Cardiopulmonary Coupling in Pediatric Patients to Characterize Obstructive Sleep Apnea Severity

Pablo Armañac-Julián1, Adrián Martín-Montero2, Salla Hietakoste3, Jesus Lazaro4, Samu Kainulainen3, David Gozal5, Roberto Hornero6, Pablo Laguna7, Gonzalo César Gutiérrez Tobal6, Eduardo Gil4, Raquel Bailón8
1BSICoS, University of Zaragoza, 2GIB de Valladolid, 3Department of Technical Physics, University of Eastern Finland, 4University of Zaragoza, 5Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, 6Universidad de Valladolid, 7Zaragoza University, 8I3A, IIS, Universidad de Zaragoza, CIBER-BBN


This study aims to investigate the use of cardiopulmonary coupling (CPC), as biomarker for characterizing obstructive sleep apnea (OSA) severity in children. CPC analysis is based on the time-frequency coherence (TFC) between the respiratory effort signal and heart rate variability.

We analyzed 255 children (5-10 years old) from the Childhood Adenotonsillectomy Trial 7 months after treatment for OSA, then having no, mild, moderate, and severe OSA. TFC markers are obtained during wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep.

Results showed that the TFC in the low-frequency band increased significantly with the severity of OSA in both NREM (p<0.001) and REM sleep (p<0.001). Conversely, the TFC in the high-frequency band, the usual parameter of CPC, is significantly lower when increasing OSA severity during NREM (p=0.02) and REM (p=0.03). The findings suggest that TFC could be a useful biomarker for assessing OSA severity in children, and could provide additional information about underlying pathophysiological mechanisms.