Sleep-Disordered Breathing in Obese Children Is Associated with Prevalent Excessive Daytime Sleepiness, Inflammation, and Metabolic Abnormalities

• Published in: The journal of clinical endocrinology and metabolism Vol. 95; no. 1; pp. 143 - 150
• Main Authors: Tsaoussoglou, Marina, Bixler, Edward O, Calhoun, Susan, Chrousos, George P, Sauder, K, Vgontzas, Alexandros N
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.01.2010; Copyright by The Endocrine Society; The Endocrine Society
• Subjects: Adolescent; Biological and medical sciences; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Inflammation - blood; Inflammation - epidemiology; Inflammation - etiology; Inflammation Mediators - analysis; Inflammation Mediators - blood; Male; Medical sciences; Metabolic Diseases - blood; Metabolic Diseases - epidemiology; Metabolic Diseases - etiology; Obesity - blood; Obesity - complications; Obesity - epidemiology; Original; Prevalence; Risk Factors; Sleep Apnea Syndromes - blood; Sleep Apnea Syndromes - complications; Sleep Apnea Syndromes - epidemiology; Sleep Disorders, Circadian Rhythm - blood; Sleep Disorders, Circadian Rhythm - complications; Sleep Disorders, Circadian Rhythm - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Human; Obesity; Nervous system diseases; Sleep apnea syndrome; Prevalence; Nutrition; Respiratory disease; Nutrition disorder; Sleep disorder; Metabolic diseases; Excessive daytime sleepiness; Inflammation; Metabolism; Association; Anomaly; Neurological disorder; Child; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2009-0435

Background: In obese adults, sleep apnea is associated with excessive daytime sleepiness (EDS) and cardiometabolic risk factors. In children, on the other hand, sleep-disordered breathing (SDB) is primarily associated with anatomic abnormalities and neurocognitive impairment, whereas studies on potential concurrent metabolic aberrations and EDS have been limited and inconsistent. In this study, we examined the joint effect of SDB and obesity in EDS as well as proinflammatory and metabolic markers. Methods: One hundred fifty children, aged 5–17 yr, were consecutively recruited from our sleep disorders clinic and a subset of the Penn State Children’s Cohort. Every child had a thorough history and physical examination, 9-h polysomnographic study, and a single blood draw for the assessment of IL-6, TNFα, soluble IL-6 receptor, TNF receptor-1, hypersensitive C-reactive protein, leptin, and adiponectin. In addition, parents completed a subjective questionnaire to assess EDS. Analysis of covariance was performed on four groups that were separated by SDB severity and body mass index. Results: EDS frequency increased progressively and significantly in the four groups. There was a significant linear trend in plasma IL-6, TNF receptor-1, hypersensitive C-reactive protein, and leptin concentrations, with lowest levels observed in lean controls and highest in overweight/obese with moderate SDB. Adiponectin followed the opposite pattern. Conclusions: This study suggests that in a clinical sample of obese children, SDB is associated with EDS, elevation of proinflammatory cytokines, increased leptin, and decreased adiponectin. All these changes point to an inflammatory/insulin resistance state, suggesting that SDB in obese children share many similarities with SDB in obese adults. In a clinical sample of obese children, SDB is associated with excessive daytime sleepiness, elevation of pro-inflammatory cytokines, increased leptin, and decreased adiponectin.