The impact of sleep disordered breathing on cardiovascular health in overweight children

Horne, Rosemary Sylvia Claire; Shandler, G; Tamanyan, Knarik; Weichard, Aidan; Odoi, Alexsandria; Biggs, Sarah Nichole; Davey, Margot J; Nixon, Gillian M.; Walter, Lisa M.

doi:10.1016/j.sleep.2017.09.012

Cited by 26 publications

(18 citation statements)

References 69 publications

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“…The common finding among previous studies pointed to increased LF activity ( 14 , 21 ) and LF/HF ratio ( 14 , 17 , 20 ), as well as decreased HF power ( 16 , 17 , 19 ) as SAHS worsens. Adenotonsillectomy, the common treatment for SAHS in children, reversed these trends ( 18 ).…”

Section: Discussionmentioning

confidence: 85%

Heart rate variability spectrum characteristics in children with sleep apnea

et al. 2020

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Background: Classic spectral analysis of heart rate variability (HRV) in pediatric sleep apnea-hypopnea syndrome (SAHS) traditionally evaluates the very low frequency (VLF: 0–0.04 Hz), low frequency (LF: 0.04–0.15 Hz), and high frequency (HF: 0.15–0.40 Hz) bands. However, specific SAHS-related frequency bands have not been explored. Methods: 1,738 HRV overnight recordings from two pediatric databases (0–13 years) were evaluated. The first one (981 children) served as training set to define new HRV pediatric SAHS-related frequency bands. The associated relative power (RP) were computed in the test set, the Childhood Adenotonsillectomy Trial database (CHAT, 757 children). Their relationships with polysomnographic variables and diagnostic ability were assessed. Results: Two new specific spectral bands of pediatric SAHS within 0–0.15 Hz were related to duration of apneic events, number of awakenings, and wakefulness after sleep onset (WASO), while an adaptive individual-specific new band from HF was related to oxyhemoglobin desaturations, arousals, and WASO. Furthermore, these new spectral bands showed improved diagnostic ability than classic HRV. Conclusions: Novel spectral bands provide improved characterization of pediatric SAHS. These findings may pioneer a better understanding of the effects of SAHS on cardiac function and potentially serve as detection biomarkers.

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Section: Discussionmentioning

confidence: 85%

Heart rate variability spectrum characteristics in children with sleep apnea

et al. 2020

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“…A recent study has demonstrated that "BMI has both combined and independent effects on BP and HR in children with OSA". 23 This can prove to be an important finding in understanding the pathophysiology of these comorbid conditions in adolescent patients.…”

Section: Discussionmentioning

confidence: 90%

“…The relationship between obesity, OSA, and HTN has been well studied in adult patients and demonstrates independent relationships amongst the comorbidities 10,12 . The relationship has not been as well studied in pediatric patients; while some prior studies demonstrate that these comorbidities often exist in adolescent patients, 21–23 there is no study that confirms a clear, independent relationship between OSA and HTN, as it does in adult patients. Additionally, this is the first study of this kind that looks at obesity/OSA in a mostly non‐white patient cohort.…”

Section: Discussionmentioning

confidence: 99%

The relationship of hypertension with obesity and obstructive sleep apnea in adolescents

Khan

Mathur

Barraza

et al. 2020

Pediatric Pulmonology

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Objectives To assess the independent relationships of obesity and obstructive sleep apnea (OSA) with hypertension/elevated blood pressure (EBP) in adolescent patients. Study Design A retrospective cohort analysis was performed on 501 patients (age 13‐21 years) with three separate blood pressure measurements within 6 months of polysomnography. EBP was defined as average systolic blood pressure (SBP) ≤120 mm Hg; obesity as body mass index Z‐score ≤1.65; and OSA as obstructive apnea‐hypopnea index <1. Pearson correlations and multivariable analyses were performed to assess the independent effects of the apnea‐hypopnea index and body mass index Z‐score on SBP. Results Of 501 patients (mean age 16 ± 2 years), 246 (49%) were male. OSA was present in 329 (66%) patients, obesity in 337 (67%), and EBP in 262 (52%). EBP was present in 70% of obese adolescents and 60% of adolescents with OSA. Univariable correlation showed a significant relationship between SBP, body mass index Z‐score, and apnea‐hypopnea index. Multivariable linear regression analysis showed blood pressure was significantly associated with body mass index Z‐score (β = .46; P < .01), age (β = .25; P < .01), and height Z‐score (β = .14; P < .01), but not apnea‐hypopnea index (β = .01; P = .72). Conclusions The relationship between OSA and EBP in adolescents is most closely associated with the degree of obesity. Further studies are needed to assess the effect of the treatment of obesity and OSA on blood pressure in adolescents.

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“…Unlike adults, children with obstructive sleep apnea (OSA) do not usually develop high blood pressure (BP), (Guilleminault et al, 2004) although the levels of overnight urinary noradrenaline and adrenaline are increased and changes occur in the sympathetic tone that may contribute to the cardiovascular consequences of the condition (O'Driscoll et al, 2011). Children with high BP usually have a co-morbid condition such as obesity (Horne et al, 2018; Walter et al, 2018) that may lead to both abnormal breathing during sleep and even higher BP. A subgroup of normal-weight children with SDB may even present low BP (Guilleminault et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Reduction in Parasympathetic Tone During Sleep in Children With Habitual Snoring

et al. 2019

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Introduction: Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described. Some pediatric studies have shown cardiovascular effects in children who do not fit the criteria for OSA; namely children with mild sleep disordered breathing.Objective: We investigated heart rate variability (HRV) during sleep in children with chronic snoring and flow limitation events during sleep.Methods: Ten children and adolescents with chronic snoring and an apnea hypopnea index < 1, associated to high Respiratory Index, and 10 controls matched for age, gender, and Tanner stage were monitored following one night of habituation in the sleep laboratory. HRV was studied at each sleep stage. The time and frequency domains were calculated for each 5-min period.Results: All patients were chronic heavy snorers. They presented an apnea hypopnea index = 0.8, respiratory disturbance index = 10.2/h with lowest O2 saturation 96.1 ± 2.4%. The total power of HRV was decreased in all stages (p < 0.05). There was also a decrease in NN50 and pNN50 during all sleep stages compared to healthy controls (p = 0.0003 and p = 0.03, respectively).Conclusion: A reduction in parasympathetic tone was found in the patient group. This may represent an autonomic impairment during sleep in children with mild SDB. A reduction in HRV in children with habitual snoring could be associated with possible increases in cardiovascular risk in adulthood.Significance: The study indicates that children with habitual snoring have important parasympathetic tone changes during sleep.

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The impact of sleep disordered breathing on cardiovascular health in overweight children

Cited by 26 publications

References 69 publications

Heart rate variability spectrum characteristics in children with sleep apnea

Heart rate variability spectrum characteristics in children with sleep apnea

The relationship of hypertension with obesity and obstructive sleep apnea in adolescents

Reduction in Parasympathetic Tone During Sleep in Children With Habitual Snoring

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