Level of urinary catecholamine in children with Sleep Disordered Breathing: A systematic review and meta-analysis
Esther T W Cheng1, Raymond N C Chan1, Kate C C Chan2
1Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Insights
Elevated urinary noradrenaline and adrenaline levels are linked to sleep-disordered breathing (SDB) in children. These catecholamines may serve as biomarkers for SDB and its complications, warranting further investigation.
Area of Science:
- Pediatric Pulmonology
- Neuroendocrinology
- Biomarker Discovery
Background:
- Sleep-disordered breathing (SDB) affects children, potentially impacting their health.
- Urinary catecholamines, such as noradrenaline, adrenaline, and dopamine, are indicators of the body's stress response.
- Understanding the relationship between SDB and catecholamine levels can provide insights into SDB pathophysiology.
Approach:
- A systematic literature search was performed on PubMed and EMBASE for studies comparing urinary catecholamines in pediatric patients with and without SDB.
- Nine studies involving 838 subjects were included in a quantitative meta-analysis.
- Standardized mean differences (SMD) were calculated for urinary catecholamine levels between groups with varying SDB severity.
Key Points:
- Urinary noradrenaline levels were significantly higher in children with SDB compared to controls.
- Children with obstructive sleep apnea (OSA), a severe form of SDB, exhibited elevated urinary noradrenaline and adrenaline levels.
- Urinary noradrenaline levels increased with OSA severity, being higher in moderate/severe OSA than in mild OSA.
Conclusions:
- Urinary noradrenaline and adrenaline may serve as potential biomarkers for sympathetic nervous system overactivity in pediatric SDB.
- These catecholamines could act as surrogate markers for identifying children at risk for SDB-related complications.
- Further research is recommended to confirm the association and clinical utility of these biomarkers in SDB management.
Objective:
To compare the levels of different urinary catecholamines amongst paediatric patients with and without sleep-disordered breathing (SDB).
Methods:
Literature searches were conducted on PubMed and EMBASE until 25/06/2022. Inclusion criteria were original human studies, English language, paediatric subjects diagnosed with SDB/obstructive sleep apnoea (OSA). The quality of studies was assessed by the Newcastle-Ottawa Quality Assessment (NOSGEN). The registered number of this study on the International Prospective Register of Systematic Reviews (PROSPERO) is CRD42022332939. The main outcome measured was standardised mean difference (SMD) of urinary catecholamine between subjects with and without SDB, between those with and without OSA, and also between subjects with mild OSA and those with moderate/ severe OSA. Sensitivity analyses were performed to avoid bias.
Results:
9 studies (8 cross-sectional and 1 cohort study) with a total of 838 subjects, were included in the quantitative analysis. Urine level of noradrenaline was higher in patients with SDB, which included primary snoring (PS), when compared to controls: SMD = 0.86 (95%CI=0.32-1.41; I2=85%, P=0.002). The levels of urinary noradrenaline and adrenaline were higher in children with OSA when compared to controls: SMD = 1.45 (95%CI=0.91-2.00; I2=75%, P < 0.001); SMD = 1.84 (0.00-3.67; I2=97%, P=0.05). Urine level of noradrenaline was higher in subjects with moderate/severe OSA compared to the mild OSA: SMD = 0.55 (95%CI=0.10-1.00; I2=0%, P=0.02). Urinary dopamine was not associated with SDB regardless of severity.
Conclusions:
Urinary noradrenaline was higher in all patients with SDB. Subjects with OSA, a more severe form of SDB, had higher urine levels of noradrenaline and adrenaline. Hence, noradrenaline and adrenaline may be markers of sympathetic overtone in patients with SDB and could potentially act as surrogate markers for SDB complications. Further studies are needed to assess this association.
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