Impact of Supplemental Oxygen on Obstructive Sleep Apnea of Infants

Das, Piyush; Kashyap, Rahul; Kotagal, Suresh

doi:10.3390/children5030034

Cited by 6 publications

(4 citation statements)

References 20 publications

(20 reference statements)

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“…Oxygen therapy in children at risk or with known pulmonary hypertension may be a reasonable option but yields variable reduction of the AHI. 29,40,41 The one patient in our cohort treated with oxygen had comorbid hypertension and cardiac disease, and she displayed persistent mild OSA on follow-up PSG.…”

Section: Discussionmentioning

confidence: 97%

Outcomes in children with down syndrome and mild obstructive sleep apnea treated non‐surgically

Howard

Sarber

et al. 2019

The Laryngoscope

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Objectives Nasal steroids, oral anti‐leukotrienes and supplemental oxygen are effective in the treatment of mild obstructive sleep apnea (OSA) in otherwise healthy children. However, their efficacy is unknown in children with Down syndrome (DS). Here we examine the effect of single medication therapy versus observation versus oxygen on polysomnographic outcomes in these children. Methods We reviewed children (<18 years) diagnosed with DS and mild OSA (obstructive apnea‐hypopnea index [oAHI] ≥1 to <5 events/hour) treated non‐surgically (with supplemental oxygen, one medication, or observation) between 2012 and 2017. Demographic data, comorbid diagnoses, and pre‐ and posttreatment polysomnograms were analyzed. We assessed pre‐ and posttreatment oAHI, oxyhemoglobin saturation nadir, percent total sleep time (%TST) in rapid eye movement (REM), and end‐tidal carbon dioxide (ETCO2) >50 mmHg. Results Twenty‐four children met inclusion criteria; 10 treated with medication, one with oxygen, and 13 with observation (baseline oAHI was 3.5, 3.3, and 2.9 events/hour, respectively). There was no significant change in oAHI, oxyhemoglobin saturation nadir, ETCO2, or percent TST in REM after treatment for any treatment group (P = .21–.94). There was no association between reported symptoms and AHI severity or change in AHI. OSA resolved in one patient treated with observation and two treated with medication, but worsened in two each in the medication and observation groups. Resolution of OSA occurred in 20% treated with medication, 7.7% with observation, and 0% with oxygen (P = .82). Conclusion In our cohort, resolution of mild OSA was low. This suggests that consideration should be given to multimodality treatments in children with DS and mild OSA. Prospective studies will help establish effectiveness in this cohort. Level of Evidence 4 Laryngoscope, 130:1828–1835, 2020

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Section: Discussionmentioning

confidence: 97%

Outcomes in children with down syndrome and mild obstructive sleep apnea treated non‐surgically

Howard

Sarber

et al. 2019

The Laryngoscope

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“…Specifically, an older study from 1982 reported that in a 58-year-old man with primary alveolar hypoventilation and central sleep apnea, after initiating treatment with low-flow nocturnal oxygen, there was a significant reduction in the number and duration of sleep apneas and an increase in ventilation levels during sleep 38 . Another study from 2018 by Das et al demonstrated that low-flow oxygen supplementation significantly reduced cAHI in children during both REM and non-REM sleep 39 . The underlying mechanism remains unclear.…”

Section: Discussionmentioning

confidence: 98%

Long term ventilation into pediatric central apneas: etiologies, profiles and therapeutic approaches over a decade

Presti,

Pavone,

Verrillo

et al. 2024

Preprint

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Central apneas are a prevalent yet complex phenomenon, particularly among children. This retrospective study, conducted over a decade (from 2012 to 2022), analyzed central apneas in a cohort of 612 pediatric patients who underwent ventilation at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children’s Hospital in Rome, Italy. Among this group, 67 patients met the inclusion criteria for central apneas. Central apneas often arise within the context of various underlying pathologies, including neurological disorders, genetic syndromes, and brain tumors. We categorized patients into three main groups including patients with “exclusively central apneas”, “predominantly central apneas”, and “predominantly obstructive apneas”. Ventilation modes were diverse, with pressure-controlled ventilation and pressure support being commonly used, reflecting the individualized nature of therapy. The choice of ventilation mode has been influenced by the underlying diagnosis and the severity of central apneas, with pressure support ventilation being the most frequently employed mode. Continuous Positive Airway Pressure was also employed in select cases. A statistically significant reduction (p<0.05) in mean cAHI was observed in patients with multimalformation syndromes, hypoxic-ischemic encephalopathy and Prader-Willi Syndrome. The reduction in mean cAHI was not statistically significant in the case of patients with brain tumors. While non-invasive ventilation was commonly used, invasive mechanical ventilation was selectively employed in more severe cases. The study highlights the need for personalized therapeutic strategies when managing central apneas in pediatric patients.

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“…Supplemental oxygen, in addition to perhaps supplying a small amount of positive airway pressure, is thought to reduce the diaphragm's contracting force with the correction of hypoxemia and the related increased respiratory drive, which can contribute to airway collapse. Furthermore, treatment of hypoxemia may improve geniohyoid muscle tone (124). Supplemental oxygen therapy can be used for abolishing intermittent hypoxia in OSA.…”

Section: Other Treatmentsmentioning

confidence: 99%

Management of Obstructive Sleep Apnea in Patients With Heart Failure

2022

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Sleep apnea is traditionally classified as obstructive sleep apnea (OSA), which occurs when the upper airway collapses due to the relaxation of oropharyngeal musculature, and central sleep apnea occurs when the brainstem cannot stimulate breathing. Most sleep apnea in patients with heart failure (HF) results from coexisting OSA and central sleep apnea (CSA), or complex sleep apnea syndrome. OSA and CSA are common in HF and can be involved in its progression by exposure to the heart to intermittent hypoxia, increased preload and afterload, activating sympathetic, and decreased vascular endothelial function. A majority of treatments have been investigated in patients with CSA and HF; however, less or short-term randomized trials demonstrated whether treating OSA in patients with HF could improve morbidity and mortality. OSA could directly influence the patient's recovery. This review will focus on past and present studies on the various therapies for OSA in patients with HF and summarize CSA treatment options for reasons of reference and completeness. More specifically, the treatment covered include surgical and non-surgical treatments and reported the positive and negative consequences for these treatment options, highlighting possible implications for clinical practice and future research directions.

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Impact of Supplemental Oxygen on Obstructive Sleep Apnea of Infants

Cited by 6 publications

References 20 publications

Outcomes in children with down syndrome and mild obstructive sleep apnea treated non‐surgically

Outcomes in children with down syndrome and mild obstructive sleep apnea treated non‐surgically

Long term ventilation into pediatric central apneas: etiologies, profiles and therapeutic approaches over a decade

Management of Obstructive Sleep Apnea in Patients With Heart Failure

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