Indiana University School of Medicine, Indianapolis, Indiana, USA.
Division of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Pediatr Pulmonol. 2021 May;56(5):1092-1102. doi: 10.1002/ppul.25242. Epub 2021 Jan 12.
BACKGROUND/OBJECTIVES: Adults with heart failure (HF) have high prevalence of central sleep apnea (CSA). While this has been repeatedly investigated in adults, there is a deficiency of similar research in pediatric populations. The goal of this study was to compare prevalence of CSA in children with and without HF and correlate central apneic events with heart function.
Retrospective analysis of data from children with and without HF was conducted. Eligible children were less than 18 years old with echocardiogram and polysomnogram within 6 months of each other. Children were separated into groups with and without HF based on left ventricular ejection fraction (LVEF). Defining CSA as central apnea-hypopnea index (CAHI) more than 1/hour, the cohort was also classified into children with and without CSA for comparative study.
A total of 120 children (+HF: 19, -HF: 101) were included. The +HF group was younger, with higher prevalence of trisomy 21, muscular dystrophy, oromotor incoordination, and structural heart disease. The +HF group had lower apnea-hypopnea index (median: 3/hour vs. 8.6/hour) and lower central apnea index (CAI) (median: 0.2/hour vs. 0.55/hour). Prevalence of CSA was similar in both groups (p = .195). LogCAHI was inversely correlated to age (Pearson correlation coefficient: -0.245, p = .022). Children with CSA were younger and had higher prevalence of prematurity (40% vs. 5.3%). There was no significant difference in LVEF between children with and without CSA. After excluding children with prematurity, relationship between CAHI and age was no longer sustained.
In contrast to adults, there is no difference in prevalence of CSA in children with and without HF. Unlike in adults, LVEF does not correlate with CAI in children. Overall, it appears that central apneic events may be more a function of age and prematurity rather than of heart function.
背景/目的：心力衰竭（HF）的成年人中，中枢性睡眠呼吸暂停（CSA）的患病率很高。尽管这在成年人中已被反复研究，但在儿科人群中类似的研究还很缺乏。本研究的目的是比较伴有和不伴有 HF 的儿童 CSA 的患病率，并将中枢性呼吸暂停事件与心功能相关联。
对伴有和不伴有 HF 的儿童数据进行回顾性分析。合格的儿童年龄小于 18 岁，在 6 个月内进行了超声心动图和多导睡眠图检查。根据左心室射血分数（LVEF）将儿童分为 HF 组和非 HF 组。将 CSA 定义为中枢性呼吸暂停-低通气指数（CAHI）>1/小时，还将队列分为伴有和不伴有 CSA 的儿童进行比较研究。
共纳入 120 名儿童（HF 组：19 名，非 HF 组：101 名）。HF 组年龄较小，21 三体综合征、肌营养不良、口运动不协调和结构性心脏病的患病率较高。HF 组的呼吸暂停-低通气指数（中位数：3/小时 vs. 8.6/小时）和中枢性呼吸暂停指数（CAI）（中位数：0.2/小时 vs. 0.55/小时）较低。两组 CSA 的患病率相似（p=0.195）。LogCAHI 与年龄呈负相关（Pearson 相关系数：-0.245，p=0.022）。伴有 CSA 的儿童年龄较小，且早产儿的患病率较高（40% vs. 5.3%）。伴有和不伴有 CSA 的儿童的 LVEF 无显著差异。排除早产儿后，CAHI 与年龄之间的关系不再维持。
与成人不同，伴有和不伴有 HF 的儿童 CSA 的患病率无差异。与成人不同，LVEF 与儿童的 CAI 不相关。总体而言，中枢性呼吸暂停事件似乎更多地是年龄和早产儿的作用，而不是心功能的作用。
