Reduction in Parasympathetic Tone During Sleep in Children With Habitual Snoring.

Maria-Cecilia Lopes,Agostinho Rosa,Leticia Azevedo-Soster,Christian Guilleminault,Karen Spruyt

doi:10.3389/fnins.2018.00997

Abstract

Introduction: Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described. Some pediatric studies have shown cardiovascular effects in children who do not fit the criteria for OSA; namely children with mild sleep disordered breathing.Objective: We investigated heart rate variability (HRV) during sleep in children with chronic snoring and flow limitation events during sleep.Methods: Ten children and adolescents with chronic snoring and an apnea hypopnea index < 1, associated to high Respiratory Index, and 10 controls matched for age, gender, and Tanner stage were monitored following one night of habituation in the sleep laboratory. HRV was studied at each sleep stage. The time and frequency domains were calculated for each 5-min period.Results: All patients were chronic heavy snorers. They presented an apnea hypopnea index = 0.8, respiratory disturbance index = 10.2/h with lowest O2 saturation 96.1 ± 2.4%. The total power of HRV was decreased in all stages (p < 0.05). There was also a decrease in NN50 and pNN50 during all sleep stages compared to healthy controls (p = 0.0003 and p = 0.03, respectively).Conclusion: A reduction in parasympathetic tone was found in the patient group. This may represent an autonomic impairment during sleep in children with mild SDB. A reduction in HRV in children with habitual snoring could be associated with possible increases in cardiovascular risk in adulthood.Significance: The study indicates that children with habitual snoring have important parasympathetic tone changes during sleep.

Highlights

Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described
Children with obstructive sleep apnea (OSA) do not usually develop high blood pressure (BP), (Guilleminault et al, 2004) the levels of overnight urinary noradrenaline and adrenaline are increased and changes occur in the sympathetic tone that may contribute to the cardiovascular consequences of the condition (O’Driscoll et al, 2011)
Inclusion criteria: All children whose parents had consented to their participation and agreed to the anonymous use of their polysomnographic data, exhibiting the presence of regular snoring during sleep associated with flow limitation that did not meet the criteria of hypopnea as defined by the International Classification of Sleep Disorders 3rd edition (2014), (American Academy of Sleep Medicine, 2014) but with respiratory disturbance index (RDI) >2 events/h based on nasal cannula-pressure transducer or esophageal pressure monitoring

Summary

Introduction

Changes in the autonomic nervous system due to Obstructive Sleep Apnea (OSA) during the life span have been described. Sleep disordered breathing (SDB) in children is associated with abnormal daytime behavior (Guilleminault et al, 1982) and neurobehavioral morbidity such as behavior problems (Ali et al, 1993; Chervin et al, 2006), cognitive deficits (Blunden et al, 2000; Halbower et al, 2006), and poor academic performance (Gozal, 1998; Urschitz et al, 2003). Children with obstructive sleep apnea (OSA) do not usually develop high blood pressure (BP), (Guilleminault et al, 2004) the levels of overnight urinary noradrenaline and adrenaline are increased and changes occur in the sympathetic tone that may contribute to the cardiovascular consequences of the condition (O’Driscoll et al, 2011). A subgroup of normal-weight children with SDB may even present low BP (Guilleminault et al, 2004)

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Results

Discussion

Conclusion