Does adenotonsillectomy change vascular function in children with sleep breathing disorders?

睡眠呼吸障碍影响10%的儿童，严重时，上呼吸道阻塞会导致生长，发育，脑功能和心脏健康的严重缺陷。但是，即使是轻微的打鼾（没有阻塞）也可能导致向大脑和心脏供血的动脉以及手臂和腿部的小动脉健康状况不佳。在患有糖尿病和肥胖症的成人和儿童中，不良的血管健康状况已被证明会大大增加未来心脏病发作，心绞痛和中风的风险。患有严重睡眠呼吸障碍（如睡眠呼吸暂停综合征）的儿童目前通过切除扁桃体和腺样体来治疗，这通常可以解决打鼾并改善睡眠，但目前还不知道是否对血管健康有任何好处。儿童血管疾病的最早体征是血管内膜功能异常（内皮功能障碍）和血管内膜增厚（内膜中层厚度）。它们先于动脉粥样硬化的成人疾病-导致心脏病发作和中风，以及糖尿病肾病和眼病。这些变化可以通过颈部和手臂动脉的超声成像来准确和非侵入性地测量。我们的主要目的是评估在严重程度范围内患有睡眠呼吸障碍的儿童中血管健康是否发生变化，次要目的是测量在睡眠期间（打鼾发生时）心血管控制的任何变化。最重要的是，通过评估手术前后的儿童，我们将能够第一次看到儿童打鼾的治疗是否改善了血管健康。这项研究可能对打鼾儿童的临床管理具有重要意义，这些儿童可能需要在更早的年龄进行治疗，以防止血管健康不良和日后患心血管疾病的风险增加。

Sleep breathing disorders affect 10% of all children and when severe, obstruction in the upper airways causes serious deficits in growth, development, brain function and heart health. But even mild snoring (without obstruction) may also cause poor health in the arteries that supply blood to the brain and heart, as well as the smaller arteries in the arms and legs. In both adults and children with conditions like diabetes and obesity, poor blood vessel health has been shown to greatly increase the future risk of heart attacks, angina and strokes. Children with severe sleep breathing disorders (such as sleep apnoea syndrome) are currently treated by removal of the tonsils and adenoids, which typically resolves snoring and improves sleep, but it is not yet known whether there are any benefits for blood vessel health. The earliest signs of blood vessel disease in children are abnormal function of the lining of the blood vessels (endothelial dysfunction) and thickening of the lining of blood vessels (intima media thickness). They precede the adult diseases of atherosclerosis - which causes heart attacks and strokes, and diabetic kidney and eye disease. These changes can be measured accurately and non-invasively using ultrasound imaging of arteries in the neck and arm. Our primary aim is to assess whether changes in blood vessel health occur in children with sleep breathing disorders across the range of severity, with a secondary aim to measure any changes in cardiovascular control during both sleep (when snoring occurs). Most importantly, by assessing children before and after surgery, we will be able to see for the first time whether treatment of childhood snoring improves blood vessel health. This study may have major implications for the clinical management of snoring children, who may require treatment at an earlier age to prevent poor blood vessel health and an increased risk of cardiovascular diseases later in life.