Sleep

Association between obstructive sleep apnea and metabolic profiles across sleep stages in pediatrics.

TL;DR

In pediatric OSA, OAHI was associated with metabolic alterations throughout sleep stages, while ODI showed more pronounced metabolic effects during REM sleep, where associations of TG, LDL-C, and TCH varied across ODI severity categories.

Key Findings

Metabolic parameters including TP, TCH, TG, HDL-C, LDL-C, LDL-C/HDL-C, TyG, and ALT levels were significantly different across OAHI-defined OSA severity groups during total sleep time and NREM sleep.

  • 514 children underwent overnight polysomnography (PSG) and biochemical testing
  • Stratification was based on OAHI-defined severity of OSA
  • All significant differences had P < 0.05 during both TST and NREM
  • Analysis adjusted for BMI z-score and other covariates using multivariate analysis of covariance

OAHI during total sleep time, NREM, and REM were each independently associated with multiple metabolic parameters in fully adjusted multivariable linear regression models.

  • OAHITST, OAHINREM, and OAHIREM were all independently associated with TP, TCH, TG, HDL-C, LDL-C, LDL-C/HDL-C, TyG, and ALT
  • Models were fully adjusted for BMI z-score and other covariates
  • Associations were observed across all sleep stage-specific OAHI measures
  • Multivariable linear regression was used to quantify independent effects

When stratified by ODI-defined OSA severity, HDL-C, LDL-C, LDL-C/HDL-C, and TyG levels differed significantly during NREM sleep and were independently related to ODINREM.

  • All significant differences in NREM-stratified ODI analysis had P < 0.05
  • Only four metabolic parameters (HDL-C, LDL-C, LDL-C/HDL-C, and TyG) showed significant differences during NREM under ODI stratification, compared to eight under OAHI stratification
  • ODINREM was independently associated with these four parameters in fully adjusted models

ODIREM was independently associated with a broader range of metabolic parameters including TP, TCH, TG, HDL-C, LDL-C, LDL-C/HDL-C, and TyG levels.

  • Seven metabolic parameters were independently associated with ODIREM
  • This broader association during REM sleep was more extensive than the four parameters associated with ODINREM
  • Associations were identified in fully adjusted multivariable linear regression models

Associations between ODI and TG, LDL-C, and TCH were evident during REM sleep but not during NREM sleep.

  • This sleep-stage-specific pattern was identified in fully adjusted multivariable linear regression models
  • TG, LDL-C, and TCH showed statistically significant associations with ODI only in the REM sleep context
  • This finding indicates that intermittent hypoxia during REM sleep may have a distinct metabolic impact compared to NREM sleep
  • The associations of TG, LDL-C, and TCH also varied across ODI severity categories during REM sleep

The study used a sample of 514 children who underwent overnight polysomnography and biochemical testing, with obstructive apnea hypopnea indices and oxygen desaturation indices recorded for total sleep time, REM, and NREM.

  • Total sample size: 514 children
  • Overnight PSG was performed to obtain sleep-stage-specific OAHI and ODI measures
  • Biochemical testing provided metabolic profile data
  • Multivariate analysis of covariance was used to assess associations of sleep variables with overall metabolic parameters
  • Multivariable linear regression models were used to quantify independent effects of sleep variables on metabolic profiles

What This Means

This research suggests that in children with obstructive sleep apnea (OSA), breathing difficulties and oxygen level drops during sleep are linked to abnormal levels of various metabolic markers in the blood, including cholesterol, triglycerides, and liver enzymes. The study followed 514 children who underwent full overnight sleep studies and blood tests, and found that the severity of breathing problems—whether measured by how often breathing stops (OAHI) or how often oxygen levels drop (ODI)—was associated with differences in multiple metabolic markers across different sleep stages. A particularly notable finding is that oxygen desaturation (drops in blood oxygen) during REM sleep (the dreaming stage) appeared to have a stronger and broader impact on certain metabolic markers—specifically triglycerides, LDL cholesterol (often called 'bad' cholesterol), and total cholesterol—compared to the non-REM sleep stage. This suggests that the type of sleep disruption and which sleep stage it occurs in may matter for how OSA affects a child's metabolic health. In contrast, the number of breathing stoppages (OAHI) was associated with metabolic changes across all sleep stages. This research suggests that treating pediatric OSA may have implications beyond just improving sleep quality, potentially affecting children's metabolic health including their cholesterol and triglyceride levels. It also highlights the potential importance of considering sleep stage-specific measures when evaluating the metabolic consequences of OSA in children, which could inform more targeted monitoring and treatment approaches.

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Citation

Wan Y, Wang X, Hu X, Zhan X, Kong Y, Liu T, et al.. (2026). Association between obstructive sleep apnea and metabolic profiles across sleep stages in pediatrics.. Sleep medicine. https://doi.org/10.1016/j.sleep.2026.108763