Acute cardiovascular changes with obstructive events in children with sleep disordered breathing.
OBJECTIVE
Obstructive apneas in adults are associated with acute changes in blood pressure (BP) and heart rate (HR) that may contribute to poor cardiovascular outcome. Children with sleep disordered breathing (SDB) are similarly at risk for cardiovascular complications. We aimed to test the hypothesis that BP and HR are augmented during obstructive events in children equivalent to levels reported in adults.


METHODS
Beat-by-beat mean arterial pressure (MAP) and HR were analyzed over the course of obstructive events (pre, early, late, and post-event) during NREM and REM sleep and compared using 2-way ANOVA with post hoc analyses.


METHODS
Pediatric sleep laboratory.


METHODS
30 children (15M/15F) aged 7-12 y referred for investigation of SDB INTERVENTIONS: N/A.


RESULTS
All children underwent overnight polysomnography with continuous BP recording. MAP and HR increased significantly from late to post event in both sleep states (mean +/- SEM, NREM: MAP, 74 +/- 3 to 93 +/- 3 mm Hg; HR, 76 +/- 2 to 97 +/- 2 bpm. REM: MAP, 76 +/- 3 to 89 +/- 3 mm Hg; HR, 76 +/- 2 to 91 +/- 2 bpm. P < 0.05 for all). NREM sleep state and arousal from sleep were significant independent predictors of the magnitude of cardiovascular change from late to post event (P < 0.05 for all).


CONCLUSIONS
Children with SDB experience significant changes in HR and BP during obstructive events with magnitudes that are similar to levels reported in adults. These changes are more pronounced during NREM sleep and with arousal. These acute cardiovascular changes may have important implications for poor cardiovascular outcome in children with OSA as repetitive cardiovascular perturbations may contribute to the development of hypertension.
Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Victoria, Australia. denise.odriscoll@med.monash.edu.au
Denise M
DM
O'Driscoll
Alison M
AM
Foster
Michelle L
ML
Ng
Joel S C
JS
Yang
Farhat
F
Bashir
Gillian M
GM
Nixon
Margot J
MJ
Davey
Vicki
V
Anderson
Adrian M
AM
Walker
John
J
Trinder
Rosemary S C
RS
Horne
D000208:Acute Disease; D000704:Analysis of Variance; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications*; D002648:Child; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D010100:Oxygen / Q000378:metabolism; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications*; D012913:Snoring / Q000150:complications
D010100:Oxygen