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. 2012 Mar;141(3):682-691.
doi: 10.1378/chest.11-1777. Epub 2011 Oct 26.

Endothelial dysfunction in children without hypertension: potential contributions of obesity and obstructive sleep apnea

Rakesh Bhattacharjee  1 , Jinkwan Kim  2 , Wadha H Alotaibi  3 , Leila Kheirandish-Gozal  4 , Oscar Sans Capdevila  3 , David Gozal  5
Affiliations

Endothelial dysfunction in children without hypertension: potential contributions of obesity and obstructive sleep apnea

Rakesh Bhattacharjee et al. Chest. 2012 Mar.

Abstract

Background: Endothelial dysfunction can develop in the context of both obesity and obstructive sleep apnea (OSA) in children. However, the potential interactions between OSA and obesity have not been defined.

Methods: Children who were prepubertal and nonhypertensive were recruited. Endothelial function was assessed in a morning fasted state, using a modified hyperemic test involving cuff-induced occlusion of the radial and ulnar arteries, and blood was drawn for assessment of myeloid-related protein 8/14 (MRP8/14) levels using a commercial enzyme-linked immunosorbent assay. Overnight polysomnography defined the presence of OSA or absence of OSA (NOSA) in subjects investigated for sleep-disordered breathing. Anthropometric measurements were performed to assign subjects to obese (OB) and nonobese (NOB) categories.

Results: Fifty-four children with OSA who were obese and nonobese (mean age, 7.90 ± 0.26 years; mean BMI z-score, 1.70 ± 0.3; obstructive apnea-hypopnea index [OAHI], 7.36 ± 1.09) were compared with 54 children without OSA who were obese and nonobese (mean age, 8.26 ± 0.24 years; mean BMI z-score, 1.41 ± 0.18; OAHI, 0.86 ± 0.07). Of those subjects, 62.5% of the OB-OSA category, 38.7% of the OB-NOSA category, and 20.0% of the NOB-OSA category had evidence of endothelial dysfunction, compared with 0.0% of the NOB-NOSA category (P < .01). The degree of endothelial dysfunction in all groups was associated with circulating MRP8/14 levels (r = 0.343, P < .001).

Conclusions: Both obesity and OSA can independently increase the risk for endothelial dysfunction, and the concurrent presence of both markedly increases such risk. Although the mechanisms underlying endothelial dysfunction remain unclear, a potential role for MRP8/14 as an inflammatory biomarker of endothelial dysfunction is suggested.

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Figures

Figure 1.
Figure 1.
Results of representative cuff occlusion tests. A, In a child with normal endothelial function. B, In a child with abnormal endothelial function. AH = area of hyperemia; AO = area of occlusion; BZ = biologic zero; PF = peak flow; PU = perfusion unit; RF = rest flow; TM = time to peak flow following occlusion.
Figure 2.
Figure 2.
Graph shows endothelial function in children who are obese and nonobese, with and without obstructive sleep apnea (OSA). AHI = apnea-hypopnea index; OAHI = obstructive apnea-hypopnea index; Tmax = time to peak regional blood flow response postocclusion release.
Figure 3.
Figure 3.
Wafer graph illustrates the associations between time to peak flow, BMI z-score, and OAHI. See Figure 2 legend for expansion of the abbreviations.
See this image and copyright information in PMC

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