Tauman Riva, Serpero Laura D, Capdevila Oscar Sans, O'Brien Louise M, Goldbart Aviv D, Kheirandish-Gozal Leila, Gozal David
Kosair Children's Hospital Research Institute, Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA.
Sleep. 2007 Apr;30(4):443-9. doi: 10.1093/sleep/30.4.443.
Associations between SDB, the metabolic syndrome, and circulating levels of adipokines have emerged in adults but have not been examined in snoring children, who, in contradistinction to adults, display insulin resistance and lipid abnormalities as a function of adiposity rather than SDB. Therefore, we aimed to examine associations between circulating adipokines levels, insulin resistance, and measures of SDB in children.
Prospective study.
Polysomnographic evaluation and assessment of plasma levels of leptin, adiponectin, resistin, glucose, insulin, and CRP.
130 children (mean age 8.2 +/- 2.8 years; 39% obese) were studied.
Log adiponectin levels were lower in obese than nonobese children (3.8 +/- 0.31 vs 4.0 +/- 0.30 corresponding to 8,381.4 +/- 5,841.0 vs 12,853.2 +/- 7,780.2 ng/ml, P < 0.0001) and were inversely correlated with BMI Z scores (r = -0.47, P < 0.0001) but not with log AHI. Log leptin concentrations were higher in the obese group than the nonobese group (4.2 +/- 0.32 vs 3.4 +/- 0.57 corresponding to 19,542.6 +/- 13,643.6 vs 5,875.5 +/- 8,425.7 pg/ml, P < 0.0001), correlated with BMI Z scores (r = 0.64, P < 0.0001), and were significantly lower in children with AHI < or = 1/hr than children with AHI > 1/hr (P = 0.006) and in children with SpO2 nadir > or = 90% than children with SpO2 nadir < 90%, even after controlling for BMI Z score (P < 0.03). No significant differences were found in log resistin levels as a function of obesity or AHI. Significant correlations between log adiponectin levels and log Insulin/Glucose (I/G) ratios (-0.28, P = 0.006) and between log leptin levels and log I/G ratios (r = 0.66, P < 0.0001) emerged.
In close agreement with the absence of a measurable effect of SDB on insulin resistance in children, circulating adipokines levels are primarily attributable to the ponderal index. However, SDB and associated hypoxemia may contribute to the elevation of leptin levels.
睡眠呼吸障碍（SDB）、代谢综合征与脂肪因子循环水平之间的关联在成年人中已被发现，但在打鼾儿童中尚未进行研究。与成年人不同，打鼾儿童表现出胰岛素抵抗和脂质异常是肥胖的函数，而非SDB的函数。因此，我们旨在研究儿童循环脂肪因子水平、胰岛素抵抗与SDB指标之间的关联。
前瞻性研究。
多导睡眠图评估以及对瘦素、脂联素、抵抗素、葡萄糖、胰岛素和CRP的血浆水平进行评估。
研究了130名儿童（平均年龄8.2±2.8岁；39%为肥胖儿童）。
肥胖儿童的脂联素对数水平低于非肥胖儿童（分别为3.8±0.31与4.0±0.30，对应8381.4±5841.0与12853.2±7780.2 ng/ml，P<0.0001），且与BMI Z评分呈负相关（r=-0.47，P<0.0001），但与AHI对数无关。肥胖组的瘦素对数浓度高于非肥胖组（分别为4.2±0.32与3.4±0.57，对应19542.6±13643.6与5875.5±8425.7 pg/ml，P<0.0001），与BMI Z评分相关（r=0.64，P<0.0001），并且AHI≤1次/小时的儿童的瘦素对数浓度显著低于AHI>1次/小时的儿童（P=0.006），即使在控制BMI Z评分后，SpO2最低点≥90%的儿童的瘦素对数浓度也低于SpO2最低点<90%的儿童（P<0.03）。未发现抵抗素对数水平随肥胖或AHI的变化存在显著差异。脂联素对数水平与胰岛素/葡萄糖（I/G）比值对数之间存在显著相关性（-0.28，P=0.006），瘦素对数水平与I/G比值对数之间也存在显著相关性（r=0.66，P<0.0001）。
与SDB对儿童胰岛素抵抗无显著影响一致，循环脂肪因子水平主要归因于体重指数。然而，SDB及相关低氧血症可能导致瘦素水平升高。
