Universidad de La Sabana, Colombia; Fundación Neumologica Colombiana, Colombia.
Universidad de La Sabana, Colombia; Fundación Neumologica Colombiana, Colombia.
Sleep Med. 2024 Jul;119:584-588. doi: 10.1016/j.sleep.2024.05.023. Epub 2024 May 10.
Exhaled nitric oxide fraction (FeNO) is employed for the diagnosis and phenotyping of asthma as an inflammatory biomarker of the airway. Limited evidence exists regarding its behavior in the presence of asthma and obstructive sleep apnea (OSA). Our objective was to determine whether FeNO levels are associated with the severity of OSA or the coexistence of asthma and OSA in residents at high altitudes.
Observational, analytical, cross-sectional study in children aged 5-16 years residing at 2600 m above sea level treated at a Sleep Study Center between 2019 and 2021. We conducted a medical history, polysomnogram, and measurement of FeNO levels. The children were categorized into four groups: OSA, asthma, asthma with OSA, and controls (without asthma or OSA). FeNO levels among the groups were compared using the Kruskal-Wallis test, and correlations were explored using the Spearman correlation coefficient. Analyses considered statistical significance at a two-tailed p-value <0.05.
Among the 261 included children, 68 (26.1 %) had OSA, 42 (16.1 %) were diagnosed with asthma, 109 (41.8 %) had both asthma and OSA, and 42 (16.1 %) were controls. Their FeNO medians were 10 ppb, 18.5 ppb, 15 ppb, and 14 ppb, respectively, with no significant differences between the evaluated groups (p = 0.263). We found no correlation between FeNO and apnea-hypopnea index and obstructive apnea index even for the groups of patients with FeNO >20 ppb and FeNO >35 ppb (>75th percentile). In the adjusted model, a significant association was observed between asthma and FeNO levels.
Our findings suggest that FeNO measurements in children would not allow establishing this biomarker as part of the diagnosis of OSA. However, these findings may be related to high altitude.
呼出气一氧化氮分数（FeNO）作为气道炎症的生物标志物，用于哮喘的诊断和表型分析。目前关于其在哮喘和阻塞性睡眠呼吸暂停（OSA）共存时的行为的证据有限。我们的目的是确定 FeNO 水平是否与 OSA 的严重程度或高海拔地区居民中哮喘和 OSA 的共存有关。
这是一项在 2019 年至 2021 年期间在海拔 2600 米以上的睡眠研究中心接受治疗的 5-16 岁儿童中进行的观察性、分析性、横断面研究。我们进行了病史、多导睡眠图和 FeNO 水平测量。将儿童分为四组：OSA、哮喘、哮喘合并 OSA 和对照组（无哮喘或 OSA）。使用 Kruskal-Wallis 检验比较各组间的 FeNO 水平，并使用 Spearman 相关系数探索相关性。分析考虑双侧 p 值<0.05 的统计学意义。
在纳入的 261 名儿童中，68 名（26.1%）患有 OSA，42 名（16.1%）被诊断为哮喘，109 名（41.8%）患有哮喘和 OSA，42 名（16.1%）为对照组。他们的 FeNO 中位数分别为 10 ppb、18.5 ppb、15 ppb 和 14 ppb，评估组之间无显著差异（p=0.263）。我们发现，即使对于 FeNO>20 ppb 和 FeNO>35 ppb（>75 百分位数）的患者组，FeNO 与呼吸暂停-低通气指数和阻塞性呼吸暂停指数之间也没有相关性。在调整后的模型中，观察到哮喘与 FeNO 水平之间存在显著关联。
我们的研究结果表明，在儿童中测量 FeNO 并不能将该生物标志物作为 OSA 诊断的一部分。然而，这些发现可能与高海拔有关。
