Metabolic alterations and systemic inflammation in obstructive sleep apnea among nonobese and obese prepubertal children
Metabolic alterations and systemic inflammation in obstructive sleep apnea among nonobese and obese prepubertal children
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DOI：
10.1164/rccm.200711-1670oc
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发表时间：
2008-05-15
影响因子：
24.7
通讯作者：
Kheirandish-Gozal, Leila
中科院分区：
文献类型：
--
作者：
Gozal, David;Capdevila, Oscar Sans;Kheirandish-Gozal, Leila
理由：阻塞性睡眠呼吸暂停（OSA）与成年患者的代谢综合征的患病率和严重程度有关，即使在控制肥胖后也是如此。相比之下，青春期前儿童中的OSA似乎与这种代谢危险的大小没有相关。目标：进一步建立OSA在青春期儿童中代谢调节中的潜在机械作用。载脂蛋白B和血清脂质浓度是在OSA和6-12的初始多聚会诊断期间确定的肥胖儿童和非肥胖儿童的腺骨切除术几个月后。测量和主要结果：62名OSA儿童（37个肥胖和25个非肥胖症），年龄7.40 +/- 2.6岁（平均+/- SD）完成了这项研究。腺孔切除术后，呼吸暂停指数和睡眠碎片的显着改善发生了显着改善，尤其是在非肥胖儿童中。在非肥胖儿童中，腺苷酸切除术与体重指数Z评分的轻度增加有关，禁食葡萄糖或胰岛素均无变化，高密度脂蛋白的显着增加和低密度脂蛋白的相互降低以及血浆C-反应蛋白的减少和载脂蛋白B水平。在肥胖儿童中，腺隆切除术并未导致体重指数或葡萄糖变化，而是与所有其他措施的明显改善有关。结论：OSA似乎并未诱导非肥胖儿科患者的胰岛素抵抗，但似乎在肥胖中起着重要作用。患者。两组腺丝膜切除术后脂质谱，C反应蛋白和载脂蛋白B的显着改善表明OSA在脂质稳态和全身性炎症中的致病作用与肥胖程度无关。
Rationale: Obstructive sleep apnea (OSA) has been associated with a higher prevalence and severity of the metabolic syndrome in adult patients, even after controlling for obesity. In contrast, OSA in prepubertal children does not appear to correlate with the magnitude of such metabolic derangements.Objectives: To further establish the potential mechanistic role of OSA in metabolic regulation in prepubertal children.Methods: Fasting glucose, insulin, C-reactive protein, apolipoprotein B, and serum lipid concentrations were determined during the initial polysomnographic diagnosis of OSA and 6-12 months after adenotonsillectomy in both obese and nonobese children.Measurements and Main Results: Sixty-two children with OSA (37 obese and 25 nonobese), age 7.40 +/- 2.6 years (mean +/- SD) completed the study. After adenotonsillectomy, significant improvements in apnea-hypopnea index and sleep fragmentation occurred, particularly among nonobese children. In nonobese children, adenotonsillectomy was associated with mild increases in body mass index z scores, no changes in either fasting glucose or insulin, significant increases in high-density lipoprotein and reciprocal decreases in low-density lipoprotein, and reductions in plasma C-reactive protein and apolipoprotein B levels. In obese children, adenotonsillectomy did not result in body mass index or glucose changes, but was associated with marked improvements in all other measures.Conclusions: OSA does not appear to induce insulin resistance in nonobese pediatric patients but seems to play a significant role in obese patients. The significant improvements in lipid profiles, C-reactive protein, and apolipoprotein B after adenotonsillectomy in the two groups suggest a pathogenic role for OSA in lipid homeostasis and systemic inflammation independent of the degree of adiposity.