Autonomic cardiovascular control in children with obstructive sleep apnea

Baharav, A.; Kotagal, Suresh; Rubin, Bruce K.; Pratt, Jesse; Akselrod, Solange

doi:10.1007/bf02318382

Cited by 121 publications

(96 citation statements)

References 39 publications

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“…Hyperactivation and increased reactivity of the sympathetic system have been reported in children with OSA [43][44][45] and systemic blood pressure elevations are not only OSA-severity dependent [46][47][48], but are also associated with altered left ventricular geometry and contractibility [49]. Recently, we reported that children with sleep-disordered breathing have elevated plasma IL-6 and P-selectin levels [41,50].…”

Section: Sleep-related Disordersmentioning

confidence: 94%

Myeloid-related protein 8/14 levels in children with obstructive sleep apnoea

Kim¹,

Bhattacharjee²,

Snow³

et al. 2009

Eur Respir J

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Obstructive sleep apnoea (OSA) is common in children and leads to multiple endorgan morbidities. Myeloid-related protein (MRP) 8/14 plays an important pathophysiological role in atherosclerosis, and plasma levels correlate with endothelial cell dysfunction. We hypothesised that MRP8/14 levels would be altered in children with OSA.255 children (aged 7.6¡1.5 yrs) were included after a sleep study and a morning blood sample. MRP8/14 and interleukin-6 plasma levels were assayed using ELISA and C-reactive protein by immunoturbidometry. Endothelial function was assessed as the hyperaemic response after occlusion of the brachial artery.Plasma log MRP8/14 levels showed apnoea/hypopnoea index (AHI) dose-dependent increases regardless of obesity. Moreover, log MRP8/14 levels correlated with log AHI (r50.340, p,0.001) after controlling for age and body mass index Z-score, and with endothelial function. Children with the highest MRP levels (.1.34 ug?mL -1 ) had 2.4-and 5.4-fold increased odds of mild OSA and moderate-to-severe OSA, respectively, after adjusting for confounding variables. Plasma MRP8/14 levels are associated with paediatric OSA and may reflect increased risk for cardiovascular morbidity. The short-and long-term consequences of elevated MRP8/14 on cardiovascular function in the context of paediatric OSA remain to be defined.

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Section: Sleep-related Disordersmentioning

confidence: 94%

Myeloid-related protein 8/14 levels in children with obstructive sleep apnoea

Kim¹,

Bhattacharjee²,

Snow³

et al. 2009

Eur Respir J

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“…27,28 Moreover, the effect of continuous positive airway pressure (CPAP) on the metabolic disturbances associated with SDB has yielded conflicting results. [29][30][31][32] SDB in children is associated with increased sympathetic activity, [33][34][35] elevated blood pressure, and left ventricular geometry changes. [36][37][38] In addition, we recently reported on altered plasma C-reactive protein (CRP) levels, a marker of inflammation and atherogenesis, as a consequence of SDB in children.…”

mentioning

confidence: 99%

Obesity Rather Than Severity of Sleep-Disordered Breathing as the Major Determinant of Insulin Resistance and Altered Lipidemia in Snoring Children

et al. 2005

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ABSTRACT. Objective. Sleep-disordered breathing (SDB) is associated with insulin resistance and dyslipidemia in adults and in obese children. However, the prevalence of such metabolic abnormalities among snoring children is unknown. This study was done to prospectively assess the relative contribution of SDB and obesity to metabolic disturbances in a large cohort of snoring children.Methods. Measurements of fasting serum glucose, insulin, and lipids were obtained after polysomnographic evaluation in 116 snoring children and in 19 control subjects. Insulin resistance was assessed using the insulin/glucose ratio (I/G ratio) and homeostasis model assessment (HOMA).Results. A total of 135 children (79 boys; mean age: 8.9 ؎ 3.5 years) were studied. Sixty-four children had moderate to severe SDB (AHI ‫؍‬ 5 per hour of total sleep time [TST]), 52 had mild SDB (AHI ‫؍‬ 1 but <5 per hour of TST), and 19 were control subjects (AHI <1 per hour of TST). Seventy of these children were obese. No significant correlations were found between AHI, lowest arterial oxygen saturation, or arousal index and serum insulin, serum glucose, I/G ratio, HOMA, or serum lipids for either the whole group or the obese children only. However, significant positive correlations were found between I/G ratio and relative BMI (relBMI; r ‫؍‬ 0.58), HOMA and relBMI (r ‫؍‬ 0.52), triglycerides and relBMI (r ‫؍‬ 0.30), and high-density lipoprotein and relBMI (r ‫؍‬ 0.50). No significant differences were found in relBMI, I/G ratio, and lipid levels between boys and girls.Conclusions. Among children with suspected SDB, insulin resistance and dyslipidemia seem to be determined primarily by the degree of body adiposity rather than by the severity of SDB. Pediatrics 2005;116:e66-e73. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-2527; metabolic syndrome, sleep apnea, pediatrics, obesity, diabetes.ABBREVIATIONS. SDB, sleep-disordered breathing; CPAP, continuous positive airway pressure; CRP, C-reactive protein; Spo 2 , arterial oxygen saturation; AHI, apnea hypopnea index; TST, total sleep time; relBMI, relative BMI; HOMA, homeostasis model assessment; I/G ratio, insulin/glucose ratio; HDL, high-density lipoprotein; TG, triglyceride.T he incidence of childhood obesity has been increasing steadily in Western countries. 1 Recent reports place the prevalence of obesity and overweight in children at levels ranging from 7% up to 22% in various countries, 2-9 and such elevated figures will undoubtedly impose major health implications, particularly on the development of insulin resistance, type 2 diabetes, and cardiovascular morbidity. [10][11][12] The term "metabolic syndrome" is a known risk factor for cardiovascular disease in adults and refers to the clustering of insulin resistance, dyslipidemia, hypertension, and obesity. Elevation of fasting insulin levels and increased BMI during childhood are the strongest predictors of the metabolic syndrome in adulthood, 13,14 possibly through the combination of altered insulin signaling and adrenocortical function, in...

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“…3 Children may sometimes adopt unusual sleeping postures, such as hyperextension of the neck to increase airway patency. Autonomic disturbances, including heart rate variability, 4 profuse sweating, and nocturnal enuresis, 5 have been reported in children with sleep disordered breathing.…”

Section: How Are Sleep Related Problems Identified?mentioning

confidence: 99%