Respiratory timing and variability during sleep in children with sleep-disordered breathing

2012 ◽  
Vol 113 (10) ◽  
pp. 1635-1642 ◽  
Author(s):  
Sarah A. Immanuel ◽  
Yvonne Pamula ◽  
Mark Kohler ◽  
James Martin ◽  
Declan Kennedy ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Stages ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Study Cohort ◽  
Healthy Children ◽  
Equivalent Time ◽  
Before And After ◽  
Disordered Breathing

Sleep-disordered breathing (SDB) in children is assessed by quantification of hypopnea and apnea events. Little is known, however, about respiratory timing and breath-to-breath variability during sleep. The aim of this study was to investigate respiratory parameters across sleep stages in children with SDB before and after treatment compared with healthy children. Overnight polysomnography (PSG) was conducted in 40 children with SDB prior to and 6 mo following adenotonsillectomy. For comparison, a control group of 40 healthy sex- and age-matched children underwent two PSGs at equivalent time points but without intervention. The following variables were measured breath by breath during obstruction-free periods in stage 2 nonrapid eye movement (NREM), stage 4 NREM, and REM sleep: inspiratory time (Ti), expiratory time (Te), total time (Ttotal), inspiratory duty cycle (DC; =Ti/Ttotal), respiratory frequency (fR), and SD of the parameters Ti, Te, fR, and DC. Variability in waveform morphology was also computed using the residue of respiratory patterns. The severity of SDB was relatively mild in the study cohort (obstructive apnea hypopnea index: baseline, 5.1 ± 9.4 vs. 0.1 ± 0.2, P < 0.001; follow-up, 0.3 ± 0.3 vs. 0.8 ± 1.0, P < 0.01). Compared with healthy controls, children with SDB showed significantly longer Ti and Te and a lower fR at the baseline study. These differences were not significant after adenotonsillectomy. Sleep stages were associated with significant differences in all of the respiratory measures in both groups of children. In conclusion, children with relatively mild SDB showed prolonged inspiration and expiration indicative of chronic narrowing of the upper airway. Treatment of SDB normalizes respiratory timing. Documentation of these parameters may aid in both understanding and management of children with SDB.

Impact of Tonsillectomy on the Life Quality of Parents to Children With Obstructive Sleep-Disordered Breathing

2021 ◽  
pp. 019459982110641
Author(s):  
Yair Heskiau Shteinberg ◽  
Netanel Eisenbach ◽  
Maayan Gruber ◽  
Ohad Ronen
Keyword(s):  
Sleep Disordered Breathing ◽  
Life Quality ◽  
Control Group ◽  
Healthy Children ◽  
Academic Center ◽  
Obstructive Sleep ◽  
Before And After ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Objective Parents of children with any chronic illness may experience increased anxiety and reduced health-related quality of life (QoL). Our objective was to evaluate the change in parental QoL before vs after tonsillectomy. Our hypothesis was that pediatric tonsil surgery with or without adenoidectomy would improve parental QoL. Study Design A prospective cohort study. Setting An otolaryngology department in a tertiary academic center. Methods We enrolled parents of 79 children <5 years old. Adenotonsillectomy due to an obstructive airway indication was performed in 45 children. A group of 34 parents to healthy children served as a control group. Initially, we validated a modified version of the PAR-ENT-QoL questionnaire; then, we analyzed QoL parameters among parents of children with obstructive sleep-disordered breathing before and after surgical treatment. Results We found significant differences between the QoL score before and after surgery ( P = .003). The QoL score after surgery significantly improved and was even lower than that of the control group ( P < .001). Conclusions These results highlight the importance of timely diagnosis and treatment of children with obstructive sleep-disordered breathing, as this condition may affect not only the children themselves but also their caregivers.

scholarly journals P065 Heart Rate and Heart Rate Variability in paediatric sleep disordered breathing: Is LF a proxy for vascular motor tone

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A42-A43
Author(s):  
A Kontos ◽  
D Kennedy ◽  
M Baumert ◽  
J Martin ◽  
M Kohler ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Body Temperature ◽  
Sleep Disordered Breathing ◽  
Slow Wave Sleep ◽  
Sleep Stages ◽  
Control Group ◽  
Healthy Children ◽  
Vascular Control ◽  
Disordered Breathing

Abstract In children, sleep disordered breathing (SDB) is associated with changes in cardiac and vascular remodeling and hence may alter cardiac rhythm. Heart rate variability (HRV) measured during different sleep stages and at discreet times across the night, where vascular tone is known to change, provides an opportunity to better understand the effect of SDB on the cardiac function. 50 children diagnosed with SDB and 51 healthy children underwent overnight polysomnography to determine sleep staging. HRV (mean NN, SDNN, RMSSD, LF, HF, and LF:HF) was determined for the following segments pre-sleep; 3 slow wave sleep and 3 segments during rapid eye movement sleep (SWS1, SWS2, REM3, REM2, REM1). Children with SDB demonstrated higher heart rate (decreased mean NN) in all sleep segments. All HRV variables were similar between groups pre-sleep and REM3 and SWS3. LF and LF:HF were significantly lower in SWS1&2 and REM1 while as were SDNN and rMSSD were lower in the SDB group in REM1&2. LF remained low in the SDB group but rose to pre sleep levels in the control group. Children with SDB have increased heart rate across the night even when HRV is similar between the groups. This suggests intrinsic changes to the cardiac components that determine heart rate. The HRV difference between groups was greatest post acrophase (body temperature dropping) and post nadir (body temperature rising) of the circadian cycle. We propose that impaired peripheral vascular control and sustained cardiac remodelling may underlie the heart rate and HRV changes observed in children with SDB.

Abstract WP357: Prevalence of Pre- and Post-intracerebral Hemorrhage Sleep-disordered Breathing

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Richard V Scheer ◽  
Lynda D Lisabeth ◽  
Chengwei Li ◽  
Erin Case ◽  
Ronald D Chervin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Mexican American ◽  
Sleep Disordered Breathing ◽  
Population Based ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Portable Monitor ◽  
Before And After ◽  
Disordered Breathing

Background: Sleep-disordered breathing (SDB) is an independent risk factor for stroke. The reported prevalence of SDB after stroke ranges from 60 to >70%, while the pre-stroke prevalence of SDB is less well described. Moreover, much of these data are derived from ischemic stroke or mixed ischemic stroke and intracerebral hemorrhage (ICH) cohorts. Studies that assess the prevalence of SDB before and after ICH are lacking, with only one prior study (n=32) that reported a post-ICH SDB prevalence of 78%. We report herein the results of a second, larger, prospective study that assessed the prevalence of pre- and post-ICH. Methods: Participants enrolled in the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) project, with ICH from 2010-2015 were screened for SDB with the well validated ApneaLink Plus portable monitor (SDB defined as apnea-hypopnea index (AHI) ≥10). The Berlin questionnaire was administered, with reference to the pre-ICH state, to assess for possible pre-stroke SDB. Results: Of the 60 ICH participants screened, the median age was 63 years (interquartile range (IQR): 55.5, 74.5). Twenty-one (35%) were female, 54 (90%) were Mexican American, and 53 (88%) had a history of hypertension. The median Glasgow Coma Scale score was 15.0 (IQR: 15.0, 15.0) and the median NIHSS was 5.5 (IQR: 1.5, 8.0). Post-ICH, the median AHI was 9.5 (IQR: 5.5, 19.0); almost half (46.7%) met criteria for SDB. Thirty-four participants (56.7%) screened as high risk for SDB pre-ICH. Conclusion: Sleep-disordered breathing was highly prevalent after ICH, and also likely common before ICH, in this mostly Mexican American, community-based sample. If SDB increases risk for ICH, the findings suggest a potential new treatment target to prevent ICH and recurrent ICH.

Relationship between surface tension of upper airway lining liquid and upper airway collapsibility during sleep in obstructive sleep apnea hypopnea syndrome

2003 ◽  
Vol 95 (5) ◽  
pp. 1761-1766 ◽  
Author(s):  
Jason P. Kirkness ◽  
Melanie Madronio ◽  
Rosie Stavrinou ◽  
John R. Wheatley ◽  
Terence C. Amis
Keyword(s):  
Surface Tension ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Obstructive Sleep ◽  
Before And After ◽  
Posterior Pharynx ◽  
Hypopnea Syndrome ◽  
Disordered Breathing

Lowering surface tension (γ) of upper airway lining liquid (UAL) reduces upper airway opening (anesthetized humans) and closing (anesthetized rabbits) pressures. We now hypothesize that in sleeping obstructive sleep apnea hypopnea syndrome (OSAHS) patients lowering γ of UAL will enhance upper airway stability and decrease the severity of sleep-disordered breathing. Nine OSAHS patients [respiratory disturbance index (RDI): 49 ± 8 (SE) events/h, diagnostic night] participated in a two-part, one-night, polysomnography study. In the first part, upper airway closing pressures (during non-rapid eye movement sleep, Pcrit) were measured and samples of UAL (awake) were obtained before and after 2.5 ml of surfactant (Exosurf, Glaxo Smith Kline) was instilled into the posterior pharynx. The γ of UAL was determined with the use of the “pull-off” force technique. In the second part, subjects received a second application of 2.5 ml of surfactant and then slept the remainder of the night (205 ± 30 min). Instillation of surfactant decreased the γ of UAL from 60.9 ± 3.1 mN/m (control) to 45.2 ± 2.5 mN/m (surfactant group) ( n = 9, P < 0.001). Pcrit decreased from 1.19 ± 1.14 cmH2O (control) to -0.56 ± 1.15 cmH2O (surfactant group) ( n = 7, P < 0.02). Compared with the second half of diagnostic night, surfactant decreased RDI from 51 ± 8 to 35 ± 8 events/h ( n = 9, P < 0.03). The fall in RDI (ΔRDI) correlated with the fall in γ of UAL (Δγ) (ΔRDI = 1.8 × Δγ, r = 0.68, P = 0.04). Hypopneas decreased ∼50% from 42 ± 8 to 20 ± 5 events/h ( n = 9, P < 0.03, paired t-test). The γ of UAL measured the next morning remained low at 49.5 ± 2.7 mN/m ( n = 9, P < 0.001, ANOVA, compared with control). In conclusion, instillation of surfactant reduced the γ of UAL in OSAHS patients and decreased Pcrit and the occurrence of hypopneas. Therapeutic manipulation of γ of UAL may be beneficial in reducing the severity of sleep-disordered breathing in OSAHS patients.

Abstract 2034: Clinical Significance of Sleep-disordered Breathing (SDB) in a Large Population of Japanese Patients: Efficacy of CPAP Therapy in SDB-associated Arrhythmias

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hidetoshi Abe ◽  
Matsumoto Kyoritsu ◽  
Masafumi Takahashi ◽  
Daisuke Yokota ◽  
Katsuaki Tsukioka ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Sinus Bradycardia ◽  
Large Population ◽  
Japanese Patients ◽  
Premature Ventricular Complex ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Cardiovascular Disorders ◽  
Cpap Therapy ◽  
Disordered Breathing

OBJECTIVES: The purpose of this study was to determine the relationship between Sleep-disordered breathing (SDB) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of SDB-associated arrhythmias. BACKGROUND: SDB is associated with cardiovascular disorders, such as hypertension, ischemic heart disease, and arrhythmias, and CPAP is one of the effective treatments for SDB; however, this relationship and the efficacy of CPAP treatment in a large population of Japanese patients remain undefined. METHODS AND RESULTS: The study population comprised 1413 Japanese subjects (mean age: 56.6 years old, 1123 men and 290 women) who were divided into 2 groups: SDB group ( n = 1064, apnea-hypopnea index (AHI)≥20)and control group ( n = 349, AHI < 20) by polysomnography (PSG) analysis. In baseline characteristics, age (58.3±14.7vs.50.0±18.4, p <0.0001), gender (male: 88.4%vs.72.9%, p <0.0001), BMI (25.9±4.4vs.23.2±3.7, p <0.0001), hypertension (38.0%vs.19.3%, p <0.0001), diabetes (10.4%vs.5.2%, p =0.015), or hyperlipidemia (15.6%vs.9.3%, p =0.018) were significantly associated with SDB. PSG revealed predominant occurrence of paroxysmal atrial fibrillation (PAF: 108/1064 vs. 3/349, p=0.005), premature ventricular complex (PVC: 359/1064vs.17/349, p=0.0012) and pause (sinus arrest ≥2 sec: 172/859vs.6/349, p=0.002) in SDB group. In the SDB group, 291 patients underwent CPAP titration and were then re-evaluated. CPAP therapy significantly reduced the occurrences of PAF (59/291vs.2/291, p=0.005), sinus bradycardia (18/291vs.0/291, p=0.002), and sinus pause (26/291 vs. 4/291, p=0.016). CONCLUSIONS: The results of this study provide a significant relationship between SDB and several cardiac disorders, and efficacy of CPAP in preventing SDB-associated arrhythmias in a large population of Japanese patients. Effect of CPAP on the arryhthmic events in patients with SAS during PSG recording

scholarly journals 1208 Sleep Stage Prediction And Sleep Disordered Breathing Detection Using Raw Actigraphy And Photoplethysmography From Wearable Consumer Device

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A461-A462
Author(s):  
M Olsen ◽  
H Sorensen ◽  
P Jennum ◽  
E Mignot
Keyword(s):  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Data Driven ◽  
Sensor Data ◽  
Sleep Stages ◽  
Apnea Hypopnea Index ◽  
Low Resolution ◽  
Automatic Data ◽  
Consumer Device ◽  
Disordered Breathing

Abstract Introduction Wearable, multisensory consumer devices that estimate sleep are prevalent and hold great potential. Most validated actigraphic prediction studies of sleep stages (SS) have only used low resolution (30 sec) data and the Cole-Kripke algorithm. Other algorithms are often proprietary and not accessible or validated. We present an automatic, data-driven deep learning algorithm that process raw actigraphy (ACC) and photoplethysmography (PPG) using a low-cost consumer device at high (25Hz) and low resolution to predict SS and to detect sleep disordered breathing (SDB) events. Methods Our automatic, data-driven algorithm is a deep neural network trained and evaluated to predict SS and SDB events on 236 recordings of ACC data from a wrist-worn accelerometer and PPG data from the overlapping PSG. The network was tested on raw ACC and PPG data, which was collected at 25 Hz using the HUAMI Arc2 wristband from 39 participants that underwent a nocturnal polysomnography (PSG). Results Overall accuracy (Acc), recall (Re), specificity (Sp), and kappa (κ) per subject on the test dataset the prediction of wake, NREM, REM was Acc=76.6%, Re=72.4%, Sp=78.0%, kappa=0.42. On average, we found a 7 % higher performance using the raw sensor data as input instead of processed, low resolution inputs. PPG was especially useful for REM detection. The network assigned 55.6% of patients to the correct SDB severity group when using an apnea-hypopnea index above 15. Conclusion Current results show that SS prediction is significantly improved when using the raw sensor data; it indicates that the system holds promise as a potential pervasive monitoring device for patients with chronic sleep disorders. In contrast the system did not show potential as a sleep apnea screening tool. Additional studies are ongoing to examine the effects of pathology such as sleep apnea and periodic leg movement on SS prediction. Support Technical University of Denmark; University of Copenhagen, Copenhagen Center for Health Technology, Klarman Family Foundation.

Cephalometric Assessment of the Posterior Airway Space in Patients with Cleft Palate after Palatoplasty

2003 ◽  
Vol 40 (5) ◽  
pp. 498-503 ◽  
Author(s):  
Edmund Rose ◽  
Ulrike Thissen ◽  
Jörg-Elard Otten ◽  
Irmtrud Jonas
Keyword(s):  
Cleft Palate ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
University Hospital ◽  
Control Group ◽  
Facial Growth ◽  
Surgical Closure ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Objective Upper airway obstruction and mouth breathing influence facial growth and development, which may result in breathing disorders while asleep. The purpose of the present investigation was to analyze cephalometric alterations between patients with cleft palate and a noncleft control group in an obstructive sleep disordered breathing-specific tracing. Setting The study was conducted in the cleft palate clinic of a university hospital. Participants Fifty-three subjects with a mean age of 12.3 ± 3.7 years (range 6.3 to 17.2 years). The cohort included 33 subjects (13 females, 20 males; mean age 12.1 ± 3.8 years, mean body mass index 17.5 ± 2.9 kg/m2) with surgical closure of a unilateral or bilateral cleft palate and a matched control of noncleft participants. None of the subjects suffered from sleep disordered breathing syndrome. Results Compared with the controls, patients with cleft palate had a significant narrow anterior-posterior dimension of the pharynx at the level of the maxillary plane and the narrowest width, a more downward hyoid position, and a longer uvula. Conclusions Patients with cleft palate appear to present pharyngeal and craniofacial distinctive features that characterize patients with obstructive sleep disordered breathing and differ from those of a noncleft control.

scholarly journals 0340 Regional Changes in Sleep Electroencephalography Power in Youth with Sleep-Disordered Breathing: A High-Density EEG Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A129-A129
Author(s):  
A Myers ◽  
C Matthews ◽  
T Kille ◽  
B Riedner ◽  
B Flaherty ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Nrem Sleep ◽  
Small Sample ◽  
High Density ◽  
Alpha Power ◽  
Healthy Children ◽  
Neurobehavioral Performance ◽  
Before And After ◽  
Daytime Impairment ◽  
Disordered Breathing

Abstract Introduction Daytime neurobehavioral impairments are commonly associated with sleep disordered breathing (SDB) in children. However, a large number of studies have shown only minimal differences in sleep between children with SDB relative to control children, suggesting that sleep dysfunction is not responsible for daytime impairment. Importantly, however, previous studies have measured sleep EEG using only frontal scalp electrodes, failing to capture the regional features of sleep that are prominent during development. Here we measure sleep using hdEEG in SDB and healthy children to determine if regional sleep impairment is related to daytime neurobehavioral performance. Methods Overnight high-density electroencephalography (hdEEG, 256 channels) was recorded in 17 children with sleep disordered breathing (SDB) (age: M = 8.46, SD = 1.82, AHI: M = 11.3, SD = 8.6, 53% female) and 17 age and sex matched controls (age: M = 8.47, SD = 1.66, AHI: M = 1.5, SD = .64). Attentional capacity was assessed using the Test of Variables of Attention (TOVA) before and after sleep. Group differences in sleep macrostructure variables were assessed using unpaired t-tests. All-night spectral analysis was performed for NREM sleep and averaged across groups. Topographic differences between groups were assessed using statistical non-parametric mapping. Pearson correlations were used to determine associations between sleep and TOVA variables. Results Sleep macrostructure did not differ between groups. All-night spectral density analysis revealed a global increase in high-frequency activity in N2N3 and N3, in the alpha band (8-12 Hz, p&lt;0.05). Global alpha power was higher in SDB youth, although this effect reached significance during N3 in a large cluster of posterior channels (N=55, p=.02). Conclusion Elevated alpha during NREM is frequently considered a correlate of nonrestorative sleep. In this sample of youth with SDB, posterior alpha is robustly increased during the deepest stage of NREM sleep. In this small sample, however, alpha power did not predict performance on an attentional task sensitive to the effects of impaired sleep. Support R21 HD092986-02 to SJ

scholarly journals Examination of Change in Sleep-disordered Breathing before and after Orthognatic Surgery-Part 1 Change of the Apnea Hypopnea Index-

2007 ◽  
Vol 17 (1) ◽  
pp. 9-15 ◽  
Author(s):  
MORIO TONOGI ◽  
TAKEHIRO ARISAKA ◽  
YUSUKE TSUKAMOTO ◽  
KAZUMICHI SATO ◽  
GEN-YUKI YAMANE ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Before And After ◽  
Orthognatic Surgery ◽  
Disordered Breathing

scholarly journals Multifunctional Monitoring: is it Possible to Simultaneously Evaluate Blood Pressure and Sleep‐Disordered Breathing?

Kardiologiia ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 10-15
Author(s):  
S. O. Bormina ◽  
L. S. Korostovtseva ◽  
M. V. Bochkarev ◽  
Yu. V. Sviryaev ◽  
A. O. Konradi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Healthy Volunteers ◽  
Sleep Disordered Breathing ◽  
Comparative Assessment ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Quality Of Sleep ◽  
Second Stage ◽  
Disordered Breathing

Objective Carry out a comparative assessment of respiratory performance, based on multifunctional monitoring (MFM) and the recommended practice for complete polysomnography (PSG), and evaluate the effect of the blood pressure (BP) measurements in MFM on the quality of sleep.Materials and Methods At the first stage, 22 healthy volunteers (control group) underwent concomitant PSG and MFM, and 14 patients with suspected sleep-disordered breathing (SDB) underwent only PSG. At the second stage, concomitant PSG and MFM were performed in patients with confirmed SDB.Results In the control group, MFM detected a lower level of SpO2, a lower desaturation index (DI), and a higher apnea index (AI) than in the PSG group. However, the apnea-hypopnea index (AHI) was comparable in both groups. During concomitant PSG-MFM, the measurements of BP increased the number of micro-arousals only in the SDB group.Conclusion Results of the assessment of respiratory performance in MFM are comparable in both groups. The detected features of MFM indicators in the evaluation of the chest movements using rheopneumography, criteria different from that generally used for desaturation and hypoxemia, can lead to underestimation of desaturation and DI and underestimation of AI in the control group. The measurements of BP during sleep induced micro-arousals in the SDB group.

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