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Sleep disordered breathing and autonomic function in overweight and obese children and adolescents

Annelies Van Eyck, Kim Van Hoorenbeeck, Benedicte Y. De Winter, Luc Van Gaal, Wilfried De Backer, Stijn L. Verhulst
ERJ Open Research 2016 2: 00038-2016; DOI: 10.1183/23120541.00038-2016
Annelies Van Eyck
1Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
2Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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  • For correspondence: Annelies.vaneyck@uantwerpen.be
Kim Van Hoorenbeeck
1Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
2Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Benedicte Y. De Winter
1Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Luc Van Gaal
1Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
3Dept of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
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Wilfried De Backer
1Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
4Dept of Pulmonology, Antwerp University Hospital, Edegem, Belgium
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Stijn L. Verhulst
1Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
2Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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  • Article
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Tables

  • Supplementary Materials
  • TABLE 1

    Comparison of characteristics of subjects with and without obstructive sleep apnoea (OSA)

    Non-OSAOSAp-value
    Subjects13160
    Male/female44/8724/360.4#
    Age years12 (6–18)11 (5–17)0.1¶
    Height m1.55 (1.14–1.83)1.51 (1.07–1.86)0.1¶
    Weight kg71.0 (30.4–129.8)67.3 (28.0–137.0)0.3¶
    BMI z-score2.5 (1.5–3.5)2.5 (1.7–4.1)0.6¶
    Waist circumference cm92.4±13.693.2±17.10.7+
    WHR0.89 (0.75–1.02)0.92 (0.79–1.04)<0.001¶
    Fat mass %36.9 (25.7–60.4)36.1 (27.3–53.1)0.9¶
    TST min512 (169–637)512 (293–648)0.6¶
    oAHI events·h−10.5 (0.0–1.9)4.9 (2.0–67.3)<0.001¶
    RDI events·h−10.85 (0.00–4.80)5.90 (2.00–67.70)<0.001¶
    Mean SpO2 %97.2 (91.2–98.2)96.7 (91.9–98.6)0.001¶
    SpO2 nadir %93 (80–100)91 (81–100)<0.001¶
    TST95 %99.7 (25.6–100.0)98.0 (2.4–100.0)<0.001¶
    ODI events·h−10.3 (0.0–8.4)0.8 (0.0–33.8)<0.001¶
    N1 %TST2 (0–13)2 (0–16)0.6
    N2 %TST51 (28–72)45 (8–65)<0.001
    N3 %TST22 (4–48)28 (8–65)<0.001
    REM %TST23 (0–36)23 (5–37)0.7
    • Data are presented as n, mean±sd or median (range), unless otherwise stated. BMI: body mass index; WHR: waist-to-hip ratio; TST: total sleep time; oAHI: obstructive apnoea–hypopnoea index; RDI: respiratory disturbance index; SpO2: arterial oxygen saturation measured by pulse oximetry; TST95: TST with SpO2 >95%; ODI: oxygen desaturation index; N1–N3: sleep stages; REM; rapid eye movement. #: Chi-squared test; ¶: Mann–Whitney U-test; +: independent sample t-test. p≤0.05 was considered statistically significant.

  • TABLE 2

    Urinary free cortisol (UFC) levels and heart rate variability parameters of subjects with and without obstructive sleep apnoea

    oAHI <2oAHI ≥2p-value
    UFC µg·24 h–136 (1–157)46 (12–171)0.7¶
    Mean RR interval ms802.3 (598.3–1182.4)758.7 (605.2–1006.3)0.02¶
    SDNN ms96.9 (34.6–198.7)94.5 (39.6–177.2)0.3¶
    Mean HR beats·min−175.88±9.7980.20±9.660.008#
    LF bands %15.5 (5.4–30.5)17.0 (8.3–40.4)0.07¶
    HF bands %21.4 (3.2–63.2)20.2 (2.3–54.4)0.4¶
    LF/HF band ratio0.707 (0.168–2.963)0.962 (0.242–12.215)0.05¶
    • Data are presented as median (range) or mean±sd, unless otherwise stated. oAHI: obstructive apnoea-hypopnoea index; UFC: urinary free cortisol; SDNN: standard deviation of RR intervals (normal sinus-to-normal sinus interbeat intervals); HR: heart rate; LF: low-frequency; HF: high-frequency. #: independent sample t-test; ¶: Mann–Whitney U-test. p≤0.05 was considered statistically significant.

  • TABLE 3

    Spearman correlation analysis between sleep-related respiratory measures and heart rate variability parameters

    oAHIRDIMean SpO2SpO2 nadirTST95ODI
    Mean RR interval−0.15#−0.18#0.15#−0.23¶
    SDNN
    Mean HR0.16#0.19#0.23¶
    LF bands
    HF bands0.22¶0.18#0.25¶
    LF/HF band ratio0.17#0.17#−0.23¶−0.20¶−0.25¶
    • Only significant Spearman correlation coefficients are shown. oAHI: obstructive apnoea–hypopnoea index; RDI: respiratory disturbance index; SpO2: arterial oxygen saturation measured by pulse oximetry; TST95: percentage of total sleep time with SpO2 >95%; ODI: oxygen desaturation index; SDNN: standard deviation of RR intervals (normal sinus-to-normal sinus interbeat intervals); HR: heart rate; LF: low-frequency; HF: high-frequency. #: p≤0.05; ¶: p≤0.01.

  • TABLE 4

    Spearman correlation analysis between measures of adiposity and age and measures of heart rate variability

    WaistFat massAge
    Mean RR interval0.34+0.46+
    SDNN0.20¶
    Mean HR−0.34+−0.47+
    LF bands−0.20#
    HF bands−0.24¶
    LF/HF band ratio0.21¶0.17#
    • Only significant Spearman correlation coefficients are shown. BMI: body mass index; WHR: waist-to-hip ratio; SDNN: standard deviation of RR intervals (normal sinus-to-normal sinus interbeat intervals); HR: heart rate; LF: low-frequency; HF: high-frequency. #: p≤0.05; ¶: p≤0.01; +: p≤0.001.

  • TABLE 5

    Linear regression model for mean heart rate (HR), mean RR interval, high-frequency (HF) bands and low/high-frequency (LF/HF) band ratio

    rr2p-value
    Mean HR
     oAHI0.100.260.1
     RDI0.110.270.1
     ODI#0.150.270.03
     Age#−0.36<0.001
     Waist0.100.1
    Mean RR
     RDI−0.880.250.2
     SpO2 nadir0.060.260.4
     ODI#−0.130.260.05
     Age#0.37<0.001
     Waist−0.120.1
    HF bands
     Mean SpO2#0.200.110.007
     SpO2 nadir#0.220.110.005
     Age0.080.3
     Waist#−0.190.01
    LF/HF band ratio
     Mean SpO2#−0.160.030.04
     SpO2 nadir#−0.180.040.02
     Age−0.050.6
     Waist0.050.5
    • HR: heart rate; oAHI: obstructive apnoea–hypopnoea index; RDI: respiratory disturbance index; SpO2: arterial oxygen saturation measured by pulse oximetry; ODI: oxygen desaturation index. Due to multicollinearity, the sleep-related respiratory parameters could not be fitted in a single regression model. Therefore, each r2-value represents a separate regression model with the sleep-related respiratory parameter as an independent variable, controlling for age and waist circumference. #: significant contributors for the model (p≤0.05).

Supplementary Materials

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    S.L. Verhulst 00038-2016_Verhulst

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Sleep disordered breathing and autonomic function in overweight and obese children and adolescents
Annelies Van Eyck, Kim Van Hoorenbeeck, Benedicte Y. De Winter, Luc Van Gaal, Wilfried De Backer, Stijn L. Verhulst
ERJ Open Research Oct 2016, 2 (4) 00038-2016; DOI: 10.1183/23120541.00038-2016

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Sleep disordered breathing and autonomic function in overweight and obese children and adolescents
Annelies Van Eyck, Kim Van Hoorenbeeck, Benedicte Y. De Winter, Luc Van Gaal, Wilfried De Backer, Stijn L. Verhulst
ERJ Open Research Oct 2016, 2 (4) 00038-2016; DOI: 10.1183/23120541.00038-2016
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