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Published on: December 6, 2016
Improving Obstructive Sleep Apnoea Mitigates Dampened Heart Rate Responses to Respiratory Events in Children With
Lisa M Walter1, Marisha Shetty1, Ahmad Bassam1
1Department of Paediatrics, Monash University, Melbourne, Australia.
Insights
Children with Down syndrome (DS) show a worsening heart rate (HR) response to respiratory events if obstructive sleep apnea (OSA) is not treated. Improving OSA severity in DS children maintained their HR response over time.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Genetics
Background:
- Children with Down syndrome (DS) exhibit a blunted heart rate (HR) recovery following obstructive respiratory events.
- The impact of obstructive sleep apnea (OSA) severity changes on the HR response to both obstructive and central events in DS is not well understood.
Purpose of the Study:
- To investigate whether improvements in OSA severity affect the HR response to obstructive and central respiratory events in children with DS.
- To determine if the dampened HR response in DS children with OSA worsens over time if OSA is untreated.
Main Methods:
- A cohort of 24 children (3-19 years) with DS underwent sleep studies at baseline and 2-year follow-up.
- Children were categorized into 'improved' (≥50% decrease in apnea-hypopnea index) and 'unimproved' OSA groups.
- Beat-to-beat HR changes were analyzed during and after obstructive and central events.
Main Results:
- In the unimproved OSA group, the post-event HR recovery was significantly smaller at follow-up for both obstructive and central events compared to baseline.
- The improved OSA group maintained their HR response to events between baseline and follow-up.
- A significant worsening of HR response was observed in DS children with persistent moderate-to-severe OSA.
Conclusions:
- Untreated or poorly managed OSA in children with Down syndrome leads to a progressive decline in heart rate regulation during sleep.
- Early diagnosis and effective management of OSA are crucial for mitigating cardiovascular risks associated with Down syndrome.
- Maintaining improved OSA severity is associated with preserved cardiac autonomic function in children with DS.
Abstract:
Children with Down syndrome (DS) have a dampened heart rate (HR) response at obstructive respiratory event termination compared with typically developing children. Whether improving obstructive sleep apnoea (OSA) severity improves the HR response to both obstructive and central events remains unknown. Twenty-four children (3-19 years at baseline) were included. Children were grouped into improved (decrease in obstructive apnoea-hypopnoea index to ≤ 50% of baseline; n = 12; seven treated between studies) and unimproved (n = 12; two treated between studies) 2 years following baseline study. Beat-to-beat HR was averaged 10 s before (pre), during, and the peak after (post) each obstructive and central event during sleep, expressed as percentage change. A total of 1018 obstructive respiratory events were analysed during total sleep; 583 events were analysed at baseline and 435 at follow-up. A total of 330 central events were analysed during total sleep; 164 central events were at baseline and 166 were at follow-up. In the unimproved group, the % change in HR from during the event to post-event was smaller at follow-up for both obstructive (mean 16.8%, 95% CI [17.4%, 20.6%] vs. 22.3% [21.1%, 26.0%] and central events: 15.8% [13.6%, 17.9%] vs. 26.1% [22.4%, 29.9%]; p < 0.05 for both). % change remained unchanged between studies in the improved group. These results suggest that the dampened HR response to respiratory events seen in children with DS worsens over time when OSA does not improve, adding weight to the need for diagnosis and management of OSA in this population.
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