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Sleep-disordered breathing in children with cardiomyopathy

Suhail Al-Saleh¹, Paul F Kantor, Neil K Chadha

¹1 Division of Respiratory Medicine and.

Annals of the American Thoracic Society

|April 15, 2014

Insights

Sleep-disordered breathing is common in children with cardiomyopathy, with nearly half experiencing it. Central sleep apnea severity correlates with cardiac dysfunction in these pediatric patients.

Area of Science:

Pediatric Cardiology
Sleep Medicine
Cardiovascular Research

Background:

Cardiomyopathy in children is a rare condition with high mortality.
Sleep-disordered breathing (SDB) is common, but its prevalence in pediatric cardiomyopathy is unknown.

Purpose of the Study:

To determine the frequency and patterns of SDB in children with primary cardiomyopathy.
To investigate the relationship between SDB and cardiac function in this population.

Main Methods:

Prospective, uncontrolled case series involving 21 children with cardiomyopathy.
Utilized polysomnography, sleep questionnaires, blood pressure monitoring, otolaryngological assessment, and echocardiography.

Main Results:

48% of patients had SDB; 24% had central sleep apnea (CSA).
Left ventricular volumes were larger in children with CSA.
CSA severity correlated with left ventricular end-diastolic and end-systolic volumes.

Conclusions:

SDB is prevalent in pediatric cardiomyopathy, with CSA being a significant finding.
Cardiac dysfunction severity is associated with CSA in these children.
Further longitudinal studies are needed to understand sleep disorders' impact on pediatric cardiomyopathy.

Read full analysis

Abstract

Rationale:

Cardiomyopathy is a rare condition in children that is associated with high mortality. Although sleep-disordered breathing is prevalent, its frequency and patterns in children with cardiomyopathy are unknown.

Objectives:

To evaluate the frequency and patterns of sleep-disordered breathing and their relationship to cardiac function in children with primary cardiomyopathy.

Methods:

This study comprised a prospective, uncontrolled case series. Children with cardiomyopathy completed a sleep questionnaire, overnight polysomnography, blood pressure monitoring, otolaryngological assessment, and transthoracic echocardiography at the Hospital for Sick Children in Toronto, Canada.

Measurements And Main Results:

Twenty-one patients (17 males) were recruited. The median age of the patients was 10.7 years, and the median body mass index z score was 0.8. Sleep-disordered breathing was observed in 10 (48%) of 21 patients. Significant central sleep apnea was the main finding in 5 (24%) of 21 of the cohort and in 50% of the sleep-disordered breathing population. The left ventricular end diastolic volume index was greater in children with central sleep apnea than in children without sleep-disordered breathing (P = 0.03). There were significant correlations between the central apnea-hypopnea index and both left ventricular end diastolic and end systolic volume indexes (Spearman's r = 0.55, P = 0.01; Spearman's r = 0.47, P = 0.03, respectively). Snoring, sleep architecture, blood pressure, and otolaryngological findings were not significantly different between children with sleep-disordered breathing versus those without sleep-disordered breathing.

Conclusions:

Sleep-disordered breathing is common in children with cardiomyopathy. In our present study, 24% of participants exhibited primarily central sleep apnea. The severity of cardiac dysfunction, as measured by left ventricular end diastolic volume index and left ventricular end systolic volume index, is associated with central sleep apnea. Longitudinal research is necessary to better characterize sleep disorders and their impact on cardiac function in a large pediatric cardiomyopathy population.

Keywords:

cardiomyopathies central obstructive pediatrics polysomnography sleep apnea

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