Fauroux Brigitte
AP-HP, Hôpital Armand Trousseau, Pediatric Pulmonary Department, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S 719, Paris, France.
Paediatr Respir Rev. 2007 Mar;8(1):85-9. doi: 10.1016/j.prrv.2007.02.010. Epub 2007 Mar 21.
The major recent advance in our understanding of paediatric sleep is the publication of reference values for sleep in children aged 3.2-8.6 years. These data show developmental changes reflecting a subtle process of the maturation of the central nervous system with regard to sleep in childhood. In infants, a significant negative correlation has been observed between a snore-associated arousal index and an infant development scale, underlining that snoring is less innocent than has been suggested. A link between obstructive sleep apnoea (OSA) and airway inflammation has been demonstrated, with children with OSA having significantly higher expression of the leukotriene (LT) 1 and 2 receptors and higher concentrations of LT C4/D4/E4 and LT B4 in adenotonsillar tissues than children with recurrent rhinitis who have no OSA. This explains the efficacy of treatment for OSA with montelukast, a LT receptor antagonist, alone or in combination with corticosteroids. By using peripheral arterial tonometry, a noninvasive technique that allows the moment-to-moment measurement of sympathetic tone, persistent waking-associated autonomic nervous system dysfunction has been demonstrated in young children with sleep-disordered breathing (SDB). As such, SDB in childhood may represent a cardiovascular risk factor in adulthood.
近年来，我们对儿童睡眠的认识取得的主要进展是公布了3.2至8.6岁儿童的睡眠参考值。这些数据显示了发育变化，反映出儿童期睡眠方面中枢神经系统成熟的微妙过程。在婴儿中，观察到打鼾相关唤醒指数与婴儿发育量表之间存在显著负相关，这表明打鼾并非像人们认为的那样无害。阻塞性睡眠呼吸暂停（OSA）与气道炎症之间的联系已得到证实，与无OSA的复发性鼻炎儿童相比，OSA儿童腺样体扁桃体组织中白三烯（LT）1和2受体的表达明显更高，LT C4/D4/E4和LT B4的浓度也更高。这解释了单用孟鲁司特（一种LT受体拮抗剂）或与皮质类固醇联合使用治疗OSA的疗效。通过使用外周动脉张力测量法（一种允许实时测量交感神经张力的非侵入性技术），已证实在患有睡眠呼吸障碍（SDB）的幼儿中存在与持续清醒相关的自主神经系统功能障碍。因此，儿童期的SDB可能是成年期的心血管危险因素。
