title: Metabolic alterations in children with obstructive sleep apnea.
abstract: OBJECTIVE
  The incidence of obesity is rising in the United States and has been linked to Obstructive Sleep Apnea (OSA) even in young children. Understanding the role that obesity and OSA play in alterations in metabolic variables that can lead to serious health issues is essential to the care and counseling of affected children.
  
  
  OBJECTIVE
  To evaluate the association of alterations in metabolic variables, including insulin resistance, to OSA in young, obese children.
  
  
  METHODS
  Retrospective, case-control series.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Obese children aged 2-12 years who had undergone overnight polysomography and routine laboratory testing for lipid levels, fasting glucose, and insulin from January 1, 2006 to December 31, 2012 were identified from a TransMed Bio-Integration Suite and Epic's clarity database search.
  
  
  RESULTS
  A total of 76 patients were included for analysis. Forty-three (56.6%) were male, and the mean age was 8.3±2.5 years (range, 2.4-11.9 years). The mean body mass index (BMI) z score was 2.8±0.75 (range, 1.7-6.3), and all patients were obese (BMI z score>95th percentile). Twenty two patients (28.9%) had an apnea-hypopnea index (AHI) <1/h (no OSA), 27 (35.5%) an AHI≥1<5/h, 12 (15.8%) had an AHI ≥5<9.99/h, and 15 (19.7%) had an AHI≥10/h. There was no significant difference in total cholesterol, triglycerides, high and low density lipoprotein levels, systolic and diastolic blood pressure in those patients with or without OSA. Fasting insulin, blood glucose, and homeostasis model assessment (HOMA) were significantly higher in patients with OSA compared to those with no OSA (p<0.01). AHI correlated to alterations in insulin as well as glucose homeostasis on multivariate analysis. Results from logistic regression analysis showed that fasting insulin (p<0.01), and HOMA (p<0.01) predicted severe OSA independent of age, gender, and BMI z score in these patients.
  
  
  CONCLUSIONS
  Metabolic alterations in glucose and insulin levels, known to be associated with obesity and increased risk for cardiovascular disease, appear to relate to the severity of OSA in young children.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern University Feinberg, School of Medicine, Chicago, IL, United States. Electronic address: bbhushan@luriechildrens.org.
authors.forename: Bharat
authors.initials: B
authors.lastname: Bhushan
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern University Feinberg, School of Medicine, Chicago, IL, United States.
authors.forename: John
authors.initials: J
authors.lastname: Maddalozzo
authors.affiliation: Division of Pulmonology, Ann and Robert H. Lurie Children's Hospital of Chicago Sleep Medicine Center, Chicago, IL, United States; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Sheldon
authors.affiliation: Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
authors.forename: Shannon
authors.initials: S
authors.lastname: Haymond
authors.affiliation: Biostatistics Research Core, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Chicago, IL, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Rychlik
authors.affiliation: Clinical and Translational Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Chicago, IL, United States.
authors.forename: George C
authors.initials: GC
authors.lastname: Lales
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Northwestern University Feinberg, School of Medicine, Chicago, IL, United States.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Billings
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D015999:Multivariate Analysis; D063766:Pediatric Obesity / Q000175:diagnosis / Q000453:epidemiology*; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose
keywords: Childhood obesity; Insulin resistance; Metabolic syndrome; Obstructive sleep apnea