# Obstructive sleep apnea is associated with impaired insulin clearance and hepatic insulin sensitivity in paediatric obesity

## TL;DR

Children with obesity and severe obstructive sleep apnea have worse insulin clearance and liver insulin sensitivity, which may explain higher insulin levels.

## Contribution

This study identifies impaired insulin clearance and hepatic insulin resistance as novel mechanisms linking OSA and hyperinsulinism in obese children.

## Key findings

- Moderate–severe OSA in obese children is associated with reduced insulin clearance during OGTT.
- Children with moderate–severe OSA show increased hepatic insulin resistance (higher HIRI).
- OSA severity negatively correlates with insulin clearance and positively correlates with hepatic insulin resistance.

## Abstract

Obstructive sleep apnea (OSA) affects up to 40% of children and adolescents with obesity and is linked to hyperinsulinism. However, the mechanisms underpinning this association remain unclear. The study aims to assess the three key determinants of hyperinsulinemia: insulin clearance, secretion, and sensitivity in paediatric patients with OSA.

We enrolled 70 Children with obesity and suspected OSA who performed a nocturnal polygraphy to confirm OSA diagnosis and a 3‐hour OGTT to assess glucose homeostasis. Mild OSA was defined for 1 < AHI ≤ 5, moderate–severe OSA as AHI >5. Insulin secretion rate (ISR) was estimated using C‐peptide deconvolution. Basal and total insulin clearance during OGTT were calculated. Whole‐body insulin sensitivity was evaluated with the Matsuda Index (WBISI), while hepatic insulin resistance index (HIRI) was calculated based on the AUCs of plasma glucose and insulin during the initial 30 minutes of OGTT.

A total of 36 children had mild OSA and 34 had moderate–severe OSA. The latter group showed reduced insulin clearance during OGTT (p = 0.008) and higher HIRI (p = 0.03). Basal insulin clearance (p = 0.07), ISR (p = 0.34), beta‐cell glucose sensitivity (p = 0.53), and WBISI (p = 0.56) were similar between the two groups. OSA severity negatively correlated with fasting insulin clearance (r = −0.29, p = 0.01) and OGTT insulin clearance (r = −0.32, p = 0.007) and positively correlated with HIRI (r = 0.29, p = 0.02).

Moderate–severe OSA in children with obesity is associated with impaired insulin clearance and hepatic insulin sensitivity. These factors may contribute to hyperinsulinism in paediatric OSA.