No abstract

GER occurs in a high percentage of asthmatic children. To determine if GER can lead to nocturnal asthma (NA), 25 pediatric inpatients (age 2-14 yrs) were selected for study based on a history of NA. Evaluation included 3 to 13 weeks (%=54 days) of observation to quantitate day and night wheezing frequency. Two groups of patients were identified: 17 patients with predominant day-time asthma (DA) and 8 patients with prominent NA.All were studied with over-night esophageal pH recordings to detect GER during sleep while also monitoring transcutaneous oxygen (TcO ) and clinical status. Reflux scores (RS) were determined (Surgery 84h6, 1978). Sixteen of 25 (64%) patients had abnormal GER including all 8 patients with NA. Overall, a significant positive correlation between RS and percentage of nights with wheezing was found (k.52, pz.005) while age, serum theophylline levels, and lung function (FEV FEF ) a t the time of study did not correlate with GER. compariA; NA % -~? I A groups, the NA patients had significantly higher RS (p <.001) but there were no differences in age, theophylline levels, or lung function. Three of the 8 NA patients had a decreased TcO and/or clinical wheezing during an episode of GER. This study shows a Significant association between NA and GER that cannot be explained by age, lung function, or theophylline levels. A causeeffect relationship was suggested in 318 patients with NA. We speculate that GER is one of several mechanisms that may produce NA in patients with reactive airways. This studv was designed t o determine cardiopulmonar~ responses t o nasal obsiruction i n d i f f e r e n t sleep states; 8 heaithy pieterm infants (wt 1.8+.1Kg) were studied a t a corrected G.A. of 35+2 wks by multiple 10 sec occlusions during a c t i v e (AS) and quiet (QS) sleep, v i a nasal prongs f i t t e d with a thermistor t o measure airflow. Heart r a t e (HR), mouth airflow, transcutaneous PO2 (Tc Pop), chest wall movements, respiratory frequency ( f ) and sleep s t a t e were continuously monitored. Nasal occlusion was invariably accompanied by a f a l l i n TcP02, which was greater during AS than QS (8+2 vs 5+3 mmHg, p<.01). In contrast, HR f e l l with only 54% of occlusions, more i n AS than QS (35+15 vs 21+7/min, pc.05). During obstruction the frequency of respiratory e f f o r t s decreased from 45210 t o 35+7/min (p<.001) compared t o preocclusion l e v e l s , while mouth airflow was only sporadic and did not influence the f a l l i n TcP02 o r HR. In the i n i t i a l 5 s e c following occlusion, f returned t o preocclusion levels. During the subsequent 5 sec, f decreased from 47+10 t o 35+13/min (p<.03) i n AS and from 41i9 t o 31i16/min (p<.03) i n QS, as compared t o preocclusion levels. Furtheremore, i n the 20 s e c following occlusion (vs preocclusion) the duration of respiratory pauses 22 s e c increased i n both AS and QS (p<.01). W e conclude t h a t 1) preterm infants a r e more vulnerable t o nasal obstruction i n AS with a greater f a l l i n PO2 and HR, 2) airway obstruction may enh...