Background

The objective of the study was to assess the relationship between autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing.

Methods

We enrolled habitually snoring children aged 3–14 years for overnight polysomnography (PSG) and high-sensitivity C-reactive protein (hsCRP) measurement. Low-grade inflammation was defined as hsCRP >1.0 mg/L to <10.0 mg/L. An electrocardiogram recording was extracted from PSG. Heart rate variability was analyzed using time and frequency domain methods.

Results

In total, 190 children were included, with 61 having primary snoring (PS), 39 mild obstructive sleep apnea (OSA), and 90 moderate-to-severe OSA. The average RR interval displayed a significant decline, whereas the low frequency/high frequency (LF/HF) ratio showed an increasing tendency in children with PS, mild OSA, and moderate-to-severe OSA. Mean RR was mainly influenced by age and the apnea hypopnea index (AHI) (all P < 0.01). AHI was an independent risk factor for the altered LF/HF ratio at all sleep stages except N3 stage (all P < 0.05). In the wake stage, low-grade inflammation was an independent risk factor of altered LF/HF ratio (P = 0.014).

Conclusions

Autonomic nervous function was impaired in children with OSA. The sympathetic–vagal balance was influenced by low-grade inflammation in the wake stage, whereas it was only affected by AHI when falling asleep.

Impact

• We found that autonomic nervous function was impaired in children with OSA.

• We found that there was a negative correlation between systemic inflammation and autonomic nervous function in children with SDB only at wake stage.

• A negative association between systemic inflammation and autonomic nervous function was demonstrated in children in this study. Furthermore, altered LF/HF ratio maybe a good indicator of autonomic nervous dysfunction in children as it only correlated with the SDB severity, not with age.

中文翻译：

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睡眠呼吸障碍儿童的自主神经功能和低度炎症

背景

该研究的目的是评估睡眠呼吸障碍儿童的自主神经功能与低度炎症之间的关系。

方法

我们招募了 3-14 岁的习惯性打鼾儿童进行夜间多导睡眠图 (PSG) 和高敏 C 反应蛋白 (hsCRP) 测量。低度炎症定义为 hsCRP >1.0 mg/L 至 <10.0 mg/L。从 PSG 中提取心电图记录。使用时域和频域方法分析心率变异性。

结果

总共包括 190 名儿童，其中 61 名患有原发性打鼾 (PS)、39 名轻度阻塞性睡眠呼吸暂停 (OSA) 和 90 名中度至重度 OSA。PS、轻度 OSA 和中重度 OSA 患儿的平均 RR 间期显着下降，而低频/高频 (LF/HF) 比值呈上升趋势。平均 RR 主要受年龄和呼吸暂停低通气指数 (AHI) 的影响（均P  < 0.01）。AHI 是除 N3 阶段外所有睡眠阶段 LF/HF 比率改变的独立危险因素（均P  < 0.05）。在苏醒期，低度炎症是 LF/HF 比值改变的独立危险因素（P  = 0.014）。

结论

OSA 儿童的自主神经功能受损。交感神经-迷走神经平衡受觉醒阶段低度炎症的影响，而仅在入睡时受 AHI 影响。

影响

• 我们发现 OSA 儿童的自主神经功能受损。

• 我们发现仅在苏醒阶段的 SDB 儿童全身炎症与自主神经功能呈负相关。

• 在这项研究中，儿童的全身炎症和自主神经功能之间存在负相关。此外，改变的 LF/HF 比率可能是儿童自主神经功能障碍的一个很好的指标，因为它只与 SDB 的严重程度相关，而不是与年龄相关。