Clinical predictors of sleep disordered breathing in children at moderate altitude

Vázquez, Juan C; Montes, Francisco Marentes; Rivera, Carlos; Vargas, Sonia Meza; Pérez‐Padilla, Rogelio

doi:10.1016/j.arcmed.2004.11.012

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…Our results support previous findings of low nocturnal SpO 2 at altitude in both native25 26 and non-acclimatised children,2 27 and illuminate the associated SDB patterns. The severity of hypoxia, hypoventilation and periodic breathing experienced at high altitude exacerbates sleep fragmentation, with recent evidence that hypoxia is the most important factor,28 but our study is in line with previous literature showing no effect on episodic memory 29.…”

Section: Discussionsupporting

confidence: 92%

The Young Everest Study: preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children

Gavlak

Stocks²,

Laverty

et al. 2013

Archives of Disease in Childhood

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BackgroundCerebral blood flow velocity (CBFV) and sleep physiology in healthy children exposed to hypoxia and hypocarbia are under-researched.AimTo investigate associations between sleep variables, daytime end-tidal carbon dioxide (EtCO2) and CBFV in children during high-altitude ascent.MethodsVital signs, overnight cardiorespiratory sleep studies and transcranial Doppler were undertaken in nine children (aged 6–13 years) at low altitude (130 m), and then at moderate (1300 m) and high (3500 m) altitude during a 5-day ascent.ResultsDaytime (130 m: 98%; 3500 m: 90%, p=0.004) and mean (130 m: 97%, 1300 m: 94%, 3500: 87%, p=0.0005) and minimum (130 m: 92%, 1300 m: 84%, 3500 m: 79%, p=0.0005) overnight pulse oximetry oxyhaemoglobin saturation decreased, and the number of central apnoeas increased at altitude (130 m: 0.2/h, 1300 m: 1.2/h, 3500 m: 3.5/h, p=0.2), correlating inversely with EtCO2 (R2 130 m: 0.78; 3500 m: 0.45). Periodic breathing occurred for median (IQR) 0.0 (0; 0.3)% (130 m) and 0.2 (0; 1.2)% (3500 m) of total sleep time. At 3500 m compared with 130 m, there were increases in middle (MCA) (mean (SD) left 29.2 (42.3)%, p=0.053; right 9.9 (12)%, p=0.037) and anterior cerebral (ACA) (left 65.2 (69)%, p=0.024; right 109 (179)%; p=0.025) but not posterior or basilar CBFV. The right MCA CBFV increase at 3500 m was predicted by baseline CBFV and change in daytime SpO2 and EtCO2 at 3500 m (R2 0.92); these associations were not seen on the left.ConclusionsThis preliminary report suggests that sleep physiology is disturbed in children even with slow ascent to altitude. The regional variations in CBFV and their association with hypoxia and hypocapnia require further investigation.

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Section: Discussionsupporting

confidence: 92%

The Young Everest Study: preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children

Gavlak

Stocks²,

Laverty

et al. 2013

Archives of Disease in Childhood

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“…Andean children with sleep-disordered breathing living at only 2,240 m who experienced > 43% of the night with SpO2 < 90% had pulmonary arterial hypertension on echocardiography. 28 In our study, at HA, infants spent a median of 79.7% of the night with SpO2 < 90% compared to 33.5% of children and 7.6% of adolescents. Based on studies of diurnal SpO2 measurements, previous authors have recommended that oxygen therapy should be initiated for SpO2 < 85% in HA hospital pediatric settings.…”

Section: Limitations Of This Studymentioning

confidence: 49%

Adaptation to Life in the High Andes: Nocturnal Oxyhemoglobin Saturation in Early Development

Hill

Bayá

Gavlak

et al. 2016

Sleep

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Physiological adaptation to high-altitude living in native Andeans is unlikely to compensate for the significant differences we observed between diurnal and nocturnal oxyhemoglobin saturation, most marked in infancy. This vulnerability to sleep-related hypoxia in early childhood has potential lifespan implications. Future studies should characterize the sleep- related respiratory physiology underpinning our observations.

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“…headache, vomiting, insomnia and cognitive alteration; Hackett, 1999;Hackett & Roach, 2001) when exposed to high altitudes (Basnyat, Sherpa, Basyal & Adhirikari, 1998;Pollard, Murdoch & Bärtsch, 1998;Yaron, Waldman, Niermeyer, Nicholas & Honigman, 1998). There is also some evidence showing increased infant mortality in indigenous populations (see Saco-Pollitt, 1989, for review), and that young children living at altitude have stunted growth (Saco-Pollitt, 1981), and may suffer from sleep disturbance (Vázquez, Marentes, Aboitiz, Meza & Pérez-Padilla, 2004;Yaron, Nieremyer, Lindgren, Hohigman, Strain & Cairns, 2003). Of greater concern, there is also an increased risk of sudden infant death syndrome (Kohlendorfer, Kiechl & Sperl, 1998).…”

Section: Introductionmentioning

confidence: 99%

Human behaviour and development under high‐altitude conditions

Virués‐Ortega

Garrido

Javierre

et al. 2006

Developmental Science

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Although we are far from a universally accepted pattern of impaired function at altitude, there is evidence indicating motor, perceptual, memory and behavioural deficits in adults. Even relatively low altitudes (2500 m) may delay reaction time, and impair motor function. Extreme altitude exposure (>5000 m) may result in more pronounced impairment that can persist after returning to the lowlands. Research into the effects of altitude exposure earlier in development is lacking by comparison. Un-acclimatized children can suffer from acute mountain sickness, and, in native populations born at altitude, subtle cognitive and behavioural deficits suggest incomplete adaptation to hypoxia. The study of neurobehavioural functioning at altitude may provide important information about the effects of clinical hypoxia on the human brain and behavioural development.

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Clinical predictors of sleep disordered breathing in children at moderate altitude

Cited by 10 publications

References 33 publications

The Young Everest Study: preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children

The Young Everest Study: preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children

Adaptation to Life in the High Andes: Nocturnal Oxyhemoglobin Saturation in Early Development

Human behaviour and development under high‐altitude conditions

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