[Endothelial dysfunction in children with obstructive sleep apnea syndrome].

Area of Science:

• Pediatric Sleep Medicine
• Cardiovascular Health
• Respiratory Physiology

Background:

• Obstructive sleep apnea syndrome (OSAS) is a prevalent condition in children, characterized by repeated episodes of upper airway obstruction during sleep.
• Endothelial dysfunction, a precursor to cardiovascular disease, has been observed in adult OSAS patients, but its status in children requires further investigation.
• Identifying factors contributing to endothelial dysfunction in pediatric OSAS is crucial for early intervention and prevention of long-term health consequences.

Purpose of the Study:

• To assess endothelial function in children diagnosed with OSAS compared to those with primary snoring (PS).
• To identify clinical and polysomnographic factors associated with endothelial dysfunction in children.

Main Methods:

• A cross-sectional study involving 355 children (aged 3-11 years) with habitual snoring.
• Participants underwent overnight polysomnography (PSG) to assess sleep-related breathing events and endothelial function testing (reactive hyperemia index - RHI).
• Children were categorized into primary snoring (PS) and OSAS groups based on the obstructive apnea hypopnea index (OAHI); statistical analyses included T-tests, Wilcoxon tests, and univariate/multivariate regression.

Main Results:

• The OSAS group exhibited significantly higher OAHI, oxygen desaturation index, and respiratory-related arousal index compared to the PS group.
• Children with OSAS showed lower minimum oxygen saturation and a significantly reduced reactive hyperemia index (RHI), indicating endothelial dysfunction.
• Multivariate analysis revealed that age, BMI Z-score (and its quadratic form), and respiratory-related arousal index were independently associated with RHI.

Conclusions:

• Pediatric OSAS is associated with significant endothelial dysfunction.
• Frequent arousals during sleep, a hallmark of OSAS, emerge as a potential risk factor contributing to endothelial dysfunction in affected children.
• These findings underscore the importance of addressing sleep-disordered breathing in children to mitigate cardiovascular risks.