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Utilizing inspiratory airflows during standard polysomnography to assess pharyngeal function in children during sleep
Author(s) -
McGinley Brian M.,
Kirkness Jason P.,
Schneider Hartmut,
Lenka Abhishek,
Smith Philip L.,
Schwartz Alan R.
Publication year - 2016
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23329
Subject(s) - medicine , polysomnography , airway obstruction , obstructive sleep apnea , airway , tonsillectomy , apnea , anesthesia , adenoidectomy , sleep (system call) , computer science , operating system
Summary Objectives Obstructive sleep apnea (OSA) is the result of pharyngeal obstruction that occurs predominantly during REM in children. Pathophysiologic mechanisms responsible for upper airway obstruction, however, are poorly understood. Thus, we sought to characterize upper airway obstruction in apneic compared to snoring children during sleep. We hypothesized that apneic compared to snoring children would exhibit an increased prevalence and severity of upper airway obstruction, that would be greater in REM compared to non‐REM, and would improve following adenotonsillectomy. Study Design Apneic children were assessed with routine polysomnography before and after adenotonsillectomy, and compared to snoring children matched for gender, age, and BMI z‐score. In addition to traditional scoring metrics, the following were used to characterize upper airway obstruction: maximal inspiratory airflow (%V I max) and percent of time with inspiratory flow‐limited breathing (%IFL). Results OSA compared to snoring children had similar degrees of upper airway obstruction in non‐REM; however, during REM, children with sleep apnea exhibited a higher %IFL (98 ± 2% vs.73 ± 8%, P < 0.01) and lower %V I max (56 ± 6 vs.93 ± 10%, P < 0.01). In children with OSA, CO 2 levels were elevated during both wake and sleep. Following adenotonsillectomy, upper airway obstruction improved during REM manifest by decreased %IFL (98 ± 2 to 63 ± 9%, P = 0.04), increased %V I max (56 ± 6 to 95 ± 5%, P = 0.01) and decreased CO 2 levels. Conclusions Differences in the prevalence and severity upper airway obstruction suggest impaired compensatory responses during REM in children with OSA, which improved following adenotonsillectomy. Pediatr Pulmonol. 2016;51:431–438 . © 2015 Wiley Periodicals, Inc.