Pediatric OSA Associated With Abnormal Metabolic Profile

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Obese pediatric patients with obstructive sleep apnea (OSA) had higher diastolic blood pressure and an abnormal metabolic profile compared with patients without OSA, according to study results presented at the CHEST Annual Meeting, held October 6-10, in San Antonio, Texas.

Presenting author, Kanika Mathur, MD, of Albert Einstein College of Medicine in Bronx, New York, pointed out that currently, there is no consensus regarding routine cardiac evaluation in children. Dr Mathur also noted that OSA has been shown to be associated with obesity, diabetes, and hypertension in adults, and although fewer data are available, OSA is similarly linked with obesity and hypertension in children. In addition, there are conflicting studies that demonstrate echocardiographic changes including left ventricle size, left ventricular function, and pulmonary arterial pressure.

Dr Mathur and fellow researchers conducted a retrospective analysis of 81 pediatric patients (mean age, 14.5 years) with a mean body mass index of 39.6 kg/m² to investigate the relationship of OSA severity and blood pressure, metabolic function, cardiac size, systolic function, and heart rate.

Patents underwent polysomnography and echocardiography. Glucose, hemoglobin A1C, liver function, and lipid panels were measured. The researchers defined mild OSA as apnea-hypopnea index (AHI) 1 to 4.9, moderate as AHI 5 to 9.9, and severe OSA as AHI >10.

Compared with patients without OSA, the group with OSA had a significantly higher diastolic blood pressure Z-scores (–0.6±0.6 vs 0.1±0.8, respectively; P =.005), and higher heart rate (78±9 vs 89±17 bpm, respectively; P =.004). In addition, triglyceride and hemoglobin A1C levels were significantly higher in patients with OSA vs without OSA (139±100 vs 84±29 mg/dL, respectively; P =.004 and 6.2±1.4 vs 5.4±0.3; P =.002). Alanine transaminase and aspartate transaminase levels were also higher in patients with OSA compared with patients without OSA.

However, there were no significant differences in cholesterol, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol levels between the 2 groups. Similarly, there were no significant differences in left atrial indexed volume, left ventricular volume, left ventricular mass, or left ventricular ejection fraction.

The researchers also conducted a subanalysis comparing patients with mild OSA with patients who had moderate or severe OSA. They found no difference in echocardiographic measurements of left atrial indexed volume, left ventricular mass, or systolic function. Patients with moderate to severe OSA did have significantly higher triglyceride and alanine transaminase levels compared with patients with mild OSA (148±103 vs 74±36 mg/dL, respectively; P =.001 and 27±20 vs 17±4 U/L, respectively; P =.005).

Although the degrees of obesity and systolic blood pressure were similar across the study population, patients with OSA had significantly higher diastolic blood pressure and heart rate, as well as an abnormal metabolic profile.

The researchers concluded that an abnormal metabolic profile vs weight may be associated with increased severity of OSA. Therefore, screening in these patients may help clinicians determine who is at risk for more severe OSA and related cardiovascular complications.

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Reference

Mathur K, Barraza G, Khan M, et al. Cardiometabolic risk factors in obese children with OSA. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.