Walter Lisa M, Shetty Marisha, Bassam Ahmad, Davey Margot J, Nixon Gillian M, Horne Rosemary S C
Department of Paediatrics, Monash University, Melbourne, Australia.
Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia.
J Sleep Res. 2025 Oct;34(5):e70053. doi: 10.1111/jsr.70053. Epub 2025 Mar 27.
Children with Down syndrome (DS) have a dampened heart rate (HR) response at obstructive respiratory event termination compared with typically developing children. Whether improving obstructive sleep apnoea (OSA) severity improves the HR response to both obstructive and central events remains unknown. Twenty-four children (3-19 years at baseline) were included. Children were grouped into improved (decrease in obstructive apnoea-hypopnoea index to ≤ 50% of baseline; n = 12; seven treated between studies) and unimproved (n = 12; two treated between studies) 2 years following baseline study. Beat-to-beat HR was averaged 10 s before (pre), during, and the peak after (post) each obstructive and central event during sleep, expressed as percentage change. A total of 1018 obstructive respiratory events were analysed during total sleep; 583 events were analysed at baseline and 435 at follow-up. A total of 330 central events were analysed during total sleep; 164 central events were at baseline and 166 were at follow-up. In the unimproved group, the % change in HR from during the event to post-event was smaller at follow-up for both obstructive (mean 16.8%, 95% CI [17.4%, 20.6%] vs. 22.3% [21.1%, 26.0%] and central events: 15.8% [13.6%, 17.9%] vs. 26.1% [22.4%, 29.9%]; p < 0.05 for both). % change remained unchanged between studies in the improved group. These results suggest that the dampened HR response to respiratory events seen in children with DS worsens over time when OSA does not improve, adding weight to the need for diagnosis and management of OSA in this population.
与发育正常的儿童相比，唐氏综合征（DS）患儿在阻塞性呼吸事件终止时心率（HR）反应减弱。改善阻塞性睡眠呼吸暂停（OSA）严重程度是否能改善对阻塞性和中枢性事件的HR反应仍不清楚。纳入了24名儿童（基线时年龄3至19岁）。在基线研究2年后，儿童被分为改善组（阻塞性呼吸暂停低通气指数降至≤基线的50%；n = 12；7名在研究期间接受治疗）和未改善组（n = 12；2名在研究期间接受治疗）。逐搏心率在睡眠期间每次阻塞性和中枢性事件之前（pre）、期间和之后（post）的10秒内进行平均，以百分比变化表示。在总睡眠期间共分析了1018次阻塞性呼吸事件；基线时分析了583次事件，随访时分析了435次。在总睡眠期间共分析了330次中枢性事件；基线时有164次中枢性事件，随访时有166次。在未改善组中，阻塞性事件（平均16.8%，95%CI[17.4%，20.6%]对22.3%[21.1%，26.0%]）和中枢性事件从事件期间到事件后的HR百分比变化在随访时较小：15.8%[13.6%，17.9%]对26.1%[22.4%，29.9%]；两者p均<0.05）。在改善组中，研究之间百分比变化保持不变。这些结果表明，当OSA没有改善时，DS患儿中观察到的对呼吸事件的HR反应减弱会随着时间的推移而恶化，这进一步说明了对该人群进行OSA诊断和管理的必要性。
