Related Experiment Video
Updated: Jun 29, 2025
Calculating Heart Rate Variability from ECG Data from Youth with Cerebral Palsy During Active Video Game Sessions
Published on: June 5, 2019
Case-control study of heart rate variability and sleep apnea in childhood sickle cell disease
Plamen Bokov1, Bérengère Koehl2,3, Benjamin Dudoignon1
1AP-HP, Robert Debré Hospital, Department of Physiology, INSERM NeuroDiderot, Paris University, Paris, France.
Insights
Children with sickle cell disease (SCD) and obstructive sleep apnea (OSA) show unique heart rate variability (HRV) and pharyngeal compliance patterns. Decreased sympathetic modulation appears protective in SCD, unlike in healthy children.
Area of Science:
- Pediatric Pulmonology
- Cardiology
- Genetics
Background:
- Obstructive sleep apnea (OSA) is prevalent in sickle cell disease (SCD), often without typical risk factors like obesity.
- Previous research indicated increased pharyngeal compliance correlates with decreased sympathetic modulation in healthy children with OSA.
- The specific pathophysiology of OSA in SCD requires further investigation, particularly concerning autonomic nervous system function and airway mechanics.
Purpose of the Study:
- To investigate the association between heart rate variability (HRV) and pharyngeal compliance in children with SCD and OSA.
- To compare these associations between children with SCD and healthy controls.
Main Methods:
- A case-control study matched 21 children with SCD and 21 healthy controls (aged 4-18 years) for sex, age, and obstructive apnea-hypopnoea index (OAHI).
- Polysomnography and acoustic pharyngometry were used to assess sleep apnea, pharyngeal compliance, and HRV from ECG recordings during different sleep states and whole night.
- Statistical analyses explored relationships between compliance and HRV parameters, specifically SD2, a marker of sympathetic modulation.
Main Results:
- Children with SCD had lower BMI z-scores and more tonsil hypertrophy than controls.
- Children with SCD and OSA exhibited lower pharyngeal compliance compared to those without OSA.
- An inverse relationship between pharyngeal compliance and SD2 (sympathetic modulation) was observed in SCD (R = -0.63, p = 0.002), contrasting with a positive relationship in controls (R = 0.59, p = 0.006).
Conclusions:
- Pharyngeal compliance and HRV show distinct associations in children with SCD compared to healthy children.
- Decreased sympathetic modulation may be protective against OSA in SCD, suggesting a unique pathophysiology possibly linked to smooth muscle dysfunction.
- These findings highlight the need for tailored approaches to managing OSA in pediatric SCD patients.
Abstract:
Obstructive sleep apnea (OSA) is common in sickle cell disease (SCD) despite the absence of overweight, suggesting a specific pathophysiology. We previously showed that otherwise healthy children with increased pharyngeal compliance, a main endotype of OSA, exhibited decreased sympathetic modulation. Our objective was to assess whether modifications of heart rate variability (HRV) and compliance are associated in SCD. Cases (children with SCD, African or Caribbean ethnicity) and controls (otherwise healthy children, same ethnicity), aged 4-18 years, were selected from our database of children referred for OSA and matched for sex, age, and obstructive apnea-hypopnoea index (OAHI) score. The children underwent polysomnography and acoustic pharyngometry (to compute compliance). HRV analyses were performed from 5 min ECG recordings in wakeful, NREM, and REM sleep states and from the whole night. Twenty-one pairs were analysed (median age 10.5 years, 24 girls). Children with SCD had lower BMI z-scores and more tonsil hypertrophy than control children. Children with SCD and OSA (OAHI ≥2/hour) were characterised by lower compliance than children with SCD without OSA. An inverse relationship between compliance and SD2 (HRV from whole night, inversely related to sympathetic modulation) was evidenced (negative relationship in SCD: R = -0.63, p = 0.002 vs. positive relationship in controls R = 0.59, p = 0.006). In conclusion, while the decrease in sympathetic modulation in control children may contribute to increasing pharyngeal compliance, its decrease seems protective in children with sickle cell disease, which underlines the specificity of OSAS pathophysiology in SCD that could be due to sickle cell disease related smooth muscle dystonia.
Related Concept Videos
01:21Sleep Apnea
The condition is more prevalent among...
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:25Hyperpnea and Hyperventilation
01:24Substance Use Disorders Affecting Sleep
Understanding the concepts of physical dependence,...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation: