Increased Platelet Aggregation in Children and Adolescents with Sleep-disordered Breathing

Abstract

Objective: Sleep disordered breathing (SDB) is associated with increased vascular resistance in children and adults. Persistent increased vascular resistance damages vascular endothelial cells—a marker of which is increased platelet activation. This study compared whole blood impedance platelet aggregation in children diagnosed clinically as SDB warranting adenotonsillectomy and healthy controls. Methods and Results: Thirty children clinically diagnosed by experienced pediatric otolaryngologists as having SDB warranting intervention were recruited from adenotonsillectomy waitlists and 20 healthy children from the community underwent overnight polysomnography to determine SDB severity (Obstructive Apnea Hypopnea Index (OAHI)). Snoring frequency was collected from parents. In the morning, a fasting blood sample was taken and whole blood platelet aggregation was measured. Children with SDB exhibited increased platelet aggregation to thrombin receptor activating peptide (TRAP) (SDB = 114.8 vs Control = 98.0 AU, p < 0.05); collagen antibody (COL) (96.7 vs 82.2 AU, p < 0.05); and an increased trend in adenosine diphosphate antibody (ADP) (82.3 vs 69.2 AU, p < 0.07); but not aspirin dialuminate (ASP) (82.1 vs 79.5 AU, p > 0.05). No significant association was observed between either OAHI and any aggregation parameter, but parental report of snoring was positively associated with TRAP aggregation (Kendall’s τ-c = 0.23, p < 0.05). Conclusion: The finding of increased platelet aggregation is consistent with endothelial damage. This suggests that the profile of cardiovascular changes noted in adults with SDB may also occur in children with SDB.