Increased systemic inflammation overnight correlates with insulin resistance among children evaluated for obstructive sleep apnea

• Published in: Sleep & breathing 2012-06, Vol.16 (2), p.349-354
• Main Authors: DeBoer, Mark D., Mendoza, James P., Liu, Lei, Ford, Gabriele, Yu, Pearl L., Gaston, Benjamin M.
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; C-Reactive Protein - metabolism; Child; Circadian Rhythm - physiology; Correlation analysis; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dentistry; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Drug resistance; Female; Fundamental and applied biological sciences. Psychology; Humans; Inflammation Mediators - blood; Inflammatory diseases; Insulin; Insulin resistance; Insulin Resistance - physiology; Interleukin-6 - blood; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Nervous system (semeiology, syndromes); Neurology; Obesity - blood; Original Article; Otorhinolaryngology; Oxygen - blood; Pediatrics; Pneumology/Respiratory System; Polysomnography; Sleep apnea; Sleep Apnea, Obstructive - blood; Sleep Apnea, Obstructive - diagnosis; Sleep. Vigilance; Statistics as Topic; Tumor Necrosis Factor-alpha - blood; Vertebrates: nervous system and sense organs; Young Adult
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-011-0499-8

Purpose Obstructive sleep apnea (OSA) in children is associated with obesity, insulin resistance, and elevated baseline inflammation as measured by high-sensitivity C-reactive protein (hsCRP). Our goal was to evaluate whether inflammation increases overnight among children suspected of having OSA and to determine whether worsened inflammation is associated with the degree of OSA severity, obesity, and/or insulin resistance. Methods Twenty-three children with clinical suspicion of OSA underwent a sleep study. Levels of hsCRP were tested the evening before and morning after the sleep study. Fasting insulin and glucose levels were measured from which the homeostasis model of insulin resistance (HOMA-IR) was calculated. Linear correlations were performed to evaluate relationships between hsCRP levels at baseline and change overnight (ΔhsCRP) vs. HOMA-IR, body mass index (BMI) z -score, and sleep study parameters related to O 2 saturation and the apnea-hypopnea index (AHI). Results Among children with OSA and the entire cohort, hsCRP values were correlated with HOMA-IR and BMI z -scores. HOMA-IR but not BMI z -score correlated with ΔhsCRP overnight in the entire cohort. Sleep study parameters, including AHI mean O 2 saturation overnight, REM O 2 nadir, and non-REM O 2 nadir were not correlated with hsCRP or ΔhsCRP overnight. Conclusion Among children being evaluated for OSA, degree of insulin resistance may be an important determinant of increased systemic inflammation overnight. Sleep study markers did not correlate with ΔhsCRP, leaving uncertain the role of OSA in increasing inflammation overnight. Further studies are needed to explore these associations and their potential mechanisms.