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Published on: April 29, 2013
Heart rate surge at respiratory event termination in preterm and term born children with sleep disordered breathing
Lisa M Walter1, Jing Y Ooi1, Elizabeth A Kleeman1
1Department of Paediatrics, Monash University, Melbourne, Australia.
Insights
Children born preterm exhibit heightened heart rate (HR) surges after respiratory events during sleep. This altered autonomic control, linked to sleep disordered breathing (SDB), may increase cardiovascular risks in these children.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Autonomic Nervous System Function
Background:
- Sleep disordered breathing (SDB) is linked to abnormal heart rate (HR) control, characterized by repetitive HR surges.
- Children born preterm face increased risks for adverse cardiovascular outcomes.
- Understanding the HR response to obstructive respiratory events in preterm-born children is crucial.
Purpose of the Study:
- To investigate if preterm-born children show an elevated HR response to obstructive respiratory events compared to term-born children.
- To assess the impact of preterm birth on autonomic HR control during SDB.
Main Methods:
- Fifty preterm-born children (3-12 years) were matched with term-born children based on SDB severity, age, and gender.
- Multilevel modeling analyzed HR changes from baseline to post-respiratory events during NREM and REM sleep.
- HR responses were compared between preterm and term groups, considering associated arousals.
Main Results:
- During NREM sleep, preterm children had fewer events terminating in arousal (68%) compared to term children (84%).
- Preterm children exhibited lower HR throughout NREM sleep events, regardless of arousal.
- % change in HR from baseline to post-event was significantly higher in preterm children during NREM sleep events associated with arousal.
Conclusions:
- Preterm-born children demonstrate a greater magnitude of HR surges following respiratory events that terminate with arousal.
- While small, these repeated HR surges throughout the night may contribute to adverse cardiovascular outcomes in preterm infants.
- Further research is needed to confirm the long-term cardiovascular implications.
Background:
Repetitive surges in heart rate (HR) at respiratory event termination underpin the altered autonomic HR control associated with sleep disordered breathing (SDB). As children born preterm are at greater risk of adverse cardiovascular outcomes, we aimed to determine whether the HR response to obstructive respiratory events was elevated compared to term-born children.
Methods:
Fifty children (3-12 years) born preterm, were matched for SDB severity, age and gender with term born children. Multilevel modelling determined the effect of preterm birth and arousal on HR changes between a 10s baseline to the latter half of respiratory events and 15s post event during NREM and REM.
Results:
1203 events were analysed (NREM: term 380; preterm 383; REM: term 207; preterm 233). During NREM fewer events terminated in arousal in the preterm compared with term group (preterm 68%; term 84%; χ2 = 27.2, p < 0.001). There were no differences in REM. During NREM, HR was lower in the preterm group at all event phases, with and without associated arousals (P < 0.01 for all). % change in HR from baseline to post event was higher in the preterm compared with term group (preterm: median 23% IQR (12%,34%); term: 18% (10%,29%); p < 0.01) and late event to post event (preterm: 30% (21%, 32%); term 28% (20%,39%); p < 0.01) in events associated with arousals.
Conclusion:
The greater magnitude of surges in HR following respiratory events terminating with arousal in preterm born children, although small, occur repeatedly throughout the night and may contribute to adverse cardiovascular outcomes, although further studies are required.
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