The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.
J Physiol. 2019 Feb;597(3):819-830. doi: 10.1113/JP276933. Epub 2018 Dec 11.
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.
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.
睡眠呼吸障碍（SDB）影响 4-11%的儿童，与神经认知、行为和心血管不良后果相关，包括自主控制降低。非打鼾对照组儿童在睡眠期间的心率变异性（HRV；自主控制的一种测量）与年龄之间的关系在 SDB 儿童睡眠期间不存在。非打鼾对照组儿童在清醒时，年龄显著预测脑氧合增加，而在睡眠时，HRV 显著预测脑氧合减少。在清醒和睡眠期间，SDB 儿童的脑氧合与年龄或 HRV 均无关联。SDB 显著破坏自主控制的正常成熟以及非打鼾儿童中自主控制与脑氧合之间的正相关关系，我们推测 SDB 儿童表现出的自主控制减弱可能通过 HRV 对脑血流的调节作用对脑自动调节产生衰减影响。
儿童睡眠呼吸障碍（SDB）的反复发作性缺氧与心率自主控制的改变有关，这种改变在年龄依赖性方式下发生。我们旨在研究心率变异性（HRV）参数与年龄以及 SDB 和非打鼾对照组儿童（3-12 岁）脑氧合指标之间的关系。儿童（SDB，n=117；对照组，n=42；3-12 岁）进行了一整夜多导睡眠图监测。在清醒和睡眠期间分析总（TP）、低（LF）和高（HF）频带功率、组织氧指数（TOI）和部分组织氧提取（FTOE）。Pearson 相关性确定了年龄与 HRV 参数之间的关联，以及 HRV、年龄和脑氧合参数之间的多元线性回归。在清醒时，LF 功率与年龄呈正相关，反映了对照组和 SDB 组随着年龄的增长，迷走神经和交感神经活动的增加。这种关联在对照组的睡眠期间也很明显，但在 SDB 儿童中却不存在。在对照组中，清醒时 TOI 与年龄呈正相关，而 FTOE 与年龄呈负相关。在睡眠期间，TP、LF 和 HF 功率是 TOI 的显著负相关因素，是 FTOE 的显著正相关因素。在清醒或睡眠期间，SDB 儿童均未出现这些关联。SDB 破坏了正常的心率自主控制成熟以及非打鼾学龄期儿童的 HRV 和脑氧合之间的关联。这些结果强调了 SDB 对心血管控制的影响，以及对不良心血管后果的潜在影响。
