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Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea
Li-Ang Lee1,2,3,4,5, Hai-Hua Chuang2,3,4,6, Hui-Shan Hsieh1,7
1Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Adenotonsillectomy improves sleep quality and autonomic function in children with obstructive sleep apnea (OSA). Improvements in OSA severity were linked to reduced OSA-18 scores and very low frequency (VLF) power.
Area of Science:
- Pediatric Sleep Medicine
- Cardiorespiratory Physiology
- Autonomic Nervous System Function
Background:
- Obstructive sleep apnea (OSA) in children is linked to poor sleep quality and autonomic dysfunction.
- Adenotonsillectomy is a common treatment, but its impact on heart rate variability (HRV) in pediatric OSA requires further clarification.
- Understanding HRV changes post-surgery is crucial for assessing cardiac autonomic function recovery.
Purpose of the Study:
- To investigate associations between sleep HRV indices, OSA severity, and subjective sleep quality (OSA-18 score) in children.
- To evaluate the effects of adenotonsillectomy on HRV, OSA-18 scores, and polysomnographic parameters.
- To explore the mediating role of HRV and OSA-18 scores in treatment outcomes.
Main Methods:
- Retrospective case series including 76 children with OSA at baseline and 64 at 3-month follow-up post-adenotonsillectomy.
- Analysis of associations between tonsil size, adenoidal-nasopharyngeal ratio, obstructive apnea-hypopnea index (OAHI), and HRV indices (VLF, normalized LF power).
- Serial mediation analysis to assess the pathway from tonsil size reduction to OAHI improvement via OSA-18 and VLF power changes.
Main Results:
- Baseline analysis showed relationships between tonsil size and OAHI, and adenoidal-nasopharyngeal ratio and VLF power.
- Adenotonsillectomy significantly improved HRV indices (SDNN, HF power), quality of life (reduced OSA-18 score), OAHI, and reduced hypoxemia.
- Changes in OSA-18 score and VLF power serially mediated the relationship between tonsil size reduction and OAHI improvement.
Conclusions:
- Adenotonsillectomy effectively improves sleep quality and autonomic function in children with OSA.
- The reduction in obstructive apnea-hypopnea index (OAHI) post-surgery is serially mediated by improvements in subjective sleep quality (OSA-18) and very low frequency (VLF) power.
- Findings suggest VLF power as a potential target for future interventions in pediatric OSA management.
Background:
Obstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA.
Methods:
Seventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined.
Results:
Multivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI.
Conclusions:
The improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.
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