The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
Sleep Med Rev. 2014 Apr;18(2):179-89. doi: 10.1016/j.smrv.2013.04.006. Epub 2013 Jul 12.
Sleep disordered breathing (SDB) ranges in severity from primary snoring (PS) to obstructive sleep apnoea (OSA). In adults, SDB is associated with adverse cardiovascular consequences which are mediated, in part, by autonomic dysfunction. Although SDB is common in children, fewer paediatric studies have investigated these cardiovascular effects. Initial research focused on those with OSA, indeed children with PS were occasionally utilised as the comparison control group. However, it is essential to understand the ramifications of this disorder in all its severities, as currently the milder forms of SDB are often untreated. Methodologies used to assess autonomic function in children with SDB include blood pressure (BP), BP variability, baroreflex sensitivity, heart rate variability, peripheral arterial tonometry and catecholamine assays. The aim of this review was to summarise the findings of paediatric studies to date and explore the relationship between autonomic dysfunction and SDB in children, paying particular attention to the roles of disease severity and/or age. This review found evidence of autonomic dysfunction in children with SDB during both wakefulness and sleep. BP dysregulation, elevated generalised sympathetic activity and impairment of autonomic reflexes occur in school-aged children and adolescents with SDB. The adverse effects of SDB seem somewhat less in young children, although more studies are needed. There is mounting evidence that the cardiovascular and autonomic consequences of SDB are not limited to those with OSA, but are also evident in children with PS. The severity of disease and age of onset of autonomic consequences may be important guides for the treatment of SDB.
睡眠呼吸障碍（SDB）的严重程度范围从单纯性打鼾（PS）到阻塞性睡眠呼吸暂停（OSA）。在成年人中，SDB 与不良心血管后果相关，部分是通过自主神经功能障碍介导的。尽管 SDB 在儿童中很常见，但对这些心血管影响的儿科研究较少。最初的研究集中在 OSA 患者上，事实上，偶尔也将 PS 儿童用作比较对照组。然而，了解这种障碍在所有严重程度下的后果至关重要，因为目前轻度 SDB 往往未得到治疗。用于评估 SDB 儿童自主神经功能的方法包括血压（BP）、BP 变异性、压力反射敏感性、心率变异性、外周动脉张力测定和儿茶酚胺测定。本综述的目的是总结迄今为止儿科研究的结果，并探讨儿童 SDB 中自主神经功能障碍之间的关系，特别注意疾病严重程度和/或年龄的作用。本综述发现，SDB 儿童在清醒和睡眠期间均存在自主神经功能障碍。BP 调节异常、广泛的交感神经活动升高和自主反射受损发生在患有 SDB 的学龄儿童和青少年中。SDB 的不良影响在幼儿中似乎稍小，但仍需要更多的研究。越来越多的证据表明，SDB 的心血管和自主神经后果不仅限于 OSA 患者，而且在 PS 儿童中也很明显。疾病的严重程度和自主神经后果的发病年龄可能是 SDB 治疗的重要指导因素。
