Changes in Central Apnea Index following Pediatric Adenotonsillectomy

Baldassari, Cristina M.; Kepchar, Jessica; Bryant, Lucas M.; Beydoun, Hind A.; Choi, Sukgi S.

doi:10.1177/0194599811428118

Cited by 39 publications

(53 citation statements)

References 8 publications

(15 reference statements)

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“…Central apnoeas in children are associated with fluctuations in heart rate and blood pressure, and movement-induced central apnoeas (after movement or sigh) are more common in children with OSAS (class IV) [133]. There is one class IV study demonstrating reduction in the central apnoea index in children with OSAS post-adenotonsillectomy [134]. c, d) In a class III multicentre study, median, 10th and 90th percentile values of polysomnography parameters for 1-18 year-old healthy, non-obese children without symptoms of SDB were reported.…”

Section: 2mentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: 2mentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…Baldassari et al showed significant reduction in central apneas following tonsillectomy in children with both OSA and mild central apnea, a study that included some children with trisomy 21. 21 In contrast, Clark et al reported Cheyne-Stokes-like central apneas that persisted despite correction of the obstruction in a small cohort of subjects with trisomy 21 and OSDB. 19 While noninvasive ventilation with a mandatory rate might be expected to improve ventilation, it is not known whether further investigation, for example, with brain imaging to evaluate for abnormalities akin to Chiari malformation, is also necessary.…”

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confidence: 90%

“…Pediatric sleep laboratories and technicians are particularly adept at obtaining PSG studies in children with trisomy 21,18 but over a quarter of our subjects were unable to be studied using the entire montage with EEG, EMG, and EOG, because of lack of cooperation. Familiar surroundings and a simpler recording scheme make it likely that pulse oximetry may be successfully performed in a child's home rather than requiring the child to come to the sleep laboratory.…”

mentioning

confidence: 99%

Overnight Pulse Oximetry for Evaluation of Sleep Apnea among Children with Trisomy 21

Coverstone

Bird

Sicard

et al. 2014

Journal of Clinical Sleep Medicine

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“…In recent decades, the interest in childhood respiratory sleep disorders has increased considerably, and the number of scholarly publications on this matter has risen accordingly. Nevertheless, most of the literature has focused on reporting obstructive events, while there have been surprisingly few publications regarding the diagnosis and management of central sleep apnea (CSA) . With the exception of a recent review on the diagnosis, management, and pathophysiology of CSEA in children, there still remains a gap in the knowledge of the importance of central events in children, the central apnea index (CAI) threshold to be considered abnormal, and the range of CSA severity.…”

Section: Introductionmentioning

confidence: 99%

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

Camacho

Castillo

Rodríguez-Catalán

et al. 2019

Pediatric Pulmonology

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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.

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Changes in Central Apnea Index following Pediatric Adenotonsillectomy

Abstract: Children with OSA and mild CSA on preoperative PSG showed significant improvement in CAI following adenotonsillectomy. Future studies are needed to determine the clinical significance of CSA in children with OSA and to identify treatment strategies.

Cited by 39 publications

References 8 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Overnight Pulse Oximetry for Evaluation of Sleep Apnea among Children with Trisomy 21

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

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