Improved Long-term Autonomic Function Following Resolution of Sleep-disordered Breathing in Preschool-aged Children

Overview

Journal Sleep Breath

Publisher Springer

Date 2015 Oct 4

PMID 26432070

Citations 5

Authors

Lisa M Walter

Sarah N Biggs

Lauren C Nisbet

Aidan J Weichard

Samantha L Hollis

Margot J Davey

Vicki Anderson

Gillian M Nixon

Rosemary S C Horne

Affiliations

Soon will be listed here.

Abstract

Purpose: Sleep-disordered breathing (SDB) prevalence peaks in preschool children and is associated with deficits in cardiovascular functioning during sleep. No long-term studies have investigated the effects of SDB resolution in mitigating these outcomes. We hypothesized that following 3 years, normalization of alterations to heart rate (HR), pulse transit time (PTT), heart rate variability (HRV), and urinary catecholamines identified at the initial diagnosis would be associated with resolution of SDB.

Methods: Forty-five children with SDB and 28 non-snoring controls underwent polysomnography at baseline (3-5 years) and follow-up (6-9 years). Children were classified into control, resolved, and unresolved SDB. Resolution was defined as an obstructive apnea-hypopnea index (OAHI) ≤1 event/h, no snoring on polysomnography (PSG), or indicated by parents. PTT is an inverse surrogate measure of blood pressure change. HRV was assessed using power spectral analysis.

Results: There was no change in PTT or HR between studies for any group. Our HRV data suggest reduced parasympathetic activity in children whose SDB resolved and increased parasympathetic activity in children whose SDB remained the same or worsened at follow-up. We identified a significant correlation between low frequency power and urinary dopamine and adrenaline levels at follow-up in the unresolved group, suggesting increased sympathetic activity in children with unresolved SDB.

Conclusion: Our findings suggest an association between resolution of SDB and normalization of HRV in the long term in these preschool children and an augmented sympathetic activity in the children with residual SDB. This highlights the autonomic impact of SDB in young children and the importance of detection and treatment.

Citing Articles

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References

. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996; 17(3):354-81. View

McConnell K, Somers V, Kimball T, Daniels S, VanDyke R, Fenchel M . Baroreflex gain in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2009; 180(1):42-8. PMC: 2701502. DOI: 10.1164/rccm.200808-1324OC. View

Nisbet L, Yiallourou S, Biggs S, Nixon G, Davey M, Trinder J . Preschool children with obstructive sleep apnea: the beginnings of elevated blood pressure?. Sleep. 2013; 36(8):1219-26. PMC: 3700719. DOI: 10.5665/sleep.2890. View

Nisbet L, Yiallourou S, Walter L, Horne R . Blood pressure regulation, autonomic control and sleep disordered breathing in children. Sleep Med Rev. 2013; 18(2):179-89. DOI: 10.1016/j.smrv.2013.04.006. View

Marcus C, Brooks L, Draper K, Gozal D, Halbower A, Jones J . Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130(3):e714-55. DOI: 10.1542/peds.2012-1672. View

Liao D, Li X, Rodriguez-Colon S, Liu J, Vgontzas A, Calhoun S . Sleep-disordered breathing and cardiac autonomic modulation in children. Sleep Med. 2010; 11(5):484-8. PMC: 2857753. DOI: 10.1016/j.sleep.2009.11.012. View

Biggs S, Walter L, Nisbet L, Jackman A, Anderson V, Nixon G . Time course of EEG slow-wave activity in pre-school children with sleep disordered breathing: a possible mechanism for daytime deficits?. Sleep Med. 2012; 13(8):999-1005. DOI: 10.1016/j.sleep.2012.05.006. View

Vlahandonis A, Yiallourou S, Sands S, Nixon G, Davey M, Walter L . Long-term changes in heart rate variability in elementary school-aged children with sleep-disordered breathing. Sleep Med. 2013; 15(1):76-82. DOI: 10.1016/j.sleep.2013.06.023. View

Gates G, Mateika S, Mateika J . Heart rate variability in non-apneic snorers and controls before and after continuous positive airway pressure. BMC Pulm Med. 2005; 5:9. PMC: 1208915. DOI: 10.1186/1471-2466-5-9. View

10.

Goldstein D, Bentho O, Park M, Sharabi Y . Low-frequency power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Exp Physiol. 2011; 96(12):1255-61. PMC: 3224799. DOI: 10.1113/expphysiol.2010.056259. View

11.

Apostolidou M, Alexopoulos E, Damani E, Liakos N, Chaidas K, Boultadakis E . Absence of blood pressure, metabolic, and inflammatory marker changes after adenotonsillectomy for sleep apnea in Greek children. Pediatr Pulmonol. 2008; 43(6):550-60. DOI: 10.1002/ppul.20808. View

12.

Chaicharn J, Lin Z, Chen M, Ward S, Keens T, Khoo M . Model-based assessment of cardiovascular autonomic control in children with obstructive sleep apnea. Sleep. 2009; 32(7):927-38. PMC: 2706908. DOI: 10.1093/sleep/32.7.927. View

13.

Gozal D, Kheirandish-Gozal L, Serpero L, Sans Capdevila O, Dayyat E . Obstructive sleep apnea and endothelial function in school-aged nonobese children: effect of adenotonsillectomy. Circulation. 2007; 116(20):2307-14. DOI: 10.1161/CIRCULATIONAHA.107.696823. View

14.

Laskar S, Iwamoto M, Nakamoto M, Koshiyama H, Harada N . Heart rate variation and urinary catecholamine excretion in response to acute psychological stress in hand-arm vibration syndrome patients. J Occup Health. 2004; 46(2):125-31. DOI: 10.1539/joh.46.125. View

15.

ODriscoll D, Horne R, Davey M, Hope S, Anderson V, Trinder J . Increased sympathetic activity in children with obstructive sleep apnea: cardiovascular implications. Sleep Med. 2011; 12(5):483-8. DOI: 10.1016/j.sleep.2010.09.015. View

16.

OBrien L, Gozal D . Autonomic dysfunction in children with sleep-disordered breathing. Sleep. 2006; 28(6):747-52. DOI: 10.1093/sleep/28.6.747. View

17.

Baharav A, Kotagal S, Rubin B, Pratt J, Akselrod S . Autonomic cardiovascular control in children with obstructive sleep apnea. Clin Auton Res. 2000; 9(6):345-51. DOI: 10.1007/BF02318382. View

18.

Gozal D, Kheirandish-Gozal L . Childhood obesity and sleep: relatives, partners, or both?--a critical perspective on the evidence. Ann N Y Acad Sci. 2012; 1264:135-41. PMC: 3464366. DOI: 10.1111/j.1749-6632.2012.06723.x. View

19.

Spicuzza L, Bernardi L, Calciati A, Ugo Di Maria G . Autonomic modulation of heart rate during obstructive versus central apneas in patients with sleep-disordered breathing. Am J Respir Crit Care Med. 2002; 167(6):902-10. DOI: 10.1164/rccm.200201-006OC. View

20.

Kelly A, Dougherty S, Cucchiara A, Marcus C, Brooks L . Catecholamines, adiponectin, and insulin resistance as measured by HOMA in children with obstructive sleep apnea. Sleep. 2010; 33(9):1185-91. PMC: 2938859. DOI: 10.1093/sleep/33.9.1185. View