Polysomnographic correlates of endothelial function in children with obstructive sleep apnea

Fengjie Zhang; Yunxiao Wu; Guoshuang Feng; Xin Ni; Zhifei Xu; David Gozal

doi:10.1016/j.sleep.2018.07.023

Polysomnographic correlates of endothelial function in children with obstructive sleep apnea

Sleep Med. 2018 Dec:52:45-50. doi: 10.1016/j.sleep.2018.07.023. Epub 2018 Aug 22.

Authors

Fengjie Zhang¹, Yunxiao Wu², Guoshuang Feng³, Xin Ni⁴, Zhifei Xu⁵, David Gozal⁶

Affiliations

¹ Capital Medical University, Beijing, China.
² Beijing Key Laboratory of Pediatric Otolaryngology, Head & Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
³ Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
⁴ Otolaryngology, Head and Neck Surgery Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
⁵ Respiratory Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. Electronic address: zhifeixu@aliyun.com.
⁶ Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA.

PMID: 30269047
DOI: 10.1016/j.sleep.2018.07.023

Abstract

Objectives: To evaluate endothelial function in a large cohort of children clinically referred for suspected obstructive sleep apnea syndrome (OSAS), and to identify risk factors contributing to the presence of endothelial dysfunction (ED).

Methods: Habitually snoring children (age range, 3-11 years) were recruited. All participants underwent overnight polysomnography (PSG). Endothelial function test used peripheral arterial tonometry (PAT) to derive the reactive hyperemia index (RHI). Subjects were then divided into mild OSA, moderate-severe OSA and primary snorers (PS), according to their obstructive apnea-hypopnea index (OAHI).

Results: A total of 355 subjects were recruited. There were no differences in age, gender, or BMI z score among the three groups. Both mild and moderate-severe OSA groups had lower RHI than PS (P < 0.001, P = 0.001, respectively). Linear regression analysis revealed that RHI was positively correlated with age (r = 0.17, P = 0.002), BMI z score (r = 0.14, P = 0.008) and oxygen saturation nadir (r = 0.15, P = 0.006), but negatively correlated with oxygen desaturation index (ODI_3%; r = -0.19, P = 0.001) and respiratory-related arousal index (ArI-resp) (r = -0.24, P < 0.001). In stepwise regression analysis, age, BMI z score, and ArI-resp were independently associated with endothelial function (r = 0.34, P < 0.001).

Conclusion: Children with OSA are at increased risk for abnormal endothelial function than habitually snoring children. Furthermore, in addition to age and BMI, which are well-established factors affecting endothelial function, both intermittent hypoxia and sleep fragmentation during sleep also emerge as candidate risk factors contributing to endothelial dysfunction in snoring children.

Clinical trial: Follow up of PS and OSAHS in Chinese children, https://clinicaltrials.gov/, Clinical number: NCT02447614.

Keywords: Cardiovascular; Children; Endothelial function; Intermittent hypoxia; Obstructive sleep apnea; Respiratory related arousal.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Cohort Studies
Endothelium, Vascular / physiopathology*
Female
Humans
Hyperemia*
Hypoxia / etiology
Male
Manometry
Polysomnography
Risk Factors
Sleep Apnea, Obstructive / physiopathology*
Sleep Deprivation / etiology
Snoring / physiopathology*

Associated data

ClinicalTrials.gov/NCT02447614