Conference Coverage

Pediatric OSA linked to abnormal metabolic values

 

Key clinical point: Children with obesity and obstructive sleep apnea have an abnormal metabolic profile.

Major finding: Diastolic blood pressure (65 vs. 58 mm Hg), heart rate (89 vs. 78 bpm), triglycerides (138 vs. 84 mg/dL), alanine transaminase (26 vs. 18 U/L), aspartate transaminase (23 vs. 18 U/L) and hemoglobin A1c (6.2% vs. 5.4%) were all elevated in obese children with OSA, compared with obese children without OSA.

Study details: The findings are based on a retrospective analysis of 81 patients aged 3-21 years, from the Children’s Hospital at Montefiore between November 2016-November 2017.

Disclosures: No external funding was noted. The authors reported having no disclosures.


 

REPORTING FROM CHEST 2018

  • Alanine transaminase: 26 U/L with OSA vs. 18 U/L without (P = .01).
  • Aspartate transaminase: 23 U/L with OSA vs. 18 U/L without (P = .03).
  • Triglycerides: 138 mg/dL with OSA vs 84 mg/dL without (P = .004).
  • Hemoglobin A1c: 6.2% with OSA vs. 5.4% without (P = .002).

Children with and without OSA did not have any significant differences in left atrial indexed volume, left ventricular volume, left ventricular ejection fraction, or left ventricular mass (measured by M-mode or 5/6 area length formula). Though research has shown these measures to differ in adults with and without OSA, evidence on echocardiographic changes in children has been conflicting, Dr. Mathur noted.

The researchers also conducted subanalyses according to OSA severity, but BMI, BMI Z-score, systolic or diastolic blood pressure Z-score, heart rate and oxygen saturation did not differ between those with mild OSA vs those with moderate or severe OSA. No differences in echocardiographic measurements existed between these subgroups, either.

However, children with moderate to severe OSA did have higher alanine transaminase (27 U/L with moderate to severe vs. 17 U/L with mild OSA; P = .005) and higher triglycerides (148 vs 74; P = .001).

“Certainly we need further evaluation to see the efficacy of obstructive sleep apnea therapies on metabolic dysfunction and whether weight loss needs to be an adjunct therapy for these patients,” Dr. Mathur told attendees. She also noted the need to define the role of echocardiography in managing children with OSA.

The study had several limitations, including its retrospective cross-sectional nature at a single center and its small sample size.

Dr. Shahid Sheikh, Nationwide Children’s Hospital, Columbus, Ohio Andrew D. Bowser/MDedge News

Dr. Shahid Sheikh

“Additionally, we have a wide variety of ages, which could represent different pathophysiology of the associated metabolic dysfunction in these patients,” Mathur said. “There is an inherent difficulty to performing echocardiograms in a very obese population as well.”

Both the moderators of the pediatrics section, Christopher Carroll, MD, FCCP, of Connecticut Children’s Medical Center in Hartford, and Shahid Sheikh, MD, FCCP, of Nationwide Children’s Hospital in Columbus, Ohio, were impressed with the research. Dr. Carroll called it a “very elegant” study, and Dr. Sheikh noted the need for these studies in pediatrics “so that we don’t have to rely on grown-up data,” which may or may not generalize to children.

SOURCE: CHEST 2018. https://journal.chestnet.org/article/S0012-3692(18)31935-4/fulltext

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