Dynamic changes in EEG spectra during obstructive apnea in children

Abstract

Children are less likely to demonstrate EEG arousal during obstructive sleep apnea (OSA) than adults. We hypothesized that changes in spectral EEG characteristics occur during REM-associated OSA in the absence of arousal. Eight snoring children underwent overnight polysomnography. OSA events during REM periods not associated with EEG or behavioral arousal were identified. EEG signals from C3A2 and C4A1 leads corresponding to 1) Յ10-sec epochs preceding OSA (PRE), 2) the obstructed period (OSA), and 3) Յ10-sec epochs following airflow resumption (POST) were subjected to fast Fourier transform (FFT) routines. Seventy-two isolated OSA, and 14 clusters of > 4 OSA events were analyzed.In single OSA, delta OSA amplitude was lower than in PRE (P < 0.01) and in POST (P < 0.001). Furthermore, POST delta amplitude was higher than PRE (P < 0.01). In contrast, in OSA clusters, the dynamic differences in delta amplitude disappeared after the second OSA. Reciprocal increases and decreases occurred for the theta frequency domain during OSA and post-OSA, while sigma and beta frequency power did not change.We conclude that during isolated OSA episodes without arousal, significant decreases in power selectively occur for delta frequency, and are followed by a rebound increase upon termination of apnea. The delta changes are progressively attenuated during repeated OSA. We postulate that delta changes may reflect ongoing adaptations in sleep pressure which are necessary to relieve the respiratory compromise, and may represent subtle evidence for arousal and consequent sleep fragmentation in children with OSAS. Pediatr Pulmonol. 2000; 29:359-365.

Neurobehavioral Implications of Habitual Snoring in Children

“…However, children with OSA seem to have a reduced propensity for sleep fragmentation and EDS when these measurements are performed using criteria originally developed for adult patients. 32,38 Our present findings regarding children who have PS suggest that current techniques used to define arousal are not sensitive enough to detect sleep frag- mentation in children 19 and/or that neurobehavioral susceptibility to sleep fragmentation is significantly higher in at least some children. Alternatively, intermittent hypoxia with or without sleep fragmentation could be a determinant of neurocognitive morbidity in snoring children.…”

“…Because UARS is characterized by increasing respiratory effort associated with decreases in oronasal airflow and/or arousal, 43 it is clear that other methods aiming to improve the detection and classification of respiratory events and arousals in children are critically needed, particularly if such new tools show improved correlation with morbidity. Such methods are now being examined critically and include analysis of spectral electroencephalogram characteristics, 19 nasal pressure measurements, 44 pulse transit time derivatives, 45 and peripheral arterial tonometry. 46 A history of snoring in the presence of a "normal" PSG evaluation is associated with lowered neurocognitive function in a subset of 5-to 7-year-old snoring children from a nonreferred community sample.…”

Neurobehavioral Implications of Habitual Snoring in Children

“…However, children with OSA seem to have a reduced propensity for sleep fragmentation and EDS when these measurements are performed using criteria originally developed for adult patients. 32,38 Our present findings regarding children who have PS suggest that current techniques used to define arousal are not sensitive enough to detect sleep frag- mentation in children 19 and/or that neurobehavioral susceptibility to sleep fragmentation is significantly higher in at least some children. Alternatively, intermittent hypoxia with or without sleep fragmentation could be a determinant of neurocognitive morbidity in snoring children.…”

“…Because UARS is characterized by increasing respiratory effort associated with decreases in oronasal airflow and/or arousal, 43 it is clear that other methods aiming to improve the detection and classification of respiratory events and arousals in children are critically needed, particularly if such new tools show improved correlation with morbidity. Such methods are now being examined critically and include analysis of spectral electroencephalogram characteristics, 19 nasal pressure measurements, 44 pulse transit time derivatives, 45 and peripheral arterial tonometry. 46 A history of snoring in the presence of a "normal" PSG evaluation is associated with lowered neurocognitive function in a subset of 5-to 7-year-old snoring children from a nonreferred community sample.…”

Urinary F2-isoprostane metabolite levels in children with sleep-disordered breathing

“…It was also established that children show a differential response to intermittent hypoxia with a lower tendency to arousal from respiratory events than adults [32] and greater circulating vascular endothelial growth factor (VEGF) levels compared to adults [33]. Thus, it might be expected that children would show a heightened response to intermittent hypoxia and indeed, dose-dependent measures of cardiovascular morbidity were found with pediatric SDB [34,35].…”

Acoustic arousal responses in children with obstructive sleep apnea

“…28 Although children with OSAS have normal sleep architecture, 10 EEG arousals are increased, 10,29 and EEG changes not detectable by standard polysomnography are present. 30,31 These changes may be responsible for changes in sleep quality, increased daytime somnolence, 11 and depressed school performance. 5,32 It is unknown whether the sleep fragmentation contributes to habituation to respiratory abnormalities, or is an independent mechanism involved in the depression of arousal from sleep.…”

“…However, several studies suggested that noncortical arousal may be present in children with OSAS. 30,31,39 These cardiovascular or mild EEG changes may be as important as cortical arousals for the development of the behavioral and cardiovascular complications found in children with OSAS.…”

Neurobehavioral Implications of Habitual Snoring in Children

“…However, children with OSA seem to have a reduced propensity for sleep fragmentation and EDS when these measurements are performed using criteria originally developed for adult patients. 32,38 Our present findings regarding children who have PS suggest that current techniques used to define arousal are not sensitive enough to detect sleep frag- mentation in children 19 and/or that neurobehavioral susceptibility to sleep fragmentation is significantly higher in at least some children. Alternatively, intermittent hypoxia with or without sleep fragmentation could be a determinant of neurocognitive morbidity in snoring children.…”

“…Because UARS is characterized by increasing respiratory effort associated with decreases in oronasal airflow and/or arousal, 43 it is clear that other methods aiming to improve the detection and classification of respiratory events and arousals in children are critically needed, particularly if such new tools show improved correlation with morbidity. Such methods are now being examined critically and include analysis of spectral electroencephalogram characteristics, 19 nasal pressure measurements, 44 pulse transit time derivatives, 45 and peripheral arterial tonometry. 46 A history of snoring in the presence of a "normal" PSG evaluation is associated with lowered neurocognitive function in a subset of 5-to 7-year-old snoring children from a nonreferred community sample.…”

Urinary F2-isoprostane metabolite levels in children with sleep-disordered breathing

“…It was also established that children show a differential response to intermittent hypoxia with a lower tendency to arousal from respiratory events than adults [32] and greater circulating vascular endothelial growth factor (VEGF) levels compared to adults [33]. Thus, it might be expected that children would show a heightened response to intermittent hypoxia and indeed, dose-dependent measures of cardiovascular morbidity were found with pediatric SDB [34,35].…”

Acoustic arousal responses in children with obstructive sleep apnea

“…28 Although children with OSAS have normal sleep architecture, 10 EEG arousals are increased, 10,29 and EEG changes not detectable by standard polysomnography are present. 30,31 These changes may be responsible for changes in sleep quality, increased daytime somnolence, 11 and depressed school performance. 5,32 It is unknown whether the sleep fragmentation contributes to habituation to respiratory abnormalities, or is an independent mechanism involved in the depression of arousal from sleep.…”

“…However, several studies suggested that noncortical arousal may be present in children with OSAS. 30,31,39 These cardiovascular or mild EEG changes may be as important as cortical arousals for the development of the behavioral and cardiovascular complications found in children with OSAS.…”

Neurobehavioral Implications of Habitual Snoring in Children

“…However, children with OSA seem to have a reduced propensity for sleep fragmentation and EDS when these measurements are performed using criteria originally developed for adult patients. 32,38 Our present findings regarding children who have PS suggest that current techniques used to define arousal are not sensitive enough to detect sleep frag- mentation in children 19 and/or that neurobehavioral susceptibility to sleep fragmentation is significantly higher in at least some children. Alternatively, intermittent hypoxia with or without sleep fragmentation could be a determinant of neurocognitive morbidity in snoring children.…”

“…Because UARS is characterized by increasing respiratory effort associated with decreases in oronasal airflow and/or arousal, 43 it is clear that other methods aiming to improve the detection and classification of respiratory events and arousals in children are critically needed, particularly if such new tools show improved correlation with morbidity. Such methods are now being examined critically and include analysis of spectral electroencephalogram characteristics, 19 nasal pressure measurements, 44 pulse transit time derivatives, 45 and peripheral arterial tonometry. 46 A history of snoring in the presence of a "normal" PSG evaluation is associated with lowered neurocognitive function in a subset of 5-to 7-year-old snoring children from a nonreferred community sample.…”

Urinary F2-isoprostane metabolite levels in children with sleep-disordered breathing

“…It was also established that children show a differential response to intermittent hypoxia with a lower tendency to arousal from respiratory events than adults [32] and greater circulating vascular endothelial growth factor (VEGF) levels compared to adults [33]. Thus, it might be expected that children would show a heightened response to intermittent hypoxia and indeed, dose-dependent measures of cardiovascular morbidity were found with pediatric SDB [34,35].…”

Acoustic arousal responses in children with obstructive sleep apnea

“…28 Although children with OSAS have normal sleep architecture, 10 EEG arousals are increased, 10,29 and EEG changes not detectable by standard polysomnography are present. 30,31 These changes may be responsible for changes in sleep quality, increased daytime somnolence, 11 and depressed school performance. 5,32 It is unknown whether the sleep fragmentation contributes to habituation to respiratory abnormalities, or is an independent mechanism involved in the depression of arousal from sleep.…”

“…However, several studies suggested that noncortical arousal may be present in children with OSAS. 30,31,39 These cardiovascular or mild EEG changes may be as important as cortical arousals for the development of the behavioral and cardiovascular complications found in children with OSAS.…”