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Updated: Feb 11, 2026

Breath Collection from Children for Disease Biomarker Discovery
Published on: February 14, 2019
Comparison of two exhaled biomarkers in children with and without sleep disordered breathing
Mario Barreto1, Paolo Montuschi2, Melania Evangelisti1
1Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Insights
8-isoprostane (8-IsoP) in exhaled breath condensate effectively identifies obstructive sleep apnea (OSA) in children. This biomarker correlates with disease severity and predicts OSA, unlike nitric oxide levels.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Biomarker Research
Background:
- Airway inflammation and oxidative stress are implicated in pediatric sleep disordered breathing (SDB).
- Understanding biomarkers for SDB severity is crucial for diagnosis and management.
Purpose of the Study:
- To measure 8-isoprostane (8-IsoP) in exhaled breath condensate (EBC) and fractional exhaled nitric oxide (FeNO) in children with SDB.
- To assess the relationship between these biomarkers, SDB severity, and overnight changes.
Main Methods:
- Exhaled measurements (EBC for 8-IsoP, FeNO) were performed in 46 children with SDB and 20 healthy controls.
- SDB severity was assessed using polysomnography, categorizing participants into primary snoring (PS) and obstructive sleep apnea (OSA).
Main Results:
- Children with OSA showed higher 8-IsoP levels in EBC compared to PS patients and controls.
- 8-IsoP levels correlated with apnea-hypopnea index (AHI) and oxygen saturation (SaO2), and accurately predicted OSA.
- FeNO levels did not correlate with disease severity, though they increased in mild OSA patients overnight.
Conclusions:
- 8-isoprostane in EBC is a valuable biomarker for distinguishing OSA from PS and healthy controls in children.
- 8-IsoP levels reflect SDB severity and can predict OSA, offering a potential diagnostic tool.
Objective:
Airway oxidative stress and inflammation are likely to be involved in sleep disordered breathing (SDB) in children. We aimed to measure concentrations of 8-isoprostane (8-IsoP) in the exhaled breath condensate (EBC) and exhaled nitric oxide (FENO) in patients with SBD and healthy children, in order to assess the relationship between these two biomarkers, disease severity, and overnight changes.
Methods:
Patients with SDB (n = 46) and healthy controls (n = 20) aged 4.5-15.1 years (M/F: 36/30) underwent exhaled measurements. Patients with SDB underwent standard polysomnography to define primary snoring (PS: AHI < 1) and obstructive sleep apnea (OSA). Upon awakening the following morning, FENO was measured and EBC was collected for the measurement of EBC 8-IsoP.
Results:
OSA patients yielded higher awakening levels of 8-IsoP in EBC than PS patients and control subjects. The 8-IsoP levels, though not FENO, correlated with AHI (r = 0.40, p = 0.003) and SaO2 (r = -0.50, p = 0.001). Cut-off levels of 8-IsoP predicted OSA with a high AUC value (0.84, p = 0.000). Sensitivity and specificity for 8-IsoP levels above the percentile 50 (33.3 pg/mL) were 76.5% and 78.1%, respectively. 8-IsoP levels did not change from the evening to morning session, whereas morning FENO levels rose significantly only in patients with mild OSA (p = 0.03).
Conclusion:
Levels of 8-IsoP, though not FENO, distinguish children with OSA from those with PS or healthy, correlate with disease severity and closely predict OSA in the whole sample.
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