Study Objectives Pediatric obstructive sleep apnea (OSA) affects cardiac autonomic regulation, altering heart rate variability (HRV). Although changes in classical HRV parameters occur after OSA treatment, they have not been evaluated as reporters of OSA resolution. Specific frequency bands (named BW1, BW2, and BWRes) have been recently identified in OSA. We hypothesized that changes with treatment in these spectral bands can reliably identify changes in OSA severity and reflect OSA resolution. Methods Four hundred and four OSA children (5–9.9 years) from the prospective Childhood Adenotonsillectomy Trial were included; 206 underwent early adenotonsillectomy (eAT), while 198 underwent watchful waiting with supportive care (WWSC). HRV changes from baseline to follow-up were computed for classical and OSA-related frequency bands. Causal mediation analysis was conducted to evaluate how treatment influences HRV through mediators such as OSA resolution and changes in disease severity. Disease resolution was initially assessed by considering only obstructive events, and was followed by adding central apneas to the analyses. Results Treatment, regardless of eAT or WWSC, affects HRV activity, mainly in the specific frequency band BW2 (0.028–0.074 Hz). Furthermore, only changes in BW2 were specifically attributable to all OSA resolution mediators. HRV activity in BW2 also showed statistically significant differences between resolved and non-resolved OSA. Conclusions OSA treatment affects HRV activity in terms of change in severity and disease resolution, especially in OSA-related BW2 frequency band. This band allowed to differentiate HRV activity between children with and without resolution, so we propose BW2 as potential biomarker of pediatric OSA resolution. Clinical Trial Registration Childhood Adenotonsillectomy Trial, NCT00560859, https://sleepdata.org/datasets/chat.

中文翻译：

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心率变异性作为小儿阻塞性睡眠呼吸暂停缓解的潜在生物标志物

研究目标 小儿阻塞性睡眠呼吸暂停 (OSA) 影响心脏自主神经调节，改变心率变异性 (HRV)。尽管经典 HRV 参数在 OSA 治疗后发生变化，但尚未将其作为 OSA 解决的报告者进行评估。最近在 OSA 中确定了特定的频段（称为 BW1、BW2 和 BWRes）。我们假设这些光谱带中的治疗变化可以可靠地识别 OSA 严重程度的变化并反映 OSA 分辨率。方法 纳入前瞻性儿童腺样体扁桃体切除术试验的 404 名 OSA 儿童（5-9.9 岁）；206 人接受了早期腺样体扁桃体切除术 (eAT)，而 198 人接受了观察等待支持治疗 (WWSC)。计算了经典和 OSA 相关频段的 HRV 从基线到随访的变化。进行因果中介分析以评估治疗如何通过诸如 OSA 解决和疾病严重程度变化等中介因素影响 HRV。最初通过仅考虑阻塞性事件来评估疾病解决，然后在分析中添加中枢性呼吸暂停。结果无论是 eAT 还是 WWSC，治疗都会影响 HRV 活动，主要在特定频带 BW2 (0.028–0.074 Hz)。此外，只有 BW2 的变化具体归因于所有 OSA 解决调解人。BW2 中的 HRV 活性在已解决和未解决的 OSA 之间也显示出统计学上的显着差异。结论 OSA 治疗会影响 HRV 活动的严重程度变化和疾病消退，尤其是在 OSA 相关的 BW2 频段。该频带允许区分有和没有消退的儿童之间的 HRV 活动，因此我们建议将 BW2 作为儿科 OSA 消退的潜在生物标志物。临床试验注册儿童腺样体扁桃体切除术试验，NCT00560859，https://sleepdata.org/datasets/chat。