The effect of adenotonsillectomy on ventilatory control in children with obstructive sleep apnea

Loop gain in paediatric sleep‐disordered breathing: A different story from adults

“…A few studies have reported that LG in children with OSA is similar to healthy controls 8,9 . However, there are no previous reports showing a decline in LG with increasing anatomical obstruction as described in this manuscript.…”

Oropharyngeal obstruction and respiratory system compliance are linked to ventilatory control parameters in pediatric obstructive sleep apnea syndrome

“…When investigating factors related to MF-PG, we found that only minute ventilation and respiratory system compliance remained independent predictors of MF-PG. Thus, the positive correlation between PG and AHI reported by two groups 5 , 6 is possibly explained by the up-regulation of inflammatory pathways known to contribute to airway inflammation in patients with OSAS 35 , 36 . OSAS is a disorder associated with oxidative stress, up-regulation of redox-sensitive genes and inflammatory cascade 35 .…”

“…5-35Hz 39 . Thus, the normalization of plant gain after adenotonsillectomy observed by Armoni Domany and colleagues 6 could be explained by the resolution of OSAS and consequent down-regulation of inflammatory pathways leading to improved peripheral lung function.…”

“…Loop gain (LG), controller gain (CG), and plant gain (PG), which reflect the stability of ventilatory control, chemoreceptor sensitivity and the pulmonary control of blood gas in response to a change in ventilation, respectively, have been evaluated in children with OSAS. While some investigators demonstrated an increase in LG in some adult patients suffering from OSAS 4 , two independent groups demonstrated an increase in PG in children with OSAS while their LG was not different from that of non-OSAS children due to a reduction of CG 5 , 6 . These two groups established a positive correlation between PG and OSAS severity assessed by the apnea–hypopnea index (AHI), which suggests that high PG may play a more important role in pediatric OSAS.…”

“…As well, the subjects with more severe OSAS and abnormal lung function had higher PG and lower CG relative to the rest of the population studied. The link between upper airway compromise and ventilatory control is important to confirm since Armoni Domany and colleagues demonstrated that six months following adenotonsillectomy, there was a significant decrease in the elevated PG in the OSAS group, while no change observed in the control group 6 . Thus, this study suggested that the mechanisms leading to increased PG are also secondary to upper airway abnormalities.…”