Farr Olivia M, Rifas-Shiman Sheryl L, Oken Emily, Taveras Elsie M, Mantzoros Christos S
Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, United States.
Metabolism. 2017 Nov;76:70-80. doi: 10.1016/j.metabol.2017.06.008. Epub 2017 Jun 29.
Obstructive sleep apnea (OSA), typically manifested as snoring, is closely associated with obesity. However, the directionality of associations of OSA with cardiometabolic risk markers is unclear, as obesity increases risk for OSA, and OSA results in excess weight gain and its metabolic consequences. Less is known about how obesity and OSA may relate in children and adolescents and whether maternal OSA may influence the development of obesity and cardiometabolic dysfunction in offspring.
Among 1078 children from the Project Viva cohort, we examined cross-sectionally and prospectively associations of parent-reported child or maternal snoring with cardiometabolic outcomes, including adiposity, adipokines, and insulin resistance.
Cross-sectionally, child snoring was related to adiposity and metabolic risk, particularly body mass index (BMI; β 0.61kg/m, 95% CI 0.33, 0.89; p<0.001), trunk fat mass index (β 0.23kg/m, CI 0.12, 0.34; p<0.001), high-density lipoprotein cholesterol (β -1.47mg/dL, CI -2.69, -0.25; p=0.02), and metabolic risk z-score (β 0.08, CI 0.02, 0.14; p=0.01) after correction for covariates. Prospectively, adiposity (BMI, trunk fat, fat mass, and waist circumference) and cardiometabolic (leptin, HOMA-IR, CRP, and global metabolic risk) measures at mid-childhood (7y) were associated with child snoring at the early teen visit (12y) after correction for covariates. Child snoring at ~9y was related to changes in adiposity between mid-childhood and early teen visits.
Child but not maternal snoring, was related to child adiposity and cardiometabolic outcomes. Adiposity and child snoring are associated with each other cross-sectionally and are each predictive of the other among children/adolescents prospectively. These results suggest similar mechanisms in pediatric/adolescent populations as in adults for the development of sleep-disordered breathing and sleep apnea that will need to be confirmed in randomized clinical trials. Importantly, this research points to the need to target both sleep and obesity in order to break this vicious cycle.
阻塞性睡眠呼吸暂停（OSA）通常表现为打鼾，与肥胖密切相关。然而，OSA与心脏代谢风险标志物之间关联的方向性尚不清楚，因为肥胖会增加患OSA的风险，而OSA会导致体重过度增加及其代谢后果。关于肥胖和OSA在儿童和青少年中可能如何关联，以及母亲的OSA是否可能影响后代肥胖和心脏代谢功能障碍的发展，我们所知甚少。
在“活力计划”队列中的1078名儿童中，我们对父母报告的儿童或母亲打鼾情况与心脏代谢结局（包括肥胖、脂肪因子和胰岛素抵抗）进行了横断面和前瞻性关联研究。
横断面研究中，校正协变量后，儿童打鼾与肥胖和代谢风险相关，尤其是体重指数（BMI；β=0.61kg/m²，95%可信区间[CI]为0.33，0.89；p<0.001）、躯干脂肪量指数（β=0.23kg/m²，CI为0.12，0.34；p<0.001）、高密度脂蛋白胆固醇（β=-1.47mg/dL，CI为-2.69，-0.25；p=0.02）和代谢风险z评分（β=0.08，CI为0.02，0.14；p=0.01）。前瞻性研究中，校正协变量后，儿童期中期（约7岁）的肥胖指标（BMI、躯干脂肪、脂肪量和腰围）和心脏代谢指标（瘦素、稳态模型评估胰岛素抵抗[HOMA-IR]、C反应蛋白[CRP]和总体代谢风险）与青少年早期（约12岁）的儿童打鼾相关。9岁左右的儿童打鼾与儿童期中期至青少年早期肥胖指标的变化有关。
儿童打鼾而非母亲打鼾与儿童肥胖和心脏代谢结局相关。肥胖和儿童打鼾在横断面研究中相互关联，并且在儿童/青少年中前瞻性地相互预测。这些结果表明，在儿童/青少年人群中，睡眠呼吸障碍和睡眠呼吸暂停的发生机制与成人相似，这需要在随机临床试验中得到证实。重要的是，这项研究指出需要同时针对睡眠和肥胖问题，以打破这个恶性循环。
