Upper airway collapsibility in children with obstructive sleep apnea syndrome

Marcus, Carole L.; McColley, Susanna A.; Carroll, John L.; Loughlin, Gerald M.; Smith, Philip L.; Schwartz, Alan R.

doi:10.1152/jappl.1994.77.2.918

Cited by 230 publications

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“…The present study is relevant because little is known regarding the consequences of the clinical manifestations of OSAS in patients with SCA; it is known, however, that when OSAS is not adequately treated it can lead to serious complications, among which is a delay in the growth curve. (8) According to one study, (9) the delay in the growth curve of children with OSAS is related to increased respiratory effort during sleep, which generates increased caloric expenditure; in addition, obstructive events might cause a reduction in growth hormone release. (10) According to one review, (11) individuals with SCA present a reduction in serum concentration of growth hormone, as well as a reduced response to growth hormone stimulation, probably secondary to the hypoxicischemic injury in the hypothalamic-pituitary axis after one or more episodes of vaso-occlusive crisis, which contributes to a delay in growth.…”

Section: Discussionmentioning

confidence: 99%

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

Salles¹,

Ramos

Daltro

et al. 2009

J. bras. pneumol.

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Objective: To estimate the prevalence of obstructive sleep apnea syndrome (OSAS) in children and adolescents with sickle cell anemia (SCA); to investigate the possible correlation between mean annual hemoglobin level and total sleep time with SpO 2 < 90%, as well as between mean annual hemoglobin level and total sleep time with SpO 2 < 80%; and to investigate the possible correlation between apnea-hypopnea index (AHI) and painful crisis. Methods: The study involved 85 patients with SCA. The patients completed a questionnaire, were submitted to polysomnography and underwent clinical evaluation (by a pediatrician and an otolaryngologist). An AHI > 1 was considered indicative of a diagnosis of OSAS. Results: The prevalence of OSAS was 10.6%. We found a negative correlation between mean annual hemoglobin level and total sleep time with SpO 2 < 90% (r = −0.343; p = 0.002), as well as between mean annual hemoglobin level and total sleep time with SpO 2 < 80% (r = −0.270; p = 0.016). There was no association between AHI and painful crisis. Conclusions: The prevalence of OSAS in this population was high (10.6%). Therefore, it is important to identify signs of OSAS as soon as possible and to determine the mean annual hemoglobin level because of the inverse correlation between that level and the total sleep time with SpO 2 < 90% or < 80%.Keywords: Prevalence; Sleep apnea, obstructive; Anemia, sickle cell; Polysomnography; Sleep apnea syndromes. ResumoObjetivo: Estimar a prevalência da síndrome da apneia obstrutiva do sono (SAOS) em crianças e adolescentes com anemia falciforme (AF) e investigar a possível correlação entre hemoglobina anual média e tempo total de sono com SpO 2 < 90% e tempo total de sono com SpO 2 < 80%, assim como investigar a possível correlação entre o índice de apneia-hipopneia (IAH) e episódios de crise álgica. Métodos: Participaram 85 pacientes com AF, que responderam a um questionário, foram avaliados por um pediatra e um otorrinolaringologista, e submetidos a estudo polissonográfico. O diagnóstico de SAOS foi definido como IAH > 1. Resultados: A prevalência da SAOS foi 10,6%. Observou-se uma correlação negativa entre hemoglobina anual média e tempo total de sono com SpO 2 < 90% (r = −0,343; p = 0,002) e tempo total de sono com SpO 2 < 80% (r = −0,270; p = 0,016). Não foi observada associação entre IAH e episódios de crise álgica. Conclusões: A prevalência da SAOS nesta população foi alta (10,6%). Portanto, é importante identificar precocemente os sinais de SAOS e avaliar hemoglobina anual média, devido à correlação inversa entre essa e o tempo total de sono com SpO 2 < 90% ou < 80%.

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Section: Discussionmentioning

confidence: 99%

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

Salles¹,

Ramos

Daltro

et al. 2009

J. bras. pneumol.

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“…In children, the primary abnormality associated with increased odds of OSA consists in the presence of adenotonsillar hypertrophy. This is not surprising, considering the obvious fact that anatomical impingement of the upper airway by enlarged lymphoid tissues will exponentially increase the airflow resistance, and ultimately culminate in recurring upper airway collapse, the latter being characteristic of OSA (27,28). Adenoids are located on the roof of the nasopharynx and enlarge from infancy through childhood, with progressive subsequent reductions in size during adolescence through adulthood.…”

Section: Pathophysiology Of Osa In Childhoodmentioning

confidence: 99%

Obstructive Sleep Apnea in Children: Implications for the Developing Central Nervous System

Gozal

2008

Seminars in Pediatric Neurology

120

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Recent increases in our awareness to the high prevalence of sleep disorders in general, and of sleepdisordered breathing among children, in particular, has led to concentrated efforts aiming to understand the pathophysiological mechanisms, clinical manifestations and potential consequences of such conditions. In this review, I will briefly elaborate on some of the pathogenetic elements leading to the occurrence of obstructive sleep apnea (OSA) in children, focus on the psychobehavioral consequences of pediatric OSA, and review the evidence on the potential mechanisms underlying the close association between CNS morbidity and the episodic hypoxia and sleep fragmentation that characterize OSA. Sleep Disorders In ChildrenPediatric sleep continues to gain significant recognition due to both increasing evidence of a high prevalence of sleep disorders among children, and by virtue of the potential somatic and psycho-behavioral effects of disrupted sleep during early development. Obstructive sleep apnea (OSA) is by far the most frequently diagnosed pediatric sleep disorder, and has been reported to affect at least 1-3% of all pre-school and school-aged children. Furthermore, symptoms consistent with an increased risk for sleep-disordered breathing have been reported in 6-27% of children (1-8).

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“…In adults, there are known anatomic risk factors for OSAS, including enlargement of the tongue, soft palate, parapharyngeal fat pads, and lateral pharyngeal walls (5) in conjunction with craniofacial restriction (retrognathia) (6). In addition to anatomic factors, physiologic mechanisms increase OSAS risk in both children and adults (7)(8)(9)(10)(11)(12). Although these risk factors for OSAS have been well described in children and adults, few studies have addressed the important transitional developmental phase of adolescence.…”

mentioning

confidence: 99%

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Schwab

Kim

Bagchi

et al. 2015

Am J Respir Crit Care Med

103

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Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children.Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI).Methods: Three groups of adolescents (age range: 12-16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50). Measurements and Main Results:We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation.Conclusions: Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.Keywords: adenoid; adolescents; MRI; obstructive sleep apnea syndrome; tonsils The obstructive sleep apnea syndrome (OSAS) is common in children and adults, but it has not been well studied in adolescents. In one study, researchers reported the prevalence of OSAS in adolescents to be 2% (1), but the prevalence is probably higher in the United States because of the adolescent obesity epidemic (2). OSAS in children is thought to be secondary to a combination of enlargement of the lymphoid tissue (tonsils and adenoid) (3) and, sometimes, obesity, as well as to reductions in neuromuscular tone (4). In adults, there are known anatomic risk factors for OSAS, including enlargement of the tongue, soft palate, parapharyngeal fat pads, and lateral pharyngeal walls (5) in conjunction with craniofacial restriction (retrognathia) (6). In addition to anatomic factors, physiologic mechanisms increase OSAS risk in both children and adults (7-12). Although these risk factors for OSAS have been well described in children and adults, few Supported by grants from the National Institutes of Health (R01 HL058585, R01 HL089447, and P01 HL094307).Author Contributions: Conception and design: R.J.S., R.M.B., S.H., and C.L...

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Upper airway collapsibility in children with obstructive sleep apnea syndrome

Cited by 230 publications

References 0 publications

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

Obstructive Sleep Apnea in Children: Implications for the Developing Central Nervous System

Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

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