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Autonomic Function and QT Interval During Night-Time Sleep in Infant Long QT Syndrome

Masao Yoshinaga1, Yu Kucho1, Hiroya Ushinohama2

  • 1Department of Pediatrics, National Hospital Organization Kagoshima Medical Center.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 29, 2018
PubMed

Insights

Infants with long QT syndrome (LQTS) show reduced parasympathetic activity and prolonged corrected QT intervals (QTc) during night sleep. This autonomic imbalance in early infancy may increase arrhythmia risk.

Area of Science:

  • Pediatric Cardiology
  • Autonomic Nervous System Research
  • Sudden Infant Death Syndrome (SIDS) Studies

Background:

  • Sudden infant death syndrome (SIDS) often occurs during sleep, with long QT syndrome (LQTS) implicated in ~10% of cases.
  • Autonomic function and QT interval dynamics in LQTS infants during sleep remain poorly understood.
  • Controversy exists regarding autonomic nervous system (ANS) function in LQTS infants during early infancy sleep.

Purpose of the Study:

  • To investigate autonomic function and QT interval variations during night-time sleep in infants with LQTS.
  • To compare ANS parameters and QTc intervals in LQTS infants versus controls.
  • To assess changes in autonomic function and QTc from early to late infancy in LQTS patients.

Main Methods:

  • Holter electrocardiography in 11 LQTS infants (pre-medication) and 11 age-matched controls.
  • Power spectral density analysis to assess parasympathetic activity and sympathovagal balance.
  • Manual measurement of QT/RR intervals during night sleep, daytime sleep, and daytime activity.

Main Results:

  • LQTS infants exhibited significantly lower parasympathetic activity and higher sympathovagal balance during night sleep compared to controls.
  • Autonomic function in LQTS infants was significantly depressed in early infancy versus late infancy.
  • Corrected QT intervals (QTc) were significantly longer in LQTS infants during night sleep (490±20 ms) compared to daytime sleep or activity, and longer than controls during night sleep.

Conclusions:

  • A combination of prolonged QTc and autonomic imbalance during early infancy night sleep may precipitate life-threatening arrhythmias in LQTS infants.
  • These findings highlight the critical role of sleep-time autonomic regulation in LQTS.
  • Future research should prioritize the inclusion of critical LQTS cases to further elucidate these risks.
Abstract

Keywords:
Autonomic functionQT intervalSleepSudden infant death

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