Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea

Li-Ang Lee; Hai-Hua Chuang; Hui-Shan Hsieh; Chao-Yung Wang; Li-Pang Chuang; Hsueh-Yu Li; Tuan-Jen Fang; Yu-Shu Huang; Guo-She Lee; Albert C Yang; Terry B J Kuo; Cheryl C H Yang

doi:10.3389/fpubh.2023.1103085

Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea

Front Public Health. 2023 Feb 27:11:1103085. doi: 10.3389/fpubh.2023.1103085. eCollection 2023.

Authors

Li-Ang Lee^{1

2

3

4

5}, Hai-Hua Chuang^{2

3

4

6}, Hui-Shan Hsieh^{1

7}, Chao-Yung Wang^{2

3

8}, Li-Pang Chuang^{2

3

9}, Hsueh-Yu Li^{1

2

3}, Tuan-Jen Fang^{1

2}, Yu-Shu Huang^{2

3

10}, Guo-She Lee^{2

11}, Albert C Yang^{5

12}, Terry B J Kuo^{5

13

14}, Cheryl C H Yang^{5

14}

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.
³ Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁴ School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
⁵ Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.
⁶ Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁷ Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
⁸ Department of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁹ Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
¹⁰ Department of Child Psychiatry, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
¹¹ Department of Otolaryngology, Taipei City Hospital, Taipei City, Taiwan.
¹² Department of Psychiatry, Taipei Veterans General Hospital, Taipei City, Taiwan.
¹³ Center for Mind and Brain Medicine, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou City, Taiwan.
¹⁴ Sleep Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.

Abstract

Background: Obstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA.

Methods: Seventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined.

Results: Multivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI.

Conclusions: The improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.

Keywords: adenotonsillectomy; children; heart rate variability (HRV); mediation; obstructive sleep apnea; quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Heart Rate / physiology
Humans
Polysomnography
Quality of Life
Retrospective Studies
Sleep Apnea, Obstructive*
Sleep Quality*

Grants and funding

This study was supported by the National Science and Technology Council, Taiwan (Grant Number 109-2314-B-182-083-MY3 to L-AL) and the Chang Gung Medical Foundation, Taoyuan, Taiwan (Grant Number CMRPG3F1091-3 to L-AL).