Nocturnal dipping of heart rate is impaired in children with Down syndrome and sleep disordered breathing

Ahmad Bassam, Julie Thacker, Lisa M. Walter, Margot J. Davey, Gillian M. Nixon, Rosemary SC Horne

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2 Citations (Scopus)


Background: Children with Down syndrome (DS) are at increased risk for sleep disordered breathing (SDB), which can have adverse effects on the cardiovascular system. In adults with SDB, nocturnal dipping of heart rate (HR) and blood pressure (BP) is reduced, and this is associated with an increased risk of future cardiovascular events. We aimed to compare nocturnal dipping of HR and pulse transit time (PTT) (a surrogate inverse measure of BP change) in children with DS and SDB to those of typically developing (TD) children with and without SDB. Methods: 19 children with DS (3–18 years) were age and sex matched with 19 TD children without SDB (TD-) and with 19 TD children with matched severity of SDB (TD+). Nocturnal dipping was assessed as the percentage change in HR and PTT from wake before sleep onset to total sleep, N2, N3 and REM sleep across the night and to the first cycle of sleep. Results: Children with DS exhibited reduced nocturnal dipping of HR during total sleep, N2, N3 and REM sleep and increased PTT (reduced BP dipping) in N2 sleep. Fewer children with DS exhibited a greater than 10% fall in HR between wake and N2 or REM sleep compared to TD+ children. Conclusions: Our findings demonstrate significantly reduced nocturnal dipping of HR in children with DS compared to TD children matched for SDB severity, suggesting SDB has a greater cardiovascular effect in these children. Further studies are required to fully understand the mechanisms involved and to assess if treatment of SDB improves nocturnal dipping.

Original languageEnglish
Pages (from-to)466-473
Number of pages8
JournalSleep Medicine
Publication statusPublished - May 2021


  • Nocturnal dipping
  • Obstructive sleep apnoea
  • Paediatric
  • Sleep

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