Kaditis Athanasios G, Alexopoulos Emmanouel I, Hatzi Fotini, Kostadima Eleni, Kiaffas Maria, Zakynthinos Epameinondas, Gourgoulianis Konstantinos
Department of Pediatrics, Larissa University Hospital, Larissa 41110, Greece.
Chest. 2006 Nov;130(5):1377-84. doi: 10.1378/chest.130.5.1377.
Obstructive sleep-disordered breathing is accompanied by episodic increases in left ventricle afterload due to large negative swings in intrathoracic pressure and repetitive surges in arterial pressure. Brain natriuretic peptide (BNP) is released by ventricular myocytes in response to pressure and volume overload. It was hypothesized that in children with snoring, overnight change in BNP levels is correlated with severity of disturbance in respiration.
Evening and morning plasma levels of BNP were measured in children with snoring referred for polysomnography.
A sleep disorders laboratory in a university hospital.
Twenty-two children with apnea-hypopnea index (AHI) > or = 5/h (mean +/- SD age, 6.4 +/- 2.5 years), 60 children with AHI < 5/h (mean age, 7 +/- 2.9 years), and 27 control subjects without snoring (mean age, 7.8 +/- 3.7 years) were recruited.
Overnight change in BNP (log-transformed ratio of morning-to-evening levels) was larger in children with AHI > or = 5/h, compared to those with AHI < 5/h or to control subjects (0.1 +/- 0.19 vs 0.01 +/- 0.14 vs - 0.06 +/- 0.18; p < 0.05). Children with AHI > or = 5/h had an odds ratio of 4.33 (95% confidence interval, 1.34 to 14) for change in peptide levels > 0.15 relatively to subjects with AHI < 5/h. AHI and oxygen saturation of hemoglobin nadir were significant predictors of overnight change in peptide levels.
In children with snoring, overnight increase in BNP levels is correlated with severity of disturbance in respiration during sleep, which may indicate presence of nocturnal cardiac strain.
阻塞性睡眠呼吸障碍伴有左心室后负荷的间歇性增加，这是由于胸内压的大幅负向波动和动脉压的反复波动所致。脑钠肽（BNP）由心室肌细胞在压力和容量超负荷时释放。研究假设，在打鼾儿童中，BNP水平的夜间变化与呼吸紊乱的严重程度相关。
对因打鼾而接受多导睡眠图检查的儿童测量其早晚血浆BNP水平。
大学医院的睡眠障碍实验室。
招募了22名呼吸暂停低通气指数（AHI）≥5次/小时（平均年龄±标准差，6.4±2.5岁）的儿童、60名AHI＜5次/小时（平均年龄，7±2.9岁）的儿童以及27名无打鼾的对照受试者（平均年龄，7.8±3.7岁）。
与AHI＜5次/小时的儿童或对照受试者相比，AHI≥5次/小时的儿童BNP的夜间变化（早晨与晚上水平的对数转换比值）更大（0.1±0.19 vs 0.01±0.14 vs -0.06±0.18；p＜0.05）。相对于AHI＜5次/小时的受试者，AHI≥5次/小时的儿童肽水平变化＞0.15的比值比为4.33（95%置信区间，1.34至14）。AHI和血红蛋白最低点时的氧饱和度是肽水平夜间变化的显著预测因素。
在打鼾儿童中，BNP水平的夜间升高与睡眠期间呼吸紊乱的严重程度相关，这可能表明存在夜间心脏负荷。
