Gozal David, Sans Capdevila Oscar, McLaughlin Crabtree Valerie, Serpero Laura D, Witcher Lisa A, Kheirandish-Gozal Leila
Kosair Children's Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville School of Medicine, 570 S. Preston Street, Suite 204, Louisville, KY 40202, USA.
Sleep Med. 2009 Feb;10(2):167-73. doi: 10.1016/j.sleep.2008.01.001. Epub 2008 Mar 7.
Pediatric OSA is associated with substantial morbidity in cognitive function. However, for any given OSA severity level, altered cognitive performance may or may not be present. Since IGF-1 is neuroprotective, we hypothesized that higher systemic IGF-1 levels may identify children at lower susceptibility for cognitive morbidity.
Consecutive habitually snoring and non-snoring children ages 5-7 years were recruited from the community, and underwent overnight polysomnography, and neurocognitive testing and a blood draw the next morning. Snoring children were divided into OSA or no OSA, and OSA children were further subdivided into those with >=2 abnormal cognitive subtests and into those with normal cognitive scores. Plasma levels of IGF-1 were also measured using ELISA.
Among snoring children without OSA, circulating IGF-1 was 910 +/- 110 pg/mL compared with 1070 +/- 240 pg/mL in those with OSA (p<0.01). However, IGF-1 was 540 +/- 70 pg/mL in children with OSA and cognitive deficits, compared to 1370 +/- 170 microg/L in children with OSA and normal cognitive scores (p<0.001).
IGF-1 levels are higher in children with OSA, particularly in those who do not manifest neurocognitive deficits, suggesting that the magnitude of the IGF-1 response elicited by OSA may play a significant protective role against the neurocognitive dysfunction associated with OSA.
小儿阻塞性睡眠呼吸暂停（OSA）与认知功能的显著发病风险相关。然而，对于任何给定的OSA严重程度级别，认知表现的改变可能存在也可能不存在。由于胰岛素样生长因子-1（IGF-1）具有神经保护作用，我们推测较高的全身IGF-1水平可能识别出认知发病风险较低的儿童。
从社区招募连续的5至7岁习惯性打鼾和不打鼾的儿童，进行夜间多导睡眠监测，次日早晨进行神经认知测试和采血。打鼾儿童分为OSA组或非OSA组，OSA儿童进一步细分为认知子测试异常≥2项的儿童和认知评分正常的儿童。还使用酶联免疫吸附测定法（ELISA）测量血浆IGF-1水平。
在无OSA的打鼾儿童中，循环IGF-1为910±110 pg/mL，而OSA儿童为1070±240 pg/mL（p<0.01）。然而，OSA且有认知缺陷的儿童中IGF-1为540±70 pg/mL，相比之下，OSA且认知评分正常的儿童中IGF-1为1370±170 μg/L（p<0.001）。
OSA儿童的IGF-1水平较高，尤其是那些未表现出神经认知缺陷的儿童，这表明OSA引发的IGF-1反应强度可能对与OSA相关的神经认知功能障碍起到显著的保护作用。
