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Autonomic nervous system function in severe breath-holding spells

F J DiMario1, J A Burleson

  • 1Department of Pediatrics, University of Connecticut, Farmington.

Pediatric Neurology
|July 1, 1993
PubMed
Summary

Children with cyanotic breath-holding spells (BHS) show autonomic nervous system dysregulation. This study found abnormal reflex functions, suggesting a link to the pathophysiology of severe BHS.

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Area of Science:

  • Pediatric Neurology
  • Autonomic Neuroscience
  • Cardiology

Background:

  • Severe cyanotic breath-holding spells (BHS) are common in children.
  • The underlying pathophysiology of BHS, particularly autonomic nervous system (ANS) involvement, remains incompletely understood.

Purpose of the Study:

  • To noninvasively assess for dysregulation of autonomic nervous system reflexes in children with severe cyanotic BHS.
  • To investigate the potential role of ANS dysfunction in the development of cyanotic BHS.

Main Methods:

  • Cross-sectional study in a neurophysiology laboratory.
  • Involved 14 children with severe cyanotic BHS and 12 healthy controls (≥18 months).
  • Assessed noninvasive parasympathetic and sympathetic reflex functions, including heart rate response to standing and 30:15 R-R interval ratios.

Main Results:

  • Children with cyanotic BHS exhibited a significantly greater increase in pulse rate upon standing (P < .06).
  • Adjusted analysis revealed a greater decrease in diastolic blood pressure in BHS patients (P < .02).
  • Abnormal 30:15 R-R interval ratios were significantly observed in the BHS group compared to controls (P < .002).

Conclusions:

  • Results support the hypothesis of underlying autonomic nervous system dysregulation in children with cyanotic BHS.
  • ANS dysregulation may be a contributing factor to the pathophysiology of severe cyanotic breath-holding spells.

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