Sleep-disordered breathing, sleep stages, and heart rate variability in children

儿童睡眠呼吸障碍、睡眠阶段和心率变异性

• 批准号: 7235076
• 负责人: Duanping Liao
• 金额: $ 18.31万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-01 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7235076
• 关键词: Adult; Apnea; Arrhythmia; Blood Pressure; Cardiac; Cardiology; Central obesity; Characteristics; Child; Childhood; Chronic; Clinical; Complex; Condition; Cross-Sectional Studies; Data; Databases; Development; Diabetes Mellitus; Dose; Electrocardiogram; Equilibrium; Event; Fatty acid glycerol esters; Frequencies; Funding; Grant; Heart Diseases; Heart Rate; Hormone replacement therapy; Hormones; Hour; Hypertension; Impairment; Inflammation; Insulin Resistance; Invasive; Knowledge; Laboratory Study; Lead; Link; Measures; Metabolic; Metabolic Diseases; Metabolic syndrome; Modification; NIH Program Announcements; Numbers; Obstructive Sleep Apnea; Pathway interactions; Pattern; Physical Examination; Play; Polycystic Ovary Syndrome; Population; Population Study; Postmenopause; Premenopause; Prevalence; Process; Psychometrics; Publishing; Purpose; Randomized; Recording of previous events; Research; Risk; Risk Assessment; Risk Factors; Role; Sampling; School-Age Population; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Stages; Staging; Standards of Weights and Measures; Testing; Time; Visceral; Woman; Women' s Health; Work; base; cardiovascular disorder risk; cognitive function; cohort; diabetes risk; elementary school; heart disease risk; improved; indexing; novel; psychologic; response; roentgen equivalent man; sudden cardiac death

DESCRIPTION (provided by applicant): The purpose of this study is to explore the significant roles of cardiac autonomic control in sleep-disordered breathing (SDB) during various sleep stages in an established cohort of 700 children randomly generated from public elementary schools (K-5). The cohort was originally established from an NHLBI-funded R01 study entitled "Prevalence of Sleep-Disordered Breathing in Children (R01-HL-63772-05)." The objectives of the original study were to evaluate the prevalence of childhood SDB and to identify correlates. One of the major findings was that systolic blood pressure was significantly associated with SDB independent of BMI. The baseline examinations included a standardized overnight sleep laboratory study, comprehensive sleep history, physical examination and a psychometric battery that assesses psychological and cognitive functions. Extensive data on SDB, episodes of apnea, sleep quality, and sleep stages were collected. As a "by-product" of the baseline standard 9-hour polysomnogram, a single channel of continuous EKG data were also recorded and stored. We propose to process and analyze these EKG data, which is a new task not included in the original study. We will derive time and frequency domain measures of heart rate variability (HRV) indices as measures of cardiac autonomic control. Specifically, we will calculate overall 9-hour HRV, sleep stage specific 5-minute HRV, and before and after apnea episode 5-minute HRV. The HRV indices will be analyzed together with the extensive and already available SDB data to examine the following research questions: (1) Whether SDB is associated with poor HRV profiles, indicating impairment of cardiac autonomic control; (2) Whether there is a dose response relationship between the degree of SDB and HRV impairment; (3) Whether there is an effect modification by BMI on the above SDB and HRV associations; (4) Whether impaired autonomic control as measured by HRV explains the relationship between SDB and elevated blood pressure in children; (5) Whether an episode of sleep apnea leads to immediate impairment of cardiac autonomic balance; and (6) What is the quantitative relationship between sleep stages (REM, nonREM, and wake stages) and cardiac autonomic control in children, and whether SDB has a negative impact on such relationship? This proposed cross-sectional study is based on our previous extensive works on cardiac autonomic control, SDB in children and adults, and metabolic disorders. It is highly responsive to a recent RFA (Program Announcement Number: PA-06-238, "Research on Sleep and Sleep Disorders (R21)." Analysis of these cardiac autonomic control data in combination with extensive sleep data from the original study will enable us to determine whether we can successfully extend our traditional sleep disorder study in cardiac risk assessment, which has grown into a distinctive and matured research and application in cardiology. This project will also enable us to test a novel research hypothesis - that SDB is associated with higher cardiovascular disease risk partially by its negative impact on cardiac autonomic control towards parasympathetic impairment and sympathetic over-activation. About 20-28% school-aged children have SDB, and 1-3% school-aged children have obstructive sleep apnea, the most severe form of SDB. This project will enable us to successfully extend our traditional sleep disorder study into cardiac risk assessment. This project will also enable us to test a novel research hypothesis - that SDB in children is associated with higher cardiac risk partially by its negative impact on cardiac autonomic control towards parasympathetic impairment and sympathetic over-activation, which can lead to decreased threshold for fatal arrhythmias and elevated blood pressure. The knowledge gained from this study can potentially improve the management and treatment of childhood SDB.

描述（由申请人提供）：本研究的目的是在各个睡眠阶段探索心脏自主神经控制在睡眠呼吸呼吸（SDB）中的重要作用。 5）。该队列最初是从NHLBI资助的R01研究中确定的，标题为“儿童睡眠呼吸的呼吸率（R01-HL-63772-05）”。原始研究的目标是评估儿童SDB的流行率并确定相关性。主要发现之一是收缩压与独立于BMI的SDB显着相关。基线检查包括标准化的隔夜睡眠实验室研究，全面的睡眠病史，体格检查以及评估心理和认知功能的心理测量电池。收集了有关SDB，呼吸暂停，睡眠质量和睡眠阶段的大量数据。作为基线标准9小时多词的“副产品”，还记录并存储了连续心电图数据的单个通道。我们建议处理和分析这些心电图数据，这是原始研究中未包括的新任务。我们将得出心率变异性（HRV）指数的时间和频域度量，作为心脏自主神经控制的度量。具体而言，我们将计算总体9小时的HRV，睡眠阶段特定的5分钟HRV，以及呼吸暂停发作5分钟的HRV之前和之后。 HRV指数将与已有广泛且已经可用的SDB数据一起进行分析，以检查以下研究问题：（1）SDB是否与HRV差不良有关，表明心脏自主神经控制损害； （2）SDB和HRV损伤程度之间是否存在剂量反应关系； （3）BMI是否对上述SDB和HRV关联进行效应修改； （4）HRV衡量的自主控制受损是否解释了儿童的SDB与升高的血压之间的关系； （5）睡眠呼吸暂停的发作是否会立即导致心脏自主平衡受损； （6）儿童的睡眠阶段（REM，非REM和唤醒阶段）和心脏自主神经控制之间的定量关系是什么，以及SDB是否对这种关系产生负面影响？这项拟议的横断面研究基于我们以前关于心脏自主神经控制，儿童和成人的SDB以及代谢疾病的广泛著作。它对最近的RFA有很高的反应（程序公告编号：PA-06-238，“睡眠和睡眠障碍研究（R21）。”对这些心脏自主神经控制数据的分析以及原始研究的广泛睡眠数据将启用我们确定我们是否可以在心脏风险评估中成功扩展我们的传统睡眠障碍研究，该研究已成长为一个独特的成熟研究和心脏病学的应用。较高的心血管疾病因其对副交感神经障碍和交感神经过度激活而对心脏自主神经控制的负面影响有部分风险。 SDB的严重形式。对心脏自主神经控制对副交感神经障碍和交感神经过度激活的影响，这可能导致致命心律不齐和血压升高的阈值降低。从这项研究中获得的知识可以改善儿童SDB的管理和治疗。