Functional Aspects and Upper Airway Control During Wakefulness and Sleep

Obstructive sleep-disordered breathing (OSDB) is a condition that affects 1% to 3% of the pediatric population. These disorders are difficult to diagnosis and left untreated may be serious, including not only medical comorbidities but also cognitive, academic, behavioral, and emotional sequelae. This article is designed to bring awareness of the severity and prevalence to family physicians and pediatricians. It reviews detailed information concerning OSDB, including the predisposing factors, assessment of presenting features, and treatment.

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“…[31][32][33][34][35] Obesity is another risk factor for OSDB. [31][32][33][34][35] Obesity is another risk factor for OSDB.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Enlarged tonsils and adenoids are the most common cause of OSDB in children. 31-35 Obesity is another risk factor for OSDB. 36,37 The reported prevalence of OSDB in obese youth ranges from 37% to 66%.…”

Section: Predisposing Factorsmentioning

confidence: 99%

Assessment and Treatment of Obstructive Sleep-Disordered Breathing

Bodenner

Jambhekar

Com

et al. 2014

Clin Pediatr (Phila)

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“…The ventilatory responses to hypoxia and hypercapnia are blunted, requiring larger deviations from baseline to evoke a ventilatory response [3]. Upon initiation of sleep and withdrawal of the wakefulness stimulus, upper airway tone decreases and airway resistance increases, leading to decreased air flow and lower minute ventilation [3,12]. Despite these physiologic variables which decrease ventilation during sleep, normal individuals continue to maintain adequate ventilation in the absence of additional impairment.…”

mentioning

confidence: 99%

Sleep Disorders in Children with Central Nervous System Tumors

Maloney¹,

Lewinter²,

Ward³

et al. 2018

obm neurobiol

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Sleep complaints are common in pediatric patients with central nervous system (CNS) tumors. These problems may result from disruption of normal homeostatic, circadian, neuroendocrine, and cardiorespiratory pathways and vary by tumor location and treatment received. Children with tumors within the hypothalamus and surrounding regions are prone to excessive daytime sleepiness. Sleep-related breathing disorders, especially those involving abnormal control of breathing, may occur in patients with tumors of the brainstem and posterior fossa. Maintaining a high index of suspicion for sleep disorders in children with CNS tumors is essential for early recognition and treatment. In this article, we will review the various sleep problems reported in pediatric brain tumor survivors, explore underlying neurobiological mechanisms, and discuss approaches to screening and diagnosis.Sleep is an essential physiologic function for growth, cognition, and physical and emotional well-being. It is particularly important in childhood, when the brain and body are undergoing rapid development. Normal sleep occurs through a complex interplay between homeostatic, circadian, neuroendocrine, and cardiorespiratory pathways. Cancer and cancer treatment may cause disruptions and imbalances in these pathways, resulting in abnormal sleep. Compared to the general population, pediatric cancer survivors are more likely to experience sleep problems. Patients with a history of brain tumors are particularly prone to sleep issues. In this article, we will review the physiology of normal sleep, describe the sleep problems and pathophysiologic mechanisms behind disrupted sleep in children with central nervous system (CNS) tumors, and discuss strategies for screening, diagnosis, and management. Sleep Mechanisms and PhysiologySleep and wakefulness. Sleep is fundamentally important in promoting growth, repair, and neurocognitive functioning. The timing, duration, and quality of sleep depend on complex, balanced interactions between sleep-promoting and wake-promoting pathways. The majority of these pathways are housed in the basal forebrain, diencephalon, and brainstem. The balance between sleep and wakefulness is governed by two distinct biologic processes: sleep-wake homeostasis (Process S) and circadian rhythm (Process C) [1]. Homeostatic drive to sleep intensifies with continued wakefulness over time and subsides as an individual sleeps. During the day, the sleep-dependent homeostatic drive is counteracted by sleep-independent circadian arousal mechanisms. Circadian rhythms are coordinated by an internal pacemaker housed in the bilateral suprachiasmatic nuclei (SCN) of the anterior hypothalamus [1]. The near-24 hour circadian rhythm is externally entrained by the light-dark cycle on Earth through direct input received by the SCN from retinal ganglion cells via the retinohypothalamic tract, which runs through the optic chiasm [2,3]. Additional input from the intergeniculate leaflet and median raphe nucleus modulate circadian phase shifts [3]. The SCN sends...

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Functional Aspects and Upper Airway Control During Wakefulness and Sleep

Cited by 2 publications

References 135 publications

Assessment and Treatment of Obstructive Sleep-Disordered Breathing

Assessment and Treatment of Obstructive Sleep-Disordered Breathing

Sleep Disorders in Children with Central Nervous System Tumors

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