Sleep Apnea In Teens Linked With Higher Risk Markers For Diabetes, Heart Disease

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By Liza Baskin

People with sleep apnea experience pauses in their breathing or shallow breaths while they sleep. In adults, the condition has been linked to diabetes and heart disease, but that link is less clear in younger people with sleep apnea.

In a recent study, researchers found that obstructive sleep apnea (OSA) was linked with greater cardiometabolic risk markers in obese youth. Cardiometabolic risk markers are signs of a patient's overall risk for type 2 diabetes and heart disease.

The findings also showed that teenage boys had a higher risk of having OSA than teenage girls.

The authors believe this relationship needs to be considered when undergoing evaluation for OSA. They also believe further research is needed on OSA and its association with cardiometabolic risk markers — especially for young men.

This study was conducted through the Indiana University School of Medicine in Indianapolis, Indiana. The lead author was S. E. Watson, MD, from the section of Pediatric Endocrinology and Diabetology in the Department of Pediatrics.

Participant data was pulled from medical records of patients who were part of the Pediatric Overweight Education and Research (POWER) Program between January 2009 and November 2011.

The researchers assessed 96 adolescents, between the ages of 12 and 16, who were obese and referred for polysomnography (PSG; sleep study that measures brain waves, oxygen level in the blood, heart rate, breathing and leg and arm movements) during the POWER program.

In order to have been referred for PSG, there had to be either parental concern or complaints of "...snoring accompanied by excessive daytime sleepiness, morning headache and/or behavioral problems suspected to be related to sleep disruption." Patient medical history was obtained at the first visit, and the patients were tested for levels of fat cells in blood, liver enzymes, glucose and insulin.

The participants underwent overnight PSG in order to calculate their apnea-hypopnea (disorder which involves overly shallow breathing or an abnormally low respiratory rate) index, or AHI. The AHI is determined by adding the total number of OSA and hypopnea events during an hour of sleep.

The researchers then put the participants in two groups: 1) the participants with AHI scores of less than five, indicating mild or no OSA, and 2) the participants with of five or more, indicating moderate or severe OSA. Eighty of the participants had mild or no OSA, and 16 of the participants had moderate or severe OSA.

Significantly more teen boys (11) were found to have moderate or severe OSA than teen girls (5), despite similar levels of obesity. Hispanic males were especially affected, with two out of five having moderate or severe OSA.

The researchers also found that there was lower insulin sensitivity — or higher insulin resistance — in the moderate and severe cases of OSA, compared to the participants with mild or no OSA. Insulin is a hormone that the body produces to help manage levels of blood sugar. If someone has a lower insulin senstivity, the body can't use the insulin properly, which puts them at risk for high blood sugar and type 2 diabetes.

The participants with moderate or severe OSA were also found to have a higher levels of fat in their blood than the other participants.

Ultimately, there was a low percentage of participants with OSA in the study sample; therefore the researchers maintained that the OSA-related symptoms of daytime drowsiness and snoring were not reliable indicators of OSA.

The researchers see a need for further research on potential race/ethnicity determinants of OSA and the associated cardiometabolic risk factors in youth — especially in young men.

The authors mentioned a few limitations of their study.

First, there was a small number of Hispanic participants, so the findings on Hispanic men could be over- or underestimated.

Second, the researchers could not draw conclusions about the underlying pathways for the relationship between cardiometabolic risk factors and the degree of OSA because of the retrospective and clinical nature of the participant data.

Third, there were no uniform measures of the risk factors the participants were tested for—only comparisons within the study group. Lastly, the study population consisted of patients who had specifically been referred for OSA testing, so the researchers argue that the study results cannot be applied to the general pediatric population without further study.

This study was published online ahead-of-print in the September edition of Pediatric Obesity ^[4] .

Indiana University-Purdue University, the National Institutes of Health, and the Regenstrief Institute provided funding.

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Sleep Apnea Increases Risk Of Heart Attack

The sleep disorder has a number of poor effects on the heart. "It's as if somebody's choking you, so your heart rate goes up, your blood pressure goes up," Charles Czeisler, M.D., the Baldino Professor of Sleep Medicine at Harvard Medical School told Health magazine. "Over time, even your daytime blood pressure is higher." Sleep apnea may be responsible for a third of all cases of <a href="http://www.huffingtonpost.com/2012/03/14/sleep-health_n_1310353.html">high blood pressure</a> in Americans, he told the magazine. A 2007 study showed just how serious these cardiovascular effects of sleep apnea are. The research found that people with sleep apnea were <a href="http://www.sciencedaily.com/releases/2007/05/070520183533.htm">30 percent more likely to have a heart attack</a> or die of any cause over a four to five year period.

Sleep Apnea May Increase Depression Risk

The under diagnosed sleep condition takes a <a href="http://www.huffingtonpost.com/2012/03/30/sleep-apnea-depression-risk_n_1391707.html">serious toll on the mood</a>, according to March research from the CDC. In fact, men with sleep apnea were more than twice as likely and women more than five times as likely to feel hopeless, lose interest in their regular activites and display other signs of clinical depression, Health.com reported. Snoring did not seem to be associated with depression. Luckily, the very same <a href="http://www.huffingtonpost.com/2012/06/15/sleep-apnea-treatment-depression-cpap_n_1597703.html">treatment for sleep apnea may also ease depression</a>, according to Cleveland Clinic research.

Sleep Apnea May Be A Risk Factor For Diabetes

There is a growing body of research supporting a link between the presence of sleep apnea and <a href="http://www.huffingtonpost.com/2012/05/24/sleep-apnea-diabetes-type-2-_n_1539933.html">metabolic disorders like diabetes</a>, HuffPost reported in May. Both moderate and severe obstructive sleep apnea were found to be predictors of the disease. A previous study found that people with sleep apnea had more than <a href="http://news.yale.edu/2007/05/24/sleep-apnea-increases-risk-heart-attack-and-diabetes">double the risk of developing diabetes</a>.

Sleep Apnea May Increase Cancer Risk

Not only do people with sleep apnea have a <a href="http://well.blogs.nytimes.com/2012/05/20/sleep-apnea-tied-to-increased-cancer-risk/">higher risk of developing cancer</a>, but they also have a higher risk of dying from the disease, the New York Times reported. Two studies in May examined this link. One found people with sleep apnea had a 65 percent higher change of developing any kind of cancer. The second found that disordered breathing contributed to a five-times higher rate of dying from the disease.

Sleep Apnea May Sap Your Libido

Excessive sleepiness is certainly enough to kill the mood, but research suggests that sleep apnea in particular has an effect on sexual function in both men and women. It may <a href="http://well.blogs.nytimes.com/2011/10/10/really-the-claim-sleep-apnea-causes-sexual-problems/">drive down sex hormones</a> like testosterone in a way that can extinguish the flame for women and cause erectile dysfunction in men, according to the New York Times. And while the typical treatment -- a CPAP machine -- is not exactly an aphrodisiac, Dr. Michael J. Breus writes, it can help not only with sleep apnea, but <a href="http://www.huffingtonpost.com/dr-michael-j-breus/sleep-apnea_b_1661687.html">with the sexual side effects as well</a>.

Sleep Apnea May Increase Stroke Risk

Researchers have long studied the link between the sleep disorder and the risk of stroke, but a small recent study found that 51 of 56 stroke patients evaluated -- or <a href="http://www.huffingtonpost.com/dr-michael-j-breus/sleep-apnea_b_1342311.html">91 percent of patients</a> -- had sleep apnea, Dr. Michael J. Breus wrote for HuffPost. More research is still needed to determine just what role disrupted breathing plays in this elevated risk.

Sleep Apnea Increases Accident Risk

It's not rocket science -- excessive sleepiness during the day leads to sleepier drivers who are at a higher risk of crashing. But a 2008 study found that people with sleep apnea have double the risk of being in a car accident and are <a href="http://www.sciencedaily.com/releases/2008/02/080218214401.htm">three to five times more likely to be in a serious crash</a>. The study was the first to examine the severity of car crashes among people with sleep apnea, and found that even mild disordered breathing was linked to increased risk.

Sleep Apnea Is Linked To Pregnancy Complications

Granted, Perry doesn't have to worry about this particular concern. While sleep apnea is often perceived as a problem predominately for men, <a href="http://www.huffingtonpost.com/2012/08/16/sleep-apnea-in-women-may-_n_1779127.html">women are not immune</a>. And, in fact, sleep apnea presents unique complications for women. A recent study found that women with sleep apnea were more likely to develop high blood pressure during their pregnancies, to require a C-section birth and their babies were more <a href="http://www.huffingtonpost.com/2012/09/21/sleep-apnea-in-pregnancy-_n_1903534.html">likely to be admitted to the neonatal intensive care unit</a>.