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Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents.

Koren D, Chirinos JA, Katz LE, Mohler ER, Gallagher PR, Mitchell GF, Marcus CL - Int J Obes (Lond) (2015)

Bottom Line: Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose.Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=-0.63, P<0.0005).Insulin levels were negatively associated with AIx (r=-0.53, P=0.02).

View Article: PubMed Central - PubMed

Affiliation: Pediatrics-Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA.

ABSTRACT

Background/objectives: Obstructive sleep apnea syndrome (OSAS) may be a cardiovascular disease (CVD) risk factor independently of obesity in adults. Pediatric studies have associated OSAS with endothelial dysfunction, but few studies have examined relationships between OSAS and macrovascular sequelae. Our objective was to examine OSAS's independent contribution to macrovascular CVD risk measures in obese adolescents.

Subjects/methods: This cross-sectional observational study was conducted at Children's Hospital of Philadelphia Clinical Research and Academic Sleep Centers, and University of Pennsylvania Vascular Research Unit. Thirty-one obese non-diabetic adolescents underwent anthropometric measurements, overnight polysomnography, fasting laboratory draw and cardiovascular imaging. Cardiovascular outcome measures included maximal carotid intima-media thickness (cIMTmax), a measure of carotid structural changes, and carotid-femoral pulse wave velocity (CFPWV), an aortic stiffness measure whose relationship vis-à-vis OSAS in children has not been previously examined. Carotid diameter and augmentation index (AIx, measuring central pressure augmentation from wave reflections) were assessed. Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose.

Results: The apnea hypopnea index, a primary OSAS measure, was not associated with cIMTmax, carotid diameter, CFPWV or AIx. body mass index (BMI) associated positively with cIMTmax (r=0.52, P=0.006) and CFPWV (r=0.45, P=0.01). Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=-0.63, P<0.0005). Insulin levels were negatively associated with AIx (r=-0.53, P=0.02).

Conclusions: OSAS did not predict carotid structural changes or arterial stiffness independently of BMI in obese adolescents. Higher insulin levels associated with lower central pressure wave augmentation. Finally, long-term hypercapnia may predispose to carotid narrowing.

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Related in: MedlinePlus

Relationship between carotid artery diameter and end-tidal CO2Association between common carotid artery diameter and mean end-tidal carbon dioxide.
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Figure 1: Relationship between carotid artery diameter and end-tidal CO2Association between common carotid artery diameter and mean end-tidal carbon dioxide.

Mentions: No significant associations were seen between any measure of OSAS and cIMTmax (table 3). However, a strong negative association was uncovered between CCA diameter and mean ETCO2 (table 3 and figure 1). Participants displayed a range of ETCO2 values (table 2), with 26% having ETCO2>50 torr for >10% of total sleep time, but only two participants met clinical criteria for hypoventilation(28), so the potential contribution of hypoventilation could not be assessed further.


Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents.

Koren D, Chirinos JA, Katz LE, Mohler ER, Gallagher PR, Mitchell GF, Marcus CL - Int J Obes (Lond) (2015)

Relationship between carotid artery diameter and end-tidal CO2Association between common carotid artery diameter and mean end-tidal carbon dioxide.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496293&req=5

Figure 1: Relationship between carotid artery diameter and end-tidal CO2Association between common carotid artery diameter and mean end-tidal carbon dioxide.
Mentions: No significant associations were seen between any measure of OSAS and cIMTmax (table 3). However, a strong negative association was uncovered between CCA diameter and mean ETCO2 (table 3 and figure 1). Participants displayed a range of ETCO2 values (table 2), with 26% having ETCO2>50 torr for >10% of total sleep time, but only two participants met clinical criteria for hypoventilation(28), so the potential contribution of hypoventilation could not be assessed further.

Bottom Line: Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose.Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=-0.63, P<0.0005).Insulin levels were negatively associated with AIx (r=-0.53, P=0.02).

View Article: PubMed Central - PubMed

Affiliation: Pediatrics-Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA.

ABSTRACT

Background/objectives: Obstructive sleep apnea syndrome (OSAS) may be a cardiovascular disease (CVD) risk factor independently of obesity in adults. Pediatric studies have associated OSAS with endothelial dysfunction, but few studies have examined relationships between OSAS and macrovascular sequelae. Our objective was to examine OSAS's independent contribution to macrovascular CVD risk measures in obese adolescents.

Subjects/methods: This cross-sectional observational study was conducted at Children's Hospital of Philadelphia Clinical Research and Academic Sleep Centers, and University of Pennsylvania Vascular Research Unit. Thirty-one obese non-diabetic adolescents underwent anthropometric measurements, overnight polysomnography, fasting laboratory draw and cardiovascular imaging. Cardiovascular outcome measures included maximal carotid intima-media thickness (cIMTmax), a measure of carotid structural changes, and carotid-femoral pulse wave velocity (CFPWV), an aortic stiffness measure whose relationship vis-à-vis OSAS in children has not been previously examined. Carotid diameter and augmentation index (AIx, measuring central pressure augmentation from wave reflections) were assessed. Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose.

Results: The apnea hypopnea index, a primary OSAS measure, was not associated with cIMTmax, carotid diameter, CFPWV or AIx. body mass index (BMI) associated positively with cIMTmax (r=0.52, P=0.006) and CFPWV (r=0.45, P=0.01). Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=-0.63, P<0.0005). Insulin levels were negatively associated with AIx (r=-0.53, P=0.02).

Conclusions: OSAS did not predict carotid structural changes or arterial stiffness independently of BMI in obese adolescents. Higher insulin levels associated with lower central pressure wave augmentation. Finally, long-term hypercapnia may predispose to carotid narrowing.

Show MeSH
Related in: MedlinePlus