Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
Sleep. 2013 Sep 1;36(9):1349-54. doi: 10.5665/sleep.2962.
Hypertrophic tonsillar tissue in children with obstructive sleep apnea (OSA) has enhanced expression of glucocorticoid receptors, which may reflect low endogenous cortisol levels. We have evaluated the effect of the interaction between tonsillar hypertrophy and OSA severity on morning serum cortisol levels.
Children with and without snoring underwent polysomnography, tonsillar size grading, and measurement of morning serum cortisol.
Seventy children (2-13 years old) were recruited: 30 with moderate-to-severe OSA (apnea-hypopnea index [AHI] > 5 episodes/h), 26 with mild OSA (AHI > 1 and ≤ 5), and 14 controls (no snoring; AHI ≤ 1). Tonsillar hypertrophy was present in 56.7%, 53.8%, and 42.9% of participants in each group, respectively. Application of a general linear model demonstrated a significant effect of the interaction between severity of OSA and tonsillar hypertrophy on cortisol levels (P = 0.04), after adjustment for obesity, gender, and age. Among children with tonsillar hypertrophy, subjects with moderate-to-severe OSA (n = 17; AHI 14.7 ± 10.6), mild OSA (n = 14; AHI 2.3 ± 1.2), and control participants (n = 6; AHI 0.7 ± 0.2) were significantly different regarding cortisol levels (P = 0.02). Subjects with moderate-to-severe OSA had lower cortisol (16.9 ± 8.7 mcg/dL) than those with mild OSA (23.3 ± 4.2; P = 0.01) and those without OSA (controls) (23.6 ± 5.3 mcg/dL; P = 0.04). In contrast, children with normal-size tonsils and moderate-to-severe OSA, mild OSA, and controls did not differ in cortisol levels.
Children with moderate-to-severe obstructive sleep apnea and the phenotype of hypertrophic tonsils have reduced morning serum cortisol levels and potentially decreased glucocorticoid inhibitory effects on tonsillar growth.
患有阻塞性睡眠呼吸暂停（OSA）的儿童的扁桃体组织肥大，糖皮质激素受体表达增强，这可能反映了内源性皮质醇水平较低。我们评估了扁桃体肥大与 OSA 严重程度之间的相互作用对清晨血清皮质醇水平的影响。
有和无打鼾的儿童进行多导睡眠图、扁桃体大小分级和清晨血清皮质醇测量。
共招募了 70 名儿童（2-13 岁）：30 名患有中重度 OSA（呼吸暂停低通气指数[AHI]＞5 次/小时）、26 名患有轻度 OSA（AHI＞1 且≤5）和 14 名对照组（无打鼾；AHI≤1）。在每组中，分别有 56.7%、53.8%和 42.9%的参与者存在扁桃体肥大。在调整肥胖、性别和年龄后，应用一般线性模型显示 OSA 严重程度和扁桃体肥大之间的相互作用对皮质醇水平有显著影响（P=0.04）。在存在扁桃体肥大的儿童中，中重度 OSA 组（n=17；AHI 14.7±10.6）、轻度 OSA 组（n=14；AHI 2.3±1.2）和对照组（n=6；AHI 0.7±0.2）的皮质醇水平存在显著差异（P=0.02）。中重度 OSA 组的皮质醇水平（16.9±8.7 mcg/dL）低于轻度 OSA 组（23.3±4.2；P=0.01）和无 OSA 组（对照组）（23.6±5.3 mcg/dL；P=0.04）。相比之下，正常大小扁桃体且患有中重度 OSA、轻度 OSA 和对照组的儿童之间的皮质醇水平没有差异。
患有中重度阻塞性睡眠呼吸暂停和扁桃体肥大表型的儿童清晨血清皮质醇水平降低，潜在地降低了糖皮质激素对扁桃体生长的抑制作用。
