@article{10902/37724,
year = {2023},
month = {3},
url = {https://hdl.handle.net/10902/37724},
abstract = {Heart rate variability (HRV) is modulated by sleep stages and apneic events. Previous studies in children compared classical HRV parameters during sleep stages between obstructive sleep apnea (OSA) and controls. However, HRV-based characterization incorporating both sleep stages and apneic events has not been conducted. Furthermore, recently proposed novel HRV OSA-specific parameters have not been evaluated. Therefore, the aim of this study was to characterize and compare classic and pediatric OSA-specific HRV parameters while including both sleep stages and apneic events. A total of 1610 electrocardiograms from the Childhood Adenotonsillectomy Trial (CHAT) database were split into 10-min segments to extract HRV parameters. Segments were characterized and grouped by sleep stage (wake, W; non-rapid eye movement, NREMS; and REMS) and presence of apneic events (under 1 apneic event per segment, e/s; 1–5 e/s; 5–10 e/s; and over 10 e/s). NREMS showed significant changes in HRV parameters as apneic event frequency increased, which were less marked in REMS. In both NREMS and REMS, power in BW2, a pediatric OSA-specific frequency domain, allowed for the optimal differentiation among segments. Moreover, in the absence of apneic events, another defined band, BWRes, resulted in best differentiation between sleep stages. The clinical usefulness of segment-based HRV characterization was then confirmed by two ensemble-learning models aimed at estimating apnea-hypopnea index and classifying sleep stages, respectively. We surmise that basal sympathetic activity during REMS may mask apneic events-induced sympathetic excitation, thus highlighting the importance of incorporating sleep stages as well as apneic events when evaluating HRV in pediatric OSA.},
organization = {This work was supported by ‘Ministerio de Ciencia, Innovación y Universidades' and ‘European Regional Development Fund (FEDER)’ under projects PID2019-104881RB-I00, PID2020-115468RB-I00, PDC2021-120775-I00 and PID2021-126734OB-C21, by ‘Sociedad Española de Sueño (SES)’ under project “Beca de Investigación SES 2019”, by ‘CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB19/01/00012)’ through ‘Instituto de Salud Carlos III’ co-funded with FEDER funds, as well as under the project SleepyHeart from 2020 valorization call, and by Gobierno de Aragón (Reference Group BSICoS T39-20R). The Childhood Adenotonsillectomy Trial (CHAT) was supported by the National Institutes of Health (HL083075, HL083129, UL1-RR-024134, UL1 RR024989). The National Sleep Research Resource was supported by the National Heart, Lung, and Blood Institute (R24 HL114473, 75N92019R002). A. Martín-Montero was in receipt of a “Ayudas para contratos predoctorales para la Formación de Doctores” grant from the Ministerio de Ciencia, Innovación y Universidades (PRE2018-085219). D. Álvarez is supported by a “Ramón y Cajal” grant (RYC2019-028566-I) from the ‘Ministerio de Ciencia e Innovación - Agencia Estatal de Investigación’ co-funded by the European Social Fund. Leila Kheirandish-Gozal and David Gozal are supported by the Leda J Sears Foundation for Pediatric Research and DG is also supported by National Institutes of Health (NIH) grant AG061824, and a Tier 2 grant from the University of Missouri.},
publisher = {Elsevier},
publisher = {Computers in Biology and Medicine, 2023, 154, 106549},
title = {Pediatric sleep apnea: characterization of apneic events and sleep stages using heart rate variability},
author = {Martín Montero, Adrián and Armañac Julián, Pablo and Gil Herrando, Eduardo and Kheirandish Gozal, Leila and Álvarez González, Daniel and Lázaro Plaza, Jesús and Bailón Luesma, Raquel and Gozal, David and Laguna Lasaosa, Pablo and Hornero Sánchez, Roberto and Gutiérrez Tobal, Gonzalo César},
}