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Hayashi A, Suresh S, Kevat A, Robinson J, Kapur N. Central sleep apnea in otherwise healthy term infants. J Clin Sleep Med 2022; 18:2813-2817. [PMID: 35962944 PMCID: PMC9713904 DOI: 10.5664/jcsm.10228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES To describe the outcomes of central sleep apnea requiring home supplemental oxygen therapy in otherwise healthy term infants. METHODS All children < 1 year of age undergoing polysomnography between 2015 and 2020 at the Queensland Children's Hospital were retrospectively studied. Children with gestational age < 37 weeks, underlying syndrome, cleft palate, those with obstructive apnea-hypopnea index > 50% of total apnea-hypopnea index, or with underlying cardiac or pulmonary parenchymal pathology were excluded. Polysomnography parameters were extracted for periods both on and off supplemental oxygenation. RESULTS Fifty-two (mean [standard deviation] age at polysomnography 32.6 [34.7] days; 21 females) term infants were included. There was a statistically significant improvement in apnea-hypopnea index on supplemental oxygen (mean [standard deviation] in room air 50.2 [36.3] vs 11.6 [9], P < .001 on supplemental oxygen), in both rapid eye movement and nonrapid eye movement sleep, as well as in mean oxygen saturations (96.6% in room air to 98.9% on oxygen; P < .001). There was no statistically significant change in transcutaneous carbon dioxide levels or sleep duration. Oxygenation was prescribed for a median (interquartile range) age of 197 (127) days. CONCLUSIONS Central sleep apnea in term infants who are otherwise healthy generally has a good prognosis, with oxygen therapy prescribed for around 6 months. Oxygen therapy was associated with improved saturations and decrease in apnea-hypopnea index when assessed with polysomnography. CITATION Hayashi A, Suresh S, Kevat A, Robinson J, Kapur N. Central sleep apnea in otherwise healthy term infants. J Clin Sleep Med. 2022; 18(12):2813-2817.
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Affiliation(s)
- Ayaka Hayashi
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sadasivam Suresh
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Ajay Kevat
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacob Robinson
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nitin Kapur
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Damian A, Gozal D. Pediatric Obstructive Sleep Apnea: What’s in a Name? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:63-78. [PMID: 36217079 DOI: 10.1007/978-3-031-06413-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea is a highly prevalent disease across the lifespan and imposes substantial morbidities, some of which may become irreversible if the condition is not diagnosed and treated in a timely fashion. Here, we focus on the clinical and epidemiological characteristics of pediatric obstructive sleep apnea, describe some of the elements that by virtue of their presence facilitate the emergence of disrupted sleep and breathing and its downstream consequences, and also discuss the potential approaches to diagnosis in at-risk children.
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Affiliation(s)
- Allan Damian
- Departments of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
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Ghirardo S, Amaddeo A, Griffon L, Khirani S, Fauroux B. Central apnea and periodic breathing in children with underlying conditions. J Sleep Res 2021; 30:e13388. [PMID: 34075643 PMCID: PMC9286345 DOI: 10.1111/jsr.13388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022]
Abstract
Central sleep apneas and periodic breathing are poorly described in childhood. The aim of the study was to describe the prevalence and characteristics of central sleep apnea and periodic breathing in children with associated medical conditions, and the therapeutic management. We retrospectively reviewed all poly(somno)graphies with a central apnea index ≥ 5 events per hr in children aged > 1 month performed in a paediatric sleep laboratory over a 6‐year period. Clinical data and follow‐up poly(somno)graphies were gathered. Ninety‐five out of 2,981 patients (3%) presented central sleep apnea: 40% were < 1 year, 41% aged 1–6 years, and 19% aged ≥ 6 years. Chiari malformation was the most common diagnosis (13%). Mean central apnea index was 20 ± 30 events per hr (range 5–177). Fifty‐eight (61%) children had an exclusive central pattern with < 5 obstructive events per hr. Periodic breathing was present in 79 (83%) patients, with a mean percentage of time with periodic breathing of 9 ± 16%. Among periodic breathing episodes, 40% appeared after a sigh, 8% after an obstructive event, 6% after breathing instability and 2% after bradypnea. The highest clinical apnea index and percentage of time with periodic breathing were observed in children with encephalopathy and/or epilepsy (68 ± 63 events per hr and 30 ± 34%). Clinical apnea index did not differ according to age, while periodic breathing duration was longer in children > 1 year old. Watchful waiting was performed in 22 (23%) patients with spontaneous improvement in 20. Other treatments (upper airway or neurosurgery, nocturnal oxygen therapy, continuous positive airway pressure, non‐invasive ventilation) were effective in selected patients. Central sleep apnea is rare in children and comprises heterogeneous conditions. Sleep studies are essential for the diagnosis, characterization and management of central sleep apnea.
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Affiliation(s)
- Sergio Ghirardo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, Paris, France.,University of Trieste Department of Medicine, Surgery and Health Sciences, Trieste, Italy
| | - Alessandro Amaddeo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, Paris, France.,Equipe d'Accueil EA VIFASOM, Université de Paris, Paris, France
| | - Lucie Griffon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, Paris, France.,Equipe d'Accueil EA VIFASOM, Université de Paris, Paris, France
| | - Sonia Khirani
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, Paris, France.,Equipe d'Accueil EA VIFASOM, Université de Paris, Paris, France.,ASV Santé, Gennevilliers, France
| | - Brigitte Fauroux
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, Paris, France.,Equipe d'Accueil EA VIFASOM, Université de Paris, Paris, France
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Siriwardhana LS, Nixon GM, Davey MJ, Mann DL, Landry SA, Edwards BA, Horne RSC. Children with down syndrome and sleep disordered breathing display impairments in ventilatory control. Sleep Med 2020; 77:161-169. [PMID: 33373902 DOI: 10.1016/j.sleep.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the role of ventilatory control instability (i.e. loop gain) in children with Down syndrome and sleep disordered breathing. METHODS Children (3-19 years) with Down syndrome and sleep disordered breathing (n = 14) were compared with typically developing children (n = 14) matched for age, sex and sleep disordered breathing severity. All children underwent overnight polysomnography. Spontaneous sighs were identified and a 180s analysis window (60s pre-sigh to 120s post-sigh) containing flow measurements and oxygen saturation were created. Loop gain, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern. Results; Loop gain was significantly higher in children with Down syndrome compared to matched typically developing children (median loop gain [interquartile range]: 0.36 [0.33, 0.55] vs 0.32 [0.24, 0.38]; P = 0.0395). While children with Down syndrome also had significantly lower average oxygen saturation associated within each analysis window compared to typically developing children (mean ± standard deviation: 96.9 ± 1.3% vs 98.0 ± 1.0%; P = 0.0155), loop gain was not related to polysomnographic measures of hypoxia. CONCLUSIONS Higher loop gain in children with Down syndrome and sleep disordered breathing indicates that these children have more unstable ventilatory control, compared to age, sex and sleep disordered breathing severity matched typically developing children. This may be due to an inherent impairment in ventilatory control in children with Down syndrome contributing to their increased risk of sleep disordered breathing which may inform alternative treatment options for this population.
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Affiliation(s)
- Leon S Siriwardhana
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Dwayne L Mann
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia.
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Siriwardhana LS, Weichard A, Nixon GM, Davey MJ, Walter LM, Edwards BA, Horne RSC. Role of ventilatory control instability in children with sleep-disordered breathing. Respirology 2020; 25:1174-1182. [PMID: 32239710 DOI: 10.1111/resp.13809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The contribution of non-anatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children. METHODS Children (aged 3-18 years) with various severities of SDB (n = 110) and non-snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern. RESULTS There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009). CONCLUSION A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway.
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Affiliation(s)
- Leon S Siriwardhana
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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