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Bokov P, Koehl B, Dudoignon B, Benkerrou M, Delclaux C. Case-control study of heart rate variability and sleep apnea in childhood sickle cell disease. J Sleep Res 2024:e14209. [PMID: 38590226 DOI: 10.1111/jsr.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
Obstructive sleep apnea (OSA) is common in sickle cell disease (SCD) despite the absence of overweight, suggesting a specific pathophysiology. We previously showed that otherwise healthy children with increased pharyngeal compliance, a main endotype of OSA, exhibited decreased sympathetic modulation. Our objective was to assess whether modifications of heart rate variability (HRV) and compliance are associated in SCD. Cases (children with SCD, African or Caribbean ethnicity) and controls (otherwise healthy children, same ethnicity), aged 4-18 years, were selected from our database of children referred for OSA and matched for sex, age, and obstructive apnea-hypopnoea index (OAHI) score. The children underwent polysomnography and acoustic pharyngometry (to compute compliance). HRV analyses were performed from 5 min ECG recordings in wakeful, NREM, and REM sleep states and from the whole night. Twenty-one pairs were analysed (median age 10.5 years, 24 girls). Children with SCD had lower BMI z-scores and more tonsil hypertrophy than control children. Children with SCD and OSA (OAHI ≥2/hour) were characterised by lower compliance than children with SCD without OSA. An inverse relationship between compliance and SD2 (HRV from whole night, inversely related to sympathetic modulation) was evidenced (negative relationship in SCD: R = -0.63, p = 0.002 vs. positive relationship in controls R = 0.59, p = 0.006). In conclusion, while the decrease in sympathetic modulation in control children may contribute to increasing pharyngeal compliance, its decrease seems protective in children with sickle cell disease, which underlines the specificity of OSAS pathophysiology in SCD that could be due to sickle cell disease related smooth muscle dystonia.
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Affiliation(s)
- Plamen Bokov
- AP-HP, Robert Debré Hospital, Department of Physiology, INSERM NeuroDiderot, Paris University, Paris, France
| | - Bérengère Koehl
- AP-HP, Robert Debré Hospital, Sickle Cell Disease Center, Hematology Unit, Paris University, Paris, France
- UMR_S1134, BIGR, INSERM, Institut National de la Transfusion Sanguine, Laboratoire d'Excellence GR-Ex, Paris, France
| | - Benjamin Dudoignon
- AP-HP, Robert Debré Hospital, Department of Physiology, INSERM NeuroDiderot, Paris University, Paris, France
| | - Malika Benkerrou
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Christophe Delclaux
- AP-HP, Robert Debré Hospital, Department of Physiology, INSERM NeuroDiderot, Paris University, Paris, France
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2
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Lee LA, Chuang HH, Hsieh HS, Wang CY, Chuang LP, Li HY, Fang TJ, Huang YS, Lee GS, Yang AC, Kuo TBJ, Yang CCH. Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea. Front Public Health 2023; 11:1103085. [PMID: 36923030 PMCID: PMC10008856 DOI: 10.3389/fpubh.2023.1103085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA. Methods Seventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined. Results Multivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI. Conclusions The improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.,Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Shan Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Chao-Yung Wang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Child Psychiatry, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Guo-She Lee
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology, Taipei City Hospital, Taipei City, Taiwan
| | - Albert C Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.,Center for Mind and Brain Medicine, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou City, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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3
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Nathan AS, Hubbell RD, Levi JR. Management of children with co-occurring sleep disordered breathing and hearing loss. Int J Pediatr Otorhinolaryngol 2022; 163:111367. [PMID: 36327913 DOI: 10.1016/j.ijporl.2022.111367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To examine hearing loss incidence in a pediatric otolaryngology patients with sleep disordered breathing, and secondarily, identify possible disparities in management. METHODS A retrospective case-control study of pediatric patients with sleep-disordered breathing or obstructive sleep apnea from 2012 to 2019 was conducted at a private, not-for-profit, academic, tertiary care center. Study parameters were extracted from the electronic medical record and compared in study groups of patients with sleep-disordered breathing generated based on presence of hearing loss (cases) versus absence (controls). Study parameters were also compared in study groups based on timing of hearing loss onset. RESULTS 14.8% of patients with sleep disordered breathing had hearing loss. Hearing loss was associated with an increased risk of undergoing adenotonsillectomy (OR 1.632 [1.294-2.058], p < 0.001, adjusted for age). In patients who underwent polysomnographic testing, 9.8% patients had pre-existing hearing loss and 12% patients developed hearing loss over the study period. Patients with pre-existing hearing loss and those who developed hearing loss had significantly more visits with otolaryngology compared to controls (p < 0.001). Hearing loss did not significantly delay adenotonsillectomy. More patients who developed hearing loss had adenotonsillectomies (OR 2.475 [1.672-3.663], p < 0.001, adjusted for age) versus controls. This difference was not identified in patients with pre-existing hearing loss. CONCLUSION Patients with evidence of hearing loss in addition to sleep disordered breathing had more adenotonsillectomies performed and more clinic visits. Further work must be done to understand the associations and implications of hearing loss in this population.
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Affiliation(s)
- Ajay S Nathan
- Boston University School of Medicine, Boston, MA, USA
| | - Richard D Hubbell
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, USA; Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
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4
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Autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing. Pediatr Res 2022; 91:1834-1840. [PMID: 34404927 DOI: 10.1038/s41390-021-01691-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of the study was to assess the relationship between autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing. METHODS We enrolled habitually snoring children aged 3-14 years for overnight polysomnography (PSG) and high-sensitivity C-reactive protein (hsCRP) measurement. Low-grade inflammation was defined as hsCRP >1.0 mg/L to <10.0 mg/L. An electrocardiogram recording was extracted from PSG. Heart rate variability was analyzed using time and frequency domain methods. RESULTS In total, 190 children were included, with 61 having primary snoring (PS), 39 mild obstructive sleep apnea (OSA), and 90 moderate-to-severe OSA. The average RR interval displayed a significant decline, whereas the low frequency/high frequency (LF/HF) ratio showed an increasing tendency in children with PS, mild OSA, and moderate-to-severe OSA. Mean RR was mainly influenced by age and the apnea hypopnea index (AHI) (all P < 0.01). AHI was an independent risk factor for the altered LF/HF ratio at all sleep stages except N3 stage (all P < 0.05). In the wake stage, low-grade inflammation was an independent risk factor of altered LF/HF ratio (P = 0.014). CONCLUSIONS Autonomic nervous function was impaired in children with OSA. The sympathetic-vagal balance was influenced by low-grade inflammation in the wake stage, whereas it was only affected by AHI when falling asleep. IMPACT We found that autonomic nervous function was impaired in children with OSA. We found that there was a negative correlation between systemic inflammation and autonomic nervous function in children with SDB only at wake stage. A negative association between systemic inflammation and autonomic nervous function was demonstrated in children in this study. Furthermore, altered LF/HF ratio maybe a good indicator of autonomic nervous dysfunction in children as it only correlated with the SDB severity, not with age.
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5
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Bokov P, Mauvais FX, Madani A, Matrot B, Lecendreux M, Delanoë C, Konofal E, Gallego J, Delclaux C. Cross-sectional case-control study of the relationships between pharyngeal compliance and heart rate variability indices in childhood obstructive sleep apnoea. J Sleep Res 2021; 30:e13337. [PMID: 33880823 DOI: 10.1111/jsr.13337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/20/2022]
Abstract
A combination of noradrenergic and antimuscarinic agents reduces the apnea-hypopnea index (AHI) in adult patients with obstructive sleep apnoea (OSA) via reduced upper airway collapsibility, suggesting that a shift in the sympathovagal balance improves OSA. The objectives of our present case-control study were to assess heart rate variability (HRV) indices in the stages of sleep in children with and without OSA to evaluate OSA-induced sleep HRV modifications and to assess whether increased collapsibility measured during wakefulness is associated with reduced sympathetic activity during non-rapid eye movement (NREM) sleep. Three groups of 15 children were matched by sex, age, z-score of body mass index and ethnicity: non-OSA (obstructive AHI [OAHI] <2 events/hr), mild (OAHI ≥2 to <5 events/hr) or moderate-severe (OAHI ≥5 events/hr) OSA. Pharyngeal compliance was measured during wakefulness using acoustic pharyngometry. HRV indices (time and frequency domain variables) were calculated on 5-min electrocardiography recordings from polysomnography during wakefulness, NREM and REM sleep in periods free of any event. As compared to children without OSA, those with OSA (n = 30) were characterised by increased compliance and no physiological parasympathetic tone increase in REM sleep. Children with increased pharyngeal compliance (n = 21) had a higher OAHI due to higher AHI in NREM sleep, whereas their sympathetic tone was lower than that of those with normal compliance (n = 24). In conclusion, children with increased pharyngeal compliance exhibit decreased sympathetic tone associated with increased AHI in NREM sleep. Therapeutics directed at sympathovagal balance modifications should be tested in childhood OSA.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, Université de Paris, AP-HP, Hôpital Robert Debré, INSERM NeuroDiderot, Paris, France
| | - François-Xavier Mauvais
- Service de Physiologie Pédiatrique-Centre du Sommeil, Université de Paris, UMR1151, AP-HP, Hôpital Robert Debré, CNRS UMR8253, Paris, France
| | - Amélia Madani
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Boris Matrot
- INSERM NeuroDiderot, Equipe NeoPhen, Paris, France
| | - Michel Lecendreux
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Catherine Delanoë
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Eric Konofal
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, Université de Paris, AP-HP, Hôpital Robert Debré, INSERM NeuroDiderot, Paris, France
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6
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Kahn S, Ehrlich P, Feldman M, Sapolsky R, Wong S. The Jaw Epidemic: Recognition, Origins, Cures, and Prevention. Bioscience 2020; 70:759-771. [PMID: 32973408 PMCID: PMC7498344 DOI: 10.1093/biosci/biaa073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Contemporary humans are living very different lives from those of their ancestors, and some of the changes have had serious consequences for health. Multiple chronic "diseases of civilization," such as cardiovascular problems, cancers, ADHD, and dementias are prevalent, increasing morbidity rates. Stress, including the disruption of traditional sleep patterns by modern lifestyles, plays a prominent role in the etiology of these diseases, including obstructive sleep apnea. Surprisingly, jaw shrinkage since the agricultural revolution, leading to an epidemic of crooked teeth, a lack of adequate space for the last molars (wisdom teeth), and constricted airways, is a major cause of sleep-related stress. Despite claims that the cause of this jaw epidemic is somehow genetic, the speed with which human jaws have changed, especially in the last few centuries, is much too fast to be evolutionary. Correlation in time and space strongly suggests the symptoms are phenotypic responses to a vast natural experiment-rapid and dramatic modifications of human physical and cultural environments. The agricultural and industrial revolutions have produced smaller jaws and less-toned muscles of the face and oropharynx, which contribute to the serious health problems mentioned above. The mechanism of change, research and clinical trials suggest, lies in orofacial posture, the way people now hold their jaws when not voluntarily moving them in speaking or eating and especially when sleeping. The critical resting oral posture has been disrupted in societies no longer hunting and gathering. Virtually all aspects of how modern people function and rest are radically different from those of our ancestors. We also briefly discuss treatment of jaw symptoms and possible clinical cures for individuals, as well as changes in society that might lead to better care and, ultimately, prevention.
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7
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Brito LC, Queiroga T, Franco RR, Passone CGB, Lopes MC, Shea SA, Bueno C, Soster LMSFA. Cardiac autonomic control during non-REM and REM sleep stages in paediatric patients with Prader-Willi syndrome. J Sleep Res 2020; 30:e13165. [PMID: 32812310 DOI: 10.1111/jsr.13165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Cardiac death is the second most prevalent cause in Prader-Willi syndrome (PWS). Paediatric patients with PWS often present cardiac autonomic dysfunction during wakefulness, obesity and sleep-disordered breathing. However, the extent of cardiac autonomic modulation during sleep in PWS has not been documented. The objective of this study was to assess alterations in cardiac autonomic modulation of paediatric patients with PWS during different sleep stages. Thirty-nine participants in three groups: 14 PWS, 13 sex and age-matched lean controls (LG) and 12 obese-matched controls (OB). All participants underwent overnight polysomnography, including continuous electrocardiogram recordings. Heart rate variability (HRV) was analysed during representative periods of each sleep stage through time and frequency domains calculated across 5-min periods. Between-within ANOVAs were employed (p < .05). The results show that total HRV was lower in PWS than OB and LG during slow-wave sleep (SWS) (standard deviation of all NN intervals [SDNN] ms, p = .006). Parasympathetic modulation assessed by time-domain analysis was lower during SWS in PWS compared to both OB and LG (square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD] ms, p = .004; SDSD, standard deviation of differences between adjacent NN intervals [SDSD] ms, p = .02; number of adjacent NN intervals differing by >50 ms [NN50] ms, p = .03; proportion of adjacent NN intervals differing by >50 ms [pNN50] ms, p = .01). Sympathovagal balance assessed by frequency-domain analysis was lower during both N2 and SWS than during the rapid eye movement (REM) sleep stage, but not different among groups. In conclusion, this group of paediatric patients with PWS had impaired cardiac autonomic balance due to reduced parasympathetic modulation during SWS. This result could imply an underlying increased cardiovascular risk in PWS even during early age and independent of obesity.
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Affiliation(s)
- Leandro C Brito
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,School of Arts, Science and Humanities, University of São Paulo, São Paulo, Brazil
| | - Thereza Queiroga
- Polisomnography Unit, Medical School, Children's Institute, University of São Paulo, São Paulo, Brazil
| | - Ruth R Franco
- Pediatric Endocrinology Unit, Medical School, Children's Institute, University of São Paulo, São Paulo, Brazil
| | - Caroline G B Passone
- Pediatric Endocrinology Unit, Medical School, Children's Institute, University of São Paulo, São Paulo, Brazil
| | - Maria-Cecilia Lopes
- Polisomnography Unit, Medical School, Children's Institute, University of São Paulo, São Paulo, Brazil.,Childhood and Adolescence Affetive Disorders Program (PRATA), Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Clarissa Bueno
- Polisomnography Unit, Medical School, Children's Institute, University of São Paulo, São Paulo, Brazil.,Department of Neurology, Clinical Hospital HCFMUSP, Medical School, University of São Paulo, São Paulo, Brazil
| | - Leticia M S F A Soster
- Polisomnography Unit, Medical School, Children's Institute, University of São Paulo, São Paulo, Brazil
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Kontos A, Baumert M, Lushington K, Kennedy D, Kohler M, Cicua-Navarro D, Pamula Y, Martin J. The Inconsistent Nature of Heart Rate Variability During Sleep in Normal Children and Adolescents. Front Cardiovasc Med 2020; 7:19. [PMID: 32154268 PMCID: PMC7046589 DOI: 10.3389/fcvm.2020.00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/03/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Cardiac function is modulated by multiple factors including exogenous (circadian rhythm) and endogenous (ultradian 90–110 min sleep cycle) factors. By evaluating heart rate variability (HRV) during sleep, we will better understand their influence on cardiac activity. The aim of this study was to evaluate HRV in the dark phase of the circadian rhythm during sleep in healthy children and adolescents. Methods: One 3 min segment of pre-sleep electrocardiography (EEG) and 3, 6 min segments of electrocardiography recorded during polysomnography from 75 healthy children and adolescents were sampled during progressive cycles of slow wave sleep (SWS1, SWS2, SWS3). Three, 3 min segments of rapid eye movement sleep (REM) were also assessed, with REM1 marked at the last REM period before awakening. Studies that recorded REM3 prior to SWS3 were used for assessment. HRV variables include the following time domain values: mean NN (average RR intervals over given time), SDNN (Standard Deviation of RR intervals), and RMSSD (root Mean Square of beat-to-beat Differences). Frequency domain values include: low frequency (LF), high frequency (HF), and LF:HF. Results: Mixed linear effects model analysis revealed a significant difference in time and frequency domain values between sleep cycles and stages. Mean NN was lowest (highest heart rate) during pre—sleep then significantly increased across SWS1-3. Mean NN in SWS1 was similar to all REM periods which was significantly lower than both SWS2 and SWS3. SDNN remained at pre-sleep levels until SWS3, and then significantly increased in REM1&2. There was a large drop in LF from pre-sleep to SWS1. As cycles progressed through the night, LF remains lower than awake but increases to awake like levels by REM2. RMSSD and HF were lowest in pre-sleep and increased significantly by SWS1 and remain high and stable across stages and cycles except during the REM3 period where RMSSD decreased. Conclusion: Our results demonstrate that there are considerable changes in the spectral analysis of cardiac function occurring during different sleep stages and between sleep cycles across the night. Hence, time of night and sleep stage need to be considered when reporting any HRV differences.
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Affiliation(s)
- Anna Kontos
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, SA, Australia.,School of Paediatrics and Reproductive Health, Robinson's Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Mathias Baumert
- School of Paediatrics and Reproductive Health, Robinson's Research Institute, University of Adelaide, Adelaide, SA, Australia.,School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, SA, Australia
| | - Kurt Lushington
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
| | - Declan Kennedy
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, SA, Australia.,School of Paediatrics and Reproductive Health, Robinson's Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Mark Kohler
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Diana Cicua-Navarro
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
| | - Yvonne Pamula
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - James Martin
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, SA, Australia.,School of Paediatrics and Reproductive Health, Robinson's Research Institute, University of Adelaide, Adelaide, SA, Australia
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9
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Guilleminault C, Hervy-Auboiron M, Huang YS, Li K, Amat P. [Obstructive sleep-disordered breathing and orthodontics. An interview with Christian Guilleminault, Michèle Hervy-Auboiron, Yu-Shu Huang and Kasey Li]. Orthod Fr 2019; 90:215-245. [PMID: 34643512 DOI: 10.1051/orthodfr/2019038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Yu-Shu Huang
- Department of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, No. 5, Fusing St, Kwei-Shan Township, Taoyuan Country, 333, Taiwan
| | - Kasey Li
- 1900 University Ave #105, East Palo Alto, CA 94303, États-Unis
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