Santana-Miranda Rafael, Murata Chiharu, Bruni Oliveiro, Rosa Agostinho, Alvarado Ruiz Gerardo Alberto, Castillo Montoya Carlos Raúl, Rojas-Zamorano José Ángel, Esqueda-León Enrique, Dominguez-Salazar Emilio, Poblano Adrian, Velazquez-Moctezuma Javier
Sleep Disorders Clinic, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Research Methodology Department, National Institute of Pediatrics, Mexico City, Mexico.
Brain Dev. 2019 Jan;41(1):66-71. doi: 10.1016/j.braindev.2018.07.002. Epub 2018 Jul 20.
Congenital hypothyroidism is defined as thyroid hormone deficiency present at birth which is crucial for brain development. Recently, the cyclic alternating pattern, a rhythm present in electroencephalography recordings in non-Rapid eye movement sleep, has been related to brain development and cognition in different pediatric conditions. Therefore, we evaluated the cyclic alternating pattern rate in infants with congenital hypothyroidism, thyroxine supplementation, and healthy controls. The parameters of the cyclic alternating pattern were evaluated in 19 healthy infants (10 female, mean age 25.5 ± 15.5 months) and 21 infants diagnosed with congenital hypothyroidism (19 female, mean age 24.3 ± 19.0 months). We considered the transient electro-cortical activations (phase A of the cycle) in non-Rapid eye movement sleep and the subdivisions of the A phase in: A1, A2 and A3, based on their frequency content. All subjects were subjected to polysomnography recording in a standard laboratory setting. Sleep data were stored computer following the International 10-20 System. Data showed that congenital hypothyroidism infants exhibited higher frequency of central apnea, hypopnea, and arousals in comparison to controls. Particularly, central apnea index decreased with age in the control group but not in congenital hypothyroidism group. Regarding to cyclic alternating pattern measurements, congenital hypothyroidism infants exhibit a higher frequency in the percentage of A3 subtype (electroencephalographic desynchrony) and conversely a lower percentage of A1 subtype (electroencephalographic synchrony), than healthy infants. An important finding of this study is the positive correlation between A1 mean duration and age, which is bigger in control group than in congenital hypothyroidism group (time duration in control group (0.52 s/month) versus congenital hypothyroidism group (0.1 s/month). Infants with congenital hypothyroidism showed an increase of A3 subtype, of central apnea, and of arousals. The reduction of percentage and mean duration of A1 subtype could be a valuable indicator of sleep development in patients with congenital hypothyroidism and healthy infants.
先天性甲状腺功能减退症被定义为出生时就存在的甲状腺激素缺乏，这对大脑发育至关重要。最近，睡眠周期交替模式是一种在非快速眼动睡眠脑电图记录中出现的节律，已被证明与不同儿科疾病中的大脑发育和认知有关。因此，我们评估了先天性甲状腺功能减退症婴儿、补充甲状腺素的婴儿以及健康对照组的睡眠周期交替模式发生率。对19名健康婴儿（10名女性，平均年龄25.5±15.5个月）和21名被诊断为先天性甲状腺功能减退症的婴儿（19名女性，平均年龄24.3±19.0个月）的睡眠周期交替模式参数进行了评估。我们在非快速眼动睡眠中考虑了短暂的皮层电激活（周期的A相），并根据其频率成分将A相细分为A1、A2和A3。所有受试者均在标准实验室环境中进行多导睡眠图记录。睡眠数据按照国际10-20系统存储在计算机中。数据显示，与对照组相比，先天性甲状腺功能减退症婴儿出现中枢性呼吸暂停、呼吸浅慢和觉醒的频率更高。特别是，对照组的中枢性呼吸暂停指数随年龄下降，而先天性甲状腺功能减退症组则不然。关于睡眠周期交替模式测量，与健康婴儿相比，先天性甲状腺功能减退症婴儿的A3亚型（脑电图去同步化）百分比更高，而A1亚型（脑电图同步化）百分比更低。本研究的一个重要发现是A1平均持续时间与年龄呈正相关，对照组的相关性大于先天性甲状腺功能减退症组（对照组的时间持续为0.52秒/月，而先天性甲状腺功能减退症组为0.1秒/月）。先天性甲状腺功能减退症婴儿的A3亚型、中枢性呼吸暂停和觉醒增加。A1亚型百分比和平均持续时间的降低可能是先天性甲状腺功能减退症患者和健康婴儿睡眠发育的一个有价值指标。
