Developmental Changes in Collapsibility of the Passive  Pharynx during Infancy

Isono, Shiroh; Tanaka, Atsuko; Ishikawa, Teruhiko; Nishino, Takashi

doi:10.1164/ajrccm.162.3.9911089

Cited by 45 publications

(36 citation statements)

References 16 publications

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“…This increased central ventilatory drive during sleep accounts for the increased upper airway reflexes and tone in children, resulting in less collapsibility than in adults. Thus, children have a specific breathing pattern of obstructive hypoventilation rather than discrete, cyclic obstructive pattern that is commonly seen in adult sleep-disordered breathing27). Children also have a higher arousal threshold than adults; the younger the child, the higher the threshold of arousal28).…”

Section: Pathophysiology Of Childhood Osasmentioning

confidence: 99%

Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae

2010

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The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.

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Section: Pathophysiology Of Childhood Osasmentioning

confidence: 99%

Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae

2010

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“…Epulis is another rare congenital abnormality. [4] The epulides are similar to gingival hyperplasia in appearance and are usually confined to one or two sites at the gum margin. They are slow growing, firm, and generally covered by intact epithelium.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of congenital epulis in neonate

2012

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The most common cause of difficult intubation in pediatrics is due to congenital anomalies of airway. We report a case of neonate with congenital epulis (CE) who presented with a difficult airway. A 7-day old neonate weighted 3.2 kg with a large mass occupying the oral cavity that was diagnosed as congenital epulis was scheduled for excision biopsy. The mass was large, mobile, and moving in and out with no clear pedicle. An intravenous line was inserted and secured. The airway was then assessed while the patient was awake and an assistant displaced the mass and a laryngoscope was placed to visualize the larynx easily. After preoxygenation, inhalation induction of anesthesia was accomplished using sevoflurane in oxygen. Endotracheal intubation was performed with conventional laryngoscopy. The baby made uneventful recovery after the surgical procedure. In conclusion, epulis presents a real challenge to anesthesiologists. It can be excised either under local or general anesthesia, depending on the size of its pedicle. If done under general anesthesia, assessment of the airway is mandatory for better airway management and safe endotracheal intubation.

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“…The infant upper airway is a highly compliant conduit in which a 2-cm H 2 O change in luminal pressure results in a 50% reduction in cross-sectional area (41). This property results in rapid changes in the caliber of the airway contributing to ventilatory instability, and therefore obstructive cycling.…”

Section: Ontogeny Of Airway and Respiratory Physiologymentioning

confidence: 99%

Obstructive Sleep Apnea in Infants

Katz

Mitchell

D’Ambrosio

2012

Am J Respir Crit Care Med

219

227

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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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Developmental Changes in Collapsibility of the Passive Pharynx during Infancy

Cited by 45 publications

References 16 publications

Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae

Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae

Anesthetic management of congenital epulis in neonate

Obstructive Sleep Apnea in Infants

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