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Autonomic dysfunction in children with sleep disordered breathing

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Abstract

Purpose

Sleep disordered breathing (SDB) has adverse effects on cardiovascular health in adults, partly due to changes in autonomic activity. However, there have been limited studies in children. We analysed the impact of SDB and sleep stage on autonomic control of heart rate in 7–12-year-old children, utilizing spectral heart rate variability (HRV) as a measure of autonomic activity.

Methods

Eighty children underwent overnight polysomnography. Subjects were grouped according to their obstructive apnoea–hypopnoea index (OAHI): controls, OAHI ≤1 event/h and no history of snoring; primary snorers (PS) OAHI ≤1, Mild (OAHI 1–5) and moderate/severe (MS) OAHI >5. HRV was analysed during Wake, nonrapid eye movement (NREM) 1&2, slow wave sleep (SWS) and REM.

Results

Compared with controls, total power, low (LF) and high frequency (HF) power were reduced in all SDB severities during REM. LF/HF ratio was less in MS SDB (median = 0.34; range, 0.20–0.49; p < 0.05) versus controls (0.38; 0.26–0.55; p < 0.05) and PS (0.39; 0.23–0.57; p < 0.05) during SWS. In all groups, total power, LF and HF power were highest during NREM 1&2 while LF/HF ratio was lowest during SWS. Blood pressure was elevated in SDB in all sleep states.

Conclusions

HRV was altered in 7–12-year-old children with SDB, which may signify an overall depression of autonomic tone, perhaps a consequence of their elevated blood pressure during sleep coupled with repeated exposure to SDB event-related cardiovascular disturbance. Further research is warranted to elucidate the long-term effects on the cardiovascular system of subjects exhibiting impaired HRV and elevated BP in childhood.

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Acknowledgments

The authors would like to thank the staff of the Melbourne Children's Sleep Centre for their help and advice and the parents and children who participated in this study.

Funding

Funding for this project was awarded by the National Health and Medical Research Council of Australia [Project Grant Number 384142] and supported by the Victorian Government's Operational Infrastructure Support Program.

Conflict of interests

None of the authors of this manuscript declare any conflict of interest.

Author information

Authors and Affiliations

  1. The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia

    Lisa M. Walter, Gillian M. Nixon, Margot J. Davey, Adrian M. Walker & Rosemary S. C. Horne

  2. Melbourne Children’s Sleep Centre, Monash Children’s, Monash Medical Centre, Melbourne, Australia

    Gillian M. Nixon & Margot J. Davey

  3. Critical Care and Neuroscience Research, Murdoch Children’s Research Institute, Melbourne, Australia

    Vicki Anderson

  4. Psychological Sciences, University of Melbourne, Melbourne, Australia

    Vicki Anderson

  5. The Ritchie Centre, Monash Institute of Medical Research, PO Box 5418, Clayton, Victoria, Australia, 3168

    Lisa M. Walter

Authors
  1. Lisa M. Walter
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  2. Gillian M. Nixon
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  4. Vicki Anderson
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  6. Rosemary S. C. Horne
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Correspondence to Lisa M. Walter.

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Walter, L.M., Nixon, G.M., Davey, M.J. et al. Autonomic dysfunction in children with sleep disordered breathing. Sleep Breath 17, 605–613 (2013). https://doi.org/10.1007/s11325-012-0727-x

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  • DOI: https://doi.org/10.1007/s11325-012-0727-x

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