Morell-Garcia Daniel, Toledo-Pons Núria, Sanchis Pilar, Bauça Josep Miquel, Sánchez José María, Peña-Zarza José, Giménez Paloma, Pierola Javier, de la Peña-Bravo Mónica, Alonso-Fernández Alberto, Barceló Antònia
Dept of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
Institut d'Investigació Sanitària de les Illes Balears, Palma de Mallorca, Spain.
ERJ Open Res. 2020 Oct 5;6(4). doi: 10.1183/23120541.00278-2019. eCollection 2020 Oct.
Red cell distribution width (RDW) is a parameter included in the complete blood count which informs about the size of the circulating red blood cell population and its distribution. In adults, an increase in RDW was shown to be associated both with obstructive sleep apnoea (OSA) and with an increase in cardiovascular mortality. The aim of this study was to determine whether RDW is a potential biomarker for screening children with moderate-severe OSA.
An observational study in snoring patients was performed. All patients underwent a sleep study and were classified either as simple snorers (apnoea-hypopnoea index (AHI) <1 event·h) or as patients with OSA (mild AHI ≥1 to <5 events·h; moderate-severe AHI ≥5 events·h). Blood analyses (complete blood count and C-reactive protein) were performed for every individual.
A total of 175 individuals were recruited. The mean age was 8.3±3.6 years. Correlation studies between RDW and several sleep-related parameters showed negative significant associations with minimum oxygen saturation, and positive significant associations with oxygen desaturation index (≥3% and ≥4%), AHI and the arousal index. A predictive model for paediatric severe OSA (AHI ≥5 events·h) was found based on mean corpuscular haemoglobin concentration (MCHC) <34.9 g·dL and RDW >13.1% values, adjusting for body mass index z-score and age (area under the curve 0.657; p=0.004). In addition, differences were found in eosinophil count and C-reactive protein concentrations among the three subgroups.
In children, RDW stands out as a biomarker associated with the severity of OSA. The use of RDW and MCHC could be a simple but useful tool for the severity prediction of paediatric OSA in snoring patients.
红细胞分布宽度（RDW）是全血细胞计数中的一个参数，可反映循环红细胞群体的大小及其分布情况。在成年人中，RDW升高与阻塞性睡眠呼吸暂停（OSA）以及心血管死亡率增加均有关联。本研究的目的是确定RDW是否为筛查中重度OSA儿童的潜在生物标志物。
对打鼾患者进行了一项观察性研究。所有患者均接受了睡眠研究，并被分类为单纯打鼾者（呼吸暂停低通气指数（AHI）<1次/小时）或OSA患者（轻度AHI≥1至<5次/小时；中重度AHI≥5次/小时）。对每位个体进行了血液分析（全血细胞计数和C反应蛋白）。
共招募了175名个体。平均年龄为8.3±3.6岁。RDW与几个睡眠相关参数之间的相关性研究显示，与最低氧饱和度呈显著负相关，与氧去饱和指数（≥3%和≥4%）、AHI和觉醒指数呈显著正相关。基于平均红细胞血红蛋白浓度（MCHC）<34.9 g/dL和RDW>13.1%的值，建立了一个针对小儿重度OSA（AHI≥5次/小时）的预测模型，并对体重指数z评分和年龄进行了校正（曲线下面积为0.657；p = 0.004）。此外，在三个亚组之间发现了嗜酸性粒细胞计数和C反应蛋白浓度的差异。
在儿童中，RDW是与OSA严重程度相关的生物标志物。使用RDW和MCHC可能是预测打鼾患者小儿OSA严重程度的一种简单而有用的工具。
