Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain.
Sleep. 2022 Feb 14;45(2). doi: 10.1093/sleep/zsab214.
Pediatric obstructive sleep apnea (OSA) affects cardiac autonomic regulation, altering heart rate variability (HRV). Although changes in classical HRV parameters occur after OSA treatment, they have not been evaluated as reporters of OSA resolution. Specific frequency bands (named BW1, BW2, and BWRes) have been recently identified in OSA. We hypothesized that changes with treatment in these spectral bands can reliably identify changes in OSA severity and reflect OSA resolution.
Four hundred and four OSA children (5-9.9 years) from the prospective Childhood Adenotonsillectomy Trial were included; 206 underwent early adenotonsillectomy (eAT), while 198 underwent watchful waiting with supportive care (WWSC). HRV changes from baseline to follow-up were computed for classical and OSA-related frequency bands. Causal mediation analysis was conducted to evaluate how treatment influences HRV through mediators such as OSA resolution and changes in disease severity. Disease resolution was initially assessed by considering only obstructive events, and was followed by adding central apneas to the analyses.
Treatment, regardless of eAT or WWSC, affects HRV activity, mainly in the specific frequency band BW2 (0.028-0.074 Hz). Furthermore, only changes in BW2 were specifically attributable to all OSA resolution mediators. HRV activity in BW2 also showed statistically significant differences between resolved and non-resolved OSA.
OSA treatment affects HRV activity in terms of change in severity and disease resolution, especially in OSA-related BW2 frequency band. This band allowed to differentiate HRV activity between children with and without resolution, so we propose BW2 as potential biomarker of pediatric OSA resolution.
Childhood Adenotonsillectomy Trial, NCT00560859, https://sleepdata.org/datasets/chat.
小儿阻塞性睡眠呼吸暂停（OSA）影响心脏自主调节，改变心率变异性（HRV）。尽管 OSA 治疗后经典 HRV 参数发生变化，但尚未评估其作为 OSA 缓解的报告者。最近在 OSA 中已经确定了特定的频带（称为 BW1、BW2 和 BWRes）。我们假设，这些频谱带在治疗中的变化可以可靠地识别 OSA 严重程度的变化，并反映 OSA 缓解。
前瞻性儿童腺样体扁桃体切除术试验纳入了 404 名 OSA 儿童（5-9.9 岁）；其中 206 名接受了早期腺样体扁桃体切除术（eAT），198 名接受了观察等待和支持性护理（WWSC）。从基线到随访，计算了经典和 OSA 相关频带的 HRV 变化。因果中介分析用于评估治疗如何通过 OSA 缓解和疾病严重程度变化等中介因素影响 HRV。疾病缓解最初仅通过考虑阻塞性事件进行评估，并在将中枢性呼吸暂停纳入分析后进行了随访。
无论接受 eAT 还是 WWSC，治疗都会影响 HRV 活动，主要是在特定的 BW2 频带（0.028-0.074 Hz）。此外，BW2 中的变化仅与所有 OSA 缓解中介因素有关。BW2 中的 HRV 活动在缓解和未缓解 OSA 之间也存在统计学差异。
OSA 治疗会影响 HRV 活动，包括严重程度的变化和疾病缓解，特别是在与 OSA 相关的 BW2 频带。该频带可以区分有缓解和无缓解的 OSA 儿童之间的 HRV 活动，因此我们提出 BW2 作为小儿 OSA 缓解的潜在生物标志物。
儿童腺样体扁桃体切除术试验，NCT00560859，https://sleepdata.org/datasets/chat。
