Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy

Abstract

Background Although the pathogenesis of central and obstructive events seems to be different, these two entities may somehow be related. We aimed to determine whether, as reported in previous research, the number of central sleep apnea (CSA) cases in a population of children with obstructive sleep apnea syndrome (OSAS) was greater than in patients without obstructive events, and if CSA worsens with increasing OSAS severity. As a second objective, we analyzed changes in central apnea index (CAI) after adenotonsillar surgery compared to changes when no surgery has been performed. Methods We retrospectively reviewed nocturnal polysomnography (PSG) data from children between 1 and 14 years of age with no neurological conditions or syndromes. Patients with CAI values greater than 5 per hour were diagnosed as having CSA. Improvements of greater than 50% in CAI on repeat PSG were considered to represent a real change. Results Data were available from 1279 PSG studies, resulting in 72 children with a CAI greater than 5 per hour (5.6%). Patients with OSAS showed a higher CAI (2.16) compared with those without OSAS (1.17), and this correlation increased with higher degrees of obstructive apnea severity. When adenotonsillectomy was performed due to OSAS, the CAI decreased by 1.37. The average decrease in PSG values was only 0.38 in cases where no surgery was performed. Conclusion The results of this study suggest that although CSA is perceived to be mostly associated with central nervous system ventilatory control, there may be a connection with airway obstruction and in children with CSA and OSA diagnosis adenotonsillectomy may improve both conditions.

Central breathing abnormalities in children with trisomy 21: Effect of age, sex, and concomitant OSA

“…We found that the TS21 individuals with a CAI > 2/h also had greater OAHI values (Table 2). These results indicate that upper airway obstruction may be linked to central apnea in Down syndrome, as previously described in the general population of children with OSA 21 …”

“…These results indicate that upper airway obstruction may be linked to central apnea in Down syndrome, as previously described in the general population of children with OSA. 21 In our study, we found that CSA was more frequent in TS21 subjects younger than 2 years of age independently of biological sex.…”

Analysis of polysomnogram findings in children with concurrent obstructive and central sleep apnea

“…Camacho and colleagues reported that with increasing severity of OSA, there was an associated increase in CAI. 18 Our results show there was significantly greater severity of OSA when CAI was greater than 5 in the OSA + CSA group. The key differences between Camacho and colleagues and our study were that we included children with neurological abnormalities, and we had separated our groups into OSA only with CAI <1, and subdivided groups of OSA + CSA into different levels of CAI, because there is not a general consensus in literature on the cutoff for CSA.…”

Polysomnographic characteristics and sleep‐disordered breathing in Schaaf‐Yang syndrome

“…While our cohort is limited, 2 out of 21 patients (9.5%) had an elevated central apnea index which is more common than is reported in the general population, and both these patients were older than 2 years 16,22–26 . In both cases, central events were only ~33% of events which may reflect a reflex apneic pause following upper airway obstruction, subsequent deep inspiration, and pulmonary stretch receptor response (Hering‐Breuer reflex) rather than a central pathologic process 27–30 . Further studies are needed to delineate the true prevalence of central sleep apnea in SYS given the limited number of patients available for this study.…”