儿童阻塞性睡眠呼吸暂停中交感神经活动增加：心血管影响。

Increased sympathetic activity in children with obstructive sleep apnea: cardiovascular implications.

机构信息

The Ritchie Centre, Monash Institute of Medical Research, Monash University, Victoria, Australia.

出版信息

Sleep Med. 2011 May;12(5):483-8. doi: 10.1016/j.sleep.2010.09.015.

DOI:10.1016/j.sleep.2010.09.015

PMID:21521626

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is associated with increased sympathetic activity and hypertension in adults. We tested the hypothesis that children with OSA also have increased sympathetic activity as measured by overnight urinary catecholamines, and that this increase is related to the severity of OSA and to blood pressure (BP).

METHODS

Seventy snoring children referred for assessment of sleep disordered breathing and 26 healthy non-snoring control children (age range: 3-12 years, 59 M/37 F) were studied. Overnight polysomnography was performed coincident with a 12h overnight urine collection. Urinary catecholamine levels were determined using high performance liquid chromatography (noradrenaline, adrenaline and dopamine, with levels adjusted for creatinine excretion). Simple linear and stepwise multiple linear regressions were used to determine the independent associations between catecholamine levels and age, gender, BMI z-score, systolic BP z-score, diastolic BP z-score, and apnea hypopnea index (AHI).

RESULTS

Simple linear regressions revealed significant associations between noradrenaline and AHI (r = 0.32) and age (r = -0.20, p < 0.05 for both). Significant associations were also found between adrenaline and AHI (r = 0.27) and age (r = -0.25, p < 0.05 for both). Systolic BP z-score and diastolic z-score were both significantly associated with adrenaline (r = 0.22 and r = 0.20 respectively, p < 0.05 for both). Multivariate analysis revealed that only AHI was a significant independent predictor of noradrenaline (model R(2) = 0.10, p = 0.001). Similarly, only AHI and age were significant independent predictors of adrenaline (model R(2) = 0.12, p < 0.05).

CONCLUSIONS

This study demonstrates that levels of overnight urinary noradrenaline and adrenaline are related to the severity of OSA in children. These data indicate that children with OSA have increased sympathetic tone that may contribute to the cardiovascular consequences of the condition.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）与成年人的交感神经活动增加和高血压有关。我们假设，患有 OSA 的儿童也存在夜间尿儿茶酚胺测量的交感神经活动增加，并且这种增加与 OSA 的严重程度和血压（BP）有关。

方法

对 70 名因睡眠呼吸障碍评估而转诊的打鼾儿童和 26 名健康非打鼾对照儿童（年龄范围：3-12 岁，59 名男性/37 名女性）进行了研究。进行了整夜多导睡眠图检查，同时进行了 12 小时夜间尿液收集。使用高效液相色谱法测定尿儿茶酚胺水平（去甲肾上腺素、肾上腺素和多巴胺，用肌酐排泄量校正水平）。使用简单线性和逐步多元线性回归来确定儿茶酚胺水平与年龄、性别、BMI z 评分、收缩压 z 评分、舒张压 z 评分和呼吸暂停低通气指数（AHI）之间的独立关联。

结果

简单线性回归显示，去甲肾上腺素与 AHI（r = 0.32）和年龄（r = -0.20，p < 0.05）之间存在显著关联。肾上腺素与 AHI（r = 0.27）和年龄（r = -0.25，p < 0.05）之间也存在显著关联。收缩压 z 评分和舒张压 z 评分均与肾上腺素显著相关（r = 0.22 和 r = 0.20，p < 0.05）。多元分析显示，只有 AHI 是去甲肾上腺素的显著独立预测因子（模型 R(2) = 0.10，p = 0.001）。同样，只有 AHI 和年龄是肾上腺素的显著独立预测因子（模型 R(2) = 0.12，p < 0.05）。