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Improved long-term autonomic function following resolution of sleep-disordered breathing in preschool-aged children

Abstract

Purpose

Sleep-disordered breathing (SDB) prevalence peaks in preschool children and is associated with deficits in cardiovascular functioning during sleep. No long-term studies have investigated the effects of SDB resolution in mitigating these outcomes. We hypothesized that following 3 years, normalization of alterations to heart rate (HR), pulse transit time (PTT), heart rate variability (HRV), and urinary catecholamines identified at the initial diagnosis would be associated with resolution of SDB.

Methods

Forty-five children with SDB and 28 non-snoring controls underwent polysomnography at baseline (3–5 years) and follow-up (6–9 years). Children were classified into control, resolved, and unresolved SDB. Resolution was defined as an obstructive apnea–hypopnea index (OAHI) ≤1 event/h, no snoring on polysomnography (PSG), or indicated by parents. PTT is an inverse surrogate measure of blood pressure change. HRV was assessed using power spectral analysis.

Results

There was no change in PTT or HR between studies for any group. Our HRV data suggest reduced parasympathetic activity in children whose SDB resolved and increased parasympathetic activity in children whose SDB remained the same or worsened at follow-up. We identified a significant correlation between low frequency power and urinary dopamine and adrenaline levels at follow-up in the unresolved group, suggesting increased sympathetic activity in children with unresolved SDB.

Conclusion

Our findings suggest an association between resolution of SDB and normalization of HRV in the long term in these preschool children and an augmented sympathetic activity in the children with residual SDB. This highlights the autonomic impact of SDB in young children and the importance of detection and treatment.

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Acknowledgments

The authors would like to thank the children and families who participated in this study and the staff of the Melbourne Children’s Sleep Centre for their support.

Funding

This research was funded by the National Health and Medical Research Council of Australia project grant number APP1008919 and the Victorian Government’s Operational Infrastructure Support Program.

Author information

Correspondence to Lisa M. Walter.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Walter, L.M., Biggs, S.N., Nisbet, L.C. et al. Improved long-term autonomic function following resolution of sleep-disordered breathing in preschool-aged children. Sleep Breath 20, 309–319 (2016). https://doi.org/10.1007/s11325-015-1268-x

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Keywords

  • Obstructive sleep apnea
  • Autonomic nervous system
  • Pediatrics
  • Power spectral analysis