[Show abstract][Hide abstract] ABSTRACT: Sleep-disordered breathing (SDB) in adults has been associated with elevated blood pressure (BP); however, the effects of severity of SDB on BP in children are uncertain. We addressed this issue by measuring BP noninvasively and continuously during sleep in children with a range of severities of SDB and in a group of nonsnoring control children.
A total of 105 children referred for assessment of SDB and 36 nonsnoring controls were studied. Routine polysomnography (PSG) was performed with continuous BP monitoring. Children were assigned to groups according to obstructive apnea/hypopnea index (OAHI). BP data were categorized as quiet awake (recorded before sleep onset), non-rapid eye movement sleep 1 and 2 combined, slow-wave sleep, and rapid eye movement sleep.
BP during awake before sleep onset and during overnight sleep was elevated by 10 to 15 mm Hg in the 3 SDB groups compared with the control group; this finding was independent of SDB severity. BP during stable sleep (with respiratory events and movements excluded) was also elevated in the children with OSA compared with the control group. BP was elevated in rapid eye movement sleep compared with the non-rapid eye movement sleep, and heart rate was higher during wake state than in all sleep states.
We recorded BP continuously overnight and found that SDB, regardless of the severity, was associated with increased BP during sleep and wake compared with nonsnoring control children. These findings highlight the importance of considering the cardiovascular effects of SDB of any severity in children, and the need to review current clinical management that focuses primarily on more severe SDB.
[Show abstract][Hide abstract] ABSTRACT: The gold standard assessment for sleep quality is polysomnography (PSG). However, actigraphy has gained popularity as an ambulatory monitor. We aimed to assess the value of actigraphy in measuring sleep fragmentation in children.
130 children aged 2-18 years referred for assessment for sleep disordered breathing (SDB) were recruited. The arousal index (AI) scored from PSG was compared to the actigraphic fragmentation index (FI) and number of wake bouts/h.
The ability of actigraphic measures to correctly classify a child as having an AI>10 events/h rated as fair for the FI and poor for wake bouts/h (area under the receiver operator characteristic curve, 0.73 and 0.67, respectively).
Actigraphy provides only a fair indication of the level of arousal from sleep in children. While the limitations of actigraphy prevent it from being a diagnostic tool for SDB, it still has a role in evaluating sleep/wake schedules in children.
Archives of Disease in Childhood 10/2009; 95(12):1031-3. DOI:10.1136/adc.2009.166561 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obstructive apneas in adults are associated with acute changes in blood pressure (BP) and heart rate (HR) that may contribute to poor cardiovascular outcome. Children with sleep disordered breathing (SDB) are similarly at risk for cardiovascular complications. We aimed to test the hypothesis that BP and HR are augmented during obstructive events in children equivalent to levels reported in adults.
Beat-by-beat mean arterial pressure (MAP) and HR were analyzed over the course of obstructive events (pre, early, late, and post-event) during NREM and REM sleep and compared using 2-way ANOVA with post hoc analyses.
Pediatric sleep laboratory.
30 children (15M/15F) aged 7-12 y referred for investigation of SDB INTERVENTIONS: N/A.
All children underwent overnight polysomnography with continuous BP recording. MAP and HR increased significantly from late to post event in both sleep states (mean +/- SEM, NREM: MAP, 74 +/- 3 to 93 +/- 3 mm Hg; HR, 76 +/- 2 to 97 +/- 2 bpm. REM: MAP, 76 +/- 3 to 89 +/- 3 mm Hg; HR, 76 +/- 2 to 91 +/- 2 bpm. P < 0.05 for all). NREM sleep state and arousal from sleep were significant independent predictors of the magnitude of cardiovascular change from late to post event (P < 0.05 for all).
Children with SDB experience significant changes in HR and BP during obstructive events with magnitudes that are similar to levels reported in adults. These changes are more pronounced during NREM sleep and with arousal. These acute cardiovascular changes may have important implications for poor cardiovascular outcome in children with OSA as repetitive cardiovascular perturbations may contribute to the development of hypertension.
[Show abstract][Hide abstract] ABSTRACT: Brief central apnoeas (CAs) during sleep are common in children and are not usually considered clinically significant unless associated with oxygen desaturation. CAs can occur spontaneously or following a movement or sigh. The aim of this study was to investigate acute cardiovascular changes associated with CAs in children. Beat-by-beat mean arterial pressure (MAP) and heart rate (HR) were analysed across CAs, and spontaneous and movement-induced events were compared using two-way analysis of variance with post hoc analyses. Fifty-three children (28 male/25 female) aged 7-12 years referred for investigation of sleep-disordered breathing (SDB) and 21 age-matched healthy controls (8 male/13 female) were studied. Children underwent routine clinical polysomnography with continuous blood pressure (BP) recordings. Movement-induced, but not spontaneous, CAs were more frequent in children with mild or moderate/severe obstructive sleep apnoea (OSA) compared with healthy controls (P < 0.05 for both). Movement-induced CAs were associated with significantly larger MAP and HR changes across the event compared with spontaneous CAs. The percentage changes in MAP and HR between late-event and post-event were significantly greater for movement-induced compared with spontaneous CAs (MAP 20.6 +/- 2.3 versus 12.2 +/- 1.8%, P < 0.01; HR 28.2 +/- 2.6 versus 14.7 +/- 2.5%, P < 0.001). This study demonstrates that movement-induced CAs are more common in children with OSA, and are associated with significantly greater changes in HR and BP compared with spontaneous CAs. These data suggest that movement-induced CAs should be considered when assessing the cardiovascular impact of SDB.
Journal of Sleep Research 09/2009; 18(4):415-21. DOI:10.1111/j.1365-2869.2009.00766.x · 3.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Periodic leg movements in sleep (PLMS) are episodes of repetitive and stereotypic leg movements occurring during sleep. In adults, research indicates that PLMS affects sleep quality and duration and are associated with a shift to relatively greater sympathetic influence over cardiovascular variables. However, little research has been performed to investigate the effect of PLMS episodes on cardiac autonomic control in children. This study aimed to quantify the effect of PLMS episodes during NREM2 sleep on heart rate variability (HRV) measures of sympathovagal balance in children.
Overnight polysomnography data from 20 children (7-12 y) referred for assessment of sleep disordered breathing (SDB) were analyzed retrospectively. Ten children with episodes of PLMS were matched for age and SDB severity with a control group of 10 children without PLMS episodes.
The LF/HF ratio was significantly higher in the PLM+ compared with both the PLM- periods from PLMS subjects (P < 0.001) and the periods from the control group (P < 0.001). However, this effect could not be parsimoniously interpreted due to the likelihood that leg movements had a direct effect on the lower frequencies. Analysis of the ratio PLM+ to PLM+ plus PLM- indicated parasympathetic inhibition during periods of periodic leg movement and the onset of individual leg movements were associated with cardiac acceleration followed by a return to pre-movement levels.
This study identified vagal inhibition in association with episodes of PLMS in children. Rapid cardiac acceleration occurring concurrently with the onset of individual leg movements also suggested decreased vagal activity associated with the movements.