Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Am J Cardiol. 2019 Jan 15;123(2):341-347. doi: 10.1016/j.amjcard.2018.09.038. Epub 2018 Oct 18.
The increasing prevalence of overweight or obese children and adolescents is a significant global health concern. Although the effect of obesity on cardiovascular function has been investigated, little is known on the impact of associated obstructive sleep apnea (OSA) in obese youth. The aim of the present study was to investigate the influence of OSA on cardiovascular functional parameters in obese youth. This is a prospective single-center observational cross-sectional study. Forty-four obese patients and 44 age- and gender-matched control subjects were included. All patients underwent polysomnography and cardiovascular assessment including functional echocardiography and carotid-femoral pulse wave velocity (PWV). Obese patients had higher left ventricular (LV) mass/height, preserved LV systolic parameters, differences in LV diastolic parameters, and increased PWV and systolic blood pressure at rest compared with control group. In obese youth, 14 of 44 (32%) had OSA. There was no correlation between obesity and the apnea-hypopnea index (AHI). LV mass/height significantly correlated with body mass index z-score (r = 0.648, p <0.001) whereas PWV correlated with AHI (r = 0.352, p = 0.038). In obese patients, body mass index z-score was an independent predictor for LV mass/height (r = 0.61, p <0.001) and AHI was an independent predictor for higher PWV (r = 0.352, p = 0.038). In conclusion, both obesity and OSA influence cardiovascular performance in obese youth. Although obesity is associated with increased LV mass and reduced LV diastolic function, OSA is associated with changes in arterial stiffness.
超重或肥胖儿童和青少年的发病率不断上升,是一个重大的全球健康问题。尽管肥胖对心血管功能的影响已得到研究,但肥胖青少年相关阻塞性睡眠呼吸暂停(OSA)的影响知之甚少。本研究旨在探讨 OSA 对肥胖青少年心血管功能参数的影响。这是一项前瞻性单中心观察性横断面研究。纳入 44 名肥胖患者和 44 名年龄和性别匹配的对照组。所有患者均接受多导睡眠图和心血管评估,包括功能超声心动图和颈股脉搏波速度(PWV)。与对照组相比,肥胖患者的左心室(LV)质量/身高更高,LV 收缩期参数正常,LV 舒张期参数存在差异,静息时 PWV 和收缩压增加。在肥胖青少年中,44 名中有 14 名(32%)患有 OSA。肥胖与呼吸暂停低通气指数(AHI)之间无相关性。LV 质量/身高与体重指数 z 评分显著相关(r=0.648,p<0.001),而 PWV 与 AHI 相关(r=0.352,p=0.038)。在肥胖患者中,体重指数 z 评分是 LV 质量/身高的独立预测因子(r=0.61,p<0.001),AHI 是 PWV 升高的独立预测因子(r=0.352,p=0.038)。总之,肥胖和 OSA 都会影响肥胖青少年的心血管功能。虽然肥胖与 LV 质量增加和 LV 舒张功能降低有关,但 OSA 与动脉僵硬度变化有关。