Central apnoeas have significant effects on blood pressure and heart rate in children

O'Driscoll, Denise Marie; Foster, Alison M.; Ng, Mah Lee; Yang, Jilin; Bashir, Farhat; Wong, Shi Ngar; Nixon, Gillian M.; Davey, Margot J; Anderson, Vicki; Walker, Adrian M.; Trinder, John; Horne, Rosemary Sylvia Claire

doi:10.1111/j.1365-2869.2009.00766.x

Cited by 46 publications

(22 citation statements)

References 19 publications

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“…Also similar to the previous study, the surge in BP at the termination of an event was much smaller compared with HR. Previous studies have identified that both isolated obstructive and central events in children have similar cardiovascular sequelae to isolated obstructive events in adults (10,14). The episodes of repetitive respiratory events included in this study, included substantial numbers of central events.…”

Section: Repetitive Respiratory Events In Childrenmentioning

confidence: 95%

“…Central apneas have been described in healthy children during sleep and are known to decrease with age (12,13). A similar cardiovascular response is also associated with central apneas in children with SDB (14). In addition, respiratory events may be associated with hypoxia and arousal, both of which have cardiovascular sequelae, increasing BP, HR, and sympathetic activity (15)(16)(17)(18).…”

mentioning

confidence: 91%

“…As there has been no previous definition this time was chosen as it was considered the minimum time allowable between isolated events in previous studies (10,11). The episodes of repetitive respiratory events included both obstructive and central events, as previous studies in children have identified similar HR and BP responses to isolated obstructive and central events (10,14).…”

Section: Polysomnographymentioning

confidence: 99%

“…Beat-by-beat HR and PTT were analyzed as previously described (11). Events were averaged for two phases during each apnea/hypopnea and were termed early-event (first half) and lateevent (second half) (10,11,14). Division of the event as such allowed for comparison of data between events of differing durations.…”

Section: Beat-by-beat Ptt and Hr Analysismentioning

confidence: 99%

“…Previous studies in adults and children, have only investigated the cardiovascular response to isolated respiratory events (8,10,11,14,21) and the effect of repetitive events has not been investigated. Therefore, the aims of this study were firstly to quantify the number of repetitive compared to isolated respiratory events and secondly to compare the HR and BP responses at event termination between these, in preschool children with SDB.…”

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confidence: 99%

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Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

et al. 2015

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Data presented as mean ± SEM or median (range). *P < 0.05; † P < 0.001. HR, heart rate; PTT, pulse transit time. Articles Walter et al. Cardiovascular Consequences of Repetitive vs. Isolated Respiratory EventsFor the episodes of repetitive events, the % change in HR from late to between events and from late event to postepisode were significantly higher when compared with the % change in HR from late to postevent in isolated respiratory events (P < 0.001 for both), as shown in Figure 2a. The % change in PTT from late event to postepisode was significantly greater (indicating a greater change in BP) for repetitive episodes when compared with the % change from late to postevents in isolated respiratory events (P < 0.05) (Figure 2b). There was no difference between % change in PTT from late to between events in repetitive episodes compared with % change from late to postevents in isolated respiratory events. The ratio of repetitive to isolated respiratory events for each child significantly predicted the mean HR, which increased with an increasing proportion of repetitive respiratory events compared with isolated events during N1, N2, REM, and total sleep (Figure 3). There were no relationships between mean PTT and the ratio of repetitive to isolated respiratory events during wake or any sleep stage. Determinants of Percentage Change in HR and PTT From Lateto Between-Event Phases in Episodes of Repetitive Respiratory EventsResults of the multiple linear regression analysis indicate that during total sleep, the repetitive to isolated events ratio, the number of individual respiratory events per episode, the number of arousals per episode, the ratio of the duration of the respiratory event to the duration of the subsequent between event period, and sleep stage were significantly, if weakly predictive of the % change in HR from the late event phase to between the respiratory events ( Table 3). The model predicted 44% of the % change in HR from the late event phase to between the respiratory events (P < 0.01). This suggests that the more repetitive events compared with isolated events, the more episodes, the more events and arousals per episode a child has, the higher the surge in HR. In contrast, there is a negative relationship between the surge in HR and sleep stage, suggesting that the HR surge is highest during N1 and decreases during N2, N3, and REM. There is also a weak negative relationship between the surge in HR and the ratio of the duration of an event to the duration of the between event period, suggesting that the closer together the events become the % change in HR is not as great.Further analyses separating the repetitive respiratory event episodes into the sleep stage in which they occurred demonstrated that when the episodes occurred during N1 sleep, the predictive variables remained the same as for total sleep. When the episodes occurred during N2 or REM sleep, only the number of arousals in the episode predicted the change in HR (r 2 = 0.3, P < 0.01; REM: r 2 = 0.5, P < 0.001). None of the variables ...

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Section: Repetitive Respiratory Events In Childrenmentioning

confidence: 95%

mentioning

confidence: 91%

Section: Polysomnographymentioning

confidence: 99%

Section: Beat-by-beat Ptt and Hr Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing

et al. 2015

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Improvement in Central Sleep Apnea Following Adenotonsillectomy in Children

et al. 2021

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Objective: Previous studies examining changes in central sleep apnea (CSA) following adenotonsillectomy (T&A) performed for obstructive sleep apnea (OSA) in children have been limited by sample size and analysis of only certain populations. The aim of this study was to determine whether CSA improves following T&A and what factors mediate this change.Methods: This was a retrospective case series from 1994 to 2020 of children undergoing primary T&A for OSA (obstructive apnea-hypopnea index ≥1) with CSA (central apnea index [CAI] ≥1) and preoperative and postoperative polysomnograms within 12 months of T&A. Polysomnograms were analyzed for improvement in CSA, defined as: 1) if preoperative CAI >5, a postoperative CAI <5; or 2) if preoperative CAI <5, a postoperative CAI <1.Results: One hundred twenty-three patients were included. Median age was 5.5 years (interquartile range, 2.9-8.4). Most patients were overweight/obese (58.5%). Nineteen (15.4%) had a syndromic condition. Preoperative CAI was ≥5 in 21 (17.1%) patients. CAI significantly decreased following T&A (preoperative 2.1, postoperative 0.4; P < .001). Thirty-two (26.0%) patients had CSA postoperatively. Improvement in the microarousal index and older age were significantly associated with improvement in CSA.Conclusions: T&A led to resolution of CSA in most children with OSA. Improvement in the microarousal index was associated with improvement in CAI, suggesting that preoperative central apneas may be postarousal and thus resolve following T&A.

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