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Heart rate variability in children with obstructive sleep apnea
G Aljadeff1, D Gozal, V L Schechtman
1Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, University of Southern California School of Medicine, USA.
Insights
Obstructive sleep apnea syndrome (OSAS) in children alters heart rate variability. These characteristic changes, particularly at slow heart rates, may aid in screening young patients for OSAS.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Autonomic Nervous System Function
Background:
- Obstructive sleep apnea syndrome (OSAS) is associated with significant heart rate changes in adults.
- Emerging evidence suggests similar heart rate alterations in children with OSAS.
- These cardiac changes may offer a non-invasive method for OSAS screening in pediatric populations.
Purpose of the Study:
- To investigate beat-to-beat cardiac variability in children diagnosed with OSAS.
- To determine if heart rate variability patterns differ between children with OSAS and healthy controls.
- To assess the potential of heart rate variability for screening pediatric OSAS.
Main Methods:
- Six-hour polysomnographic recordings were analyzed in seven children with OSAS and seven age-matched controls.
- Poincaré plots were utilized to evaluate beat-to-beat cardiac variability across different heart rate ranges.
- Statistical comparisons were made between the OSAS group and the control group.
Main Results:
- Children with OSAS exhibited significantly increased beat-to-beat variation at slow heart rates compared to controls.
- Conversely, beat-to-beat variation at fast and intermediate heart rates was significantly reduced in children with OSAS.
- These alterations in cardiac variability were observed across all heart rates but were most pronounced at slower rates.
Conclusions:
- Pediatric OSAS demonstrably alters beat-to-beat cardiac variability in a distinct manner.
- The observed heart rate variability patterns, especially at slow rates, show promise for assisting in the screening of suspected pediatric OSAS cases.
- Heart rate variability analysis presents a potential tool for early identification of OSAS in children.
Abstract:
Adults with obstructive sleep apnea syndrome (OSAS) display substantial heart rate changes associated with obstructive events, and recent reports suggest similar heart rate changes in children with OSAS. These rate changes could assist screening of young patients for OSAS. Six-hour polysomnographic recordings were obtained from seven children with OSAS (mean age: 4.5 years; apnea index: 19.5 +/- 5.1) and from seven primary snorers without OSAS who served as controls (mean age: 4.7; apnea index: 0). Scatterplots of each cardiac R-R interval against the preceding interval (Poincaré plots) were used to assess beat-to-beat cardiac variability at different heart rates. Beat-to-beat variation at slow rates was significantly increased in children with OSAS relative to controls, while variation at fast and intermediate heart rates was significantly reduced in these children. We conclude that OSAS alters beat-to-beat variation in characteristic fashions in children, that the variability changes occur at all heart rates but are most significant at slow heart rates, and that these heart rate patterns could assist in screening of suspected cases of OSAS.