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: 7414751
• 负责人: Duanping Liao
• 金额: $ 21.98万
• 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 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7414751
• 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）：本研究的目的是在公立小学（K-5）随机产生的 700 名儿童的既定队列中，探讨不同睡眠阶段心脏自主控制在睡眠呼吸障碍（SDB）中的重要作用。该队列最初是根据 NHLBI 资助的一项题为“儿童睡眠呼吸障碍的患病率 (R01-HL-63772-05)”的 R01 研究建立的。最初研究的目的是评估儿童 SDB 的患病率并确定相关因素。主要发现之一是收缩压与 SDB 显着相关，与 BMI 无关。基线检查包括标准化的夜间睡眠实验室研究、全面的睡眠史、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、呼吸暂停发作、睡眠质量和睡眠阶段的大量数据。作为基线标准 9 小时多导睡眠图的“副产品”，还记录并存储了单通道连续 EKG 数据。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含的新任务。我们将得出心率变异性（HRV）指数的时域和频域测量作为心脏自主控制的测量。具体来说，我们将计算总体 9 小时 HRV、特定睡眠阶段的 5 分钟 HRV 以及呼吸暂停发作前后 5 分钟 HRV。 HRV 指数将与广泛且现有的 SDB 数据一起进行分析，以检验以下研究问题：（1）SDB 是否与 HRV 曲线较差有关，表明心脏自主控制受损； （2）SDB程度与HRV受损程度是否存在剂量反应关系； (3) BMI对上述SDB和HRV关联是否存在影响修正； (4) HRV测量的自主神经控制受损是否可以解释SDB与儿童血压升高之间的关系； （5）睡眠呼吸暂停发作是否会立即导致心脏自主神经平衡受损； （6）儿童睡眠阶段（快速眼动阶段、非快速眼动阶段、觉醒阶段）与心脏自主控制之间的定量关系如何？SDB是否对这种关系产生负面影响？这项横断面研究基于我们之前在心脏自主控制、儿童和成人 SDB 以及代谢紊乱方面的广泛研究。它对最近的 RFA（计划公告号：PA-06-238，“睡眠和睡眠障碍研究 (R21)”高度响应。对这些心脏自主控制数据与原始研究中的大量睡眠数据相结合的分析将使我们能够确定是否可以成功地将传统的睡眠障碍研究扩展到心脏风险评估中，该研究已发展成为心脏病学中独特且成熟的研究和应用。该项目还将使我们能够测试一种新颖的方法 研究假设——SDB 与较高的心血管疾病风险相关，部分原因在于它对心脏自主控制副交感神经损伤和交感神经过度激活的负面影响。大约 20-28% 的学龄儿童患有 SDB，1-3% 的学龄儿童患有阻塞性睡眠呼吸暂停，这是 SDB 最严重的形式。该项目将使我们能够成功地将传统的睡眠障碍研究扩展到心脏风险评估。该项目还将 使我们能够检验一项新的研究假设——儿童 SDB 与较高的心脏病风险相关，部分原因是它对心脏自主控制副交感神经损伤和交感神经过度激活产生负面影响，这可能导致致命性心律失常的阈值降低和血压升高。从这项研究中获得的知识有可能改善儿童 SDB 的管理和治疗。