Sleep-disordered Breathing In Adolescents Research Articles

0536 Association of a Novel EEG Biomarker of Sleep Depth with Sleep Disordered Breathing in Adolescents

Abstract Introduction The odds ratio product (ORP) provides a standardized, continuous measure of sleep depth that ranges from 0 (deep sleep) to 2.5 (full wakefulness). ORP has been shown to increase during adolescence, representing the decline in sleep depth that occurs during this developmental period. In adults, higher ORP has been associated with sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), while there have been no studies in youth. We aimed to determine the association of ORP with SDB in adolescents. Methods We extracted ORP from the sleep EEG of 261 typically developing adolescents aged 12-23y (median 16y) from the Penn State Child Cohort. Higher ORP during rapid eye movement (REM) and non-REM sleep indicates less deep sleep, while higher ORP-9 (i.e., average ORP in the 9-seconds following non-REM cortical arousals) indicates greater arousability. We used general linear models, adjusted for sex, age and race/ethnicity, to examine mean differences in ORP metrics among clinically meaningful groups of SDB based on the apnea/hypopnea index (AHI) consisting of no SDB (AHI<2 and no snoring, n=100), primary snoring (AHI<2 and snoring, n=75), 2≤AHI<5 (n=64), and AHI≥5 (n=22). Results Adolescents with primary snoring or 2≤AHI<5 did not significantly differ in ORP metrics from those without SDB (all p≥0.12). Adolescents with AHI≥5 had higher ORP-NREM compared to those without SDB, with primary snoring or with 2≤AHI<5 (all p≤0.01), while ORP-REM was significantly higher compared to those without SDB (p=0.02). ORP-9 was significantly greater in adolescents with AHI≥5 compared to those with no SDB (p<0.01) and those with primary snoring (p=0.02), but not when compared to those with 2≤AHI<5 (p=0.07). Conclusion Our data suggest that adolescents with OSA experience lower REM and non-REM sleep depth/intensity (higher ORP) compared to those without SDB. In addition, these adolescents experience a slower progression back to deep sleep following cortical arousals (higher ORP-9), which suggests they remain in a high arousability state and, thus, are more likely to repeat arousals. Commensurate with previous studies in adults, our data show that ORP is a useful sleep EEG biomarker able to capture decreased sleep depth in adolescents with OSA. Support (If Any) National Institutes of Health (R01MH118308, UL1TR000127)

Sleep disordered breathing from preschool to early adult age and its neurocognitive complications: A preliminary report.

ObjectiveThe onset and development of sleep disordered breathing (SDB) remains unclear in an age - dependent manner. Despite treatment, persistent symptoms such as snoring and excessive daytime sleepiness, as well as cognitive impairment may be present. The aim of the research was to determine the prevalence of residual symptoms of SDB in adolescence and early adulthood, the predisposing factors and its neurocognitive complications.MethodsIn the present pilot study-cohort, a questionnaire was utilized to 154 people (average age: 17.9 ± 3), who as children (mean age: 5.3 ± 1.4) had AHI ≥2.5 episodes/h. They were divided into two groups based on AHI = 5 episodes/h. Depending on the results, they were invited to undergo a repeated polysomnography (PSG) and complete the Montreal Cognitive Assessment (MoCA) test. Statistical analysis was made with IBM SPSS software.ResultsOut of the total, 35.7% claimed to still snore. AHI was negatively correlated to the severity of residual symptoms (Mann-Witney U test, p <0.005). According to repeated PSGs, 9/17 met the criteria for OSAS, while high BMI was associated with the severity of new AHI (chi squared test, p<0.005). Additionally, 7/16 scored below the MoCA baseline (<26/30). The characteristics of cognitive declines were mapped, with most prominent having been visuospatial, short - term memory and naming/language deficits.DiscussionA significant percentage of children with sleep breathing disorder present with residual symptoms during their transition to early adulthood, as well as undiagnosed neurocognitive complications. Clinicians suspicion for the underlying neurocognitive complications is required, even in young adults, while guidelines on monitoring pediatric OSAS patients after treatment should be addressed.

Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders.

Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD. Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference. Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants. HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD. Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med. 2021;17(8):1579-1590.

Association of visceral adiposity and systemic inflammation with sleep disordered breathing in normal weight, never obese adolescents

Objective/backgroundWhile obesity is a known risk factor for sleep disordered breathing (SDB), a large proportion of children with SDB are not overweight as per body mass index percentile (BMI%) criteria. This study aimed to examine whether premorbid or concurrent adiposity phenotypes and inflammation are associated with SDB in normal weight youth. Patients/methodsA total of 242 persistently non-overweight (BMI%<85) subjects from the Penn State Child Cohort (PSCC, N = 421, 5-12 y at baseline and 12-23 y at follow-up), were studied. The apnea/hypopnea index (AHI) was ascertained via polysomnography (PSG) at both time points. At follow-up, a dual-energy X-ray absorptiometry (DXA) scan assessed android and gynoid distribution and subcutaneous (SAT) and visceral (VAT) adiposity composition, while a fasting blood draw was assayed for C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Multivariable linear regression models with AHI at follow-up as primary outcome were adjusted for sex, race, adenotonsillectomy, age and AHI at baseline. Results and conclusionsIncreased waist circumference (β = 0.227, p = 0.001) at baseline, but not BMI%, neck or hip circumference, was significantly associated with a higher AHI at follow-up. VAT (β = 0.309, p < 0.001), IL-6 (β = 0.243, p < 0.001), SAT (β = 0.235, p = 0.013), CRP (β = 0.221, p = 0.001), and an android distribution (β = 0.196, p = 0.003) at follow-up were significantly associated with a higher AHI at follow-up. Childhood central adiposity predicts SDB in adolescence, even in individuals who have never been overweight since childhood as per BMI criteria. Visceral adiposity and inflammation are concurrent to adolescent SDB, which supports the clinical utility of these biomarkers in predicting its associated cardiometabolic risk.

Sleep-disordered breathing in adolescents with obesity: When does it start to affect cardiometabolic health?

Background and aimsPediatric obesity and sleep-disordered breathing (SDB) are associated with cardiometabolic risk (CMR), but the degree of severity at which SDB affects cardiometabolic health is unknown. We assessed the relationship between the CMR and the apnea-hypopnea index (AHI), to identify a threshold of AHI from which an increase in the CMR is observed, in adolescents with obesity. We also compared the clinical, cardiometabolic and sleep characteristics between adolescents presenting a high (CMR+) and low CMR (CMR-), according to the threshold of AHI. Methods and results114 adolescents with obesity were recruited from three institutions specialized in obesity management. Sleep and SDB as assessed by polysomnography, anthropometric parameters, fat mass (FM), glucose and lipid profiles, and blood pressure (BP) were measured at admission. Continuous (MetScoreFM) and dichotomous (metabolic syndrome, MetS) CMR were determined. Associations between MetScoreFM and AHI adjusted for BMI, sex and age were assessed by multivariable analyses.Data of 82 adolescents were analyzed. Multivariable analyses enabled us to identify a threshold of AHI = 2 above which we observed a strong and significant association between CMR and AHI (Cohen's d effect-size = 0.57 [0.11; 1.02] p = 0.02). Adolescents with CMR+ exhibited higher MetScoreFM (p < 0.05), insulin resistance (p < 0.05), systolic BP (p < 0.001), sleep fragmentation (p < 0.01) and intermittent hypoxia than CMR- group (p < 0.0001). MetS was found in 90.9% of adolescents with CMR+, versus 69.4% in the CMR- group (p < 0.05). ConclusionsThe identification of a threshold of AHI ≥ 2 corresponding to the cardiometabolic alterations highlights the need for the early management of SDB and obesity in adolescents, to prevent cardiometabolic diseases. Clinical trialsNCT03466359, NCT02588469 and NCT01358773

Sleep-disordered breathing in adolescents with obesity: when does it start to affect cardiometabolic health?

Sleep-disordered breathing in adolescents with obesity: when does it start to affect cardiometabolic health?

Abstract MP26: Visceral Obesity and Systemic Inflammation Predict Sleep Disordered Breathing in Normal Weight, Never Obese Adolescents: A Longitudinal, Population-Based Study

Introduction: Although obesity is a known risk factor for sleep disordered breathing (SDB), a significant proportion of children with SDB are not obese or overweight as per body mass index percentile (BMI%) for age-and-sex. It is unknown whether premorbid or concurrent adiposity phenotypes are associated with SDB in normal weight youth. Hypothesis: We hypothesize that central obesity is a predictor of apnea/hypopnea index (AHI) in adolescents who have been otherwise normal weight since childhood. Methods: We analyzed data from the Penn State Child Cohort (N=421), a random population-based sample of 8.7 (1.7) year old children followed-up as 17.0 (2.3) year old adolescents. Of these, 242 subjects (49.2% female, 18.2% minority) were classified as persistently normal weight based on BMI%&lt;85 at both baseline and follow-up. Neck, hip and waist circumference (WC) were measured and “central obesity” was defined as a WC%≥85 for age-and-sex at baseline. During the follow-up exam, android and gynoid distribution and subcutaneous (SAT) and visceral (VAT) adipose tissue composition were assessed via DEXA scan, while inflammatory biomarkers were assayed from a fasting blood sample. The AHI was obtained from 9-hour, in-lab polysomnography at baseline and follow-up. Multivariable linear regression models examined the association between adiposity and inflammation with AHI at follow-up while adjusting for sex, race, adenotonsillectomy, age and AHI at baseline. Results: The average AHI at baseline was 0.7 (0.9) events/hour and 2.3 (6.3) events/hour at follow-up. Unadjusted analyses showed that WC (β=0.159) and central obesity (β=0.227) at baseline, but not BMI%, neck or hip circumference, and VAT (β=0.307), IL-6 (β=0.245), SAT (β=0.235), CRP (β=0.222), and android distribution (β=0.195) at follow-up were significantly (P&lt;0.05) associated with a higher follow-up AHI. Multivariable-adjusted analyses showed that VAT (β=0.299), IL-6 (β=0.191), central obesity (β=0.185) and CRP (β=0.163) were independently associated with a higher follow-up AHI. Conclusions: This is the first study to demonstrate that central obesity in childhood is a strong predictor of SDB in adolescence, even in individuals who have been persistently normal weight since childhood as per BMI% standards. These data support the clinical utility of simple measures of central obesity in childhood (i.e., WC) as early surrogate markers of increased risk of future development of SDB in the transition to adolescence. Furthermore, our study demonstrates that increased visceral adiposity and systemic inflammation are strong correlates of adolescent SDB, which supports the clinical utility of these biomarkers in predicting the cardiometabolic risk associated with adolescent SDB.

Polysomnographic characteristics of adolescents with asthma and low risk for sleep-disordered breathing.

The aim of this study was to describe the polysomnographic characteristics of adolescents with asthma who are at low risk for sleep-disordered breathing (SDB) based on the Pediatric Sleep Questionnaire (PSQ). Overnight polysomnography was performed on 85 adolescents with asthma and a score < 0.33 on the PSQ. The Asthma Control Questionnaire was used to define "well-controlled" versus "inadequately controlled" asthma. Mean age of participants was 14.5 ± 1.6years (range, 11 to 17years), 63.5% were girls, 57.6% were Caucasians, and the mean body mass index percentile was 65.1 ± 26.5. Asthma was well-controlled in 51.7% of the adolescents and inadequately controlled in 15.3%. Mean sleep efficiency (SE) was 88.0 ± 11.1%, and 24.7% had SE < 85%. Mean wakefulness after sleep onset (WASO) was 40.9 ± 44.0min, and the mean arousal index was 10.8 ± 5.6 per hour. The mean apnea/hypopnea index (AHI) was 2.3 ± 4.2, and 29.4% of participants had SDB (defined by an AHI ≥ 2). Compared with normative values, adolescents with asthma had more nocturnal awakenings and WASO, and less REM sleep. SDB risk was higher in boys [odds ratio = 4.6 (confidence interval 1.4-14.7), p = 0.01]. Asthma control did not impact sleep and respiratory parameters, with no differences found between youth with well-controlled and inadequately controlled asthma. Adolescents with asthma are at increased risk of sleep-disordered breathing and suffer from disturbances in sleep continuity with more arousals and sleep fragmentation. Study results highlight the importance of proper screening for sleep-disordered breathing in adolescents with asthma.

0896 DO NOT WAIT FOR CHILD OBESITY: OVERWEIGHT LEADS TO SLEEP DISORDERED BREATHING AND WEIGHT LOSS TO ITS REMISSION IN PRE-PUBERTAL CHILDREN TRANSITIONING TO ADOLESCENCE

Identifying the factors that predict the incidence, persistence, and remission of sleep disordered breathing (SDB) in the transition from childhood to adolescence is essential for its prevention. We investigated the role of body weight on the natural history of SDB in pre-pubertal children transitioning to adolescence. Data from the Penn State Child Cohort, a randomly- selected sample of 421 children (5-12y) followed-up as adolescents (12-23y) was used. Incidence, persistence and remission of SDB, including primary snoring and obstructive sleep apnea (OSA), was ascertained by in-lab, 9-hour polysomnography (PSG). Body mass index (BMI) percentile and its change from baseline to follow-up (∆BMI) was ascertained during the physical examination. Overweight children had 2.6-fold odds (95%CI 1.02–6.52) of developing OSA in adolescence and obese children had 3.4-fold odds (95%CI 1.55–7.23) of persisting with SDB in adolescence. In contrast, weight loss was significantly associated with remitting from SDB, particularly among children with normal tonsil or adenoid size (-12.0 ± 5.2 ∆BMI percentiles) but not among those with enlarged tonsils and/or adenopathy in childhood (-1.0 ± 4.3 ∆BMI percentiles). Only 4.4% of the remitted SDB cases had a history of adeno/tonsillectomy. These data support a causal role for overweight, obesity and weight loss in the development, chronicity and remission, respectively, of SDB in the transition from childhood to adolescence. Thus, weight loss should be pursued already in overweight children in order to prevent SDB. Importantly, neither weight loss nor adeno/tonsillectomy were predictive of the remission of SDB in a large proportion of children with a history of enlarged tonsils and/or adenopathy. These data support that the remission of SDB in these children is related to normal developmental trajectories of the upper airway and, thus, frequent watchful waiting may be indicated. National Institutes of Health R01 HL63772, R01 HL97165, UL1 TR000127, C06 RR16499

Natural history of sleep disordered breathing in prepubertal children transitioning to adolescence.

Because there is a lack of agreed upon diagnostic criteria, it is critical to understand the natural history of obstructive sleep apnoea (OSA) in children in order to establish treatment strategies based on objective data.The Penn State Child Cohort is a representative, general-population sample of 700 elementary school children at baseline, of whom 421 were reassessed 8 years later, during adolescence.The remission of childhood apnoea-hypopnoea index (AHI) ≥2 events per h in adolescence was 52.9%. Using the higher threshold of AHI ≥5 events per h, remission was 100.0%, with 50.0% partially remitting to AHI 2- <5 events per h and the other half remitting to AHI <2 events per h. The incidence of adolescent AHI ≥2 events per h in those with childhood AHI <2 events per h was 36.5%, while the incidence of AHI ≥5 events per h in those with childhood AHI <5 events per h was 10.6%. This longitudinal study confirms that prepubertal OSA tends to resolve naturally during the transition to adolescence, and that primary snoring and mild sleep disordered breathing (SDB) do not appear to be strongly associated with progression to more severe SDB.The key risk factors for SDB in adolescence are similar to those found in middle-aged adults (i.e. male sex, older age and obesity). Moreover, consistent with recent studies in adults, this study includes the novel cross-sectional finding that visceral fat is associated with SDB as early as adolescence.

Sleep-Disordered Breathing in Adolescents and Younger Adults: A Representative Population-Based Survey in Chile.

Prevalence and potential risk contributors of sleep-disordered breathing (SDB) in adolescents and younger adults remain unclear. We hypothesized that SDB prevalence in younger Hispanic adults is higher than the limited evidence indicates. This is a population-based study of Hispanic subjects surveyed as part of the Chilean National Health Survey database. For this study, only subjects aged 15 to 40 years were included. Sleep and demographic questionnaires were used to assess SDB prevalence and its risk factors. Anthropometric measurements were performed in each subject. Prevalence was calculated for each SDB-related symptom. A regression model was constructed to investigate demographic risk factors of SDB. A total of 2,147 subjects were included. Mean age (± SD) was 27.2 ± 7.2 years, n = 899 (42%) were men. Habitual snoring was highly prevalent, with an average of 53.8% in men and 38.3% in women. Snoring, witnessed apneas, and daytime somnolence increased continuously with age, with an abnormal SDB questionnaire score detected in 2.5%. Reported sleep duration was 7.61 ± 1.67 hours during weekdays and 8.27 ± 2.11 hours during weekends. Snoring frequency was significantly higher in men than women at nearly all age groups, and an adjusted regression model (OR [95% CI]) identified male sex (2 [1.6-2.5]; P < .001) and BMI (1.08 [1.03-1.12]; P < .001) as independent risk factors for snoring. The risk of SDB is highly prevalent in younger adults, even in females, and increases with age and BMI. The high prevalence and low awareness justify active screening and treatment of SDB in this population.

Abstract P105: Sleep Disordered Breathing and Cardiac Autonomic Modulation in Adolescents - Penn State Child Cohort (PSCC) Study

Objectives: To investigate the relationship between sleep disordered breathing (SDB) and cardiac autonomic modulation (CAM) in a population-based sample of adolescents. Methods: We used available data from 400 adolescents who completed the follow up examinations in the population-based PSCC study. 1-night polysomnography was used to assess apnea hypopnea index (AHI). AHI was used to define no-SDB (AHI&lt;1), mild SDB (1≤AHI&lt;5), and moderate SDB (AHI≥5). CAM was assessed by heart rate variability (HRV) analysis of beat-to-beat normal R-R intervals from a 39-hour high resolution Holter ECG. The HRV indices in frequency domain [high frequency power (HF), low frequency power (LF), and LF/HF ratio] and time domain [standard deviation of normal RR intervals (SDNN), and the square root of the mean squared difference of successive normal RR intervals (RMSSD), and heart rate (HR)] were calculated on a 30-minute basis (78 repeated measures). Mixed-effects models were used to assess the SDB and HRV relationship. Results: The mean age was 16.9 yrs (SD=2.19), with 54% male and 77% white. The mean (SD) AHI were 0.52 (0.26), 2.38 (1.03), and 12.27 (14.54) for no-, mild-, and moderate-SDB participants. The age, race, sex, and BMI percentile adjusted mean (SE) HRV indices across three SDB groups are presented in Table 1. In summary, sleep disordered breathing was associated with lower HRV and higher HR in this population-based adolescent sample, with a significant dose-response relationship. Conclusion: moderate SDB in adolescents is already associated with lower HRV, indicative of sympathetic activation and lower parasympathetic modulation, which has been associated with cardiac events in adults.

Abstract P249: Incident Sleep-Disordered Breathing is Associated with Obesity: Penn State Child Cohort

Objectives: To study the epidemiology of sleep-disordered breathing (SDB) in adolescents, which has received little attention. Methods: The Penn State Child Cohort (PSCC) is a representative general population sample of 700 children aged 5-12 years. Our preliminary results are based on an average 8 year follow up of the initial 300 prospective subjects (~43%) from this ongoing cohort study. A logistic regression was used to assess the association between potential risk factors and incident SDB. Results: The mean age at the 8-year follow up examination was 17.2 ± 0.1 years, with an average BMI percentile of 66.6 ± 1.6 and 56.5% boys. At baseline 1.5% of this subsample had SDB, defined by Apnea Hypopnia Index (AHI &gt; 5 /hour). Surprisingly, there was no persistence of SDB. Eight-year incident SDB was 10.5%. The average AHI in those with incident SDB was 12.7 with a maximum of 92.4. Incident SDB was similar for girls (7.8%) and boys (12.7%). Those with SDB were older than those without (18.7 vs 17.0 years, P&lt;0.001) and girls with SDB were older than boys with SDB (20.0 vs 18.0 years, P=0.002). Those with incident SDB tended to have a greater change in BMI percentile (8.2 vs 1.8, P = 0.143) during the follow up and slightly higher minority representation (25.8% vs 21.9%, P=0.655). A logistic regression model identified three variables that were associated with incident SDB, controlling for baseline AHI: age (OR = 1.5 (1.3, 1.9) P&lt;0.001), male (OR= 2.5 (1.11,10.00) P=0.021), and [[Unable to Display Character: &amp;#8710;]]BMIPCT (OR=1.2(1.02, 1.5) P=0.032). Conclusion: In this population based sample of adolescents, the 8-year incidence of SDB was high (10.5%), whereas childhood SDB did not persist into adolescence. Further, the results indicate that risk factors for incident SDB in adolescents are age, male and the development of obesity.

Prevalence of habitual snoring and symptoms of sleep-disordered breathing in adolescents

Objective Sleep-disordered breathing is an important public health problem in adolescents. The aim of this study was to investigate the prevalence and risk factors of habitual snoring and symptoms of sleep-disordered breathing in adolescents. Methods A cross-sectional study was conducted with children from primary schools and high schools that the ages ranged from 12 to 17 years. Data were collected by physical examination and questionnaires filled in by parents regarding sleep habits and possible risk factors of snoring. According to answers, children were classified into three groups: non-snorers, occasional snorers, and habitual snorers. Results The response rate was 79.2%; 1030 of 1300 questionnaires were fully completed and analyzed. The prevalence of habitual snoring was 4.0%. Habitual snorers had significantly more nighttime symptoms including observed apneas, difficulty breathing, restless sleep and mouth breathing during sleep compared to occasional and non-snorers. Prevalence of habitual snoring was increased in children who had had tonsillar hypertrophy, allergic rhinitis, and maternal smoking. Conclusion We found the prevalence of habitual snoring to be 4.0% in adolescents from the province of Manisa, Turkey which is low compared to previous studies. Habitual snoring is an important problem in adolescents and habitual snorers had significantly more nighttime symptoms of sleep-disordered breathing compared to non-snorers.

Association between metabolic syndrome and sleep-disordered breathing in adolescents.

Metabolic syndrome (MetS) affects 4 to 10% of adolescents. Risk factors include overweight, male sex, and Hispanic ethnicity. Although sleep-disordered breathing (SDB) has been implicated as a risk factor for MetS in adults, its association with SDB in adolescents is unknown. To define the association of SDB with MetS in adolescents. Standardized measurements of SDB, anthropometry and bioassays, were made in 270 adolescents, aged 13.6 +/- 0.7 years. MetS was identified if threshold levels were exceeded in three of five areas: waist circumference, blood pressure, triglyceride level, high-density lipoprotein cholesterol level, and glucose levels. Although 70% of children with SDB (apnea-hypopnea index >or= 5) were overweight and 59% had MetS, 16% of children without SDB had MetS. Twenty-five percent of those with MetS had SDB. After adjusting for age, race, sex, and preterm status, children with SDB had a 6.49 (95% confidence interval, 2.52, 16.70) increased odds of MetS compared with children without SDB. Indices of SDB stress associated with MetS included respiratory event frequency, degree of oxygen desaturation, and sleep efficiency. Analyses of individual metabolic parameters showed that, after adjustment for body mass index, SDB was associated with systolic and diastolic blood pressure, low-density lipoprotein cholesterol, and fasting insulin levels. A majority of adolescents with SDB are overweight and meet criteria for MetS. The close association between MetS and SDB and their putative interacting pathophysiologies suggests a need to develop screening, prevention, and treatment strategies for both disorders in high-risk, overweight adolescents.

ADHD Linked to Sleep-Disordered Breathing in Adolescents

ADHD Linked to Sleep-Disordered Breathing in Adolescents

Effects of sex on sleep-disordered breathing in adolescents.

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred > 1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared < 1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean +/- SD age 13.5 +/- 1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3 +/- 1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.