Related Experiment Video
Updated: Jun 6, 2026
Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children
Published on: April 29, 2013
Autonomic cardiovascular tests in children with obstructive sleep apnea syndrome
Marilisa Montesano1, Silvia Miano, Maria Chiara Paolino
1Pediatric Department, "La Sapienza" University, II Faculty, Medicine, Rome, Italy.
Insights
Children with obstructive sleep apnea (OSA) show increased sympathetic activity and impaired cardiovascular responses during wakefulness. These autonomic dysfunctions correlate with OSA severity, impacting overall cardiovascular health.
Area of Science:
- Pediatric cardiology
- Autonomic nervous system function
- Sleep medicine
Background:
- Obstructive sleep apnea (OSAS) is increasingly recognized in children.
- Autonomic nervous system (ANS) dysfunction is a potential complication of OSAS.
- Understanding cardiovascular autonomic activity in children with OSAS is crucial for risk assessment.
Purpose of the Study:
- To investigate cardiovascular autonomic activity during wakefulness in children diagnosed with OSAS.
- To assess autonomic function using standardized cardiovascular tests.
- To correlate autonomic parameters with the severity of OSAS.
Main Methods:
- Prospective study involving 25 children with OSAS and 25 age-matched healthy controls.
- Overnight polysomnography to diagnose OSAS.
- Autonomic cardiovascular tests (Ewing test battery: head-up tilt, Valsalva maneuver, deep breathing test).
Main Results:
- Children with OSAS exhibited higher blood pressure, resting heart rate, and altered responses during tilt and deep breathing tests compared to controls.
- A significant inverse correlation was found between the apnea-hypopnea index (AHI) and cardiovascular autonomic function tests (30:15 index, Valsalva ratio).
- Increased AHI correlated positively with blood pressure changes during autonomic testing.
Conclusions:
- Children with OSAS demonstrate heightened basal sympathetic activity during wakefulness.
- Impaired cardiovascular autonomic responses are evident and linked to OSAS severity.
- Findings suggest a significant impact of OSAS on the pediatric autonomic cardiovascular system.
Study Objectives:
The aim of our study was to investigate cardiovascular autonomic activity during wakefulness, using cardiovascular tests, in a population of children with OSAS.
Design:
Prospective study.
Setting:
Sleep unit of an academic center.
Participants:
We included 25 children (mean age 10.2 +/- 2.3 years) undergoing a diagnostic assessment for OSAS, and 25 age-matched healthy control subjects. All subjects underwent an overnight polysomnography and autonomic cardiovascular tests using parts of the Ewing test battery, which is a physiological test used for the assessment of autonomic function (head-up tilt test, Valsalva maneuver, deep breathing test).
Measurements And Results:
Eighteen of 25 children with OSAS (11 males, mean age 9.4 +/- 1.7 years) concluded the study. OSAS patients had higher systolic blood pressure, diastolic blood pressure, baseline heart rate, the 30:15 index (which represents the RR interval at the 15th and 30th beats during the head up tilt test), and delta diastolic and systolic blood pressure during the head-up tilt test, while the heart rate variability during the deep breathing test was lower, compared with controls. A positive correlation between systolic and diastolic blood pressure and the apnea-hypopnea index (AHI), and negative between AHI and both the 30:15 index and Valsalva ratio, were found. Stepwise linear regression analysis detected a negative correlation between AHI and the 30:15 index and Valsalva ratio, a positive correlation between overnight mean oxygen saturation and delta heart rate, and between AHI and delta systolic blood pressure.
Conclusions:
Our data point to an increase in basal sympathetic activity during wakefulness and to an impaired reaction to several physiological stimuli, which is dependent on the severity of OSAS.
Related Concept Videos
01:21Sleep Apnea
The condition is more prevalent among...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:27Physical Assessment of the Respiratory Tract II: Inspection
Chest Configuration
The chest configuration can...
01:23Assessment of blood pressure in brachial artery(two-step method)