Sleep-disordered breathing and the metabolic syndrome in overweight and obese children and adolescents

Objective To assess whether sleep-disordered breathin (SDB) is a risk factor of the metabolic syndrome (MS) in children 9 and adolescents who are overweight and to examine whether the severity of SDB was independently associated with glucose intolerance, insulin resistance, and/or dyslipidemia. Study design Consecutive subjects who were overweight or obese underwent polysomnograpby, fasting blood sample, and oral glucose tolerance test (for calculation of area under the curve [AUC]). SDB was defined as a respiratory disturbance index :>= 2. MS was present when; >= 3 of these factors were present: waist circumference; >= 90th percentile; fasting glucose level :110 mg/dL; triglyceride level 2:110 mg/dL; high-density lipoprotein cholesterol level :540 mg/dL; blood pressure :>= 90th percentile. Results A total of 104 subjects were included in the study (44% boys; 58% prepubertal; mean age, 11.1 +/- 2.6 years; 69% obese). Mean SaO2 (odds ratio, 0.54) and SaO2nadir (odds ratio, 0.89) were independent, significant predictors of the presence of MS. Multiple regression showed significant associations between SaO2nadir and high-density lipoprotein cholesterol level, mean SaO2 and both AUC glucose and tiriglyceride levels, and between the percentage of total sleep time with SaO2 >= 95% and cholesterol level, while controlling for adiposity and sex, puberty, or both. Conclusion This study supports the hypothesis of an interaction between SDB and metabolic abnormalities, independent of estimates of body fat distribution, in children and adolescents who are overweight and obese.