Upper Airway Structure and Body Fat Composition in Obese Children with Obstructive Sleep Apnea Syndrome
Upper Airway Structure and Body Fat Composition in Obese Children with Obstructive Sleep Apnea Syndrome
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DOI：
10.1164/rccm.201008-1249oc
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发表时间：
2011-03-15
影响因子：
24.7
通讯作者：
Shifteh, Keivan
中科院分区：
文献类型：
--
作者：
Arens, Raanan;Sin, Sanghun;Shifteh, Keivan
理由：肥胖儿童导致阻塞性睡眠呼吸暂停综合征（OSAS）的机制尚不清楚。目的：本研究的目的是确定与肥胖儿童OSAS相关的解剖学危险因素，并将其与没有OSAS的肥胖对照组进行比较。方法：采用磁共振成像法测定上呼吸道结构大小、体脂组成。组间比较采用配对分析。采用混合效应回归模型和条件多元logistic回归模型来确定体重指数（BMI） Z-score是否为与OSAS相关的各解剖特征的效应修饰因子。测量方法和主要结果：我们研究了22名肥胖OSAS患者（12.5 +/- 2.8年，BMI z -评分为2.4 +/- 0.4）和22名肥胖对照组（12.3 +/- 2.9年，BMI z -评分为2.3 +/- 0.3）。与对照组相比，osaas患者的口咽部较小（P < 0.05），腺样体（P < 0.01）、扁桃体（P < 0.05）和咽后淋巴结较大（P < 0.05）。淋巴组织的大小与OSAS的严重程度相关，而BMI z评分对这些组织没有调节作用。OSAS患者的咽旁脂肪垫增大（P < 0.05），腹部内脏脂肪增大（P < 0.05）。这些组织的大小与OSAS的严重程度无关，BMI z评分对这些组织没有调节作用。结论：肥胖OSAS患儿上呼吸道淋巴细胞增生明显。淋巴组织大小与肥胖缺乏相关性表明，这种肥大是由其他机制引起的。虽然伴有OSAS的肥胖儿童咽旁脂肪垫和腹部内脏脂肪更大，但我们没有发现它们与OSAS严重程度或肥胖之间的直接关联。
Rationale: Mechanisms leading to obstructive sleep apnea syndrome (OSAS) in obese children are not well understood.Objectives: The aim of the study was to determine anatomical risk factors associated with OSAS in obese children as compared with obese control subjects without OSAS.Methods: Magnetic resonance imaging was used to determine the size of upper airway structure, and body fat composition. Paired analysis was used to compare between groups. Mixed effects regression models and conditional multiple logistic regression models were used to determine whether body mass index (BMI) Z-score was an effect modifier of each anatomic characteristic as it relates to OSAS.Measurements and Main Results: We studied 22 obese subjects with OSAS (12.5 +/- 2.8 yr; BMI Z-score, 2.4 +/- 0.4) and 22 obese control subjects (12.3 +/- 2.9 yr; BMI Z-score, 2.3 +/- 0.3). As compared with control subjects, subjects with OSAS had a smaller oropharynx (P < 0.05) and larger adenoid (P < 0.01), tonsils (P < 0.05), and retropharyngeal nodes (P < 0.05). The size of lymphoid tissues correlated with severity of OSAS whereas BMI Z-score did not have a modifier effect on these tissues. Subjects with OSAS demonstrated increased size of parapharyngeal fat pads (P < 0.05) and abdominal visceral fat (P < 0.05). The size of these tissues did not correlate with severity of OSAS and BMI Z-score did not have a modifier effect on these tissues.Conclusions: Upper airway lymphoid hypertrophy is significant in obese children with OSAS. The lack of correlation of lymphoid tissue size with obesity suggests that this hypertrophy is caused by other mechanisms. Although the parapharyngeal fat pads and abdominal visceral fat are larger in obese children with OSAS we could not find a direct association with severity of OSAS or with obesity.