{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:07:38Z","timestamp":1792508858385,"version":"4.5.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001407","name":"Department of Biotechnology, Ministry of Science and Technology","doi-asserted-by":"publisher","award":["BT\/2014"],"award-info":[{"award-number":["BT\/2014"]}],"id":[{"id":"10.13039\/501100001407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Aim and objective<\/jats:title><jats:p>Systemic inflammation has been documented in obstructive sleep apnea (OSA). However studies on childhood OSA and systemic inflammation are limited. This study aimed to determine the relation between OSA in overweight\/obese children and various inflammatory markers.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Material and methods<\/jats:title><jats:p>In this cross sectional study, we enrolled 247 overweight\/ obese children from pediatric outpatient services. We evaluated demographic and clinical details, anthropometric parameters, body composition and estimation of inflammatory cytokines such as interleukin (IL) 6, IL-8, IL-10, IL-17, IL-18, IL-23, macrophage migration inhibitory factor (MIF), high sensitive C-reactive protein (Hs-CRP), tumor necrosis factor-alpha (TNF-\u03b1), plasminogen activator inhibitor-1 (PAI-1) and leptin levels. Overnight polysomnography was performed.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Findings<\/jats:title><jats:p>A total of 247 children (190 with OSA and 57 without OSA) were enrolled. OSA was documented on polysomnography in 40% of patients. We observed significantly high values body mass index, waist circumference (WC), % body fat, fasting blood glucose (FBG), alanine transaminase (ALT), alkaline phosphate, fasting insulin and HOMA-IR in children with OSA. Inflammatory markers IL-6, IL-8, IL-17, IL-18, MIF, Hs CRP, TNF- \u03b1, PAI-1, and leptin levels were significantly higher in OSA patients (p&lt;0.05). There was strong positive correlation of IL-6, IL-8, IL-17, IL-23, MIF, Hs CRP, TNF-A, PAI-1 and leptin with BMI, % body fat, AHI, fasting Insulin, triglyceride, FBG, WC, HOMA-IR, AST and ALT.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Children with OSA have increased obesity, insulin resistance and systemic inflammation. Further studies are require to confirm our findings and evaluate their utility in diagnosis of OSAs, assessing severity and possible interventions.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0252353","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T17:36:36Z","timestamp":1622828196000},"page":"e0252353","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":76,"title":["Metabolic alterations and systemic inflammation in overweight\/obese children with obstructive sleep apnea"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9489-9747","authenticated-orcid":true,"given":"Surya Prakash","family":"Bhatt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randeep","family":"Guleria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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Li","year":"2010","journal-title":"Thorax"},{"issue":"6","key":"pone.0252353.ref004","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1164\/rccm.201008-1249OC","article-title":"Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome","volume":"183","author":"R Arens","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"issue":"7","key":"pone.0252353.ref005","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1038\/oby.2005.139","article-title":"Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery","volume":"13","author":"M Kalra","year":"2005","journal-title":"Obes Res"},{"issue":"1","key":"pone.0252353.ref006","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1378\/chest.130.1.143","article-title":"Inflammatory mediators in exhaled breath condensate of children with obstructive sleep apnea syndrome","volume":"130","author":"AD Goldbart","year":"2006","journal-title":"Chest"},{"issue":"2","key":"pone.0252353.ref007","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.resp.2013.03.016","article-title":"Genotype-phenotype interactions in pediatric obstructive sleep apnea","volume":"189","author":"L Kheirandish-Gozal","year":"2013","journal-title":"Respir Physiol Neurobiol"},{"issue":"41","key":"pone.0252353.ref008","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000004944","article-title":"Inflammatory cytokines in pediatric obstructive sleep apnea","volume":"95","author":"YS Huang","year":"2016","journal-title":"Medicine (Baltimore)."},{"key":"pone.0252353.ref009","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1164\/rccm.200407-928OC","article-title":"Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing","volume":"171","author":"AG Kaditis","year":"2005","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"pone.0252353.ref010","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.sleep.2007.04.013","article-title":"Systemic inflammation in non-obese children with obstructive sleep apnea","volume":"9","author":"D Gozal","year":"2008","journal-title":"Sleep Med"},{"key":"pone.0252353.ref011","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1038\/ijo.2015.37","article-title":"Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study","volume":"39","author":"L Kheirandish-Gozal","year":"2015","journal-title":"I J of Obesity"},{"issue":"2","key":"pone.0252353.ref012","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/sleep\/34.2.161","article-title":"Macrophage migratory inhibitory factor (MIF) may be a key factor in inflammation in obstructivesleep apnea","volume":"34","author":"KM Edwards","year":"2011","journal-title":"Sleep"},{"issue":"1","key":"pone.0252353.ref013","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.atherosclerosis.2013.07.006","article-title":"Independent associations of low 25 hydroxy vitamin D and high PTH levels with non-alcoholic fatty liver disease in Asian Indians residing in north India","volume":"230","author":"SP Bhatt","year":"2013","journal-title":"Athroscorosis"},{"key":"pone.0252353.ref014","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1136\/adc.85.3.263","article-title":"Measurement of body fat using leg to leg bioimpedance","volume":"85","author":"RY Sung","year":"2001","journal-title":"Arch Dis Child"},{"key":"pone.0252353.ref015","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S0021-9150(03)00096-0","article-title":"Correlations of C-reactive protein levels with anthropometric profile, percentage of body fat and lipids in healthy adolescents and young adults in urban North India","volume":"168","author":"NK Vikram","year":"2003","journal-title":"Atherosclerosis"},{"key":"pone.0252353.ref016","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.rmed.2008.10.001","article-title":"TNF-alpha gene polymorphism and TNF-alpha levels in obese Asian Indians with obstructive sleep apnea","volume":"103","author":"B Bhushan","year":"2009","journal-title":"Respir Med"},{"issue":"4","key":"pone.0252353.ref017","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s11325-014-0939-3","article-title":"A comparison between the AASM 2012 and 2007 definitions for detecting hypopnea","volume":"18","author":"AS BaHammam","year":"2014","journal-title":"Sleep Breath."},{"key":"pone.0252353.ref018","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1056\/NEJMp0706538","article-title":"Childhood obesity\u2013the shape of things to come","volume":"357","author":"DS Ludwig","year":"2007","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0252353.ref019","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1164\/rccm.200703-375OC","article-title":"Association between metabolic syndrome and sleep-disordered breathing in adolescents,","volume":"176","author":"S. Redline","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0252353.ref020","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1002\/ppul.20508","article-title":"Insulin and obstructive sleep apnea in obese Chinese children","volume":"41","author":"AM Li","year":"2006","journal-title":"Pediatr Pulmonol"},{"key":"pone.0252353.ref021","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1038\/oby.2008.673","article-title":"The effect of weight loss on sleep-disordered breathing inobese teenagers","volume":"17","author":"SL Verhulst","year":"2009","journal-title":"Obesity"},{"key":"pone.0252353.ref022","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1136\/adc.2006.101089","article-title":"Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution","volume":"92","author":"SL Verhulst","year":"2007","journal-title":"Arch Dis Child"},{"key":"pone.0252353.ref023","doi-asserted-by":"crossref","first-page":"493409","DOI":"10.1155\/2015\/493409","article-title":"Reduced systemic levels of IL-10 are associated with the severity of obstructive sleep apnea and insulin resistance in morbidly obese humans","volume":"2015","author":"Cabrera Sonia Leon","year":"2015","journal-title":"Mediators Inflamm"},{"key":"pone.0252353.ref024","first-page":"605280","article-title":"Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study","volume":"2014","author":"Alex Gileles-Hillel","year":"2014","journal-title":"Mediators Inflamm"},{"key":"pone.0252353.ref025","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1378\/chest.11-1777","article-title":"Endothelial dysfunction in children without hypertension: potential contributions of obesity and obstructive sleep apnea","volume":"141","author":"R Bhattacharjee","year":"2012","journal-title":"Chest"},{"issue":"1","key":"pone.0252353.ref026","first-page":"81","article-title":"OS capdevila, D Gozal. TNF- \u03b1 Gene Polymorphisms and Excessive Daytime Sleepiness In Pediatric Obstructive Sleep Apnea","volume":"158","author":"K Abdelnaby","year":"2011","journal-title":"J Pediatr"},{"issue":"10","key":"pone.0252353.ref027","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1002\/ppul.22560","article-title":"Macrophage migration inhibitory factor gene polymorphisms and plasma levels in children with obstructive sleep apnea","volume":"47","author":"A Khalyfa","year":"2012","journal-title":"Pediatr Pulmonol"},{"key":"pone.0252353.ref028","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.immuni.2011.02.012","article-title":"Functional specialization of interleukin-17 family members","volume":"34","author":"Y Iwakura","year":"2011","journal-title":"Immunity"},{"key":"pone.0252353.ref029","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1074\/jbc.M207577200","article-title":"Interleukin-23 promotes a distinct CD4 T cell activation state characterized by the production of interleukin-17","volume":"278","author":"S Aggarwal","year":"2003","journal-title":"J Biol Chem"},{"issue":"4","key":"pone.0252353.ref030","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/sleep\/30.4.443","article-title":"Adipokines in children with sleep disordered breathing","volume":"30","author":"R Tauman","year":"2007","journal-title":"Sleep"},{"issue":"4","key":"pone.0252353.ref031","doi-asserted-by":"crossref","first-page":"283","DOI":"10.5578\/tt.21009","article-title":"Leptin levels in children with obstructive sleep apnea syndrome.","volume":"64","author":"A S\u00f6\u011f\u00fct","year":"2016","journal-title":"Tuberk Toraks"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252353","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,1]],"date-time":"2024-09-01T07:23:50Z","timestamp":1725175430000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252353"}},"subtitle":[],"editor":[{"given":"Jonathan M.","family":"Peterson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,4]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0252353","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,4]]}}}