Poincaré Plot Width, Morning Urine Norepinephrine Levels, and Autonomic Imbalance in Children With Obstructive Sleep Apnea

Chaidas, Konstantinos; Tsaoussoglou, Marina; Theodorou, E.; Lianou, Loukia; Chrousos, George P.; Kaditis, Athanasios G.

doi:10.1016/j.pediatrneurol.2014.05.003

Cited by 18 publications

(18 citation statements)

References 30 publications

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“…Upon termination of an obstructive event, heart rate becomes faster compared to baseline, its variability decreases, and blood pressure rises transiently . Reduced heart rate variability along with repetitive rises in blood pressure may reset the baroreceptors predisposing to hypertension and cardiovascular morbidity in adult life . Results of uncontrolled studies in children with OSAS indicate post‐AT reduction of nocturnal heart rate and diastolic blood pressure .…”

Section: Discussionmentioning

confidence: 99%

Assessing the need for adenotonsillectomy for sleep‐disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study

Papadakis

Chaidas

Chimona

et al. 2019

Pediatric Pulmonology

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Objective To assess whether children with sleep‐disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention. Methods Children with snoring and tonsillar hypertrophy (4 to 10‐years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3‐month follow‐up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3‐month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep‐related breathing disorder scale (PSQ‐SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ‐SRBD <0.33 (low‐risk for apnea‐hypopnea index ≥5/h) if they had score ≥0.33 at baseline. Results Sixty‐eight children were assigned to the AT and 72 to the control group and two‐thirds of them had PSQ‐SRBD ≥0.33. The AT group experienced significantly larger improvement between follow‐up and baseline than controls (between‐group difference [95% CI] for PSQ‐SRBD: −0.31 [−0.35 to −0.27]; and mESS: −2.76 [−3.63 to −1.90]; P < .001 for both). Children with baseline PSQ‐SRBD ≥0.33 in the AT group had an eight‐times higher probability of achieving PSQ‐SRBD <0.33 at follow‐up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92‐17.54]; P < .001). Conclusion Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ‐SRBD score ≥0.33 show measurable clinical benefit postoperatively.

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Section: Discussionmentioning

confidence: 99%

Assessing the need for adenotonsillectomy for sleep‐disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study

Papadakis

Chaidas

Chimona

et al. 2019

Pediatric Pulmonology

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“…The Poincaré Plot is a scattergram of the R-R interval variability and represents the dynamic of HRV. 12,18 Two studies 11,12 used Poincaré Plot for HRV analysis and showed discrepant results. One study demonstrates that children with OSA and moderate-to-severe hypoxemia (318.7±139.3 ms) had significantly narrower plots than control subjects (482.2±104.4 ms).…”

Section: Non-linear Method: Poincaré Plotmentioning

confidence: 99%

“…Among the OSA children and controls, the majority were male. The earliest study was from 1997 11 and the latest, 2014 12 Table 1. Those studies were published in different countries: Greece 12 , Israel 13 , Australia 14 , China 15 and USA.…”

Section: Studies Characteristicsmentioning

confidence: 99%

“…Those studies were published in different countries: Greece 12 , Israel 13 , Australia 14 , China 15 and USA. 11,16 Of those selected studies, four [13][14][15][16] analysed the heart rate variability with linear methods (time and frequency) and two, 11,12 used a non-linear method (Poincaré Plot) of analysis Table 2. All of them selected the eletrocardiogram for registered, but time of recording varied: 260 seconds for each sleep stage, 60 minutes or not determined.…”

Section: Studies Characteristicsmentioning

confidence: 99%

“…All of them selected the eletrocardiogram for registered, but time of recording varied: 260 seconds for each sleep stage, 60 minutes or not determined. Five 11,12,[14][15][16] of them recorded HRV while the children were asleep and one 13 recorded also at supine position but they were awake. Three studies [12][13][14] searched for secondary outcomes, such as Ln-transformed morning urine norepinephrine-to-creatinine ratio for nocturnal sympathetic output measurement and respiratory measures, urinary catecolamines and respiratory disturbance index.…”

Section: Studies Characteristicsmentioning

confidence: 99%

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