Bokov Plamen, Dudoignon Benjamin, Delclaux Christophe
Paris Cité University, AP-HP, Robert Debré Hospital, Department of Physiology and Sleep Laboratory, INSERM NeuroDiderot, Paris, France.
Pediatr Res. 2025 May 23. doi: 10.1038/s41390-025-04153-3.
To assess whether hypoxic burden (HB) is associated with cardiac autonomic nervous system dysfunction and increased blood pressure (BP) in otherwise healthy children with moderate to severe obstructive sleep apnea (OSA).
Among 103 children with moderate-to-severe OSA, twenty pairs, matched for age, sex and obstructive apnea-hypopnea index (OAHI) were selected, with low (first quartile) or high (fourth quartile) HB in each pair: median [25th-75th percentiles]; age: 10.8 years [7.3; 13.2] vs. 11.4 [8.6; 13.5]; sex: 7 and 10 girls; z-score of body mass index: 1.50 [0.11; 2.43] vs. 2.40 [1.92; 2.70] (p = 0.012); OAHI: 8.6/hr [6.4; 13.3] vs. 11.1 [6.6; 17.2] and HB: 0.8%.min/h [0.3; 1.5] vs. 13.8 [10.1; 22.3], respectively.
Non-linear heart rate variability (HRV) indices obtained from polysomnography showed sympathetic overflow (Poincaré plot: decreased SD2) and weaker parasympathetic modulation (decreased SD1) in children with high versus low HB. The high versus low HB group had higher percentiles of office BP: systolic, 75th [61; 81] vs. 57th [47; 69], p = 0.049 and diastolic, 70th [60; 78] vs. 55th [46; 65], p = 0.007, adjusted for obesity and arousal index.
Despite similar levels of OAHI, children with higher HB demonstrate parasympathetic withdrawal and increased daytime blood pressure.
The hypoxic burden predicts cardiovascular morbidity/mortality in adult obstructive sleep apnea syndrome. Our study shows that in children with moderate to severe obstructive sleep apnea, despite similar levels of obstructive apnea-hypopnea index, those with higher hypoxic burden show cardiac autonomic nervous system dysfunction and increased daytime blood pressure. This study is the first one suggesting that the hypoxic burden is a valuable marker of cardiovascular morbidity in childhood obstructive sleep apnea.
评估在其他方面健康的中重度阻塞性睡眠呼吸暂停（OSA）儿童中，低氧负荷（HB）是否与心脏自主神经系统功能障碍及血压（BP）升高有关。
在103例中重度OSA儿童中，选取年龄、性别和阻塞性呼吸暂停低通气指数（OAHI）相匹配的20对儿童，每对中分别有低（第一四分位数）或高（第四四分位数）HB：中位数[第25 - 75百分位数]；年龄：10.8岁[7.3；13.2]与11.4岁[8.6；13.5]；性别：女孩分别为7名和10名；体重指数z评分：1.50[0.11；2.43]与2.40[1.92；2.70]（p = 0.012）；OAHI：8.6次/小时[6.4；13.3]与11.1次/小时[6.6；17.2]，HB分别为0.8%·分钟/小时[0.3；1.5]与13.8[10.1；22.3]。
多导睡眠图获得的非线性心率变异性（HRV）指标显示，高HB儿童与低HB儿童相比，存在交感神经亢进（庞加莱图：SD2降低）和副交感神经调节减弱（SD1降低）。高HB组与低HB组的诊室血压百分位数更高：收缩压，第75百分位数[61；81]与第57百分位数[47；69]，p = 0.049；舒张压，第70百分位数[60；78]与第55百分位数[46；65]，p = 0.007，校正了肥胖和觉醒指数。
尽管OAHI水平相似，但HB较高的儿童表现出副交感神经活动减退和日间血压升高。
低氧负荷可预测成人阻塞性睡眠呼吸暂停综合征的心血管发病率/死亡率。我们的研究表明，在中重度阻塞性睡眠呼吸暂停儿童中，尽管阻塞性呼吸暂停低通气指数水平相似，但低氧负荷较高的儿童表现出心脏自主神经系统功能障碍和日间血压升高。本研究首次表明低氧负荷是儿童阻塞性睡眠呼吸暂停心血管发病的一个有价值的标志物。
