Delayed brachial artery dilation response and increased resting blood flow velocity in young children with mild sleep-disordered breathing

Kontos, Anna; Heuvel, Corinna van den; Pamula, Yvonne; Martin, James; Lushington, Kurt; Baumert, Mathias; Gent, Roger; Couper, Jennifer; Kennedy, Declan

doi:10.1016/j.sleep.2015.08.004

Cited by 15 publications

(11 citation statements)

References 48 publications

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“…We have previously shown in a different cohort that those children with SDB that have greater capacity to desaturate to lower oxygen throughout the night (particularly non-REM sleep) are those with increased vascular resistance. 23 However, oxygen saturation levels during event-free sleep were comparable between groups (data not shown). The PTTm prolongation observed in SDB children may therefore correspond to a prolonged prerejection period due to increased afterload, which may normalize following AT.…”

Section: Discussionmentioning

confidence: 82%

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing

El-Hamad

Immanuel

Liu

et al. 2017

Sleep

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Section: Discussionmentioning

confidence: 82%

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing

El-Hamad

Immanuel

Liu

et al. 2017

Sleep

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“…Overnight PSG was conducted using the Compumedics E‐Series Sleep System (Melbourne, Australia) . The following standard measures were collected: EEG (C3‐A2, C4‐A1, and F3‐A2 F4‐A1, O1‐A2, and O2‐A1), left and right EOG, submental, diaphragmatic, and leg EMG, heart rate by ECG, oronasal airflow by thermistor and nasal pressure, respiratory movements of the chest and abdominal wall using uncalibrated respiratory inductive plethysmography, and arterial oxygen saturation by pulse oximetry (Nellcor N‐595; 2‐second averaging time).…”

Section: Methodsmentioning

confidence: 95%

“…In adults with SDB, there is evidence that the effects of sympathetic overactivity on blood vessels is systemic . Our group and others have postulated that some children with SDB also develop systemic changes in vascular compliance, which arise in direct response to increased sympathetic activity …”

Section: Introductionmentioning

confidence: 87%

“…FMD was measured upon waking following overnight PSG and while still fasting . The brachial artery diameter was determined from a 30‐second resting scan measured perpendicular to the brachial artery and 10 cm proximal to the elbow.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously reported altered cardiovascular function in children with SDB, including: an accelerated heart rate response to cortical arousals and a delayed hyperemic dilatation response and increased blood flow velocity, both at rest and during hyperemia, in the brachial artery suggestive of reduced vascular compliance . Others have also reported abnormal vascular function in all severity levels of the disorder compared with nonsnoring children, including reduced dilation capacity, reduced vascular compliance, and increased blood flow velocity .…”

Section: Introductionmentioning

confidence: 95%

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Relationship between Vascular Resistance and Sympathetic Nerve Fiber Density in Arterial Vessels in Children With Sleep Disordered Breathing

Kontos

Lushington

Martin

et al. 2017

JAHA

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BackgroundSleep disordered breathing in children is associated with increased blood flow velocity and sympathetic overactivity. Sympathetic overactivity results in peripheral vasoconstriction and reduced systemic vascular compliance, which increases blood flow velocity during systole. Augmented blood flow velocity is recognized to promote vascular remodeling. Importantly, increased vascular sympathetic nerve fiber density and innervation in early life plays a key role in the development of early‐onset hypertension in animal models. Examination of sympathetic nerve fiber density of the tonsillar arteries in children undergoing adenotonsillectomy for Sleep disordered breathing will address this question in humans.Methods and ResultsThirteen children scheduled for adenotonsillectomy to treat sleep disordered breathing underwent pupillometry, polysomnography, flow‐mediated dilation, resting brachial artery blood flow velocity (velocity time integral), and platelet aggregation. The dorsal lingual artery (tonsil) was stained and immunofluorescence techniques used to determine sympathetic nerve fiber density. Sympathetic nerve fiber density was correlated with increased resting velocity time integral (r=0.63; P<0.05) and a lower Neuronal Pupillary Index (r=−0.71, P<0.01), as well as a slower mean pupillary constriction velocity (mean, r=−0.64; P<0.05). A faster resting velocity time integral was associated with a slower peak pupillary constriction velocity (r=−0.77; P<0.01) and higher platelet aggregation to collagen antigen (r=0.64; P<0.05). Slower mean and peak pupillary constriction velocity were associated with higher platelet aggregation scores (P<0.05; P<0.01, respectively).ConclusionsThese results indicate that sympathetic activity is associated with change in both the function and structure of systemic vasculature in children with sleep disordered breathing.

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Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8 + T cells expressing TNFα and IFNγ

et al. 2017

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Sleep-disordered breathing (SDB) is associated with cardiovascular disease and systemic inflammation in adults but this remains to be explored in children, especially in children with the most common form of SDB, i.e. primary snoring/mild SDB. This pilot study investigated the relationship between the cardiovascular function and inflammation in children with mild SDB. Nineteen participants aged 5-14 years underwent overnight polysomnography, cardiac magnetic resonance imaging (aortic blood flow velocity and left and right ventricular systolic function) and assessment for inflammatory markers (intracellular cytokine analysis of T cells by flow cytometry). Parents also completed the Sleep Disturbances Scale for Children (SDSC). Children with mild SDB exhibited increased ascending aortic peak systolic velocity compared to controls (SDB 119.95 m/s vs. control 101.49 m/s, p < 0.05). No significant group differences were observed for left and right ventricular ejection fraction or mean aortic blood flow velocity from either the ascending aorta or pulmonary artery. Children with mild SDB had increased inflammatory markers as demonstrated by elevated T cell interferon gamma (IFNγ) (SDB 52 ± 4% vs. control 25 ± 3% positive cells, p < 0.005) and tumour necrosis factor alpha (TNFα) (SDB 39 ± 4% vs. control 20 ± 2% positive cells, p < 0.005) expression from CD8 cells. A strong positive correlation was observed between ascending aorta peak blood flow velocity and both TNFα and IFNγ (TNFα, r = 0.54, p < 0.03; IFNγ, r = 0.63, p < 0.005, respectively). Polysomnography revealed that oxygen saturation (SaO) nadir was significantly lower in children with mild SDB compared to controls (SDB 92.3 ± 2.7% vs. control 94.4 ± 1.6%, p < 0.05). A lower SaO nadir was associated with an increased ascending aorta peak systolic velocity (r = - 0.48, p < 0.05). As well, both a lower SaO nadir and an increased ascending aorta peak systolic velocity were associated with higher SDSC Sleep-Disordered Breathing and Disorder of Initiating and Maintaining Sleep subscale scores but not the polysomnographic-derived Obstructive Apnea-Hypopnea Index. The finding of elevated ascending aortic peak systolic blood flow velocity and its association with increased inflammatory markers suggests that the profile of cardiovascular changes noted in adult SDB may also occur in children with mild SDB.

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Delayed brachial artery dilation response and increased resting blood flow velocity in young children with mild sleep-disordered breathing

Cited by 15 publications

References 48 publications

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing

Relationship between Vascular Resistance and Sympathetic Nerve Fiber Density in Arterial Vessels in Children With Sleep Disordered Breathing

Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8 + T cells expressing TNFα and IFNγ

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