Measurement of pharyngeal dimensions may contribute to the characterization of anatomic risk factors for sleep-disordered breathing (SDB) in children. Acoustic pharyngometry, a noninvasive method, has been used successfully in adults, but application in children has been limited. We sought to evaluate the feasibility and utility of this technique in children, including assessment of the variation of pharyngeal measurements with height, sex, ethnicity, prematurity, and indices of SDB. Subjects were drawn from a large, community-based cohort of children of age 8-11 years. Demographic, morphologic, and sleep-related information were collected via standard questionnaires, direct measurement, and home cardiorespiratory monitoring during sleep. Pharyngeal dimensions were assessed in 203 children using acoustic pharyngometry performed with an optimized mouthpiece. In this sample, the coefficient of variation of minimum pharyngeal cross-sectional area (CSA) and mean CSA were similar to those in adults (8.0 and 11.1%, respectively). The minimum CSA, but not mean CSA, was significantly reduced in preterm children, habitual snorers, and children with SDB relative to unaffected children. Thus, minimum CSA is a useful measure for evaluating SDB risk factors in preadolescent children.
The frequency content of the heart rate (HR) series contains information regarding the state of the autonomic nervous system. Of particular importance is respiratory sinus arrhythmia (RSA), the high-frequency fluctuation in HR attributable to respiration. The unevenly sampled nature of heart rate data, however, presents a problem for the discrete Fourier transform. Interpolation of the HR series allows even sampling, but filters high-frequency content. The Lomb periodogram (LP) is a regression-based method that addresses these issues. To evaluate the efficacy of the LP and Fourier techniques in detecting RSA, we compared the spectrum of intervals, the spectrum of HR samples, and the LP of simulated and clinical neonatal time series. We found the LP was superior to the spectrum of intervals and the spectrum of HR samples in analysis near the critical frequency of one half the average sampling rate. Applying the LP to clinical data, we found (1) evidence of stochastic resonance, an enhancement of periodicity with the addition of small amounts of noise, and (2) reduced power at all frequencies prior to clinical diagnosis of neonatal sepsis.
This study sought to (1) investigate ethnic and gender differences in oropharyngeal dimensions in subjects with and without sleep disordered breathing (SDB) and (2) assess the utility of novel pharyngometric measures in the evaluation of the upper airway. Methods: Demographic, anthropomorphic, and sleep-related information were collected from 210 subjects enrolled in a genetic-epidemiology study of SDB via standard questionnaires, direct measurement, and polysomnography. Oropharyngeal dimensions were assessed with acoustic pharyngometry using standard and novel measures. Results: Mean and minimum cross-sectional areas (CSA) were smaller in Whites and Blacks with SDB compared to unaffected individuals of the same ethnicity. Unaffected Blacks had smaller mean and minimum CSA compared to unaffected Whites. No difference in either parameter was detected between Blacks without SDB and Whites with SDB. Neither parameter varied with SDB status in women, but both were smaller in men with SDB compared to unaffected men. Analysis of novel parameters suggested that differences in upper airway anatomy in Whites and Blacks with SDB were focused in the proximal and distal oropharynx, respectively. Conclusions: Acoustic reflectometry demonstrates differences in the relationship of oropharyngeal dimensions and SDB status according to gender and ethnicity. Novel pharyngometric parameters assist in elucidating these differences.
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