Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants

2021 ◽  
pp. archdischild-2020-320527
Author(s):  
Hanna-Leena Kristiina Kukkola ◽  
Pia Vuola ◽  
Maija Seppä-Moilanen ◽  
Päivi Salminen ◽  
Turkka Kirjavainen
Keyword(s):  
Eye Movement ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Sleep Position ◽  
Pierre Robin Sequence ◽  
Rapid Eye Movement ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Sleep Positioning ◽  
Pierre Robin

IntroductionObstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated.DesignTo complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position.ResultsOne-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient.ConclusionsThe incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.

Tongue–lip adhesion and tongue repositioning for obstructive sleep apnoea in Pierre Robin sequence: A systematic review and meta-analysis

2017 ◽  
Vol 131 (5) ◽  
pp. 378-383 ◽  
Author(s):  
M Camacho ◽  
M W Noller ◽  
S Zaghi ◽  
L K Reckley ◽  
C Fernandez-Salvador ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Pierre Robin Sequence ◽  
Inclusion Criteria ◽  
Robin Sequence ◽  
Obstructive Sleep ◽  
The Mean ◽  
Pierre Robin

AbstractObjective:To search for studies on tongue–lip adhesion and tongue repositioning used as isolated treatments for obstructive sleep apnoea in children with Pierre Robin sequence.Methods:A systematic literature search of PubMed/Medline and three additional databases, from inception through to 8 July 2016, was performed by two authors.Results:Seven studies with 90 patients (59 tongue–lip adhesion and 31 tongue repositioning patients) met the inclusion criteria. Tongue–lip adhesion reduced the mean (± standard deviation) apnoea/hypopnoea index from 30.8 ± 22.3 to 15.4 ± 18.9 events per hour (50 per cent reduction). The apnoea/hypopnoea index mean difference for tongue–lip adhesion was −15.28 events per hour (95 per cent confidence interval = −30.70 to 0.15;p= 0.05). Tongue–lip adhesion improved the lowest oxygen saturation from 75.8 ± 6.8 to 84.4 ± 7.3 per cent. Tongue repositioning reduced the apnoea/hypopnoea index from 46.5 to 17.4 events per hour (62.6 per cent reduction). Tongue repositioning improved the mean oxygen saturation from 90.8 ± 1.2 to 95.0 ± 0.5 per cent.Conclusion:Tongue–lip adhesion and tongue repositioning can improve apnoea/hypopnoea index and oxygenation parameters in children with Pierre Robin sequence and obstructive sleep apnoea.

scholarly journals Apnoea–Hypopnoea Index during Rapid Eye Movement and Non-Rapid Eye Movement Sleep in Obstructive Sleep Apnoea

2008 ◽  
Vol 36 (5) ◽  
pp. 906-913 ◽  
Author(s):  
M Muraki ◽  
S Kitaguchi ◽  
H Ichihashi ◽  
R Haraguchi ◽  
T Iwanaga ◽  
...  
Keyword(s):  
Eye Movement ◽  
Obstructive Sleep Apnoea ◽  
Rem Sleep ◽  
Nrem Sleep ◽  
Sleep Apnoea ◽  
Rapid Eye Movement ◽  
Rapid Eye Movement Sleep ◽  
Multivariate Logistic Regression ◽  
Obstructive Sleep ◽  
Nocturnal Polysomnography

This study investigated the differences in apnoea-hypopnoea index (AHI) during rapid eye movement (REM) sleep (AHI-REM) and AHI during non-REM (NREM) sleep (AHI-NREM) in patients with obstructive sleep apnoea (OSA). Nocturnal polysomnography was performed in 102 Japanese OSA patients and their AHI along with a variety of other factors were retrospectively evaluated. Regardless of the severity of AHI, mean apnoea duration was longer and patients' lowest recorded oxygen saturation measured by pulse oximetry was lower during REM sleep than during NREM sleep. Approximately half of the patients ( n = 50) had a higher AHI-NREM than AHI-REM. In subjects with AHI ≤ 60 events/h, AHI-NREM was significantly higher than AHI-REM. On multivariate logistic regression, severe AHI ≤ 30 events/h was the only predictor of a higher AHI-NREM than AHI-REM. This may indicate that important, but unknown, factors related to the mechanism responsible for the severity of OSA are operative during NREM sleep.

scholarly journals Polysomnographic Study to Evaluate Obstructive Sleep Apnoea Syndrome in Obese and Non Obese Adolescents

2021 ◽  
Author(s):  
HP Arun Kumar ◽  
K Pushpa
Keyword(s):  
Eye Movement ◽  
Obstructive Sleep Apnoea ◽  
Sleep Onset ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Sleep Stages ◽  
Rapid Eye Movement ◽  
Obese Adolescents ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep

Introduction: Obesity in adolescents is an emerging problem in developing countries like India, especially among higher socioeconomic status group. Obesity is the most important reversible risk factor for Obstructive Sleep Apnoea Syndrome (OSAS) in adolescents. Adolescent obesity with OSAS if not treated, can result in serious morbidity in cognitive, cardiovascular, somatic growth, development and metabolic disorders in future. Aim: To compare the sleep pattern between the obese and non obese adolescents and to evaluate OSAS. Materials and Methods: This was an observational study carried out at Life Style Laboratory, Department of Physiology, Bangalore Medical College and Research Institute, Karnataka, India. The study involved 30 obese and 30 non obese male adolescents, who were subjected to overnight Polysomnography (PSG) in the sleep laboratory. According to Kale’s criteria, epochs were manually scored which were compiled and statistically analysed for parameters like Sleep Latency (SL), Actual Sleep Time (AST), wake after sleep onset, percentage of Non Rapid Eye Movement (NREM), Rapid Eye Movement (REM) sleep stages, Sleep Efficiency (SE). The number of apnoeas and hypopnoeas were also noted to calculate Apnoea Hypopnoea Index (AHI). These parameters were compared for statistical significance using student t-test. Adolescents with AHI ≥1 were diagnosed with OSAS. Results: Mean age of obese adolescents was 17.7±0.97 years and their mean BMI was 28±0.73 kg/m2. OSAS was found in 22 out of 30 obese (73%) and 14 out of 30 (46%) non obese adolescents. It was found that apnoeas (3±4.80 vs 1±0.89), hypopnoeas (27.36±26.5 vs 5.46±2.97) and AHI (4.17±3.90 vs 0.89±0.43) were significantly more among obese adolescents when compared with non obese adolescents respectively. PSG parameters like SL, Wake After Sleep Onset (WASO) were prolonged and AST, SE were reduced significantly in obese adolescents. Conclusion: Adolescents with obesity had greater occurrence of OSAS, along with altered sleep architecture in them.

Orthodontic plate for management of obstructive sleep apnoea in infants with Pierre Robin sequence: experience and protocol in Hong Kong

2019 ◽  
Vol 46 (4) ◽  
pp. 367-373
Author(s):  
Angus CH Ho ◽  
Ricky WK Wong ◽  
Tania Cheung ◽  
Daniel K Ng ◽  
KK Siu ◽  
...  
Keyword(s):  
Hong Kong ◽  
Obstructive Sleep Apnoea ◽  
Chinese Population ◽  
Sleep Apnoea ◽  
Respiratory Support ◽  
Pierre Robin Sequence ◽  
Diagnosis And Management ◽  
Southern Chinese ◽  
Obstructive Sleep ◽  
Pierre Robin

Objective: To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre. Design: Retrospective case series of three patients with PRS. Setting: Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong. Participants: Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis. Methods: A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3–5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP. Results: All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3–6 months. Conclusions: The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.

scholarly journals P151 Short-term mandibular advancement splint therapy for Obstructive Sleep Apnoea improves parasympathetic modulation

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A70-A71
Author(s):  
S Ucak ◽  
H Dissanayake ◽  
K Sutherland ◽  
Y Bin ◽  
P de Chazal ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Linear Regression ◽  
Eye Movement ◽  
Obstructive Sleep Apnoea ◽  
Autonomic Function ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Rapid Eye Movement ◽  
Short Term ◽  
Obstructive Sleep

Abstract Introduction Altered autonomic function (specifically, sympathoexcitation and vagal withdrawal) contributes to cardiovascular risk. Obstructive sleep apnoea (OSA) is associated with altered autonomic function. Heart rate variability (HRV) is a non-invasive measure of autonomic function. We aimed to assess whether short-term OSA treatment with mandibular advancement splints (MAS) improves autonomic function measured by HRV. Methods A retrospective analysis of participants in MAS treatment studies (N=105, 56% male, age, 56±1 years; BMI, 30±5 kg/m2) was undertaken. Nocturnal HRV was assessed using electrocardiograms from pre and post-treatment polysomnograms. HRV was calculated across 2-minute epochs over the entire electrocardiogram and divided into each sleep stage (wake, non-rapid eye movement (NREM), and rapid eye movement (REM)). HRV measures reflecting sympathetic (normalised low frequency (LFnu)), parasympathetic (pNN50%, RMSSD (ms), normalised high frequency (HFnu)), total HRV (SDNN (ms) and HTI) and R-R interval were calculated. Changes in HRV measures following treatment were assessed (paired t-test) and compared to AHI change (linear regression, with adjustment for age, sex, BMI). Results Following MAS treatment, HTI increased (14.78±39.99, p=0.008), and LFnu reduced during wake (-0.43±38.18, p=0.03). Linear regression, showed AHI reduction related to increased R-R interval during wake (-0.002, 0.001), p=0.009) [unstandardised β/SE] and REM (-0.002, 0.001) [unstandardised β/SE], p=0.008), and increased pNN50% during wake (-0.24, 0.08), p=0.005) [unstandardised β/SE] suggesting MAS efficacy relates to these improvements. Conclusion We found evidence of reduced sympathetic and increased parasympathetic modulation, following short-term MAS therapy. This suggests MAS therapy has potential to improve cardiac autonomic function and hence reduce cardiovascular risk.

scholarly journals Predicting response to oxygen therapy in obstructive sleep apnoea patients using a 10-minute daytime test

2018 ◽  
Vol 51 (1) ◽  
pp. 1701587 ◽  
Author(s):  
David Wang ◽  
Keith K. Wong ◽  
Luke Rowsell ◽  
Garrick W. Don ◽  
Brendon J. Yee ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Oxygen Therapy ◽  
Characteristic Curve ◽  
Personalised Medicine ◽  
Sleep Apnoea ◽  
Low Flow ◽  
Response Threshold ◽  
Clinical Tool ◽  
Obstructive Sleep ◽  
Osa Treatment

There is no satisfactory treatment for obstructive sleep apnoea (OSA). Supplemental low-flow oxygen therapy (LFO2) has been shown to reduce hypoxaemia and is well tolerated by patients with OSA. However, oxygen therapy may be beneficial only to certain subsets of patients with OSA. In this study, we evaluated a 10-min awake ventilatory chemoreflex test in predicting individual OSA response to 2 months of LFO2therapy.At baseline, patients with OSA underwent ventilatory chemoreflex testing in the afternoon, prior to the overnight polysomnography. Subjects were reassessed with polysomnography after 2 months of nocturnal oxygen treatment.20 patients with OSA completed the study. After 2 months of O2treatment, changes in the apnoea–hypopnoea index (AHI) were significantly correlated with baseline CO2ventilatory response threshold (VRT) and chemosensitivity (p<0.05). In predicting a fall in AHI, the area under the receiver operating characteristic curve (AUC) was 0.79 for VRT and 0.89 for chemosensitivity. When these two variables were combined in a logistic regression model, the prediction effect became stronger with an AUC of 0.97, sensitivity of 0.92 and specificity of 0.83.Our awake ventilatory chemoreflex test could be considered a simple potential clinical tool to predict individual OSA response to oxygen therapy. It could provide a novel personalised medicine approach to OSA treatment.

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