1
|
Sonsuwan N, Houngsuwannakorn K, Chattipakorn N, Sawanyawisuth K. An association between heart rate variability and pediatric obstructive sleep apnea. Ital J Pediatr 2024; 50:54. [PMID: 38500213 PMCID: PMC10949611 DOI: 10.1186/s13052-024-01576-2] [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: 03/16/2023] [Accepted: 01/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND There are different findings on heart rate variability (HRV) and pediatric obstructive sleep apnea (pOSA) by an overnight HRV or a 1-hr HRV. However, there is limited data of HRV and pOSA diagnosis by using a 24-h HRV test. This study aimed to evaluate if HRV had potential for OSA diagnosis by using a 24-h HRV test. METHODS This was a prospective study included children age between 5 and 15 years old, presenting with snoring, underwent polysomnography and a 24-h Holter monitoring. Predictors for pOSA diagnosis were analyzed using logistic regression analysis. RESULTS During the study period, there were 81 pediatric patients met the study criteria. Of those, 65 patients (80.25%) were diagnosed as OSA. There were three factors were independently associated with OSA: standard deviation of all normal interval (SDNN), high frequency (HF), and low frequency (LF). The adjusted odds ratios of these factors were 0.949 (95% confidence interval 0.913, 0.985), 0.786 (95% confidence interval 0.624, 0.989), and 1.356 (95% confidence interval 1.075, 1.709). CONCLUSIONS HRV parameters including SDNN, HF, and LF were associated with pOSA diagnosis in children by using the 24-h Holter monitoring.
Collapse
Affiliation(s)
- Nuntigar Sonsuwan
- Department of Otolaryngology Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, 40002, Khon Kaen, Thailand.
| |
Collapse
|
2
|
Qin H, Fietze I, Mazzotti DR, Steenbergen N, Kraemer JF, Glos M, Wessel N, Song L, Penzel T, Zhang X. Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring. J Sleep Res 2024; 33:e14020. [PMID: 37709966 DOI: 10.1111/jsr.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
Obstructive sleep apnea is a highly prevalent sleep-related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter-individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea-Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea-Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea-Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.
Collapse
Affiliation(s)
- Hua Qin
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- The Fourth People's Hospital of Guangyuan, Guangyuan, China
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Information Processing and Analytics Group, School of Library and Information Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medicine, Medical School Berlin, Berlin, Germany
| | - Lijun Song
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Xiaowen Zhang
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
3
|
Armañac-Julián P, Martín-Montero A, Lázaro J, Hornero R, Laguna P, Kheirandish-Gozal L, Gozal D, Gil E, Bailón R, Gutiérrez-Tobal G. Persistent sleep-disordered breathing independently contributes to metabolic syndrome in prepubertal children. Pediatr Pulmonol 2024; 59:111-120. [PMID: 37850730 DOI: 10.1002/ppul.26720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor for metabolic syndrome (MetS) in adults, but its association in prepubertal children is still questionable due to the relatively limited cardiometabolic data available and the phenotypic heterogeneity. OBJECTIVE To identify the role of OSA as a potential mediator of MetS in prepubertal children. METHODS A total of 255 prepubertal children from the Childhood Adenotonsillectomy Trial were included, with standardized measurements taken before OSA treatment and 7 months later. MetS was defined if three or more of the following criteria were present: adiposity, high blood pressure, elevated glycemia, and dyslipidemia. A causal mediation analysis was conducted to assess the effect of OSA treatment on MetS. RESULTS OSA treatment significantly impacted MetS, with the apnea-hypopnea index emerging as mediator (p = .02). This mediation role was not detected for any of the individual risk factors that define MetS. We further found that the relationship between MetS and OSA is ascribable to respiratory disturbance caused by the apnea episodes, while systemic inflammation as measured by C-reactive protein, is mediated by desaturation events and fragmented sleep. In terms of evolution, patients with MetS were significantly more likely to recover after OSA treatment (odds ratio = 2.56, 95% confidence interval [CI] 1.20-5.46; risk ratio = 2.06, 95% CI 1.19-3.54) than the opposite, patients without MetS to develop it. CONCLUSION The findings point to a causal role of OSA in the development of metabolic dysfunction, suggesting that persistent OSA may increase the risk of MetS in prepubertal children. This mediation role implies a need for developing screening for MetS in children presenting OSA symptoms.
Collapse
Affiliation(s)
- Pablo Armañac-Julián
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Adrián Martín-Montero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Jesús Lázaro
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Roberto Hornero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Pablo Laguna
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Leila Kheirandish-Gozal
- Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri, United States
| | - David Gozal
- Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, Virginia, United States
| | - Eduardo Gil
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Raquel Bailón
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Gonzalo Gutiérrez-Tobal
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| |
Collapse
|
4
|
Gomez-Pilar J, Gutiérrez-Tobal GC, Gozal D, Hornero R. Are we missing something? Different obstructive sleep apnea phenotypes as a possible driver of discrepancies in cognitive recovery after continuous positive airway pressure treatment. Sleep 2023; 46:zsad269. [PMID: 37864844 PMCID: PMC10710986 DOI: 10.1093/sleep/zsad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Indexed: 10/23/2023] Open
Affiliation(s)
- Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - David Gozal
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| |
Collapse
|
5
|
Solano-Pérez E, Coso C, Castillo-García M, Romero-Peralta S, Lopez-Monzoni S, Laviña E, Cano-Pumarega I, Sánchez-de-la-Torre M, García-Río F, Mediano O. Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed. Biomedicines 2023; 11:1708. [PMID: 37371803 DOI: 10.3390/biomedicines11061708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. OSA has relevant consequences in the pediatric population, mainly in the metabolic, cardiovascular (CV), and neurological spheres. However, contrary to adults, advances in diagnostic and therapeutic management have been scarce in the last few years despite the increasing scientific evidence of the deleterious consequences of pediatric OSA. The problem of underdiagnosis and the lack of response to treatment in some groups make an update to the management of OSA in children necessary. Probably, the heterogeneity of OSA is not well represented by the classical clinical presentation and severity parameters (apnea/hypopnea index (AHI)), and new strategies are required. A specific and consensus definition should be established. Additionally, the role of simplified methods in the diagnosis algorithm should be considered. Finally, the search for new biomarkers for risk stratification is needed in this population. In conclusion, new paradigms based on personalized medicine should be implemented in this population.
Collapse
Affiliation(s)
- Esther Solano-Pérez
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Carlota Coso
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - María Castillo-García
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - Sofía Romero-Peralta
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - Sonia Lopez-Monzoni
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Eduardo Laviña
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Sleep Unit, Pneumology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, 25198 Lleida, Spain
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, 25002 Lleida, Spain
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Respiratory Diseases Group, Respiratory Service, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
- Pneumology Department, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Olga Mediano
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
| |
Collapse
|
6
|
Kim HJ. A New Simpler and More Accurate Approach to the Diagnosis of Sleep Apnea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:276-278. [PMID: 37188484 DOI: 10.4168/aair.2023.15.3.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Hyun Jun Kim
- Department of Otorhinolaryngology, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
7
|
Martín-Montero A, Armañac-Julián P, Gil E, Kheirandish-Gozal L, Álvarez D, Lázaro J, Bailón R, Gozal D, Laguna P, Hornero R, Gutiérrez-Tobal GC. Pediatric sleep apnea: Characterization of apneic events and sleep stages using heart rate variability. Comput Biol Med 2023; 154:106549. [PMID: 36706566 DOI: 10.1016/j.compbiomed.2023.106549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 01/16/2023]
Abstract
Heart rate variability (HRV) is modulated by sleep stages and apneic events. Previous studies in children compared classical HRV parameters during sleep stages between obstructive sleep apnea (OSA) and controls. However, HRV-based characterization incorporating both sleep stages and apneic events has not been conducted. Furthermore, recently proposed novel HRV OSA-specific parameters have not been evaluated. Therefore, the aim of this study was to characterize and compare classic and pediatric OSA-specific HRV parameters while including both sleep stages and apneic events. A total of 1610 electrocardiograms from the Childhood Adenotonsillectomy Trial (CHAT) database were split into 10-min segments to extract HRV parameters. Segments were characterized and grouped by sleep stage (wake, W; non-rapid eye movement, NREMS; and REMS) and presence of apneic events (under 1 apneic event per segment, e/s; 1-5 e/s; 5-10 e/s; and over 10 e/s). NREMS showed significant changes in HRV parameters as apneic event frequency increased, which were less marked in REMS. In both NREMS and REMS, power in BW2, a pediatric OSA-specific frequency domain, allowed for the optimal differentiation among segments. Moreover, in the absence of apneic events, another defined band, BWRes, resulted in best differentiation between sleep stages. The clinical usefulness of segment-based HRV characterization was then confirmed by two ensemble-learning models aimed at estimating apnea-hypopnea index and classifying sleep stages, respectively. We surmise that basal sympathetic activity during REMS may mask apneic events-induced sympathetic excitation, thus highlighting the importance of incorporating sleep stages as well as apneic events when evaluating HRV in pediatric OSA.
Collapse
Affiliation(s)
- Adrián Martín-Montero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain.
| | - Pablo Armañac-Julián
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Eduardo Gil
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO, USA
| | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Jesús Lázaro
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Raquel Bailón
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO, USA
| | - Pablo Laguna
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| |
Collapse
|