Early dynamic glucose dysregulation in obese adolescents with obstructive sleep apnea: a comparative analysis with...

Pediatric obstructive sleep apnea (OSA) is an independent factor associated with cardiometabolic disease in obese youth. While chronic intermittent hypoxia alters metabolic homeostasis, evaluating this "hypoxic burden" through fasting biomarkers frequently yields inconsistent results in pediatric cohorts. We investigated whether OSA is associated with early dynamic glycemic dysfunction independent of obesity severity and evaluated the diagnostic utility of morning serum lactate.

This retrospective cross-sectional study evaluated 53 obese adolescents (mean age 13.5 ± 1.7 years) undergoing diagnostic overnight polysomnography in a hospital setting. Participants were stratified into Mild OSA (AHI ≤ 5; n = 35) and Moderate-to-Severe OSA (AHI > 5; n = 18) cohorts. Due to the non-normal distribution of glycemic data, we performed an Analysis of Covariance (ANCOVA) using log10-transformed 2-hour OGTT glucose levels while adjusting for age. Morning serum lactate and standard metabolic indices were evaluated using non-parametric tests.

The Moderate-to-Severe OSA cohort demonstrated significantly elevated 2-hour OGTT glucose levels compared to the Mild OSA cohort (Median: 100 [IQR: 95-135] vs. 98 [IQR: 90-108] mg/dL; p = 0.048, Cohen's d = 0.609). After adjusting for age as a covariate using log10-transformed data, the difference remained statistically significant (adjusted mean difference [log10]: 0.042, 95% CI [0.001 to 0.083]; p = 0.049). Morning serum lactate indicated a marginal trend toward elevation in the Moderate-to-Severe group (Median: 14.5 [IQR: 12-18] vs. 12.0 [IQR: 10-14] mg/dL; p = 0.068, Cohen's d = 0.343). Fasting glucose and insulin levels remained comparable between groups.

Dynamic glucose dysregulation is independently associated with OSA severity in obese adolescents. The OGTT may unmask early metabolic impairment that remains hidden in fasting states.