Baroreflex Sensitivity after Adenotonsillectomy in Children with Obstructive Sleep Apnea during Wakefulness and Sleep

Crisalli, Joseph; McConnell, Keith; VanDyke, Rhonda; Fenchel, Matthew; Somers, Virend K.; Shamszumann, A.; Chini, Barbara A.; Daniels, Stephen R.; Amin, Raouf S.

doi:10.5665/sleep.2108

Cited by 37 publications

(29 citation statements)

References 40 publications

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“…Nevertheless, the baroreflex system sensitivity is blunted in children with OSAS, not controlling exaggerated blood pressure variability . When SDB resolves, baroreflex sensitivity improves and blood pressure variability decreases . In addition, upper airway obstruction is accompanied by exaggerated negative intrathoracic pressure swings, increased systemic venous return, and preload to the right ventricle and decreased ejection fraction .…”

Section: Morbidity From the Cardiovascular Systemmentioning

confidence: 99%

“…Several case‐control or uncontrolled studies have demonstrated resolution of subtle pathophysiologic and subclinical abnormalities related to OSAS in children following treatment interventions to relieve upper airway obstruction (Table ) . In the CHAT study, for each 5‐unit improvement in AHI and 5‐mmHg decrease in peak end‐tidal CO 2 , heart rate reductions by 1 and 1.5 bpm were measured, respectively .…”

Section: Morbidity From the Cardiovascular Systemmentioning

confidence: 99%

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When and why to treat the child who snores?

Tan

Álvarez

Tsaoussoglou

et al. 2016

Pediatric Pulmonology

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Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.

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Section: Morbidity From the Cardiovascular Systemmentioning

confidence: 99%

Section: Morbidity From the Cardiovascular Systemmentioning

confidence: 99%

When and why to treat the child who snores?

Tan

Álvarez

Tsaoussoglou

et al. 2016

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…The presence of this feature indicates greater subject responsiveness to blood pressure regulation. Rates of change close to zero may indicate poor blood pressure control (Amin et al, 2008; Crisalli et al, 2012). …”

Section: Methodsmentioning

confidence: 99%

Semiparametric Mixed Models for Nested Repeated Measures Applied to Ambulatory Blood Pressure Monitoring Data

Szczesniak

Amin

2016

J. Mod. App. Stat. Meth.

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Semiparametric mixed models are increasingly popular for statistical analysis of medical device studies in which long sequences of repeated measurements are recorded. Monitoring these sequences at different periods over time on the same individual, such as before and after an intervention, results in nested repeated measures (NRM). Covariance models to account for NRM and simultaneously address mean profile estimation with penalized splines via semiparametric regression are considered with application to a prospective study of 24-hour ambulatory blood pressure and the impact of surgical intervention on obstructive sleep apnea.

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“…Animal experiments suggest that this dysfunction may persist after resolution of sleep apnea. Studies in children looking at changes 6 months after adenotonsillectomy indicate that autonomic dysfunction estimated by LF/HF ratio and BRS substantially improve, but not completely and some evidence of dysfunction persists despite treatment (Crisalli et al, 2012; Muzumdar et al, 2011). These persistent changes may be related to inadequate resolution of OSAS or duration of follow up but certainly merit concern regarding their potential to contribute to long term cardiovascular morbidity.…”

Section: Physiological Effects Of Osasmentioning

confidence: 99%

Physiological effects of obstructive sleep apnea syndrome in childhood

Muzumdar

Arens

2013

Respiratory Physiology & Neurobiology

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Sleep disordered breathing in children refers to a group of respiratory disorders that occur or are exacerbated during sleep. Obstructive sleep apnea syndrome (OSAS) is one of the most significant disorders in this group. OSAS can present in all age groups from early infancy to adolescent years. The cardinal feature of OSAS is limitation of inspiratory flow and volume during sleep resulting in abnormal gas exchange and/or alteration of sleep patterns. When OSAS is a chronic condition it often results in adverse physiological effects that impact on health and development. The present review discusses genesis of OSAS in children and consequent end organ injury with special emphasis on behavior and cognition, cardiovascular function, autonomic regulation, inflammation, endothelial function and metabolic syndrome.

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Baroreflex Sensitivity after Adenotonsillectomy in Children with Obstructive Sleep Apnea during Wakefulness and Sleep

Abstract: Treatment of obstructive sleep apnea in children by adenotonsillectomy is associated with gradual improvement in known risk factors for cardiovascular disease. Complete normalization of baroreceptor sensitivity was not achieved 6 months postoperatively.

Cited by 37 publications

References 40 publications

When and why to treat the child who snores?

When and why to treat the child who snores?

Semiparametric Mixed Models for Nested Repeated Measures Applied to Ambulatory Blood Pressure Monitoring Data

Physiological effects of obstructive sleep apnea syndrome in childhood

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