Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea

Marcus, Carole L.; Moreira, Gustavo; Bamford, Owen S.; Lutz, Janita

doi:10.1152/jappl.1999.87.4.1448

Cited by 72 publications

(47 citation statements)

References 24 publications

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“…AEP changes post-treatment of OSAS did not correlate with OSAS improvement as measured by AHI reduction (r ¼ 20.246; P ¼ 0.557) (16).…”

Section: Sleep Aepmentioning

confidence: 87%

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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“…AEP changes post-treatment of OSAS did not correlate with OSAS improvement as measured by AHI reduction (r ¼ 20.246; P ¼ 0.557) (16).…”

Section: Sleep Aepmentioning

confidence: 87%

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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“…Thus, whereas the rate of obstructive events per hour of sleep (apnea-hypopnea index [AHI]) allows for quantification of changes in upper airway obstruction for REM sleep, other measures are needed to assess upper airway obstruction during NREM sleep. It has been demonstrated previously that the inspiratory time relative to the duration of the respiratory cycle, the inspiratory duty cycle, increases linearly with the degree of upper airway obstruction 22–24. Therefore, we determined the effect of TNI on upper airway obstruction in children by assessing both the AHI and the inspiratory duty cycle.…”

mentioning

confidence: 99%

Effect of a High-Flow Open Nasal Cannula System on Obstructive Sleep Apnea in Children

et al. 2009

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OBJECTIVE-Obstructive sleep apnea syndrome in children is associated with significant morbidity. Continuous positive airway pressure (CPAP) treats obstructive apnea in children, but is impeded by low adherence. We, therefore, sought to assess the effect of warm humidified air delivered through an open nasal cannula (treatment with nasal insufflation [TNI]) on obstructive sleep apnea in children with and without adenotonsillectomy.METHODS-Twelve participants (age: 10 ± 1 years; BMI: 35 ± 14 kg/m 2 ), with obstructive apneahypopnea syndrome ranging from mild to severe (2-36 events per hour) were administered 20 L/min of air through a nasal cannula. Standard sleep architecture, sleep-disordered breathing, and arousal indexes were assessed at baseline, on TNI, and on CPAP. Additional measures of the percentage of time with inspiratory flow limitation, respiratory rate, and inspiratory duty cycle were assessed at baseline and on TNI.RESULTS-TNI reduced the amount of inspiratory flow limitation, which led to a decrease in respiratory rate and inspiratory duty cycle. TNI improved oxygen stores and decreased arousals, which decreased the occurrence of obstructive apnea from 11 ± 3 to 5 ± 2 events per hour (P < .01). In the majority of children, the reduction in the apnea-hypopnea index on TNI was comparable to that on CPAP.CONCLUSIONS-TNI offers an alternative to therapy to CPAP in children with mild-to-severe sleep apnea. Additional studies will be needed to determine the efficacy of this novel form of therapy. bmcginley@jhmi.edu. FINANCIAL DISCLOSURE: Dr Schneider received consulting fees from TNI medical in 2006 and is entitled to royalty payments on the future sales of products described in this article. Under a separate licensing agreement between Dr Schneider and TNI medical and Johns Hopkins University, Dr Schneider is entitled to a share of royalty received by the university on sales of products described in this article. The terms of this agreement are being managed by Johns Hopkins University in accordance with its conflict of interest policies. Dr Schneider was not involved in the analysis of the study data, and data collected under this study were masked with respect to patient identifiers and clinical outcomes to Dr Schneider. The nonconflicted faculty members were responsible for all of the data analysis. Funding for the study described in this article was partially provided by TNI medical. NIH Public Access PATIENTS AND METHODS Study PopulationChildren 5 to 15 years of age were recruited consecutively from the Johns Hopkins Pediatric Sleep Disorders Center if they had OSA and were recommended treatment with CPAP. Patients were excluded if they had a nocturnal oxygen requirement or other serious medical conditions. Informed consent was obtained from 1 parent or guardian, assent was obtained from the children, and the Johns Hopkins Medicine Institutional Review Board approved the protocol. ProtocolsEach participant underwent 2 over-night polysomnograms, 1 with TNI at 20 L/min and 1 night off TNI, p...

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“…Studies in children with OSA have confirmed a higher tendency of the upper airway to collapse compared to agematched controls [1,2]. This tendency is complicated by the fact that sleep apnoeic children are less likely to arouse in response to upper airway obstruction or to the apnoeaassociated hypercapnia [2,3].…”

Section: Definition Aetiology and Pathophysiologymentioning

confidence: 99%

Obstructuve sleep apnoea in children

Verhulst

Kaditis

2011

Breathe

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Obstructive sleep apnoea in childrenEducational aims µ To understand the aetiology and pathophysiology of obstructive sleep apnoea in childhood. µ To recognise sleep apnoea-related morbidity from the cardiovascular and central nervous systems. µ To get familiar with treatment indications and available therapeutic modalities for obstructive sleep apnoea in childhood. SummaryAdenotonsillar hypertrophy, obesity, craniofacial anomalies and abnormal neuromotor tone are the main conditions predisposing to obstructive sleep apnoea (OSA) in childhood. Overnight polysomnography is the gold standard for diagnosis of the disorder. Sleep apnoeic children experience increased prevalence of enuresis, elevated blood pressure, excessive daytime sleepiness, hyperactivity, learning problems and neurocognitive dysfunction. Successful treatment of paediatric OSA requires a multifaceted approach which will address all the different conditions related to dysfunctional upper airway during sleep.

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Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea

Cited by 72 publications

References 24 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

Effect of a High-Flow Open Nasal Cannula System on Obstructive Sleep Apnea in Children

Obstructuve sleep apnoea in children

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