpha, and OSA severity were found. CONCLUSION These results suggest that serum adipokine levels are mostly dependent on central obesity, while they are not influenced by OSA in an obese pediatric population.
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Affiliation(s)
- Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Luc Van Gaal
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Wilfried De Backer
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn L Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2015; 47:69-94. [PMID: 26541535 DOI: 10.1183/13993003.00385-2015] [Citation(s) in RCA: 445] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).
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Affiliation(s)
- Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Pediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Bhatia R, Lesser DJ, Oliveira FGSA, Tran WH, Keens TG, Khoo MCK, Davidson Ward SL. Body Fat Composition: A Predictive Factor for Sleep Related Breathing Disorder in Obese Children. J Clin Sleep Med 2015; 11:1039-45. [PMID: 26094935 DOI: 10.5664/jcsm.5022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/25/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The association between body fat composition as measured by dual energy x-ray absorptiometry (DEXA) scanning and pediatric sleep related breathing disorder (SRBD) is not well established. We investigated the relationship between body mass index (BMI) and DEXA parameters and their association with SRBD in obese children. PATIENTS AND METHODS Overnight polysomnography was performed on obese/overweight children (10-17 years) with habitual snoring. Total body fat mass (g), trunk fat mass (g), total body % fat, and trunk % fat were determined by DEXA. RESULTS Forty-one subjects were studied. Logarithm (Log) total arousal index correlated with BMI (p < 0.01, r = 0.473), total body fat mass (p < 0.05, r = 0.331), and trunk fat mass (p < 0.05, r = 0.319). Log desaturation index correlated with BMI (p < 0.05, r = 0.313), total body fat mass (p < 0.05, r = 0.375), and trunk fat mass (p < 0.05, r = 0.391), whereas obstructive apnea hypopnea index (OAHI) did not. In males 10-12 years, there was a significant correlation between Log total arousal index and obesity parameters, but not for males aged 13-17 years. BMI correlated with DEXA parameters in all subjects: total body fat mass (p < 0.001, r = 0.850); total body % fat (p < 0.01, r = 0.425); trunk fat mass (p < 0.001, r = 0.792) and trunk % fat (p < 0.05, r = 0.318) and in 10-12 year old males. This relationship was not significant in males aged 13-17 years. CONCLUSIONS Total body fat mass and trunk fat mass as well as BMI correlated with total arousal index and desaturation index. BMI correlated with DEXA parameters in 10-12 year old males but not in 13-17 year old males. The value of using DEXA scanning to study the relationship between obesity and SRBD may depend on age and pubertal stage.
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Affiliation(s)
- Rajeev Bhatia
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Daniel J Lesser
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Flavia G S A Oliveira
- University of Southern California, Vitterbi School of Biomedical Engineering, Los Angeles, CA
| | - Winston H Tran
- University of Southern California, Vitterbi School of Biomedical Engineering, Los Angeles, CA
| | - Thomas G Keens
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael C K Khoo
- University of Southern California, Vitterbi School of Biomedical Engineering, Los Angeles, CA
| | - Sally L Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Dalesio NM, McMichael DH, Benke JR, Owens S, Carson KA, Schwengel DA, Schwartz AR, Ishman SL. Are nocturnal hypoxemia and hypercapnia associated with desaturation immediately after adenotonsillectomy? Paediatr Anaesth 2015; 25:778-785. [PMID: 26149770 PMCID: PMC4944843 DOI: 10.1111/pan.12647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children who undergo adenotonsillectomy for sleep-disordered breathing frequently have postoperative oxygen desaturations. Nocturnal hypoxia has been shown to predict postoperative respiratory complications; however, other gas exchange abnormalities detected on polysomnography (PSG) have not been evaluated. AIM We sought to determine whether hypercapnia seen on preoperative nocturnal PSG can predict postoperative hypoxemia. METHODS We conducted a retrospective review of 319 children who underwent polysomnography before adenotonsillectomy. Saturation levels were recorded for at least 2 h postoperatively, and the primary outcome was desaturation (<90%). RESULTS The median patient age was 5 years (range, 5 months-17 years). Patients who desaturated postoperatively had higher median peak endtidal CO2 (EtCO2 ) levels (55.5 vs 52 mmHg; P = 0.02), lower saturation nadirs (80.5% vs 88%; P = 0.048), and were younger (2 vs 6 years; P < 0.001) than those without desaturation. Age was significantly correlated with peak EtCO2 (r = -0.16), respiratory disturbance index (RDI; r = -0.23), and oxygen saturation nadir (r = 0.25; all P < 0.01). In unadjusted analysis, age <3 years compared to ≥9 years (odds ratio [OR] = 10.09; 95% confidence interval [CI] = 2.13-96.26), peak EtCO2 > 55 mmHg (OR = 3.38; 95% CI = 1.21-9.47), and RDI ≥ 10 (OR = 2.89; 95% CI = 1.05-8.42) were associated with increased odds of desaturation. Multivariable logistic regression on age, race, sex, peak EtCO2 , RDI, opioid use, and saturation nadir showed that only age was significantly associated with postoperative desaturation. Patients 0-2 years old were 10.43 (95% CI = 1.89-110.9) times more likely to have desaturation than patients 9-17 years old. CONCLUSION Patients <3 years of age are most likely to have postoperative hypoxemia after adenotonsillectomy. Gas exchange abnormalities did not correlate with postoperative desaturations, although age and peak EtCO2 did strongly correlate.
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Affiliation(s)
- Nicholas M. Dalesio
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology/Critical Care Medicine, Baltimore, USA,Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - D. Hale McMichael
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology/Critical Care Medicine, Baltimore, USA
| | - James R. Benke
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - Sean Owens
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology/Critical Care Medicine, Baltimore, USA
| | - Kathryn A. Carson
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, USA
| | - Deborah A. Schwengel
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology/Critical Care Medicine, Baltimore, USA
| | - Alan R. Schwartz
- Johns Hopkins School of Medicine, Department of Internal Medicine-Division of Pulmonary and Critical Care Medicine, Baltimore, USA
| | - Stacey L. Ishman
- Cincinnati Children’s Hospital Medical Center, Division of Otolaryngology and Division of Pulmonary Medicine, Cincinnati, USA; University of Cincinnati School of Medicine, Department of Otolaryngology – Head & Neck Surgery and Department of Pediatrics, Cincinnati, USA
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Mathew JL, Narang I. Sleeping too close together: obesity and obstructive sleep apnea in childhood and adolescence. Paediatr Respir Rev 2014; 15:211-8. [PMID: 24094775 DOI: 10.1016/j.prrv.2013.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To review the current available literature exploring the prevalence, severity, consequences and treatments for obesity related OSA in children and adolescents. The published literature was searched through EMBASE and Pubmed using a pre-defined search strategy. There is evidence showing that OSA occurs more frequently and may be more severe in children and adolescents who are overweight or obese compared with lean children. Obesity and OSA are independently associated with adverse cardiovascular, metabolic, and neuropsychological consequences. The magnitude of these abnormalities when obesity and OSA co-exist is not well established. Treatment options for obesity related OSA includes adenotonsillectomy, but it does not cure OSA in over 50% of obese children. Positive airway pressure (PAP) therapy delivered through continuous or bi-level modes is successful, but limited by generally poor compliance. There is increasing experience with bariatric surgical techniques which are effective for the treatment of obesity and its related complications. As obesity related OSA is highly prevalent, more research is needed to understand the interaction of these two conditions with regards to pathophysiology, adverse consequences and optimal management strategies.
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Affiliation(s)
- Joseph L Mathew
- Pediatric Pulmonology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India 160012
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Canada.
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Austeng ME, Øverland B, Kværner KJ, Andersson EM, Axelsson S, Abdelnoor M, Akre H. Obstructive sleep apnea in younger school children with Down syndrome. Int J Pediatr Otorhinolaryngol 2014; 78:1026-9. [PMID: 24809771 DOI: 10.1016/j.ijporl.2014.03.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to assess the prevalence of obstructive sleep apnea (OSA) in 8 year old school children with Down syndrome (DS). While the prevalence in otherwise healthy children is below 5%, the prevalence estimates in children with DS are uncertain (30-80%). OSA directly affects cognitive development and school performance. STUDY DESIGN Population based cross sectional study in a limited geographical area. METHODS Polysomnography (PSG) with video and audio recordings was performed in 8-year-old children with DS in a pediatric sleep unit according to the guidelines of American Academy of Sleep Medicine. Twenty-nine of all 32 children with DS within a restricted area comprising >50% of the Norwegian population and 54% of the children with DS born in Norway in 2002 were enrolled. RESULTS This study reports an apnea hypopnea index AHI>1.5 in 28 of 29 children and an obstructive apnea index (OAI)>1 in 24 of 29 children. 19 children (66%) had an AHI>5 and 17 children (59%) had an OAI>5 which indicated moderate to severe OSA. No correlation was found between OSA and obesity or gender. CONCLUSION The high prevalence of disease found in these previously undiagnosed 8-year-old children underlines the importance of performing OSA diagnostics in children with DS throughout childhood. These findings suggest that the prevalence of OSA remains high up to early school years. In contrast to earlier publications, this current study has the advantage of being population based, the study is performed on children of a narrow age band to estimate prevalence of disease and the diagnostic gold standard of PSG is applied.
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Affiliation(s)
- Marit Erna Austeng
- Østfold Hospital Trust, Department of Otorhinolaryngology, Head and Neck Surgery, Norway; Department of Health Economics and Health Management, University of Oslo, Norway.
| | - Britt Øverland
- Sleep Unit, Department of Otorhinolaryngology/Head and Neck Surgery, Lovisenberg Diakonale Hospital, Norway
| | - Kari Jorunn Kværner
- Department of Health Economics and Health Management, University of Oslo, Norway; Research, Innovation and Education Unit, Oslo University Hospital, Norway
| | - Els-Marie Andersson
- TAKO-Centre, Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Norway
| | - Stefan Axelsson
- TAKO-Centre, Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Norway
| | - Michael Abdelnoor
- Centre of Clinical Research, Unit of Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Harriet Akre
- Sleep Unit, Department of Otorhinolaryngology/Head and Neck Surgery, Lovisenberg Diakonale Hospital, Norway
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Bhushan B, Maddalozzo J, Sheldon SH, Haymond S, Rychlik K, Lales GC, Billings KR. Metabolic alterations in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2014; 78:854-9. [PMID: 24656225 DOI: 10.1016/j.ijporl.2014.02.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 01/19/2023]
Abstract
IMPORTANCE The incidence of obesity is rising in the United States and has been linked to Obstructive Sleep Apnea (OSA) even in young children. Understanding the role that obesity and OSA play in alterations in metabolic variables that can lead to serious health issues is essential to the care and counseling of affected children. OBJECTIVES To evaluate the association of alterations in metabolic variables, including insulin resistance, to OSA in young, obese children. DESIGN Retrospective, case-control series. SETTING Tertiary care children's hospital. PARTICIPANTS Obese children aged 2-12 years who had undergone overnight polysomography and routine laboratory testing for lipid levels, fasting glucose, and insulin from January 1, 2006 to December 31, 2012 were identified from a TransMed Bio-Integration Suite and Epic's clarity database search. RESULTS A total of 76 patients were included for analysis. Forty-three (56.6%) were male, and the mean age was 8.3±2.5 years (range, 2.4-11.9 years). The mean body mass index (BMI) z score was 2.8±0.75 (range, 1.7-6.3), and all patients were obese (BMI z score>95th percentile). Twenty two patients (28.9%) had an apnea-hypopnea index (AHI) <1/h (no OSA), 27 (35.5%) an AHI≥1<5/h, 12 (15.8%) had an AHI ≥5<9.99/h, and 15 (19.7%) had an AHI≥10/h. There was no significant difference in total cholesterol, triglycerides, high and low density lipoprotein levels, systolic and diastolic blood pressure in those patients with or without OSA. Fasting insulin, blood glucose, and homeostasis model assessment (HOMA) were significantly higher in patients with OSA compared to those with no OSA (p<0.01). AHI correlated to alterations in insulin as well as glucose homeostasis on multivariate analysis. Results from logistic regression analysis showed that fasting insulin (p<0.01), and HOMA (p<0.01) predicted severe OSA independent of age, gender, and BMI z score in these patients. CONCLUSION Metabolic alterations in glucose and insulin levels, known to be associated with obesity and increased risk for cardiovascular disease, appear to relate to the severity of OSA in young children.
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Affiliation(s)
- Bharat Bhushan
- Division of Otolaryngology - Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern University Feinberg, School of Medicine, Chicago, IL, United States.
| | - John Maddalozzo
- Division of Otolaryngology - Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern University Feinberg, School of Medicine, Chicago, IL, United States
| | - Stephen H Sheldon
- Division of Pulmonology, Ann and Robert H. Lurie Children's Hospital of Chicago Sleep Medicine Center, Chicago, IL, United States; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Shannon Haymond
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Karen Rychlik
- Biostatistics Research Core, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Chicago, IL, United States
| | - George C Lales
- Clinical and Translational Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Chicago, IL, United States
| | - Kathleen R Billings
- Division of Otolaryngology - Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern University Feinberg, School of Medicine, Chicago, IL, United States
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Nobili V, Cutrera R, Liccardo D, Pavone M, Devito R, Giorgio V, Verrillo E, Baviera G, Musso G. Obstructive sleep apnea syndrome affects liver histology and inflammatory cell activation in pediatric nonalcoholic fatty liver disease, regardless of obesity/insulin resistance. Am J Respir Crit Care Med 2014; 189:66-76. [PMID: 24256086 DOI: 10.1164/rccm.201307-1339oc] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Obstructive sleep apnea syndrome (OSAS) and nonalcoholic fatty liver disease (NAFLD) are frequently encountered in obese children. Whether OSAS and intermittent hypoxia are associated with liver injury in pediatric NAFLD is unknown. OBJECTIVES To assess the relationship of OSAS with liver injury in pediatric NAFLD. METHODS Sixty-five consecutive children with biopsy-proven NAFLD (age, mean ± SD, 11.7 ± 2.1 yr; 58% boys; body mass index z score, 1.93 ± 0.61) underwent a clinical-biochemical assessment and a standard polysomnography. Insulin sensitivity, circulating proinflammatory cytokines, markers of hepatocyte apoptosis (cytokeratin-18 fragments), and hepatic fibrogenesis (hyaluronic acid) were measured. Liver inflammatory infiltrate was characterized by immunohistochemistry for CD45, CD3, and CD163, surface markers of leukocytes, T cells, and activated macrophage/Kupffer cells, respectively. OSAS was defined by an apnea/hypopnea index (AHI) greater than or equal to 1 event/h, and severe OSAS was defined by an AHI greater than or equal to 5 events/h. MEASUREMENTS AND MAIN RESULTS Fifty-five percent of children with NAFLD had nonalcoholic steatohepatitis (NASH), and 34% had significant (stage F ≥ 2) fibrosis. OSAS affected 60% of children with NAFLD; the presence and severity of OSAS were associated with the presence of NASH (odds ratio, 4.89; 95% confidence interval, 3.08-5.98; P = 0.0001), significant fibrosis (odds ratio, 5.91; 95% confidence interval, 3.23-7.42; P = 0.0001), and NAFLD activity score (β, 0.347; P = 0.029), independently of body mass index, abdominal adiposity, metabolic syndrome, and insulin resistance. This relationship held also in nonobese children with NAFLD. The duration of hemoglobin desaturation (Sa(O2) < 90%) correlated with increased intrahepatic leukocytes and activated macrophages/Kupffer cells and with circulating markers of hepatocyte apoptosis and fibrogenesis. CONCLUSIONS In pediatric NAFLD, OSAS is associated with biochemical, immunohistochemical, and histological features of NASH and fibrosis. The impact of hypoxemia correction on liver disease severity warrants evaluation in future trials.
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Jambhekar S, Carroll JL. Diagnosis of pediatric obstructive sleep disordered breathing: beyond the gold standard. Expert Rev Respir Med 2014; 2:791-809. [DOI: 10.1586/17476348.2.6.791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Van Hoorenbeeck K, Verhulst SL. Metabolic complications and obstructive sleep apnea in obese children: time to wake up! Am J Respir Crit Care Med 2014; 189:13-5. [PMID: 24381991 DOI: 10.1164/rccm.201311-2079ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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T regulatory lymphocytes and endothelial function in pediatric obstructive sleep apnea. PLoS One 2013; 8:e69710. [PMID: 23936084 PMCID: PMC3728363 DOI: 10.1371/journal.pone.0069710] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a low-grade inflammatory disease affecting the cardiovascular and metabolic systems. Increasing OSA severity reduces T-regulatory lymphocytes (Tregs) in OSA children. Since Tregs modulate endothelial activation, and attenuate insulin resistance, we hypothesized that Tregs are associated with endothelial and metabolic dysfunction in pediatric OSA. METHODS 50 consecutively recruited children (ages 4.8-12 years) underwent overnight polysomnography and fasting homeostatic model (HOMA) of insulin resistance was assessed. Percentage of Tregs using flow cytometry, and endothelial function, expressed as the time to peak occlusive hyperemia (Tmax), were examined. In a subgroup of children (n = 21), in vitro Treg suppression tests were performed. RESULTS Circulating Tregs were not significantly associated with either BMI z score or HOMA. However, a significant inverse correlation between percentage of Tregs and Tmax emerged (p<0.0001, r = -0.56). A significant negative correlation between Tregs suppression and the sleep pressure score (SPS), a surrogate measure of sleep fragmentation emerged (p = 0.02, r = -0.51) emerged, but was not present with AHI. CONCLUSIONS Endothelial function, but not insulin resistance, in OSA children is strongly associated with circulating Tregs and their suppressive function, and appears to correlate with sleep fragmentation. Thus, alterations in T cell lymphocytes may contribute to cardiovascular morbidity in pediatric OSA.
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Van Hoorenbeeck K, Franckx H, Debode P, Aerts P, Ramet J, Van Gaal LF, Desager KN, De Backer WA, Verhulst SL. Metabolic disregulation in obese adolescents with sleep-disordered breathing before and after weight loss. Obesity (Silver Spring) 2013; 21:1446-50. [PMID: 23408643 DOI: 10.1002/oby.20337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is prevalent in obesity. Weight loss is one of the most effective treatment options. The aim was to assess the association of SDB and metabolic disruption before and after weight loss. DESIGN AND METHODS Obese adolescents were included when entering an in-patient weight loss program. Fasting blood analysis was performed at baseline and after 4-6 months. Sleep screening was done at baseline and at follow-up in case of baseline SDB. RESULTS 224 obese adolescents were included. Median age was 15.5 years (10.1-18.0) and mean BMI z-score was 2.74 ± 0.42. About 30% had SDB at baseline (N = 68). High-density lipoprotein (HDL)-cholesterol was associated with mean nocturnal oxygen saturation (<SaO2>) (partial r = 0.21; P = 0.002). Aspartate aminotransferase (ASAT) and alanine aminotransferase were related with oxygen desaturation index (partial r = -0.15; P = 0.03 and partial r = -0.15; P = 0.02), but this became insignificant after correction for sex. After weight loss, 24% had residual SDB. Linear regression showed an association between ASAT and <SaO2> (partial r = -0.34; P = 0.002). There were no significant correlations between improvements in laboratory measurements and sleep parameters. HDL-cholesterol improved in relation with the decrease in BMI z-score. CONCLUSION SDB at baseline was associated with higher levels of liver enzymes and lower HDL-cholesterol concentration. Improvements in sleep parameters were not associated with improvements in laboratory measurements.
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Affiliation(s)
- K Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
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Nandalike K, Shifteh K, Sin S, Strauss T, Stakofsky A, Gonik N, Bent J, Parikh SR, Bassila M, Nikova M, Muzumdar H, Arens R. Adenotonsillectomy in obese children with obstructive sleep apnea syndrome: magnetic resonance imaging findings and considerations. Sleep 2013; 36:841-7. [PMID: 23729927 DOI: 10.5665/sleep.2708] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. METHODS Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®). RESULTS Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm(3), P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm(3), P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm(3), P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm(3), P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm(3), P = 0.005, respectively). CONCLUSIONS This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.
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Affiliation(s)
- Kiran Nandalike
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USA
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Assessment of endothelial dysfunction in childhood obesity and clinical use. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:174782. [PMID: 23691262 PMCID: PMC3649697 DOI: 10.1155/2013/174782] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/06/2013] [Indexed: 12/11/2022]
Abstract
The association of obesity with noncommunicable diseases, such as cardiovascular complications and diabetes, is considered a major threat to the management of health care worldwide. Epidemiological findings show that childhood obesity is rapidly rising in Western society, as well as in developing countries. This pandemic is not without consequences and can affect the risk of future cardiovascular disease in these children. Childhood obesity is associated with endothelial dysfunction, the first yet still reversible step towards atherosclerosis. Advanced research techniques have added further insight on how childhood obesity and associated comorbidities lead to endothelial dysfunction. Techniques used to measure endothelial function were further brought to perfection, and novel biomarkers, including endothelial progenitor cells, were discovered. The aim of this paper is to provide a critical overview on both in vivo as well as in vitro markers for endothelial integrity. Additionally, an in-depth description of the mechanisms that disrupt the delicate balance between endothelial damage and repair will be given. Finally, the effects of lifestyle interventions and pharmacotherapy on endothelial dysfunction will be reviewed.
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Quantity and Quality of Nocturnal Sleep Affect Morning Glucose Measurement in Acutely Burned Children. J Burn Care Res 2013; 34:483-91. [DOI: 10.1097/bcr.0b013e3182a2a89c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lesser DJ, Bhatia R, Tran WH, Oliveira F, Ortega R, Keens TG, Mittelman SD, Khoo MCK, Davidson Ward SL. Sleep fragmentation and intermittent hypoxemia are associated with decreased insulin sensitivity in obese adolescent Latino males. Pediatr Res 2012; 72:293-8. [PMID: 22669298 PMCID: PMC3427473 DOI: 10.1038/pr.2012.73] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although sleep-related breathing disorder (SRBD) has been linked to insulin resistance in adults, this has not been as well established in children. We hypothesized that the severity of SRBD in adolescents was associated with metabolic impairment. METHODS Polysomnography was performed on obese, Latino males referred for snoring. The frequently sampled intravenous glucose tolerance test was used to assess glucose homeostasis. Total-body dual-energy X-ray absorptiometry was used to quantify adiposity. RESULTS A total of 22 males (mean age ± SD: 13.4 ± 2.1 y, BMI z-score 2.4 ± 0.3, obstructive apnea hypopnea index 4.1 ± 3.2) were studied. After correcting for age and adiposity in multiple-regression models, Log frequency of desaturation (defined as ≥3% drop in oxygen saturation from baseline) negatively correlated with insulin sensitivity. Sleep efficiency was positively correlated with glucose effectiveness (S(G), the capacity of glucose to mediate its own disposal). The Log total arousal index was positively correlated with Log homeostasis model assessment-estimated insulin resistance. CONCLUSION Sleep fragmentation and intermittent hypoxemia are associated with metabolic impairment in obese adolescent Latino males independent of age and adiposity. We speculate that SRBD potentiates the risk for development of metabolic syndrome and type 2 diabetes in the obese adolescent population.
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Affiliation(s)
- Daniel J. Lesser
- Division of Pediatric Pulmonology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Rajeev Bhatia
- Division of Pediatric Pulmonology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Winston H. Tran
- University of Southern California Vitterbi School of Biomedical Engineering, Los Angeles, CA
| | - Flavia Oliveira
- University of Southern California Vitterbi School of Biomedical Engineering, Los Angeles, CA
| | - Ricardo Ortega
- Division of Pediatric Pulmonology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Thomas G. Keens
- Division of Pediatric Pulmonology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Steven D. Mittelman
- Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Michael C. K. Khoo
- University of Southern California Vitterbi School of Biomedical Engineering, Los Angeles, CA
| | - Sally L. Davidson Ward
- Division of Pediatric Pulmonology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
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Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714-55. [PMID: 22926176 DOI: 10.1542/peds.2012-1672] [Citation(s) in RCA: 928] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
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Abstract
Dentists have an important role in preventing and detecting oral and systemic diseases because of their diagnostic and screening abilities and the frequency of patient visits. These skills and practice paradigms should be considered in solving the obesity epidemic. The well-described connection between periodontal disease and diabetes is a reason for dentists to intervene in the rise of obesity. Dentists are in a unique position to identify and aid in treatment of obstructive sleep apnea, a condition associated with obesity and diabetes. Dentists can play a role in raising awareness of overweight status and obesity risk behaviors in children.
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Yin Q, Chen X, Li L, Zhou R, Huang J, Yang D. Apolipoprotein B/apolipoprotein A1 ratio is a good predictive marker of metabolic syndrome and pre-metabolic syndrome in Chinese adolescent women with polycystic ovary syndrome. J Obstet Gynaecol Res 2012; 39:203-9. [PMID: 22672648 DOI: 10.1111/j.1447-0756.2012.01907.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio is well known to be related to metabolic syndrome (MS) and its components in adults of different races. There is low prevalence of MS but high occurrence of various metabolic disorders in Chinese adolescent women with polycystic ovary syndrome (PCOS). We sought to assess if the ApoB/ApoA1 ratio can be used as a predictive marker of MS and pre-MS in Chinese adolescent women with PCOS. MATERIAL AND METHODS This cross-sectional study included 160 Chinese adolescent women. Based on International Diabetes Federation criteria for MS, patients who had no less than two components of MS but did not meet the criteria for the diagnosis of MS were considered as having pre-MS. RESULTS The ApoB/ApoA1 ratio was higher in obese subjects with high free androgen index (FAI). The ApoB/ApoA1 ratio increased significantly as the number of MS components increased and provided 87.5% of sensitivity and 78.9% of specificity with a threshold value of 0.63 for MS, 86.2% of sensitivity and 79.4% of specificity with a threshold value of 0.58 for pre-MS in Chinese adolescent women with PCOS. CONCLUSION The ApoB/ApoA1 ratio was a good predictive marker of MS and pre-MS in Chinese adolescent women with PCOS. FAI could be involved in obesity-related metabolic abnormalities.
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Affiliation(s)
- Qianqian Yin
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Esteller-Moré E, Castells-Vilella L, Segarra-Isern F, Argemí-Renom J. Childhood Obesity and Sleep-related Breathing Disorders. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bhattacharjee R, Hakim F, Gozal D. Sleep, sleep-disordered breathing and lipid homeostasis: translational evidence from murine models and children. ACTA ACUST UNITED AC 2012; 7:203-214. [PMID: 22942904 DOI: 10.2217/clp.12.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Impaired sleep, particularly in the context of sleep-disordered breathing (SDB), is associated with a vast array of comorbidities, including obesity. It is well known that the etiology of obesity is both complex and multifactorial. Recent trends have shown that obesity rates have risen at an alarming rate in children, and this has likely contributed to an increased prevalence of SDB in children. Like the 'chicken and the egg' hypothesis, the temporal relationship of obesity and SDB is unclear but it is speculated that these two conditions converge to promote a fundamental disruption to normal lipid homeostasis. In this review, the effect of sleep disruption and SDB on lipid homeostasis in both murine and human models will be critically examined, with the intent of demonstrating that disrupted sleep in children is itself a precursor to obesity via disordered lipid homeostasis.
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Affiliation(s)
- Rakesh Bhattacharjee
- Department of Pediatrics, Pritzker School of Medicine, Comer Children's Hospital, University of Chicago, 5721 S Maryland Avenue, MC 8000, Suite K-160, Chicago, IL 60637, USA
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Kaditis A, Kheirandish-Gozal L, Gozal D. Algorithm for the diagnosis and treatment of pediatric OSA: A proposal of two pediatric sleep centers. Sleep Med 2012; 13:217-27. [DOI: 10.1016/j.sleep.2011.09.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 09/04/2011] [Accepted: 09/07/2011] [Indexed: 01/28/2023]
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