Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-06-01T19:44:25.155Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of heart rate variability in breath holding children by 24 hour Holter monitoring

Published online by Cambridge University Press:  19 December 2013

Osman Yilmaz ,
Murat Ciftel ,
Kezban Ozturk ,
Omer Kilic ,
Hasan Kahveci ,
Fuat Laloğlu  and
Ozben Ceylan
Osman Yilmaz
Affiliation:
Department of Pediatric Cardiology, Erzurum District Training and Research Hospital, Erzurum, Turkey
Murat Ciftel
Affiliation:
Department of Pediatric Cardiology, Erzurum District Training and Research Hospital, Erzurum, Turkey
Kezban Ozturk
Affiliation:
Department of Pediatrics, Erzurum District Training and Research Hospital, Erzurum, Turkey
Omer Kilic*
Affiliation:
Department of Pediatric Infectious Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey
Hasan Kahveci
Affiliation:
Department of Neonatology, Erzurum District Training and Research Hospital, Erzurum, Turkey
Fuat Laloğlu
Affiliation:
Department of Neonatology, Erzurum Nenehatun Obstetrics and Gynecology Hospital, Erzurum, Turkey
Ozben Ceylan
Affiliation:
Department of Pediatric Cardiology, Suleymaniye Maternity Training and Research Hospital, Istanbul, Turkey
*
Correspondence to: O. Kilic, Department of Pediatric Infectious Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey. Tel: +90 442 2325364; Fax: +90 442 2325090; E-mail: omerkilic7@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose: Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. Methods: We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells – 56 cyanotic type and 12 pallid type – and 39 healthy controls. Results: Clinical and heart rate variability results were compared between each spell type – cyanotic or pallid – and the control group; significant differences (p<0.05) in standard deviation of all NN intervals, mean of the standard deviations of all NN intervals for all 5-minute segments, percentage of differences between adjacent RR intervals >50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. Conclusions: Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes.

Keywords

Breath holdingpallid breath holdingautonomic dysregulationheart rate variabilitysinus pauses
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 2 , February 2015 , pp. 317 - 323
Copyright
© Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. DiMario, FJ Jr. Breath-holding spells in childhood. Am J Dis Child 1992; 146: 125–131.Google ScholarPubMed
2. Kelly, AM, Porter, CJ, McGoon, MD, Espinosa, RE, Osborn, MJ, Hayes, DL. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics 2001; 108: 698–702.Google Scholar
3. Di Pino, A, Calabrò, MP, Gitto, P, Bianca, I, Oreto, G. Permanent cardiac pacing for severe pallid breath-holding spells. Pacing Clin Electrophysiol 2007; 30: 280–282.Google Scholar
4. Ergul, Y, Otar, G, Nisli, K, Dindar, A. Permanent cardiac pacing in a 2.5 month-old infant with severe cyanotic breath-holding spells and prolonged asystole. Cardiol J 2011; 18: 704–706.Google Scholar
5. Malik, M. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996; 17: 354–381.Google Scholar
6. Villain, E, Lucet, V, Do Ngoc, D, Bonnet, D, Fraisse, A, Kachaner, J. Cardiac pacing in children with breath-holding spells. Arch Mal Coeur Vaiss 2000; 93: 547–552.Google ScholarPubMed
7. Vinik, AI, Ziegler, D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387–397.Google Scholar
8. Anil, BG, Nedunchezian, K, Jayanthini, V, Pathmanabhan, M. Breath holding spells: evaluation of autonomic nervous system function. Indian Pediatr 2005; 42: 923–927.Google Scholar
9. DiMario, FJ Jr, Bauer, L, Baxter, D. Respiratory sinus arrhythmia in children with severe cyanotic and pallid breath-holding spells. J Child Neurol 1998; 13: 440–442.Google Scholar
10. DiMario, FJ Jr, Chee, CM, Berman, PH. Pallid breath-holding spells. Evaluation of autonomous nervous system. J Clin Pediatr 1990; 29: 17–24.CrossRefGoogle Scholar
11. DiMario, FJ Jr, Burleson, JA. Autonomic nervous system function in severe breath-holding spells. Pediatr Neurol 1993; 9: 268–274.CrossRefGoogle ScholarPubMed
12. DiMario, FJ Jr, Bauer, L, Volpe, J, Baxter, D. Respiratory sinus arrhythmia in children with severe cyanotic breath-holding spells. J Child Neurol 1997; 12: 260–262.Google Scholar
13. Evans, OB. Breath-holding spells. Pediatr Ann 1997; 26: 410–414.Google Scholar
14. Lombroso, CT, Lerman, P. Breathholding spells (cyanotic and pallid infantile syncope). Pediatrics 1967; 39: 563–581.CrossRefGoogle ScholarPubMed
15. Hartikainen, JEK, Tahvannainen, KUO, Kuusela, TA. Short term measurement of heart rate variability. In: Malik M (ed.). Clinical Guide to Cardiac Autonomic Tests. Kluwer Academic Publishers, Norwell, MA, USA, 1998, pp 149–176.CrossRefGoogle Scholar
16. Rajendra Acharya, U, Paul Joseph, K, Kannathal, N, Lim, CM, Suri, JS. Heart rate variability: a review. Med Biol Eng Comput 2006; 44: 1031–1051.CrossRefGoogle ScholarPubMed
17. Sztajzel, J. Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Med Wkly 2004; 134: 514–522.Google Scholar
18. Kayıkçıoğlu, M, Payzın, S. Heart rate variability. Arch Turk Soc Cardiol 2001; 29: 238–245.Google Scholar
19. DiMario, FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics 2001; 107: 265–269.CrossRefGoogle ScholarPubMed
20. Holmes, GL. Breath-holding attacks in children. Postgrad Med 1988; 84: 196–198.CrossRefGoogle ScholarPubMed
21. Boysen, A, Lewin, MA, Hecker, W, Leichter, HE, Uhlemann, F. Autonomic function testing in children and adolescent with diabetes mellitus. Pediatr Diabetes 2007; 8: 261–264.CrossRefGoogle ScholarPubMed
22. Ewing, DJ, Clarke, BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J 1982; 285: 916–918.Google Scholar
23. Lahiri, MK, Kannankeril, PJ, Goldberger, JJ. Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 2008; 51: 1725–1733.Google Scholar
24. Kolkiran, A, Tutar, E, Atalay, S, Deda, G, Cin, S. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Paediatr 2005; 94: 1227–1231.CrossRefGoogle ScholarPubMed
25. Noritake, M, Takase, B, Kudoh, K, Kugai, N, Kurita, A, Nagata, N. Diurnal change in heart rate variability in healthy and diabetic subjects. Intern Med 1992; 31: 453–456.CrossRefGoogle ScholarPubMed
26. Massin, MM, Maeyns, K, Withofs, N, Ravet, F, Gérard, P. Circadian rhythm of heart rate and heart rate variability. Arch Dis Child 2000; 83: 179–182.CrossRefGoogle ScholarPubMed
27. Boudreau, P, Yeh, WH, Dumont, GA, Boivin, DB. A circadian rhythm in heart rate variability contributes to the increased cardiac sympathovagal response to awakening in the morning. Chronobiol Int 2012; 29: 757–768.Google Scholar
28. Gula, LJ, Krahn, AD, Skanes, A, et al. Heart rate variability in obstructive sleep apnea: a prospective study and frequency domain analysis. Ann Noninvasive Electrocardiol 2003; 8: 144–149.CrossRefGoogle ScholarPubMed
29. Grossman, P, Karemaker, J, Wieling, W. Prediction of tonic parasympathetic cardiac control using respiratory sinus arrhythmia: the need for respiratory control. Psychophysiology 1991; 28: 201–216.Google Scholar
30. Katona, PG, Jih, F. Respiratory sinus arrhythmia: noninvasive measure of parasympathetic cardiac control. J Appl Physiol 1975; 39: 801–805.Google Scholar
31. Lucet, V, de Bethmann, O, Denjoy, I. Paroxysmal vagal overactivity, apparent life-threatening event and sudden infant death. Biol Neonate 2000; 78: 1–7.Google Scholar
32. Lucet, V, Le Gall, MA, Shojaeï, T, et al. Vagal hyperreactivity and sudden infant death. Study of 15 families. Arch Mal Coeur Vaiss 2002; 95: 454–459.Google Scholar