Published ahead of print on May 31, 2007, doi:10.1164/rccm.200703-375OC Am. J. Respir. Crit. Care Med., Volume 176, Number 4, August 2007, 401-408 A more recent version of this article appeared on August 15, 2007
Submitted on March 6, 2007 Association Between Metabolic Syndrome and Sleep Disordered Breathing in AdolescentsSusan Redline1*,1 Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA, 2 Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA, 3 Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA * To whom correspondence should be addressed. E-mail: Susan.redline{at}case.edu.
Rationale: Metabolic Syndrome (MetS) affects 4 to 10% of adolescents. Risk factors include overweight, male gender and Hispanic ethnicity. Although Sleep Disordered Breathing (SDB) has been implicated as a risk factor for MetS in adults, its association with SDB in adolescents is unknown. Objective: To define the association of SDB with MetS in adolescents. Methods and Main Results: Standardized measurements of SDB, anthropometry and bioassays were made in 270 adolescents, age 13.6 ± 0.7 years. MetS was identified if threshold levels were exceeded in 3 of 5 areas: waist circumference; blood pressure; triglyceride level; HDL cholesterol level; and glucose levels. Whereas 70% of children with SDB (apnea hypopnea index >5) were overweight and 59% had MetS, 16% of children without SDB had MetS. 25% of those with MetS had SDB. After adjusting for age, race, sex, and preterm status, children with SDB had a 6.49 (95% C.I.: 2.52, 16.70) increased odds of MetS compared to children without SDB. Indices of SDB stress associated with MetS included respiratory event frequency, degree of oxygen desaturation, and sleep efficiency. Analyses of individual metabolic parameters showed that after adjustment for body mass index, SDB was associated with systolic and diastolic blood pressure, LDL cholesterol, and fasting insulin levels. Conclusions: A majority of adolescents with SDB are overweight and meet criteria for MetS. The close association between MetS and SDB and their putative interacting pathophysiologies suggests a need to develop screening, prevention and treatment strategies for both disorders in high risk, overweight adolescents. Key words: pediatric sleep apnea, metabolic syndrome
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