Objective To evaluate the sleep quality and salivary cortisol level in children with postural tachycardia syndrome (POTS), and to analyze the correlation among salivary cortisol level, sleep quality and the severity of clinical symptoms. Methods This prospective study included 40 children with POTS (case group) from May 2018 to May 2019, and 20 healthy children who took health examination in the same period were selected as controls.Saliva samples were collected from two groups of children at six time points (awakening, 30 minutes after awakening, at 12:00 p.m., 4:00 p.m., and 8:00 p.m., and at bedtime), and the concentration of salivary cortisol was determined by enzyme-linked immunosorbent assay.The Pittsburgh Sleep Quality Index (PSQI) and POTS symptom scale were filled in to evaluate the sleep quality and the severity of clinical symptoms of POTS. Results The systolic blood pressure in supine position (t＝2.194), systolic blood pressure in upright position(t＝2.351), diastolic blood pressure in upright position (t＝2.227), stable heart rate in supine position(t＝2.117) in control group were significantly higher than those in POTS group, while the maximal heart rate in the upright position(t＝-3.88)and the difference in the resting and standing position (t＝-7.86) were significantly lower than those in POTS group(P＜0.05).The concentration of salivary cortisol in POTS group was significantly higher than that in the control group(P＜0.05) when waking up in the morning, 30 minutes after waking, at12:00, 4:00 pm and 8:00 pm.POTS group had poorer sleep quality (PSQI score) than control group[(7.2±3.0)vs.(1.35±1.39), t＝-10.370, P＜0.001], including sleep quality score, sleep time, sleep hours, sleep efficiency, sleep disorder, daytime dysfunction and overall comparison between groups.Symptom score and PSQI score were positively correlated with cortisol concentration in saliva after waking(r＝0.62, 0.60, P＜0.001).Moreover, symptom score and PSQI score were positively correlated(r=0.58,P＜0.001). Conclusionss Salivary cortisol concentration was positively correlated with the severity of clinical symptoms and PSQI score.To some extent, salivary cortisol concentration can reflect the sleep quality and clinical symptoms of children with POTS.
Key words
postural tachycardia syndrome /
salivary cortisol /
Pittsburgh Sleep Quality Index /
severity of clinical symptoms
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