Research Article| Volume 76, P70-80, November 2017

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Current child, but not maternal, snoring is bi-directionally related to adiposity and cardiometabolic risk markers: A cross-sectional and a prospective cohort analysis

  • Olivia M. Farr
    Corresponding author at: 330 Brookline Ave, ST820, Boston, MA 02215, United States.
    Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States
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  • Sheryl L. Rifas-Shiman
    Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, United States
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  • Emily Oken
    Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, United States

    Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
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  • Elsie M. Taveras
    Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
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  • Christos S. Mantzoros
    Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States

    Section of Endocrinology, VA Boston Healthcare System, Boston, MA, United States
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      Obstructive sleep apnea (OSA), typically manifested as snoring, is closely associated with obesity. However, the directionality of associations of OSA with cardiometabolic risk markers is unclear, as obesity increases risk for OSA, and OSA results in excess weight gain and its metabolic consequences. Less is known about how obesity and OSA may relate in children and adolescents and whether maternal OSA may influence the development of obesity and cardiometabolic dysfunction in offspring.

      Basic Procedures

      Among 1078 children from the Project Viva cohort, we examined cross-sectionally and prospectively associations of parent-reported child or maternal snoring with cardiometabolic outcomes, including adiposity, adipokines, and insulin resistance.

      Main Findings

      Cross-sectionally, child snoring was related to adiposity and metabolic risk, particularly body mass index (BMI; β 0.61 kg/m2, 95% CI 0.33, 0.89; p < 0.001), trunk fat mass index (β 0.23 kg/m2, CI 0.12, 0.34; p < 0.001), high-density lipoprotein cholesterol (β −1.47 mg/dL, CI −2.69, −0.25; p = 0.02), and metabolic risk z-score (β 0.08, CI 0.02, 0.14; p = 0.01) after correction for covariates. Prospectively, adiposity (BMI, trunk fat, fat mass, and waist circumference) and cardiometabolic (leptin, HOMA-IR, CRP, and global metabolic risk) measures at mid-childhood (~7 y) were associated with child snoring at the early teen visit (~12 y) after correction for covariates. Child snoring at ~9 y was related to changes in adiposity between mid-childhood and early teen visits.


      Child but not maternal snoring, was related to child adiposity and cardiometabolic outcomes. Adiposity and child snoring are associated with each other cross-sectionally and are each predictive of the other among children/adolescents prospectively. These results suggest similar mechanisms in pediatric/adolescent populations as in adults for the development of sleep-disordered breathing and sleep apnea that will need to be confirmed in randomized clinical trials. Importantly, this research points to the need to target both sleep and obesity in order to break this vicious cycle.


      OSA (obstructive sleep apnea), MRI (magnetic resonance imaging), HOMA-IR (homeostatic assessment of insulin resistance), TNF-α (tumor necrosis factor alpha), TNFR2 (tumor necrosis factor receptor 2), BMI (body mass index), DXA (dual energy X-ray absorptiometry), FM (fat mass), FFM (fat-free mass), hsCRP (high sensitivity c-reactive protein), HDL (high density lipoprotein), LDL (low density lipoprotein), AHI (apnea-hypopnea index), CPAP (continuous positive air pressure), CI (confidence interval)


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