Association of obstructive sleep apnea with hyperinsulinemia in adolescents with severe obesity

Aim. The aim of this study was to determine the association between obstructive sleep apnea (OSA) and fasting insulin levels in adolescents with severe obesity. Methods. A review of demographic, biochemical and polysomnogram PSG) data on all adolescents with body mass indexes between 40 to 60 kg/m ² who underwent weight loss surgery at Cincinnati Children's Hospital & Medical Center was performed. OSA was defined as apnea-hypopnea index AHI) ≥5 and severe OSA was defined as AHI ≥15. OSA patients were compared to controls AHI<5) for fasting insulin, cholesterol, and triglyceride levels. To test for the independent association of OSA on fasting insulin level, subjects with severe OSA were compared to BMI, gender, and age matched controls. Results. Of the initial 53 patients that underwent bariatric surgery, 34 met BMI inclusion criteria. The mean age for all subjects was 17.7±0.3 years, mean BMI was 51.6±0.9 kg/m², and 70% were female. OSA was present in 21 subjects 61%). The group with OSA n=21) had a significantly higher fasting insulin level as compared to the group without OSA n=13; 44.7±3.6 μU/mL vs 29.8 μU/mL±5.1, P=0.01). The groups, however, did not differ in their BMI, waist to hip ratio, percentage body fat, triglyceride or cholesterol levels. Fasting insulin levels were significantly correlated with AHI Spearman r=0.46, P=0.01) in the whole study group; the strength of the association being similar in the subset of patients with polysomnogram performed at one institution. Conclusion. Our data suggest that in adolescents with severe obesity, OSA is associated with fasting hyperinsulinemia independent of degree of obesity.