Increased inflammation from childhood to adolescence predicts sleep apnea in boys: A preliminary study

Abstract

While chronic systemic inflammation in obstructive sleep apnea (OSA) has been traditionally considered a consequence of intermittent hypoxia, several treatment studies targeting inflammation suggest that this process may precede the development of the disorder. A recent cross-sectional study in the Penn State Child Cohort (PSCC) revealed that inflammation largely mediates the association between visceral adiposity and OSA in adolescence. The purpose of this study was to examine for the first time whether, longitudinally, inflammation precedes OSA during this developmental period. A subsample of the PSCC with longitudinal sleep and inflammation data (n=51) was included in this study. Participants underwent 9-h polysomnography (22:00-7:00), physical exam, and fasting morning blood draw at both time points. Plasma C-reactive protein (CRP) was measured via ELISA. At follow-up, visceral, subcutaneous, and total fat area were assessed via dual X-ray absorptiometry. Sex differences in body composition emerged in adolescence, with boys having more visceral adiposity than girls. Longitudinal increases in waist circumference from childhood to adolescence were associated with increases in CRP (ΔCRP) and follow-up CRP in boys, but not girls. Furthermore, in boys, ΔCRP was associated with higher follow-up apnea/hypopnea index (AHI). When ΔCRP was entered into a model predicting follow-up AHI, Δwaist circumference was no longer significant, indicating that inflammation largely explains the association between increasing central obesity and OSA severity. These preliminary findings, in a longitudinal, non-clinical sample of children developing OSA, suggest that inflammation derived from visceral adipose tissue precedes the development of the disorder, suggesting a potential causal mechanism.

The relationship between inflammation and neurocognitive dysfunction in obstructive sleep apnea syndrome

“…Interestingly, all of these biomarkers except fibrinogen were correlated with sleep time spent with SaO 2 less than 90% (TST90), and fibrinogen was related to active smoking [ 34 ]. Similar studies conducted by other researchers demonstrated parallel results; CRP was positively correlated with AHI, even adjusted for BMI [ 39 – 42 ].…”

Obstructive sleep apnea and the metabolic syndrome: The road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment

“…Visceral fat accounts for 5–8% of total body fat in women and increases during menopause, and up to 10–20% in men [23], which may, in large part, explain the sex dimorphism in OSA prevalence. Of note, longitudinal pediatric studies have also demonstrated that incident OSA in adolescents is most strongly predicted by childhood waist circumference [24], and OSA severity in adolescence is positively associated with a greater increase in waist circumference between childhood and adolescence [25].…”

Current child, but not maternal, snoring is bi-directionally related to adiposity and cardiometabolic risk markers: A cross-sectional and a prospective cohort analysis

“…Similarly, children with resolved OSA showed increased baroreflex sensitivity and children with resolved or unresolved OSA demonstrated decreased blood pressure variability after four years [50]. Increased hsCRP, denoting increased inflammation, in childhood was related to later worsened OSA in adolescence in another study [21]. A full prospective evaluation of potential cardiometabolic biomarkers and adiposity with snoring is completed for the first time herein.…”

“…A few prospective studies have looked at only inflammation and overweight/obesity in association with snoring and OSA, but not in-depth the complete spectrum of cardiometabolic biomarkers [20,21]. For instance, OSA in obese children was associated with greater visceral fat area derived using MRI [22].…”