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Contemporary Reviews in Sleep MedicinePediatric OSA Syndrome Morbidity Biomarkers: The Hunt Is Finally On!
Section snippets
High-Sensitivity C-Reactive Protein and Other Cardiovascular Biomarker Candidates
The concept linking inflammation and pediatric OSAS was initially invoked by Tauman et al39 in 2004. Since then, a large body of evidence has accumulated and confirmed such an association, particularly when concurrent obesity, another chronic low-grade inflammatory disorder, is present.32, 40, 41, 42, 43, 44 Considering the fact that plasma C-reactive protein (CRP) levels appear to be strongly associated with cardiovascular disease (CVD) risk in both adults and children,45, 46 it was reasonable
Metabolic Morbidity Markers of OSAS
The cumulative evidence strongly supports the presence of metabolic dysfunction, particularly among obese children with OSAS, manifesting as increased risk for insulin resistance and dyslipidemia.11, 48, 73, 74, 75, 76, 77, 78 In this context, increases in low-density lipoprotein and reciprocal decreases in high-density lipoprotein have been inconsistently identified among lean children with OSAS but are more likely to occur in obese children with OSAS.79, 80, 81 Similarly, evidence of
Cognitive Morbidity Including Excessive Daytime Sleepiness
As mentioned previously, we have found that elevated CRP levels are associated with increased risk for neurocognitive deficits among children with OSAS.22 Such findings were not surprising considering the high degree of concordance between cognitive deficits and endothelial dysfunction.84 Preliminary evidence also suggested that the magnitude of the inflammatory response as illustrated by circulating tumor necrosis factor-α may also provide cues as to the presence or absence of excessive
Acknowledgments
Financial/nonfinancial disclosures: None declared.
Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
References (92)
- et al.
Endothelial dysfunction in children without hypertension: potential contributions of obesity and obstructive sleep apnea
Chest
(2012) - et al.
Impact of adenotonsillectomy on insulin resistance and lipoprotein profile in nonobese and obese children
Chest
(2016) - et al.
Biomarkers of sleep apnea
Chest
(2012) - et al.
Biomarkers associated with obstructive sleep apnea and morbidities: a scoping review
Sleep Med
(2015) - et al.
Circulating adropin concentrations in pediatric obstructive sleep apnea: potential relevance to endothelial function
J Pediatr
(2013) - et al.
B-type natriuretic peptide and cardiovascular function in young children with obstructive sleep apnea
Chest
(2010) - et al.
Endothelial dysfunction in children with obstructive sleep apnea is associated with epigenetic changes in the eNOS gene
Chest
(2013) - et al.
Vitamin D levels and pediatric obstructive sleep apnea
Sleep Med
(2014) - et al.
Fatty-acid binding protein 4 gene polymorphisms and plasma levels in children with obstructive sleep apnea
Sleep Med
(2011) - et al.
Urinary neurotransmitters are selectively altered in children with obstructive sleep apnea and predict cognitive morbidity
Chest
(2013)
Effect of adenotonsillectomy on C-reactive protein levels in children with obstructive sleep apnea: a meta-analysis
Sleep Med
Variants in C-reactive protein and IL-6 genes and susceptibility to obstructive sleep apnea in children: a candidate-gene association study in European American and Southeast European populations
Sleep Med
Identification of adropin as a secreted factor linking dietary macronutrient intake with energy homeostasis and lipid metabolism
Cell Metab
Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea
Sleep Med
Endothelial dysfunction and oxidative stress in children with sleep disordered breathing: role of NADPH oxidase
Atherosclerosis
Endothelial function in children with OSA and the effects of adenotonsillectomy
Chest
Circulating microRNAs as potential biomarkers of endothelial dysfunction in obese children
Chest
Circulating microparticles in children with sleep disordered breathing
Chest
Sociedad Española de Sueño; Área de Sueño de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). [Consensus document on sleep apnea-hypopnea syndrome in children (full version)]
Arch Bronconeumol
Metabolic alterations in children with obstructive sleep apnea
Int J Pediatr Otorhinolaryngol
Serum lipids alterations in adenoid hypertrophy or adenotonsillar hypertrophy children with sleep disordered breathing
Int J Pediatr Otorhinolaryngol
TNF-α gene polymorphisms and excessive daytime sleepiness in pediatric obstructive sleep apnea
J Pediatr
Plasma IGF-1 levels and cognitive dysfunction in children with obstructive sleep apnea
Sleep Med
Genotype-phenotype interactions in pediatric obstructive sleep apnea
Respir Physiol Neurobiol
Sleep disordered breathing in children in a general population sample: prevalence and risk factors
Sleep
Effect of sleep-disordered breathing severity on cognitive performance measures in a large community cohort of young school-aged children
Am J Respir Crit Care Med
Kheirandish-Gozal L. Impact of sleep disordered breathing among elementary school-aged children: a cross-sectional analysis of a large community-based sample
Eur Respir J
Circulating plasma extracellular microvesicle miRNA cargo and endothelial dysfunction in OSA children
Am J Respir Crit Care Med
Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study
Thorax
Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing
Hypertension
Arterial alterations in severely obese children with obstructive sleep apnoea
Int J Pediatr Obes
Biological plausibility linking sleep apnoea and metabolic dysfunction
Nat Rev Endocrinol
Increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep-disordered breathing: a community-based study
Pediatrics
Objective sleepiness measures in pediatric obstructive sleep apnea
Pediatrics
Obesity and excessive daytime sleepiness in prepubertal children with obstructive sleep apnea
Pediatrics
Elevated morbidity and health care use in children with obstructive sleep apnea syndrome
Am J Respir Crit Care Med
Public health implications of obstructive sleep apnea burden
Indian J Pediatr
Childhood Adenotonsillectomy Trial (CHAT): a randomized trial of adenotonsillectomy for childhood sleep apnea
N Engl J Med
Diagnosis and management of childhood obstructive sleep apnea syndrome
Pediatrics
Developing biomarker arrays predicting sleep and circadian-coupled risks to health
Sleep
C-reactive protein, obstructive sleep apnea, and cognitive dysfunction in school-aged children
Am J Respir Crit Care Med
C-reactive protein as a potential biomarker of residual obstructive sleep apnea following adenotonsillectomy in children
Sleep
Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: a community-based study
Int J Obes (Lond)
TREM-1 and pentraxin-3 plasma levels and their association with obstructive sleep apnea, obesity, and endothelial function in children
Sleep
Myeloid-related protein 8/14 levels in children with obstructive sleep apnoea
Eur Respir J
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Sleep and Inflammation: Bidirectional Relationship
2023, Sleep Medicine ClinicsSleep Measurement in Children—Are We on the Right Track?
2021, Sleep Medicine ClinicsCitation Excerpt :Such biomarkers could help in designing specific algorithms for population screening and potentially enable priority assignment for treatment and outcome monitoring in those children considered at increased risk.69 In pediatric OSA several biomarkers aimed at the diagnosis or detection of OSA-related morbidities have been explored but are not necessarily implemented by all sleep practitioners.91,93 However, the usability of other biomarkers in clinical practice is often limited, as no references for normal ranges of metabolites exist.92
Erythropoietin levels in children with obstructive sleep apnea
2021, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Therefore, there is a need for new, cheap, reliable and easy to use diagnostic tools, able for accurate identification of the presence or absence of OSA and able for expanded screening of the disease [6,7]. Currently, a lot of investigators are trying to identify potential biomarkers as diagnostic tools for pediatric OSA [6–9]. Erythropoietin (EPO) is a high glucozylated protein which consists of 165 amino acids that inhibits apoptosis of erythroid progenitors, supporting by this way their clonal proliferation and differentiation.
Advances and challenges in pursuing biomarkers for obstructive sleep apnea: Implications for the cardiovascular risk
2021, Trends in Cardiovascular MedicineCitation Excerpt :Biomarkers should have high specificity for the diagnosis and prognosis of a disease with a low rate of false-positives [17]. Like in other chronic disease, in the OSA scenario a biomarker should be able to provide useful information about prognosis and response to treatment and should be highly sensitive and specific for OSA-induced end-organ dysfunction, while also being implicated in an important mechanistic pathway of the disease [19]. Ideally, the selected biomarker should guide physicians for more aggressive management of OSA or other cardiovascular risk factors over and above what we can determine with parameters of OSA severity such as apnea-hypopnea index and oxygen desaturation.
Question 5: Which children with OSA should be considered for medical therapy?
2021, Paediatric Respiratory Reviews
FUNDING/SUPPORT: L. K.-G. is supported in part by a grant from the National Institutes of Health [1R01HL130984-01].