Heart failure is not a determinant of central sleep apnea in the pediatric population

Abstract

Background/Objectives Adults with heart failure (HF) have high prevalence of central sleep apnea (CSA). While this has been repeatedly investigated in adults, there is a deficiency of similar research in pediatric populations. The goal of this study was to compare prevalence of CSA in children with and without HF and correlate central apneic events with heart function. Methods Retrospective analysis of data from children with and without HF was conducted. Eligible children were less than 18 years old with echocardiogram and polysomnogram within 6 months of each other. Children were separated into groups with and without HF based on left ventricular ejection fraction (LVEF). Defining CSA as central apnea‐hypopnea index (CAHI) more than 1/hour, the cohort was also classified into children with and without CSA for comparative study. Results A total of 120 children (+HF: 19, −HF: 101) were included. The +HF group was younger, with higher prevalence of trisomy 21, muscular dystrophy, oromotor incoordination, and structural heart disease. The +HF group had lower apnea‐hypopnea index (median: 3/hour vs. 8.6/hour) and lower central apnea index (CAI) (median: 0.2/hour vs. 0.55/hour). Prevalence of CSA was similar in both groups (p = .195). LogCAHI was inversely correlated to age (Pearson correlation coefficient: −0.245, p = .022). Children with CSA were younger and had higher prevalence of prematurity (40% vs. 5.3%). There was no significant difference in LVEF between children with and without CSA. After excluding children with prematurity, relationship between CAHI and age was no longer sustained. Conclusions In contrast to adults, there is no difference in prevalence of CSA in children with and without HF. Unlike in adults, LVEF does not correlate with CAI in children. Overall, it appears that central apneic events may be more a function of age and prematurity rather than of heart function.

Pediatric pulmonary year in review 2021: Sleep medicine

“…These findings showed that contrary to adults where heart failure contributes to central apnea, pediatric patients who have additional underlying conditions such as prematurity or underlying neurologic disorders are at increased risk for central sleep apnea. [37][38][39] Naime et al 40 42 Given the heterogeneous nature of their cohort, more extensive studies are needed to identify which subgroups would benefit most from PSG to assess specific ventilatory needs.…”

“…Children with CSA were younger ( p = 0.002) and had higher prevalence of prematurity ( p < 0.001. These findings showed that contrary to adults where heart failure contributes to central apnea, pediatric patients who have additional underlying conditions such as prematurity or underlying neurologic disorders are at increased risk for central sleep apnea 37–39 . Naime et al 40 helped further explore the occurrence of central sleep apnea syndrome in children with Down Syndrome.…”

“…35,36 While obstructive sleep apnea is commonly seen, polysomnography is essential to identify additional forms of sleep-disordered breathing, including central sleep apnea or hypoventilation. 37 Wheeler et al 38 published work to highlight the differences in central apnea syndrome etiologies in adults and children. This retrospective study conducted a cross-sectional analysis of children with and without heart failure, comparing their demographics, medical comorbidities, polysomnograms (PSGs), and echocardiograms.…”