Appetite adipokines and insulin resistance shape the link between sleep quality and cardiac structure in youths with cardiometabolic risk: the BCAMS study.

Background: Poor sleep quality (PSQ) is associated with cardiovascular disease, but the key intermediate variables underlying this relationship in youths remain unclear. We aimed to explore the relationship between PSQ and adverse cardiac structure in Chinese youths with elevated cardiometabolic risk, focusing on the roles of appetite adipokines and insulin resistance.

Methods: We utilized cross-sectional data from the Beijing Children and Adolescents Metabolic Syndrome (BCAMS) Study Cohort (n = 559, mean age = 20.2 years). Participants underwent echocardiographic assessments, a sleep quality questionnaire, an oral glucose tolerance test, and plasma levels of insulin and five appetite adipokines.

Results: Elevated PSQ scores were associated with adverse left ventricular mass index (LVMI) (0.64 g/m per unit increase in PSQ score), altered appetite adipokines, including 8.3 % higher leptin, 1.9 % higher retinol-binding protein 4 (RBP4), and 3.2 % lower high-molecular-weight adiponectin (HMW-adiponectin), as well as impaired insulin sensitivity, reflected by 6.6 % higher fasting insulin levels, 6.7 % higher homeostasis model assessment of insulin resistance (HOMA-IR), and 4.9 % lower insulin sensitivity index (Matsuda Index) (ISI), per point increase in PSQ score (all p < 0.05). In mediation analyses, leptin significantly mediated 28.5 % of the PSQ-LVMI association (p < 0.001), and insulin-related indices explained 13.6 %-23.6 % (p < 0.05); HMW-adiponectin showed a marginal mediating effect (8.1 %, p = 0.077). Furthermore, interaction analysis revealed that insulin resistance amplified the adverse impact of PSQ on LVMI (p = 0.04 for HOMA-IR; 0.029 for ISI), with high PSQ-related elevations in LVMI more pronounced among youths with higher insulin resistance.

Conclusions: PSQ is associated with early adverse cardiac remodeling in youths with cardiometabolic risk, potentially driven by elevated leptin and insulin resistance. Targeting sleep quality, adipokine signaling, and insulin sensitivity, may offer synergistic strategies for early cardiovascular prevention in at-risk youths.