Why the study?
Heart rate variability may represent the physiologic burden of OSA, prompting evaluation of whether treatment-related effects on HRV in children are causally attributable to improvement in OSA severity.
Does early adenotonsillectomy improve heart rate variability in children with obstructive sleep apnea?
Does early adenotonsillectomy improve heart rate variability in children with obstructive sleep apnea?
In children with obstructive sleep apnea, changes in heart rate variability following early adenotonsillectomy are strongly modulated by average heart rate rather than specific improvements in apnea severity.
This is the authors' abstract. We don't add key points for this paper.
Objective Heart rate variability (HRV), a noninvasive indicator of autonomic regulation of cardiac rhythm, may represent the physiologic burden of obstructive sleep apnea (OSA). We hypothesized that the treatment‐related effects of OSA on HRV in children are causally attributable to the improvement in OSA severity. Study Design Secondary analysis of outcomes from the Childhood Adenotonsillectomy Trial (CHAT). Setting Analysis of database. Subjects and Methods Time‐ and frequency‐domain HRV parameters along with polysomnographic (PSG) and demographic variables were obtained from the CHAT study, which compared early adenotonsillectomy (eAT) to watchful waiting (WW) in children with OSA. The relative contributions of PSG variables and covariates to each HRV parameter were quantified. The proportion of changes in HRV parameters causally attributable to changes in OSA severity, measured by the apnea‐hypopnea index (AHI) and oxygen desaturation index (ODI), was estimated. Results In total, 404 children aged 5 to 10 years were included. The median (interquartile range) age was 6 (3‐9) years. The median body mass index percentile was 82 (53), 195 (48%) children were male, and 147 (36%) were African American. The average heart rate during PSG was the strongest independent predictor of each HRV parameter ( P <. 001). Although eAT resulted in statistically significant changes in the majority of HRV parameters, these effects were not causally attributable to treatment‐related changes in AHI or ODI. Conclusions The average heart rate strongly modulates HRV in children with OSA. Although eAT results in discernible changes in HRV, it appears to not be causally attributable to specific treatment‐related changes in AHI or ODI.
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Changes in HRV after early adenotonsillectomy track average heart rate rather than apnea severity in children with OSA; leaves open whether treatment improves autonomic function.
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Isaiah et al. (2020) studied this question.
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