Walter Lisa M, Bhatnagar Dhruv, Ong Miles B H, Staykov Eric, Mann Dwayne L, Davey Margot J, Nixon Gillian M, Horne Rosemary S C, Edwards Bradley A
Department of Paediatrics, Monash University, Melbourne, Australia.
School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia.
J Sleep Res. 2025 Mar 18:e70032. doi: 10.1111/jsr.70032.
Hypoxic burden (HB) is a measure incorporating frequency, depth and duration of respiratory event-related desaturations. While HB is associated with cardiovascular disease in adults with obstructive sleep apnea (OSA), it has not been assessed in typically developing (TD) children with OSA, nor in children with Down syndrome (DS), who have a higher incidence of OSA with more severe hypoxia. We assessed whether HB in these children was related to heart rate variability (HRV), an indicator of cardiovascular outcomes. Children (3-19 years, n = 44) with DS and TD children matched for OSA severity, age and sex underwent overnight polysomnography and were grouped into primary snoring (PS), Mild or Moderate/Severe (MS) OSA. HRV was analysed using power spectral analysis of the electrocardiograph. Regression analysis determined whether HB was predictive of HRV. Children with MS OSA in both groups had higher HB compared with children with PS (p < 0.001 for both) and Mild OSA (DS, p < 0.001; TD, p < 0.05). Children with DS and PS or Mild OSA had higher HB compared with TD children (PS p < 0.05; Mild OSA p < 0.001). There was no difference between the MS OSA groups. HB predicted dampened sympathetic and parasympathetic activity only in children with DS (R = 0.12, β = -10.6, SE = 4.6, p = 0.03). HB was higher in children with DS and PS or Mild OSA compared to TD children and predicted dampened autonomic function in children with DS. The potential contribution of the adverse effects of HB on autonomic function adds weight to the importance of identifying and treating OSA in children with DS.
缺氧负荷（HB）是一种综合了呼吸事件相关去饱和的频率、深度和持续时间的测量方法。虽然HB与阻塞性睡眠呼吸暂停（OSA）成人的心血管疾病有关，但尚未在典型发育（TD）的OSA儿童中进行评估，也未在唐氏综合征（DS）儿童中进行评估，DS儿童的OSA发病率更高，缺氧更严重。我们评估了这些儿童的HB是否与心率变异性（HRV）相关，HRV是心血管结局的一个指标。患有DS的儿童（3 - 19岁，n = 44）和与OSA严重程度、年龄和性别相匹配的TD儿童接受了整夜多导睡眠图检查，并被分为原发性打鼾（PS）、轻度或中度/重度（MS）OSA组。使用心电图的功率谱分析来分析HRV。回归分析确定HB是否可预测HRV。两组中患有MS OSA的儿童与患有PS的儿童相比，HB更高（两者均p < 0.001），与轻度OSA儿童相比也更高（DS组，p < 0.001；TD组，p < 0.05）。患有DS且为PS或轻度OSA的儿童与TD儿童相比，HB更高（PS组p < 0.05；轻度OSA组p < 0.001）。MS OSA组之间没有差异。仅在患有DS的儿童中，HB可预测交感神经和副交感神经活动减弱（R = 0.12，β = -10.6，SE = 4.6，p = 0.03）。与TD儿童相比，患有DS且为PS或轻度OSA的儿童HB更高，且可预测患有DS的儿童自主神经功能减弱。HB对自主神经功能的不良影响的潜在作用进一步凸显了识别和治疗DS儿童OSA的重要性。
