Body position and obstructive sleep apnea in 8–12-month-old infants

Pereira, Kevin D.; Rathi, Nisha; Fatakia, Adil; Haque, Sajid; Castriotta, Richard J.

doi:10.1016/j.ijporl.2008.03.002

Cited by 21 publications

(17 citation statements)

References 11 publications

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“…The median respiratory rate in term infants at birth during sleep is 40 breaths/minute (10-90th percentile is 32-66 breaths/min); this decreases to 35 breaths/minute (10-90th percentile is 24-45 breaths/min) by 3 months of age and to 23 breaths/ minute (10-90th percentile is 20-28 breaths/min) at 1 year old (65). In a population of infants referred for evaluation of apnea, there was no difference in the incidence of OSA between the prone and supine positions (66,67). Normative polysomnographic data for infants are presented in Table 2.…”

Section: Normative Datamentioning

confidence: 84%

“…The preponderance of studies have reported a higher incidence of obstructive events in otherwise normal infants during REM sleep (66,73,74,82), but some have not (104). REM sleep is associated with hypotonia of the chest wall and upper airway muscles, lower lung volumes, paroxysmal reductions in pharyngeal tone, and increased respiratory variability.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Obstructive Sleep Apnea in Infants

Katz

Mitchell

D’Ambrosio

2012

Am J Respir Crit Care Med

225

224

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Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux.Keywords: sleep-disordered breathing; adenotonsillar hypertrophy; craniofacial; micrognathia; laryngomalacia Infants experience a wide range of sleep-disordered breathing patterns, including periodic breathing (1), apnea of prematurity (2), and central apnea, but little attention has been given to obstructive sleep apnea (OSA). Infants are particularly vulnerable to obstructive sleep-disordered breathing related to their upper airway structure (3), adverse pulmonary mechanics (4), ventilatory control (5), arousal threshold (6), laryngeal chemoreflex (7), and an REM-predominant sleep state distribution (8). The anatomical and physiological predispositions toward airway obstruction in infants are summarized in Table 1. Airway collapse may occur passively related to the balance between the viscoelastic properties of the pharynx, pharyngeal dilators, and the transmural pressure. Alternatively, obstructive apnea may result from active glottic closure, termed the laryngeal chemoreflex. The diagnosis of OSA in infants is confirmed by polysomnography and the etiology is often determined via direct endoscopic visualization of the airway. Infants with severe OSA will often have marked hypoxemia or sleep fragmentation, which is likely to result in considerable morbidity. As such, successful therapy is mandatory, even if this requires invasive treatment including nasopharyngeal tubes, continuous positive airway pressure (CPAP), supraglottoplasty, or even tracheostomy. This review focuses on the clinical features, polysomnographic patterns, pathogenesis, diagnosis, and mana...

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Section: Normative Datamentioning

confidence: 84%

Section: Clinical Featuresmentioning

confidence: 99%

Obstructive Sleep Apnea in Infants

Katz

Mitchell

D’Ambrosio

2012

Am J Respir Crit Care Med

225

224

View full text Add to dashboard Cite

show abstract

“…16,17 Because REM apneas tend to be longer and associated with longer desaturations, REM-predominant apneas may predispose the exposed children population to higher risk of future neurocognitive dysfunction. 5,9,18 Prior studies that evaluated sleep distribution of respiratory events between REM and NREM sleep in children did not target adolescent population. In fact, the mean age of the enrolled subjects in these studies ranged between 5 to 7.3 y, which is Table 2-Polysomnographic data of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Also, the effect of position on the distribution of obstructive respiratory events in the pediatric population is not consistent among different studies. [7][8][9][10][11][12] Furthermore, previous studies assessing the effect of sleep stage and position on the distribution of obstructive respiratory events did not explore such effects in a pediatric adolescent population. …”

Section: Introductionmentioning

confidence: 99%

Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children

El‐Kersh

Cavallazzi

Patel

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: This study aimed to examine the effect of sleep state (rapid eye movement [REM] versus non-rapid eye movement [NREM]) and position (supine versus non-supine position) on obstructive respiratory events distribution in adolescent population (ages 12 to 18 y). Methods: This was a retrospective study that included 150 subjects between the ages of 12 to 18 y with an apnea-hypopnea index (AHI) > 1/h. Subjects using REM sleep-suppressant medications and subjects with history of genetic anomalies or craniofacial syndromes were excluded. Results: The median age was 14 y with interquartile range (IQR) of 13 to 16 y, 56% of patients were males and the median body mass index (BMI) z-score was 2.35 (IQR: 1.71-2.59) with 77.3% of patients fulfilling obesity criteria. Respiratory obstructive events were more common in REM sleep. The median REM obstructive AHI (OAHI) was 8.9 events per hour (IQR: 2.74-22.8), whereas the median NREM OAHI was 3.2 events per hour (IQR: 1.44-8.29; p < 0.001). African American adolescents had more REM obstructive events with median REM OAHI of 13.2 events per hour (IQR: 4.88-30.6), which was significantly higher than median REM OAHI of 4.94 (IQR: 2.05-11.36; p = 0.004) in white adolescents. Obstructive events were more common in supine position with higher median supine OAHI of 6.55 (IQR: 4-17.73) when compared to median non-supine OAHI of 2.94 (IQR: 1-6.54; p < 0.001).Conclusions: This study shows that sleep related obstructive respiratory events in the adolescents (12 to 18 y of age) occur predominantly in REM sleep and in supine position. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a sleep related breathing disorder that can affect up to 5% of children.1 It is characterized by partial or complete upper airway obstruction that can disrupt normal sleep ventilation and sleep pattern.2 This upper airway obstruction can occur in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. In REM sleep, the withdrawal of excitatory noradrenergic and serotonergic inputs to upper airway motor neurons further reduces pharyngeal muscle activity, which together with reduced arousal threshold and reduced ventilatory responses to hypoxia and hypercapnia increase the propensity for upper airway obstruction in REM sleep, with more prolonged obstructions accompanied by severe desaturations. Although obstructive respiratory events in children, unlike adults, is thought to be REM predominant, a subset of pediatric population may have NREM predominance of their obstructive respiratory events. [4][5][6] Also, the effect of position on the distribution of obstructive respiratory events in the pediatric population is not consistent among different studies. [7][8][9][10][11][12] Furthermore, previous studies assessing the effect of sleep stage and position on the distribution of obstructive respiratory events did not explore such effects in a pediatric adolescent population. ObjectiveThe objective of this study was to examine the distribution of obstructive respiratory events in REM versu...

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“…There have been a number of studies analysing the influence of body position, particularly the dorsal position, on snoring and sleep apnea throughout the life cycle (Pereira, Rathi, Fatakia, Haque, & Castriotta, 2008;Willinger, Ko, Hoffman, Kessler, & Corwin, 2003), leading to the design of preventive and therapeutic strategies based on it (Van Maanen & de Vries, 2014;Van Maanen et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Sleeping Position, Expression of Anger and Subjective Sleep Quality in University Students

Arbinaga¹,

Quiñones²,

Ozcorta³

2018

Sleep Hypn

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Objective: To analyze the subjective quality of sleep and the expression of anger according to the position adopted during sleep. Methods: Using an ex-post facto design and an incidental sampling procedure, 729 university students participated in the study, 63% of which were women. The subjective quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and anger was measured using the State-Trait Anger Expression Inventory-2 (STAXI-2). Conclusion:The data appear to support the existence of relationships between the posture adopted during sleep, the subjective quality of sleep and emotional states. In future research it will be necessary to apply methodologies with greater control of the variables along with objective measures of body position.

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Body position and obstructive sleep apnea in 8–12-month-old infants

Cited by 21 publications

References 11 publications

Obstructive Sleep Apnea in Infants

Obstructive Sleep Apnea in Infants

Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children

Sleeping Position, Expression of Anger and Subjective Sleep Quality in University Students

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