D2.139 - Oxidative stress and tissue hypoxia are triggered through the increased respiratory effort during sleep and reflect the inflammation as a stress link in the gut-brain axis in children suffering asthma, allergic/non-allergic rhinitis, and/or eczema

Sleep disorders is a common complaint in allergic children, however the causality relationships in between asthma, allergies and sleep disorders have not been clarified. 

91 children suffering from asthma, eczema, respiratory or/and food allergies effectuated a respiratory polygraphy (PG) in ambulatory. Apnoea hypopnea Index (AHI), Respiratory effort during sleep (RE) were recorded along with a personalised allergology evaluation. Written informed consent was received from the parents of the children for the inclusion in a prospective study for the amelioration of clinical practice. An internal study was effectuated to evaluate the relationship and inter-causalities in between sleep disorders and allergies, asthma, allergy signs. Principal reason for consultation was: asthma (42N), respiratory signs (7N), ORL signs (13N), sleep disorders (9N), digestive signs (8N), eczema (6N), urticaria (1N). Respiratory allergy: 35N, seasonal allergy: 15N, allergy to mites or alternaria alternata: 28N, IgE-mediated food allergy: 6N, Non-IgE mediated food allergy: 79N. 

RE: increased: 85N, normal: 4N. Mean AHI: 5,8132 (Std.E.: ,387, St.D. 3,69), RE: 30,894 (St.D.:1,91,St.D.:18,036),arousal index(AI):27,598(Std.E.: 1,2) (Table 1). Eosinophilia: 26N, eosinopenia: 4N, increased eosinophilic cationic protein (ECP): 17N, hormonal variations: 17N, decreased insulin at fast: 6/12N, acetone increased: 7N, cetonemia, acetose stigmata, or lactic acid increased: 13N, increased ratio lactates/pyruvates: 5N, increased copper values: 6/16N, decreased selenium values: 2/22N, increased magnesium: 12/36N, increased VitB6: 7/29N, decreased folates(VitB9): 8/33, increased VitB12: 7/36, coefficient iron saturation: (decreased: 20/47, increased: 7/47), ferritin: (increased: 6/48, decreased: 10/48), transferrin:(decreased: 4/47, increased: 1/47), serum iron: (increased: 3/15, decreased: 3/15), HDL decreased: 12/40. Defective redox balance: 9/12N. Prealbumin decreased: 9/18N. Amino acids chromatography: cystine decreased: 38/42N, valine (decreased: 8/42N, increased:4/42N), leucine: (decreased: 7/42N, increased: 2/42N), isoleucine: (increased: 3/42N, decreased: 3/42N), lysine: (decreased:5/42N, lowest limit: 3/42N), glutamine: (increased: 2/42N, decreased: 15/42N), proline: (increased:1/40N, decreased: 7/40), phenylalanine: (increased: 1/36N), alanine: (increased:4/41N, decreased: 4/41N), decreased: 1/36N), tyrosine: (increased: 6/42N, decreased: 3/42N), threonine: (increased: 7/37N, decreased: 2/37N), glycine: (increased: 3/42N, decreased: 3/42N), glycine: (increased: 3/42N, decreased: 3/42N). 1-mthylhistidine urinaire: increased: 6/28N.

The increased RE reflects the inflammatory effect from respiratory and food allergies (principally non-IgE mediated allergies). The increased respiratory effort during sleep leads to a hormonal disturbance and a hypercatabolic state, perturbative on the redox balance and boosting the oxidative stress which is at the origin of asthma and allergic reactions. The increased RE also favours tissue hypoxia, indicated from perturbations in ornithine, arginine and citrulline, all three participating in the urea cycle (with a pivotal role in the azote wash out from the proteins' metabolism). The increased RE reflects the stress mechanisms connecting the gut brain axis, multiplying the oxidative stress, altering the microbiome, affecting interactively the nutritional status of asthmatic, allergic children, favouring lack of essential amino acids and anti-oxidants and a metabolic switch in vulnerable children.