Verhulst S L, Schrauwen N, Haentjens D, Rooman R P, Van Gaal L, De Backer W A, Desager K N
Department of Pediatrics, Antwerp University Hospital, Wilrijk, Belgium.
J Pediatr. 2007 Jun;150(6):608-12. doi: 10.1016/j.jpeds.2007.01.051.
To assess whether sleep-disordered breathing (SDB) is a risk factor of the metabolic syndrome (MS) in children and adolescents who are overweight and to examine whether the severity of SDB was independently associated with glucose intolerance, insulin resistance, and/or dyslipidemia.
Consecutive subjects who were overweight or obese underwent polysomnography, fasting blood sample, and oral glucose tolerance test (for calculation of area under the curve [AUC]). SDB was defined as a respiratory disturbance index > or = 2. MS was present when > or = 3 of these factors were present: waist circumference > or = 90th percentile; fasting glucose level > or = 110 mg/dL; triglyceride level > or = 110 mg/dL; high-density lipoprotein cholesterol level < or = 40 mg/dL; blood pressure > or = 90th percentile.
A total of 104 subjects were included in the study (44% boys; 58% prepubertal; mean age, 11.1 +/- 2.6 years; 69% obese). Mean SaO2 (odds ratio, 0.54) and SaO2nadir (odds ratio, 0.89) were independent, significant predictors of the presence of MS. Multiple regression showed significant associations between SaO2nadir and high-density lipoprotein cholesterol level, mean SaO2 and both AUC glucose and triglyceride levels, and between the percentage of total sleep time with SaO2 > or = 95% and cholesterol level, while controlling for adiposity and sex, puberty, or both.
This study supports the hypothesis of an interaction between SDB and metabolic abnormalities, independent of estimates of body fat distribution, in children and adolescents who are overweight and obese.
评估睡眠呼吸障碍（SDB）是否为超重儿童及青少年代谢综合征（MS）的危险因素，并探讨SDB的严重程度是否与葡萄糖不耐受、胰岛素抵抗和/或血脂异常独立相关。
对超重或肥胖的连续受试者进行多导睡眠图监测、空腹血样采集及口服葡萄糖耐量试验（用于计算曲线下面积[AUC]）。SDB定义为呼吸紊乱指数≥2。当出现以下≥3个因素时诊断为MS：腰围≥第90百分位数；空腹血糖水平≥110mg/dL；甘油三酯水平≥110mg/dL；高密度脂蛋白胆固醇水平≤40mg/dL；血压≥第90百分位数。
本研究共纳入104名受试者（44%为男孩；58%为青春期前儿童；平均年龄11.1±2.6岁；69%为肥胖者）。平均血氧饱和度（优势比，0.54）和最低血氧饱和度（优势比，0.89）是MS存在的独立显著预测因素。多元回归显示，在控制肥胖、性别、青春期或两者因素后，最低血氧饱和度与高密度脂蛋白胆固醇水平、平均血氧饱和度与AUC葡萄糖及甘油三酯水平、以及血氧饱和度≥95%的总睡眠时间百分比与胆固醇水平之间存在显著关联。
本研究支持以下假说：在超重和肥胖的儿童及青少年中，SDB与代谢异常之间存在相互作用，且独立于体脂分布评估。
