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Vitamin D as a biomarker of health in snoring children: a familial aggregation study



Hypovitaminosis D is a common health problem. The purpose of this study was to investigate the inter-relationship between serum 25(OH)D levels and paternal and maternal vitamin D status in a sample of snoring children.


We selected 137 participants for whom serum 25(OH)D had been measured and underwent overnight polysomnography evaluation. Serum glucose, lipids, liver enzymes, parathyroid hormone, insulin, and glycated hemoglobin were also measured. Glucose and insulin levels were used to estimate insulin resistance with the homeostasis model assessment (HOMA-IR).


Vitamin D insufficiency (<30 ng/mL) and deficiency (<20 ng/mL) were found in 40.9 and 17.5% of children, respectively. After adjustments for age, BMI z-score and seasonality, the odds ratio for risk of vitamin D insufficiency according to the vitamin D status of parents were: OR (95% CI): paternal insufficiency 15.1 (2.7–35.7), p = 0.002; maternal insufficiency 7.2 (2.4–22), p = 0.001. When children with vitamin D deficiency were analyzed separately, serum 25(OH)D concentration was found to be associated with the apnea–hypopnea index (r = −0.647, p = 0.009) and respiratory arousal index (r = −0.669, p = 0.034).


Family patterns of vitamin D could be helpful for the early identification of children at risk of metabolic and/or sleep disturbances and when considering strategies to improve vitamin D status.


  • Family patterns of vitamin D could be helpful for the early identification of snoring children at risk of metabolic and/or sleep disturbances.

  • Significant associations were found between serum 25-hydroxyvitamin D (25(OH)D) concentrations in children and their parents.

  • An inverse association between 25(OH)D levels and OSA severity was detected in deficient vitamin D children.

  • Children with insufficient and deficient vitamin D status tended to have a worse metabolic profile, so strategies are needed to improve vitamin D status.

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Fig. 1: Serum 25(OH)D levels in parents and in their children.


  1. 1.

    Bouillon, R. et al. Skeletal and extraskeletal actions of vitamin D: current evidence and outstanding questions. Endocr. Rev. (2019).

  2. 2.

    Saponaro, F., Marcocci, C. & Zucchi, R. Vitamin D status and cardiovascular outcome. J. Endocrinol. Invest. (2019).

  3. 3.

    McCarty, D. E., Chesson, A. L., Jain, S. K. & Marino, A. A. The link between vitamin D metabolism and sleep medicine. Sleep Med. Rev. (2014).

  4. 4.

    Antonucci, R., Locci, C., Clemente, M. G., Chicconi, E. & Antonucci, L. Vitamin D deficiency in childhood: old lessons and current challenges. J. Pediatr. Endocrinol. Metab. (2018).

  5. 5.

    Chang, S. W. & Lee, H. C. Vitamin D and health - the missing vitamin in humans. Pediatr. Neonatol. (2019).

  6. 6.

    Moschonis, G. et al. Vitamin D insufficiency is associated with insulin resistance independently of obesity in primary schoolchildren. The healthy growth study. Pediatr. Diabetes (2018).

  7. 7.

    Kheirandish-Gozal, L., Peris, E. & Gozal, D. Vitamin D levels and obstructive sleep apnoea in children. Sleep Med. (2014).

  8. 8.

    Clemente, M. G. et al. Family-related factors may affect serum vitamin D levels. Acta Paediatr. (2019).

  9. 9.

    Madsen, K. H. et al. Vitamin D status and its determinants in children and adults among families in late summer in Denmark. Br. J. Nutr. (2014).

  10. 10.

    Must, A. & Anderson, S. E. Body mass index in children and adolescents: considerations for population-based applications. Int. J. Obes. (2006).

  11. 11.

    Montgomery-Downs, H. E., O’Brien, L. M., Gulliver, T. E. & Gozal, D. Polysomnographic characteristics in normal preschool and early school-aged children. Pediatrics (2006).

  12. 12.

    Iber, C., Ancoli-Israel, S., Chesson, A. & Quan, S. F. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specification (AASM, 2007).

  13. 13.

    Matthews, D. R. et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia (1985).

  14. 14.

    Holick, M. F. et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. (2011).

  15. 15.

    Holick, M. F. The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev. Endocr. Metab. Disord. (2017).

  16. 16.

    Carpenter, T. O. et al. Rickets. Nat. Rev. Dis. Prim. (2017).

  17. 17.

    Cediel, G., Corvalan, C., Lopez Romaña, D., Mericq, V. & Uauy, R. Prepubertal adiposity, Vitamin D status, and insulin resistance. Pediatrics (2016).

  18. 18.

    Denova-Gutiérrez, E. et al. Low serum vitamin D concentrations are associated with insulin resistance in Mexican children and adolescents. Nutrients (2019).

  19. 19.

    Wang, M. et al. Association between vitamin D status and asthma control: a meta-analysis of randomized trials. Respir Med. (2019).

  20. 20.

    Livshits, G., Karasik, D. & Seibel, M. J. Statistical genetic analysis of plasma levels of vitamin D: familial study. Ann. Hum. Genet. (1999).

  21. 21.

    Hong, N., Lee, Y. K. & Rhee, Y. Familial clustering of vitamin D deficiency via shared environment: The Korean National Health and Nutrition Examination Survey 2008–2012. Eur. J. Clin. Nutr. (2018).

  22. 22.

    Robinson, S. L., Ramirez-Zea, M., Roman, A. V. & Villamor, E. Correlates and family aggregation of Vitamin D concentrations in school-aged children and their parents in nine Mesoamerican countries. Public Health Nutr. (2017).

  23. 23.

    Yao, S. et al. Demographic, lifestyle, and genetic determinants of circulating concentrations of 25-hydroxyvitamin D and Vitamin D-binding protein in African American and European American women. Am. J. Clin. Nutr. (2017).

  24. 24.

    Caristia, S. et al. Vitamin D as a biomarker of ill health among the over-50s: a systematic review of cohort studies. Nutrients (2019).

  25. 25.

    Mayer, O. et al. Serum vitamin D status, vitamin D receptor polymorphism, and glucose homeostasis in healthy subjects. Horm. Metab. Res. (2018).

  26. 26.

    Olson, M. L., Maalouf, N. M., Oden, J. D., White, P. C. & Hutchison, M. R. Vitamin D deficiency in obese children and its relationship to glucose homeostasis. J. Clin. Endocrinol. Metab. (2012).

  27. 27.

    Yaribeygi, H. et al. The molecular mechanisms by which vitamin D improve glucose homeostasis: a mechanistic review. Life Sci. (2020).

  28. 28.

    Asghari, G. et al. The relation between circulating levels of Vitamin D and parathyroid hormone in children and adolescents with overweight or obesity: quest for a threshold. PLoS ONE (2019).

  29. 29.

    Zhang, Z., Thorne, J. L. & Moore, J. B. Vitamin D and nonalcoholic fatty liver disease. Curr. Opin. Clin. Nutr. Metab. Care (2019).

  30. 30.

    Salepçi, B. M. et al. The association between obstructive sleep apnea syndrome and vitamin D deficiency. Eur. Respir. J. (2016).

  31. 31.

    Van Eyck, A., Eelen, Y., Van Hoorenbeeck, K. & Verhulst, S. L. Obstructive sleep apnea syndrome and vitamin D levels in obese children and adolescents. Am. J. Respir. Crit. Care Med. (2015).

  32. 32.

    Fan, Z. et al. Independent association of vitamin D and insulin resistance in obstructive sleep apnea. Ann. Endocrinol. (2019).

  33. 33.

    Al-Shawwa, B., Ehsan, Z. & Ingram, D. G. Vitamin D and sleep in children. Sleep (2020).

  34. 34.

    Dogan-Sander, E. et al. Association of serum 25-hydroxyvitamin D concentrations with sleep phenotypes in a German community sample. PLoS ONE (2019).

  35. 35.

    Wang, D. et al. Distribution of free 25OHD in elderly population based on LC-MS/MS. J. Steroid Biochem. Mol. Biol. (2020).

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This work was supported by Fondo de Investigación Sanitaria [Grant: FIS PI1302120].

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A.B. and J.P. conceived and designed the study. A.B., D.M.-G., J.P., M.d.l.P., A.A.-F., C.R., and J.A.P.-Z. supervised the data collection and managed the data, including quality control. M.d.l.P. and A.B. provided statistical advice on study design and analyzed the data; A.B. and A.A.-F. chaired the data oversight committee. A.B. and D.M.-G. drafted the manuscript, and all authors contributed substantially to its revision. A.B. and J.P. take responsibility for the paper as a whole.

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Correspondence to Daniel Morell-Garcia.

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The authors declare no competing interests.

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Barceló, A., Morell-Garcia, D., Ribot, C. et al. Vitamin D as a biomarker of health in snoring children: a familial aggregation study. Pediatr Res (2021).

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