Abstract
Sleep-disordered breathing is highly prevalent in childhood obesity. Two recent cross-sectional studies have demonstrated an independent association between the severity of sleep-disordered breathing and the metabolic syndrome. A limited number of studies have also addressed the correlation between sleep-disordered breathing and insulin resistance, the core factor of the metabolic syndrome. Cross-sectional reports in modestly obese children are in favor of an association between sleep apnea and insulin resistance. However, these findings were not confirmed in studies of normal-weight children and of morbidly obese children. Only one out of three treatment studies before and after adenotonsillectomy confirmed the association between sleep apnea and insulin resistance, but only in obese children. Although statistical power issues and differences in patient characteristics might partially explain these contradicting results, the evidence to date is far from establishing a causal link between sleep-disordered breathing and insulin resistance. Longitudinal studies and randomized control trials are therefore warranted to investigate a possible causal link between sleep-disordered breathing and insulin resistance.
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References
Speiser PW, Rudolf MC, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A et al. Childhood obesity. J Clin Endocrinol Metab 2005; 90: 1871–1887.
Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH . Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 2003; 157: 821–827.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362–2374.
Invitti C, Maffeis C, Gilardini L, Pontiggia B, Mazzilli G, Girola A et al. Metabolic syndrome in obese Caucasian children: prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors. Int J Obes (Lond) 2006; 30: 627–633.
Berenson GS, Srinivasan SR, Bao W, Newman III WP, Tracy RE, Wattigney WA . Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338: 1650–1656.
Steinberger J, Moran A, Hong CP, Jacobs Jr DR, Sinaiko AR . Adiposity in childhood predicts obesity and insulin resistance in young adulthood. J Pediatr 2001; 138: 469–473.
Sinaiko AR, Steinberger J, Moran A, Hong CP, Prineas RJ, Jacobs Jr DR . Influence of insulin resistance and body mass index at age 13 on systolic blood pressure, triglycerides, and high-density lipoprotein cholesterol at age 19. Hypertension 2006; 48: 730–736.
Verhulst SL, Van Gaal L, De Backer W, Desager KN . The prevalence, anatomic correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev 2008; 12: 339–346.
Greene MG, Carroll JL . Consequences of sleep-disordered breathing in childhood. Curr Opin Pulm Med 1997; 3: 456–463.
Corbo GM, Forastiere F, Agabiti N, Pistelli R, Dell’Orco V, Perucci CA et al. Snoring in 9- to 15-year-old children: risk factors and clinical relevance. Pediatrics 2001; 108: 1149–1154.
Urschitz MS, Guenther A, Eitner S, Urschitz-Duprat PM, Schlaud M, Ipsiroglu OS et al. Risk factors and natural history of habitual snoring. Chest 2004; 126: 790–800.
Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. Am J Respir Crit Care Med 1996; 153: 866–878.
Verhulst SL, Schrauwen N, Haentjens D, Suys B, Rooman RP, Van Gaal L et al. Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child 2007; 92: 205–208.
Kohler M, Lushington K, Couper R, Martin J, van den Heuvel C, Pamula Y et al. Obesity and risk of sleep related upper airway obstruction in Caucasian children. J Clin Sleep Med 2008; 4: 129–136.
Lavie L . Obstructive sleep apnoea syndrome—an oxidative stress disorder. Sleep Med Rev 2003; 7: 35–51.
Verhulst SL, Van Hoeck K, Schrauwen N, Haentjens D, Rooman R, Van Gaal L et al. Sleep-disordered breathing and uric acid in overweight and obese children and adolescents. Chest 2007; 132: 76–80.
Tauman R, O’Brien LM, Gozal D . Hypoxemia and obesity modulate plasma C-reactive protein and interleukin-6 levels in sleep-disordered breathing. Sleep Breath 2007; 11: 77–84.
Larkin EK, Rosen CL, Kirchner HL, Storfer-Isser A, Emancipator JL, Johnson NL et al. Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation 2005; 111: 1978–1984.
Aljadeff G, Gozal D, Schechtman VL, Burrell B, Harper RM, Ward SL . Heart rate variability in children with obstructive sleep apnea. Sleep 1997; 20: 151–157.
Bratel T, Wennlund A, Carlstrom K . Pituitary reactivity, androgens and catecholamines in obstructive sleep apnoea. Effects of continuous positive airway pressure treatment (CPAP). Respir Med 1999; 93: 1–7.
Tauman R, Serpero LD, Capdevila OS, O’Brien LM, Goldbart AD, Kheirandish-Gozal L et al. Adipokines in children with sleep disordered breathing. Sleep 2007; 30: 443–449.
Spiegel K, Knutson K, Leproult R, Tasali E, Van CE . Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. J Appl Physiol 2005; 99: 2008–2019.
Flint J, Kothare SV, Zihlif M, Suarez E, Adams R, Legido A et al. Association between inadequate sleep and insulin resistance in obese children. J Pediatr 2007; 150: 364–369.
Verhulst SL, Schrauwen N, Haentjens D, Rooman RP, Van GL, DE Backer WA et al. Sleep duration and metabolic dysregulation in overweight children and adolescents. Arch Dis Child 2008; 93: 89–90.
Iiyori N, Alonso LC, Li J, Sanders MH, Garcia-Ocana A, O’Doherty RM et al. Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med 2007; 175: 851–857.
Van Gaal LF, Mertens IL, De Block CE . Mechanisms linking obesity with cardiovascular disease. Nature 2006; 444: 875–880.
Verhulst SL, Schrauwen N, Haentjens D, Rooman R, Van Gaal L, De Backer W et al. Sleep-disordered breathing and the metabolic syndrome in overweight and obese children and adolescents. J Pediatr 2007; 150: 612–616.
Redline S, Storfer-Isser A, Rosen CL, Johnson NL, Kirchner HL, Emancipator J et al. Association between metabolic syndrome and sleep-disordered breathing in adolescents. Am J Respir Crit Care Med 2007; 176: 401–408.
de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N . Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation 2004; 110: 2494–2497.
de la Eva RC, Baur LA, Donaghue KC, Waters KA . Metabolic correlates with obstructive sleep apnea in obese subjects. J Pediatr 2002; 140: 654–659.
Tauman R, O’Brien LM, Ivanenko A, Gozal D . Obesity rather than severity of sleep-disordered breathing as the major determinant of insulin resistance and altered lipidemia in snoring children. Pediatrics 2005; 116: e66–e73.
Kaditis AG, Alexopoulos EI, Damani E, Karadonta I, Kostadima E, Tsolakidou A et al. Obstructive sleep-disordered breathing and fasting insulin levels in nonobese children. Pediatr Pulmonol 2005; 40: 515–523.
Li AM, Chan MH, Chan DF, Lam HS, Wong EM, So HK et al. Insulin and obstructive sleep apnea in obese Chinese children. Pediatr Pulmonol 2006; 41: 1175–1181.
Dubern B, Tounian P, Medjadhi N, Maingot L, Girardet JP, Boule M . Pulmonary function and sleep-related breathing disorders in severely obese children. Clin Nutr 2006; 25: 803–809.
Waters KA, Mast BT, Vella S, de la ER, O’Brien LM, Bailey S et al. Structural equation modeling of sleep apnea, inflammation, and metabolic dysfunction in children. J Sleep Res 2007; 16: 388–395.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.
Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF . Clinical screening of school children for polysomnography to detect sleep-disordered breathing—the Tucson Children's Assessment of Sleep Apnea study (TuCASA). J Clin Sleep Med 2005; 1: 247–254.
Waters KA, Sitha S, O’Brien LM, Bibby S, de TC, Vella S et al. Follow-up on metabolic markers in children treated for obstructive sleep apnea. Am J Respir Crit Care Med 2006; 174: 455–460.
Gozal D, Sans CO, Kheirandish-Gozal L . Metabolic alterations in obstructive sleep apnea among non-obese and obese prepubertal children. Am J Respir Crit Care Med 2008; 177: 1142–1149.
Apostolidou MT, Alexopoulos EI, Damani E, Liakos N, Chaidas K, Boultadakis E et al. Absence of blood pressure, metabolic, and inflammatory marker changes after adenotonsillectomy for sleep apnea in Greek children. Pediatr Pulmonol 2008; 43: 550–560.
Weaver TE, Grunstein RR . Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008; 5: 173–178.
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Verhulst, S., Rooman, R., Van Gaal, L. et al. Is sleep-disordered breathing an additional risk factor for the metabolic syndrome in obese children and adolescents?. Int J Obes 33, 8–13 (2009). https://doi.org/10.1038/ijo.2008.152
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DOI: https://doi.org/10.1038/ijo.2008.152
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