Sleep Architecture and Respiratory Disturbances in  Children with Obstructive Sleep Apnea

Goh, Daniel Y T; Galster, Patricia; Marcus, Carole L.

doi:10.1164/ajrccm.162.2.9908058

Cited by 320 publications

(247 citation statements)

References 28 publications

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“…29 In adults, there is convincing evidence of a consistent relationship be- tween SWS and increased GH secretion and decreased GH secretion with awakenings. 35 In OSAS children, the sleep architecture is relatively well-preserved, 36 and the distribution pattern of apneas over the night is different from the profile of GH secretion. 29,36 One of the limitations of the methods used in this study was the lack of electroencephalogram, electro-oculogram, and chin EMG tracing, so the different sleep stages could not be differentiated, but changes in the proportion of SWS do not seem to be significant after treatment of OSAS.…”

Section: Discussionmentioning

confidence: 99%

“…35 In OSAS children, the sleep architecture is relatively well-preserved, 36 and the distribution pattern of apneas over the night is different from the profile of GH secretion. 29,36 One of the limitations of the methods used in this study was the lack of electroencephalogram, electro-oculogram, and chin EMG tracing, so the different sleep stages could not be differentiated, but changes in the proportion of SWS do not seem to be significant after treatment of OSAS. 37 Impaired GH secretion is probably not the only cause for the failure to thrive, because OSAS children may also be obese, 38,39 but only the minority was overweight in this study.…”

Section: Discussionmentioning

confidence: 99%

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Growth and Biochemical Markers of Growth in Children With Snoring and Obstructive Sleep Apnea

et al. 2002

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ABSTRACT. Objective. The pathophysiological mechanisms of growth impairment frequently associated with the obstructive sleep apnea syndrome (OSAS) in children are poorly defined. The main objective of this study was to evaluate whether nighttime upper airway obstruction attributable to adenotonsillar hypertrophy and subsequent surgical treatment affect the circulating concentrations of insulin-like growth factor-I (IGF-I) and IGFbinding protein 3 (IGFBP-3) along with other growth parameters in children.Patients and Methods. We initially studied 70 children (mean age: 5.8 years; range: 2.4 -10.5 years) admitted to a university hospital because of clinical symptoms of OSAS. Their sleep was monitored with a 6-channel computerized polygraph. Data on anthropometry and circulating concentrations of IGF-I and IGFBP-3 were generated and compared with corresponding characteristics in control children (N ‫؍‬ 35). Thirty children with an obstructive apnea-hypopnea index (OAHI) of 1 or more were categorized as children with OSAS (mean OAHI: 5.4 [95% confidence interval for mean (CI): 3.8 -6.9]), whereas 40 children with an OAHI of <1 were considered as primary snorers (PS) (mean OAHI 0.13 [95% CI: 0.05-0.21]). Nineteen children with OAHI >2 underwent adenotonsillectomy attributable to OSAS and were reassessed 6 months later together with 34 nonoperated children with OAHI <2.Results. There were no initial differences in relative height and weight for height between the 3 groups of children. No differences were observed in peripheral IGF-I concentrations, but both OSAS and PS children had reduced peripheral IGFBP-3 levels. The operated children with initial OSAS experienced a highly significant reduction in their OAHI from 7.1 (95% CI: 5.1-9.1) to 0.37 (95% CI: 0.2-0.95). Weight-for-height, body mass index, body fat mass, and fat-free mass increased during the follow-up in the operated children with OSAS, whereas only fat-free mass and relative height increased in the PS children. Both the IGF-I and the IGFBP-3 concentrations increased significantly in the operated children, whereas no significant changes were seen in the PS children.Conclusions. These observations indicate that growth hormone secretion is impaired in children with OSAS and PS. Respiratory improvement after adenotonsillectomy in children with OSAS results in weight gain and restored growth hormone secretion. Pediatrics 2002;109(4). URL: http://www.pediatrics.org/cgi/content/full/109/4/e55; snoring, obstructive sleep apnea, growth hormone, insulinlike growth factor-I, insulin-like growth factor-binding protein 3.ABBREVIATIONS. OSAS, obstructive sleep apnea syndrome; GH, growth hormone; IGF-I, insulin-like growth factor-I; IGFBP-3, insulin-like growth factor-binding protein 3; PS, primary snorer; EMG, electromyogram; OAHI, obstructive sleep apnea-hypopnea index; SDS, standard deviation score; BMI, body mass index; SWS, slow-wave sleep. S noring is relatively common in children, with the prevalence of regular snoring about 10% in preschool-aged subjects. 1-3 Obs...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Growth and Biochemical Markers of Growth in Children With Snoring and Obstructive Sleep Apnea

et al. 2002

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“…Proportionally, REM sleep increases and respiratory function is at its nadir, later in the sleep period. 12,22 There is a strong possibility that the combination of opioids and sleep promote desaturation following adenotonsillectomy in children with severe OSAS.…”

Section: Time Of Day Of Surgerymentioning

confidence: 99%

Les enfants atteints d’un SAOS sévere, opérés pour amygdalectomie le matin, sont moins susceptibles de désaturation postopératoire que les opérés d’après-midi

Koomson

Morin

Brouillette

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To determine, in a subset of children previously reported, if the time of day when adenotonsillectomy for severe obstructive sleep apnea syndrome (OSAS) was performed affected the incidence of postoperative respiratory complications.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : Children having adenotonsillectomy were included if they had a polysomnographic diagnosis of severe OSAS within six months prior to operation. Patients who met the inclusion criteria were grouped by the occurrence of postoperative desaturation into a saturated (SAT) and desaturated (deSAT) group. The charts of children in group deSAT were reviewed. The clock time of the surgical procedure was recorded and categorized as morning (AM) or afternoon (PM).R Re es su ul lt ts s: : Eighty-eight patients met the inclusion criteria. There were 31 girls and 57 boys. The mean ± SD age (yr) and weight (kg) were 4.6 ± 2.9 yr and 20.8 ± 14.5 kg respectively. There were 63 children in the SAT group and 25 in the deSAT group. Differences in age, weight and gender were not significant. The preoperative oxygen saturation (SaO 2 ) nadir for the SAT and deSAT groups was 80.8 ± 10.2% and 67.6 ± 17.5% (P < 0.05) respectively. The preoperative obstructive apnea and hypopnea index was 15.8 ± 10.2 and 35.7 ± 34.6 events·hr -1 (P < 0.05), respectively. Surgery in 63 (71.6%) children was performed in the AM. Univariate logistic regression identified PM surgery [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.7 to 12.6, P = 0.002] and a preoperative SaO 2 nadir < 80% (OR 3.6, 95% CI 1.4 to 9.4, P = 0.009) as risk factors predicting postadenotonsillectomy desaturation.C Co on nc cl lu us si io on n: : Children with severe OSAS whose surgery is performed in the AM are less likely to desaturate following adenotonsillectomy than children whose surgery is performed in the PM. 80,8 ± 10,2 % et de 67,6 ± 17,5 % (P < 0,05) de 15,8 ± 10,2 et de 35,7 ± 34,6 événements·h -1 (P < 0,05), respectivement. L'opération de 63 (71,6 %) Éléments cliniques : Des enfants subissant une amygdalectomie ont été inclus dans notre étude si un diagnostic polysomnographique de SAOS sévère avait été établi dans les six mois avant l'opération. Les patients admis ont été répartis selon l'occurrence de désaturation postopératoire dans un groupe de saturation (SAT) ou de désaturation (deSAT). Les dossiers des enfants du groupe deSAT ont été révisés. L'heure de l'opération a été notée sous matin (AM) ou après-midi (PM). Résultats dans les groupes SAT et deSAT respectivement. Les indices d'apnée obstructive et d'hypopnée préopératoires étaient

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“…Physiological homeostatic control appears to be suppressed under REM sleep condition, representing an increased risk due to marked cardiovascular instability (Parmeggiani, 2000). Clinically, obstructive sleep apnea is very much a REM-sleep related disease, with obstructive apneas occurring more frequently for a longer duration, and with more desaturation during REM sleep than non-REM sleep (Arens and Marcus, 2004;Goh et al, 2000). However, the central mechanism for this autonomic change associated with REM sleep remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Arterial Pressure and Heart Rate Increase during REM Sleep in Adenosine A2A-Receptor Knockout Mice, but not in Wild-Type Mice

Sakata

Séi

Eguchi³

et al. 2005

Neuropsychopharmacol

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Rapid eye movement (REM)-sleep related changes in arterial pressure (AP) and heart rate (HR) were observed in homozygous and heterozygous adenosine A 2A receptor (A2AR) knockout (KO) mice, and the corresponding wild-type mice. During REM sleep, the mean AP (MAP) and HR were clearly increased in the homozygous A2AR KO mice, while, in the wild-type mice, they were decreased or maintained at the same level. Neither homozygous nor heterozygous A2AR KO mice showed significant difference in diurnal pattern and the hourly values of MAP and HR compared to the wild-type mice. From these findings, it is likely that the adenosine A2AR is involved in autonomic regulation during REM sleep.

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Sleep Architecture and Respiratory Disturbances in Children with Obstructive Sleep Apnea

Cited by 320 publications

References 28 publications

Growth and Biochemical Markers of Growth in Children With Snoring and Obstructive Sleep Apnea

Growth and Biochemical Markers of Growth in Children With Snoring and Obstructive Sleep Apnea

Les enfants atteints d’un SAOS sévere, opérés pour amygdalectomie le matin, sont moins susceptibles de désaturation postopératoire que les opérés d’après-midi

Arterial Pressure and Heart Rate Increase during REM Sleep in Adenosine A2A-Receptor Knockout Mice, but not in Wild-Type Mice

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