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nCPAP improves abnormal autonomic function in at-risk-for-SIDS infants with OSA

¹David Read Laboratory, University of Sydney, and Sydney Children's Hospital, Sydney 2006;²University of Helsinki, Helsinki 00014, Finland; and ³Sydney Children's Hospital, Sydney 2031, Australia

Submitted 22 April 2002 ; accepted in final form 25 April 2003

We evaluated cardiovascular autonomic control and arousability during sleep in infants with obstructive sleep apnea (OSA) before and after 10 ± 4 (mean ± SD) days of treatment with nasal continuous positive airway pressure (nCPAP). Six OSA infants and 12 age-matched control infants were studied with polygraphic sleep studies at the age of 13 ± 4 wk. During the study, 45° head-up tilt tests were performed in slow-wave and rapid eye movement sleep. Blood pressure (BP) and heart rate (HR) were continuously monitored. All OSA infants had decreased initial BP and HR responses, followed by hypotension in two and hypertension in two. OSA infants displayed higher arousal thresholds in response to the tilt in rapid eye movement sleep (P < 0.005) and higher baseline HR (P < 0.05) than controls. nCPAP treatment normalized BP and HR responses as well as arousal thresholds to tilting and stabilized HR levels. OSA in infants may be linked with cardiovascular autonomic control disturbances and decreased arousability during sleep. These defects are improved by control of OSA with nCPAP.

infant; obstructive sleep apnea; blood pressure; heart rate; nasal continuous positive airway pressure; sudden infant death syndrome

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