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

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.

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Sleep Disordered Breathing: Pathogenesis of Obstructive Sleep Apnea-hypopnea Syndrome

Journal of Nihon University Medical Association ◽

10.4264/numa.69.17 ◽

2010 ◽

Vol 69 (1) ◽

pp. 17-22

Author(s):

Toshiki Akahoshi ◽

Tsuneto Akashiba ◽

Akihito Uematsu ◽

Naoki Okamoto ◽

Yasuhiro Gon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Obstructive Sleep ◽

Hypopnea Syndrome ◽

Disordered Breathing

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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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Surface Tension of Upper Airway Mucosal Lining Liquid in Obstructive Sleep Apnea/Hypopnea Syndrome

SLEEP ◽

10.1093/sleep/28.4.457 ◽

2005 ◽

Vol 28 (4) ◽

pp. 457-463 ◽

Cited By ~ 29

Author(s):

Jason P. Kirkness ◽

Melanie Madronio ◽

Rosie Stavrinou ◽

John R. Wheatley ◽

Terence C. Amis

Keyword(s):

Surface Tension ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Obstructive Sleep ◽

Mucosal Lining ◽

Hypopnea Syndrome

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Emotional Content of Dreams in Obstructive Sleep Apnea Hypopnea Syndrome Patients and Sleepy Snorers attending a Sleep-Disordered Breathing Clinic

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.28043 ◽

2011 ◽

Vol 07 (01) ◽

pp. 69-74 ◽

Cited By ~ 5

Author(s):

Samantha Fisher ◽

Keir E. Lewis ◽

Iona Bartle ◽

Robin Ghosal ◽

Lois Davies ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Emotional Content ◽

Obstructive Sleep ◽

Hypopnea Syndrome ◽

Disordered Breathing

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Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103531 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3531 ◽

Cited By ~ 1

Author(s):

Nosetti Luana ◽

Zaffanello Marco ◽

De Bernardi Francesca ◽

Piacentini Giorgio ◽

Roberto Giulia ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Gastroesophageal Reflux ◽

Sleep Disordered Breathing ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Clinical Approach ◽

Obstructive Sleep ◽

Disordered Breathing

Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.

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Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1709195 ◽

2020 ◽

Author(s):

Juliana Alves Sousa Caixeta ◽

Jessica Caixeta Silva Sampaio ◽

Vanessa Vaz Costa ◽

Isadora Milhomem Bruno da Silveira ◽

Carolina Ribeiro Fernandes de Oliveira ◽

...

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Long Term Effects ◽

Obstructive Sleep ◽

Long Term Impact ◽

Disordered Breathing

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

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569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽

10.1093/sleep/zsab072.567 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A224-A225

Author(s):

Fayruz Araji ◽

Cephas Mujuruki ◽

Brian Ku ◽

Elisa Basora-Rovira ◽

Anna Wani

Keyword(s):

Sleep Apnea ◽

Primary Care Physicians ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Study ◽

Surgical Interventions ◽

Screening Guidelines ◽

Obstructive Sleep ◽

Children’S Sleep ◽

Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

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Comparisons of Thyroid Hormone, Intelligence, Attention, and Quality of Life in Children with Obstructive Sleep Apnea Hypopnea Syndrome before and after Endoscopic Adenoidectomy

BioMed Research International ◽

10.1155/2015/523716 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Hui-Wei Feng ◽

Tao Jiang ◽

Hong-Ping Zhang ◽

Zhe Wang ◽

Hai-Ling Zhang ◽

...

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Thyroid Hormone ◽

Intelligence Quotient ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

Hypopnea Syndrome

Objective. The aim of this study was to compare the differences in thyroid hormone, intelligence, attention, and quality of life (QoL) of children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after endoscopic adenoidectomy.Method. A total of 35 OSAHS children (21 males and 14 females with a mean age of6.81±1.08years) were included in this study for analyzing the levels of thyroid hormone, intelligence, attention, and QoL. There were 22 children underwent endoscopic adenoidectomy with bilateral tonsillectomy (BT), while the other 13 children who underwent endoscopic adenoidectomy without bilateral tonsillectomy without BT.Results. Our results revealed no significant difference in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels in OSAHS children before and after endoscopic adenoidectomy (allP>0.05). However, there were significant differences in full-scale intelligence quotient (FIQ) (92.45±5.88versus106.23±7.39,P<0.001), verbal intelligence quotient (VIQ) (94.17±15.01versus103.91±9.74,P=0.006), and performance intelligence quotient (PIQ) (94.12±11.04versus104.31±10.05,P=0.001), attention (98.48±8.74versus106.87±8.58,P<0.001), and total OSA-18 scores (87.62±17.15versus46.61±10.15,P<0.001) between before and after endoscopic adenoidectomy in OSAHS children.Conclusion. Our findings provided evidence that the intelligence, attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.

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