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  • Pediatric Original Article
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Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents

International Journal of Obesity volume 39, pages 1086–1093 (2015)Cite this article

Subjects

Abstract

Background/Objectives:

Obstructive sleep apnea syndrome (OSAS) may be a cardiovascular disease (CVD) risk factor independently of obesity in adults. Pediatric studies have associated OSAS with endothelial dysfunction, but few studies have examined relationships between OSAS and macrovascular sequelae. Our objective was to examine OSAS’s independent contribution to macrovascular CVD risk measures in obese adolescents.

Subjects/Methods:

This cross-sectional observational study was conducted at Children’s Hospital of Philadelphia Clinical Research and Academic Sleep Centers, and University of Pennsylvania Vascular Research Unit. Thirty-one obese non-diabetic adolescents underwent anthropometric measurements, overnight polysomnography, fasting laboratory draw and cardiovascular imaging. Cardiovascular outcome measures included maximal carotid intima–media thickness (cIMTmax), a measure of carotid structural changes, and carotid-femoral pulse wave velocity (CFPWV), an aortic stiffness measure whose relationship vis-à-vis OSAS in children has not been previously examined. Carotid diameter and augmentation index (AIx, measuring central pressure augmentation from wave reflections) were assessed. Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose.

Results:

The apnea hypopnea index, a primary OSAS measure, was not associated with cIMTmax, carotid diameter, CFPWV or AIx. body mass index (BMI) associated positively with cIMTmax (r=0.52, P=0.006) and CFPWV (r=0.45, P=0.01). Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=−0.63, P<0.0005). Insulin levels were negatively associated with AIx (r=−0.53, P=0.02).

Conclusions:

OSAS did not predict carotid structural changes or arterial stiffness independently of BMI in obese adolescents. Higher insulin levels associated with lower central pressure wave augmentation. Finally, long-term hypercapnia may predispose to carotid narrowing.

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Acknowledgements

We would like to thank our research participants and their families for their time and efforts in participating in our study, the sleep technicians who oversaw and scored the polysomnography studies, and the research coordinators who helped with study recruitment. The study was supported by NIH KL2 RR024132 and NIH RO1 HL58585.

Author information

Authors and Affiliations

  1. Pediatrics—Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA

    D Koren

  2. Perelman School of Medicine and Philadelphia VA Medical Center,

    J A Chirinos

  3. , University of Pennsylvania, Philadelphia, PA, USA

    J A Chirinos

  4. Pediatrics—Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA

    L E L Katz

  5. Department of Medicine, Cardiovascular Division, Vascular Medicine Section,

    E R Mohler

  6. , Perelman School of Medicine at the University of Pennsylvania,, Philadelphia, PA, USA

    E R Mohler

  7. Biostatistics Core, Clinical and Translational Research Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    P R Gallagher

  8. Cardiovascular Engineering Inc, Norwood, MA, USA

    G F Mitchell

  9. Pediatrics—Sleep Center, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA

    C L Marcus

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Correspondence to D Koren.

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Competing interests

LE Levitt Katz provides consultation services to Janssen pharmaceuticals and to Takeda Pharmaceuticals. CL Marcus has research support from Ventus and Philips Respironics in the form of loaned equipment only for investigator-initiated studies, not relevant to the current manuscript. Dr Mitchell is the owner of Cardiovascular Engineering, Inc., a company that develops and manufactures devices to measure vascular stiffness, serves as a consultant to and receives honoraria from Novartis, Merck and Enopace, and is funded by research grants HL094898, DK082447, HL107385 and HL104184 from the National Institutes of Health. The remaining authors declare no conflict of interest.

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Koren, D., Chirinos, J., Katz, L. et al. Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents. Int J Obes 39, 1086–1093 (2015). https://doi.org/10.1038/ijo.2015.67

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  • DOI: https://doi.org/10.1038/ijo.2015.67

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