Metabolic biomarkers in community obese children: effect of obstructive sleep apnea and its treatment

María Luz Alonso-Alvarez a, b, Joaquin Teran-Santos a, b, Monica Gonzalez Martinez a, c,
Jose Aurelio Cordero-Guevara a, María Jose Jurado-Luque b, d, Jaime Corral-Pe~nafiel b, e,
Joaquin Duran-Cantolla b, f, Estrella Ordax Carbajo a, Fernando MasaJimenez b, e,
Leila Kheirandish-Gozal g, David Gozal g, *, the Spanish Sleep Network
a Sleep Unit, Hospital Universitario de Burgos (HUBU), Burgos, Spain
b CIBER of Respiratory Diseases, Instituto Carlos III, Ciberes, Spain
c Hospital Universitario Valdecilla, Santander, Spain
d Hospital Val D’Hebron, Barcelona, Spain
e Hospital San Pedro de Alcantara, Caceres, Spain
f Hospital Universitario de Araba, Vitoria, Spain
g Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago,
IL, USA

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Abstract

Objective: Obesity and obstructive sleep apnea in children have been associated with metabolic morbidities. The present study aimed to evaluate the presence of metabolic alterations among obese children recruited from the community, with and without obstructive sleep apnea syndrome (OSAS), and the impact of treatment of OSAS on metabolic profiles.

Methods: A cross-sectional, prospective, multicenter study of Spanish children aged 3e14 years with a body mass index (BMI) 95th percentile for age and sex were randomly selected in the first phase. Four groups emerged for follow-up: (1) no treatment; (2) dietary intervention; (3) surgical treatment of OSA; and (4) continuous positive airway pressure (CPAP) treatment of OSA. Fasting blood tests were performed at baseline (T0) and approximately one year after the intervention (T1).

Results: A total of 113 obese children with a mean age of 11.3 ± 2.9 years completed T0 and T1 assessments. Their mean BMI z-score at T1 was 1.34 ± 0.59, and mean Respiratory Disturbance Index was 8.6 ± 13.0 at T0 and 3.3 ± 4.0/hour total sleep time at T1. Only glucose fasting levels differed among metabolic parameters in obese children with OSAS and without OSAS at baseline (T0) (p ¼ 0.018). There were statistically significant differences between surgically treated OSAS (p ¼ 0.002), and CPAP-treated OSAS (p ¼ 0.024) versus the non-OSAS group in the glucose levels between baseline (T0) and follow-up (T1) after controlling for age and change in BMI. Significant univariate associations between BMI and C-reactive protein, insulin, and homeostasis model assessment of insulin resistance emerged at both T0 and T1.

Conclusions: Concurrent obesity and OSAS could promote metabolic and inflammatory alterations, and the latter appeared to be sensitive to OSAS treatment outcomes.ClinicalTrials.gov Identifier: NCT01322763.