Abstract 18082: Obstructive Sleep Apnea Independently Mediates Cardio-Metabolic Risk in Obese Adolescents
Introduction: Obstructive sleep apnea (OSA) is characterized by snoring, recurrent obstruction of the upper airway and intermittent desaturations. OSA complicates obesity in 30% of adolescents. Chronic untreated OSA in adults is associated with increased cardiometabolic (CM) risk but limited data in obese adolescents are conflicting and suggest that body mass index (BMI) primarily confers CM risk rather than OSA.
Objective: To evaluate the impact of OSA on CM risk in obese adolescents. We hypothesized that OSA independently mediates CM risk in obese adolescents.
Methods: This was a cross-sectional, prospective study where obese children and adolescents, aged 8-18 years without a history of OSA were consecutively recruited. After an overnight fast, participants had standardized measurements of height, weight, waist circumference and blood pressure. BMI z scores and waist to height ratio (WHtR) were calculated. Fasting blood samples for lipid profile, insulin, glucose, high sensitivity C-reactive protein (CRP) were obtained. All participants underwent an overnight polysomnography. An obstructive apnea-hypopnea index (OAHI) of ≤5 events/hour was used to define OSA.
Results: 105 obese participants (45% males) were recruited and 27/105 (26%) had OSA. In the OSA group versus the no-OSA group, the mean age (±SD) in years was 15.1±2.5 and 14.7±2.5 respectively (p=0.45). The mean BMI (SD) z scores and WHtR (SD) were significantly higher in the OSA group compared to the no-OSA group (2.66±0.54 vs 2.36±0.49, respectively, p=0.01 and 0.75±0.16 vs 0.66±0.12 respectively, p=0.01). After adjusting for age, gender and WHtR in multivariable linear regression model, OAHI ≥5 was significantly associated with greater CM risk, specifically, higher fasting insulin (EST (SE): +243 (93) pmol/L, p=0.01), higher HOMA-IR: (7.7 (3.1), p=0.01), lower high density lipoprotein (-0.60 (0.23) mmol/L, p=0.01), higher CRP (+16 (5) mg/L, p=0.001) and higher systolic and diastolic BP z scores (+2.9 (0.9) z systolic, +2.2 (0.6) z diastolic, p=0.001 for both).
Conclusion: OSA in the context of obesity may further potentiate CM risk in adolescents. Early screening and targeted therapeutic interventions for OSA should be optimized in obese youth to minimize long-term CM risk.
Author Disclosures: I. Narang: None. B.W. McCrindle: None. C. Manlhiot: None. C. Birken: None. J. Hamilton: None.
- © 2014 by American Heart Association, Inc.