Glycated hemoglobin and sleep apnea syndrome in children: beyond the apnea–hypopnea index
Snoring and obstructive sleep apnea syndrome (OSA) are frequent conditions in pediatrics. Glycated hemoglobin (HbA1C) is a useful homeostatic biomarker of glycemia and may reflect alterations deriving from sleep breathing disorders. The aim of this study was to relate the severity of OSA with blood HbA1C levels in children.
A descriptive observational study in snoring patients was performed. All patients underwent a sleep study and classified either as simple snorers (apnea–hypopnea index; AHI ≤ 1 episodies/h) or as OSA patients (AHI > 1 episodes/h). In the following morning, a blood glycemic profile (fasting glucose, insulin, HbA1C, and the HOMA index) was performed to every individual.
A total of 48 patients were included. HbA1C levels were shown to be increased in the moderate OSA (AHI > 5 episodes/h) group (5.05 ± 0.25 vs. 5.24 ± 0.29%; p = 0.019). Significant correlations were found between HbA1C values and AHI (r = 0.345; p = 0.016) and also with oxygen desaturation index (r = 0.40; p = 0.005). Correlations remained significant after adjusting by age and body mass index. The AHI-associated change in HbA1C was 13.4% (p = 0.011).
In the pediatric population, HbA1C is a biomarker associated with OSA severity, and this relationship is age- and obesity-independent. The fact that this association was observed in snoring patients could help the physician in the distinction between those patients affected with OSA and those with simple snoring. Therefore, HbA1C measurement could play a major role in the diagnosis and the management of the syndrome.
KeywordsSnoring Sleep apnea Sleep disorder breathing Glycated hemoglobin Pediatric sleep disorder
JAPZ, AB, JMB, DMG, and MP conceived and designed the study. JAPZ, AB, DMG, and AY supervised the data collection and managed the data, including quality control. JAPZ, AB, DMG, and AY provided statistical advice on study design and analyzed the data; AB and MP chaired the data oversight committee. JAPZ, MP, AB, DMG, and JMB drafted the manuscript, and all authors contributed substantially to its revision. JAPZ, AB, MC, and JF take responsibility for the paper as a whole.
Compliance with ethical standards
A funding statement
This work was supported by Fondo de Investigación Sanitaria [Grant: FIS PI1302120]. The sponsor had no role in the design or conduct of this research.
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Previous presetation in a meeting
The manuscript content has not been presented elsewhere.
- 1.AASM (2014) International classification of sleep disorders, 3rd edn. American academy of sleep medicine, DarienGoogle Scholar
- 6.Feng Y, Zhang Z, Dong ZZ (2015) Effects of continuous positive airway pressure therapy on glycaemic control, insulin sensitivity and body mass index in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis. NPJ Prim Care Respir Med 25:15005CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the american academy of sleep medicine. J Clin Sleep Med 8(5):597–619PubMedPubMedCentralGoogle Scholar