Obstructive sleep apnea and insulin resistance in children with obesity
Rasintra Siriwat1, Lu Wang2, Vaishal Shah2
1Phramongkutklao Hospital, Bangkok, Thailand.
Insights
Obstructive sleep apnea (OSA) in obese children is linked to higher insulin resistance (IR). Older children (age ≥ 12) showed increased IR, and specific apnea-hypopnea index cutoffs can help identify significant IR.
Area of Science:
- Pediatric Endocrinology
- Sleep Medicine
- Metabolic Disorders
Background:
- Inconsistent data exists on the relationship between obstructive sleep apnea (OSA) and insulin resistance (IR).
- Investigating this link in pediatric obesity is crucial for understanding metabolic health in children.
Purpose of the Study:
- To examine the association between OSA and IR in children attending a pediatric obesity clinic.
- To identify potential predictors and age-related interactions in this relationship.
Main Methods:
- Included 80 children (2-18 years) from an obesity clinic undergoing polysomnography (PSG), anthropometric measurements, and lab tests.
- Linear regression analyzed OSA (obstructive apnea-hypopnea index, oAHI) and IR (HOMA-IR).
- Logistic regression and ROC analysis determined optimal oAHI and oxygen desaturation index (ODI) cutoffs for IR.
Main Results:
- Children with OSA (oAHI ≥ 5 events/h) had higher HOMA-IR (5 vs 3.8, P = .034).
- This association remained significant after adjusting for BMI z-score (P = .041).
- Increased IR was observed in older children (age ≥ 12) and correlated with oAHI cutoffs of 4.9 and ODI cutoffs of 4.6.
Conclusions:
- Pediatric obesity with OSA is associated with increased IR, independent of BMI z-score.
- Age ≥ 12 years is a significant factor interacting with OSA severity and IR.
- oAHI ≥ 4.9 shows moderate potential for discriminating significant IR in this population.
Study Objectives:
Because existing data investigating obstructive sleep apnea (OSA) and insulin resistance (IR) are inconsistent, we examine OSA and IR in a pediatric obesity clinic.
Methods:
Children (2-18 years) in the obesity clinic (2013-2017) undergoing polysomnography (PSG), anthropometric measurements, and fasting laboratory tests were included. Linear regression assessed OSA defined by the obstructive apnea-hypopnea index (oAHI) with the homeostatic model assessment of insulin resistance (HOMA-IR). Secondary aims assessed oxygen desaturation index (ODI) and age interactions with HOMA-IR. Logistic regression models and receiver operating characteristic analysis were performed to investigate optimal oAHI and ODI cutoffs relative to HOMA-IR ≥ 3.
Results:
Eighty children were included (mean age, 11.4 ± 4.0 years; 56% female; 46% Caucasian; median body mass index [BMI], 34.6 kg/m² [interquartile ratio, 29.9-40.1], median BMI z-score, 2.5 [interquartile ratio, 2.3-2.8); 46% with oAHI ≥ 5 events/h. HOMA-IR was higher in the OSA group (oAHI ≥ 5 events/h): 5 vs 3.8 (P = .034). After adjustment for sex, race, and BMI z-score, oAHI ≥ 5 events/h retained significance with HOMA-IR (P = .041). HOMA-IR increased in older children (age ≥ 12 years) when adjusting for waist circumference z-score and waist-height ratio (statistical interaction, P = .020 and .034, respectively). Receiver operating characteristic showed optimal cut points of oAHI and ODI for predicting significant IR 4.9 (area under the curve, 0.70; 95% confidence interval, 0.57-0.83; sensitivity, 0.76; specificity, 0.66) and 4.6 (area under the curve, 0.68; 95% confidence interval, 0.55-0.80; sensitivity, 0.70; specificity, 0.67), respectively.
Conclusions:
In a clinic-based pediatric cohort with obesity, OSA is associated with increased IR even after adjusting for confounders including obesity defined by the BMI z-score. Age ≥ 12 years was associated with AHI relative to IR after adjustment for waist circumference z-score and waist-height ratio. Significant IR could be discriminated by oAHI ≥ 4.9 with moderate sensitivity/specificity. Future studies are needed to verify these findings.
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