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Intermittent nocturnal hypoxia and metabolic risk in obese adolescents with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

There is conflicting data regarding the independent associations of obstructive sleep apnea (OSA) with metabolic risk in obese youth. Previous studies have not consistently addressed central adiposity, specifically elevated waist to height ratio (WHtR), which is associated with metabolic risk independent of body mass index.

Objective

The objective of this study was to determine the independent effects of the obstructive apnea-hypopnea index (OAHI) and associated indices of nocturnal hypoxia on metabolic function in obese youth after adjusting for WHtR.

Methods

Subjects had standardized anthropometric measurements. Fasting blood included insulin, glucose, glycated hemoglobin, alanine transferase, and aspartate transaminase. Insulin resistance was quantified with the homeostatic model assessment. Overnight polysomnography determined the OAHI and nocturnal oxygenation indices.

Results

Of the 75 recruited subjects, 23% were diagnosed with OSA. Adjusting for age, gender, and WHtR in multivariable linear regression models, a higher oxygen desaturation index was associated with a higher fasting insulin (coefficient [standard error] = 48.076 [11.255], p < 0.001), higher glycated hemoglobin (coefficient [standard error] = 0.097 [0.041], p = 0.02), higher insulin resistance (coefficient [standard error] = 1.516 [0.364], p < 0.001), elevated alanine transferase (coefficient [standard error] = 11.631 [2.770], p < 0.001), and aspartate transaminase (coefficient [standard error] = 4.880 [1.444], p = 0.001). However, there were no significant associations between OAHI, glucose metabolism, and liver enzymes.

Conclusion

Intermittent nocturnal hypoxia rather than the OAHI was associated with metabolic risk in obese youth after adjusting for WHtR. Measures of abdominal adiposity such as WHtR should be considered in future studies that evaluate the impact of OSA on metabolic health.

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Sources of support

This work was supported by a Canadian Institute of Health Research team grant in childhood obesity (HISTORY: High Impact Strategies Toward Overweight Reduction in Youth). JH is supported with unrestricted research funds by the Mead Johnson Chair in Nutritional Science.

Subject Category List for Authors: 14.5 Pediatric Sleep and Control of Breathing.

Funding

The Canadian Institute of Health Research provided financial support in the form of research funding for childhood obesity. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

    Indra Narang, Brian W. McCrindle, Zihang Lu, Suhail Al-Saleh, Catherine S. Birken & Jill Hamilton

  2. University of Toronto, Toronto, Ontario, Canada

    Indra Narang, Brian W. McCrindle, Zihang Lu, Suhail Al-Saleh, Catherine S. Birken & Jill Hamilton

  3. The Cardiovascular Data Management Centre, The Hospital for Sick Children, Toronto, Canada

    Cedric Manlhiot

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  1. Indra Narang
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Contributions

Dr. Indra Narang contributed substantially as the first author by designing the study, acquiring the data, reviewing the data and statistical results in depth, writing the manuscript, and approving the final version of the manuscript.

Dr. Brian McCrindle contributed substantially as a co-author by designing the study, reviewing the data, revising the manuscript critically, and approving the final version of the manuscript.

Cedric Manlhiot contributed substantially as a co-author by designing the study, reviewing the data, undertaking the statistical analyses, revising the manuscript critically, and approving the final version of the manuscript.

Zihang Lu contributed substantially as a co-author by reviewing the data, undertaking the statistical analyses, revising the manuscript critically and approving the final version of the manuscript.

Dr. Suhail Al-Saleh contributed substantially as a co-author by reviewing the data, revising the manuscript critically, and approving the final version of the manuscript.

Dr. Catherine Birken contributed substantially as a co-author by reviewing the data, revising the manuscript critically, and approving the final version of the manuscript.

Dr. Jill Hamilton contributed substantially as the senior author by designing the study, acquiring the data, reviewing the data and statistical results in depth, writing the manuscript, and approving the final version of the manuscript.

Corresponding author

Correspondence to Indra Narang.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Narang, I., McCrindle, B.W., Manlhiot, C. et al. Intermittent nocturnal hypoxia and metabolic risk in obese adolescents with obstructive sleep apnea. Sleep Breath 22, 1037–1044 (2018). https://doi.org/10.1007/s11325-018-1631-9

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  • DOI: https://doi.org/10.1007/s11325-018-1631-9

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