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소아청소년의 중등도/중증 폐쇄수면무호흡증후군의 예측인자로서 혈액 표지자

Hematologic Markers as a Predictive Factor for Moderate to Severe Obstructive Sleep Apnea Syndrome in Children and Adolescents

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초록

Objectives: We conducted this study to evaluate the diagnostic value of hematologic markers for moderate to severe obstructive sleep apnea syndrome (OSAS). Methods: We performed the study using medical records from our sleep disorders center. We collected information regarding obstructive apnea-hypopnea index (oAHI), age, sex, body mass index, and complete blood counts with differential counts [white blood cell (WBC) count, neutrophil count, lymphocyte count, red blood cell distribution width (RDW), mean platelet volume, platelet count, platelet distribution width (PDW), neutrophil-lymphocyte ratio, and platelet- lymphocyte ratio]. We excluded patients who were younger than 2 years, older than 14 years, obese/underweight, and those who had a hematologic or severe medical illness. Results: We assessed records from 57 patients (7.98±3.25 years old, 35 men). We classified the subjects into three groups based on their oAHI scores, as follows: normal (oAHI<1), mild OSAS (1≤oAHI<5), and moderate/severe OSAS (oAHI≥5). Using a multivariate multinomial logistic regression model (pseudo R2=0.33), we found significant differences among the groups in RDW [moderate/severe OSAS vs. mild OSAS, adjusted odds ratio (OR): 8.77, p-value: 0.03], PDW (mild OSAS vs. normal, adjusted OR: 1.05, p-value: 0.04), and WBC (moderate/severe OSAS vs. normal, adjusted OR: 1.42, p-value: 0.03). Conclusions: RDW, PDW, and WBC had diagnostic value for moderate/severe OSAS in our study. Further prospective and validation studies are required to develop a screening tool for moderate/severe OSAS in children and adolescents.

Abstract

Objectives: We conducted this study to evaluate the diagnostic value of hematologic markers for moderate to severe obstructive sleep apnea syndrome (OSAS). Methods: We performed the study using medical records from our sleep disorders center. We collected information regarding obstructive apnea-hypopnea index (oAHI), age, sex, body mass index, and complete blood counts with differential counts [white blood cell (WBC) count, neutrophil count, lymphocyte count, red blood cell distribution width (RDW), mean platelet volume, platelet count, platelet distribution width (PDW), neutrophil-lymphocyte ratio, and platelet- lymphocyte ratio]. We excluded patients who were younger than 2 years, older than 14 years, obese/underweight, and those who had a hematologic or severe medical illness. Results: We assessed records from 57 patients (7.98±3.25 years old, 35 men). We classified the subjects into three groups based on their oAHI scores, as follows: normal (oAHI<1), mild OSAS (1≤oAHI<5), and moderate/severe OSAS (oAHI≥5). Using a multivariate multinomial logistic regression model (pseudo R2=0.33), we found significant differences among the groups in RDW [moderate/severe OSAS vs. mild OSAS, adjusted odds ratio (OR): 8.77, p-value: 0.03], PDW (mild OSAS vs. normal, adjusted OR: 1.05, p-value: 0.04), and WBC (moderate/severe OSAS vs. normal, adjusted OR: 1.42, p-value: 0.03). Conclusions: RDW, PDW, and WBC had diagnostic value for moderate/severe OSAS in our study. Further prospective and validation studies are required to develop a screening tool for moderate/severe OSAS in children and adolescents.

참고문헌 (45)

  1. Marcus CL, "Diagnosis and management of childhood obstructive sleep apnea syndrome", Pediatrics, 130, pp.e714~e755 (2012)[DOI]
  2. Horwood L, "Testing for pediatric obstructive sleep apnea when health care resources are rationed", JAMA Otolaryngol Head Neck Surg, 140, pp.616~623 (2014)[DOI]
  3. Carroll JL, "Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children", Chest, 108, pp.610~618 (1995)[DOI]
  4. Constantin E, "Can the OSA-18 quality-oflife questionnaire detect obstructive sleep apnea in children?", Pediatrics, 125, pp.e162~e168 (2010)[DOI]
  5. Brouillette RT, "Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea", Pediatrics, 105, pp.405~412 (2000)[DOI]
  6. 김승수, "한국 소아의 중등도 및 중증 폐쇄수면무호흡증후군 진단에서 McGill 야간 산소포화도 점수의 유용성", Journal of sleep medicine, 13(1), pp.15~20 (2016), 대한수면연구학회
  7. De Luca Canto G, "Diagnostic capability of biological markers in assessment of obstructive sleep apnea: a systematic review and meta-analysis", J Clin Sleep Med, 11, pp.27~36 (2015)
  8. Sokucu SN, "Is mean platelet volume really a severity marker for obstructive sleep apnea syndrome without comorbidities?", Pulm Med, 2014, pp.754839~ (2014)
  9. Nena E, "Mean platelet volume and platelet distribution width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity?", Platelets, 23, pp.447~454 (2012)[DOI]
  10. Varol E, "The effects of continuous positive airway pressure therapy on mean platelet volume in patients with obstructive sleep apnea", Platelets, 22, pp.552~556 (2011)[DOI]
  11. Kurt OK, "The importance of laboratory parameters in patients with obstructive sleep apnea syndrome", Blood Coagul Fibrinolysis, 24, pp.371~374 (2013)[DOI]
  12. Korkmaz M, "Evaluation of the association of sleep apnea-related systemic inflammation with CRP, ESR, and neutrophil-to-lymphocyte ratio", Med Sci Monit, 21, pp.477~481 (2015)[DOI]
  13. Oyama J, "The relationship between neutrophil to lymphocyte ratio, endothelial function, and severity in patients with obstructive sleep apnea", J Cardiol, 67, pp.295~302 (2016)[DOI]
  14. Yenigun A, "Investigation of the relationship between neutrophil-to-lymphocyte ratio and obstructive sleep apnoea syndrome", J Laryngol Otol, 129, pp.887~892 (2015)[DOI]
  15. Koseoglu HI, "Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome", J Thromb Thrombolysis, 39, pp.179~185 (2015)[DOI]
  16. Sokucu SN, "Can red blood cell distribution width predict severity of obstructive sleep apnea syndrome?", J Clin Sleep Med, 8, pp.521~525 (2012)
  17. Erdim I, "Blood count values and ratios for predicting sleep apnea in obese children", Int J Pediatr Otorhinolaryngol, 98, pp.85~90 (2017)[DOI]
  18. Zicari AM, "Mean platelet volume, vitamin D and C reactive protein levels in normal weight children with primary snoring and obstructive sleep apnea syndrome", PLoS One (2016)
  19. 김재현, "The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects", Clinical and Experimental Pediatrics, 61(5), pp.135~149 (2018), 대한소아청소년과학회
  20. Berry RB, "The AASM manual for the scoring of sleep and association events: rules, terminology and technical specifications, version 2.0" (2012), American Academy of Sleep Medicine
  21. Gileles-Hillel A, "Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study", Mediators Inflamm (2014)
  22. Ryan S, "Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome?", Thorax, 64, pp.631~636 (2009)
  23. Tan HL, "Alterations in circulating T-cell lymphocyte populations in children with obstructive sleep apnea", Sleep, 36, pp.913~922 (2013)
  24. Gozal D, "Systemic inflammation in non-obese children with obstructive sleep apnea", Sleep Med, 9, pp.254~259 (2008)[DOI]
  25. Vagdatli E, "Platelet distribution width: a simple, practical and specific marker of activation of coagulation", Hippokratia, 14, pp.28~32 (2010)
  26. Felker GM, "Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank", J Am Coll Cardiol, 50, pp.40~47 (2007)[DOI]
  27. Patel KV, "Red blood cell distribution width and the risk of death in middle-aged and older adults", Arch Intern Med, 169, pp.515~523 (2009)[DOI]
  28. Perlstein TS, "Red blood cell distribution width and mortality risk in a community-based prospective cohort", Arch Intern Med, 169, pp.588~594 (2009)[DOI]
  29. Braun E, "Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia", Crit Care, 15, pp.R194~ (2011)[DOI]
  30. Otero TMN, "Elevated red cell distribution width is associated with decreased ventilator-free days in critically ill patients", J Intensive Care Med, 33, pp.241~247 (2018)[DOI]
  31. Wang F, "Red cell distribution width as a novel predictor of mortality in ICU patients", Ann Med, 43, pp.40~46 (2011)[DOI]
  32. Harrington AM, "Iron deficiency anemia, betathalassemia minor, and anemia of chronic disease: a morphologic reappraisal", Am J Clin Pathol, 129, pp.466~471 (2008)[DOI]
  33. Romero Artaza J, "Red cell distribution width (RDW): its use in the characterization of microcytic and hypochromic anemias", Medicina (B Aires), 59, pp.17~22 (1999)
  34. Sadaka F, "Red cell distribution width and outcome in patients with septic shock", J Intensive Care Med, 28, pp.307~313 (2013)[DOI]
  35. Paulson RF, "Stress erythropoiesis: new signals and new stress progenitor cells", Curr Opin Hematol, 18, pp.139~145 (2011)[DOI]
  36. Broudy VC, "Interaction of stem cell factor and its receptor c-kit mediates lodgment and acute expansion of hematopoietic cells in the murine spleen", Blood, 88, pp.75~81 (1996)
  37. von Lindern M, "The glucocorticoid receptor cooperates with the erythropoietin receptor and c-Kit to enhance and sustain proliferation of erythroid progenitors in vitro", Blood, 94, pp.550~559 (1999)
  38. Bauer A, "The glucocorticoid receptor is required for stress erythropoiesis", Genes Dev, 13, pp.2996~3002 (1999)[DOI]
  39. Jenne CN, "Platelets in inflammation and infection", Platelets, 26, pp.286~292 (2015)[DOI]
  40. Choi JH, "Obstructive sleep apnea syndrome: a child is not just a small adult", Ann Otol Rhinol Laryngol, 119, pp.656~661 (2010)[DOI]
  41. Onder S, "Relation of mean platelet volume with obstructive adenoid hypertrophy in children", Int J Pediatr Otorhinolaryngol, 78, pp.1449~1451 (2014)[DOI]
  42. Coban E, "The mean platelet volume in patients with obesity", Int J Clin Pract, 59, pp.981~982 (2005)[DOI]
  43. Soyalic H, "Evaluation of mean platelet volume and its ratio over platelet count in children with obstructive sleep apnea syndrome", Kulak Burun Bogaz Ihtis Derg, 25, pp.16~21 (2015)[DOI]
  44. Sal E, "Relationship between obesity and iron deficiency anemia: is there a role of hepcidin?", Hematology, pp.1~7 (2018)
  45. Wang GC, "Establishment of complete blood count reference intervals for Chinese preschoolers", J Clin Lab Anal (2016)

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