School of Nursing, University of Maryland Baltimore, Baltimore, Maryland.
School of Medicine, University of Maryland Baltimore, Baltimore, Maryland.
Pediatr Pulmonol. 2018 Sep;53(9):1200-1207. doi: 10.1002/ppul.24074. Epub 2018 Jun 3.
A bi-directional relationship exists between asthma and obstructive sleep apnea (OSA) in which presence of one is associated with increased prevalence and severity of the other. Our objective was to determine whether OSA accounted for differences in airway and systemic inflammation in asthmatic children and whether inflammation was associated with asthma control. We hypothesized that greater severity of SDB would correlate with increased upper airway and systemic inflammation and result in reduced asthma control.
Non-obese children aged 4-12 years with persistent asthma, with or without OSA were recruited. Asthma control was measured with the Childhood Asthma Control Test. Children underwent polysomnography and blood sampling, and children with OSA underwent clinically indicated adenotonsillectomy. Tonsils and sera were analyzed for 11 cytokines.
Twenty-seven children (20 with OSA, seven without OSA) participated, mean age 7.9 years, 55.6% female, 92.6% African American. Levels did not differ for any cytokine between children with and without OSA. Lower nadir oxygen saturation was associated with higher levels of tonsil TNF-α (P < 0.001) and IL-10 (P < 0.05). Higher REM-related apnea-hypopnea index was associated with higher levels of tonsil TNF-α (P < 0.05). Children with uncontrolled asthma had significantly higher levels of serum IL-10, IL-13, and TNF-α, and tonsil TNF-α (all P < 0.05) than well-controlled asthmatic children. There was no association between OSA, or any polysomnography variable, and asthma control.
Despite the presence of OSA-associated airway inflammation, and asthma control-associated airway and systemic inflammation, OSA was not related to level of asthma control in this non-obese, largely minority, low income sample.
哮喘和阻塞性睡眠呼吸暂停（OSA）之间存在双向关系，其中一种疾病的存在与另一种疾病的患病率和严重程度增加有关。我们的目的是确定 OSA 是否导致哮喘儿童气道和全身炎症的差异，以及炎症是否与哮喘控制有关。我们假设，严重程度更高的 SDB 将与上气道和全身炎症的增加相关，并导致哮喘控制的降低。
招募了年龄在 4-12 岁、非肥胖、持续哮喘且有或没有 OSA 的儿童。采用儿童哮喘控制测试（Childhood Asthma Control Test）来衡量哮喘控制情况。儿童接受了多导睡眠图和血液采样，有 OSA 的儿童接受了临床指征的腺样体扁桃体切除术。对扁桃体和血清进行了 11 种细胞因子的分析。
共有 27 名儿童（20 名有 OSA，7 名没有 OSA）参与，平均年龄 7.9 岁，55.6%为女性，92.6%为非裔美国人。在有和没有 OSA 的儿童中，细胞因子的水平没有差异。最低血氧饱和度与扁桃体 TNF-α（P<0.001）和 IL-10（P<0.05）水平较高相关。更高的 REM 相关呼吸暂停低通气指数与扁桃体 TNF-α水平较高相关（P<0.05）。未控制哮喘的儿童血清 IL-10、IL-13 和 TNF-α，以及扁桃体 TNF-α水平均显著高于控制良好的哮喘儿童（均 P<0.05）。OSA 或任何多导睡眠图变量与哮喘控制均无相关性。
在这个非肥胖、主要是少数民族、低收入的样本中，尽管存在 OSA 相关的气道炎症以及与哮喘控制相关的气道和全身炎症，但 OSA 与哮喘控制水平无关。
