TY - JOUR
T1 - Cardiac and sympathetic activation are reduced in children with Down syndrome and sleep disordered breathing
AU - O'Driscoll, Denise Marie
AU - Horne, Rosemary Sylvia Claire
AU - Davey, Margot J
AU - Hope, Sarah Anne
AU - Anderson, Vicki Anne
AU - Trinder, John A
AU - Walker, Adrian Mark
AU - Nixon, Gillian Michelle
PY - 2012
Y1 - 2012
N2 - Sleep disordered breathing (SDB) occurs at an increased incidence in children with Down Syndrome (DS) compared to the general pediatric population. We hypothesized that, compared with typically developing (TD) children with SDB, children with DS have a reduced cardiovascular response with delayed reoxygenation after obstructive respiratory events, and reduced sympathetic drive, providing a potential explanation for their increased risk of pulmonary hypertension. DESIGN: Beat-by-beat heart rate (HR) was analyzed over the course of obstructive events (pre, early, late, post-event) and compared between groups. Also compared were the time for oxygen resaturation post-event and overnight urinary catecholamines. SETTING: Pediatric sleep laboratory. PATIENTS: Sixty-four children aged 2-17 y referred for investigation of SDB (32 DS; 32 TD) matched for age and obstructive apnea/hypopnea index. MEASUREMENT AND RESULTS: Children underwent overnight polysomnography with overnight urine collection. Compared to TD children, those with DS had significantly reduced HR changes post-event during NREM (DS: 21.4 +/- 1.8 , TD: 26.6 +/- 1.6 , change from late to post-event, P <0.05). The time to resaturation post-event was significantly increased in the DS group (P <0.05 for both NREM and REM sleep). Children with DS had significantly reduced overnight urinary noradrenaline (P <0.01), adrenaline (P <0.05) and dopamine levels (P <0.01) compared with TD children. CONCLUSION: Children with DS and SDB exhibit a compromised acute cardio-respiratory response and dampened sympathetic response to SDB compared with TD children with SDB. These data may reflect autonomic dysfunction in children with DS that may place them at increased risk for cardiovascular complications such as pulmonary hypertension.
AB - Sleep disordered breathing (SDB) occurs at an increased incidence in children with Down Syndrome (DS) compared to the general pediatric population. We hypothesized that, compared with typically developing (TD) children with SDB, children with DS have a reduced cardiovascular response with delayed reoxygenation after obstructive respiratory events, and reduced sympathetic drive, providing a potential explanation for their increased risk of pulmonary hypertension. DESIGN: Beat-by-beat heart rate (HR) was analyzed over the course of obstructive events (pre, early, late, post-event) and compared between groups. Also compared were the time for oxygen resaturation post-event and overnight urinary catecholamines. SETTING: Pediatric sleep laboratory. PATIENTS: Sixty-four children aged 2-17 y referred for investigation of SDB (32 DS; 32 TD) matched for age and obstructive apnea/hypopnea index. MEASUREMENT AND RESULTS: Children underwent overnight polysomnography with overnight urine collection. Compared to TD children, those with DS had significantly reduced HR changes post-event during NREM (DS: 21.4 +/- 1.8 , TD: 26.6 +/- 1.6 , change from late to post-event, P <0.05). The time to resaturation post-event was significantly increased in the DS group (P <0.05 for both NREM and REM sleep). Children with DS had significantly reduced overnight urinary noradrenaline (P <0.01), adrenaline (P <0.05) and dopamine levels (P <0.01) compared with TD children. CONCLUSION: Children with DS and SDB exhibit a compromised acute cardio-respiratory response and dampened sympathetic response to SDB compared with TD children with SDB. These data may reflect autonomic dysfunction in children with DS that may place them at increased risk for cardiovascular complications such as pulmonary hypertension.
UR - http://www.journalsleep.org/ViewAbstract.aspx?pid=28640
U2 - 10.5665/sleep.2084
DO - 10.5665/sleep.2084
M3 - Article
SN - 0161-8105
VL - 35
SP - 1269
EP - 1275
JO - Sleep
JF - Sleep
IS - 9
ER -