Roche Johanna, Corgosinho Flavia C, Dâmaso Ana R, Isacco Laurie, Miguet Maud, Fillon Alicia, Guyon Aurore, Moreira Gustavo A, Pradella-Hallinan Marcia, Tufik Sergio, Túlio de Mello Marco, Gillet Valérie, Pereira Bruno, Duclos Martine, Boirie Yves, Masurier Julie, Franco Patricia, Thivel David, Mougin Fabienne
EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France; Sleep and Health Medicine Center Ellipse, Franois, France; Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Universidade Federal de Goiás - Faculdade de Nutrição - Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil.
Nutr Metab Cardiovasc Dis. 2020 Apr 12;30(4):683-693. doi: 10.1016/j.numecd.2019.12.003. Epub 2019 Dec 16.
Pediatric obesity and sleep-disordered breathing (SDB) are associated with cardiometabolic risk (CMR), but the degree of severity at which SDB affects cardiometabolic health is unknown. We assessed the relationship between the CMR and the apnea-hypopnea index (AHI), to identify a threshold of AHI from which an increase in the CMR is observed, in adolescents with obesity. We also compared the clinical, cardiometabolic and sleep characteristics between adolescents presenting a high (CMR+) and low CMR (CMR-), according to the threshold of AHI.
114 adolescents with obesity were recruited from three institutions specialized in obesity management. Sleep and SDB as assessed by polysomnography, anthropometric parameters, fat mass (FM), glucose and lipid profiles, and blood pressure (BP) were measured at admission. Continuous (MetScore) and dichotomous (metabolic syndrome, MetS) CMR were determined. Associations between MetScore and AHI adjusted for BMI, sex and age were assessed by multivariable analyses. Data of 82 adolescents were analyzed. Multivariable analyses enabled us to identify a threshold of AHI = 2 above which we observed a strong and significant association between CMR and AHI (Cohen's d effect-size = 0.57 [0.11; 1.02] p = 0.02). Adolescents with CMR+ exhibited higher MetScore (p < 0.05), insulin resistance (p < 0.05), systolic BP (p < 0.001), sleep fragmentation (p < 0.01) and intermittent hypoxia than CMR- group (p < 0.0001). MetS was found in 90.9% of adolescents with CMR+, versus 69.4% in the CMR- group (p < 0.05).
The identification of a threshold of AHI ≥ 2 corresponding to the cardiometabolic alterations highlights the need for the early management of SDB and obesity in adolescents, to prevent cardiometabolic diseases.
NCT03466359, NCT02588469 and NCT01358773.
儿童肥胖与睡眠呼吸障碍（SDB）均与心脏代谢风险（CMR）相关，但SDB影响心脏代谢健康的严重程度尚不清楚。我们评估了CMR与呼吸暂停低通气指数（AHI）之间的关系，以确定在肥胖青少年中观察到CMR升高的AHI阈值。我们还根据AHI阈值比较了高CMR（CMR+）和低CMR（CMR-）青少年的临床、心脏代谢和睡眠特征。
从三家专门治疗肥胖症的机构招募了114名肥胖青少年。入院时测量通过多导睡眠图评估的睡眠和SDB、人体测量参数、脂肪量（FM）、血糖和血脂谱以及血压（BP）。确定连续（MetScore）和二分法（代谢综合征，MetS）CMR。通过多变量分析评估调整了BMI、性别和年龄后的MetScore与AHI之间的关联。分析了82名青少年的数据。多变量分析使我们能够确定AHI = 2的阈值，高于该阈值，我们观察到CMR与AHI之间存在强烈且显著的关联（Cohen's d效应量 = 0.57 [0.11; 1.02]，p = 0.02）。与CMR-组相比，CMR+青少年表现出更高的MetScore（p < 0.05）、胰岛素抵抗（p < 0.05）、收缩压（p < 0.001）、睡眠碎片化（p < 0.01）和间歇性缺氧（p < 0.0001）。在CMR+青少年中，90.9%发现患有MetS，而CMR-组为69.4%（p < 0.05）。
确定与心脏代谢改变相对应的AHI≥2阈值，凸显了对青少年SDB和肥胖症进行早期管理以预防心脏代谢疾病的必要性。
NCT03466359、NCT02588469和NCT01358773。
