Utilizing inspiratory airflows during standard polysomnography to assess pharyngeal function in children during sleep

Brian M. McGinley, Jason P. Kirkness, Hartmut Schneider, Abhishek Lenka, Philip L Smith, Alan R Schwartz

Research output: Contribution to journalArticle

Abstract

Objectives Obstructive sleep apnea (OSA) is the result of pharyngeal obstruction that occurs predominantly during REM in children. Pathophysiologic mechanisms responsible for upper airway obstruction, however, are poorly understood. Thus, we sought to characterize upper airway obstruction in apneic compared to snoring children during sleep. We hypothesized that apneic compared to snoring children would exhibit an increased prevalence and severity of upper airway obstruction, that would be greater in REM compared to non-REM, and would improve following adenotonsillectomy. Study Design Apneic children were assessed with routine polysomnography before and after adenotonsillectomy, and compared to snoring children matched for gender, age, and BMI z-score. In addition to traditional scoring metrics, the following were used to characterize upper airway obstruction: maximal inspiratory airflow (%VImax) and percent of time with inspiratory flow-limited breathing (%IFL). Results OSA compared to snoring children had similar degrees of upper airway obstruction in non-REM; however, during REM, children with sleep apnea exhibited a higher %IFL (98 ± 2% vs.73 ± 8%, P <0.01) and lower %VImax (56 ± 6 vs.93 ± 10%, P <0.01). In children with OSA, CO2 levels were elevated during both wake and sleep. Following adenotonsillectomy, upper airway obstruction improved during REM manifest by decreased %IFL (98 ± 2 to 63 ± 9%, P = 0.04), increased %VImax (56 ± 6 to 95 ± 5%, P = 0.01) and decreased CO2 levels. Conclusions Differences in the prevalence and severity upper airway obstruction suggest impaired compensatory responses during REM in children with OSA, which improved following adenotonsillectomy.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalPediatric Pulmonology
Volume51
Issue number4
DOIs
StatePublished - Apr 1 2016

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Polysomnography
Airway Obstruction
Sleep
Snoring
Obstructive Sleep Apnea
Sleep Apnea Syndromes
Respiration

Keywords

  • adenotonsillectomy
  • compensatory responses to sleep apnea
  • obstructive sleep apnea

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Utilizing inspiratory airflows during standard polysomnography to assess pharyngeal function in children during sleep. / McGinley, Brian M.; Kirkness, Jason P.; Schneider, Hartmut; Lenka, Abhishek; Smith, Philip L; Schwartz, Alan R.

In: Pediatric Pulmonology, Vol. 51, No. 4, 01.04.2016, p. 431-438.

Research output: Contribution to journalArticle

McGinley, Brian M. ; Kirkness, Jason P. ; Schneider, Hartmut ; Lenka, Abhishek ; Smith, Philip L ; Schwartz, Alan R. / Utilizing inspiratory airflows during standard polysomnography to assess pharyngeal function in children during sleep. In: Pediatric Pulmonology. 2016 ; Vol. 51, No. 4. pp. 431-438.
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abstract = "Objectives Obstructive sleep apnea (OSA) is the result of pharyngeal obstruction that occurs predominantly during REM in children. Pathophysiologic mechanisms responsible for upper airway obstruction, however, are poorly understood. Thus, we sought to characterize upper airway obstruction in apneic compared to snoring children during sleep. We hypothesized that apneic compared to snoring children would exhibit an increased prevalence and severity of upper airway obstruction, that would be greater in REM compared to non-REM, and would improve following adenotonsillectomy. Study Design Apneic children were assessed with routine polysomnography before and after adenotonsillectomy, and compared to snoring children matched for gender, age, and BMI z-score. In addition to traditional scoring metrics, the following were used to characterize upper airway obstruction: maximal inspiratory airflow ({\%}VImax) and percent of time with inspiratory flow-limited breathing ({\%}IFL). Results OSA compared to snoring children had similar degrees of upper airway obstruction in non-REM; however, during REM, children with sleep apnea exhibited a higher {\%}IFL (98 ± 2{\%} vs.73 ± 8{\%}, P <0.01) and lower {\%}VImax (56 ± 6 vs.93 ± 10{\%}, P <0.01). In children with OSA, CO2 levels were elevated during both wake and sleep. Following adenotonsillectomy, upper airway obstruction improved during REM manifest by decreased {\%}IFL (98 ± 2 to 63 ± 9{\%}, P = 0.04), increased {\%}VImax (56 ± 6 to 95 ± 5{\%}, P = 0.01) and decreased CO2 levels. Conclusions Differences in the prevalence and severity upper airway obstruction suggest impaired compensatory responses during REM in children with OSA, which improved following adenotonsillectomy.",
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AB - Objectives Obstructive sleep apnea (OSA) is the result of pharyngeal obstruction that occurs predominantly during REM in children. Pathophysiologic mechanisms responsible for upper airway obstruction, however, are poorly understood. Thus, we sought to characterize upper airway obstruction in apneic compared to snoring children during sleep. We hypothesized that apneic compared to snoring children would exhibit an increased prevalence and severity of upper airway obstruction, that would be greater in REM compared to non-REM, and would improve following adenotonsillectomy. Study Design Apneic children were assessed with routine polysomnography before and after adenotonsillectomy, and compared to snoring children matched for gender, age, and BMI z-score. In addition to traditional scoring metrics, the following were used to characterize upper airway obstruction: maximal inspiratory airflow (%VImax) and percent of time with inspiratory flow-limited breathing (%IFL). Results OSA compared to snoring children had similar degrees of upper airway obstruction in non-REM; however, during REM, children with sleep apnea exhibited a higher %IFL (98 ± 2% vs.73 ± 8%, P <0.01) and lower %VImax (56 ± 6 vs.93 ± 10%, P <0.01). In children with OSA, CO2 levels were elevated during both wake and sleep. Following adenotonsillectomy, upper airway obstruction improved during REM manifest by decreased %IFL (98 ± 2 to 63 ± 9%, P = 0.04), increased %VImax (56 ± 6 to 95 ± 5%, P = 0.01) and decreased CO2 levels. Conclusions Differences in the prevalence and severity upper airway obstruction suggest impaired compensatory responses during REM in children with OSA, which improved following adenotonsillectomy.

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