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. 2025 Oct:194:156998.
doi: 10.1016/j.cyto.2025.156998. Epub 2025 Jul 18.

Appetite adipokines and insulin resistance shape the link between sleep quality and cardiac structure in youths with cardiometabolic risk: the BCAMS study

Mengyu He  1 , Ling Zhong  1 , Lanwen Han  2 , Xinghao Yi  1 , Ming Li  3 , Shan Gao  4
Affiliations

Appetite adipokines and insulin resistance shape the link between sleep quality and cardiac structure in youths with cardiometabolic risk: the BCAMS study

Mengyu He et al. Cytokine. 2025 Oct.

Abstract

Background: Poor sleep quality (PSQ) is associated with cardiovascular disease, but the key intermediate variables underlying this relationship in youths remain unclear. We aimed to explore the relationship between PSQ and adverse cardiac structure in Chinese youths with elevated cardiometabolic risk, focusing on the roles of appetite adipokines and insulin resistance.

Methods: We utilized cross-sectional data from the Beijing Children and Adolescents Metabolic Syndrome (BCAMS) Study Cohort (n = 559, mean age = 20.2 years). Participants underwent echocardiographic assessments, a sleep quality questionnaire, an oral glucose tolerance test, and plasma levels of insulin and five appetite adipokines.

Results: Elevated PSQ scores were associated with adverse left ventricular mass index (LVMI) (0.64 g/m2.7 per unit increase in PSQ score), altered appetite adipokines, including 8.3 % higher leptin, 1.9 % higher retinol-binding protein 4 (RBP4), and 3.2 % lower high-molecular-weight adiponectin (HMW-adiponectin), as well as impaired insulin sensitivity, reflected by 6.6 % higher fasting insulin levels, 6.7 % higher homeostasis model assessment of insulin resistance (HOMA-IR), and 4.9 % lower insulin sensitivity index (Matsuda Index) (ISIMatsuda), per point increase in PSQ score (all p < 0.05). In mediation analyses, leptin significantly mediated 28.5 % of the PSQ-LVMI association (p < 0.001), and insulin-related indices explained 13.6 %-23.6 % (p < 0.05); HMW-adiponectin showed a marginal mediating effect (8.1 %, p = 0.077). Furthermore, interaction analysis revealed that insulin resistance amplified the adverse impact of PSQ on LVMI (pinteraction = 0.04 for HOMA-IR; 0.029 for ISIMatsuda), with high PSQ-related elevations in LVMI more pronounced among youths with higher insulin resistance.

Conclusions: PSQ is associated with early adverse cardiac remodeling in youths with cardiometabolic risk, potentially driven by elevated leptin and insulin resistance. Targeting sleep quality, adipokine signaling, and insulin sensitivity, may offer synergistic strategies for early cardiovascular prevention in at-risk youths.

Keywords: Cardiac structure; Insulin resistance; Leptin; Sleep quality; Youth.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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