{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:17:32Z","timestamp":1790108252035,"version":"4.0.1"},"reference-count":65,"publisher":"American Physiological Society","issue":"5","funder":[{"name":"HHS | National Institutes of Health (NIH)","award":["R01 HL63772"],"award-info":[{"award-number":["R01 HL63772"]}]},{"name":"HHS | National Institutes of Health (NIH)","award":["R01 HL97165"],"award-info":[{"award-number":["R01 HL97165"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American Journal of Physiology-Endocrinology and Metabolism"],"published-print":{"date-parts":[[2016,11,1]]},"abstract":"<jats:p>Only a handful of studies, primarily in clinical samples, have reported an association between obesity, inflammation, and obstructive sleep apnea (OSA) in children and adolescents. No studies, however, have examined the pathogenetic link between visceral adiposity, systemic inflammation, and incident OSA in a large general population sample using objective measures of sleep and body fat. Adolescents ( n = 392; mean age 17.0 \u00b1 2.2 yr, 54.0% male) from the Penn State Child Cohort (PSCC) underwent 9-h overnight polysomnography; a DXA scan to assess body fat distribution; and a single fasting blood draw for the assessment of plasma interleukin-6 (IL-6), IL-6 soluble receptor (IL-6 sR), tumor necrosis factor alpha (TNF\u03b1), tumor necrosis factor receptor 1A (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels via ELISA. Visceral fat area was significantly elevated in moderate OSA (AHI \u2265 5), especially in boys. IL-6, CRP, and leptin were highest in adolescents with moderate OSA, even after adjusting for BMI percentile. Mediation analysis revealed that 42% of the association between visceral fat and OSA in adolescents was mediated by IL-6 ( p = 0.03), while 82% of the association was mediated by CRP ( p = 0.01). These data are consistent with the model of a feed-forward, vicious cycle, in which the release of proinflammatory cytokines by visceral adipocytes largely explains the association between central obesity and OSA; in turn, inflammation is also elevated in OSA independent of BMI. These findings, in a large, representative, non-clinical sample of young people, add to our understanding of the developmental pathogenesis of sleep apnea.<\/jats:p>","DOI":"10.1152\/ajpendo.00249.2016","type":"journal-article","created":{"date-parts":[[2016,9,21]],"date-time":"2016-09-21T03:38:42Z","timestamp":1474429122000},"page":"E851-E858","source":"Crossref","is-referenced-by-count":73,"title":["Inflammation mediates the association between visceral adiposity and obstructive sleep apnea in adolescents"],"prefix":"10.1152","volume":"311","author":[{"given":"Jordan","family":"Gaines","sequence":"first","affiliation":[{"name":"Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros N.","family":"Vgontzas","sequence":"additional","affiliation":[{"name":"Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Fernandez-Mendoza","sequence":"additional","affiliation":[{"name":"Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Calhoun","sequence":"additional","affiliation":[{"name":"Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duanping","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjorie D.","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward O.","family":"Bixler","sequence":"additional","affiliation":[{"name":"Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"24","reference":[{"key":"B1","volume-title":"International Classification of Sleep Disorders","author":"American Academy of Sleep Medicine","year":"2014","edition":"4"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01771-2015"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.108.116756"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/32.6.731"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.3.9911064"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.157.1.9706079"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.5664\/JCSM.1068"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/1054-139X(93)90004-9"},{"key":"B10","volume-title":"National Health and Nutrition Examination Survey (NHANES). Anthropometry Procedures Manual","author":"Centers for Disease Control and Prevention","year":"2011"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2165\/00129784-200404040-00004"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1291\/hypres.30.229"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.100.7.706"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-010-1845-0"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsmc.2007.05.004"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.54.3.672"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.3.8630548"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/S0083-6729(06)74018-3"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.genm.2009.02.002"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/605280"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1210\/en.2009-0647"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6300(1999)11:2<201::AID-AJHB8>3.0.CO;2-R"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/33.3.319"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3109\/17477166.2010.482156"},{"key":"B25","unstructured":"Hologic, Inc. Body Composition User Guide. Document No. MAN-02354, Revision 001. Waltham, MA: Hologic, 2010."},{"key":"B26","volume-title":"The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications","author":"Iber C","year":"2007"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.3.580"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181801d40"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1210\/en.2006-0692"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/61.2.274"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1159\/000348703"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6300(1999)11:2<225::AID-AJHB10>3.0.CO;2-J"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.2001.280.5.E745"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1177\/0148607104028006410"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-2288"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00183411"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2006.43"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.83.5.4717"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000161819.76138.5E"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200708-135MG"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215881"},{"key":"B43","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/clinchem\/47.3.426","volume":"47","author":"Meier-Ewert HK","year":"2001","journal-title":"Clin Chem"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.49.6.883"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.732"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.40"},{"key":"B47","first-page":"3909","volume":"81","author":"Ostlund RE","year":"1996","journal-title":"J Clin Endocrinol Metab"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.23.3015"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1172\/JCI200318921"},{"key":"B50","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.5665\/sleep.4976","volume":"38","author":"Quante M","year":"2015","journal-title":"Sleep"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000091406.72832.11"},{"key":"B52","volume-title":"Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects","author":"Rechtshaffen A","year":"1968"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.1388"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0800511"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.51.12.3391"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.1997.63889000.x"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.4318"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803587"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2006.08.003"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.6.e564"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-006-0085-7"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0435"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2005.01.006"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1159\/000084844"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.3.6484"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1111\/j.2047-6310.2013.00198.x"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1172\/JCI20514"}],"container-title":["American Journal of Physiology-Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.physiology.org\/doi\/pdf\/10.1152\/ajpendo.00249.2016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,26]],"date-time":"2020-09-26T04:53:51Z","timestamp":1601096031000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.physiology.org\/doi\/10.1152\/ajpendo.00249.2016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,1]]},"references-count":65,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2016,11,1]]}},"alternative-id":["10.1152\/ajpendo.00249.2016"],"URL":"https:\/\/doi.org\/10.1152\/ajpendo.00249.2016","relation":{},"ISSN":["0193-1849","1522-1555"],"issn-type":[{"value":"0193-1849","type":"print"},{"value":"1522-1555","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,1]]}}}