Effect of Obstructive Sleep Apnea on Cardiovascular Function in Obese Youth

Published:October 18, 2018DOI:
      The increasing prevalence of overweight or obese children and adolescents is a significant global health concern. Although the effect of obesity on cardiovascular function has been investigated, little is known on the impact of associated obstructive sleep apnea (OSA) in obese youth. The aim of the present study was to investigate the influence of OSA on cardiovascular functional parameters in obese youth. This is a prospective single-center observational cross-sectional study. Forty-four obese patients and 44 age- and gender-matched control subjects were included. All patients underwent polysomnography and cardiovascular assessment including functional echocardiography and carotid-femoral pulse wave velocity (PWV). Obese patients had higher left ventricular (LV) mass/height2.7, preserved LV systolic parameters, differences in LV diastolic parameters, and increased PWV and systolic blood pressure at rest compared with control group. In obese youth, 14 of 44 (32%) had OSA. There was no correlation between obesity and the apnea-hypopnea index (AHI). LV mass/height2.7 significantly correlated with body mass index z-score (r = 0.648, p <0.001) whereas PWV correlated with AHI (r = 0.352, p = 0.038). In obese patients, body mass index z-score was an independent predictor for LV mass/height2.7 (r = 0.61, p <0.001) and AHI was an independent predictor for higher PWV (r = 0.352, p = 0.038). In conclusion, both obesity and OSA influence cardiovascular performance in obese youth. Although obesity is associated with increased LV mass and reduced LV diastolic function, OSA is associated with changes in arterial stiffness.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Olshansky S.J.
        • Passaro D.J.
        • Hershow R.C.
        • Layden J.
        • Carnes B.A.
        • Brody J.
        • Hayflick L.
        • Butler R.N.
        • Allison D.B.
        • Ludwig D.S.
        A potential decline in life expectancy in the United States in the 21st century.
        N Engl J Med. 2005; 352: 1138-1145
        • Shields M.
        • Tremblay M.S.
        Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points.
        Int J Pediatr Obes. 2010; 5: 265-273
        • McCrindle B.W.
        Cardiovascular consequences of childhood obesity.
        Can J Cardiol. 2015; 31: 124-130
        • Cote A.T.
        • Harris K.C.
        • Panagiotopoulos C.
        • Sandor G.G.
        • Devlin A.M.
        Childhood obesity and cardiovascular dysfunction.
        J Am Coll Cardiol. 2013; 62: 1309-1319
        • Koopman L.P.
        • McCrindle B.W.
        • Slorach C.
        • Chahal N.
        • Hui W.
        • Sarkola T.
        • Manlhiot C.
        • Jaeggi E.T.
        • Bradley T.J.
        • Mertens L.
        Interaction between myocardial and vascular changes in obese children: a pilot study.
        J Am Soc Echocardiogr. 2012; 25 (e401): 401-410
        • Rowland T.W.
        Effect of obesity on cardiac function in children and adolescents: a review.
        J Sports Sci Med. 2007; 6: 319-326
        • Kasai T.
        • Bradley T.D.
        Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications.
        J Am Coll Cardiol. 2011; 57: 119-127
        • Verhulst S.L.
        • Van Gaal L.
        • De Backer W.
        • Desager K.
        The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents.
        Sleep Med Rev. 2008; 12: 339-346
        • Romero-Corral A.
        • Caples S.M.
        • Lopez-Jimenez F.
        • Somers V.K.
        Interactions between obesity and obstructive sleep apnea: implications for treatment.
        Chest. 2010; 137: 711-719
        • Kuczmarski R.J.
        • Ogden C.L.
        • Grummer-Strawn L.M.
        • Flegal K.M.
        • Guo S.S.
        • Wei R.
        • Mei Z.
        • Curtin L.R.
        • Roche A.F.
        • Johnson C.L.
        CDC growth charts: United States.
        Adv Data. 2000; : 1-27
        • Lopez L.
        • Colan S.D.
        • Frommelt P.C.
        • Ensing G.J.
        • Kendall K.
        • Younoszai A.K.
        • Lai W.W.
        • Geva T.
        Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council.
        J Am Soc Echocardiogr. 2010; 23 (quiz 576-467): 465-495
        • Devereux R.B.
        • Lutas E.M.
        • Casale P.N.
        • Kligfield P.
        • Eisenberg R.R.
        • Hammond I.W.
        • Miller D.H.
        • Reis G.
        • Alderman M.H.
        • Laragh J.H.
        Standardization of M-mode echocardiographic left ventricular anatomic measurements.
        J Am Coll Cardiol. 1984; 4: 1222-1230
        • de Simone G.
        • Daniels S.R.
        • Devereux R.B.
        • Meyer R.A.
        • Roman M.J.
        • de Divitiis O.
        • Alderman M.H.
        Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight.
        J Am Coll Cardiol. 1992; 20: 1251-1260
        • Iber C.
        • Ancoli-Israel S.
        • Chesson A.L.J.
        • Quan S.F.
        The AASM Manual For The Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications.
        1st ed. American Academy of Sleep Medicine, Westchester, IL2007
      1. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
        Pediatrics. 2004; 114: 555-576
        • Khoury P.R.
        • Mitsnefes M.
        • Daniels S.R.
        • Kimball T.R.
        Age-specific reference intervals for indexed left ventricular mass in children.
        J Am Soc Echocardiogr. 2009; 22: 709-714
        • Foster B.J.
        • Mackie A.S.
        • Mitsnefes M.
        • Ali H.
        • Mamber S.
        • Colan S.D.
        A novel method of expressing left ventricular mass relative to body size in children.
        Circulation. 2008; 117: 2769-2775
        • Brady T.M.
        The role of obesity in the development of left ventricular hypertrophy among children and adolescents.
        Curr Hypertens Rep. 2016; 18: 3
        • Abel E.D.
        • Litwin S.E.
        • Sweeney G.
        Cardiac remodeling in obesity.
        Physiol Rev. 2008; 88: 389-419
        • Amin R.S.
        • Kimball T.R.
        • Bean J.A.
        • Jeffries J.L.
        • Willging J.P.
        • Cotton R.T.
        • Witt S.A.
        • Glascock B.J.
        • Daniels S.R.
        Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea.
        Am J Respir Crit Care Med. 2002; 165: 1395-1399
        • Doonan R.J.
        • Scheffler P.
        • Lalli M.
        • Kimoff R.J.
        • Petridou E.T.
        • Daskalopoulos M.E.
        • Daskalopoulou S.S.
        Increased arterial stiffness in obstructive sleep apnea: a systematic review.
        Hypertens Res. 2011; 34: 23-32
        • Cheng S.
        • Vasan R.S.
        Advances in the epidemiology of heart failure and left ventricular remodeling.
        Circulation. 2011; 124: e516-e519
        • Kulsum-Mecci N.
        • Goss C.
        • Kozel B.A.
        • Garbutt J.M.
        • Schechtman K.B.
        • Dharnidharka V.R.
        Effects of obesity and hypertension on pulse wave velocity in children.
        J Clin Hypertens (Greenwich). 2017; 19: 221-226
        • Caterini J.E.
        • Banks L.
        • Wells G.D.
        • Cifra B.
        • Slorach C.
        • McCrindle B.W.
        • Seed M.
        Magnetic resonance imaging reveals elevated aortic pulse wave velocity in obese and overweight adolescents.
        Clin Obes. 2017; 7: 360-367
        • Dangardt F.
        • Chen Y.
        • Berggren K.
        • Osika W.
        • Friberg P.
        Increased rate of arterial stiffening with obesity in adolescents: a five-year follow-up study.
        PLoS One. 2013; 8: e57454
        • Reusz G.S.
        • Cseprekal O.
        • Temmar M.
        • Kis E.
        • Cherif A.B.
        • Thaleb A.
        • Fekete A.
        • Szabo A.J.
        • Benetos A.
        • Salvi P.
        Reference values of pulse wave velocity in healthy children and teenagers.
        Hypertension. 2010; 56: 217-224
      2. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values.
        Eur Heart J. 2010; 31: 2338-2350
        • Tan I.
        • Butlin M.
        • Liu Y.Y.
        • Ng K.
        • Avolio A.P.
        Heart rate dependence of aortic pulse wave velocity at different arterial pressures in rats.
        Hypertension. 2012; 60: 528-533
        • Correia-Costa A.
        • Correia-Costa L.
        • Caldas Afonso A.
        • Schaefer F.
        • Guerra A.
        • Moura C.
        • Mota C.
        • Barros H.
        • Areias J.C.
        • Azevedo A.
        Determinants of carotid-femoral pulse wave velocity in prepubertal children.
        Int J Cardiol. 2016; 218: 37-42