844 Pediatric Vagus Nerve Stimulator-Induced Obstructive Sleep Apnea

Abstract Introduction Vagus nerve stimulation (VNS) is an adjunct treatment for seizures refractory to medications. VNS in children with epilepsy can reduce seizures by up to 90%. VNS settings include stimulation on-time, off-time, frequency and output current. Complications of VNS include sleep-disordered breathing due to laryngopharyngeal dysfunction, which can also cause voice alteration, hoarseness, and cough. Both obstructive apneas (more common) and central apneas can be seen in those patients who have VNS-induced sleep-disordered breathing. Report of case(s) A 14-year-old male with Lennox-Gastaut syndrome treated with multiple antiepileptic drugs and VNS was admitted to the PICU with worsening seizures. He developed acute respiratory failure due to status epilepticus, requiring intubation. After extubation, he was observed to have repetitive respiratory obstruction at regular intervals, occurring throughout the day and night, and associated with mild oxygen desaturations. Polysomnography showed cyclical obstructive respiratory events lasting 30 seconds followed by approximately 2-minute intervals of regular breathing. Interrogation of his VNS device revealed the following settings: output current of 1.75 mA, 30 seconds on, and 1.8 minutes off. CPAP therapy improved his oxygen saturations, but he continued to clinically exhibit the repetitive obstructive apneas even on positive pressure. However, after his VNS device settings were decreased, repeat polysomnography showed resolution of his obstructive breathing. Conclusion This case report demonstrates pediatric VNS-induced obstructive sleep apnea. Activation of the vagus nerve can cause laryngopharyngeal dysfunction, including laryngospasm and vocal cord dysfunction, with subsequent upper airway obstruction, causing obstructive apneas or hypopneas. Treatment options for pediatric VNS-induced OSA include CPAP, decreasing the VNS settings and adenotonsillectomy. Support (if any):

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Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1709195 ◽

2020 ◽

Author(s):

Juliana Alves Sousa Caixeta ◽

Jessica Caixeta Silva Sampaio ◽

Vanessa Vaz Costa ◽

Isadora Milhomem Bruno da Silveira ◽

Carolina Ribeiro Fernandes de Oliveira ◽

...

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Long Term Effects ◽

Obstructive Sleep ◽

Long Term Impact ◽

Disordered Breathing

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

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Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.4764 ◽

2015 ◽

Vol 11 (06) ◽

pp. 597-602 ◽

Cited By ~ 5

Author(s):

Virginia Skiba ◽

Cathy Goldstein ◽

Helena Schotland

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Esophageal Pressure ◽

Pressure Monitoring ◽

Obstructive Sleep ◽

Disordered Breathing

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Strategies to improve patient care for obstructive sleep apnea: a report from the American Academy of Sleep Medicine Sleep-Disordered Breathing Collaboration Summit

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8834 ◽

2020 ◽

Vol 16 (11) ◽

pp. 1933-1937

Author(s):

Ilene M. Rosen ◽

James A. Rowley ◽

Raman K. Malhotra ◽

David A. Kristo ◽

Kelly A. Carden ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

American Academy ◽

Patient Care ◽

Sleep Disordered Breathing ◽

Improve Patient Care ◽

Sleep Medicine ◽

Obstructive Sleep ◽

Improve Patient ◽

Disordered Breathing

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Postoperative Changes in Sleep-disordered Breathing and Sleep Architecture in Patients with Obstructive Sleep Apnea

Anesthesiology ◽

10.1097/aln.0000000000000040 ◽

2014 ◽

Vol 120 (2) ◽

pp. 287-298 ◽

Cited By ~ 75

Author(s):

Frances Chung ◽

Pu Liao ◽

Balaji Yegneswaran ◽

Colin M. Shapiro ◽

Weimin Kang

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Slow Wave Sleep ◽

Sleep Architecture ◽

Secondary Outcome ◽

Apnea Hypopnea Index ◽

Postoperative Changes ◽

Obstructive Sleep ◽

Disordered Breathing

Abstract Background: Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA. Methods: After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture. Results: Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] >5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P < 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P < 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery. Conclusions: Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.

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P.069 Respiratory dysfunction and sleep disordered breathing in children with Myasthenia Gravis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.171 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S34-S34

Author(s):

HF Qashqari ◽

I Narang ◽

H Katzberg ◽

K Vezina ◽

A Khayat ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Myasthenia Gravis ◽

Sleep Disordered Breathing ◽

Pediatric Population ◽

Respiratory Muscles ◽

Apnea Hypopnea Index ◽

Respiratory Dysfunction ◽

Obstructive Sleep ◽

Disordered Breathing

Background: Myasthenia Gravis ( MG) is an autoimmune disease that affects the neuromuscular junction. It typically presents with fluctuating muscle weakness which can affect respiratory muscles. Data about the prevalence of sleep disordered breathing in children with MG and the benefits of non-invasive ventilation outside the setting of MG crisis has not been studied so far. Methods: Eleven children between 3 and 18 years old with confirmed MG were recruited from the The Hospital for Sick Children Neuromuscular clinic in a prospective observational study. Informed consent was obtained and patients underwent PFTs, MIP/MEP, SNIP, FVC and standard polysomnography testing’s. Results: In our study, we found that 2/11 children had abnormal Apnea Hypopnea index (AHI) and were diagnosed with obstructive sleep apnea (OSA). One of them has juvenile ocular MG with mild to moderate OSA and the second child has congenital MG with mild OSA. CPAP therapy was initiated for both patients. Conclusions: In our cohort, obstructive sleep apnea rate was significantly higher in children with MG than the known prevalence in general pediatric population ( 18% vs 2-3% ). Early diagnosis and management of OSA can have great impact on children’s health and quality of life. A larger study is needed to validate our findings.

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Impaired Glucose Metabolisms of Patients with Obstructive Sleep Apnea and Type 2 Diabetes

Journal of Diabetes Research ◽

10.1155/2018/6714392 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Ye Zhang ◽

Yanpeng Xing ◽

Haibo Yuan ◽

Xiaokun Gang ◽

Weiying Guo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Plasma Cortisol ◽

Sleep Disordered Breathing ◽

Model Assessment ◽

Obstructive Sleep ◽

Underlying Mechanisms ◽

Disordered Breathing

Aims. Obstructive sleep apnea (OSA) is a very common disorder which is associated with metabolic comorbidities. The aims of this study were to analyze clinical data of patients with OSA and evaluate influence of sleep-disordered breathing on glycometabolism and its underlying mechanisms. Methods. We designed a cross-sectional study involving 53 OSA patients in The First Hospital of Jilin University from March 2015 to March 2016. They underwent a full-night polysomnography, measurement of fasting blood glucose and blood lipid profiles. Besides, we chose 20 individuals with type 2 diabetes mellitus (T2DM) as a subgroup for an in-depth study. This group additionally underwent a steamed bread meal test and measurement of HbA1c, C-reactive protein, tumor necrosis factor-α, interleukin 6, morning plasma cortisol, and growth hormone. Results. The two groups which with or without T2DM showed no significant differences in baseline characteristics. As for OSA patients with T2DM, the severe OSA group had higher homeostasis model assessment of insulin resistance (HOMA-IR) (P=0.013) than the mild-to-moderate OSA group, whereas had lower morning plasma cortisol levels (P=0.005) than the mild-to-moderate OSA group. AHI was positive correlated with HOMA-IR (r=0.523, P=0.018), yet negative correlated with morning plasma cortisol (r=−0.694, P=0.001). However, nadir SpO2 was positive correlated with morning plasma cortisol (rs=0.646, P=0.002), while negative correlated with HOMA-IR (rs=−0.489, P=0.029). Conclusions. Our study showed that sleep-disordered breathing exerted negative influence on glucose metabolisms. The impairment of hypothalamic-pituitary-adrenal axis activity may be one of the underlying mechanisms of the glycometabolic dysfunctions in OSA with T2DM patients.

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