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Children with Down syndrome are at increased risk of obstructive sleep disordered breathing, which has deleterious effects on daytime functioning. We aimed to examine the effects of treatment of sleep disordered breathing on sleep quality and daytime functioning in children with Down syndrome, and hypothesised that these would be improved. Thirty-four children completed a baseline study and a follow-up 2 years later. Measures at both time points included 7 days of actigraphy and parents completed a number of questionnaires assessing sleep, behaviour, daytime functioning, and quality of life. All children had overnight polysomnography at baseline; 15 children (44%) were treated. At baseline the treated group had more severe sleep disordered breathing compared with the untreated group: obstructive apneoa-hypopnoea index 29.3 ± 38.2 events/h versus 3.3 ± 5.2 events/h (p < 0.01). Actigraphy showed no significant differences in total sleep time, sleep efficiency, sleep schedules from baseline to follow up in either group. The sleep disturbance (p < 0.01) and total problems (p < 0.05) scales on the OSA-18 and the sleep disordered breathing subscale on the Paediatric Sleep Problem Survey Instrument (p < 0.01) improved in the treated children. There were no changes in any measure in the untreated children. Treatment of sleep disordered breathing improves symptoms, sleep disturbance and quality of life in children with Down syndrome, but has no demonstrable impact on actigraphic sleep measures or daytime behaviour or function. In contrast, children who were not treated, despite having less severe disease at baseline, had increased sleep disruption and no change in quality of life.
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Síndrome de Down , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Transtornos do Sono-Vigília , Humanos , Criança , Seguimentos , Qualidade de Vida , Síndrome de Down/complicações , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/terapia , Síndromes da Apneia do Sono/diagnóstico , Sono , Transtornos do Sono-Vigília/complicaçõesRESUMO
There is conflicting evidence for impaired autonomic control of heart rate (HR) in adults with narcolepsy and idiopathic hypersomnolence (IH). Despite these chronic hypersomnia conditions primarily being diagnosed around the age of puberty, there are limited studies in children. The present study investigated cardiovascular control using heart rate variability (HRV) and the extent of nocturnal HR dipping during sleep in children and adolescents with narcolepsy and IH. Children having an overnight polysomnographic study followed by a multiple sleep latency test (MSLT) for investigation of excessive daytime sleepiness (EDS) between May 2010 to December 2023 were included: 28 children diagnosed with narcolepsy, 11 with IH, and 26 subjectively sleepy children who did not meet the diagnostic criteria for either narcolepsy or IH. Each clinically referred child was matched for age and sex with a control. Time domain and frequency domain HRV were calculated from ECG recorded at 512 Hz. There were no differences in either time domain or spectral analysis of HRV between clinical groups or between clinical groups and their control group. The expected sleep state differences in HRV were observed in all groups. There was also no difference in HR nocturnal dipping between groups. Despite evidence for abnormal autonomic function in adults with narcolepsy and IH, our study did not identify any abnormalities in HR, HR control, or nocturnal dipping of HR in children referred for assessment of EDS. This suggests that autonomic dysfunction may be a feature of these conditions that develops in later life.
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BACKGROUND: Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB). We investigated sleep spindle activity, as a marker of sleep quality, and its relationship with daytime functioning in children with DS compared to typically developing (TD) children. METHODS: Children with DS and SDB (n = 44) and TD children matched for age, sex and SDB severity underwent overnight polysomnography. Fast or Slow sleep spindles were identified manually during N2/N3 sleep. Spindle activity was characterized as spindle number, density (number of spindles/h) and intensity (density × average duration) on central (C) and frontal (F) electrodes. Parents completed the Child Behavior Check List and OSA-18 questionnaires. RESULTS: In children with DS, spindle activity was lower compared to TD children for F Slow and F Slow&Fast spindles combined (p < 0.001 for all). Furthermore, there were no correlations between spindle activity and CBCL subscales; however, spindle activity for C Fast and C Slow&Fast was negatively correlated with OSA-18 emotional symptoms and caregiver concerns and C Fast activity was also negatively correlated with daytime function and total problems. CONCLUSIONS: Reduced spindle activity in children with DS may underpin the increased sleep disruption and negative effects of SDB on quality of life and behavior. IMPACT: Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. Sleep spindles are a sensitive marker of sleep quality. We identified for the first time that children with DS had reduced sleep spindle activity compared to typically developing children matched for SDB severity. The reduced spindle activity likely underpins the more disrupted sleep and may be associated with reduced daytime functioning and quality of life and may also be an early biomarker for an increased risk of developing dementia later in life in children with DS.
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This paper investigated cortical thickness and volumetric changes in children to better understand the impact of obstructive sleep disordered breathing (SDB) on the neurodevelopment of specific regions of the brain. We also aimed to investigate how these changes were related to the behavioral and cognitive deficits observed in the condition. Neuroimaging, behavioral, and sleep data were obtained from 30 children (15 non-snoring controls, 15 referred for assessment of SDB) aged 7 to 17 years. Gyral-based regions of interest were identified using the Desikan-Killiany atlas. Student's t-tests were used to compare regions of interest between the controls and SDB groups. We found that the cortical thickness was significantly greater in the right caudal anterior cingulate and right cuneus regions and there were volumetric increases in the left caudal middle frontal, bilateral rostral anterior cingulate, left, right, and bilateral caudate brain regions in children with SDB compared with controls. Neither cortical thickness nor volumetric changes were associated with behavioral or cognitive measures. The findings of this study indicate disruptions to neural developmental processes occurring in structural regions of the brain; however, these changes appear unrelated to behavioural or cognitive outcomes.
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BACKGROUND: Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with intermittent hypoxia and sleep disruption affecting daytime functioning. We aimed to compare the impact of SDB on sleep quality in children with DS compared to typically developing (TD) children with and without SDB. METHODS: Children with DS and SDB (n = 44) were age- and sex-matched with TD children without SDB (TD-) and also for SDB severity with TD children with SDB (TD+). Children underwent overnight polysomnography with sleep macro- and micro-architecture assessed using electroencephalogram (EEG) spectral analysis, including slow-wave activity (SWA, an indicator of sleep propensity). RESULTS: Children with DS had greater hypoxic exposure, more respiratory events during REM sleep, higher total, delta, sigma, and beta EEG power in REM than TD+ children, despite the same overall frequency of obstructive events. Compared to TD- children, they also had more wake after sleep-onset and lower sigma power in N2 and N3. The DS group had reduced SWA, indicating reduced sleep drive, compared to both TD groups. CONCLUSIONS: Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children. IMPACT: SDB in children with DS exacerbates disruption of sleep quality, compared to TD children. The prevalence of SDB is very high in children with DS; however, studies on the effects of SDB on sleep quality are limited in this population. Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children, and should be screened for and treated as soon as possible.
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Síndrome de Down , Síndromes da Apneia do Sono , Criança , Síndrome de Down/complicações , Eletroencefalografia , Humanos , Hipóxia/complicações , Polissonografia , Sono , Síndromes da Apneia do Sono/complicaçõesRESUMO
BACKGROUND: Sleep disordered breathing (SDB) in typically developing (TD) children is associated with adverse cardiovascular effects. As children with Down syndrome (DS) are at increased risk for SDB, we aimed to compare the cardiovascular effects of SDB in children with DS to those of TD children with and without SDB. METHODS: Forty-four children with DS (3-19 years) were age and sex matched with 44 TD children without SDB (TD-) and with 44 TD children with matched severity of SDB (TD+). Power spectral density was calculated from ECG recordings, for low frequency (LF), high frequency (HF), total power and the LF/HF ratio. RESULTS: Children with DS had lower HF power, and higher LF/HF during sleep and when awake. There were no differences between groups for LF power. SpO2 nadir, average SpO2 drop and SpO2 > 4% drop were larger in the DS group compared to the TD+ group (p < 0.05 for all). CONCLUSIONS: Our findings demonstrate significantly reduced parasympathetic activity (reduced HF power) and increased LF/HF (a measure of sympathovagal balance) in children with DS, together with greater exposure to hypoxia, suggesting SDB has a greater effect in these children that may contribute to an increased risk of adverse cardiovascular outcomes. IMPACT: Sleep disordered breathing in children with Down syndrome exacerbates impaired autonomic control and increases exposure to hypoxia, compared to typically developing children. In typically developing children sleep disordered breathing has adverse effects on autonomic cardiovascular control. The prevalence of sleep disordered breathing is very high in children with Down syndrome; however, studies on the effects on cardiovascular control are limited in this population. This study supports screening and early treatment of sleep disordered breathing in children with Down syndrome.
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Sistema Cardiovascular/fisiopatologia , Síndrome de Down/fisiopatologia , Síndromes da Apneia do Sono/diagnóstico , Adolescente , Pressão Sanguínea , Criança , Pré-Escolar , Feminino , Frequência Cardíaca , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVE: The contribution of non-anatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children. METHODS: Children (aged 3-18 years) with various severities of SDB (n = 110) and non-snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern. RESULTS: There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009). CONCLUSION: A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway.
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Tonsila Faríngea/patologia , Antropometria/métodos , Tonsila Palatina/patologia , Polissonografia/métodos , Síndromes da Apneia do Sono , Ronco , Criança , Correlação de Dados , Feminino , Humanos , Hiperplasia , Masculino , Tamanho do Órgão , Ventilação Pulmonar , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Ronco/etiologia , Ronco/fisiopatologiaRESUMO
BACKGROUND AND OBJECTIVE: Frequent central apnoeas are sometimes observed in healthy children; however; the pathophysiology of an elevated central apnoea index (CAI) is poorly understood. A raised CAI may indicate underlying ventilatory control instability (i.e. elevated loop gain, LG) or a depressed ventilatory drive. This pilot study aimed to compare LG in otherwise healthy children with an elevated CAI to healthy controls. METHODS: Polysomnographic recordings from children (age > 6 months) without obstructive sleep apnoea and with a CAI > 5 events/h (n = 13) were compared with age and gender-matched controls with a CAI < 5 events/h (n = 13). Spontaneous sighs were identified during non-rapid eye movement (NREM) sleep, and breath-breath measurements of ventilation were derived from the nasal pressure signal. A standard model of ventilatory control (gain, time constant and delay) was used to calculate LG by transforming ventilatory fluctuations seen in response to a sigh into a ventilatory-drive signal that best matches observed ventilation. RESULTS: The high CAI group had an elevated LG (median = 0.36 (interquartile range, IQR = 0.35-0.53) vs 0.28 (0.23-0.36); P ≤ 0.01). There was no difference in either the time constant (P = 0.63) or delay (P = 0.29) between groups. Elevated LG observed in the high CAI group remained after accounting for degree of hypoxia (average oxygen saturation (SpO2 ) during each analysable window) experienced (0.40 (0.30-0.53) vs 0.25 (0.23-0.37); P = 0.04). CONCLUSION: An elevated CAI in otherwise healthy children is associated with a raised LG compared to matched controls with a low CAI, irrespective of level of hypoxia. This relative ventilatory instability helps explain the high CAI and may ultimately be able to help guide diagnosis and management in patients with high CAI.
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Apneia do Sono Tipo Central/etiologia , Apneia do Sono Tipo Central/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Hipóxia/fisiopatologia , Lactente , Masculino , Pressão Parcial , Projetos Piloto , Polissonografia , Ventilação Pulmonar , Respiração , Sistema Respiratório/fisiopatologia , Índice de Gravidade de DoençaRESUMO
PURPOSE: Sleep-disordered breathing (SDB) in children has been associated with craniofacial characteristics. Facial photography provides a radiation-free means of estimating facial morphology through facial landmark analysis. Our objective was to determine whether facial analysis provides information about SDB severity. Specifically, we aimed to determine whether facial photographic measurements differ with SDB status, or were associated with SDB severity. METHODS: Single-center cohort of children undergoing overnight polysomnography for assessment of SDB; non-snoring controls were recruited from the community to undergo polysomnography. Standardized front and lateral facial photographs were analyzed according to previously published protocols. Multivariate analysis of variance was used to determine if facial measurements differed between SDB groups and controls. Linear regression was performed to determine if facial measurements were associated with SDB severity. RESULTS: Seventy-eight children (9 controls, 17 primary snoring, 23 mild SDB, 27 moderate-severe SDB) were included. Facial angles and upper-to-lower face height ratio showed variation between SDB groups (p = 0.038). Facial measurements related to SDB severity, specifically an increased cervicomental angle (p = 0.001), and increased lower-to-upper face height (p = 0.006). CONCLUSION: Evaluation of craniofacial features using clinical photography is feasible. Preliminary investigation shows some relationship with SBD severity. Further work is needed to determine if craniofacial photography is useful for stratifying SDB risk in children.
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Face/anatomia & histologia , Síndromes da Apneia do Sono/diagnóstico , Ronco/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Masculino , Fotografação , Polissonografia , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/fisiopatologia , Ronco/fisiopatologiaRESUMO
KEY POINTS: Sleep disordered breathing (SDB) affects 4-11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control. The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non-snoring control children was absent during sleep in children with SDB. Age significantly predicted increasing cerebral oxygenation during wake in non-snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation. Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep. SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non-snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. ABSTRACT: The repetitive episodes of hypoxia that are features of sleep disordered breathing (SDB) in children are associated with alterations in autonomic control of heart rate in an age-dependent manner. We aimed to relate heart rate variability (HRV) parameters to age and measures of cerebral oxygenation in children (3-12 years old) with SDB and non-snoring controls. Children (SDB, n = 117; controls, n = 42; 3-12 years) underwent overnight polysomnography. Total (TP), low- (LF) and high-frequency (HF) power, tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) were analysed during wake and sleep. Pearson's correlations determined the association between age and HRV parameters, and multiple linear regressions between HRV, age and cerebral oxygenation parameters. During wake, age had a positive association with LF power, reflecting increased parasympathetic and sympathetic activity with increasing age for both control and SDB groups. This association was also evident during sleep in controls, but was absent in children with SDB. In controls, during wake TOI had a positive, and FTOE a negative association with age. During sleep, TP, LF and HF power were significant, negative determinants of TOI and positive determinants of FTOE. These associations were not seen in children with SDB during wake or sleep. SDB disrupts the normal maturation of the autonomic control of heart rate and the association between HRV and cerebral oxygenation exhibited by non-snoring control children of primary school age. These results highlight the impact SDB has on cardiovascular control and the potential impact on adverse cardiovascular outcomes.
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Sistema Nervoso Autônomo/fisiologia , Síndromes da Apneia do Sono/fisiopatologia , Sono/fisiologia , Pressão Sanguínea/fisiologia , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hipóxia/fisiopatologia , Masculino , Polissonografia/métodos , Fenômenos Fisiológicos RespiratóriosRESUMO
BACKGROUND: To assess if the effects of sleep disordered breathing (SDB) on heart rate (HR) and HR variability, as a measure of autonomic control, were more severe in a group of children born preterm compared with a group of children born at term referred to our sleep laboratory for assessment of SDB. STUDY DESIGN: Children (3-12 years of age) referred for polysomnographic assessment of SDB were recruited; 50 born preterm (<37 weeks of gestation) and 50 at term, matched for age and SDB severity. The mean HR and HR variability using power spectral analysis were calculated for each child for wake and sleep, and stages N1, N2, N3, and rapid eye movement sleep. RESULTS: Ex-preterm children were born between 23 and 35 weeks of gestational age (29.3 ± 3.6; mean ± SEM). There were no differences in the demographic, sleep, or respiratory characteristics between the groups. High-frequency power (reflecting parasympathetic activity) was greater in the ex-preterm children in both N2 and N3 (P < .05 for both) and total power was greater in N3 (P < .05). When the children were divided by SDB severity, these effects were most marked in those preterm born children with moderate to severe disease. CONCLUSIONS: Preterm born children matched for age and SDB severity with children born at term showed no differences in sleep characteristics; however, they did exhibit increased parasympathetic tone during non-rapid eye movement sleep.
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Sistema Nervoso Autônomo , Doenças Cardiovasculares/fisiopatologia , Recém-Nascido Prematuro , Síndromes da Apneia do Sono/fisiopatologia , Sono , Pressão Sanguínea , Sistema Cardiovascular/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Frequência Cardíaca , Humanos , Recém-Nascido , Masculino , Polissonografia , Estudos Retrospectivos , Sono REMRESUMO
RATIONALE: Childhood sleep-disordered breathing ranges in severity from primary snoring to obstructive sleep apnea and is associated with behavioral and neurocognitive deficits. It remains unknown why children with primary snoring, who do not experience peripheral oxygen desaturation or sleep fragmentation, experience similar daytime deficits as those with obstructive sleep apnea or why effects are age-dependent. OBJECTIVES: To examine cerebral tissue oxygenation and oxygen extraction as an explanation for daytime deficits in children with primary snoring. METHODS: Children referred for suspected sleep-disordered breathing and nonsnoring control subjects underwent overnight polysomnography with near-infrared spectroscopy. Children were categorized into 3- to 6-year (n = 87) and 7- to 12-year (n = 72) old groups, and according to the obstructive apnea-hypopnea index into primary snoring (≤1 event/h), mild (>1-5 events/h), and moderate/severe obstructive sleep apnea (>5 events/h). Cognitive and behavioral performance were assessed. MEASUREMENTS AND MAIN RESULTS: In the 3- to 6-year group, there were no differences in cerebral oxygenation or oxygen extraction between severity groups. In the 7- to 12-year group, cerebral oxygenation was significantly lower, although these differences were small, in control subjects versus primary snoring during quiet wakefulness before sleep onset, N1, and REM. Oxygen extraction was significantly higher in control subjects versus primary snoring during N1 sleep, with no differences between primary snoring and obstructive sleep apnea groups. Cerebral oxygenation was not associated with cognitive performance in either age group or behavior in the 3- to 6-year group; however, it was associated with behavior in the school-aged children. CONCLUSIONS: Children with sleep-disordered breathing are able to maintain cerebral oxygenation, and the small changes observed are not related to cognitive deficits. However, in older children these differences were related to behavioral measures.
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Comportamento/fisiologia , Encéfalo/fisiologia , Oxigenação por Membrana Extracorpórea/métodos , Oxigênio/fisiologia , Fenômenos Fisiológicos Respiratórios , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/terapia , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
PURPOSE: Allergic rhinitis (AR) is a common risk factor for sleep disordered breathing (SDB) in children. Allergy to pollen is a trigger for allergic rhinitis, causing nasal inflammation, upper airway congestion and obstruction. We aimed to determine if the pollen count on the day of diagnostic polysomnography for SDB affected the result. METHODS: Children (3-18 years; n = 90) who participated in research studies between 1 October and 31 December, when daily regional pollen counts were available, in the years 2005-2016 were eligible for inclusion. All children underwent overnight polysomnography for assessment of SDB severity. Pollen was categorised as grass or other pollen. Multiple stepwise linear regression was performed to determine whether the pollen count for that day, a diagnosis of asthma, age, and BMI-z-score were determinants of respiratory parameters measured on polysomnography, including the obstructive apnoea hypopnoea index (OAHI), SpO2 nadir, average SpO2 drop, SpO2 < 90%, oxygen desaturation index > 4% (ODI4), and average transcutaneous CO2 (TCM). RESULTS: Sixteen/90 children had AR. In children with AR, an increase in grass pollen of 1 grain/m3 predicted an increase in OAHI of 0.2 events/h, ODI4 of 0.18 times/h, SpO2 < 90% of 0.03 times/h, and TCM of 0.07 mmHg. None of the factors were determinants of SDB severity in children without AR. CONCLUSION: Our findings highlight that daily pollen counts may be an important factor influencing the severity of SDB on a single night of polysomnography in children with clinical allergic rhinitis and should be taken into account when determining treatment options.
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Pólen , Polissonografia , Rinite Alérgica Sazonal/diagnóstico , Síndromes da Apneia do Sono/diagnóstico , Adolescente , Asma/diagnóstico , Asma/epidemiologia , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Rinite Alérgica Sazonal/epidemiologia , Fatores de Risco , Síndromes da Apneia do Sono/epidemiologiaRESUMO
AIM: Pulse oximetry has become a widely used technology in medicine and is a standard part of monitoring in neonatal medicine. Knowledge of basic principles, clinical and technical considerations is important to optimise clinical benefit of use, but have been shown to be insufficient in paediatric staff. We aimed to assess knowledge of pulse oximetry in neonatal medical staff, a population not previously studied. METHODS: A 21-item questionnaire (seven demographic, 14 knowledge) was devised and then administered to neonatal medical staff at all postgraduate levels working in the major public neonatal services in the state of Victoria, Australia. RESULTS: Average test score was 64.4% (range 30.8-92.3%) with no correlation between years of experience and score. All respondents reported experience with oximetry, but only 57% reported adequate training in practical oximetry skills and only 28% in interpretation of downloaded oximetry data. About 45% reported knowing what an averaging time was but only 29% were able to provide an acceptable definition and only 10% knew what averaging time was used on devices in their units. CONCLUSION: Significant knowledge deficits regarding oximetry are evident in neonatal staff, supporting the need for targeted and continuous training in oximetry.
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Competência Clínica/estatística & dados numéricos , Berçários Hospitalares/estatística & dados numéricos , Oximetria , Humanos , Recém-Nascido , VitóriaRESUMO
BACKGROUND: Obesity and anthropometric measurements predict more severe sleep-disordered breathing (SDB) in children, and are associated with cardiovascular risk factors in children without SDB. We aimed to investigate whether anthropometric measurements predicted autonomic control in children with SDB. We hypothesised that anthropometric measures would be significant predictors of decreased heart rate variability. METHODS: Children (3-17 years) with SDB (n = 298) and non-snoring controls (n = 126) underwent polysomnography. BMI z-score, neck, waist and hip circumference were recorded. Heart rate variability, indicating autonomic control, was analysed during wake, non-rapid eye movement stages N1, N2 and N3, and rapid eye movement (REM) sleep. The determinants of heart rate variability (low-frequency power [LF], high-frequency power [HF] and LF/HF ratio) were analysed using multiple stepwise linear regression. Independent variables were age, neck, waist and hip circumference, neck-to-waist ratio, waist-to-hip ratio and waist-to-height ratio, obstructive apnoea hypopnoea index, arousal index and SpO2 nadir. RESULTS: Waist and hip circumference, and waist-to-height ratio were significant negative determinants of both HF and LF power during wake, reflecting dampened autonomic control (LF: waist/height ratio, B = -1917 (95% CI: -3640, -194), p = 0.03; HF: hip circumference, B = -27, (-48, -7), p = 0.01), N1&2 (LF/HF: hip circumference, B = 0.01 (0.004, 0.024), p = 0.005) and N3 (LF: waist/height ratio, B = -2495, (-4005, -986), p = 0.001; HF, hip circumference, B = -54, (-102, -6), p = 0.03; LF/HF, waist circumference, B = 0.01, (0.004, 0.015), p = 0.002). Age was the strongest determinant of heart rate variability during wake and sleep. CONCLUSION: This study suggests that while age is a determinant of autonomic control in children with SDB, the strongest modifiable factor determining dampened autonomic control is increased central adiposity, as reflected in the waist and hip circumference and the waist-to-height ratio.
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Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca/fisiologia , Obesidade Infantil/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade Infantil/complicações , Polissonografia , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença , Sono , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/etiologia , Razão Cintura-Estatura , Relação Cintura-QuadrilRESUMO
AIM: Many children with severe developmental and epileptic encephalopathies experience significant sleep disturbance, causing major disruption to the family's quality of life. We aimed to determine the frequency and nature of sleep problems in individuals with Dravet syndrome. METHODS: The Sleep Disturbance Scale for Children and a seizure questionnaire were distributed to the parents/guardians of 96 patients with Dravet syndrome. Sixteen patients had two nights of home oximetry. RESULTS: Fifty-seven out of 96 questionnaires were completed. Forty-three out of 57 (75%) individuals had sleep problems. Twenty-five out of 57 (44%) individuals had an abnormal total sleep score, with difficulty initiating and maintaining sleep (22 out of 57, 39%), sleep-wake transition disorders (20 out of 57, 35%), and sleep breathing disorders (19 out of 57, 33%). Twenty-two out of 57 (39%) individuals took medication to assist sleep, predominantly melatonin (n=14). Thirty out of 57 (53%) recently had nocturnal seizures. Overnight oximetry showed 14 out of 16 (88%) had a higher oxygen desaturation index (>3%), and six out of 16 (38%) had higher mean pulse rates than normative values. Home oximetry was normal or inconclusive in all patients. INTERPRETATION: Seventy-five per cent of individuals with Dravet syndrome had sleep problems, highlighting the importance of routinely assessing sleep and initiating appropriate behavioural and pharmacological interventions to improve the patient and family's quality of life. A high oxygen desaturation index and mean pulse rates on pulse oximetry may reflect unrecognized nocturnal seizures. WHAT THIS PAPER ADDS: More than 70% of patients with Dravet syndrome have sleep problems. Difficulty initiating and maintaining sleep was most common, particularly in those older than 20 years. Second most common were sleep-wake transition disorders, affecting more than 50% of those younger than 5 years. Sleep breathing disorders were a frequent problem across all age groups. Oximetry was not diagnostic of sleep-disordered breathing or obvious seizures.
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Epilepsias Mioclônicas/complicações , Epilepsias Mioclônicas/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Masculino , Oximetria , Qualidade de Vida , Inquéritos e Questionários , Adulto JovemRESUMO
PURPOSE: This study aimed to examine slow wave activity (SWA), a marker of homeostatic regulation, as a potential mechanism linking sleep disordered breathing (SDB) with executive dysfunction in children. METHODS: Executive function domains of working memory, spatial planning, information processing, and sustained attention were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) in children (N = 40; 5-12 years) referred for clinical diagnosis of SDB. Polysomnography records of non-snoring, age-matched controls (N = 34) were retrospectively examined for comparison of SWA. Power spectral analysis of the delta wave determined SWA. Group differences in sleep, respiratory, and SWA outcomes were examined. Mean CANTAB scores were compared to standardized norms and correlated against SWA. RESULTS: Children with SDB showed increased SWA compared to non-snoring controls and scored < 25th percentile for planning accuracy, speed of mental processing, and task efficiency, when compared against population norms. Increasing severity of SDB was associated with an increased difficulty in solving complex tasks and time on task performance. SWA was associated with performance on tasks of early problem solving and efficiency during sustained attention. CONCLUSIONS: SWA, a subtle measure of sleep disruption and sleep regulation, is associated with deficits in problem solving and sustained attention in children with SDB. As current mechanistic theories do not account for deficits observed in children with mild forms of SDB, this study provides a promising alternative.
Assuntos
Função Executiva , Síndromes da Apneia do Sono/fisiopatologia , Sono , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Polissonografia , Estudos Retrospectivos , Ronco/fisiopatologiaRESUMO
Sleep disorders in infants and children are common and often behavioural in origin. Problems include difficulties going to sleep and/or maintaining sleep. History taking should focus on the bedtime routine, consistency of caregiver approach to settling, sleep cues and exclusion of medical problems including atopy and obstructive sleep apnoea. Management includes ascertaining parent goals, ensuring these are realistic and then offering parents a choice of evidence-based strategies, tailored to family need and capacity. Sleep diaries and parent education materials from evidence-based web sites complement the consultation.
Assuntos
Terapia Comportamental/métodos , Comportamento Infantil , Transtornos do Sono-Vigília/terapia , Criança , Humanos , Lactente , Pais/educação , Transtornos do Sono-Vigília/etiologiaRESUMO
PURPOSE: Sleep-disordered breathing (SDB) prevalence peaks in preschool children and is associated with deficits in cardiovascular functioning during sleep. No long-term studies have investigated the effects of SDB resolution in mitigating these outcomes. We hypothesized that following 3 years, normalization of alterations to heart rate (HR), pulse transit time (PTT), heart rate variability (HRV), and urinary catecholamines identified at the initial diagnosis would be associated with resolution of SDB. METHODS: Forty-five children with SDB and 28 non-snoring controls underwent polysomnography at baseline (3-5 years) and follow-up (6-9 years). Children were classified into control, resolved, and unresolved SDB. Resolution was defined as an obstructive apnea-hypopnea index (OAHI) ≤1 event/h, no snoring on polysomnography (PSG), or indicated by parents. PTT is an inverse surrogate measure of blood pressure change. HRV was assessed using power spectral analysis. RESULTS: There was no change in PTT or HR between studies for any group. Our HRV data suggest reduced parasympathetic activity in children whose SDB resolved and increased parasympathetic activity in children whose SDB remained the same or worsened at follow-up. We identified a significant correlation between low frequency power and urinary dopamine and adrenaline levels at follow-up in the unresolved group, suggesting increased sympathetic activity in children with unresolved SDB. CONCLUSION: Our findings suggest an association between resolution of SDB and normalization of HRV in the long term in these preschool children and an augmented sympathetic activity in the children with residual SDB. This highlights the autonomic impact of SDB in young children and the importance of detection and treatment.