Arterial alterations in severely obese children with obstructive sleep apnoea.
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.
Dubern
Beatrice
B
Pediatric Gastroenterology and Nutrition Department, Armand-Trousseau Hospital, AP-HP, Paris, France.
Aggoun
Yacine
Y
Boulé
Michèle
M
Fauroux
Brigitte
B
Bonnet
Damien
D
Tounian
Patrick
P
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