Koren D, Chirinos J A, Katz L E L, Mohler E R, Gallagher P R, Mitchell G F, Marcus C L
Pediatrics-Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA.
Perelman School of Medicine and Philadelphia VA Medical Center, University of Pennsylvania, Philadelphia, PA, USA.
Int J Obes (Lond). 2015 Jul;39(7):1086-93. doi: 10.1038/ijo.2015.67. Epub 2015 May 18.
BACKGROUND/OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) may be a cardiovascular disease (CVD) risk factor independently of obesity in adults. Pediatric studies have associated OSAS with endothelial dysfunction, but few studies have examined relationships between OSAS and macrovascular sequelae. Our objective was to examine OSAS's independent contribution to macrovascular CVD risk measures in obese adolescents.
SUBJECTS/METHODS: This cross-sectional observational study was conducted at Children's Hospital of Philadelphia Clinical Research and Academic Sleep Centers, and University of Pennsylvania Vascular Research Unit. Thirty-one obese non-diabetic adolescents underwent anthropometric measurements, overnight polysomnography, fasting laboratory draw and cardiovascular imaging. Cardiovascular outcome measures included maximal carotid intima-media thickness (cIMTmax), a measure of carotid structural changes, and carotid-femoral pulse wave velocity (CFPWV), an aortic stiffness measure whose relationship vis-à-vis OSAS in children has not been previously examined. Carotid diameter and augmentation index (AIx, measuring central pressure augmentation from wave reflections) were assessed. Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose.
The apnea hypopnea index, a primary OSAS measure, was not associated with cIMTmax, carotid diameter, CFPWV or AIx. body mass index (BMI) associated positively with cIMTmax (r=0.52, P=0.006) and CFPWV (r=0.45, P=0.01). Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=-0.63, P<0.0005). Insulin levels were negatively associated with AIx (r=-0.53, P=0.02).
OSAS did not predict carotid structural changes or arterial stiffness independently of BMI in obese adolescents. Higher insulin levels associated with lower central pressure wave augmentation. Finally, long-term hypercapnia may predispose to carotid narrowing.
背景/目的：阻塞性睡眠呼吸暂停综合征（OSAS）可能是成年人中独立于肥胖的心血管疾病（CVD）危险因素。儿科研究已将OSAS与内皮功能障碍相关联，但很少有研究探讨OSAS与大血管后遗症之间的关系。我们的目的是研究OSAS对肥胖青少年大血管CVD风险指标的独立影响。
受试者/方法：这项横断面观察性研究在费城儿童医院临床研究与学术睡眠中心以及宾夕法尼亚大学血管研究室进行。31名肥胖非糖尿病青少年接受了人体测量、夜间多导睡眠图检查、空腹实验室检查和心血管成像。心血管结局指标包括最大颈动脉内膜中层厚度（cIMTmax），这是一种颈动脉结构变化的指标，以及颈股脉搏波速度（CFPWV），这是一种主动脉僵硬度指标，其与儿童OSAS的关系此前尚未得到研究。评估了颈动脉直径和增强指数（AIx，测量来自波反射的中心压力增强）。所检查的潜在混杂变量包括血压、脂蛋白、高敏C反应蛋白、胰岛素和葡萄糖。
作为OSAS主要指标的呼吸暂停低通气指数与cIMTmax、颈动脉直径、CFPWV或AIx均无关联。体重指数（BMI）与cIMTmax呈正相关（r = 0.52，P = 0.006），与CFPWV呈正相关（r = 0.45，P = 0.01）。平均睡眠末潮气二氧化碳与颈动脉直径呈负相关（r = -0.63，P < 0.0005）。胰岛素水平与AIx呈负相关（r = -0.53，P = 0.02）。
在肥胖青少年中，OSAS不能独立于BMI预测颈动脉结构变化或动脉僵硬度。较高的胰岛素水平与较低的中心压力波增强相关。最后，长期高碳酸血症可能易导致颈动脉狭窄。
