Ehsan Zarmina, Ishman Stacey L, Kimball Thomas R, Zhang Nanhua, Zou Yuanshu, Amin Raouf S
Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO.
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Sleep. 2017 Mar 1;40(3). doi: 10.1093/sleep/zsx015.
The presence of sleep disordered breathing (SDB) is known to impact long-term cardiovascular morbidity in adults; however, the long-term effects in children are poorly understood. We aimed to systematically review and synthesize studies published to date on the long-term effects of SDB in children.
Meta-analysis and systematic review using PubMed, CINAHL, Embase, and Scopus (all indexed years).
We searched for English-language articles containing original human data from prospective studies, with ≥7 participants, in children ≤18 years of age. Data regarding study design, demographics, clinical characteristics, outcomes, level of evidence, and risk of bias were obtained. Articles were independently reviewed by three investigators. Retrospective and cross-sectional studies were excluded.
Of 1701 identified abstracts, 25 articles (combined n = 1418) were ultimately included. All studies reported longitudinal outcomes following treatment of SDB, 21 studies exclusively reporting outcomes after adenotonsillectomy. Therefore, studies were combined to objectively assess the effect of SDB treatment on cardiovascular outcomes. Although all cardiovascular parameters were within the normal range at baseline, at follow-up there was a significant decrease in mean pulmonary artery pressure, right ventricular end diastolic diameter, heart rate, mitral Em/Am ratio, and C-reactive protein. There was no significant change in interventricular septum thickness, left ventricular parameters (shortening fraction, systolic and end diastolic diameters, ejection fraction, posterior wall thickness, isovolumetric relaxation time), left atrial diameter, and aortic and pulmonary valve peak velocities.
Studies assessing the long-term cardiovascular effects of SDB in children are limited. The available literature indicates effects on autonomic function, right, and left heart function following treatment for SDB. However, well-designed, large-scale, prospective cohort studies (using standardized outcomes) are needed to better understand the relationship of cardiovascular morbidity in the context of pediatric SDB.
已知睡眠呼吸障碍（SDB）的存在会影响成人的长期心血管发病率；然而，其对儿童的长期影响却知之甚少。我们旨在系统回顾和综合迄今为止发表的关于SDB对儿童长期影响的研究。
使用PubMed、CINAHL、Embase和Scopus（所有索引年份）进行荟萃分析和系统回顾。
我们搜索了包含前瞻性研究原始人类数据的英文文章，研究对象为18岁及以下儿童，参与者≥7名。获取了有关研究设计、人口统计学、临床特征、结局、证据水平和偏倚风险的数据。文章由三名研究人员独立评审。排除回顾性和横断面研究。
在1701篇识别出的摘要中，最终纳入了25篇文章（合并样本量n = 1418）。所有研究均报告了SDB治疗后的纵向结局，21项研究专门报告了腺样体扁桃体切除术后的结局。因此，将这些研究合并以客观评估SDB治疗对心血管结局的影响。尽管所有心血管参数在基线时均在正常范围内，但在随访时，平均肺动脉压、右心室舒张末期内径、心率、二尖瓣E/A比值和C反应蛋白均显著降低。室间隔厚度、左心室参数（缩短分数、收缩期和舒张末期直径、射血分数、后壁厚度、等容舒张时间）、左心房直径以及主动脉和肺动脉瓣峰值速度均无显著变化。
评估SDB对儿童长期心血管影响的研究有限。现有文献表明，SDB治疗后对自主神经功能、左右心功能有影响。然而，需要设计良好的大规模前瞻性队列研究（使用标准化结局），以更好地了解儿科SDB背景下心血管发病率之间的关系。
