title: Arterial alterations in severely obese children with obstructive sleep apnoea.
abstract: BACKGROUND
  Obstructive sleep apnoea (OSA) in obese adults is associated with cardiovascular disease independently of obesity. Vascular alterations exist in children with obesity and may constitute the first stage in the development of adulthood cardiovascular disease.
  
  
  OBJECTIVE
  To investigate the relationship between OSA and early arterial alterations in obese children.
  
  
  METHODS
  Cross-sectional study of a prospective cohort.
  
  
  METHODS
  A total of 51 children with severe obesity managed at a teaching hospital outpatient clinic.
  
  
  METHODS
  Polysomnography was performed. We measured the intima-media thickness and incremental elastic modulus (Einc) to assess the mechanical characteristics of the common carotid artery. Arterial endothelial function was evaluated by measuring flow-mediated dilation and glyceryl trinitrate-mediated dilation (GTNMD) of the brachial artery.
  
  
  RESULTS
  A total of 24 (47%) children had a desaturation index (DI) >10/h and 7 (14%) had a respiratory event index >10/h. DI >10/h was associated with significantly higher values of Einc (4.0 + or - 0.5 vs. 2.4 + or - 0.4 mm Hg(-1) x 10(3), p=0.003) and GTNMD (18.0 + or - 1.1 vs. 14.1 + or - 1.0 %, p=0.02) after adjustment for age, sex, body mass index, fasting insulin, and leptin. In the univariate analysis, GTNMD correlated positively with DI (r=0.14, p=0.02) after adjustment for age, sex, fasting insulin and leptin. By multivariate analysis with BMI as an additional independent variable, both GTNMD and Einc correlated significantly with DI (beta=0.4, p=0.02 and beta=0.27, p=0.04, respectively).
  
  
  CONCLUSIONS
  OSA in children is associated with arterial alterations independently from obesity. The increased vasodilation in response to glyceryl trinitrate reflects pre-existing vasoconstriction probably induced by intermittent hypoxia. OSA should be detected early in children with severe obesity.
authors.affiliation: Pediatric Gastroenterology and Nutrition Department, Armand-Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Dubern
authors.forename: Yacine
authors.initials: Y
authors.lastname: Aggoun
authors.forename: Michèle
authors.initials: M
authors.lastname: Boulé
authors.forename: Brigitte
authors.initials: B
authors.lastname: Fauroux
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.forename: Patrick
authors.initials: P
authors.lastname: Tounian
mesh_terms: D001696:Biomechanical Phenomena; D001916:Brachial Artery / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology*; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D014661:Vasoconstriction