title: Impact of obstructive sleep apnoea on insulin resistance in nonobese and obese children.
abstract: Obstructive sleep apnoea (OSA) has been inconsistently associated with insulin resistance and adverse metabolic states. We aimed to assess independent contributions of OSA to insulin resistance and dyslipidaemia in a large paediatric cohort.Habitually snoring children underwent overnight polysomnography, anthropometric measurements and fasting laboratory evaluations. Primary outcome measures included insulin, glucose, homeostasis model of insulin resistance, lipoproteins and sleep disturbance measures.Among 459 children aged 5-12 years, obesity was the primary driver of most associations between OSA and metabolic measures, but sleep duration was inversely associated with glucose levels, with N3 and rapid eye movement (REM) sleep being negatively associated and sleep fragmentation positively associated with insulin resistance measures. In children with mild OSA, the presence of obesity increased the odds for insulin resistance, while higher apnoea/hypopnoea index values emerged among obese children who were more insulin-resistant.The exclusive presence of interactions between OSA and obesity in the degree of insulin resistance is coupled with synergistic contributions by sleep fragmentation to insulin resistance in the context of obesity. Insufficient N3 or REM sleep may also contribute to higher glycaemia independently of obesity. Studies are needed to better delineate the roles of puberty and sleep fragmentation in insulin resistance and the metabolic syndrome.
authors: Sleep Medicine Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA Endocrinology and Metabolism Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
authors: Dorit
authors: D
authors: Koren
authors: Sleep Medicine Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA Pulmonology Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
authors: David
authors: D
authors: Gozal
authors: Sleep Medicine Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
authors: Mona F
authors: MF
authors: Philby
authors: Sleep Medicine Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA Pulmonology Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA Division of Respiratory Medicine, Dept of Pediatrics, University of California San Diego, San Diego, CA, USA.
authors: Rakesh
authors: R
authors: Bhattacharjee
authors: Sleep Medicine Section, Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA lgozal@peds.bsd.uchicago.edu.
authors: Leila
authors: L
authors: Kheirandish-Gozal
mesh_terms: D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008074:Lipoproteins / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications*; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications*; D012895:Sleep, REM; D012913:Snoring
chemical_list: D001786:Blood Glucose; D008074:Lipoproteins