Sleep disordered breathing in children disrupts the maturation of autonomic control of heart rate and its association with cerebral oxygenation

Abstract

Key points Sleep disordered breathing (SDB) affects 4–11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control. The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non‐snoring control children was absent during sleep in children with SDB. Age significantly predicted increasing cerebral oxygenation during wake in non‐snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation. Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep. SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non‐snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. Abstract The repetitive episodes of hypoxia that are features of sleep disordered breathing (SDB) in children are associated with alterations in autonomic control of heart rate in an age‐dependent manner. We aimed to relate heart rate variability (HRV) parameters to age and measures of cerebral oxygenation in children (3–12 years old) with SDB and non‐snoring controls. Children (SDB, n = 117; controls, n = 42; 3–12 years) underwent overnight polysomnography. Total (TP), low‐ (LF) and high‐frequency (HF) power, tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) were analysed during wake and sleep. Pearson's correlations determined the association between age and HRV parameters, and multiple linear regressions between HRV, age and cerebral oxygenation parameters. During wake, age had a positive association with LF power, reflecting increased parasympathetic and sympathetic activity with increasing age for both control and SDB groups. This association was also evident during sleep in controls, but was absent in children with SDB. In controls, during wake TOI had a positive, and FTOE a negative association with age. During sleep, TP, LF and HF power were significant, negative determinants of TOI and positive determinants of FTOE. These associations were not seen in children with SDB during wake or sleep. SDB disrupts the normal maturation of the autonomic control of heart rate and the association between HRV and cerebral oxygenation exhibited by non‐snoring control children of primary school age. These results highlight the impact SDB has on cardiovascular control and the potential impact on adverse cardiovascular outcomes.

Heart rate variability during sleep in children and adolescents with restless sleep disorder: a comparison with restless legs syndrome and normal controls

“…On the contrary, Finley and Nugent 24 studied 61 healthy participants from 1 month until 24 years of age during wakefulness, quiet sleep, and active sleep and showed that HRV changed with age with a gradual increase in parasympathetic modulation in the first 6 years of life, with a following gradual decrease. Finally, Walter et al 25 recently reported that in individuals without disorders, age is associated with increasing parasympathetic and sympathetic activity (LF power) during both wakefulness and sleep during the developmental period. Thus, similarly to many other sleep features, HRV does show age-related changes during the developmental period that still need to be detailed in more refined studies.…”

Resting‐State Cerebral Hemodynamics is Associated With Problem Behaviors in Pediatric Sleep‐Disordered Breathing

“…Despite most studies concluding that fNIRS recordings tend to be abnormal in children with SDB, fNIRS‐derived cerebral oxygenation parameters have not been able to explain the higher prevalence of problem behaviors in children with SDB despite the promising aspects of this method. A major advance was a study by Walter et al 43 that helped characterize adverse neurobehavioral outcomes of SDB better by examining the link between impaired autonomic control and cerebral hemodynamics. The authors demonstrated that SDB disrupts the normal maturation of the autonomic control of heart rate and the association between heart rate variability and cerebral oxygenation exhibited by nonsnoring controls.…”

Association of sleep disorders with heart rate variability in children and adolescents with cystic fibrosis

“…This corroborates with another study in children aged between three and 12, which concluded that sleep-disordered breathing with frequent hypoxia disrupt the maturation of the ANS. 30 On the other hand, Urbanik et al 14 demonstrated that patients with OSAS had reduced HRV in the time-domain and spectral parameters, and that these changes occur not only during sleep, but also during daily activity. Data herein demonstrated the presence of OSAS in 30% of the sample.…”