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The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population
Sofie Jacobs1, Emilie Mylemans1, Marijke Ysebaert1
1Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
Insights
Weight loss in obese children improves blood vessel function. However, obstructive sleep apnea (OSA) can limit these improvements, highlighting the need for integrated treatment approaches.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Health
- Sleep Medicine
Background:
- Childhood obesity is a growing concern, linked to serious health issues like obstructive sleep apnea (OSA) and cardiovascular problems.
- Endothelial dysfunction, a precursor to cardiovascular disease, is associated with both obesity and OSA in children.
Purpose of the Study:
- To assess how weight loss impacts endothelial function and OSA in obese children.
- To determine if improvements in endothelial function correlate with better OSA outcomes.
Main Methods:
- Obese children (8-18 years) joined a 12-month weight loss program.
- Endothelial function and anthropometry were measured at baseline, 10 months, and 18 months.
- Sleep screening for OSA was conducted at baseline and repeated at 10 months if initially diagnosed.
Main Results:
- Weight loss significantly improved endothelial function (shorter time to peak response, higher reactive hyperemia index) in obese children.
- Obstructive sleep apnea (OSA) was present in 67% of participants at baseline.
- Residual OSA after weight loss was associated with poorer endothelial function and less improvement.
Conclusions:
- Weight loss effectively enhances endothelial function in obese children.
- The presence of obstructive sleep apnea (OSA) can impede the full benefits of weight loss on endothelial function.
Background:
Childhood obesity is an increasing problem with substantial comorbidities such as obstructive sleep apnea (OSA) and increased cardiovascular morbidity. Endothelial dysfunction is an underlying mechanism related to both obesity and OSA.
Research Question:
To investigate the effect of weight loss on endothelial function and OSA in obese children and to determine whether a change in endothelial function can be linked to an improvement in OSA.
Methods:
Obese children between 8 and 18 years of age were recruited while entering a 12-month inpatient weight loss program. Patients were followed at 3 study visits: baseline, after 10 months of weight loss, and 6 months after ending the program (18 months). Anthropometry and endothelial function (EndoPAT) were determined at all study visits. At baseline, sleep screening with a portable device (ApneaLink) was performed. This was repeated after 10 months if OSA was diagnosed at baseline.
Results:
At baseline, 130 children were included, of which 87 had OSA (67%). Seventy-two patients attended the follow-up visit at 10 months, and 28 patients attended the follow-up visit at 18 months. The BMI z-score decreased after 10 months (from 2.7 (1.4-3.4) to 1.7 (0.5-2.7); p < 0.001) and remained stable at 18 months. Endothelial function improved significantly after weight loss, evidenced by a shorter time to peak response (TPR) and higher reactive hyperemia index (p = 0.02 and p < 0.001), and remained improved after 18 months (p < 0.001 and p = 0.007). After 10 months of weight loss, 10 patients had residual OSA. These patients had a higher TPR at 10 months (225 (75-285)s) than those without OSA (135 (45-225)s) and patients with a normalized sleep study (105 (45-285)s; p = 0.02). Linear mixed models showed that more severe OSA was associated with a worse TPR at baseline and less improvement after weight loss.
Conclusion:
Weight loss improves endothelial function in an obese pediatric population. However, even after weight loss, endothelial function improved less in the presence of OSA.
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