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Published on: December 6, 2016
Elevated serum aminotransferase levels in children at risk for obstructive sleep apnea
Leila Kheirandish-Gozal1, Oscar Sans Capdevila, Ebrahim Kheirandish
1Department of Pediatrics, Division of Pediatric Sleep Medicine, University of Louisville, Louisville, KY 40202, USA.
Insights
Obstructive sleep apnea (OSA) is common in obese children with fatty liver disease (FLD). Treating OSA improved liver function in most children, suggesting a link between OSA and FLD.
Area of Science:
- Pediatric Gastroenterology
- Sleep Medicine
- Metabolic Disorders
Background:
- Fatty liver disease (FLD) is prevalent in obese children.
- Obese children have an increased risk for obstructive sleep apnea (OSA).
- The role of OSA in pediatric FLD is not well understood.
Purpose of the Study:
- To investigate the association between OSA and FLD in obese children.
- To determine if OSA treatment improves FLD in this population.
Main Methods:
- Prospective study of 518 snoring children (4-17 years).
- Evaluated polysomnography, insulin, glucose, lipids, and liver function tests.
- Assessed FLD based on elevated liver enzymes.
Main Results:
- 65.9% of children had OSA; 32.4% of overweight/obese children had elevated liver enzymes.
- Obese children with FLD were more likely to have OSA (91.3%).
- OSA treatment improved FLD in 76% of obese children with FLD.
Conclusions:
- Elevated liver enzymes are common in obese, snoring children, especially with OSA and metabolic dysfunction.
- Effective OSA treatment significantly improves liver function in these children.
- OSA is a potential contributor to FLD in obese children.
Background:
Fatty liver disease (FLD) is a highly prevalent condition in obese (Ob) children, who are at increased risk for obstructive sleep apnea (OSA). However, the contribution of OSA to FLD remains unknown.
Design:
Prospective study.
Setting:
Polysomnographic evaluation and assessment of plasma levels of insulin, glucose, and lipids, and liver function tests.
Participants:
A total of 518 consecutive snoring children 4 to 17 years of age who were being evaluated for habitual snoring and suspected OSA.
Results:
A total of 376 children had body mass index z score of < 1.20 (non-Ob children), 3 children (<1%) had elevated serum aminotransferase (LFT) levels, and 248 had OSA (65.9%). Among the 142 overweight/Ob children, 46 had elevated LFT levels (32.4%); of these children, 42 had OSA (91.3%). In contrast, OSA was present in only 71.8% of Ob children without elevated LFT level (p < 0.01). Insulin resistance and hyperlipidemia were more likely to occur in children with FLD. Furthermore, FLD was improved after treatment of OSA in 32 of 42 Ob children (p < 0.0001).
Conclusion:
Increased liver enzyme levels are frequently found in Ob snoring children, particularly among those with OSA and/or metabolic dysfunction. Effective treatment of OSA results in improved liver function test results in the vast majority of these patients.
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