Inflammation in children with neuromuscular disorders and sleep disordered breathing

Introduction: Paediatric obstructive sleep apnoea is associated with systemic inflammation and co-morbidities. We assessed whether sleep disordered breathing (SDB) due to neuromuscular weakness was associated with elevated airway and systemic pro-inflammatory cytokines.

Methods: Consecutive neuromuscular children (age 5-18years) underwent overnight full polysomnography and morning collection of serum and breath condensate, analysed for cytokines (Interleukin-10, Interleukin-6, Interleukin-1β, Tumour Necrosis Factorα, high-sensitivity C-Reactive Protein, Intercellular and Vascular Adhesion Molecules ICAM-1, VCAM-1). Cytokine levels were related to Oxygen desaturation index (ODI), desaturation>4%/h, and levels of transcutaneous carbon dioxide overnight (tcCO2≥6.7 kPa > 2% sleep).

Results: A total of 23 patients were included, median age 12.6 years (IQR 8.7-14.6). ODI>3/h was associated with higher breath and serum IL-6 (p = 0.02). Children with elevated CO₂ overnight had higher ICAM-1 and VCAM-1. CO₂ levels correlated with serum ICAM-1 (rs0.570, p = 0.026) and VCAM-1 (rs0.76, p = 0.001).

Discussion: SDB in neuromuscular children is associated with raised serum IL-6, VCAM-1, ICAM-1. This may predispose these children to future cardiovascular and other co-morbidities.

Keywords: Cytokines; Hypoventilation; ICAM-1; IL-6; Neuromuscular disorders; VCAM-1.