Assessment of Central Sleep Apnea Events in Children with Sleep-Disordered Breathing

Abstract

Purpose. To determine the prevalence of central apnea (CA) events and central sleep apnea (CSA) in children with sleep-disordered breathing (SDB) and to assess the effect of tonsillectomy and adenoidectomy (TA) on CSA in children with obstructive sleep apnea (OSA). Material and Methods. The medical charts of children with SDB were reviewed to obtain information on past medical history, polysomnography (PSG) findings, and surgical management. Counts and indexes of obstructive apnea, obstructive hypopnea, and central apnea were evaluated before and after TA. The prevalence of CSA and the effect of age, gender, obesity, and comorbid conditions on CSA were assessed in children with SDB as well as in children with PSG proven OSA. Results. Seven hundred twelve children with SDB (age range: 1 to 18 yrs, mean: 5.8 ± 3.4 ) were identified. CA events occurred in 640 of 712 (89.5%) patients. Of the 712 patients, 315 (44.2%) met the criteria for the diagnosis of CSA. CSA was more prevalent in toddlers and preschoolers ( p < 0.001 ). Obese children had a higher prevalence of CSA compared to nonobese children ( p < 0.001 ). The prevalence of CSA in patients with OSA was 45.4%. The number of CA events, CAI, and OAHI after TA was less than that of before TA ( p < 0.001 ). Residual CSA after TA occurred in 20 children (26%). Conclusion. Central apnea events and central sleep apnea occur in children who present to a pediatric otolaryngology clinic for evaluation of sleep disordered breathing. Central sleep apnea and obstructive sleep apnea both improve after tonsillectomy and adenoidectomy.

Severely obese 14-year-old boy with central sleep apnea several years after head trauma

“…Although obesity is more commonly associated with OSA, its link with CSA has also been deduced ( 3 , 5 ). Mechanistically, obesity may lead to suppression of the respiratory center through upper airway mechanoreceptor stimulation due to pharyngeal collapse and reduction of the oxygen reserve due to reduced thoracic volume ( 5 ).…”

“…Obesity is associated with obstructive sleep apnea (OSA). Moreover, obese children had a significantly higher frequency of CSA than nonobese children (3). Herein, we present the case of a child with CSA and severe obesity.…”

“…In healthy children, central apneas for short durations within 20 sec are considered physiological, followed by a sigh, movement, and rapid eye movement sleep, which gradually decrease with the maturation of the central nervous system ( 2 ). The frequency of CSA in children is approximately 5.4–14.9% ( 3 ). Neurological disorders are the most common causes of CSA in non-preterm infants.…”

Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center

“…OSA affects 1%–4% of otherwise healthy children 4 and 25%–70% of children and adolescents who are obese and/or have underlying medical comorbidity such as Trisomy 21 and neuromuscular disease 5–7 . CSA has a diverse range of aetiologies and is characterized by the absence of central respiratory drive during sleep resulting in compromised gas exchange and inadequate ventilation 8–12 . NH is a result of inadequate minute ventilation during sleep typically secondary to reduced muscle strength, scoliosis, and obesity 13–15 .…”

“…[5][6][7] CSA has a diverse range of aetiologies and is characterized by the absence of central respiratory drive during sleep resulting in compromised gas exchange and inadequate ventilation. [8][9][10][11][12] NH is a result of inadequate minute ventilation during sleep typically secondary to reduced muscle strength, scoliosis, and obesity. [13][14][15] All three types of SDB may lead to metabolic risk, poor neurocognitive and school performance as well as poor quality of life [16][17][18] and are more prevalent in children with neuromuscular disease and/or children with medical complexity.…”