睡眠障碍呼吸儿童的睡眠测量和清晨血浆 TNF-α 水平。
Sleep measures and morning plasma TNF-alpha levels in children with sleep-disordered breathing.
机构信息
Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
出版信息
Sleep. 2010 Mar;33(3):319-25. doi: 10.1093/sleep/33.3.319.
BACKGROUND
Sleep disordered breathing in children is associated with severity-dependent increases in excessive daytime sleepiness (EDS). TNF-alpha is an inflammatory cytokine that has been implicated in EDS. Since, at any given level of apnea-hypopnea index, there is significant variability in EDS, we hypothesized that morning tumor necrosis factor (TNF)-alpha plasma levels may provide a biologic correlate of EDS.
METHODS
Children being evaluated for sleep disordered breathing underwent a blood draw after nocturnal polysomnography, and TNF-alpha plasma concentrations were assayed using ELISA. In a subset of 15 children with sleep disordered breathing and in 15 matched control subjects, whole blood cultures in the presence of lipopolysaccharide and Multiple Sleep Latency Test were conducted. Furthermore, 22 children with obstructive sleep apnea had TNF-alpha levels assayed and underwent nocturnal polysomnography and Multiple Sleep Latency Test before and after adenotonsillectomy.
RESULTS
In 298 children, morning TNF-alpha levels were globally increased in the presence of obstructive sleep apnea, particularly in more severe cases, and correlated with obstructive apnea-hypopnea index and sleep pressure score, a measure of respiratory-induced sleep fragmentation, but not with nadir Sa02. A stepwise logistic regression analysis revealed that sleep pressure score and body mass index accounted for 36.2% of the adjusted variance in TNF-alpha levels (P < 0.0001). Furthermore, multiple sleep latencies were correlated with whole blood culture-derived TNF-alpha levels (n = 15), and morning TNF-alpha levels decreased after adenotonsillectomy in 22 children.
CONCLUSIONS
TNF-alpha levels are increased in pediatric obstructive sleep apnea, are primarily driven by sleep fragmentation and body mass index, and are closely associated with the degree of sleepiness, as measured by Multiple Sleep Latency Test. Furthermore, surgical treatment of obstructive sleep apnea results in significant reductions in TNF-alpha levels with reciprocal prolongations in sleep latency.
背景
儿童睡眠呼吸障碍与日间过度嗜睡（EDS）的严重程度相关。TNF-α 是一种炎症细胞因子，与 EDS 有关。由于在任何特定的呼吸暂停低通气指数水平，EDS 都有显著的可变性，因此我们假设清晨肿瘤坏死因子（TNF）-α 血浆水平可能提供 EDS 的生物学相关性。
方法
正在接受睡眠呼吸障碍评估的儿童在夜间多导睡眠图检查后进行采血，并使用 ELISA 检测 TNF-α 血浆浓度。在睡眠呼吸障碍的 15 名儿童和 15 名匹配的对照组儿童中，进行了存在脂多糖和多次睡眠潜伏期试验的全血培养。此外，22 名阻塞性睡眠呼吸暂停患儿进行了 TNF-α 水平检测，并在腺样体扁桃体切除术前和术后进行了夜间多导睡眠图和多次睡眠潜伏期试验。
结果
在 298 名儿童中，存在阻塞性睡眠呼吸暂停时，清晨 TNF-α 水平普遍升高，尤其是在病情较重的情况下，与阻塞性呼吸暂停低通气指数和睡眠压力评分（呼吸引起的睡眠碎片化的一种测量方法）相关，但与最低 Sa02 无关。逐步逻辑回归分析显示，睡眠压力评分和体重指数占 TNF-α 水平调整后方差的 36.2%（P<0.0001）。此外，多项睡眠潜伏期与全血培养衍生的 TNF-α 水平相关（n=15），22 名患儿腺样体扁桃体切除术后清晨 TNF-α 水平降低。
结论
TNF-α 水平在儿童阻塞性睡眠呼吸暂停中升高，主要由睡眠碎片化和体重指数驱动，与多导睡眠潜伏期试验测量的嗜睡程度密切相关。此外，阻塞性睡眠呼吸暂停的手术治疗可显著降低 TNF-α 水平，并使睡眠潜伏期相应延长。
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