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

2014 ◽  
Vol 120 (2) ◽  
pp. 287-298 ◽  
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.

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

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.

scholarly journals The Association between Sleep-Disordered Breathing and Magnetic Resonance Imaging Findings in a Pediatric Cohort with Chiari 1 Malformation

2015 ◽  
Vol 22 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Reshma Amin ◽  
Priya Sayal ◽  
Aarti Sayal ◽  
Colin Massicote ◽  
Robin Pham ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Clinical Symptoms ◽  
Apnea Hypopnea Index ◽  
Imaging Findings ◽  
Tonsillar Herniation ◽  
Predominant Type ◽  
Obstructive Sleep ◽  
Disordered Breathing

BACKGROUND: The prevalence of sleep-disordered breathing (SDB) reported in the literature for Chiari malformation type 1 (CM1) is uniformly high (24% to 70%). In Canada, there is limited access to pediatric polysomnography (PSG). Therefore, the identification of clinical features would be invaluable for triaging these children.OBJECTIVE: To identify demographic features, clinical symptoms/signs and radiological findings associated with SDB in a large pediatric cohort with CM1.METHODS: A retrospective review was conducted on children with CM1 who underwent baseline PSG. Data were collected on patient demographics (age, sex, weight, height, body mass index), clinical symptoms (chart review and clinical questionnaires), diagnostic imaging of the brain and cervicothoracic spine, and medical history at the time of referral.RESULTS: A total of 68 children were included in the review. The mean (± SD) age of the children at the time of PSG was 7.33±4.01 years; 56% (n=38) were male. There was a 49% prevalence of SDB in this cohort based on the overall apnea-hypopnea index. Obstructive sleep apnea was the predominant type of SDB. Tonsillar herniation was significantly correlated with obstructive apnea-hypopnea index (r=0.24; P=0.036).CONCLUSIONS: A direct relationship between the degree of cerebellar tonsillar herniation and obstructive sleep apnea was demonstrated. However, further prospective studies that include neurophysiological assessment are needed to further translate the central nervous system imaging findings to predict the presence of SDB.

scholarly journals Inflammatory Factors: Nonobese Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

2020 ◽  
Vol 9 (4) ◽  
pp. 1028
Author(s):  
Yu-Shu Huang ◽  
Wei-Chih Chin ◽  
Christian Guilleminault ◽  
Kuo-Chung Chu ◽  
Cheng-Hui Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Tnf Α ◽  
Cytokine Levels ◽  
Hs Crp ◽  
Disordered Breathing

Background: Inflammation is often considered relating to pediatric obstructive sleep apnea (OSA). We conducted a study investigating cytokines, including Il-17 and Il-23, in children with OSA before and after adenotonsillectomy (T&A), compared with controls. Methods: Children with OSA between age 4 and 12 receiving T&A were prospectively followed. Evaluation before and reevaluation six months after the treatment were done, including polysomnography (PSG), blood tests, and questionnaires. Blood samples were obtained to determine the values of high-sensitivity-C-reactive-protein (HS-CRP); tumor-necrosis-factor-alpha (TNF-α); and interleukin (IL)-1, 6, 10, 12, 17, and 23. We compared the results with an age-matched control group. Results: We included 55 OSA children and 32 controls. Children with OSA presented significant improvement after T&A in complaints, signs, apnea hypopnea index (AHI) (p < 0.001), mean oxygen desaturation index (p < 0.001), and mean oxygen saturation (p = 0.010). Upon entering this study, children with OSA had significantly higher cytokine levels than the controls and significant changes in HS-CRP (p = 0.013), TNF-α (p = 0.057), IL-1β (p = 0.022), IL-10 (p = 0.035), and IL-17 (p = 0.010) after T&A. Children with improved but persistently abnormal AHI did not have all cytokine levels normalized, particularly IL-23 and HS-CRP. Conclusion: Sleep-disordered breathing can persist after T&A and can continue to have a negative inflammatory effect. HS-CRP and IL-23 may serve as blood markers for the persistence of sleep-disordered breathing after T&A.

scholarly journals Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients

2020 ◽  
Vol 17 (10) ◽  
pp. 3531 ◽  
Author(s):  
Nosetti Luana ◽  
Zaffanello Marco ◽  
De Bernardi Francesca ◽  
Piacentini Giorgio ◽  
Roberto Giulia ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gastroesophageal Reflux ◽  
Sleep Disordered Breathing ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Clinical Approach ◽  
Obstructive Sleep ◽  
Disordered Breathing

Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.

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

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.

Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis

2019 ◽  
Vol 162 (2) ◽  
pp. 168-176
Author(s):  
Chia-Hsuan Lee ◽  
Wei-Chung Hsu ◽  
Jenq-Yuh Ko ◽  
Te-Huei Yeh ◽  
Ming-Tzer Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Success Rate ◽  
Cochrane Review ◽  
Velopharyngeal Insufficiency ◽  
Apnea Hypopnea Index ◽  
Prader Willi Syndrome ◽  
Postoperative Changes ◽  
Obstructive Sleep ◽  
Osa Treatment

Objective Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. Data Source PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. Review Methods The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Results Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, −10.8 to −5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Conclusion Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

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