Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada.
Stollery Children's Hospital/University of Alberta, Edmonton, Alberta, Canada.
J Clin Sleep Med. 2017 Sep 15;13(9):1039-1047. doi: 10.5664/jcsm.6718.
There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB.
A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP).
Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups.
In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth.
A commentary on this article appears in this issue on page 1025.
有证据表明，与肥胖和睡眠呼吸障碍（SDB）相关的心脏代谢疾病在年轻人中存在。肥胖的年轻人中 SDB 常采用气道正压通气（PAP）治疗。我们的目的是确定：（1）心脏代谢疾病的患病率，以及（2）PAP 是否改善肥胖青少年新诊断的中重度 SDB 的心脏代谢疾病标志物。
一项前瞻性多中心队列研究在肥胖、新诊断为中重度 SDB 的青少年中进行，为其开具 PAP 治疗处方。评估在基线和 6 个月及 12 个月时进行。结局指标包括胰岛素抵抗标志物（6 个月时稳态模型评估的胰岛素抵抗（HOMA-IR）变化=主要结局）、高血压（24 小时动态/血压）和炎症（高敏 C 反应蛋白：hs-CRP）。
共纳入 27 名参与者。在可进行基线检测的患者中，10/25（40%）HOMA-IR 高于第 97 百分位数，10/23（44%）高血压，16/23（70%）夜间血压下降丧失，hs-CRP 升高 16/27（64%）。代谢功能障碍或血压的标志物在随访期间没有显著变化，也没有在 PAP 依从性和不依从性亚组之间发生变化。
肥胖合并 SDB 的青少年代谢功能障碍和高血压患病率较高。PAP 治疗处方 1 年后，心脏代谢标志物无统计学意义的改善，但胰岛素抵抗和收缩压负荷有临床相关改善，这是心血管疾病未来风险的重要预测因素。需要更大、更长期的研究来确定 PAP 是否能改善肥胖青少年的心脏代谢结局。
本文的一篇评论文章刊登在本期第 1025 页。
