非糖尿病肥胖儿童中胰岛素抵抗与阻塞性睡眠呼吸暂停之间的关联

文献信息

中文摘要

背景： 尽管多项研究已证明阻塞性睡眠呼吸暂停（OSA）与胰岛素抵抗之间存在独立关联，但证据仍不一致。我们旨在探讨非糖尿病肥胖儿童中OSA的存在及严重程度与胰岛素抵抗之间的关系，并探索稳态模型评估-胰岛素抵抗指数（HOMA-IR）在识别OSA高风险儿童中的潜在作用。方法：回顾性分析接受多导睡眠监测的6-18岁肥胖儿童。排除患有糖尿病、神经肌肉疾病、颅面畸形或正在接受影响胰岛素敏感性治疗的患者。从病历中提取年龄、性别、BMI和口服葡萄糖耐量试验（OGTT）结果，并计算HOMA-IR。根据阻塞性呼吸暂停低通气指数（OAHI）将患者分为两组：<2次/小时和≥2次/小时。对HOMA-IR进行ROC分析，以确定识别OSA患者的最佳截断值。结果：共纳入90名肥胖儿童，其中39名（43.3%）患有OSA。两组在年龄和性别方面具有可比性。OSA组的中位HOMA-IR值显著更高（p=0.014）。总OAHI与HOMA-IR呈中度正相关（ρ=0.325，p=0.002），与OGTT期间测得的基线胰岛素水平也呈中度正相关（ρ=0.323，p=0.002）。在多元线性回归分析中，调整年龄、性别、BMI z评分、睡眠效率和青春期状态后，HOMA-IR仍与OSA严重程度独立相关（β=0.691，p=0.025）。ROC分析确定HOMA-IR截断值为3.39，对OSA的敏感性为72%，特异性为59%。结论：HOMA-IR与肥胖儿童的OSA严重程度独立相关，提示胰岛素抵抗可能作为一种有用的辅助标志物，用于识别高风险患者并优先安排PSG评估。已知内容：• 儿童肥胖与阻塞性睡眠呼吸暂停（OSA）和胰岛素抵抗均密切相关。胰岛素抵抗是否在肥胖效应之外促进OSA风险仍存在争议。• 多导睡眠监测（PSG）的可及性有限，因此迫切需要实用工具来识别OSA风险最高的儿童。新发现：• 据我们所知，这是首个评估HOMA-IR作为识别肥胖儿童阻塞性睡眠呼吸暂停风险增加工具、并提出临床可用的HOMA-IR阈值以优先安排多导睡眠监测转诊的儿科研究。• 在非糖尿病肥胖儿童中，胰岛素抵抗与OSA严重程度独立相关，与肥胖、青春期状态和其他临床相关混杂因素无关。HOMA-IR≥3.39的儿童阻塞性睡眠呼吸暂停负担显著更重。这些发现支持HOMA-IR作为一种简单、广泛可用的生物标志物，可帮助优先安排肥胖儿童进行PSG评估，并改善儿科睡眠医学中的风险分层。

英文摘要

UNLABELLED: Although several studies have demonstrated an independent association between obstructive sleep apnea (OSA) and insulin resistance, the evidence remains inconsistent. We aimed to investigate the relationship between the presence and severity of OSA and insulin resistance in non-diabetic children with obesity and to explore the potential role of homeostasis model assessment-insulin resistance index (HOMA-IR) in identifying children at higher risk for OSA. Children with obesity aged 6-18 years who underwent polysomnography were retrospectively analyzed. Patients with diabetes, neuromuscular disorders, craniofacial anomalies, or those receiving treatment affecting insulin sensitivity were excluded. Age, sex, BMI, and oral glucose tolerance test (OGTT) results were extracted from medical records, and HOMA-IR was calculated. Patients were divided into two groups based on their obstructive apnea-hypopnea index (OAHI): < 2 and ≥ 2 events/h. ROC analysis was performed for HOMA-IR to determine the optimal cutoff value for identifying patients with OSA. A total of 90 children with obesity were enrolled, among whom 39 (43.3%) had OSA. The groups were comparable in terms of age and sex. Median HOMA-IR values were significantly higher in the OSA group (p = 0.014). Total OAHI showed moderately positive correlation with HOMA-IR (ρ = 0.325, p = 0.002), and baseline insulin levels measured during OGTT (ρ = 0.323, p = 0.002). In multiple linear regression analysis, HOMA-IR remained independently associated with OSA severity after adjustment for age, sex, BMI z-score, sleep efficiency, and pubertal status (β = 0.691, p = 0.025). ROC analysis identified a HOMA-IR cutoff of 3.39, with 72% sensitivity and 59% specificity for OSA.
CONCLUSION: HOMA-IR was independently associated with OSA severity in children with obesity, suggesting that insulin resistance may serve as a useful adjunct marker for identifying patients at higher risk and prioritizing PSG evaluation.
WHAT IS KNOWN: • Childhood obesity is strongly associated with both obstructive sleep apnea (OSA) and insulin resistance. Whether insulin resistance contributes to OSA risk beyond the effect of obesity remains controversial. • Access to polysomnography (PSG) is limited, creating an unmet need for practical tools to identify children at greatest risk for OSA.
WHAT IS NEW: • To our knowledge, this is the first pediatric study to evaluate HOMA-IR as a tool for identifying children with obesity at increased risk of obstructive sleep apnea and to propose a clinically applicable HOMA-IR threshold for prioritizing polysomnography referral. • In non-diabetic children with obesity, insulin resistance was independently associated with OSA severity, regardless of obesity, pubertal status, and other clinically relevant confounders. Children with HOMA-IR ≥ 3.39 had a substantially greater burden of obstructive sleep apnea. These findings support HOMA-IR as a simple, widely available biomarker that could help prioritize children with obesity for PSG evaluation and improve risk stratification in pediatric sleep medicine.