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Autonomic imbalance during apneic episodes in pediatric obstructive sleep apnea
Ottavio Vitelli1, Marco Del Pozzo1, Giorgio Baccari1
1Neuroscience, Mental Health and Sense Organs Department, Sleep Disorder Centre, Faculty of Medicine and Psychology, "La Sapienza" University, Rome, Italy.
Insights
Children with obstructive sleep apnea (OSA) show autonomic nervous system (ANS) imbalance. A new heart rate variability (HRV) index, R-apnea, can detect early ANS dysfunction in pediatric OSA.
Area of Science:
- Pediatric Sleep Medicine
- Cardiology
- Autonomic Nervous System Research
Background:
- Obstructive sleep apnea (OSA) is common in children and can affect cardiovascular health.
- Autonomic nervous system (ANS) imbalances are suspected in pediatric OSA.
- Heart rate variability (HRV) is a non-invasive measure of ANS activity.
Purpose of the Study:
- To investigate ANS activity during sleep in children with OSA using HRV.
- To identify potential cardiac ANS imbalances in pediatric OSA.
- To evaluate a novel HRV index (R-apnea index) for detecting ANS dysfunction.
Main Methods:
- Studied 43 children (4-12 years) undergoing OSA diagnostic assessment.
- Developed and applied the R-apnea index to assess HRV related to obstructive events.
- Calculated whole-night Poincaré plots of RR intervals.
Main Results:
- The R-apnea index negatively correlated with the apnea-hypopnea index (AHI).
- Severe OSA patients had significantly lower R-apnea index values compared to mild OSA/primary snoring.
- SD1 from Poincaré plots showed a trend of diminishing with OSA severity, but not statistically significant.
Conclusions:
- Findings suggest autonomic impairment in children with OSA, indicated by altered HRV.
- The R-apnea index is a simple and cost-effective method for early detection of ANS imbalance in pediatric OSA.
Objectives:
To investigate the activity of the autonomic nervous system (ANS) during sleep in children with obstructive sleep apnea (OSA), in order to detect a possible cardiac ANS imbalance analyzing heart rate variability (HRV).
Methods:
43 subjects between 4 and 12 years of age (7.26 ± 2.8 years), undergoing a diagnostic assessment for OSA were evaluated. A time domain index (R-apnea index) was developed to evaluate HRV strictly related to obstructive events during sleep. Poincaré plot of RR intervals during the whole night was calculated.
Results:
R-apnea index was negatively correlated with apnea hypopnea index (AHI) (r=-0.360, p=0.028). AHI and the duration of the disease were the only variables that were significantly correlated with R-apnea index. Three groups were subsequently created according to polysomnographic findings considering AHI. R-apnea index resulted significantly lower in patient with severe OSA compared to primary snoring/mild OSA subjects (p<0.05). Looking at Poincaré plot, SD1 showed a diminishing trend with severity of OSA, however not reaching statistical significance.
Conclusions:
Our findings suggest an autonomic impairment in OSA children evidenced by the altered HRV both in the very short term (R-apnea index) and in short term (SD1).
Significance:
R-apnea index is an easy and cheap method to undelay early ANS imbalance.
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