一项针对有和没有睡眠呼吸紊乱的肥胖青少年的多学科减肥干预措施，无论睡眠呼吸紊乱是否恢复正常，都能改善心脏代谢健康。
A multidisciplinary weight loss intervention in obese adolescents with and without sleep-disordered breathing improves cardiometabolic health, whether SDB was normalized or not.
作者信息
Roche Johanna, Corgosinho Flavia Campos, Isacco Laurie, Scheuermaier Karine, Pereira Bruno, Gillet Valérie, Moreira Gustavo A, Pradella-Hallinan Marcia, Tufik Sergio, de Mello Marco Túlio, Mougin Fabienne, Dâmaso Ana R, Thivel David
机构信息
EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, CHRU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France; Sleep and Health Medicine Center Ellipse, Besançon, France; Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA3533, 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, São Paulo, Brazil.
出版信息
Sleep Med. 2020 Nov;75:225-235. doi: 10.1016/j.sleep.2020.06.030. Epub 2020 Jun 30.
OBJECTIVES
Pediatric obesity and sleep-disordered breathing (SDB) are strongly associated, and both promote metabolic impairments. However, the effects of a lifestyle intervention on the overall metabolic syndrome (MetS) are unknown. The objectives were i) to evaluate the effects of a lifestyle intervention on cardiometabolic risk (CMR), assessed with a dichotomous (MetS) and a continuous (MetScore) instrument, in obese adolescents with and without SDB and ii) to compare the post-intervention cardiometabolic responses between adolescents with persistent (apnea-hypopnea index; AHI≥2) or normalized-SDB (AHI<2).
METHODS
Seventy-six adolescents with obesity recruited from two specialized institutions underwent a 9-12month diet and exercise intervention. Sleep and SDB (AHI≥2) were studied by polysomnography. Anthropometric parameters, fat mass (FM), glucose, insulin, lipid and leptin profiles, blood pressure (BP), MetScore and MetS were assessed pre- and post-intervention. We performed comparisons between Non-SDB and SDB groups and between Normalized-SDB and Persistent-SDB subgroups.
RESULTS
Fifty participants completed the study. Pre-intervention, twenty youth had SDB (40%) with higher insulin concentrations and systolic BP than Non-SDB participants (p < 0.01), for a similar degree of obesity. Post-intervention, MetScore (p < 0.001) and MetS prevalence (p < 0.05) were decreased in both groups. Eleven participants (55%) normalized SDB along with a decrease in insulin concentrations and BP (p < 0.05). Triglycerides, total cholesterol and LDL-cholesterol concentrations (p < 0.01) improved equally in the Normalized and Persistent-SDB subgroups.
CONCLUSION
SDB was associated with lower insulin sensitivity and higher BP but did not affect the lipid profile. A diet and exercise lifestyle intervention is effective in decreasing the CMR whether or not SDB was normalized in obese adolescents.
目的
儿童肥胖与睡眠呼吸障碍（SDB）密切相关，二者均会促进代谢功能受损。然而，生活方式干预对整体代谢综合征（MetS）的影响尚不清楚。本研究的目的是：i）评估生活方式干预对肥胖青少年（无论有无SDB）心脏代谢风险（CMR）的影响，采用二分法（MetS）和连续变量（MetScore）工具进行评估；ii）比较持续性（呼吸暂停低通气指数；AHI≥2）或SDB恢复正常（AHI<2）的青少年干预后的心脏代谢反应。
方法
从两家专业机构招募了76名肥胖青少年，进行为期9至12个月的饮食和运动干预。通过多导睡眠图研究睡眠和SDB（AHI≥2）情况。在干预前后评估人体测量参数、脂肪量（FM）、血糖、胰岛素、血脂和瘦素水平、血压（BP）、MetScore和MetS。我们对无SDB组和SDB组之间以及SDB恢复正常组和持续性SDB亚组之间进行了比较。
结果
50名参与者完成了研究。干预前，20名青少年存在SDB（40%），在肥胖程度相似的情况下，其胰岛素浓度和收缩压高于无SDB的参与者（p<0.01）。干预后，两组的MetScore（p<0.001）和MetS患病率（p<0.05）均降低。11名参与者（55%）的SDB恢复正常，同时胰岛素浓度和血压降低（p<0.05）。SDB恢复正常组和持续性SDB亚组的甘油三酯、总胆固醇和低密度脂蛋白胆固醇浓度（p<0.01）均有同等程度改善。
结论
SDB与较低的胰岛素敏感性和较高的血压相关，但不影响血脂水平。饮食和运动生活方式干预对降低肥胖青少年的CMR有效，无论SDB是否恢复正常。
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