Columbus, OH — July 2017
Problems such as sleep-disordered breathing are often associated with cardiovascular complications in adults. However, most of the research in this area has not considered children.
In an effort to better understand the pediatric implications of sleep on heart health, Grace Paul, MD, and Swaroop, both members of the Section of Pulmonary Medicine at Nationwide Children’s Hospital, recently published a review of available information on the bidirectional effect of cardiovascular issues and sleep-disordered breathing in children.
There are a number of categories of sleep-disordered breathing in children, and they can range in severity from mild snoring to severe sleep apnea and nighttime hypoventilation.
Sleep disordered breathing is often seen in healthy children who have enlarged tonsils and/or adenoids or nasal defects who exhibit snoring and nocturnal breathing problems. These issues can often be corrected with surgery.
Children with craniofacial abnormalities have variations in their upper airways which can also cause obstructive sleep apnea. Patients with neuromuscular disorders are also at risk for sleep apnea due to their muscle weakness and shallow breathing. Another at-risk population is children and adolescents with obesity.
“Obesity affects children and contributes to cardiac morbidity,” says Dr. Paul, who is also an assistant professor of Pediatrics at The Ohio State University College of Medicine. “Because of the rise in obesity, we are seeing more obstructive sleep apnea in children.”
Dr. Pinto notes that obesity is not only the cause of obstructive sleep apnea. She is currently conducting research in children with sickle cell anemia, who are more prone to both obstructive sleep apnea and cardiovascular disease. The goal is to identify children with sickle cell disease and sleep apnea to prevent their cardiovascular problems from escalating.
Sleep-disordered breathing affects the heart, but it also works the other way: cardiovascular complications can affect sleep. Issues like arrhythmias and abnormal heart beats can lead to sleep problems like insomnia and waking up many times at night.
Drs. Paul and Pinto recommend further review of the available data, plus more studies in the future, to help physicians understand the interconnected nature of sleep-disordered breathing and cardiovascular complications in children. The ultimate goal is early diagnosis and intervention to improve quality of life and prevent further damage.
“We have to make sure that children who are snoring are seen by sleep specialists so that they can undergo evaluation for sleep-disordered breathing, since sleep-disordered breathing can lead to cardiovascular disease,” says Dr. Pinto, who is also an assistant professor of Pediatrics at The Ohio State University College of Medicine.
“If we can pick it up in childhood and treat it, for instance with tonsillectomy or use of a CPAP machine, we can prevent these children from growing into adults with cardiovascular disease.”
Dr. Paul points to the example of children with Down syndrome.
“Children with Down syndrome may snore, but what could also be happening every night during sleep is that they are not breathing well enough, resulting in drops in their oxygen levels,” she says. “Over time, this puts a lot of strain on the heart, especially if they have underlying cardiac anomalies, and can lead to reduced cardiac function.”
More research will help physicians understand the prevalence of sleep-disordered breathing and cardiac complications in children and help generate specific recommendations for early diagnosis and management.
The Sleep Disorder Center at Nationwide Children’s is one of the few centers conducting this type of research. Drs. Paul, Pinto, and the rest of the team hope to identify children with sleep-disordered breathing early, so they can treat it to prevent cardiovascular problems.
Paul, G. R. and Pinto, S. (2017). Sleep and the Cardiovascular System in Children. Sleep Medicine Clinics. 2017 Jun; 12(2):179-191.