Clinical Symptoms Associated With Brief Obstructive Sleep Apnea in Normal Infants

Kahn, André; Groswasser, José; Sottiaux, Martine; Rebuffat, Elisabeth; Sunseri, Maria; Franco, Patricia; Dramaix, M.; Bochner, A.; Belhadi, B; Foerster, Matthew

doi:10.1093/sleep/16.5.409

Cited by 53 publications

(35 citation statements)

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“…An association between night sweats and obstructive sleep apnea has become virtually axiomatic among sleep specialists, even though there has been only one published study investigating the association in infants. 4 Our findings cast doubt on such an association in adults. We could find no association between subjective night sweats and AI or AHI.…”

Section: Discussionmentioning

confidence: 58%

“…Sleep apnea is often included on lists of probable causes. [3][4][5] In a series of cross-sectional studies conducted in primary care settings, we have documented a statistical association between reported night sweats and a variety of sleep-related symptoms including "sleep problems" not otherwise defined, general tiredness, restless or fidgety legs, legs jerking during sleep, increased sleep latency, frequent nighttime awakenings, and waking up with a sour or bitter taste in the mouth. 1,2,6 Interestingly, we have not found associations between night sweats and snoring or between night sweats and high body mass index.…”

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confidence: 99%

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Associations Between Subjective Night Sweats and Sleep Study Findings

Mold¹,

Goodrich²,

Orr³

2008

The Journal of the American Board of Family Medicine

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Background:In 2 previous studies, patients reporting night sweats were found to be more likely to have other sleep-related symptoms. Sleep apnea is often mentioned as a possible cause of night sweats, but there is little evidence to support this assertion.Methods: Retrospective review of data from 2 sleep laboratories in Oklahoma City, Oklahoma. Analyses included bivariate and multivariate tests of associations between reported night sweats and other sleep-related symptoms, scores on specific sleep inventories, and findings from polysomnography.Results: Patients who reported night sweats were more likely to report daytime fatigue (P ‫؍‬ .001); creepy/crawly feelings in their legs (P ‫؍‬ .003); kicking during sleep (P ‫؍‬ .004); snoring (P ‫؍‬ .03); nighttime breathing trouble (P < .0001); awakening in the night with aches and pains (P < .0001); and waking in the morning with a headache (P ‫؍‬ .0002) and still tired (P ‫؍‬ .002) as compared with those who did not report night sweats. They also had higher mean scores on the Epworth Sleepiness Scale (P < .0001). However, there was no statistically significant association between reported night sweats and sleep onset latency, arousal index, apnea hypopnea index, periodic leg movement index, or total sleep time.Conclusions: Subjective night sweats are associated with a variety of other sleep-related symptoms, but we could find no evidence for an association between subjective night sweats and objective evidence of specific sleep disorders. (J Am Board Fam Med 2008;21:96 -100.)

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Section: Discussionmentioning

confidence: 58%

mentioning

confidence: 99%

Associations Between Subjective Night Sweats and Sleep Study Findings

Mold¹,

Goodrich²,

Orr³

2008

The Journal of the American Board of Family Medicine

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“…54 However, some studies have reported a high incidence of snoring in infants with (26%-44%) and without (22%-26%) OSA, making the distinction difficult. 55 or novel gene findings at the long QT loci. 60 A syncopal episode, which could present as a BRUE, is strongly associated with subsequent sudden cardiac arrest in patients with long QT syndrome.…”

Section: E Clinicians Should Not Obtain Anmentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

138

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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“…A population-based study reported snoring or noisy breathing in 22-26% of normal infants, compared with 26-44% of infants with OSA (98). The diagnosis of OSA has been reported to be delayed in infants because of a lack of symptomatology and a normal physical examination (99).…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Nevertheless, there is considerable overlap in the incidence of symptoms of sleep-disordered breathing, including snoring, in infants with and without OSA (98). In addition, infants with OSA typically have a normal physical examination during wakefulness.…”

Section: Diagnosismentioning

confidence: 99%

Obstructive Sleep Apnea in Infants

Katz

Mitchell

D’Ambrosio

2012

Am J Respir Crit Care Med

219

224

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Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux.Keywords: sleep-disordered breathing; adenotonsillar hypertrophy; craniofacial; micrognathia; laryngomalacia Infants experience a wide range of sleep-disordered breathing patterns, including periodic breathing (1), apnea of prematurity (2), and central apnea, but little attention has been given to obstructive sleep apnea (OSA). Infants are particularly vulnerable to obstructive sleep-disordered breathing related to their upper airway structure (3), adverse pulmonary mechanics (4), ventilatory control (5), arousal threshold (6), laryngeal chemoreflex (7), and an REM-predominant sleep state distribution (8). The anatomical and physiological predispositions toward airway obstruction in infants are summarized in Table 1. Airway collapse may occur passively related to the balance between the viscoelastic properties of the pharynx, pharyngeal dilators, and the transmural pressure. Alternatively, obstructive apnea may result from active glottic closure, termed the laryngeal chemoreflex. The diagnosis of OSA in infants is confirmed by polysomnography and the etiology is often determined via direct endoscopic visualization of the airway. Infants with severe OSA will often have marked hypoxemia or sleep fragmentation, which is likely to result in considerable morbidity. As such, successful therapy is mandatory, even if this requires invasive treatment including nasopharyngeal tubes, continuous positive airway pressure (CPAP), supraglottoplasty, or even tracheostomy. This review focuses on the clinical features, polysomnographic patterns, pathogenesis, diagnosis, and mana...

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Clinical Symptoms Associated With Brief Obstructive Sleep Apnea in Normal Infants

Cited by 53 publications

References 0 publications

Associations Between Subjective Night Sweats and Sleep Study Findings

Associations Between Subjective Night Sweats and Sleep Study Findings

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Obstructive Sleep Apnea in Infants

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