RESUMEN
OBJECTIVE: To assess whether sleep-disordered breathing (SDB) is a risk factor of the metabolic syndrome (MS) in children and adolescents who are overweight and to examine whether the severity of SDB was independently associated with glucose intolerance, insulin resistance, and/or dyslipidemia. STUDY DESIGN: Consecutive subjects who were overweight or obese underwent polysomnography, fasting blood sample, and oral glucose tolerance test (for calculation of area under the curve [AUC]). SDB was defined as a respiratory disturbance index > or = 2. MS was present when > or = 3 of these factors were present: waist circumference > or = 90th percentile; fasting glucose level > or = 110 mg/dL; triglyceride level > or = 110 mg/dL; high-density lipoprotein cholesterol level < or = 40 mg/dL; blood pressure > or = 90th percentile. RESULTS: A total of 104 subjects were included in the study (44% boys; 58% prepubertal; mean age, 11.1 +/- 2.6 years; 69% obese). Mean SaO2 (odds ratio, 0.54) and SaO2nadir (odds ratio, 0.89) were independent, significant predictors of the presence of MS. Multiple regression showed significant associations between SaO2nadir and high-density lipoprotein cholesterol level, mean SaO2 and both AUC glucose and triglyceride levels, and between the percentage of total sleep time with SaO2 > or = 95% and cholesterol level, while controlling for adiposity and sex, puberty, or both. CONCLUSION: This study supports the hypothesis of an interaction between SDB and metabolic abnormalities, independent of estimates of body fat distribution, in children and adolescents who are overweight and obese.
Asunto(s)
Síndrome Metabólico/epidemiología , Sobrepeso , Síndromes de la Apnea del Sueño/epidemiología , Adolescente , Área Bajo la Curva , Glucemia/análisis , Niño , Comorbilidad , Femenino , Humanos , Masculino , Obesidad/epidemiología , Sobrepeso/fisiología , Polisomnografía , Factores de RiesgoRESUMEN
We conducted a metaanalysis and methods review of 80 studies, published in the last decade, that explored the outcome of low birth weight infants; 27% involved infants whose birth weights were less than or equal to 2500 gm (low birth weight), 44% less than or equal to 1500 gm (very low birth weight), and 29% less than or equal to 1000 gm (extremely low birth weight). Problems found in these studies were grouped into three categories: subject and methods issues, environmental factors, and outcome measurement. The combined average intelligence quotient/developmental quotient (IQ/DQ) of all low birth weight groups was 97.77 (SD 6.19); for control subjects the mean IQ/DQ was 103.78 (SD 8.16). This difference was statistically significant but perhaps not clinically significant. No differences in mean IQ/DQ scores were found among the low birth weight, very low birth weight, and extremely low birth weight subgroups. Statistically significant differences among all groups and control subjects were found when categoric data were analyzed, as were differences among the three subgroups; however, the variety of outcome criteria makes interpretation of the categoric analyses difficult.