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Signs of sympathetic dominance in sleep and wake based on spectral analysis of heart rate variability in children with obstructive sleep apnea

A meta-analysis

Zeichen der Sympathikusdominanz beim Schlafen und Wachen auf der Basis einer Spektralanalyse der Herzfrequenzvariabilität bei Kindern mit obstruktiver Schlafapnoe

Eine Metaanalyse

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Abstract

Background

The low- to high-frequency components ratio (LF/HF) of heart rate variability reflects the balance between sympathetic and parasympathetic activity. The autonomic response in individuals with obstructive sleep apnea (OSA) may lead to sympathetic activation demonstrated by an increase in the LF/HF ratio. Studies examining autonomic function during sleep and wake in children with OSA are relatively scarce.

Aim

A meta-analysis of the relevant available publications.

Methods

A MEDLINE search from 2000 through 2013 at PubMed (NLM) was performed. A search for the index terms (“sleep disordered breathing” OR “obstructive sleep apnea”) AND “heart rate” in all fields was done. Studies that included comparisons between children with and without diagnosed OSA were included into the analysis. Types of “outcome measures” were the values of the LF/HF indices in different states of the sleep–wake cycle.

Results

Four studies met the inclusion criteria. A total of 518 control children and 272 children with different degrees of OSA whose mean age ranged between 4.2 and 9.8 years were reported in the studies. Large inconsistencies concerning the effect sizes across publications were found. Meta-regression revealed a statistically significant association between calculated values of the effect sizes and the reported mean values of the apnea–hypopnea indices in the OSA groups (intercept: − 0.11826, regression coefficient: 0.01667, p = 0.048).

Conclusion

Power analysis of heart rate variability in children with OSA may help to provide further information regarding neural control mechanisms that are altered in OSA. The LF/HF index may serve as an indicator of OSA severity and as a possible marker for risk stratification in children with OSA.

Zusammenfassung

Hintergrund

Das Verhältnis der Niedrig- zu den Hochfrequenzkomponenten („low frequency“/„high frequency“, LF/HF) der Herzfrequenzvariabilität spiegelt das Gleichgewicht zwischen Sympathikus- und Parasympathikusaktivität wider. Die autonome Reaktion bei Personen mit obstruktiver Schlafapnoe (OSA) kann zur Sympathikusaktivierung führen, was sich an einem Anstieg des LF-HF-Quotienten zeigt. Studien zur autonomen Funktion im Schlafen und Wachen bei Kindern mit OSA sind relativ selten.

Ziel

Ziel war eine Metaanalyse der relevanten verfügbaren Publikationen.

Methoden

Eine Suche in MEDLINE von 2000 bis einschließlich 2013 wurde mittels PubMed (NLM, National Library of Medicine) durchgeführt. Dabei erfolgte die Suche nach folgenden Indexbegriffen: „sleep disordered breathing“ OR „obstructive sleep apnea“ und in sämtlichen Feldern: AND „heart rate“. Studien mit Vergleichen zwischen Kindern mit und ohne Diagnose einer OSA wurden in die Auswertung aufgenommen. Als Endpunktparameter waren die Werte der LF-HF-Quotienten in verschiedenen Stadien des Schlaf-Wach-Zyklus maßgeblich.

Ergebnisse

Die Einschlusskriterien wurden von 4 Studien erfüllt. In den Studien wurde über 518 Kinder als Kontrollen und 272 Kinder mit verschiedenen Graden der OSA berichtet, das Alter lag zwischen 4,2 und 9,8 Jahren. Es wurde erhebliche Inkonsistenzen in Bezug auf die Effektstärken bei den Publikationen festgestellt. Die Metaregression ergab einen statistisch signifikanten Zusammenhang zwischen den berechneten Werten der Effektstärken und den dokumentierten Mittelwerten der Apnoe-Hypopnoe-Indizes in der OSA-Gruppe (Intercept: − 0,11826; Regressionskoeffizient: 0,01667; p = 0,048).

Schlussfolgerung

Die Power-Spektrum-Analyse der Herzfrequenzvariabilität bei Kindern mit OSA kann dazu beitragen, weitere Informationen zu neuralen Kontrollmechanismen zu liefern, die bei OSA verändert sind. Der LF-HF-Quotient dient möglicherweise als Indikator des Schweregrads der OSA und als möglicher Marker zur Risikostratifizierung bei Kindern mit OSA.

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Conflict of interest. I.A. Kelmanson states that there are no conflicts of interest. This manuscript does not include studies on humans or animals.

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  1. Institute of Special Education and Special Psychology, Raoul Wallenberg International University for Family and Child, St. Petersburg, Russia

    I.A. Kelmanson

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Kelmanson, I. Signs of sympathetic dominance in sleep and wake based on spectral analysis of heart rate variability in children with obstructive sleep apnea. Somnologie 18, 194–201 (2014). https://doi.org/10.1007/s11818-014-0672-y

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