Sleep and Breathing

, Volume 23, Issue 1, pp 95–101 | Cite as

Biochemical markers of cardiac dysfunction in children with obstructive sleep apnoea (OSA)

  • Daniel Hirsch
  • Carla A. Evans
  • Melanie Wong
  • Rita Machaalani
  • Karen A. WatersEmail author
Sleep Breathing Physiology and Disorders • Original Article



We explored relationships between biochemical markers and cardiac responses of children with and without obstructive sleep apnoea (OSA) during exercise. We hypothesised that serum markers of sympathetic nervous system activity and low-grade inflammation would correlate with cardiac responses to exercise in children with or without OSA.


The study included 40 of 71 children with previously characterised responses to cardiopulmonary exercise testing. Measures included serum cytokine levels using a multiplex bead-based assay (interleukins IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α and IFN-γ). Serum amyloid A (SAA) was quantified by nephelometry, and metanephrine/normetanephrine levels were measured by liquid chromatography, mass-spectroscopy. Comparisons were made between children with and without OSA, and with and without obesity. Relationships between biomarkers and various cardiac parameters were explored by linear regression.


Amongst the 40 children in this study, OSA was present in 23. Compared to the 17 children without OSA, those with OSA had higher resting serum IL-6 levels compared to those without (median 3.22 pg/ml vs. 2.31, p < 0.05). Regarding correlations with cardiac function after adjusting for OSA, IL-8 negatively correlated to heart rate (HR) response following exercise (p = 0.03) and IFN-γ negatively correlated with Stroke Volume Index (SVI) (p = 0.03). Both metanephrine and normetanephrine levels positively correlated with SVI (p = 0.04, p = 0.047; respectively) and QI (p = 0.04, p = 0.04; respectively) during exercise when adjusting for OSA.


Children with OSA have raised morning levels of serum IL-6. Separately, higher levels of IFN-γ and IL-8 and lower levels of metanephrine and normetanephrine related to poorer cardiac function during exercise.


Biochemical markers Cardiac responses Obstructive sleep apnoea Cardiopulmonary exercise testing (CPET) 



Body mass index


Blood pressure


C-reactive protein


Cardiopulmonary exercise testing


Granulocyte-macrophage colony-stimulating factor


Heart rate
















Obstructive sleep apnoea


Cardiac output


Cardiac Output Index


Serum amyloid A


Stroke volume


Stroke Volume Index


Tumour necrosis factor-alpha



The authors thank the staff from the David Read Sleep Unit, Respiratory Function Unit, The Children’s Hospital Institute of Sport’s Medicine and Weight Management Service and the Immunology laboratory at The Children’s Hospital at Westmead for contributing and supporting this study. Also, we thank the children and families who agree to participate in this study.


The National Health and Medical Research Council (NHMRC) provided financial support in the form of a postgraduate scholarship for Dr. Evans. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name the institution/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

11325_2018_1666_MOESM1_ESM.docx (39 kb)
ESM 1 (DOCX 38 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Daniel Hirsch
    • 1
  • Carla A. Evans
    • 2
  • Melanie Wong
    • 3
  • Rita Machaalani
    • 2
    • 3
  • Karen A. Waters
    • 2
    • 3
    Email author
  1. 1.School of MedicineUniversity of SydneySydneyAustralia
  2. 2.Department of MedicineUniversity of SydneySydneyAustralia
  3. 3.The Children’s HospitalSydneyAustralia

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