Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome
Open accessPublished version of a preprint
Abstract
Obstructive sleep apnea syndrome (OSAS) in childhood is a complex disease primarily due both to adenotonsillar hypertrophy and pediatric obesity. Notably, inflammation has been recognized as one of the most important shared pathogenic factor between obesity and OSAS resulting in an increased cardiometabolic risk for these patients. To date, evidence is still limited in non-obese population with OSAS. We aimed to evaluate the cardiometabolic risk profile of a pediatric population of non-obese subjects affected by OSAS. A total of 128 school-aged children (mean age 9.70 ± 3.43) diagnosed with OSAS and 213 non-OSAS children (mean age 9.52 ± 3.35) as control group were enrolled. All subjects underwent a complete clinical and biochemical assessment (including white blood cell count (WBC), platelet count (PLT), mean platelet volume (MPV), % of neutrophils (NEU%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), uric acid, fasting insulin, iron, ferritin, and transferrin levels). A significant association between inflammation markers (including WBC, PLT, MPV, NEU%, ferritin, CPR, and ESR) and OSAS was found (all p < 0.001). Children with OSAS also showed increased transaminase, glucose, uric acid, and insulin levels (all p < 0.001) compared to healthy controls.Conclusion Taken together, these findings suggested a worse cardiometabolic profile in non-obese children with OSAS. Given the pivotal pathogenic role of inflammation both for hypoxiemia and metabolic derangements, therapeutic strategies for OSAS might also counteract the increased cardiometabolic risk of these patients, by improving their long-term quality of life.What is known • Pediatric OSAS has shown a close relationship with obesity and its cardiometabolic comorbidities. • Inflammation represents the hallmark of both obesity and OSAS.What is new • Non obese children with OSAS presented with a worse cardiometabolic risk profile. • OSAS treatment might serve as an effective approach also for the increased cardiometabolic risk of these children.
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Long-term chronic hypoxia caused by OSA can lead to changes in NLR, PLR, C-reactive protein levels, and serum inflammation markers.
“Long-term chronic hypoxia caused by OSA can lead to several physiological and biochemical modifications, such as changes in the NLR, PLR, and levels of C-reactive proteins and markers of serum inflammation [33–37].”
From Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances (2025) · cites this paper as [37]
The Discussion links recurrent hypoxemia in children with OSAS to inflammation, including elevated serum C-reactive protein. The Results report higher inflammatory markers in non-obese children with OSAS, but the paper does not report NLR or PLR changes or establish effects of long-term chronic hypoxia. (LLM, conf=0.86)
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References 59 · Cited by 18
Research works printed but not linked: 2
- Gozal D, Kheirandish-Gozal L, Bhattacharjee R, Kim J (2012 Jun) C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosci (Elite Ed) 4(1):2410-2422
- Marotta R, Precenzano F, Operto FF, Lanzara L, Risoleo MC, Vetri L, Parisi L, Pastorino GMG, Gallai B, Scarinci A, Gleijeses MG, Solimeno M, Merolla E, Sabatino M, Messina G, Marcuccio G, Carotenuto M, Roccella M (2020) Nocturnal obstructive respiratory events severity is associated with low parental quality. Curr Pediatr Res 24(2):194-198
- Authors
- Di Sessa, A., Messina, G., Bitetti, I., Falanga, C., Farello, G., Verrotti, A., & Carotenuto, M.
- Affiliations
- University of Foggia (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- University of L'Aquila (IT)
- Venue
- European Journal of Pediatrics
- Published
- 2022-01-10
- Volume
- 181
- Issue
- 4
- Pages
- 1689-1697
- ISSN
- 0340-6199 (ISSN-L)
- 1432-1076
- OpenAlex
- W4225357293
- Cited by
- 18
- References
- 59
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 3 · 2022: 3
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- European Journal of Pediatrics (publishedVersion)
- Research Square (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, pediatric sleep apnea, cardiometabolic risk, non-obese children, inflammation, inflammatory markers, ferritin, C-reactive protein, erythrocyte sedimentation rate, mean platelet volume, transaminases, insulin, uric acid, adenotonsillar hypertrophy
- MeSH terms
- Adolescent, C-Reactive Protein, Cardiovascular Diseases, Child, Humans, Quality of Life, Sleep Apnea, Obstructive, Pediatric Obesity
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