Abstract
Context: Obstructive sleep apnea (OSA) represents a chronic condition characterized by complete or partial upper airway obstruction during sleep. Prevalence rates of both OSA and obesity are still growing worldwide; the prevalence of OSA reaches 33-61% in youth with obesity, while it represents 1-3% of the general pediatric population. However, there is to date no consensus for OSA threshold in adolescent obesity. OSA has been found to alter sleep quality while obesity is associated with shorter sleep duration and impaired sleep architecture. Through different pathways, OSA and obesity have both been found to be involved in the development of systemic inflammation and metabolic disorders leading to an increased risk of cardiovascular disease. While the evidence regarding the efficacy of multidisciplinary interventions to improve pediatric obesity is compelling, less is known about their effect on overall sleep and cardiometabolic health in the case of OSA. The purpose of the present project conducted in adolescents with obesity was therefore i) to determine a clinical cut-off for the diagnosis of OSA based on cardiometabolic alterations; ii) to assess the effects of a lifestyle intervention on OSA severity, on sleep duration, sleep architecture and cardiometabolic risk.
Methods: Comparable data from three different centers (Besançon and Clermont-Ferrand, France and São Paulo, Brazil) were compiled and data from 82 participants were analyzed. Sleep, investigated by polysomnography, body composition and anthropometric measures, glucose and lipid profiles, and cardiorespiratory fitness were assessed at admission and at the end a 3 to 9 months lifestyle intervention including chronic exercise and a balanced diet.
Results: Multivariable analyses enabled us to identify a threshold of apnea-hypopnea index (AHI) = 2 above which a strong and significant relation between cardiometabolic risk and AHI was observed.
Out of the 50 participants who completed the lifestyle intervention, 20 (40%) had OSA at baseline, as defined by an AHI ≥ 2 events/hour. Overall, the participants exhibited a short sleep duration and reduced proportions of rapid-eye movement (REM) sleep. REM sleep % was increased, and sleep duration unchanged post-intervention, both overall and in participants initially diagnosed with OSA. OSA was normalized (AHI <2) in 11 participants and persisted in 9. OSA was associated at baseline with lower insulin sensitivity and higher blood pressure, but it did not affect the lipid profile. Post-intervention, the cardiometabolic profile was improved, whether OSA was normalized or not.
Conclusions: OSA starts affecting cardiometabolic health from and AHI of 2 in adolescents with obesity. A lifestyle intervention including chronic exercise and a balanced diet is useful to decrease OSA severity, improve sleep architecture, and improve the metabolic parameters whether or not OSA is normalized post-intervention. Mechanisms mediating OSA persistence remain unelucidated.
Disclosure: Nothing to disclose