Related Experiment Videos
Severe hypoxemia in children with upper airway obstruction during sleep does not lead to significant changes in heart
L A D'Andrea1, C L Rosen, G G Haddad
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520.
Insights
Pediatric obstructive sleep apnea syndrome (OSAS) can cause severe hypoxemia, but life-threatening cardiac arrhythmias are rare in children. R-R interval changes during desaturation were modest, unlike in adults.
Area of Science:
- Pediatric cardiology
- Sleep medicine
- Cardiorespiratory physiology
Background:
- Obstructive sleep apnea syndrome (OSAS) in adults is linked to severe cardiac arrhythmias.
- Pediatric OSAS presents differently than in adults, raising questions about arrhythmia prevalence.
Purpose of the Study:
- To investigate the occurrence of cardiac arrhythmias in pediatric OSAS.
- To analyze R-R interval patterns during hypoxemic events in children with OSAS.
Main Methods:
- Analysis of R-R interval patterns in 12 pediatric OSAS patients (8 months–14 years).
- Identification of severe hypoxemia episodes (SaO2 ≤ 85% for ≥ 30 seconds).
- Comparison of R-R intervals before and during desaturation events.
Main Results:
- 209 severe hypoxemia episodes identified; only 14% linked to obstructive apneas.
- R-R intervals showed statistically significant but modest changes during desaturation.
- No life-threatening arrhythmias or profound bradycardia observed in pediatric patients.
Conclusions:
- Cardiac arrhythmias are not a common feature of pediatric OSAS, despite hypoxemia.
- The R-R interval response to desaturation in children is less pronounced than in adults.
- Pediatric OSAS requires distinct clinical evaluation for cardiac sequelae compared to adults.
Abstract:
Life-threatening cardiac arrhythmias, including bradyarrhythmias, are well-known sequelae of obstructive sleep apnea syndrome (OSAS) in adults and are associated with apnea and severe hypoxemia. Since the clinical expression of OSAS in children is different, we questioned whether arrhythmias are a common feature of pediatric OSAS. Therefore, we analyzed R-R interval patterns from 12 subjects (age 8 months to 14 years) with OSAS in detail. The diagnosis of pediatric OSAS is based on clinical signs of loud snoring and paradoxical respiratory efforts, as well as elevated end-tidal carbon dioxide tension (PETCO2) and major phasic decreases of oxyhemoglobin saturation (SaO2). Two hundred and nine episodes of severe hypoxemia, defined as SaO2 values < or = 85% lasting > or = 30 seconds, were identified. Only 29 (14%) of these episodes were associated with obstructive apneas. The R-R intervals were analyzed before and during each desaturation. Compared to baseline, mean and minimum R-R intervals (RRmean, RRmin) decreased during the desaturation episodes (P < 0.05), while maximum R-R interval (RRmax) increased (P < 0.05). Although the absolute changes in all parameters were significantly different from baseline, the magnitude of these changes was small, with a mean of -5.3%, -12.2%, and 10.4% for RRmean, RRmin, and RRmax, respectively. No child had life-threatening arrhythmias. Although severe hypoxemia existed in these children, the magnitude of the R-R interval changes was modest, and profound bradycardia as described in adults, was rare.(ABSTRACT TRUNCATED AT 250 WORDS)