Skip to main content
SpringerLink
Log in

Cardiac Autonomic Modulation of Children with Down Syndrome

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

The aim of this study is to analyze the autonomic modulation in children with Down syndrome (DS). The study was conducted with a convenience sample of children with DS and without heart disease, from the Genetics Clinic of the Hospital Infantil Darcy Vargas and APAE São Paulo, São Paulo, SP, Brazil. The control group was matched for sex and age. The analysis of autonomic modulation was performed using the indices of heart rate variability (HRV). The children remained in the supine position with spontaneous breathing for 20 min. Heart rate was recorded beat-to-beat. HRV analysis was performed in time and frequency domain. For data analysis, we used Student’s t test: unpaired and Mann–Whitney. It was considered statistically significant at p < 0.05. From 75 children with DS, 50 were excluded, a total of 25 children [16 boys, 8.6 (1.4) years] participated in this study, and the control group also consisted of 25 children [16 boys, 9.0 (1.2) years] without the syndrome. The BMI of the volunteers with DS was higher than the controls [19.1 (2.9) vs. 15.8 (1.2), p < 0.0001]. There were differences between groups in the indices in frequency domain: LFms2 [1242.1 (788.25) vs. 786.44 (481.90), p = 0.040], LFun [69.104 (11.247) vs. 57.348 (11.683), p = 0.0004], HFun [30.896 (11.247) vs. 42.520 (11.634), p = 0.0004] and LF/HF [2.594 (1.104) vs. 1.579 (0.9982), p = 0.0004]. No differences were observed in time domain indices. The results indicate increased indices representing the sympathetic branch of the autonomic nervous system and those that indicate the overall modulation in children with DS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Agiovlasitis S, Collier SR, Baynard T, Echols GH, Goulopoulou S, Figueroa A et al (2010) Autonomic response to upright tilt in people with and without Down syndrome. Res Dev Disabil 31:857–863

    Article  PubMed  Google Scholar 

  2. Angiovlasitis S, Baynard T, Pitetti KH, Fernhall BO (2011) Heart rate complexity in response to upright tilt in persons with Down syndrome. Res Dev Disabil 32:2102–2107

    Article  Google Scholar 

  3. Baynard T, Pitetti KH, Guerra M, Fernhall B (2004) Heart rate variability at rest and during exercise in persons with Down syndrome. Arch Phys Med Rehabil 85:1285–1290

    Article  PubMed  Google Scholar 

  4. Costa ACS (2011) On the promise of drug therapies for Down syndrome. Dev Neurosci 33:414–427

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Dierssen M, Vallina IF, Baamonde C, Garcıa-Calatayud S, Lumbreras MA, Florez J (1997) Alterations of central noradrenergic transmission in Ts65Dn mouse, a model for Down syndrome. Brain Res 749:238–244

    Article  CAS  PubMed  Google Scholar 

  6. Fernhall B, Otterstetter M (2003) Attenuated responses to sympathoexcitation in individuals with Down syndrome. J Appl Physiol 94:2158–2165

    PubMed  Google Scholar 

  7. Fernhall B, Figueroa A, Collier S, Baynard T, Giannopoulou I, Goulopoulou S (2005) Blunted heart rate response to upright tilt in people with Down syndrome. Arch Phys Med Rehabil 86:813–818

    Article  PubMed  Google Scholar 

  8. Fernhall BO, Mendonca GV, Baynard T (2013) Reduced work capacity in individuals with Down syndrome: a consequence of autonomic dysfunction? Exerc Sport Sci Rev 41(3):138–147

    Article  PubMed  Google Scholar 

  9. Ferri R, Dascalova LC, DelGracco S, Elia M, Musumeci SA, Pettinat S (1998) Heart rate variability and apnea during sleep in Down’s syndrome. J Sleep Res 7:282–287

    Article  CAS  PubMed  Google Scholar 

  10. Figueroa A, Collier S, Baynard T, Giannopoulou I, Goulopoulou S, Fernhall B (2005) Impaired vagal modulation of heart rate in individuals with Down syndrome. Clin Autonomic Res 15:45–50

    Article  Google Scholar 

  11. Gamelin FX, Berthoin S, Bosquet L (2006) Validity of the polar S810 heart rate monitor to measure RR intervals at rest. Med Sci Sports Exerc 38(5):887–893

    Article  PubMed  Google Scholar 

  12. Giagkoudaki F, Dimitros E, Kouidi E, Deligiannis A (2010) Effects of exercise training on heart-rate-variability indices in individuals with Down syndrome. J Sport Rehabil 19:173Y83

    Google Scholar 

  13. Godoy MF, Takakura IT, Correa PR (2005) Relevância da análise do comportamento dinâmico não-linear (Teoria do Caos) como elemento prognóstico de morbidade e mortalidade em pacientes submetidos à cirurgia de revascularização miocárdica. [The relevance of nonlinear dynamic analysis (Chaos Theory) to predict morbidity and mortality in patients undergoing surgical myocardial revascularization]. Arq Ciênc Saúde 12(4):167–171

    Google Scholar 

  14. Goulopoulou S, Baynard T, Collier S et al (2006) Cardiac autonomic control in individuals with Down syndrome. Am J Ment Retard 111:27–34

    Article  PubMed  Google Scholar 

  15. Guerra M, Llorens N, Fernhall B (2003) Chronotropic incompetence inindividuals with Down syndrome. Arch Phys Med Rehabil 84:1604–1608

    Article  PubMed  Google Scholar 

  16. Iellamo F, Galante A, Legramante JM, Lippi ME, Condoluci C, Albertini Giorgio, Volterrani M (2005) Altered autonomic cardiac regulation in individuals with Down syndrome. Am J Physiol Heart Circ Physiol 289:H2387–H2391

    Article  CAS  PubMed  Google Scholar 

  17. Karim N, Hasan JA, Ali SS (2011) Heart rate variability—a review. J Basic Appl Sci 7(1):71–77

    Google Scholar 

  18. Kingsley M, Lewis MJ, Marson RE (2005) Comparison of polar 810 s and an ambulatory ECG system for RR interval measurement during progressive exercise. J Sports Med 26(10):39–44

    CAS  Google Scholar 

  19. Lake CR, Ziegler MG, Coleman M, Kopin IJ (1979) Evaluation of the sympathetic nervous system in trisomy-21 (Down’s syndrome). Psychat Res 15:1–6

    Article  CAS  Google Scholar 

  20. Lohman T.G, Roche A.F, Martorell R (eds) (1988) Anthropometric standardization reference manual. Human Kinetics, Champaign: 177p

  21. Marilyn JB and the committee on genetics (2011) Health supervision for children with Down syndrome. Pediatrics 128:393

  22. Mendonca GV, Pereira FD, Fernhall B (2011) Cardiac autonomic function during submaximal treadmill exercise in adults with Down syndrome. Res Dev Disabil 32:532–539

    Article  PubMed  Google Scholar 

  23. Naveen KV, Telles S (1999) Sudomotor sympathetic hypofunction in down’s syndrome. Indian J Physiol Pharmacol 43(4):463–466

    CAS  PubMed  Google Scholar 

  24. Niskanen JP, Tarvainen MP, Ranta-aho PO, Karjalainen PA (2004) Software for advanced HRV analysis. Comp Meth Progr Biomed 76(1):73–81

    Article  Google Scholar 

  25. Qijerman We, Winter JP (2010) The care of children with Down syndrome. Eur J Pediatr 169:1445–1452

    Article  Google Scholar 

  26. Sacks B, Smith S (1989) People with Down’s syndrome can be distinguished on the basis of cholinergic dysfunction. J Neurol Neurosurg Psychiatry 52:1294–1295

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Saleem S, Hussain MM, Majeed SM, Khan MA (2012) Gender differences of heart rate variability in healthy volunteers. J Pak Med Assoc 62(5):422–425

    PubMed  Google Scholar 

  28. Souza NM, Rossi RC, Vanderlei FM, Vitor ALR, Bernardo AFB, Gonçalves ACCR et al (2012) Heart rate variability in obese children. J Hum Growth Dev 22(3):328–333

    Google Scholar 

  29. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93(5):1043–1065

    Article  Google Scholar 

  30. Udeschini G, Casati G, Bassani F, Picotti GB, Culotta P (1985) Plasma catecholamines in Down’s syndrome, at rest and during sympathetic stimulation. J Neurol Neurosurg Psychiatry 48:1060–1061

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Van Gameren-Oosterom HBM, Van Dommelen P, Oudesluys-Murphy AM, Buitendijk SE, Van Buuren S et al (2012) Healthy Growth in Children with Down Syndrome. PLoS One 7(2):e31079

    Article  PubMed Central  PubMed  Google Scholar 

  32. Van Gameren-Oosterom HB, Fekkes M, Reijneveld SA, Oudesluys-Murphy AM, Verkerk PH, Van Wouwe JP, Buitendijk SE (2013) Practical and social skills of 16-19-year-olds with Down syndrome: independence still far away. Res Dev Disabil 34(12):4599–4607

    Article  PubMed  Google Scholar 

  33. Vanderlei LCM, Silva RA, Pastre CM, Azevedo FM, Godoy MF (2008) Comparison of polar S810i monitor and the ECG for the analysis of heart rate variability in the time and frequency domains. Braz J Med Bio Res 41(7):854–859

    Article  CAS  Google Scholar 

  34. Vanderlei LC, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF (2009) Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc 24:205–217

    Article  PubMed  Google Scholar 

  35. Vanderlei LCM, Pastre CM, Freitas IF Jr, Godoy MF (2010) Analysis of cardiac autonomic modulation in obese and eutrophic children. Clinics 65(8):789–792

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study received financial support from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo. Process number: 2010/18005-0). The authors thank the staff of the Genetics Clinic of the Hospital Infantil Darcy Vargas and APAE São Paulo for their co-operation in providing data. Also we would like to thank the group from Associação das Voluntárias of the Hospital Infantil Darcy Vargas for their help in contacting volunteers.

Author information

Authors and Affiliations

  1. Departamento de Medicina, Disciplina de Cardiologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 715 Térreo Vila Clementino, São Paulo, SP, Brazil

    Tatiana Dias de Carvalho, Talita Dias da Silva, Vivian Ribeiro Finotti & Celso Ferreira

  2. Laboratório de Escrita Científica da Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brazil

    Tatiana Dias de Carvalho, Luiz Carlos de Abreu, Rodrigo Daminello Raimundo & Talita Dias da Silva

  3. Departamento de Saúde Materno-infantil da Faculdade de Saúde Pública, Universidade de São Paulo (USP), São Paulo, SP, Brazil

    Luiz Carlos de Abreu

  4. Ambulatório de Genética do Hospital Infantil Darcy Vargas, São Paulo, SP, Brazil

    Zan Mustacchi

  5. Departamento de Fisioterapia da Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil

    Luiz Carlos Marques Vanderlei

  6. Núcleo Transdisciplinar de Estudos do Caos e da Complexidade, Faculdade de Medicina de São José de Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil

    Moacir Fernandes Godoy

  7. Departamento de Medicina, Disciplina de Clínica Médica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

    Celso Ferreira Filho

  8. APAE SÃO PAULO (Association of Parents and Friends of People With Intellectual Disability of São Paulo), São Paulo, SP, Brazil

    Laura Guilhoto & Viviane Perico

Authors
  1. Tatiana Dias de Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luiz Carlos de Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zan Mustacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luiz Carlos Marques Vanderlei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Moacir Fernandes Godoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rodrigo Daminello Raimundo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Celso Ferreira Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Talita Dias da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Laura Guilhoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Viviane Perico
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vivian Ribeiro Finotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Celso Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tatiana Dias de Carvalho.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Carvalho, T.D., de Abreu, L.C., Mustacchi, Z. et al. Cardiac Autonomic Modulation of Children with Down Syndrome. Pediatr Cardiol 36, 344–349 (2015). https://doi.org/10.1007/s00246-014-1012-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-014-1012-5

Keywords

Search

Navigation