Abstract
Purpose
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.
Conclusions
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.
Abbreviations:
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)Keywords
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Article info
Publication history
Published online: June 29, 2017
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© 2017 Elsevier Inc. All rights reserved.
