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Nasal nitric oxide in sleep-disordered breathing in children

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Abstract

Background

Inflammation plays a role in the pathogenesis and consequences of sleep-disordered breathing (SDB). The nasal mucosa and paranasal sinuses produce high levels of nitric oxide (NO). In asthma, exhaled NO is a marker of airway inflammation. There is only limited information whether nasal NO (nNO) accompanies also chronic upper airway obstruction, specifically, SDB. The objective of this study was to investigate nNO levels in children with SDB in comparison to healthy non-snoring children.

Methods

Nasal NO was measured in children who underwent overnight polysomnographic studies due to habitual snoring and suspected SDB and in healthy non-snoring controls.

Results

One hundred and eleven children participated in the study: 28 with obstructive sleep apnea (OSA), 60 with primary snoring (PS), and 23 controls. Nasal NO levels were significantly higher in children with OSA and PS compared to controls (867.4 ± 371.5, 902.0 ± 330.9, 644.1 ± 166.5 ppb, respectively, p = 0.047). No difference was observed between children with OSA and PS. No correlations were found between nNO levels and any of the PSG variables, nor with age, BMI percentile or tonsils size.

Conclusions

Compared to healthy controls, nNO is increased in children with SDB, but it is not correlated with disease severity. This is probably due to the local mechanical processes and snoring.

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Abbreviations

ADD:

Attention deficit disorder

AHI:

Apnea/hypopnea index

AT:

Adenotonsillectomy

BMI:

Body mass index

ENO:

Exhaled nitric oxide

nNO:

Nasal nitric oxide

NO:

Nitric oxide

OSA:

Obstructive sleep apnea

PPB:

Parts per billion

PS:

Primary snoring

PSG:

Polysomnography

SDB:

Sleep-disordered breathing

SpO2:

Blood oxygen saturation

TST:

Total sleep time

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Acknowledgments

We are grateful to Bat-el Yakir, Ety Kadosh, and Ety Zefania for their help and support.

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 national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Sackler Faculty of Medicine, 6 Weizmann St., Tel Aviv, 64239, Israel

    Guy Gut, Riva Tauman, Michal Greenfeld, Keren Armoni-Domany & Yakov Sivan

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  1. Guy Gut
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  2. Riva Tauman
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Correspondence to Guy Gut.

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Gut, G., Tauman, R., Greenfeld, M. et al. Nasal nitric oxide in sleep-disordered breathing in children. Sleep Breath 20, 303–308 (2016). https://doi.org/10.1007/s11325-015-1189-8

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