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Updated: Jun 16, 2026
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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Autonomic function, gastroesophageal reflux in apparent life threatening event
Emanuel Tirosh1, Noga Ariov-Antebi, Ayala Cohen
1The Hannah Khoushy Child Development Center, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 47 Golomb St., Haifa 31048, Israel. tirosh-e@b-zion.org.il
Summary
Infants with apparent life-threatening events (ALTE) and GER show abnormal autonomic function, especially during combined apnea and GER episodes. This suggests potential issues with central nervous system autonomic regulation.
Area of Science:
- Pediatric cardiology
- Autonomic nervous system function
- Sleep medicine
Background:
- Idiopathic apparent life-threatening events (IALTE) are concerning episodes in infants.
- Gastroesophageal reflux (GER) is often associated with IALTE, but the interplay of autonomic function is not fully understood.
Purpose of the Study:
- To evaluate autonomic function in infants with IALTE, comparing those with and without GER.
- To differentiate autonomic activity during obstructive apnea versus apnea coupled with GER.
Main Methods:
- Seventeen infants with IALTE and GER and 17 with IALTE only (3-28 weeks) underwent polysomnography with esophageal pH monitoring.
- Heart rate variability (HRV) was analyzed using time-domain methods before, during, and after apneic events.
Main Results:
- Infants with IALTE and GER exhibited decreased baseline short-term HRV.
- HRV increased before obstructive apnea but not before apnea coupled with GER.
- Long-term HRV increased after obstructive apnea, but not after coupled apnea-GER events.
Conclusions:
- Infants with IALTE and GER demonstrate significant autonomic dysregulation, particularly during combined apnea-GER events.
- Findings suggest a potential link to medullary autonomic regulatory mechanisms.
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