Effects of obstructive sleep apnea and obesity on exercise function in children
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Carla A Evans1, Hiran Selvadurai2, Louise A Baur3
1The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia.
Insights
Children with obstructive sleep apnea (OSA) experience reduced exercise capacity due to lower cardiac output and peak oxygen consumption, regardless of weight. Obesity alone is linked to physical deconditioning.
Area of Science:
- Pediatric cardiology
- Sleep medicine
- Exercise physiology
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized in children, potentially impacting cardiovascular health.
- The interplay between weight status, OSA, and exercise performance in pediatric populations requires further elucidation.
Purpose of the Study:
- To determine the independent and combined effects of weight status and OSA on cardiopulmonary exercise responses in children.
- To differentiate the impact of OSA from obesity on exercise limitations.
Main Methods:
- A prospective, cross-sectional study involving 71 children aged 7-12 years.
- Evaluated participants through anthropometry, polysomnography, spirometry, cardiopulmonary exercise testing, and cardiac Doppler imaging.
- Analyzed exercise parameters, adjusting for body mass index (BMI) z-scores and OSA severity (apnea-hypopnea index).
Main Results:
- Children with OSA exhibited lower peak cardiac output, stroke volume index, heart rate, and oxygen consumption (VO2 peak) compared to weight-matched controls.
- After adjusting for BMI z-score, OSA remained associated with a significant reduction in peak cardiac output.
- Obesity was primarily linked to physical deconditioning, while cardiac dysfunction in OSA patients correlated with sleep-disordered breathing severity.
Conclusions:
- Obstructive sleep apnea (OSA) independently limits exercise capacity in children by reducing cardiac output and VO2 peak.
- Comorbid OSA exacerbates exercise limitations in obese children, highlighting the distinct pathophysiological contributions of each condition.
Study Objectives:
Evaluate the relative contributions of weight status and obstructive sleep apnea (OSA) to cardiopulmonary exercise responses in children.
Design:
Prospective, cross-sectional study. Participants underwent anthropometric measurements, overnight polysomnography, spirometry, cardiopulmonary exercise function testing on a cycle ergometer, and cardiac doppler imaging. OSA was defined as ≥ 1 obstructive apnea or hypopnea per hour of sleep (OAHI). The effect of OSA on exercise function was evaluated after the parameters were corrected for body mass index (BMI) z-scores. Similarly, the effect of obesity on exercise function was examined when the variables were adjusted for OAHI.
Setting:
Tertiary pediatric hospital.
Participants:
Healthy weight and obese children, aged 7-12 y.
Interventions:
N/A.
Measurements And Results:
Seventy-one children were studied. In comparison with weight-matched children without OSA, children with OSA had a lower cardiac output, stroke volume index, heart rate, and oxygen consumption (VO2 peak) at peak exercise capacity. After adjusting for BMI z-score, children with OSA had 1.5 L/min (95% confidence interval -2.3 to -0.6 L/min; P = 0.001) lower cardiac output at peak exercise capacity, but minute ventilation and ventilatory responses to exercise were not affected. Obesity was only associated with physical deconditioning. Cardiac dysfunction was associated with the frequency of respiratory-related arousals, the severity of hypoxia, and heart rate during sleep.
Conclusions:
Children with OSA are exercise limited due to a reduced cardiac output and VO2 peak at peak exercise capacity, independent of their weight status. Comorbid OSA can further decrease exercise performance in obese children.
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