Mean Platelet Volume, Vitamin D and C Reactive Protein Levels in Normal Weight Children with Primary Snoring and Obstructive Sleep Apnea Syndrome

Abstract

IntroductionStudies on Mean Platelet Volume (MPV) in children with Sleep Disordered Breathing (SDB) report conflicting results and the hypothesis of an intermittent hypoxemia leading to a systemic inflammation is reaching consensus. Vitamin D exerts anti-inflammatory properties and its deficiency has been supposed to play a role in sleep disorders. Emerging interest is rising about Primary Snoring (PS) since it is reasonable that also undetectable alteration of hypoxia might predispose to an increased production of inflammatory mediators. In this perspective, in a group of children affected by SDB, our aim was to investigate MPV, vitamin D and C Reactive Protein (CRP) levels, which had been previously evaluated separately in different studies focused only on Obstructive Sleep Apnea Syndrome (OSAS).Materials and MethodsWe enrolled 137 children: 70 healthy controls (HC), 67 affected by SDB undergoing a polysomnographic evaluation, 22 with a diagnosis of PS and 45 with a diagnosis of OSAS. All patients underwent routine biochemical evaluations including blood cell counts, CRP and vitamin D.ResultsChildren affected by SDB had a mean age of 8.49±2.19 and were prevalently males (23 females, 34%; 44 males, 66%). MPV levels were higher in OSAS and PS when compared to HC; platelet count (PLT) and CRP levels were higher while Vitamin D levels were lower in children with SDB when compared to HC. MPV levels were correlated with PLT (r = -0.54; p<0.001), vitamin D (r = -0.39; p<0.001) and CRP (r = 0.21; p<0.01). A multiple regression was run to predict MPV levels from vitamin D, CRP and PLT and these variables significantly predicted MPV (F = 17.42, p<0.0001; adjusted R2 = 0.37). Only platelet count and vitamin D added statistically significantly to the prediction (p<0.05).ConclusionThe present study provides evidence of higher MPV and lower vitamin D levels in children with PS as well as in children with OSAS, and supports the underlying inflammation, hence, highlighting the importance of an early diagnosis of this previously considered benign form of SDB.

Indoor/outdoor not-voluptuary-habit pollution and sleep-disordered breathing in children: a systematic review

“…Increased levels of inflammation have been found in children with OSAS (11), linking cardiovascular pathologies with secondary oxidative stress and intermittent hypoxia (12).…”

Nocturnal Enuresis in Children and Adolescent with Sickle cell Anemia

“…Low level of serum 25(OH) D was reported to increase the risk of developing OSAS [135][136][137] and primary snoring [138]. Persistent low level of vitamin D may also increase the risk for obstructive sleep apnea by promoting adenotonsillar hypertrophy, chronic rhinitis and/or airway muscle myopathy [137,139].…”

“…Persistent low level of vitamin D may also increase the risk for obstructive sleep apnea by promoting adenotonsillar hypertrophy, chronic rhinitis and/or airway muscle myopathy [137,139].…”

Pediatric OSA Syndrome Morbidity Biomarkers

“…20 Over the last decade, a constellation of morbidity-related biomarkers has been proposed for pediatric OSAS, and a scoping review was previously published and investigated potential associations and predictive abilities of such published candidate biomarkers in OSAS-induced morbidities in both adults and children. 21 In this article, we focus on the more promising of such biomarkers, and particularly on those potentially contributing to detection and monitoring of cardiometabolic morbidity (see Table 1 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] residual OSAS following T&A. 23 On the basis of the interindividual variability of the responses to T&A we previously found in a large panel of inflammatory markers among a large group of obese children with OSAS, 24 it is likely that use of CRP alone, rather than as a component of a multiarray panel, may not provide sufficiently accurate prediction of CVD risk or its resolution with treatment.…”