scholarly journals Site and mechanics of spontaneous, sleep-associated obstructive apnea in infants

2000 ◽  
Vol 89 (6) ◽  
pp. 2453-2462 ◽  
Author(s):  
Garrick W. Don ◽  
Turkka Kirjavainen ◽  
Catherine Broome ◽  
Chris Seton ◽  
Karen A. Waters
Keyword(s):  
Airway Obstruction ◽  
Airway Resistance ◽  
Upper Airway ◽  
Magnetic Resonance Images ◽  
Upper Airway Obstruction ◽  
Older Children ◽  
Obstructive Apnea ◽  
Obstructive Sleep ◽  
Lumen Catheter ◽  
Overnight Polysomnography

To examine the mechanics of infantile obstructive sleep apnea (OSA), airway pressures were measured using a triple-lumen catheter in 19 infants (age 1–36 wk), with concurrent overnight polysomnography. Catheter placement was guided by correlations between measurements of magnetic resonance images and body weight of 70 infants. The level of spontaneous obstruction was palatal in 52% and retroglossal in 48% of all events. Palatal obstruction predominated in infants treated for OSA (80% of events), compared with 38.6% from infants with infrequent events ( P = 0.02). During obstructive events, successive respiratory efforts increased in amplitude (mean intrathoracic pressures −11.4, −15.0, and −20.4 cmH2O; ANOVA, P < 0.05), with arousal after only 29% of the obstructive and mixed apneas. The soft palate is commonly involved in the upper airway obstruction of infants suffering OSA. Postterm, infant responses to upper airway obstruction are intermediate between those of preterm infants and older children, with infrequent termination by arousal but no persisting “upper airway resistance” and respiratory efforts exceeding baseline during the event.

scholarly journals Compensatory responses to upper airway obstruction in obese apneic men and women

2012 ◽  
Vol 112 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Chien-Hung Chin ◽  
Jason P. Kirkness ◽  
Susheel P. Patil ◽  
Brian M. McGinley ◽  
Philip L. Smith ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Rem Sleep ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Upper Airway Obstruction ◽  
Men And Women ◽  
Compensatory Responses ◽  
Obstructive Sleep

Defective structural and neural upper airway properties both play a pivotal role in the pathogenesis of obstructive sleep apnea. A more favorable structural upper airway property [pharyngeal critical pressure under hypotonic conditions (passive Pcrit)] has been documented for women. However, the role of sex-related modulation in compensatory responses to upper airway obstruction (UAO), independent of the passive Pcrit, remains unclear. Obese apneic men and women underwent a standard polysomnography and physiological sleep studies to determine sleep apnea severity, passive Pcrit, and compensatory airflow and respiratory timing responses to prolonged periods of UAO. Sixty-two apneic men and women, pairwise matched by passive Pcrit, exhibited similar sleep apnea disease severity during rapid eye movement (REM) sleep, but women had markedly less severe disease during non-REM (NREM) sleep. By further matching men and women by body mass index and age ( n = 24), we found that the lower NREM disease susceptibility in women was associated with an approximately twofold increase in peak inspiratory airflow ( P = 0.003) and inspiratory duty cycle ( P = 0.017) in response to prolonged periods of UAO and an ∼20% lower minute ventilation during baseline unobstructed breathing (ventilatory demand) ( P = 0.027). Thus, during UAO, women compared with men had greater upper airway and respiratory timing responses and a lower ventilatory demand that may account for sex differences in sleep-disordered breathing severity during NREM sleep, independent of upper airway structural properties and sleep apnea severity during REM sleep.

scholarly journals 1244 A Curious Case of ASV Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A474
Author(s):  
Nishant Chaudhary ◽  
Mirna Ayache ◽  
John Carter
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Neck Extension ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

Upper airway obstruction in the critically ill

2016 ◽  
Author(s):  
Edmond Cohen
Keyword(s):  
Airway Obstruction ◽  
Pulmonary Function Tests ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Upper Airway Obstruction ◽  
Breath Sounds ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Facial Swelling ◽  
Conscious Patient

Upper airway obstruction (UAO) from any cause should be considered a life-threatening emergency. In a conscious patient, UAO may present as respiratory distress, stridor, dyspnoea, altered voice, cyanosis, cough, decreased or absent breath sounds, wheezing, the hand-to-the-throat choking sign in the case of a foreign body, facial swelling, and distended neck veins. The cause of UAO should be identified and airway management devices must be immediately available prior to any airway manipulation CT scan, flexible bronchoscopy, and pulmonary function tests should be performed to evaluate the cause and the extent of the obstruction. Obstructive sleep apnoea (OSA) patients are at increased risk of developing UAO. Endotracheal intubation, insertion of a supraglottic device, laser therapy, and endotracheal stents maybe life-saving

Relief of Upper Airway Obstruction by Adenotonsillectomy

1986 ◽  
Vol 94 (4) ◽  
pp. 476-480 ◽  
Author(s):  
William P. Potsic ◽  
Patrick S. Pasquariello ◽  
Christine Corso Baranak ◽  
Roger R. Marsh ◽  
Linda M. Miller
Keyword(s):  
Airway Obstruction ◽  
Sleep Disturbances ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Respiratory Sounds ◽  
Obstructive Sleep ◽  
Computer Aided Analysis ◽  
A Prospective Study ◽  
And Behavior ◽  
Postoperative Improvement

Adenotonsillectomy is often performed to relieve upper airway obstruction, even in children who do not present with severe apnea. Although adenotonsillectomy provides dramatic relief from obstructive sleep apnea, little evidence is available as to the efficacy of surgery in the far more prevalent cases of partial airway obstruction. We report the results of a prospective study of 100 children with adenotonsillar obstruction (without severe apnea) and 50 age-matched control children. The majority of patients exhibited appreciable sleep disturbances preoperatively, as compared to controls, and had substantial postoperative improvement, as demonstrated by parental questionnaire and sleep sonography—the computer-aided analysis of respiratory sounds. Mouth breathing and behavior problems were also prevalent preoperatively and were affected positively by adenotonsillectomy. It appears that surgery in such cases can have far-ranging benefits, even for the child whose obstruction does not demonstrate severe apnea.

Retropharyngeal Tuberculous Abscess: A Rare Cause of Upper Airway Obstruction and Obstructive Sleep Apnea in Children: A Case Report

2019 ◽  
Vol 65 (6) ◽  
pp. 642-645
Author(s):  
Abate Yeshidinber Weldetsadik ◽  
Alemayehu Bedane ◽  
Frank Riedel
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Case Reports ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Obstructive Sleep ◽  
Tuberculous Abscess ◽  
Rare Manifestation

Abstract Retropharyngeal tuberculous abscess (RPTBA) is a rare manifestation of tuberculosis (TB) even in high TB burden areas. It rarely manifests as a cause of upper airway obstruction and obstructive sleep apnea (OSA) in children with few case reports in the literature. We report a 22 months old toddler who presented with upper airway obstruction and OSA and was diagnosed with RPTBA. The child recovered completely and growing normally after intra-oral aspiration and 6 months of anti-tuberculosis treatment.

scholarly journals Children with Upper Airway Dysfunction: At Risk of Obstructive Sleep Apnea

2019 ◽  
Vol 09 (01) ◽  
pp. e59-e67
Author(s):  
Carlos Sisniega ◽  
Umakanth Katwa
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Adverse Outcomes ◽  
Upper Airway Obstruction ◽  
Lymphoid Tissues ◽  
Obstructive Sleep ◽  
Potential Risk Factors

AbstractObstructive sleep apnea is characterized by prolonged partial upper airway obstruction or intermittent complete obstruction that disrupts normal ventilation during sleep and alters normal sleep patterns. Patients with obstructive sleep apnea tend to develop neurocognitive, cardiovascular, behavioral, attention issues, and poor academic performance. Therefore, it is essential to diagnose and treat obstructive sleep apnea early and avoid significant and long-lasting adverse outcomes. Most commonly, upper airway obstruction is caused by enlarged lymphoid tissues within the upper airway, and therefore adenotonsillectomy is considered as the first-line treatment of obstructive sleep apnea in children. Fifty to 70% of patients who have obstructive sleep apnea and treated by surgery are not entirely cured on follow-up polysomnography. In light of this, it is recommended that patients with suspected obstructive sleep apnea undergo a thorough evaluation, and all potential risk factors are identified and treated. The purpose of this review is to familiarize pediatricians with developmental, anatomical, and physiological risk factors involved in the development of obstructive sleep apnea. Additionally, we will present an array of evaluation techniques that can offer adequate assessment of the patient's upper airway anatomy and physiology.

DOZ047.107: Increased quality of life burden related to obstructive sleep apnea in children with aerodigestive disease

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
C T Wootten ◽  
B Lipscomb ◽  
S Acra ◽  
M Fazili
Keyword(s):  
Quality Of Life ◽  
Airway Obstruction ◽  
Sleep Disturbance ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Systematic Screening ◽  
Obstructive Sleep ◽  
Physical Suffering ◽  
The Impact

Abstract Objective The aim of this study was to determine the impact of sleep-disordered breathing on quality of life (QOL) in children with aerodigestive disease compared to children without aerodigestive disease. Methods Retrospective, IRB-approved, single-institution review of OSA-18 survey results administered to an unselected population of pediatric otolaryngology patients, some of whom had also been seen in the multidisciplinary aerodigestive clinic, was carried out. Results 476 non-aerodigestive patients and 43 aerodigestive patients were compared using total OSA-18 score and the summed scores from the 5 domains that comprise the OSA-18: (1) sleep disturbance, (2) physical suffering, (3) emotional distress, (4) daytime problems, and (5) caregiver concern. Sleep-related QOL was significantly worse for children with aerodigestive disease compared to those without aerodigestive disease across domains of sleep disturbance (P = 0.011), physical suffering (P = 0.028), and caregiver concern (P = 0.016). Total OSA-18 scores were in the mild impact range, and they did not differ significantly between the two populations. Conclusion While the focus of many aerodigestive programs is on the pathophysiological relationship between the upper digestive tract, the laryngotracheal airway, and the lungs, the present study elucidates a significant impact of upper airway obstruction during sleep on the QOL of children with aerodigestive disease. In recognition of this impact, certain airway centers have added a multidisciplinary approach to upper airway obstruction to their aerodigestive treatment armamentarium. At the minimum, airway treatment centers should consider systematic screening of all children with aerodigestive disease for QOL burden related to OSA.

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