Glycated hemoglobin and sleep apnea syndrome in children: beyond the apnea-hypopnea index

Abstract

Purpose: Snoring and obstructive sleep apnea syndrome (OSA) are frequent conditions in pediatrics. Glycated hemoglobin (Hb_A1C) is a useful homeostatic biomarker of glycemia and may reflect alterations deriving from sleep breathing disorders. The aim of this study was to relate the severity of OSA with blood Hb_A1C levels in children.

Methods: A descriptive observational study in snoring patients was performed. All patients underwent a sleep study and classified either as simple snorers (apnea-hypopnea index; AHI ≤ 1 episodies/h) or as OSA patients (AHI > 1 episodes/h). In the following morning, a blood glycemic profile (fasting glucose, insulin, Hb_A1C, and the HOMA index) was performed to every individual.

Results: A total of 48 patients were included. Hb_A1C levels were shown to be increased in the moderate OSA (AHI > 5 episodes/h) group (5.05 ± 0.25 vs. 5.24 ± 0.29%; p = 0.019). Significant correlations were found between Hb_A1C values and AHI (r = 0.345; p = 0.016) and also with oxygen desaturation index (r = 0.40; p = 0.005). Correlations remained significant after adjusting by age and body mass index. The AHI-associated change in Hb_A1C was 13.4% (p = 0.011).

Conclusions: In the pediatric population, Hb_A1C is a biomarker associated with OSA severity, and this relationship is age- and obesity-independent. The fact that this association was observed in snoring patients could help the physician in the distinction between those patients affected with OSA and those with simple snoring. Therefore, Hb_A1C measurement could play a major role in the diagnosis and the management of the syndrome.

Keywords: Glycated hemoglobin; Pediatric sleep disorder; Sleep apnea; Sleep disorder breathing; Snoring.