Sleep-disordered breathing in children with metabolic syndrome: the role of leptin and sympathetic nervous system activity and the effect of continuous positive airway pressure.
Sleep-disordered breathing in children with metabolic syndrome: the role of leptin and sympathetic nervous system activity and the effect of continuous positive airway pressure.
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代谢综合征儿童睡眠呼吸障碍：瘦素和交感神经系统活动的作用以及持续气道正压通气的作用。
DOI：
10.1542/peds.2008-0154
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发表时间：
2008-09
期刊：
影响因子：
8
通讯作者：
Bazzy-Asaad A
中科院分区：
文献类型：
--
作者：
Nakra N;Bhargava S;Dzuira J;Caprio S;Bazzy-Asaad A
这项工作的目的是确定在患有代谢综合征和睡眠障碍呼吸的儿童中，代谢标志物是否将他们与没有睡眠障碍呼吸的代谢综合征儿童区分开来，以及持续气道正压治疗睡眠障碍呼吸是否与代谢紊乱的改善有关。受试者年龄在7到19岁之间，患有代谢综合征，并有有效的睡眠问卷。受试者接受了夜间多导睡眠监测，在此期间，通过每8小时测量去甲肾上腺素和肾上腺素以及瘦素来评估交感神经系统的活动。第二天早上，进行空腹3小时口服葡萄糖耐量试验，计算全身胰岛素敏感性。同时检测空腹血脂、白介素6、脂联素和C反应蛋白水平。睡眠呼吸障碍儿童接受持续气道正压治疗3个月，并再次进行研究。对睡眠呼吸障碍组和无睡眠障碍呼吸组进行比较，对独立样本进行Fisher精确检验和t检验，并对年龄和BMI进行协方差分析。在34名被研究的儿童中，有25名患有睡眠呼吸紊乱(呼吸暂停低通气指数：>；1.5)。有睡眠呼吸障碍组的每小时平均去甲肾上腺素和瘦素水平高于无睡眠呼吸障碍组(P<；.005)，但全身胰岛素敏感性没有差异。11名睡眠呼吸障碍患者完成了为期3个月的夜间持续正压治疗。在随访研究中，平均每小时瘦素水平显著低于最初研究，BMI z评分或其他测量没有变化。我们的发现支持这样的假设，即代谢综合征儿童的睡眠呼吸障碍与交感神经系统活动和瘦素水平的增加有关，而与胰岛素抵抗的恶化无关。持续气道正压治疗睡眠障碍呼吸可显著降低瘦素水平。
The purpose of this work was to determine whether, in children with metabolic syndrome and sleep-disordered breathing, metabolic markers separate them from children with metabolic syndrome without sleep-disordered breathing and whether treatment of sleep-disordered breathing with continuous positive airway pressure is associated with an improvement in metabolic derangement. Subjects aged 7 to 19 years old with metabolic syndrome and a positive validated sleep questionnaire were recruited. Subjects underwent overnight polysomnography, during which sympathetic nervous system activity was assessed via 8-hourly measurements of norepinephrine and epinephrine, together with leptin. The next morning, a fasting 3-hour oral glucose-tolerance test was performed to calculate whole-body insulin sensitivity. A fasting lipid panel interleukin 6, adiponectin, and C-reactive protein levels were also measured. Children with sleep-disordered breathing were placed on continuous positive airway pressure for 3 months and studied again. Sleep-disordered breathing and no sleep-disordered breathing groups were compared by using Fisher's exact test and t test for independent samples with analysis of covariance to adjust for age and BMI. Of 34 children studied, 25 had sleep-disordered breathing (apnea-hypopnea index: >1.5). Mean hourly norepinephrine and leptin levels were higher in the group with sleep-disordered breathing compared with the group without sleep-disordered breathing (P < .005), with no difference in whole-body insulin sensitivity. Eleven subjects with sleep-disordered breathing completed 3 months of nightly continuous positive airway pressure treatment. In the follow-up study, mean hourly leptin levels were significantly lower than in the initial study, with no change in BMI z score or other measurements. Our findings support the hypothesis that sleep-disordered breathing in children with metabolic syndrome is associated with increased sympathetic nervous system activity and leptin levels but not worsening of insulin resistance. Treatment of sleep-disordered breathing with continuous positive airway pressure led to a significant decrease in leptin levels.
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影响因子：
8
作者：
Chervin, RD;Archbold, KH;Guilleminault, C
通讯作者：
Guilleminault, C
DOI：
10.1164/ajrccm/146.5_pt_1.1235
发表时间：
1992-11-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
MARCUS, CL;OMLIN, KJ;WARD, SLD
通讯作者：
WARD, SLD
影响因子：
168.9
作者：
Caro, JF;Kolaczynski, JW;Considine, RV
通讯作者：
Considine, RV
影响因子：
4.8
作者：
Chervin, RD;Clarke, DF;Giordani, BJ
通讯作者：
Giordani, BJ
影响因子：
3.4
作者：
Mitchell, RB;Kelly, J
通讯作者：
Kelly, J