肥胖儿童人群减肥过程中阻塞性睡眠呼吸暂停对血管内皮功能的影响。
The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population.
机构信息
Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
出版信息
Sleep Med. 2021 Oct;86:48-55. doi: 10.1016/j.sleep.2021.08.002. Epub 2021 Aug 12.
BACKGROUND
Childhood obesity is an increasing problem with substantial comorbidities such as obstructive sleep apnea (OSA) and increased cardiovascular morbidity. Endothelial dysfunction is an underlying mechanism related to both obesity and OSA.
RESEARCH QUESTION
To investigate the effect of weight loss on endothelial function and OSA in obese children and to determine whether a change in endothelial function can be linked to an improvement in OSA.
METHODS
Obese children between 8 and 18 years of age were recruited while entering a 12-month inpatient weight loss program. Patients were followed at 3 study visits: baseline, after 10 months of weight loss, and 6 months after ending the program (18 months). Anthropometry and endothelial function (EndoPAT) were determined at all study visits. At baseline, sleep screening with a portable device (ApneaLink) was performed. This was repeated after 10 months if OSA was diagnosed at baseline.
RESULTS
At baseline, 130 children were included, of which 87 had OSA (67%). Seventy-two patients attended the follow-up visit at 10 months, and 28 patients attended the follow-up visit at 18 months. The BMI z-score decreased after 10 months (from 2.7 (1.4-3.4) to 1.7 (0.5-2.7); p < 0.001) and remained stable at 18 months. Endothelial function improved significantly after weight loss, evidenced by a shorter time to peak response (TPR) and higher reactive hyperemia index (p = 0.02 and p < 0.001), and remained improved after 18 months (p < 0.001 and p = 0.007). After 10 months of weight loss, 10 patients had residual OSA. These patients had a higher TPR at 10 months (225 (75-285)s) than those without OSA (135 (45-225)s) and patients with a normalized sleep study (105 (45-285)s; p = 0.02). Linear mixed models showed that more severe OSA was associated with a worse TPR at baseline and less improvement after weight loss.
CONCLUSION
Weight loss improves endothelial function in an obese pediatric population. However, even after weight loss, endothelial function improved less in the presence of OSA.
背景
儿童肥胖是一个日益严重的问题，与阻塞性睡眠呼吸暂停（OSA）和心血管发病率增加等多种合并症有关。内皮功能障碍是肥胖和 OSA 相关的潜在机制。
研究问题
研究减肥对肥胖儿童内皮功能和 OSA 的影响，并确定内皮功能的变化是否与 OSA 的改善相关。
方法
招募年龄在 8 至 18 岁之间的肥胖儿童，进入为期 12 个月的住院减肥计划。患者在 3 次研究访视时进行随访：基线时、减肥 10 个月后和结束计划后 6 个月（18 个月）。所有研究访视时均进行人体测量学和内皮功能（EndoPAT）检测。基线时，使用便携式设备（ApneaLink）进行睡眠筛查。如果基线时诊断为 OSA，则在 10 个月后重复进行。
结果
基线时有 130 名儿童入组，其中 87 名患有 OSA（67%）。72 名患者在 10 个月时进行了随访，28 名患者在 18 个月时进行了随访。10 个月后 BMI z 评分下降（从 2.7（1.4-3.4）降至 1.7（0.5-2.7）；p<0.001），18 个月时保持稳定。减肥后内皮功能显著改善，表现为到达峰值反应（TPR）的时间缩短和反应性充血指数升高（p=0.02 和 p<0.001），18 个月后仍保持改善（p<0.001 和 p=0.007）。减肥 10 个月后，有 10 名患者仍存在 OSA。这些患者的 TPR 更高（225（75-285）s），高于无 OSA 患者（135（45-225）s）和睡眠研究正常患者（105（45-285）s；p=0.02）。线性混合模型显示，更严重的 OSA 与基线时 TPR 较差和减肥后改善较少相关。
结论
减肥可改善肥胖儿童的内皮功能。然而，即使减肥后，存在 OSA 时内皮功能的改善也较小。
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