Cortical Processing of Respiratory Afferent Stimuli during Sleep in Children with the Obstructive Sleep Apnea Syndrome

Huang, Jingtao; Colrain, Ian M.; Melendres, Maria Cecilia; Karamessinis, Laurie; Pepe, Michelle; Samuel, John; Abi-Raad, Ronald F.; Trescher, William H.; Marcus, Carole L.

doi:10.1093/sleep/31.3.403

Cited by 24 publications

(21 citation statements)

References 43 publications

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“…We have previously shown blunting of the RREP N350 during N3 sleep in children with OSAS and control subjects (5). In the present study, we confirmed those results and also showed blunting of the N550 peak and delayed latency, which has been well documented in adults (17,28).…”

Section: Rrep During Sleepsupporting

confidence: 92%

“…Subjects slept wearing a snug face mask and ear pieces. RREP were elicited as previously described (5). For AEP, auditory stimuli were applied 500 times by the ear inserts as a monotonous series of 80-dB, 1,000-Hz, and 50-ms tone pips.…”

Section: Sleep Rrep and Aepmentioning

confidence: 99%

“…For AEP, auditory stimuli were applied 500 times by the ear inserts as a monotonous series of 80-dB, 1,000-Hz, and 50-ms tone pips. Data were obtained and analyzed as previously described (5). RREP and AEP were calculated at Fz, Cz, and Pz.…”

Section: Sleep Rrep and Aepmentioning

confidence: 99%

“…Studies have shown that upper airway neuromotor tone and reflexes during sleep play an important role in maintaining airway patency during sleep in the pediatric population (3,4). Recently, it has been shown that central nervous system processing of upper airway respiratory stimuli is abnormal during sleep in children with OSAS (5). However, it is not known whether this abnormal afferent processing is limited to respiratory stimuli, or whether it is an indicator of broader abnormalities in stimulus processing, secondary to the hypoxemia, hypercapnia, and sleep fragmentation of OSAS.…”

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confidence: 99%

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Respiratory and Auditory Cortical Processing in Children with Obstructive Sleep Apnea Syndrome

Huang¹,

Marcus²,

Davenport³

et al. 2013

Am J Respir Crit Care Med

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Rationale: Children with obstructive sleep apnea syndrome (OSAS) have impaired cortical processing of respiratory afferent stimuli, manifested by blunted sleep respiratory-related evoked potentials (RREP). However, whether this impairment is limited to respiratory stimuli, or reversible after successful treatment, is unknown. We hypothesized that, during sleep, children with OSAS have (1) abnormal RREP, (2) normal cortical processing of nonrespiratory stimuli, and (3) persistence of abnormal RREP after treatment. Objectives: To measure sleep RREP and auditory evoked potentials in normal control subjects and children with OSAS before and after treatment. Methods: Twenty-four children with OSAS and 24 control subjects were tested during N3 sleep. Thirteen children with OSAS repeated testing 4-6 months after adenotonsillectomy. Measurements and Main Results: RREP were blunted in OSAS compared with control subjects (N350 at Cz 227 6 15.5 vs. 247.4 6 28.5 mV; P ¼ 0.019), and did not improve after OSAS treatment (N350 at Cz pretreatment 225.1 6 7.4 vs. 229.8 6 8.1 posttreatment). Auditory evoked potentials were similar in OSAS and control subjects at baseline (N350 at Cz 258 6 33.1 vs. 266 6 31.1 mV), and did not change after treatment (N350 at Cz 267.5 6 36.8 vs. 6 20.3).Conclusions: Children with OSAS have persistent primary or irreversible respiratory afferent cortical processing deficits during sleep that could put them at risk of OSAS recurrence. OSAS does not seem to affect the cortical processing of nonrespiratory (auditory) afferent stimuli during sleep.Keywords: evoked potentials; children; auditory; respiratory; obstructive sleep apnea syndromeThe pathophysiology of the childhood obstructive sleep apnea syndrome (OSAS) is not clear. In most children, OSAS is related to adenotonsillar hypertrophy or obesity. However, these structural factors cannot fully explain the degree of upper airway collapsibility (1, 2). Studies have shown that upper airway neuromotor tone and reflexes during sleep play an important role in maintaining airway patency during sleep in the pediatric population (3, 4). Recently, it has been shown that central nervous system processing of upper airway respiratory stimuli is abnormal during sleep in children with OSAS (5). However, it is not known whether this abnormal afferent processing is limited to respiratory stimuli, or whether it is an indicator of broader abnormalities in stimulus processing, secondary to the hypoxemia, hypercapnia, and sleep fragmentation of OSAS. Furthermore, it is not known whether this deficit resolves after treatment of OSAS. Determining reversibility would help elucidate whether the blunted responses were a primary and perhaps predisposing abnormality, or were secondary to the OSAS.Respiratory-related evoked potentials (RREP) have been used to study the central nervous system processing of upper airway stimuli (6, 7). Auditory evoked potentials (AEP) are a useful tool to investigate cortical responses to nonrespiratory stimuli and produce the same set of longer...

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Section: Rrep During Sleepsupporting

confidence: 92%

Section: Sleep Rrep and Aepmentioning

confidence: 99%

Section: Sleep Rrep and Aepmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Respiratory and Auditory Cortical Processing in Children with Obstructive Sleep Apnea Syndrome

Huang¹,

Marcus²,

Davenport³

et al. 2013

Am J Respir Crit Care Med

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“…In adults, there are known anatomic risk factors for OSAS, including enlargement of the tongue, soft palate, parapharyngeal fat pads, and lateral pharyngeal walls (5) in conjunction with craniofacial restriction (retrognathia) (6). In addition to anatomic factors, physiologic mechanisms increase OSAS risk in both children and adults (7)(8)(9)(10)(11)(12). Although these risk factors for OSAS have been well described in children and adults, few studies have addressed the important transitional developmental phase of adolescence.…”

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confidence: 99%

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Schwab

Kim

Bagchi

et al. 2015

Am J Respir Crit Care Med

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Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children.Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI).Methods: Three groups of adolescents (age range: 12-16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50). Measurements and Main Results:We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation.Conclusions: Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.Keywords: adenoid; adolescents; MRI; obstructive sleep apnea syndrome; tonsils The obstructive sleep apnea syndrome (OSAS) is common in children and adults, but it has not been well studied in adolescents. In one study, researchers reported the prevalence of OSAS in adolescents to be 2% (1), but the prevalence is probably higher in the United States because of the adolescent obesity epidemic (2). OSAS in children is thought to be secondary to a combination of enlargement of the lymphoid tissue (tonsils and adenoid) (3) and, sometimes, obesity, as well as to reductions in neuromuscular tone (4). In adults, there are known anatomic risk factors for OSAS, including enlargement of the tongue, soft palate, parapharyngeal fat pads, and lateral pharyngeal walls (5) in conjunction with craniofacial restriction (retrognathia) (6). In addition to anatomic factors, physiologic mechanisms increase OSAS risk in both children and adults (7-12). Although these risk factors for OSAS have been well described in children and adults, few Supported by grants from the National Institutes of Health (R01 HL058585, R01 HL089447, and P01 HL094307).Author Contributions: Conception and design: R.J.S., R.M.B., S.H., and C.L...

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Treatment of obstructive sleep apnoea for chronic cough in children

Teoh

Hurwitz

Chang

2010

Cochrane Database of Systematic Reviews

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Cortical Processing of Respiratory Afferent Stimuli during Sleep in Children with the Obstructive Sleep Apnea Syndrome

Cited by 24 publications

References 43 publications

Respiratory and Auditory Cortical Processing in Children with Obstructive Sleep Apnea Syndrome

Respiratory and Auditory Cortical Processing in Children with Obstructive Sleep Apnea Syndrome

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Treatment of obstructive sleep apnoea for chronic cough in children

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