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Published on: February 14, 2019
Cardiovascular Autonomic Control Is Altered in Children Born Preterm with Sleep Disordered Breathing
Blessy Thomas1, Kamsajini Thillainathan1, Maeve Delahunty1
1The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia.
Insights
Children born preterm exhibit altered autonomic control during sleep, even when matched for sleep disordered breathing severity. This suggests a lasting impact of prematurity on the developing nervous system.
Area of Science:
- Pediatric Sleep Medicine
- Autonomic Nervous System Function
- Cardiovascular Regulation
Background:
- Sleep disordered breathing (SDB) can affect heart rate (HR) and autonomic control.
- Assessing SDB's impact on HR and HR variability is crucial for understanding autonomic function.
- Preterm birth may influence the severity of SDB's effects on cardiovascular regulation.
Purpose of the Study:
- To compare the effects of SDB on heart rate (HR) and HR variability in preterm-born versus term-born children.
- To investigate if autonomic control differences are more pronounced in preterm children with SDB.
- To evaluate the impact of prematurity on cardiovascular regulation during sleep.
Main Methods:
- Recruited 50 preterm (<37 weeks) and 50 term-born children (3-12 years) with SDB.
- Matched children for age and SDB severity.
- Analyzed heart rate and HR variability using power spectral analysis during wake and sleep stages (N1, N2, N3, REM).
Main Results:
- No demographic, sleep, or respiratory differences were found between groups.
- Ex-preterm children showed significantly greater high-frequency power (parasympathetic activity) in N2 and N3 sleep stages.
- Total power was also greater in N3 sleep for ex-preterm children, particularly in moderate to severe SDB cases.
Conclusions:
- Preterm-born children, matched for SDB severity, demonstrated increased parasympathetic tone during non-rapid eye movement sleep.
- These findings suggest that prematurity may lead to altered autonomic regulation during sleep, independent of SDB severity.
- The study highlights potential long-term cardiovascular implications of preterm birth on autonomic nervous system development.
Background:
To assess if the effects of sleep disordered breathing (SDB) on heart rate (HR) and HR variability, as a measure of autonomic control, were more severe in a group of children born preterm compared with a group of children born at term referred to our sleep laboratory for assessment of SDB.
Study Design:
Children (3-12 years of age) referred for polysomnographic assessment of SDB were recruited; 50 born preterm (<37 weeks of gestation) and 50 at term, matched for age and SDB severity. The mean HR and HR variability using power spectral analysis were calculated for each child for wake and sleep, and stages N1, N2, N3, and rapid eye movement sleep.
Results:
Ex-preterm children were born between 23 and 35 weeks of gestational age (29.3 ± 3.6; mean ± SEM). There were no differences in the demographic, sleep, or respiratory characteristics between the groups. High-frequency power (reflecting parasympathetic activity) was greater in the ex-preterm children in both N2 and N3 (P < .05 for both) and total power was greater in N3 (P < .05). When the children were divided by SDB severity, these effects were most marked in those preterm born children with moderate to severe disease.
Conclusions:
Preterm born children matched for age and SDB severity with children born at term showed no differences in sleep characteristics; however, they did exhibit increased parasympathetic tone during non-rapid eye movement sleep.
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