Breathing Patterns in Prepubertal Children With Sleep-Related Breathing Disorders

Guilleminault, Christian; Li, Kasey; Khramtsov, Andrei; Palombini, Luciana; Pelayo, Rafael

doi:10.1001/archpedi.158.2.153

Cited by 61 publications

(51 citation statements)

References 15 publications

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“…All data were de-identified. PSG were scored following international criteria for determination of an apnea-hypopnea index (AHI) [8,9] and following preestablished criteria to determine presence of respiratory events not included in the AHI to determine a respiratory disturbance index (RDI) [10].…”

Section: Discussionmentioning

confidence: 99%

Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study

Monteyrol²,

et al. 2010

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Introduction When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirtyone children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests. Results The mean age of the children at entry was 6.5± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences. Conclusion This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.

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Section: Discussionmentioning

confidence: 99%

Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study

Monteyrol²,

et al. 2010

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“…The following are all part of the Respiratory Disturbance Index: nasal flattening of the nasal cannula curve, esophageal manometry crescendos, continuous sustained effort, and tachypnea (Guilleminault et al 2004). 'Esophageal manometry crescendos' are a sequence of four or more breaths that show increasingly negative, peak end inspiratory esophageal pressure (Guilleminault et al 1995(Guilleminault et al , 2004) that can be seen with flow limitation on the nasal cannula (Serebrisky et al 2002). 'Continuous sustained effort' was classified as repetitive, abnormally negative, peak end inspiratory pressures, ending at the same negative peak end esophageal pressure without a crescendo pattern.…”

Section: Discussionmentioning

confidence: 99%

Periodic leg movements in prepubertal children with sleep disturbance

Martínez

Guilleminault

2004

Develop Med Child Neuro

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This study's aims were to determine: (1) prevalence of periodic leg movements (PLMs) in walking prepubertal children consulting a sleep clinic for any sleep disorder; (2) associations between PLMs and other sleep and medical disorders; and (3) the response of other sleep disorders to treatment with the dopamine agonist pramipexol. Clinical evaluation and polysomnography were carried out for a period of 12 months on 252 consecutively seen, prepubertal children with sleep disorders (156 males, 96 females; aged 15mo to 11y, mean 7y 1mo, SD3y 10mo). Sleep disorders unrelated to PLMs were treated, and six children received pramipexol for PLMs. Follow‐up included clinical evaluation and polysomnography. Twenty‐three per cent of children were diagnosed with PLMs on the basis of polysomnography. The presence of PLMs had usually been unrecognized clinically. The only clinical symptom that could be related to periodic limb movement disorder was a report of leg pains at morning awakening. Only two of 58 children had PLMs without other clinical or polysomnographic findings. Comorbidity seen with PLMs included neuropsychiatric syndromes (n=20), isolated sleep disordered breathing (SDB; n=29), and several other comorbid conditions (n=7). Seven of 11 children seen with attention‐deficit‐hyperactivity disorder also had PLMs. Surgery for SDB was associated with subsequent cessation of PLMs in 15 of 29 children. Five out of six children with PLMs who received pramipexol were able to tolerate the drug and experienced a complete disappearance of their PLMs. Presence of chronic fatigue, sleepiness, disrupted nocturnal sleep, and difficulties in falling asleep should lead to a systematic search for PLMs that is independent of associated syndromes. Isolated treatment of SDB might help eliminate some, but not all, PLMs.

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“…The respiratory anomalies caused by this breakdown in equilibrium of forces are extremely variable and range from increased effort in breathing, lowered intake of oxygen, rapid respiration and assorted anomalies of aeration exchange to complete obstruction 35,41 .…”

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“…With means and devices of evaluation, primarily polysomnography, becoming increasingly sensitive 15,17,37,41,60,79,91 , many cases of ''increased resistance in the upper airways syndrome'' that would have escaped undetected only a few years ago, are now being diagnosed correctly.…”

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How to detect Obstructive Sleep Apnea Syndrome (OSAS) in children

Seailles¹,

Couloigner²,

Cohen-Lévy³

2009

J Dentofacial Anom Orthod

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Obstructive Sleep Apnea Syndrome (OSAS) is a frequently occurring childhood malady, whose is incidence is largely underestimated, that can lead to serious complications. Because of their understanding of the anatomy and physiology of the masticatory apparatus and of the upper airways, orthodontist are in a strategic position to detect in their young patients developing disorders in these regions; accordingly when they suspect the existence of OSAS they should ask systematic and well targeted questions of parents who may not be aware of the relationship between certain symptoms their children display and sleep breathing problems. The goal of this article is to provide practitioners with a better understanding of the symptoms and the physio-pathological mechanics of OSAS so that they can spare their afflicted patients the complications it provokes by seeing that early treatment is undertaken. KEYWORDSObstructive sleep apnea syndrome Children Diagnosis Polysomnography.

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Breathing Patterns in Prepubertal Children With Sleep-Related Breathing Disorders

Abstract: Currently published polysomnographic scoring recommendations overlook common breathing abnormalities during sleep that are associated with clinical complaints.

Cited by 61 publications

References 15 publications

Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study

Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study

Periodic leg movements in prepubertal children with sleep disturbance

How to detect Obstructive Sleep Apnea Syndrome (OSAS) in children

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