A multidisciplinary weight loss intervention in obese adolescents with and without sleep-disordered breathing improves cardiometabolic health, whether SDB was normalized or not

Johanna Roche; Flavia Campos Corgosinho; Laurie Isacco; Karine Scheuermaier; Bruno Pereira; Valérie Gillet; Gustavo A Moreira; Marcia Pradella-Hallinan; Sergio Tufik; Marco Túlio de Mello; Fabienne Mougin; Ana R Dâmaso; David Thivel

doi:10.1016/j.sleep.2020.06.030

A multidisciplinary weight loss intervention in obese adolescents with and without sleep-disordered breathing improves cardiometabolic health, whether SDB was normalized or not

Sleep Med. 2020 Nov:75:225-235. doi: 10.1016/j.sleep.2020.06.030. Epub 2020 Jun 30.

Affiliations

¹ EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, CHRU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France; Sleep and Health Medicine Center Ellipse, Besançon, France; Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA3533, Clermont Auvergne University, Clermont-Ferrand, France; Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: rochejohanna7@gmail.com.
² Universidade Federal de Goiás, Faculdade de Nutrição - Programa de Pos-Graduação em Nutrição, São Paulo, Brazil.
³ EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, CHRU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France.
⁴ Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France.
⁶ Sleep and Health Medicine Center Ellipse, Besançon, France.
⁷ Universidade Federal de São Paulo, Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, São Paulo, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Departameno de Psicobiologia, São Paulo, Brazil.
⁸ Universidade Federal de São Paulo, Escola Paulista de Medicina, Departameno de Psicobiologia, São Paulo, Brazil.
⁹ Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Educação Física, Minas Gerais, Brazil.
¹⁰ Universidade Federal de São Paulo, Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, São Paulo, Brazil.
¹¹ Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA3533, Clermont Auvergne University, Clermont-Ferrand, France; Auvergne Research Center for Human Nutrition (CRNH), 58 Rue Montalembert, 63009 Clermont-Ferrand, France.

PMID: 32861060
DOI: 10.1016/j.sleep.2020.06.030

Abstract

Objectives: Pediatric obesity and sleep-disordered breathing (SDB) are strongly associated, and both promote metabolic impairments. However, the effects of a lifestyle intervention on the overall metabolic syndrome (MetS) are unknown. The objectives were i) to evaluate the effects of a lifestyle intervention on cardiometabolic risk (CMR), assessed with a dichotomous (MetS) and a continuous (MetScore_FM) instrument, in obese adolescents with and without SDB and ii) to compare the post-intervention cardiometabolic responses between adolescents with persistent (apnea-hypopnea index; AHI≥2) or normalized-SDB (AHI<2).

Methods: Seventy-six adolescents with obesity recruited from two specialized institutions underwent a 9-12month diet and exercise intervention. Sleep and SDB (AHI≥2) were studied by polysomnography. Anthropometric parameters, fat mass (FM), glucose, insulin, lipid and leptin profiles, blood pressure (BP), MetScore_FM and MetS were assessed pre- and post-intervention. We performed comparisons between Non-SDB and SDB groups and between Normalized-SDB and Persistent-SDB subgroups.

Results: Fifty participants completed the study. Pre-intervention, twenty youth had SDB (40%) with higher insulin concentrations and systolic BP than Non-SDB participants (p < 0.01), for a similar degree of obesity. Post-intervention, MetScore_FM (p < 0.001) and MetS prevalence (p < 0.05) were decreased in both groups. Eleven participants (55%) normalized SDB along with a decrease in insulin concentrations and BP (p < 0.05). Triglycerides, total cholesterol and LDL-cholesterol concentrations (p < 0.01) improved equally in the Normalized and Persistent-SDB subgroups.

Conclusion: SDB was associated with lower insulin sensitivity and higher BP but did not affect the lipid profile. A diet and exercise lifestyle intervention is effective in decreasing the CMR whether or not SDB was normalized in obese adolescents.

Keywords: Cardiometabolic risk; Chronic exercise; Leptin resistance; Pediatric obesity; Polysomnography; Sleep apnea.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Body Mass Index
Child
Humans
Hypertension*
Metabolic Syndrome* / complications
Metabolic Syndrome* / therapy
Risk Factors
Sleep Apnea Syndromes* / complications
Sleep Apnea Syndromes* / therapy
Weight Loss