Top

Published in:

01-10-2014 | Original Article

Are frequency and severity of sleep-disordered breathing in obese children and youth with and without type 2 diabetes mellitus different?

Authors: Shlomit Shalitin, Riva Tauman, Joseph Meyerovitch, Yakov Sivan

Published in: Acta Diabetologica | Issue 5/2014

Abstract

Obstructive sleep apnea (OSA) is a risk factor for insulin resistance and type 2 diabetes mellitus (T2DM) in adults. Data in children are limited. The aim was to study the frequency and severity of OSA and its association with cardiometabolic risk factors in obese children and adolescents with and without T2DM. In this prospective cross-sectional study, obese children and adolescents with and without T2DM underwent polysomnography and blood tests for fasting lipids, insulin, glucose, liver functions, and C-reactive protein. All participants completed a questionnaire on past and present sleep-disordered breathing (SDB). Results were compared between T2DM and obese non-diabetic controls matched for body mass index–standard deviation score (BMI–SDS) and also according to the glycemic status: T2DM, impaired glucose tolerance (IGT), and normal glycemic control. Eleven patients with T2DM (age 15.9 ± 3.6 years) and 30 BMI–SDS matched non-diabetic subjects (age 12.7 ± 3.0 years) were studied. Among the entire cohort, 45 % had a history of snoring, 26 % reported apneic episodes during sleep, and 65 % had daytime fatigue. There were no significant between-group differences in SDB history or abnormal polysomnographic results [apnea–hypopnea index (AHI) >5/h]. The percentage of subjects with AHI >5/h was 45.5 % in T2DM patients, 25 % in obese patients with IGT, and 18.2 % in obese patients without IGT, although the difference was not statistically significant (p = 0.25). Plasma C-reactive protein levels were related to both glycemic status and OSA severity. The severity of OSA in obese children and adolescents is unrelated to the presence of diabetes. OSA may play a minor role in the development and progression of T2DM in children and adolescents. Further studies in larger cohorts are required.

Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 307:483–490PubMedCrossRef

Lobstein T, Baur L, Uauy R; IASO International Obesity Task Force (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5(Suppl 1):1–4

Rosenblum AL, Joe JR, Young RS, Winter WE (1999) Emerging epidemic of type 2 diabetes in youth. Diabetes Care 22:345–354CrossRef

Vivian EM (2006) Type 2 diabetes in children and adolescents—the next epidemic? Curr Med Res Opin 22:297–306PubMedCrossRef

Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P (1996) Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 128:608–615PubMedCrossRef

Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR (1999) Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996. J Pediatr 134:668–674PubMedCrossRef

Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, Robinson TN, Scott BJ, St Jeor S, Williams CL (2005) Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 111:1999–2012PubMedCrossRef

Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G (1999) Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 159:1527–1532PubMedCrossRef

Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM (1996) Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol 21:176–183PubMedCrossRef

10.

American Thoracic Society (1995) Standards and indications for cardiopulmonary sleep studies in children. Am J Crit Care Med 153:866–878

11.

Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K, American Academy of Pediatrics, (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):e714–e755PubMedCrossRef

12.

Strohl KP, Novak RD, Singer W, Cahan C, Boehm KD, Denko CW, Hoffstem VS (1994) Insulin levels, blood pressure and sleep apnea. Sleep 17:614–618PubMed

13.

Grunstein RR (1996) Metabolic aspects of sleep apnea. Sleep 19:S218–S220PubMed

14.

Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165:677–682PubMedCrossRef

15.

Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676PubMedCrossRef

16.

West SD, Nicoll DJ, Stradling JR (2006) Prevalence of obstructive sleep apnea in men with type 2 diabetes. Thorax 61(11):945–950PubMedCrossRefPubMedCentral

17.

Wang X, Bi Y, Zhang Q, Pan F (2013) Obstructive sleep apnoea and the risk of type 2 diabetes: a meta-analysis of prospective cohort studies. Respirology 18(1):140–146PubMedCrossRef

18.

Waters KA, Sitha S, O’brien LM, Bibby S, de Torres C, Vella S, de la Eva R (2007) Follow-up on metabolic markers in children treated for OSA. Am J Respir Crit Care Med 174(4):455–460CrossRef

19.

Gozal D, Capdavila OS, Kheirandish-Gozal L (2008) Metabolic alterations and systemic inflammation in OSA among non obese and obese children. Am J Respir Crit Care Med 177(10):1142–1149PubMedCrossRefPubMedCentral

20.

Tauman R, O’Brien LM, Ivanenko A, Gozal D (2005) Obesity rather than severity of sleep-disordered breathing as the major determinant of insulin resistance and altered lipidemia in snoring children. Pediatrics 116:e66–e73PubMedCrossRef

21.

Kaditis AG, Alexopoulos EI, Damani E, Karadonta I, Kostadima E, Tsolakidou A, Gourgoulianis K, Syrogiannopoulos GA (2005) Obstructive sleep-disordered breathing and fasting insulin levels in nonobese children. Pediatr Pulmonol 40:515–523PubMedCrossRef

22.

de la Eva RC, Baur LA, Donaghue KC, Waters KA (2002) Metabolic correlates with obstructive sleep apnea in obese subjects. J Pediatr 140:641–643CrossRef

23.

Hanon TS, Lee S, Chakravorty S, Lin Y, Arsalanian SA (2011) Sleep-disordered breathing in obese adolescents is associated with visceral adiposity and markers of insulin resistance. Int J Pediatr Obes 6(2):157–160CrossRef

24.

Nakra N, Bhargava S, Dzuira J, Caprio S, Bazzy-Asaad A (2008) Sleep-disordered breathing in children with metabolic syndrome: the role of leptin and sympathetic nervous system activity and the effect of continuous positive airway pressure. Pediatrics 122:e634–e642PubMedCrossRef

25.

Redline S, Storfer-Isser A, Rosen CL, Johnson NL, Kirchner HL, Emancipator J, Marie Kibler AM (2007) Association between metabolic syndrome and sleep-disordered breathing in adolescents. Am J Respir Crit Care Med 176:401–408PubMedCrossRefPubMedCentral

26.

Kelly A, Dougherty S, Cucchiara A, Marcus CL, Brooks LJ (2010) Catecholamines, adiponectin, and insulin resistance as measured by HOMA in children with obstructive sleep apnea. Sleep 33(9):1185–1191PubMedPubMedCentral

27.

Tsaoussoglou M, Bixler EO, Calhoun S, Chrousos GP, Sauder K, Vgontzas AN (2010) Sleep-disordered breathing in obese children is associated with prevalent excessive daytime sleepiness, inflammation, and metabolic abnormalities. J Clin Endocrinol Metab 95(1):143–150PubMedCrossRefPubMedCentral

28.

Verhulst SL, Rooman R, Van Gaal L, De Backer W, Desager K (2009) Is sleep-disordered breathing an additional risk factor for the metabolic syndrome in obese children and adolescents? Int J Obes 33(1):8–13CrossRef

29.

Taylor RW, Jones IE, Williams SM, Goulding A (2000) Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr 72:490–495PubMed

30.

Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:12–23CrossRef

31.

Marshall WA, Tanner JM (1969) Variations in the pattern of pubertal changes in girls. Arch Dis Child 44:291–303PubMedCrossRefPubMedCentral

32.

Rosner B, Prineas RJ, Loggie JM, Daniels SR (1993) Blood pressure nomograms for children and adolescents, by height, sex, and age, in the United States. J Pediatr 123(6):871–886PubMedCrossRef

33.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee (2003) Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 complete report. Hypertension 42:1206–1252PubMedCrossRef

34.

Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche EF, Johnson C (2002) 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11(246):1–190

35.

Drake C, Nickel C, Burduvali E, Roth T, Jefferson C, Pietro B (2003) The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcomes in middle school children. Sleep 26(4):455–458PubMed

36.

Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring systems for sleep stages of human subject. Publ. No. 204 National Institutes of Health, Washington

37.

EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association (1992) Sleep 15(2):173–184

38.

Mograss MA, Ducharme FM, Brouillette RT (1994) Movement/arousals. Description, classification, and relationship to sleep apnea in children. Am J Respir Crit Care Med 150:1690–1696PubMedCrossRef

39.

Iber C, Ancoli-Israel S, Chesson A, Quan SF. for the American Academy of Sleep Medicine (2007) Rules, terminology and technical specifications. 1 edn. Westchester IL: American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events

40.

Tamir I, Heiss G, Glueck CJ, Christensen B, Kwiterovich P, Rifkind B (1981) Lipid and lipoprotein distributions in white children ages 6–19 yrs: the Lipid Research Clinics Program Prevalence Study. J Chronic Dis 34(1):27–39PubMedCrossRef

41.

Jellinger PS, Smith DA, Mehta AE, Ganda O, Handelsman Y, Rodbard HW, Shepherd MD, Seibel JA, the AACE Task Force for Management of Dyslipidemia and Prevention of Atherosclerosis (2012) American Association of Clinical Endocrinologists’ guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract 18(Suppl 1):1–78PubMedCrossRef

42.

Quon MJ (2001) Limitations of the fasting glucose to insulin ratio as an index of insulin sensitivity. J Clin Endocrinol Metab 86:4615–4617PubMedCrossRef

43.

Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG (2006) Prevalence and determinants of insulin resistance among U.S. adolescents: a population-based study. Diabetes Care 29(11):2427–2432PubMedCrossRef

44.

Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK (1990) Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 263:2893–2898PubMedCrossRef

45.

Kahn SE (2003) The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of type 2 diabetes. Diabetologia 46:3–19PubMedCrossRef

46.

Harsch IA, Schahin SP, Radespiel-Troger M, Weintz O, Jahreiss H, Fuchs FS, Wiest GH, Hahn EG, Lohmann T, Konturek PC, Ficker JH (2004) Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 169:156–162PubMedCrossRef

47.

Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T (2005) Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 165:447–452PubMedCrossRef

48.

Hassaballa HA, Tulaimat A, Herdegen JJ, Mokhlesi B (2005) The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath 9:176–180PubMedCrossRef

49.

Hannon TS, LEE S, Hakravorty S, Lin Y, Arslanian SA (2011) Sleep-disordered breathing in obese adolescents is associated with visceral adiposity and markers of insulin resistance. Int J Pediatr Obes 6(2):157–160PubMedCrossRefPubMedCentral

50.

Spranger J, Kroke A, Mohlig M, Hoffmann K, Bergmann MM, Ristow M, Boeing H, Pfeiffer AF (2003) Inflammatory cytokines and the risk to develop type 2 diabetes: results of the prospective population-based European Prospective Investigation into Cancer and Nutrition (EPIC)—Potsdam Study. Diabetes 52:812–817PubMedCrossRef

51.

Shamsuzzaman ASM, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464PubMedCrossRef

52.

Tauman R, O’Brien LM, Gozal D (2007) Hypoxemia and obesity modulate plasma C-reactive protein and IL-6 levels in sleep disordered breathing. Sleep Breath 11(2):77–84PubMedCrossRef

53.

Ceriello A, Motz E (2004) Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes and cardiovascular disease? The common soil hypothesis revisited. Arterioscler Thromb Vasc Biol 24:816–823PubMedCrossRef

Title: Are frequency and severity of sleep-disordered breathing in obese children and youth with and without type 2 diabetes mellitus different?
Authors: Shlomit Shalitin
Riva Tauman
Joseph Meyerovitch
Yakov Sivan
Publication date: 01-10-2014
Publisher: Springer Milan
Published in: Acta Diabetologica / Issue 5/2014
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-014-0583-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2014

Prospective study of cytomegalovirus seropositivity and risk of mortality from diabetes

Serum uric acid predicts vascular complications in adults with type 1 diabetes: the coronary artery calcification in type 1 diabetes study

The degree of fetal metformin exposure does not influence fetal outcome in gestational diabetes mellitus

Differences in pancreatic volume, fat content, and fat density measured by multidetector-row computed tomography according to the duration of diabetes

High circulating irisin levels are associated with insulin resistance and vascular atherosclerosis in a cohort of nondiabetic adult subjects

Bartter-like syndrome in patients with molecular defects of the insulin receptor gene

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials