Relationship between sleep apnea, fat distribution, and insulin resistance in obese children
Craig A Canapari1, Alison G Hoppin, T Bernard Kinane
1Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA. ccanapari@partners.org
Insights
Visceral fat, not just overall obesity, is a key predictor of obstructive sleep apnea (OSA) severity in children. This finding highlights the importance of fat distribution in pediatric OSA.
Area of Science:
- Pediatric Endocrinology
- Sleep Medicine
- Obesity Research
Background:
- Obstructive sleep apnea (OSA) is linked to obesity, inflammation, and insulin resistance in children.
- The specific role of fat distribution in the development of pediatric OSA remains unclear.
- Understanding these relationships is crucial for managing obese children's health.
Purpose of the Study:
- To investigate the connection between fat distribution, OSA, and insulin resistance in obese children.
- To determine if fat distribution patterns are independent predictors of OSA in this population.
Main Methods:
- Study included obese children (age 5-18 years) with BMI > 95th percentile.
- Participants underwent polysomnography, blood tests for dyslipidemia, inflammation, and insulin resistance (HOMA).
- A subset received MRI/MRS to quantify visceral and subcutaneous adipose tissue and intramyocellular lipids.
Main Results:
- 48% of the 31 enrolled obese children had OSA (mean AHI 6.26 events/h).
- Children with OSA showed higher BMI, triglycerides, leptin, and HOMA scores.
- Visceral fat area significantly predicted OSA severity (AHI), independent of BMI z-score, age, or gender.
Conclusions:
- Visceral fat distribution is a significant and independent predictor of obstructive sleep apnea severity in obese children.
- Targeting visceral adiposity may be a key strategy in managing pediatric OSA.
Background:
Obstructive sleep apnea (OSA) is associated with obesity, inflammation, and insulin resistance. The role of fat distribution in OSA pathogenesis has not been established in children. The objective of the study is to examine the relationship between fat distribution, OSA, and insulin resistance in an unselected population of obese children.
Methods:
All obese (BMI > 95th percentile) children (ages 5-18 y) seen at a pediatric obesity clinic were invited to participate. Subjects underwent polysomnography, and were tested for dyslipidemia, inflammation, and insulin resistance measured by the homeostasis model assessment (HOMA). In a subset of subjects, magnetic resonance (MRI) imaging was used to determine the abdominal visceral and subcutaneous adipose tissue areas and magnetic resonance spectroscopy (MRS) spectroscopy was used to intramyocellular lipids in leg muscles.
Measurements And Main Results:
31 obese subjects enrolled and completed polysomnography and serum testing, and 19 subjects underwent MRI/MRS. The mean age was 12.6 ± 3.0 y and the mean body mass index (BMI) was 39.5 ± 11.2 kg/m(2). Forty-eight percent had OSA (mean apnea hypopnea index [AHI] 6.26 ± 6.77 events/h) Subjects with OSA had significantly increased BMI, log HOMA, triglycerides, and leptin compared to those without OSA. In regression analysis, only BMI z-score was associated with log HOMA. In the subset of patients with imaging data, visceral fat area was strongly predictive of AHI (p = 0.003, r(2) = 0.556). BMI z-score, gender, and age were not predictive.
Conclusions:
Visceral fat distribution is independently predictive of OSA severity in obese children.
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