Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study

Alex Gileles-Hillel, María Luz Alonso-Álvarez, Leila Kheirandish-Gozal, Eduard Peris, José Aurelio Cordero-Guevara, Joaquin Terán-Santos, Mónica Gonzalez Martinez, María José Jurado-Luque, Jaime Corral-Peñafiel, Joaquin Duran-Cantolla, David Gozal, Alex Gileles-Hillel, María Luz Alonso-Álvarez, Leila Kheirandish-Gozal, Eduard Peris, José Aurelio Cordero-Guevara, Joaquin Terán-Santos, Mónica Gonzalez Martinez, María José Jurado-Luque, Jaime Corral-Peñafiel, Joaquin Duran-Cantolla, David Gozal

Abstract

Introduction: Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities.

Aim: To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4-15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers.

Results: 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001).

Conclusion: IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

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