Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents.
Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents.
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DOI：
10.1038/ijo.2015.67
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发表时间：
2015-07
影响因子：
4.9
通讯作者：
Marcus, C. L.
中科院分区：
文献类型：
--
作者：
Koren, D.;Chirinos, J. A.;Katz, L. E. L.;Mohler, E. R.;Gallagher, P. R.;Mitchell, G. F.;Marcus, C. L.
阻塞性睡眠呼吸暂停综合征（OSAS）可能是成人心血管疾病（CVD）的危险因素，与肥胖无关。儿科研究将OSAS与内皮功能障碍联系起来，但很少有研究探讨OSAS与大血管后遗症之间的关系。我们的目的是研究OSAS对肥胖青少年大血管CVD风险测量的独立贡献。这项横断面观察性研究在费城儿童医院临床研究和学术睡眠中心以及宾夕法尼亚大学血管研究中心进行。31名肥胖非糖尿病青少年接受人体测量、整夜多导睡眠图、空腹实验室抽血和心血管成像。心血管结局指标包括最大颈动脉内膜中层厚度（cIMTmax），一种颈动脉结构变化的指标，和颈动脉-股动脉脉搏波速度（CFPWV），一种主动脉僵硬度指标，其与维斯OSAS的关系以前尚未研究。评估颈动脉直径和增强指数（AIx，从波反射测量中心压力增强）。检查的潜在混杂变量包括血压、脂蛋白、高敏C反应蛋白、胰岛素和葡萄糖。呼吸暂停低通气指数是OSAS的主要测量指标，与cIMTmax、颈动脉直径、CFPWV或AIx无关。BMI与cIMTmax（r=0.52，p=0.006）和CFPWV（r=0.45，p=0.01）呈正相关。平均睡眠潮气末CO2与颈动脉直径呈负相关（r=-0.63，p<0.0005）。胰岛素水平与AIx呈负相关（r=-0.53，p=0.02）。在肥胖青少年中，OSAS不能独立于BMI预测颈动脉结构改变或动脉僵硬度。较高的胰岛素水平与较低的中心压力波增强相关。最后，长期的高碳酸血症可能会导致颈动脉狭窄。
Obstructive sleep apnea syndrome (OSAS) may be a cardiovascular disease (CVD) risk factor independently of obesity in adults. Pediatric studies have associated OSAS with endothelial dysfunction, but few studies have examined relationships between OSAS and macrovascular sequelae. Our objective was to examine OSAS’s independent contribution to macrovascular CVD risk measures in obese adolescents. This cross-sectional observational study was conducted at Children’s Hospital of Philadelphia Clinical Research and Academic Sleep Centers, and University of Pennsylvania Vascular Research Unit. 31 obese non-diabetic adolescents underwent anthropometric measurements, overnight polysomnography, fasting laboratory draw, and cardiovascular imaging. Cardiovascular outcome measures included maximal carotid intima-media thickness (cIMTmax), a measure of carotid structural changes, and carotid-femoral pulse wave velocity (CFPWV), an aortic stiffness measure whose relationship vis-à-vis OSAS in children has not been previously examined. Carotid diameter and augmentation index (AIx, measuring central pressure augmentation from wave reflections) were assessed. Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose. The apnea hypopnea index, a primary OSAS measure, was not associated with cIMTmax, carotid diameter, CFPWV or AIx. BMI associated positively with cIMTmax (r=0.52, p=0.006) and CFPWV (r=0.45, p=0.01). Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=−0.63, p<0.0005). Insulin levels were negatively associated with AIx (r=−0.53, p=0.02). OSAS did not predict carotid structural changes or arterial stiffness independently of BMI in obese adolescents. Higher insulin levels associated with lower central pressure wave augmentation. Finally, long-term hypercapnia may predispose to carotid narrowing.
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