Plamen Bokov, Benjamin Dudoignon, Christophe Delclaux
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引用次数: 0
Abstract
Background: To assess whether hypoxic burden (HB) is associated with cardiac autonomic nervous system dysfunction and increased blood pressure (BP) in otherwise healthy children with moderate to severe obstructive sleep apnea (OSA).
Methods: Among 103 children with moderate-to-severe OSA, twenty pairs, matched for age, sex and obstructive apnea-hypopnea index (OAHI) were selected, with low (first quartile) or high (fourth quartile) HB in each pair: median [25th-75th percentiles]; age: 10.8 years [7.3; 13.2] vs. 11.4 [8.6; 13.5]; sex: 7 and 10 girls; z-score of body mass index: 1.50 [0.11; 2.43] vs. 2.40 [1.92; 2.70] (p = 0.012); OAHI: 8.6/hr [6.4; 13.3] vs. 11.1 [6.6; 17.2] and HB: 0.8%.min/h [0.3; 1.5] vs. 13.8 [10.1; 22.3], respectively.
Results: Non-linear heart rate variability (HRV) indices obtained from polysomnography showed sympathetic overflow (Poincaré plot: decreased SD2) and weaker parasympathetic modulation (decreased SD1) in children with high versus low HB. The high versus low HB group had higher percentiles of office BP: systolic, 75th [61; 81] vs. 57th [47; 69], p = 0.049 and diastolic, 70th [60; 78] vs. 55th [46; 65], p = 0.007, adjusted for obesity and arousal index.
Conclusions: Despite similar levels of OAHI, children with higher HB demonstrate parasympathetic withdrawal and increased daytime blood pressure.
Impact: The hypoxic burden predicts cardiovascular morbidity/mortality in adult obstructive sleep apnea syndrome. Our study shows that in children with moderate to severe obstructive sleep apnea, despite similar levels of obstructive apnea-hypopnea index, those with higher hypoxic burden show cardiac autonomic nervous system dysfunction and increased daytime blood pressure. This study is the first one suggesting that the hypoxic burden is a valuable marker of cardiovascular morbidity in childhood obstructive sleep apnea.
背景：评估中重度阻塞性睡眠呼吸暂停（OSA）患儿缺氧负担（HB）是否与心脏自主神经系统功能障碍和血压升高（BP）相关。方法：选取103例中重度OSA患儿，选取年龄、性别、阻塞性呼吸暂停低通气指数（OAHI）匹配的20对，每对HB低（第1四分位数）或高（第4四分位数）：中位数[25 -75百分位数]；年龄：10.8岁[7.3；13.2 vs. 11.4 [8.6；13.5);性别：7个女孩和10个女孩；体重指数Z-score: 1.50 [0.11；2.43 vs. 2.40 [1.92；2.70] (p = 0.012)；OAHI: 8.6/hr [6.4；13.3] vs. 11.1 [6.6；17.2] HB: 0.8%。分钟/小时(0.3;1.5] vs. 13.8 [10.1；分别为22.3)。结果：从多导睡眠图获得的非线性心率变异性（HRV）指数显示，高HB和低HB儿童的交感神经溢出（poincar图：SD2降低）和副交感神经调节较弱（SD1降低）。高血红蛋白组与低血红蛋白组的办公室血压百分位数更高：收缩压，75 [61]；[81]; [47]69], p = 0.049，舒张70 [60]；78] vs. 55 [46；[65], p = 0.007，校正肥胖和觉醒指数。结论：尽管OAHI水平相似，但HB较高的儿童表现出副交感神经戒断和白天血压升高。影响：低氧负担预测成人阻塞性睡眠呼吸暂停综合征的心血管发病率/死亡率。我们的研究表明，在中度至重度阻塞性睡眠呼吸暂停患儿中，尽管阻塞性呼吸暂停低通气指数水平相似，但低氧负担较高的患儿表现出心脏自主神经系统功能障碍和日间血压升高。这项研究首次提出缺氧负担是儿童阻塞性睡眠呼吸暂停患者心血管疾病发病率的一个有价值的标志。
期刊介绍：
Pediatric Research publishes original papers, invited reviews, and commentaries on the etiologies of children''s diseases and
disorders of development, extending from molecular biology to epidemiology. Use of model organisms and in vitro techniques
relevant to developmental biology and medicine are acceptable, as are translational human studies
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