Department of Internal Medicine, A. Cardarelli Hospital, Naples, Italy.
J Clin Sleep Med. 2013 May 15;9(5):493-8. doi: 10.5664/jcsm.2674.
Obesity is a risk factor for sleep disordered breathing (SDB) in children. Plasma levels of high-sensitivity C-reactive protein (Hs-CRP) are predictive of cardiovascular morbidity in adults, and CRP levels are associated with over-weight. Increased carotid intima-media thickness (IMT) is associated with several cardiovascular risk factors. We evaluated the effect of SDB on CRP levels and IMT in lean and obese children not selected for snoring.
101 children (age 5-15 years) attending a weight clinic or scheduled for routine visit. IMT was measured with quantitative B-mode ultrasound scans. The apnea-hypopnea index (AHI) was measured overnight: AHI < 1 defined controls, AHI ≥ 1 to < 5 = mild SDB, and AHI ≥ 5 = obstructive sleep apnea (OSA).
AHI was significantly associated with Hs-CRP concentration (r = 0.32, p = 0.002) in all 101 children irrespective of age and sex. Body mass index (BMI) was higher in OSA children than controls (25.5 ± 7.0 vs 22.1 ± 6.9, p = 0.05). Obese children had 3.3 times more probability of having OSA (HR 3.3, 95% CI 1.2-9.3, p = 0.02) than lean children. Hs-CRP values were significantly higher in children with OSA than in children without (p = 0.011), but not when BMI z-score was added as covariate. IMT was not associated with AHI or SDB.
The results of this study suggest an association between OSA and Hs-CRP concentrations (mainly mediated by overweight and obesity), but not between OSA and subclinical atherosclerosis. There is scope for prevention in childhood before OSA syndrome causes the irreversible damage to arteries observed in adult patients.
肥胖是儿童睡眠呼吸紊乱（SDB）的一个危险因素。高敏 C 反应蛋白（Hs-CRP）的血浆水平可预测成年人的心血管发病率，且 CRP 水平与超重相关。颈动脉内膜中层厚度（IMT）的增加与多种心血管危险因素相关。我们评估了 SDB 对非因打鼾而选择的瘦和肥胖儿童的 CRP 水平和 IMT 的影响。
101 名年龄在 5-15 岁之间的儿童参加了体重诊所或进行了常规就诊。通过定量 B 型超声扫描测量 IMT。整夜测量呼吸暂停低通气指数（AHI）：AHI<1 定义为对照组，AHI≥1 至<5=轻度 SDB，AHI≥5=阻塞性睡眠呼吸暂停（OSA）。
无论年龄和性别如何，AHI 与 Hs-CRP 浓度均呈显著相关（r=0.32，p=0.002）。与对照组相比，OSA 患儿的 BMI 更高（25.5±7.0 vs 22.1±6.9，p=0.05）。肥胖儿童发生 OSA 的可能性是瘦儿童的 3.3 倍（HR 3.3，95%CI 1.2-9.3，p=0.02）。与无 OSA 儿童相比，OSA 儿童的 Hs-CRP 值显著更高（p=0.011），但当将 BMI z 评分作为协变量添加时则不然。IMT 与 AHI 或 SDB 均无关联。
本研究结果表明，OSA 与 Hs-CRP 浓度之间存在关联（主要通过超重和肥胖介导），但 OSA 与亚临床动脉粥样硬化之间无关联。在 OSA 综合征引起成人患者观察到的动脉不可逆损伤之前，在儿童期就有预防的空间。
