Department of Respiratory and Sleep Medicine and.
Robinson Research Institute.
Am J Respir Crit Care Med. 2020 Dec 1;202(11):1560-1566. doi: 10.1164/rccm.201911-2229OC.
Sleep-disordered breathing (SDB) is associated with increased vascular resistance in children and adults. Persistent increased vascular resistance damages vascular endothelial cells-a marker of which is increased platelet activation. This study compared whole-blood impedance platelet aggregation in children with clinically diagnosed SDB warranting adenotonsillectomy and healthy control subjects. Thirty children who had SDB warranting intervention clinically diagnosed by experienced pediatric otolaryngologists were recruited from adenotonsillectomy waitlists, and 20 healthy children from the community underwent overnight polysomnography to determine SDB severity (obstructive apnea-hypopnea index). Snoring frequency was collected from parents. In the morning, a fasting blood sample was taken, and whole-blood platelet aggregation was measured. Children with SDB exhibited increased platelet aggregation to TRAP (thrombin receptor-activating peptide) (children with SDB = 114.8 aggregation units [AU] vs. control subjects = 98.0 AU; < 0.05) and COL antibody (96.7 vs. 82.2 AU; < 0.05) and an increased trend in ADP antibody (82.3 vs. 69.2 AU; < 0.07) but not aspirin dialuminate (82.1 vs. 79.5 AU; > 0.05). No significant association was observed between either the obstructive apnea-hypopnea index and any aggregation parameter, but parental report of snoring was positively associated with TRAP aggregation (Kendall's τ-c = 0.23; < 0.05). The finding of increased platelet aggregation is consistent with endothelial damage. This suggests that the profile of cardiovascular changes noted in adults with SDB may also occur in children with SDB.
睡眠呼吸障碍（SDB）与儿童和成人的血管阻力增加有关。持续的血管阻力增加会损害血管内皮细胞——血小板活化增加就是一个标志物。本研究比较了经经验丰富的儿科耳鼻喉科医生临床诊断为需要行腺样体扁桃体切除术的 SDB 儿童和健康对照组儿童的全血阻抗血小板聚集。30 名经临床诊断为 SDB 的儿童（需要行腺样体扁桃体切除术），从腺样体扁桃体切除术等候名单中招募，20 名健康儿童从社区接受过夜多导睡眠图检查以确定 SDB 严重程度（阻塞性呼吸暂停低通气指数）。父母报告打鼾频率。早上采集空腹血样，测量全血血小板聚集。SDB 儿童对 TRAP（血栓素受体激活肽）的血小板聚集增加（SDB 儿童=114.8 聚集单位 [AU] vs. 对照组=98.0 AU；<0.05）和 COL 抗体（96.7 vs. 82.2 AU；<0.05），ADP 抗体也有增加趋势（82.3 vs. 69.2 AU；<0.07），但阿司匹林二联磺（82.1 vs. 79.5 AU；>0.05）则没有。阻塞性呼吸暂停低通气指数与任何聚集参数均无显著相关性，但父母报告的打鼾与 TRAP 聚集呈正相关（Kendall's τ-c=0.23；<0.05）。血小板聚集增加的发现与内皮损伤一致。这表明，在成人 SDB 中观察到的心血管变化特征也可能发生在儿童 SDB 中。
