Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Pediatric Intensive Care Unit, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
Sleep Med. 2018 May;45:1-6. doi: 10.1016/j.sleep.2017.09.036. Epub 2017 Nov 14.
In the spectrum of children with symptomatic sleep disordered breathing (SDB), some individuals - such as those with upper airway resistance syndrome (UARS) - do not have abnormalities on polysomnography (PSG). In this study we have assessed whether assessment of respiratory arrhythmia (RA) and heart rate variability (HRV) analysis helps in management of children with syndromic craniosynostosis and none-to-mild obstructive sleep apnea (OSA).
Prospective cohort study in children aged 1-18 years old with syndromic craniosynostosis. Children were selected for HRV analysis from the ECG if their obstructive apnea-hypopnea index (oAHI) was between zero and five per hour (ie, oAHI ≤5/hour). Subjects were divided into groups based on the presence or absence of respiratory arrhythmia (with or without RA respectively) using the electrocardiogram (ECG). The main analysis included studying the relationship between RA and HRV, symptoms, interventions, and sleep architecture.
We identified 42 patients with, at worst, mild OSA. We found higher parasympathetic control and higher total power in children with RA during the non-rapid eye movement (non-REM) sleep. Children with RA also have a relatively higher percentage of paradoxical breathing during non-REM sleep (P = 0.042). Intracranial hypertension was distributed equally between groups. Last, RA patients showed increased parasympathetic activity that further increased in non-REM sleep.
In syndromic craniosynostosis cases with SDB and PSG showing oAHI ≤5/hour, the presence of RA may indicate subsequent need for treatment interventions, and a trend toward higher occurrence of clinical symptoms. ECG analyses of HRV variables in subjects with RA demonstrate increased parasympathetic activity and total power. Such findings may add to the diagnosis of apparently asymptomatic children.
在有症状性睡眠呼吸障碍（SDB）的儿童中，有些患者，如存在上气道阻力综合征（UARS）的患者，在多导睡眠图（PSG）上并无异常。本研究旨在评估呼吸节律紊乱（RA）和心率变异性（HRV）分析是否有助于患有综合征性颅缝早闭和无至轻度阻塞性睡眠呼吸暂停（OSA）的儿童的管理。
这是一项前瞻性队列研究，研究对象为患有综合征性颅缝早闭的 1-18 岁儿童。如果患儿的阻塞性呼吸暂停低通气指数（oAHI）在 0-5 次/小时之间（即 oAHI≤5 次/小时），则从心电图（ECG）中选择患儿进行 HRV 分析。根据心电图（ECG）是否存在呼吸节律紊乱（分别为有或无 RA），将患儿分为两组。主要分析包括研究 RA 与 HRV、症状、干预措施和睡眠结构之间的关系。
我们共纳入 42 例患有重度 OSA 的患儿。我们发现，在非快速眼动（non-REM）睡眠期间，存在 RA 的患儿副交感神经控制更好，总功率更高。在非快速眼动（non-REM）睡眠期间，存在 RA 的患儿也有相对更高比例的矛盾呼吸（P=0.042）。颅内压增高在两组间分布均匀。最后，RA 患者表现出副交感神经活动增加，且在非快速眼动（non-REM）睡眠时进一步增加。
在 SDB 综合征性颅缝早闭病例中，PSG 显示 oAHI≤5 次/小时，RA 的存在可能提示需要后续治疗干预，且有更高的临床症状发生趋势。RA 患者的 HRV 变量心电图（ECG）分析显示副交感神经活动和总功率增加。这些发现可能有助于诊断无症状患儿。
