Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea

Gozal, David; Hakim, Fahed; Kheirandish‐Gozal, Leila

doi:10.1016/j.resp.2012.08.019

Cited by 46 publications

(29 citation statements)

References 142 publications

(156 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rodent models of long-term intermittent hypoxia have demonstrated hypertension and increased sympathetic activity (22), increased right ventricular systolic pressure, right ventricular mass, neovascularization of distal pulmonary vessels (23), systemic and pulmonary vascular pressure (24,25), cardiac hypertrophy, and cardiac and perivascular fibrosis (26). Previous studies in children have however not found a strong link between arterial desaturation and elevated HR and BP (27). Similarly in our study, oxygen desaturation Figure 2.…”

Section: Repetitive Respiratory Events In Childrensupporting

confidence: 81%

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

et al. 2015

View full text Add to dashboard Cite

Data presented as mean ± SEM or median (range). *P < 0.05; † P < 0.001. HR, heart rate; PTT, pulse transit time. Articles Walter et al. Cardiovascular Consequences of Repetitive vs. Isolated Respiratory EventsFor the episodes of repetitive events, the % change in HR from late to between events and from late event to postepisode were significantly higher when compared with the % change in HR from late to postevent in isolated respiratory events (P < 0.001 for both), as shown in Figure 2a. The % change in PTT from late event to postepisode was significantly greater (indicating a greater change in BP) for repetitive episodes when compared with the % change from late to postevents in isolated respiratory events (P < 0.05) (Figure 2b). There was no difference between % change in PTT from late to between events in repetitive episodes compared with % change from late to postevents in isolated respiratory events. The ratio of repetitive to isolated respiratory events for each child significantly predicted the mean HR, which increased with an increasing proportion of repetitive respiratory events compared with isolated events during N1, N2, REM, and total sleep (Figure 3). There were no relationships between mean PTT and the ratio of repetitive to isolated respiratory events during wake or any sleep stage. Determinants of Percentage Change in HR and PTT From Lateto Between-Event Phases in Episodes of Repetitive Respiratory EventsResults of the multiple linear regression analysis indicate that during total sleep, the repetitive to isolated events ratio, the number of individual respiratory events per episode, the number of arousals per episode, the ratio of the duration of the respiratory event to the duration of the subsequent between event period, and sleep stage were significantly, if weakly predictive of the % change in HR from the late event phase to between the respiratory events ( Table 3). The model predicted 44% of the % change in HR from the late event phase to between the respiratory events (P < 0.01). This suggests that the more repetitive events compared with isolated events, the more episodes, the more events and arousals per episode a child has, the higher the surge in HR. In contrast, there is a negative relationship between the surge in HR and sleep stage, suggesting that the HR surge is highest during N1 and decreases during N2, N3, and REM. There is also a weak negative relationship between the surge in HR and the ratio of the duration of an event to the duration of the between event period, suggesting that the closer together the events become the % change in HR is not as great.Further analyses separating the repetitive respiratory event episodes into the sleep stage in which they occurred demonstrated that when the episodes occurred during N1 sleep, the predictive variables remained the same as for total sleep. When the episodes occurred during N2 or REM sleep, only the number of arousals in the episode predicted the change in HR (r 2 = 0.3, P < 0.01; REM: r 2 = 0.5, P < 0.001). None of the variables ...

show abstract

Section: Repetitive Respiratory Events In Childrensupporting

confidence: 81%

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Thus, the recurrent hypoxemic events and the episodic arousals that characterize sleep in patients with OSA likely enhance sympathetic tonic outfl ow, and result in increased recovery of catecholamines in the urine. 4 Taken together, we surmise that the changes in evening-to-morning epinephrine and norepinephrine levels are probably better suited for detection of OSA and the response to specifi c therapeutic interventions for pediatric OSA. Notwithstanding, the individual ROCs for overnight changes in urinary catecholamine levels were not suffi ciently adequate predictors of OSA to enable their use as single biomarkers.…”

Section: Discussionmentioning

confidence: 78%

Urinary Neurotransmitters Are Selectively Altered in Children With Obstructive Sleep Apnea and Predict Cognitive Morbidity

Kheirandish‐Gozal

McManus²,

Kellermann³

et al. 2013

Chest

Self Cite

View full text Add to dashboard Cite

Snoring is a very frequent complaint affecting 10% to 12% of all children 1 and is the primary symptom of obstructive sleep apnea (OSA). OSA is the occurrence of repeated events of partial or complete upper airway obstruction during sleep, leading to disruption of normal ventilation, and to hypoxemia and sleep fragmentation. The pathophysiology of pediatric OSA is multifactorial, but adenotonsillar hypertrophy with or without concurrent obesity constitutes the major pathophysiologic mechanism underlying OSA in children. 2 Pediatric OSA has been extensively associated with an increased risk for behavioral and mood disturbances, as well as with cognitive defi cits. Furthermore, cardiovascular and metabolic morbidities, such as pulmonary hypertension, systemic hypertension, endothelial dysfunction, insulin resistance, and serum lipid alterations, are also frequently observed. 3 However, identifi cation of those children who have developed any such OSAassociated morbidities is diffi cult, and is usually complicated by the need for laborious and onerous test batteries that are not routinely available in most clinical settings. Therefore, such assessments are usually not pursued.Background: Pediatric obstructive sleep apnea (OSA) is associated with cognitive dysfunction, suggesting altered neurotransmitter function. We explored overnight changes in neurotransmitters in the urine of children with and without OSA. Methods: Urine samples were collected from children with OSA and from control subjects before and after sleep studies. A neurocognitive battery assessing general cognitive ability (GCA) was administered to a subset of children with OSA. Samples were subjected to multiple enzyme-linked immunosorbent assays for 12 neurotransmitters, and adjusted for creatinine concentrations. Results: The study comprised 50 children with OSA and 20 control subjects. Of the children with OSA, 20 had normal GCA score (mean Ϯ SD) (101.2 Ϯ 14.5) and 16 had a reduced GCA score (87.3 Ϯ 13.9; P , .001). Overnight increases in epinephrine, norepinephrine, and g -aminobutyric acid (GABA) levels emerged in children with OSA; taurine levels decreased. Using combinatorial approaches and cutoff values for overnight changes of these four neurotransmitters enabled prediction of OSA (area under the curve [AUC]: 0.923; P , .0001). Furthermore, GABA and taurine alterations, as well as overnight reductions in phenylethylamine, were more prominent in children with OSA and low GCA than in children with OSA and normal GCA ( P , .001), and they reliably discriminated GCA status (AUC: 0.977; P , .0001). Conclusions: Pediatric OSA is associated with overnight increases in urinary concentrations of catecholamines indicative of heightened sympathetic outfl ow. Increases in GABA levels and decreases in taurine levels could underlie mechanisms of neuronal excitotoxicity and dysfunction. Combinatorial approaches using defi ned cutoffs in overnight changes in concentrations of selected neurotransmitters in urine may not only predict OSA but also the presence ...

show abstract

“…As in adults, OSA in children leads to sympathetic nervous system activation, increased heart rate variability, and increased catecholamine production,295,355,405,412–414 which likely underlie many of the associations between OSA and blood pressure in children 415. Oxidative stress in children with OSA relating to IH has been found to increase lipid peroxidation, which can accelerate atherosclerosis.…”

Section: Obstructive Sleep Apnea and Cardiometabolic Riskmentioning

confidence: 99%

Role of sleep quality in the metabolic syndrome

Koren¹,

Dumin²,

Gozal³

2016

DMSO

Self Cite

151

View full text Add to dashboard Cite

Emerging evidence has assigned an important role to sleep as a modulator of metabolic homeostasis. The impact of variations in sleep duration, sleep-disordered breathing, and chronotype to cardiometabolic function encompasses a wide array of perturbations spanning from obesity, insulin resistance, type 2 diabetes, the metabolic syndrome, and cardiovascular disease risk and mortality in both adults and children. Here, we critically and extensively review the published literature on such important issues and provide a comprehensive overview of the most salient pathophysiologic pathways underlying the links between sleep, sleep disorders, and cardiometabolic functioning.

show abstract

Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea

Cited by 46 publications

References 142 publications

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

Urinary Neurotransmitters Are Selectively Altered in Children With Obstructive Sleep Apnea and Predict Cognitive Morbidity

Role of sleep quality in the metabolic syndrome

Contact Info

Product

Resources

About