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Cardiovascular Implications

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Sleep Disordered Breathing in Children

Part of the book series: Respiratory Medicine ((RM))

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Abstract

The physiological aberrations induced by obstructive sleep apnea (OSA) in children, namely the abnormalities in gas exchange, frequent cortical arousals, and fluxes of intrathoracic pressure induced by respiration in the setting of an occluded airway, can have significant ramifications of homeostasis in several organs including the cardiovascular system. In this chapter, the evidence supporting cardiovascular dysfunction in pediatric OSA is presented; prompting the hypothesis that untreated OSA may induce end-organ injury to the cardiovascular system thereby promoting long-term cardiovascular disease.

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References

  1. Quan SF, Gersh BJ. Cardiovascular consequences of sleep-disordered breathing: past, present and future: report of a workshop from the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute. Circulation. 2004;109(8): 951–7.

    PubMed  Google Scholar 

  2. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52(8):686–717.

    PubMed  Google Scholar 

  3. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.

    PubMed  Google Scholar 

  4. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–85.

    PubMed  Google Scholar 

  5. Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, et al. Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol. 2001;154(1):50–9.

    PubMed  CAS  Google Scholar 

  6. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.

    PubMed  CAS  Google Scholar 

  7. Peled N, Abinader EG, Pillar G, Sharif D, Lavie P. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. J Am Coll Cardiol. 1999;34(6):1744–9.

    PubMed  CAS  Google Scholar 

  8. Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–6.

    PubMed  Google Scholar 

  9. Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke. 2006;37(9):2317–21.

    PubMed  Google Scholar 

  10. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.

    PubMed  Google Scholar 

  11. Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.

    PubMed  CAS  Google Scholar 

  12. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.

    PubMed  CAS  Google Scholar 

  13. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–904.

    PubMed  CAS  Google Scholar 

  14. Doherty LS, Kiely JL, Swan V, McNicholas WT. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest. 2005;127(6):2076–84.

    PubMed  Google Scholar 

  15. Milleron O, Pilliere R, Foucher A, de Roquefeuil F, Aegerter P, Jondeau G, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J. 2004;25(9): 728–34.

    PubMed  Google Scholar 

  16. Gami AS, Somers VK. Obstructive sleep apnoea, metabolic syndrome, and cardiovascular outcomes. Eur Heart J. 2004;25(9):709–11.

    PubMed  Google Scholar 

  17. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9): 1217–39.

    PubMed  Google Scholar 

  18. Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444(7121):875–80.

    PubMed  Google Scholar 

  19. Wickelgren I. Obesity: how big a problem? Science. 1998;280(5368):1364–7.

    PubMed  CAS  Google Scholar 

  20. Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Circulation. 2006;113(25):2943–6.

    PubMed  Google Scholar 

  21. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103(6 Pt 1):1175–82.

    PubMed  CAS  Google Scholar 

  22. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352(11):1138–45.

    PubMed  CAS  Google Scholar 

  23. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992;327(19):1350–5.

    PubMed  CAS  Google Scholar 

  24. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303(3):242–9.

    PubMed  CAS  Google Scholar 

  25. Gidding SS, Bao W, Srinivasan SR, Berenson GS. Effects of secular trends in obesity on coronary risk factors in children: the Bogalusa Heart Study. J Pediatr. 1995;127(6):868–74.

    PubMed  CAS  Google Scholar 

  26. Morrison JA, Laskarzewski PM, Rauh JL, Brookman R, Mellies M, Frazer M, et al. Lipids, lipoproteins, and sexual maturation during adolescence: the Princeton maturation study. Metabolism. 1979;28(6): 641–9.

    PubMed  CAS  Google Scholar 

  27. Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr. 1996;128(5 Pt 1):608–15.

    PubMed  CAS  Google Scholar 

  28. Richards GE, Cavallo A, Meyer 3rd WJ, Prince MJ, Peters EJ, Stuart CA, et al. Obesity, acanthosis nigricans, insulin resistance, and hyperandrogenemia: pediatric perspective and natural history. J Pediatr. 1985;107(6):893–7.

    PubMed  CAS  Google Scholar 

  29. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346(11):802–10.

    PubMed  CAS  Google Scholar 

  30. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298(8):874–9.

    PubMed  CAS  Google Scholar 

  31. Schiel R, Beltschikow W, Kramer G, Stein G. Overweight, obesity and elevated blood pressure in children and adolescents. Eur J Med Res. 2006; 11(3):97–101.

    PubMed  CAS  Google Scholar 

  32. Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, et al. Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents. Hypertension. 2008; 51(3):635–41.

    PubMed  CAS  Google Scholar 

  33. Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol. 1996;21(3):176–83.

    PubMed  CAS  Google Scholar 

  34. Gozal D, Simakajornboon N, Holbrook CR, Crabtree VM, Krishna J, Jones JH, Kheirandish-Gozal L. Secular trends in obesity and parentally reported daytime sleepiness among children referred to a pediatric sleep center for snoring and suspected sleep-disordered breathing (SDB). Sleep. 2006; 29:A74.

    Google Scholar 

  35. Gozal D, Kheirandish-Gozal L. The multiple challenges of obstructive sleep apnea in children: morbidity and treatment. Curr Opin Pediatr. 2008;20(6):654–8.

    PubMed  Google Scholar 

  36. Dayyat E, Kheirandish-Gozal L, Gozal D. Childhood obstructive sleep apnea: one or two distinct disease entities? Sleep Med Clin. 2007;2(3):433–44.

    PubMed  Google Scholar 

  37. Bhattacharjee R, Kim J, Kheirandish-Gozal L, Gozal D. Obesity and obstructive sleep apnea syndrome in children: a tale of inflammatory cascades. Pediatr Pulmonol. 2011;46(4):313–23.

    PubMed  Google Scholar 

  38. Leuenberger U, Jacob E, Sweer L, Waravdekar N, Zwillich C, Sinoway L. Surges of muscle sympathetic nerve activity during obstructive apnea are linked to hypoxemia. J Appl Physiol. 1995;79(2): 581–8.

    PubMed  CAS  Google Scholar 

  39. Smith ML, Niedermaier ON, Hardy SM, Decker MJ, Strohl KP. Role of hypoxemia in sleep apnea-induced sympathoexcitation. J Auton Nerv Syst. 1996;56(3): 184–90.

    PubMed  CAS  Google Scholar 

  40. Imadojemu VA, Mawji Z, Kunselman A, Gray KS, Hogeman CS, Leuenberger UA. Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy. Chest. 2007;131(5):1406–13.

    PubMed  Google Scholar 

  41. Carlson JT, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin BG. Augmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest. 1993;103(6):1763–8.

    PubMed  CAS  Google Scholar 

  42. Ziegler MG, Mills PJ, Loredo JS, Ancoli-Israel S, Dimsdale JE. Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea. Chest. 2001;120(3):887–93.

    PubMed  CAS  Google Scholar 

  43. Imadojemu VA, Gleeson K, Gray KS, Sinoway LI, Leuenberger UA. Obstructive apnea during sleep is associated with peripheral vasoconstriction. Am J Respir Crit Care Med. 2002;165(1):61–6.

    PubMed  Google Scholar 

  44. Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand. 2003;177(3):385–90.

    PubMed  CAS  Google Scholar 

  45. Aljadeff G, Gozal D, Schechtman VL, Burrell B, Harper RM, Ward SL. Heart rate variability in children with obstructive sleep apnea. Sleep. 1997;20(2): 151–7.

    PubMed  CAS  Google Scholar 

  46. Baharav A, Kotagal S, Rubin BK, Pratt J, Akselrod S. Autonomic cardiovascular control in children with obstructive sleep apnea. Clin Auton Res. 1999;9(6):345–51.

    PubMed  CAS  Google Scholar 

  47. O’Brien LM, Gozal D. Autonomic dysfunction in children with sleep-disordered breathing. Sleep. 2005;28(6):747–52.

    PubMed  Google Scholar 

  48. Chaicharn J, Lin Z, Chen ML, Keens TG, Davidson Ward SL, Khoo MK. Time-varying closed-loop modeling of autonomic control in pediatric obstructive sleep apnea syndrome during cold face stimulation. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3569–71.

    PubMed  CAS  Google Scholar 

  49. Deng ZD, Poon CS, Arzeno NM, Katz ES. Heart rate variability in pediatric obstructive sleep apnea. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3565–8.

    PubMed  Google Scholar 

  50. Shouldice RB, O’Brien LM, O’Brien C, de Chazal P, Gozal D, Heneghan C. Detection of obstructive sleep apnea in pediatric subjects using surface lead electrocardiogram features. Sleep. 2004;27(4):784–92.

    PubMed  Google Scholar 

  51. Muzumdar HV, Sin S, Nikova M, Gates G, Kim D, Arens R. Changes in heart rate variability after adenotonsillectomy in children with obstructive sleep apnea. Chest. 2011;139(5):1050–9.

    PubMed  Google Scholar 

  52. Foo JY, Lim CS. Pulse transit time as an indirect marker for variations in cardiovascular related reactivity. Technol Health Care. 2006;14(2):97–108.

    PubMed  Google Scholar 

  53. O’Brien LM, Gozal D. Potential usefulness of noninvasive autonomic monitoring in recognition of arousals in normal healthy children. J Clin Sleep Med. 2007;3(1):41–7.

    PubMed  Google Scholar 

  54. Tauman R, O’Brien LM, Mast BT, Holbrook CR, Gozal D. Peripheral arterial tonometry events and electroencephalographic arousals in children. Sleep. 2004;27(3):502–6.

    PubMed  Google Scholar 

  55. Katz ES, Lutz J, Black C, Marcus CL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res. 2003;53(4):580–8.

    PubMed  Google Scholar 

  56. Pillar G, Bar A, Shlitner A, Schnall R, Shefy J, Lavie P. Autonomic arousal index: an automated detection based on peripheral arterial tonometry. Sleep. 2002;25(5):543–9.

    PubMed  Google Scholar 

  57. Brietzke SE, Katz ES, Roberson DW. Pulse transit time as a screening test for pediatric sleep-related breathing disorders. Arch Otolaryngol Head Neck Surg. 2007;133(10):980–4.

    PubMed  Google Scholar 

  58. Foo JY, Bradley AP, Wilson SJ, Williams GR, Dakin C, Cooper DM. Screening of obstructive and central apnoea/hypopnoea in children using variability: a preliminary study. Acta Paediatr. 2006;95(5):561–4.

    PubMed  Google Scholar 

  59. Pepin JL, Delavie N, Pin I, Deschaux C, Argod J, Bost M, et al. Pulse transit time improves detection of sleep respiratory events and microarousals in children. Chest. 2005;127(3):722–30.

    PubMed  Google Scholar 

  60. Snow AB, Khalyfa A, Serpero LD, Capdevila OS, Kim J, Buazza MO, Gozal D. Catecholamine alterations in pediatric obstructive sleep apnea: effect of obesity. Pediatr Pulmonol. 2009;44:559–67.

    Google Scholar 

  61. Alexopoulos EI, Kaditis AG, Damani E, Hatzi F, Chaidas K, Kostadima E, et al. Urine catecholamines in children with obstructive sleep-disordered breathing. ATS. 2007;2007:A277.

    Google Scholar 

  62. Gozal D, Jortani S, Snow AB, Kheirandish-Gozal L, Bhattacharjee R, Kim J, et al. Two-dimensional differential in-gel electrophoresis proteomic approaches reveal urine candidate biomarkers in pediatric obstructive sleep apnea. Am J Respir Crit Care Med. 2009;180(12):1253–61.

    PubMed  CAS  Google Scholar 

  63. Kraiczi H, Hedner J, Peker Y, Carlson J. Increased vasoconstrictor sensitivity in obstructive sleep apnea. J Appl Physiol. 2000;89(2):493–8.

    PubMed  CAS  Google Scholar 

  64. Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995;8(7):657–65.

    PubMed  CAS  Google Scholar 

  65. Goonasekera CD, Dillon MJ. Measurement and interpretation of blood pressure. Arch Dis Child. 2000;82(3):261–5.

    PubMed  CAS  Google Scholar 

  66. Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR. Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics. 2007;119(2):237–46.

    PubMed  Google Scholar 

  67. Sinaiko AR. Hypertension in children. N Engl J Med. 1996;335(26):1968–73.

    PubMed  CAS  Google Scholar 

  68. Ford ES, Mokdad AH, Ajani UA. Trends in risk factors for cardiovascular disease among children and adolescents in the United States. Pediatrics. 2004;114(6):1534–44.

    PubMed  Google Scholar 

  69. Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR. Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996. J Pediatr. 1999;134(6):668–74.

    PubMed  CAS  Google Scholar 

  70. Morrison JA, James FW, Sprecher DL, Khoury PR, Daniels SR. Sex and race differences in cardiovascular disease risk factor changes in schoolchildren, 1975-1990: the Princeton School Study. Am J Public Health. 1999;89(11):1708–14.

    PubMed  CAS  Google Scholar 

  71. Thompson DR, Obarzanek E, Franko DL, Barton BA, Morrison J, Biro FM, et al. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2007;150(1):18–25.

    PubMed  Google Scholar 

  72. Zintzaras E, Kaditis AG. Sleep-disordered breathing and blood pressure in children: a meta-analysis. Arch Pediatr Adolesc Med. 2007;161(2):172–8.

    PubMed  Google Scholar 

  73. Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med. 1998;157(4 Pt 1):1098–103.

    PubMed  CAS  Google Scholar 

  74. Kohyama J, Ohinata JS, Hasegawa T. Blood pressure in sleep disordered breathing. Arch Dis Child. 2003;88(2):139–42.

    PubMed  CAS  Google Scholar 

  75. Enright PL, Goodwin JL, Sherrill DL, Quan JR, Quan SF. Blood pressure elevation associated with sleep-related breathing disorder in a community sample of white and Hispanic children: the Tucson Children’s Assessment of Sleep Apnea study. Arch Pediatr Adolesc Med. 2003;157(9):901–4.

    PubMed  Google Scholar 

  76. Guilleminault C, Khramsov A, Stoohs RA, Kushida C, Pelayo R, Kreutzer ML, et al. Abnormal blood pressure in prepubertal children with sleep-disordered breathing. Pediatr Res. 2004;55(1):76–84.

    PubMed  Google Scholar 

  77. Kirk V, Midgley J, Giuffre M, Ronksley P, Nettel-Aguirre A, Al-Shamrani A. Hypertension and obstructive sleep apnea in Caucasian children. World J Cardiol. 2010;2(8):251–6.

    PubMed  Google Scholar 

  78. O’Driscoll DM, Horne RS, Davey MJ, Hope SA, Anderson V, Trinder J, et al. Increased sympathetic activity in children with obstructive sleep apnea: Cardiovascular implications. Sleep Med. 2011;12(5):483–8.

    PubMed  Google Scholar 

  79. Horne RS, Yang JS, Walter LM, Richardson HL, O’Driscoll DM, Foster AM, et al. Elevated blood pressure during sleep and wake in children with sleep-disordered breathing. Pediatrics. 2011;128(1):e85–92.

    PubMed  Google Scholar 

  80. Amin RS, Carroll JL, Jeffries JL, Grone C, Bean JA, Chini B, et al. Twenty-four-hour ambulatory blood pressure in children with sleep-disordered breathing. Am J Respir Crit Care Med. 2004;169(8):950–6.

    PubMed  Google Scholar 

  81. Amin R, Somers VK, McConnell K, Willging P, Myer C, Sherman M, et al. Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing. Hypertension. 2008;51(1):84–91.

    PubMed  CAS  Google Scholar 

  82. Leung LC, Ng DK, Lau MW, Chan CH, Kwok KL, Chow PY, et al. Twenty-four-hour ambulatory BP in snoring children with obstructive sleep apnea syndrome. Chest. 2006;130(4):1009–17.

    PubMed  Google Scholar 

  83. Soukhova-O’Hare GK, Cheng ZJ, Roberts AM, Gozal D. Postnatal intermittent hypoxia alters baroreflex function in adult rats. Am J Physiol Heart Circ Physiol. 2006;290(3):H1157–64.

    PubMed  Google Scholar 

  84. Reeves SR, Guo SZ, Brittian KR, Row BW, Gozal D. Anatomical changes in selected cardio-respiratory brainstem nuclei following early post-natal chronic intermittent hypoxia. Neurosci Lett. 2006;402(3): 233–7.

    PubMed  CAS  Google Scholar 

  85. Soukhova-O’Hare GK, Roberts AM, Gozal D. Impaired control of renal sympathetic nerve activity following neonatal intermittent hypoxia in rats. Neurosci Lett. 2006;399(3):181–5.

    PubMed  Google Scholar 

  86. Hui AS, Striet JB, Gudelsky G, Soukhova GK, Gozal E, Beitner-Johnson D, et al. Regulation of catecholamines by sustained and intermittent hypoxia in neuroendocrine cells and sympathetic neurons. Hypertension. 2003;42(6):1130–6.

    PubMed  CAS  Google Scholar 

  87. Fletcher EC, Lesske J, Behm R, Miller 3rd CC, Stauss H, Unger T. Carotid chemoreceptors, systemic blood pressure, and chronic episodic hypoxia mimicking sleep apnea. J Appl Physiol. 1992;72(5):1978–84.

    PubMed  CAS  Google Scholar 

  88. Lesske J, Fletcher EC, Bao G, Unger T. Hypertension caused by chronic intermittent hypoxia—influence of chemoreceptors and sympathetic nervous system. J Hypertens. 1997;15(12 Pt 2):1593–603.

    PubMed  CAS  Google Scholar 

  89. Prabhakar NR, Dick TE, Nanduri J, Kumar GK. Systemic, cellular and molecular analysis of chemoreflex-mediated sympathoexcitation by chronic intermittent hypoxia. Exp Physiol. 2007;92(1):39–44.

    PubMed  CAS  Google Scholar 

  90. Fletcher EC, Bao G, Li R. Renin activity and blood pressure in response to chronic episodic hypoxia. Hypertension. 1999;34(2):309–14.

    PubMed  CAS  Google Scholar 

  91. Sica AL, Greenberg HE, Ruggiero DA, Scharf SM. Chronic-intermittent hypoxia: a model of sympathetic activation in the rat. Respir Physiol. 2000;121(2–3):173–84.

    PubMed  CAS  Google Scholar 

  92. Drager LF, Bortolotto LA, Figueiredo AC, Silva BC, Krieger EM, Lorenzi-Filho G. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest. 2007;131(5):1379–86.

    PubMed  Google Scholar 

  93. Alchanatis M, Tourkohoriti G, Kosmas EN, Panoutsopoulos G, Kakouros S, Papadima K, et al. Evidence for left ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J. 2002;20(5):1239–45.

    PubMed  CAS  Google Scholar 

  94. Kraiczi H, Caidahl K, Samuelsson A, Peker Y, Hedner J. Impairment of vascular endothelial function and left ventricular filling: association with the severity of apnea-induced hypoxemia during sleep. Chest. 2001;119(4):1085–91.

    PubMed  CAS  Google Scholar 

  95. Niroumand M, Kuperstein R, Sasson Z, Hanly PJ. Impact of obstructive sleep apnea on left ventricular mass and diastolic function. Am J Respir Crit Care Med. 2001;163(7):1632–6.

    PubMed  CAS  Google Scholar 

  96. Amin RS, Kimball TR, Kalra M, Jeffries JL, Carroll JL, Bean JA, et al. Left ventricular function in children with sleep-disordered breathing. Am J Cardiol. 2005;95(6):801–4.

    PubMed  Google Scholar 

  97. Amin RS, Kimball TR, Bean JA, Jeffries JL, Willging JP, Cotton RT, et al. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165(10):1395–9.

    PubMed  Google Scholar 

  98. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest. 1996;109(2):380–6.

    PubMed  CAS  Google Scholar 

  99. Fletcher EC, Schaaf JW, Miller J, Fletcher JG. Long-term cardiopulmonary sequelae in patients with sleep apnea and chronic lung disease. Am Rev Respir Dis. 1987;135(3):525–33.

    PubMed  CAS  Google Scholar 

  100. Krieger J, Sforza E, Apprill M, Lampert E, Weitzenblum E, Ratomaharo J. Pulmonary hypertension, hypoxemia, and hypercapnia in obstructive sleep apnea patients. Chest. 1989;96(4):729–37.

    PubMed  CAS  Google Scholar 

  101. Laks L, Lehrhaft B, Grunstein RR, Sullivan CE. Pulmonary hypertension in obstructive sleep apnoea. Eur Respir J. 1995;8(4):537–41.

    PubMed  CAS  Google Scholar 

  102. Podszus T, Bauer W, Mayer J, Penzel T, Peter JH, von Wichert P. Sleep apnea and pulmonary hypertension. Klin Wochenschr. 1986;64(3):131–4.

    PubMed  CAS  Google Scholar 

  103. Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvoy RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1994;149(2 Pt 1): 416–22.

    PubMed  CAS  Google Scholar 

  104. Sajkov D, Wang T, Neill AM, Bune AJ, Saunders NA, Douglas Mcevoy R. Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung disease. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1518–26.

    PubMed  CAS  Google Scholar 

  105. Tavil Y, Kanbay A, Sen N, Ciftci TU, Abaci A, Yalcin MR, et al. Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension. Int J Cardiovasc Imaging. 2007;23(4): 469–77.

    PubMed  Google Scholar 

  106. Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr. 1982;100(1):31–40.

    PubMed  CAS  Google Scholar 

  107. Arias MA, Garcia-Rio F, Alonso-Fernandez A, Martinez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J. 2006;27(9):1106–13.

    PubMed  Google Scholar 

  108. Sajkov D, Wang T, Saunders NA, Bune AJ, McEvoy RD. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165(2):152–8.

    PubMed  Google Scholar 

  109. Sofer S, Weinhouse E, Tal A, Wanderman KL, Margulis G, Leiberman A, et al. Cor pulmonale due to adenoidal or tonsillar hypertrophy or both in children. Noninvasive diagnosis and follow-up. Chest. 1988;93(1):119–22.

    PubMed  CAS  Google Scholar 

  110. Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol. 1988;4(3):139–43.

    PubMed  CAS  Google Scholar 

  111. Tang JR, Le Cras TD, Morris Jr KG, Abman SH. Brief perinatal hypoxia increases severity of pulmonary hypertension after reexposure to hypoxia in infant rats. Am J Physiol. 2000;278(2):L356–64.

    CAS  Google Scholar 

  112. Gozal D, Kheirandish-Gozal L. Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med. 2008;177(4):369–75.

    PubMed  CAS  Google Scholar 

  113. Dyugovskaya L, Lavie P, Hirsh M, Lavie L. Activated CD8+ T-lymphocytes in obstructive sleep apnoea. Eur Respir J. 2005;25(5):820–8.

    PubMed  CAS  Google Scholar 

  114. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med. 2002;165(7):934–9.

    PubMed  Google Scholar 

  115. Dyugovskaya L, Lavie P, Lavie L. Phenotypic and functional characterization of blood gammadelta T cells in sleep apnea. Am J Respir Crit Care Med. 2003;168(2):242–9.

    PubMed  Google Scholar 

  116. Ryan S, Taylor CT, McNicholas WT. Predictors of elevated nuclear factor-kappaB-dependent genes in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2006;174(7):824–30.

    PubMed  CAS  Google Scholar 

  117. Kataoka T, Enomoto F, Kim R, Yokoi H, Fujimori M, Sakai Y, et al. The effect of surgical treatment of obstructive sleep apnea syndrome on the plasma TNF-alpha levels. Tohoku J Exp Med. 2004;204(4):267–72.

    PubMed  Google Scholar 

  118. Tam CS, Wong M, McBain R, Bailey S, Waters KA. Inflammatory measures in children with obstructive sleep apnoea. J Paediatr Child Health. 2006;42(5): 277–82.

    PubMed  Google Scholar 

  119. Waters KA, Mast BT, Vella S, de la Eva R, O’Brien LM, Bailey S, et al. Structural equation modeling of sleep apnea, inflammation, and metabolic dysfunction in children. J Sleep Res. 2007;16(4):388–95.

    PubMed  Google Scholar 

  120. Gozal D, Serpero LD, Kheirandish-Gozal L, Capdevila OS, Khalyfa A, Tauman R. Sleep measures and morning plasma TNF-alpha levels in children with sleep-disordered breathing. Sleep. 2010;33(3):319–25.

    PubMed  Google Scholar 

  121. Serpero LD, Kheirandish-Gozal L, Tauman R, Sans Capdevila O, Gozal D. Sleep fragmentation and circulating TNF alpha levels in children with sleep-disordered breathing. Proc Am Thor Soc. 2006;3:A555.

    Google Scholar 

  122. Khalyfa A, Serpero LD, Kheirandish-Gozal L, Capdevila OS, Gozal D. TNF-alpha gene polymorphisms and excessive daytime sleepiness in pediatric obstructive sleep apnea. J Pediatr. 2011;158(1):77–82.

    PubMed  CAS  Google Scholar 

  123. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342(12):836–43.

    PubMed  CAS  Google Scholar 

  124. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347(20):1557–65.

    PubMed  CAS  Google Scholar 

  125. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation. 2000;102(18): 2165–8.

    PubMed  CAS  Google Scholar 

  126. Can M, Acikgoz S, Mungan G, Bayraktaroglu T, Kocak E, Guven B, et al. Serum cardiovascular risk factors in obstructive sleep apnea. Chest. 2006;129(2):233–7.

    PubMed  CAS  Google Scholar 

  127. Chung S, Yoon IY, Shin YK, Lee CH, Kim JW, Lee T, et al. Endothelial dysfunction and C-reactive protein in relation with the severity of obstructive sleep apnea syndrome. Sleep. 2007;30(8):997–1001.

    PubMed  Google Scholar 

  128. Friedman M, Bliznikas D, Vidyasagar R, Woodson BT, Joseph NJ. Reduction of C-reactive protein with surgical treatment of obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg. 2006;135(6):900–5.

    PubMed  Google Scholar 

  129. Kageyama N, Nomura M, Nakaya Y, Watanabe T, Ito S. Relationship between adhesion molecules with hs-CRP and changes therein after ARB (Valsartan) administration in patients with obstructive sleep apnea syndrome. J Med Invest. 2006;53(1–2):134–9.

    PubMed  Google Scholar 

  130. Minoguchi K, Yokoe T, Tanaka A, Ohta S, Hirano T, Yoshino G, et al. Association between lipid peroxidation and inflammation in obstructive sleep apnoea. Eur Respir J. 2006;28(2):378–85.

    PubMed  CAS  Google Scholar 

  131. Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, et al. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(5):625–30.

    PubMed  Google Scholar 

  132. Punjabi NM, Beamer BA. C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep. 2007;30(1):29–34.

    PubMed  Google Scholar 

  133. Saletu M, Nosiska D, Kapfhammer G, Lalouschek W, Saletu B, Benesch T, et al. Structural and serum surrogate markers of cerebrovascular disease in obstructive sleep apnea (OSA): association of mild OSA with early atherosclerosis. J Neurol. 2006;253(6):746–52.

    PubMed  CAS  Google Scholar 

  134. Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation. 2002;105(21):2462–4.

    PubMed  CAS  Google Scholar 

  135. Zouaoui Boudjeltia K, Van Meerhaeghe A, Doumit S, Guillaume M, Cauchie P, Brohee D, et al. Sleep apnoea-hypopnoea index is an independent predictor of high-sensitivity C-reactive protein elevation. Respiration. 2006;73(2):243–6.

    PubMed  CAS  Google Scholar 

  136. Larkin EK, Rosen CL, Kirchner HL, Storfer-Isser A, Emancipator JL, Johnson NL, et al. Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation. 2005;111(15):1978–84.

    PubMed  CAS  Google Scholar 

  137. Tauman R, Ivanenko A, O’Brien LM, Gozal D. Plasma C-reactive protein levels among children with sleep-disordered breathing. Pediatrics. 2004;113(6):e564–9.

    PubMed  Google Scholar 

  138. Tauman R, O’Brien LM, Gozal D. Hypoxemia and obesity modulate plasma C-reactive protein and interleukin-6 levels in sleep-disordered breathing. Sleep Breath. 2007;11(2):77–84.

    PubMed  Google Scholar 

  139. Kheirandish-Gozal L, Capdevila OS, Tauman R, Gozal D. Plasma C-reactive protein in nonobese children with obstructive sleep apnea before and after adenotonsillectomy. J Clin Sleep Med. 2006;2(3):301–4.

    PubMed  Google Scholar 

  140. Li AM, Chan MH, Yin J, So HK, Ng SK, Chan IH, et al. C-reactive protein in children with obstructive sleep apnea and the effects of treatment. Pediatr Pulmonol. 2008;43(1):34–40.

    PubMed  Google Scholar 

  141. Barcelo A, Barbe F, Llompart E, Mayoralas LR, Ladaria A, Bosch M, et al. Effects of obesity on C-reactive protein level and metabolic disturbances in male patients with obstructive sleep apnea. Am J Med. 2004;117(2):118–21.

    PubMed  CAS  Google Scholar 

  142. Guilleminault C, Kirisoglu C, Ohayon MM. C-reactive protein and sleep-disordered breathing. Sleep. 2004;27(8):1507–11.

    PubMed  Google Scholar 

  143. Kaditis AG, Alexopoulos EI, Kalampouka E, Kostadima E, Germenis A, Zintzaras E, et al. Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing. Am J Respir Crit Care Med. 2005;171(3):282–6.

    PubMed  Google Scholar 

  144. Ryan S, Nolan GM, Hannigan E, Cunningham S, Taylor C, McNicholas WT. Cardiovascular risk markers in obstructive sleep apnoea syndrome and correlation with obesity. Thorax. 2007;62(6): 509–14.

    PubMed  Google Scholar 

  145. Sharma SK, Mishra HK, Sharma H, Goel A, Sreenivas V, Gulati V, et al. Obesity, and not obstructive sleep apnea, is responsible for increased serum hs-CRP levels in patients with sleep-disordered breathing in Delhi. Sleep Med. 2008;9(2):149–56.

    PubMed  CAS  Google Scholar 

  146. Taheri S, Austin D, Lin L, Nieto FJ, Young T, Mignot E. Correlates of serum C-reactive protein (CRP)—no association with sleep duration or sleep disordered breathing. Sleep. 2007;30(8):991–6.

    PubMed  Google Scholar 

  147. Baldwin CM, Bootzin RR, Schwenke DC, Quan SF. Antioxidant nutrient intake and supplements as potential moderators of cognitive decline and cardiovascular disease in obstructive sleep apnea. Sleep Med Rev. 2005;9(6):459–76.

    PubMed  Google Scholar 

  148. Gozal D, Kheirandish L. Oxidant stress and inflammation in the snoring child: confluent pathways to upper airway pathogenesis and end-organ morbidity. Sleep Med Rev. 2006;10(2):83–96.

    PubMed  Google Scholar 

  149. Khalyfa A, Bhushan B, Hegazi M, Kim J, Kheirandish-Gozal L, Bhattacharjee R, et al. Fatty-acid binding protein 4 gene variants and childhood obesity: potential implications for insulin sensitivity and CRP levels. Lipids Health Dis. 2010;9:18.

    PubMed  Google Scholar 

  150. Gozal D, Crabtree VM, Sans Capdevila O, Witcher LA, Kheirandish-Gozal L. C-reactive protein, obstructive sleep apnea, and cognitive dysfunction in school-aged children. Am J Respir Crit Care Med. 2007;176(2):188–93.

    PubMed  CAS  Google Scholar 

  151. Lavie L, Dyugovskaya L, Lavie P. Sleep-apnea-related intermittent hypoxia and atherogenesis: adhesion molecules and monocytes/endothelial cells interactions. Atherosclerosis. 2005;183(1):183–4.

    PubMed  CAS  Google Scholar 

  152. Chin K, Nakamura T, Shimizu K, Mishima M, Nakamura T, Miyasaka M, et al. Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med. 2000;109(7):562–7.

    PubMed  CAS  Google Scholar 

  153. El-Solh AA, Mador MJ, Sikka P, Dhillon RS, Amsterdam D, Grant BJ. Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest. 2002;121(5):1541–7.

    PubMed  CAS  Google Scholar 

  154. Ohga E, Nagase T, Tomita T, Teramoto S, Matsuse T, Katayama H, et al. Increased levels of circulating ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome. J Appl Physiol. 1999;87(1):10–4.

    PubMed  CAS  Google Scholar 

  155. O’Brien LM, Serpero LD, Tauman R, Gozal D. Plasma adhesion molecules in children with sleep-disordered breathing. Chest. 2006;129(4):947–53.

    PubMed  Google Scholar 

  156. Kaditis AG, Alexopoulos EI, Kalampouka E, Hatzi F, Karadonta I, Kyropoulos T, et al. Nocturnal change of circulating intercellular adhesion molecule 1 levels in children with snoring. Sleep Breath. 2007;11(4):267–74.

    PubMed  Google Scholar 

  157. Gozal D, Sans Capdevila O, Kheirandish-Gozal L. Metabolic alterations in obstructive sleep apnea among non-obese and obese prepubertal children. Am J Respir Crit Care Med. 2008;177:1142–9.

    Google Scholar 

  158. Rammes A, Roth J, Goebeler M, Klempt M, Hartmann M, Sorg C. Myeloid-related protein (MRP) 8 and MRP14, calcium-binding proteins of the S100 family, are secreted by activated monocytes via a novel, tubulin-dependent pathway. J Biol Chem. 1997;272(14):9496–502.

    PubMed  CAS  Google Scholar 

  159. Guignard F, Mauel J, Markert M. Phosphorylation of myeloid-related proteins MRP-14 and MRP-8 during human neutrophil activation. Eur J Biochem. 1996;241(1):265–71.

    PubMed  CAS  Google Scholar 

  160. Croce K, Gao H, Wang Y, Mooroka T, Sakuma M, Shi C, et al. Myeloid-related protein-8/14 is critical for the biological response to vascular injury. Circulation. 2009;120(5):427–36.

    PubMed  CAS  Google Scholar 

  161. Ionita MG, Vink A, Dijke IE, Laman JD, Peeters W, van der Kraak PH, et al. High levels of myeloid-related protein 14 in human atherosclerotic plaques correlate with the characteristics of rupture-prone lesions. Arterioscler Thromb Vasc Biol. 2009;29(8): 1220–7.

    PubMed  CAS  Google Scholar 

  162. Altwegg LA, Neidhart M, Hersberger M, Muller S, Eberli FR, Corti R, et al. Myeloid-related protein 8/14 complex is released by monocytes and granulocytes at the site of coronary occlusion: a novel, early, and sensitive marker of acute coronary syndromes. Eur Heart J. 2007;28(8):941–8.

    PubMed  CAS  Google Scholar 

  163. Kim J, Bhattacharjee R, Snow AB, Capdevila OS, Kheirandish-Gozal L, Gozal D. Myeloid-related protein 8/14 levels in children with obstructive sleep apnoea. Eur Respir J. 2010;35(4):843–50.

    PubMed  CAS  Google Scholar 

  164. Bokinsky G, Miller M, Ault K, Husband P, Mitchell J. Spontaneous platelet activation and aggregation during obstructive sleep apnea and its response to therapy with nasal continuous positive airway pressure. A preliminary investigation. Chest. 1995;108(3): 625–30.

    PubMed  CAS  Google Scholar 

  165. Nobili L, Schiavi G, Bozano E, De Carli F, Ferrillo F, Nobili F. Morning increase of whole blood viscosity in obstructive sleep apnea syndrome. Clin Hemorheol Microcirc. 2000;22(1):21–7.

    PubMed  CAS  Google Scholar 

  166. Rangemark C, Hedner JA, Carlson JT, Gleerup G, Winther K. Platelet function and fibrinolytic activity in hypertensive and normotensive sleep apnea patients. Sleep. 1995;18(3):188–94.

    PubMed  CAS  Google Scholar 

  167. Robinson GV, Pepperell JC, Segal HC, Davies RJ, Stradling JR. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax. 2004;59(9):777–82.

    PubMed  CAS  Google Scholar 

  168. von Kanel R, Loredo JS, Ancoli-Israel S, Dimsdale JE. Association between sleep apnea severity and blood coagulability: treatment effects of nasal continuous positive airway pressure. Sleep Breath. 2006;10(3):139–46.

    Google Scholar 

  169. Wessendorf TE, Thilmann AF, Wang YM, Schreiber A, Konietzko N, Teschler H. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med. 2000;162(6):2039–42.

    PubMed  CAS  Google Scholar 

  170. Kaditis AG, Alexopoulos EI, Kalampouka E, Kostadima E, Angelopoulos N, Germenis A, et al. Morning levels of fibrinogen in children with sleep-disordered breathing. Eur Respir J. 2004;24(5): 790–7.

    PubMed  CAS  Google Scholar 

  171. Kheirandish-Gozal L, Bhattacharjee R, Gozal D. Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea. Sleep Med. 2010;11(7):714–20.

    PubMed  Google Scholar 

  172. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, et al. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation. 2000;102(21):2607–10.

    PubMed  CAS  Google Scholar 

  173. Nieto FJ, Herrington DM, Redline S, Benjamin EJ, Robbins JA. Sleep apnea and markers of vascular endothelial function in a large community sample of older adults. Am J Respir Crit Care Med. 2004;169(3):354–60.

    PubMed  Google Scholar 

  174. Oflaz H, Cuhadaroglu C, Pamukcu B, Meric M, Ece T, Kasikcioglu E, et al. Endothelial function in patients with obstructive sleep apnea syndrome but without hypertension. Respiration. 2006;73(6):751–6.

    PubMed  Google Scholar 

  175. Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004;169(3):348–53.

    PubMed  Google Scholar 

  176. Lattimore JL, Wilcox I, Skilton M, Langenfeld M, Celermajer DS. Treatment of obstructive sleep apnoea leads to improved microvascular endothelial function in the systemic circulation. Thorax. 2006;61(6):491–5.

    PubMed  CAS  Google Scholar 

  177. Ohike Y, Kozaki K, Iijima K, Eto M, Kojima T, Ohga E, et al. Amelioration of vascular endothelial dysfunction in obstructive sleep apnea syndrome by nasal continuous positive airway pressure–possible involvement of nitric oxide and asymmetric NG, NG-dimethylarginine. Circ J. 2005;69(2):221–6.

    PubMed  CAS  Google Scholar 

  178. Itzhaki S, Dorchin H, Clark G, Lavie L, Lavie P, Pillar G. The effects of 1-year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest. 2007;131(3):740–9.

    PubMed  Google Scholar 

  179. Itzhaki S, Wertheimer E. Metabolism of adipose tissue in vitro: nutritional factors and effect of insulin. Endocrinology. 1957;61(1):72–8.

    PubMed  CAS  Google Scholar 

  180. de la Pena M, Barcelo A, Barbe F, Pierola J, Pons J, Rimbau E, et al. Endothelial function and circulating endothelial progenitor cells in patients with sleep apnea syndrome. Respiration. 2007;76:28–32.

    Google Scholar 

  181. Gozal D, Lipton AJ, Jones KL. Circulating vascular endothelial growth factor levels in patients with obstructive sleep apnea. Sleep. 2002;25(1):59–65.

    PubMed  Google Scholar 

  182. Suheyl Ezgu F, Hasanoglu A, Tumer L, Ozbay F, Aybay C, Gunduz M. Endothelial activation and inflammation in prepubertal obese Turkish children. Metabolism. 2005;54(10):1384–9.

    PubMed  Google Scholar 

  183. Valle Jimenez M, Estepa RM, Camacho RM, Estrada RC, Luna FG, Guitarte FB. Endothelial dysfunction is related to insulin resistance and inflammatory biomarker levels in obese prepubertal children. Eur J Endocrinol. 2007;156(4):497–502.

    PubMed  Google Scholar 

  184. Giannini C, de Giorgis T, Scarinci A, Ciampani M, Marcovecchio ML, Chiarelli F, et al. Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children. Atherosclerosis. 2008;197(1): 448–56.

    PubMed  CAS  Google Scholar 

  185. Huang K, Zou CC, Yang XZ, Chen XQ, Liang L. Carotid intima-media thickness and serum endothelial marker levels in obese children with metabolic syndrome. Arch Pediatr Adolesc Med. 2010;164(9):846–51.

    PubMed  Google Scholar 

  186. Shachor-Meyouhas Y, Pillar G, Shehadeh N. Uncontrolled type 1 diabetes mellitus and endothelial dysfunction in adolescents. Isr Med Assoc J. 2007;9(9):637–40.

    PubMed  CAS  Google Scholar 

  187. DiMeglio LA, Tosh A, Saha C, Estes M, Mund J, Mead LE, et al. Endothelial abnormalities in adolescents with type 1 diabetes: a biomarker for vascular sequelae? J Pediatr. 2010;157(4):540–6.

    PubMed  CAS  Google Scholar 

  188. Trigona B, Aggoun Y, Maggio A, Martin XE, Marchand LM, Beghetti M, et al. Preclinical noninvasive markers of atherosclerosis in children and adolescents with type 1 diabetes are influenced by physical activity. J Pediatr. 2010;157(4):533–9.

    PubMed  Google Scholar 

  189. Short KR, Blackett PR, Gardner AW, Copeland KC. Vascular health in children and adolescents: effects of obesity and diabetes. Vasc Health Risk Manag. 2009;5:973–90.

    PubMed  CAS  Google Scholar 

  190. Bhattacharjee R, Alotaibi WH, Kheirandish-Gozal L, Capdevila OS, Gozal D. Endothelial dysfunction in obese non-hypertensive children without evidence of sleep disordered breathing. BMC Pediatr. 2010;10:8.

    PubMed  Google Scholar 

  191. Gozal D, Kheirandish-Gozal L, Sans Capdevila O, Serpero LD, Dayyat E. Obstructive sleep apnea and endothelial function in school-aged nonobese children: effect of adenotonsillectomy. Circulation. 2007;116(20):2307–14.

    PubMed  Google Scholar 

  192. Bhattacharjee R, Kim J, Alotaibi WH, Kheirandish-Gozal L, Capdevila OS, Gozal D. Endothelial dysfunction in non-hypertensive children: potential contributions of obesity and obstructive sleep apnea. Chest. 2011;141:682–791.

    Google Scholar 

  193. Dubern B, Aggoun Y, Boule M, Fauroux B, Bonnet D, Tounian P. Arterial alterations in severely obese children with obstructive sleep apnoea. Int J Pediatr Obes. 2010;5(3):230–6.

    PubMed  Google Scholar 

  194. Kelly AS, Hebbel RP, Solovey AN, Schwarzenberg SJ, Metzig AM, Moran A, et al. Circulating activated endothelial cells in pediatric obesity. J Pediatr. 2010;157(4):547–51.

    PubMed  CAS  Google Scholar 

  195. Kheirandish-Gozal L, Bhattacharjee R, Kim J, Clair HB, Gozal D. Endothelial progenitor cells and vascular dysfunction in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2010;182(1): 92–7.

    PubMed  CAS  Google Scholar 

  196. Kim J, Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Gozal D. Circulating microparticles in children with sleep disordered breathing. Chest. 2011;140(2):408–17.

    Google Scholar 

  197. Kim J, Bhattacharjee R, Snow AB, Capdevila OS, Kheirandish-Gozal L, Gozal D. Myeloid related protein 8/14 levels in children with obstructive sleep apnoea. Eur Respir J. 2009;35(4):843–50.

    Google Scholar 

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Acknowledgments

Funding sources: Leila Kheirandish-Gozal is supported by NIH grant K12 HL-090003.

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Authors and Affiliations

  1. Divisions of Pulmonary and Sleep Medicine, Department of Pediatrics, The University of Chicago, 5841 South Maryland Avenue, MC 4064, Chicago, IL, 60637-1470, USA

    Rakesh Bhattacharjee MD

  2. Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 2117, Office C113, Chicago, IL, 60637, USA

    Leila Kheirandish-Gozal MD

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  1. Rakesh Bhattacharjee MD
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Correspondence to Rakesh Bhattacharjee MD .

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  1. Section of Sleep Medicine, Pritzker School of Medicine, Department of Pediatrics, S. Maryland Ave. 5721, Chicago, 60637, Illinois, USA

    Leila Kheirandish-Gozal

  2. Pritzker School of Medicine, Comer Children's Hospital, Department of Pediatrics, S. Maryland Ave. 5721, Chicago, 60637, Illinois, USA

    David Gozal

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Bhattacharjee, R., Kheirandish-Gozal, L. (2012). Cardiovascular Implications. In: Kheirandish-Gozal, L., Gozal, D. (eds) Sleep Disordered Breathing in Children. Respiratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-725-9_35

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