Prolonged partial upper airway obstruction during sleep – an underdiagnosed phenotype of sleep-disordered breathing

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1–23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g.snoring) and/or conditions predisposing to SDB (e.g.mandibular hypoplasia) as well as children with SDB and complex conditions (e.g.Down syndrome, Prader–Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g.supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1–23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.

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Patterns of Upper Airway Obstruction on Drug-Induced Sleep Endoscopy in Patients with Sleep-Disordered Breathing with AHI <5

OTO Open ◽

10.1177/2473974x17721483 ◽

2017 ◽

Vol 1 (3) ◽

pp. 2473974X1772148

Author(s):

Sam Spinowitz ◽

Mimi Kim ◽

Steven Y. Park

Keyword(s):

Airway Obstruction ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Apnea Hypopnea Index ◽

Sleep Endoscopy ◽

Drug Induced ◽

Drug Induced Sleep Endoscopy ◽

Multiple Levels ◽

Disordered Breathing

Objective To describe the patterns of upper airway obstruction in patients with sleep-disordered breathing with apnea-hypopnea index (AHI) <5 using drug-induced sleep endoscopy (DISE). Study Design Retrospective study. Setting Tertiary care center. Subjects and Methods Inclusion of patients with sleep-disordered breathing with AHI <5 on polysomnography who underwent DISE. Patients <18 years of age were excluded. DISE findings were reported with the VOTEL classification system: the level of collapse was described as occurring at the velum, oropharynx, tongue base, epiglottis, and the lingual tonsils. The degree of collapse was reported as complete, partial, or none. The pattern of the obstruction was described as anteroposterior, lateral, or concentric when applicable. Results A total of 54 patients with sleep-disordered breathing with AHI <5 underwent DISE. Ages ranged from 19 to 65 years. DISE was performed alone in 7% (n = 4) of patients and in conjunction with surgery in 93% (n = 50) of patients. The velum was the most frequent site of upper airway obstruction (85%, n = 46), followed by base of tongue (63%, n = 34), epiglottis (39%, n = 21), lingual tonsils (35%, n = 19), and oropharynx (31%, n = 17). Eighty-three percent (n = 45) of patients had multiple levels of upper airway obstruction, and 15% (n = 8) had a single level of upper airway obstruction. Conclusion Patients with sleep-disordered breathing with AHI <5 have significant upper airway obstruction as seen on DISE. DISE findings indicate that a majority of these patients have multiple levels of upper airway obstruction, which can lead to significant symptoms.

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Gender differences in age and BMI distributions in partial upper airway obstruction during sleep

Respiratory Physiology & Neurobiology ◽

10.1016/j.resp.2007.07.007 ◽

2007 ◽

Vol 159 (2) ◽

pp. 219-226 ◽

Cited By ~ 20

Author(s):

Ulla Anttalainen ◽

Tarja Saaresranta ◽

Nea Kalleinen ◽

Jenni Aittokallio ◽

Tero Vahlberg ◽

...

Keyword(s):

Gender Differences ◽

Airway Obstruction ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Partial Upper Airway Obstruction

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EFFECTIVE BYPASS OF A PARTIAL UPPER AIRWAY OBSTRUCTION USING HIGH-FLOW HUMIDIFIED GASSES THROUGH A TRANSTRACHEAL CATHETER

CHEST Journal ◽

10.1378/chest.130.4_meetingabstracts.287s-a ◽

2006 ◽

Vol 130 (4) ◽

pp. 287S

Author(s):

Wissam B. Abouzgheib ◽

Huma Q. Rana ◽

Daniel Markley ◽

Thaddeus Bartter

Keyword(s):

Airway Obstruction ◽

Upper Airway ◽

High Flow ◽

Upper Airway Obstruction ◽

Partial Upper Airway Obstruction

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Hypercapnic respiratory failure and partial upper airway obstruction during high frequency oscillatory ventilation in an adult burn patient

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03017453 ◽

2002 ◽

Vol 49 (7) ◽

pp. 724-728 ◽

Cited By ~ 9

Author(s):

Andrew B. Cooper ◽

Avinash Islur ◽

Manuel Gomez ◽

Gordon L. Goldenson ◽

Robert C. Cartotto

Keyword(s):

Respiratory Failure ◽

Airway Obstruction ◽

High Frequency ◽

Upper Airway ◽

High Frequency Oscillatory Ventilation ◽

Upper Airway Obstruction ◽

Hypercapnic Respiratory Failure ◽

Partial Upper Airway Obstruction ◽

High Frequency Oscillatory ◽

Burn Patient

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The Percutaneous Transtracheal Jet Ventilation in a Patient with Partial Upper Airway Obstruction

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790100800406 ◽

2001 ◽

Vol 8 (4) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

KY Fung ◽

MC Yuen ◽

WK Tung

Keyword(s):

Airway Obstruction ◽

Difficult Airway ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Emergency Physicians ◽

Jet Ventilation ◽

Partial Upper Airway Obstruction ◽

Set Up

Difficult airway is a challenging emergency problem for emergency physicians. We reported a patient with partial upper airway obstruction managed by percutaneous transtracheal jet ventilation (PTJV) before definite airway was secured. The development, the set up, the advantages, and the precautions of using PTJV are briefly described.

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Neuropsychological Consequences of Sleep-Disordered Breathing

Cognitive and Behavioral Abnormalities of Pediatric Diseases ◽

10.1093/oso/9780195342680.003.0066 ◽

2010 ◽

Author(s):

Jennifer Janusz ◽

Ann Halbower

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Obstruction ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Fragmentation ◽

Primary Snoring ◽

Respiratory Events ◽

Obstructive Sleep ◽

Disordered Breathing

Pediatric sleep disorders have been gaining awareness among practitioners due to their potential for cognitive, behavioral, and somatic effects (Gozal 2008; Moore et al. 2006). Sleep-disordered breathing (SDB) is commonly seen in children and encompasses a range of disorders, in primary snoring to obstructive sleep apnea (Marcus 2000). Sleep-disordered breathing is characterized by partial or complete upper airway obstruction during sleep due to collapse or narrowing of the pharynx. This can result in sleep fragmentation due to brief arousals during the night, as well as disruption or cessation of airflow (Blunden and Beebe 2006; Halbower and Mahone 2006). This chapter describes the neuropsychological and behavioral consequences of SDB, comorbid disorders, and effects of treatment. Sleep-disordered breathing is considered a spectrum of airflow limitation, from mild to severe. For instance, primary snoring (PS), defined as snoring without oxygen desaturation or sleep arousals, is at the mild end of the spectrum. Upper airway resistance syndrome (UARS), in the middle of the spectrum, is characterized by increased negative intrathoracic pressure with sleep arousals and sleep fragmentation but no oxygen desaturations (Bao and Guilleminault 2004; Garetz 2008; Lumeng and Chervin 2008). In obstructive sleep apnea (OSA), at the severe end of the spectrum, there are repeated episodes of blockage of the airway with changes in oxygenation. Obstructive sleep apnea results from a combination of factors, including anatomical obstruction from adenoids, tonsils, or a narrow pharynx, and decreased neuromuscular tone required to maintain airway patency (Arens and Marcus 2004). An overnight polysomnogram (PSG) completed in a sleep laboratory and measuring sleep–wake states, respiration, movement, blood levels of oxygen and carbon dioxide, and cardiac activity, is considered the “gold standard” for the diagnosis of OSA (American Academy of Pediatrics 2002). The PSG is used to diagnose respiratory events, cardiac changes, and arousals from different sleep states. Respiratory events include obstructive apneas and hypopneas. Obstructive apnea events are episodes of complete airway obstruction, while hypopneas are partial obstructions or airflow limitations (Garetz 2008; Redline et al. 2007).

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