Central sleep apnoea syndrome with upper airway collapse

Pépin, Jean‐Louis; Pajon, A; Veale, D; Ferretti, G.; Lévy, Patrick

doi:10.1183/09031936.93.06040592

Cited by 12 publications

(2 citation statements)

References 15 publications

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“…Obesity often increases the prevalence of obstructive apnea and central apnea associated with severe desaturation 40,41 . This could be explained by factors such as decreased intrathoracic volume, resulting in fewer oxygen reserves 42 , altered ventilatory response to hypoxia and hypercapnia, hypoventilation caused by leptin resistance 43 , and central apnea, followed by narrowing or collapse of the upper airway 44,45 . The previous meta-analysis showed that TA can improve AHI without complete resolution of OSA in obese children 46 .…”

Section: Discussionmentioning

confidence: 99%

The Improvement of Central Apnea Index after Adenotonsillectomy in Children: A Systematic Review and Meta-analysis

Wijitpan,

Tanphaichitr,

Kasemsuk

et al. 2023

Preprint

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Background Central sleep apnea has been reported in pediatric patients with obstructive sleep apnea (OSA). However, the effect of adenotonsillectomy (TA) on the presentation of the central apnea index (CAI) remains unclear. We investigated the effect of TA on CAI in children with OSA through a systematic review and meta-analysis. Methods A systematic search was performed to identify original studies that compare the CAI obtained before and after TA from polysomnography in children under 18 years of age. Non-original studies and full papers that were not available were excluded. Only relevant data were pooled for meta-analysis. Results Eleven studies with 689 participants were included. The mean age was 5.6 ± 3.0 years and the mean BMI was 21.0 ± 10.6 kg/m2. Post-TA CAI decreased significantly from pre-TA CAI with a mean difference (MD) of 0.70 events/h (95%CI, 0.25–1.15), especially in the non-Down syndrome subgroup [MD of 0.75 events/h (95%CI, 0.24 to 1.26)]. Other parameters, including the apnea-hypopnea index and oxygen saturation, were also significantly improved after TA. However, there was no significant difference in CAI reduction between the subgroups of patients with and without TA, and those with and without obesity. Conclusion This meta-analysis revealed that pediatric patients with OSA who underwent TA had a significant reduction in CAI, particularly in patients without Down syndrome. The study suggests that CAI should be considered an important PSG parameter in post-TA patients. A further well-controlled and long-term study considering the impact of pediatric OSA surgery on CAI is needed.

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Section: Discussionmentioning

confidence: 99%

The Improvement of Central Apnea Index after Adenotonsillectomy in Children: A Systematic Review and Meta-analysis

Wijitpan,

Tanphaichitr,

Kasemsuk

et al. 2023

Preprint

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“…Such conditions encompass idiopathic central apnea syndrome, central hypoventilation syndromes, instances involving heart diseases, Prader-Willi syndrome, Down syndrome, achondroplasia, and various neurological conditions such as Arnold-Chiari malformation and encephalopathy and/or epilepsy 11 . Additionally, central apneas can also manifest within the context of obstructive apneas, likely stemming from hyperrventilation 2,[12][13][14][15][16][17][18][19][20][21] . Therapeutic options for central apneas remain relatively underexplored and sparsely documented in the literature so far [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Long term ventilation into pediatric central apneas: etiologies, profiles and therapeutic approaches over a decade

Presti,

Pavone,

Verrillo

et al. 2024

Preprint

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Central apneas are a prevalent yet complex phenomenon, particularly among children. This retrospective study, conducted over a decade (from 2012 to 2022), analyzed central apneas in a cohort of 612 pediatric patients who underwent ventilation at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children’s Hospital in Rome, Italy. Among this group, 67 patients met the inclusion criteria for central apneas. Central apneas often arise within the context of various underlying pathologies, including neurological disorders, genetic syndromes, and brain tumors. We categorized patients into three main groups including patients with “exclusively central apneas”, “predominantly central apneas”, and “predominantly obstructive apneas”. Ventilation modes were diverse, with pressure-controlled ventilation and pressure support being commonly used, reflecting the individualized nature of therapy. The choice of ventilation mode has been influenced by the underlying diagnosis and the severity of central apneas, with pressure support ventilation being the most frequently employed mode. Continuous Positive Airway Pressure was also employed in select cases. A statistically significant reduction (p<0.05) in mean cAHI was observed in patients with multimalformation syndromes, hypoxic-ischemic encephalopathy and Prader-Willi Syndrome. The reduction in mean cAHI was not statistically significant in the case of patients with brain tumors. While non-invasive ventilation was commonly used, invasive mechanical ventilation was selectively employed in more severe cases. The study highlights the need for personalized therapeutic strategies when managing central apneas in pediatric patients.

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Long Term Ventilation in Pediatric Central Apnea: Etiologies and Therapeutic Approach over a Decade

Presti,

Pavone,

Verrillo

et al. 2024

Pediatric Pulmonology

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ObjectiveThis retrospective study aimed to analyze the clinical characteristics, ventilatory strategies, and effectiveness of ventilation in pediatric patients with central apneas treated at the Sleep Medicine and Long‐Term Ventilation Unit of the Bambino Gesù Children's Hospital in Rome from 2012 to 2022.MethodsAmong all ventilated patients at our Center from January 2012 to December 2022, we retrospectively included children with a cAHI ≥ 1 events/h on baseline poly(somno)graphic study. Additional parameters assessed included the underlying disease, type of ventilation (non‐invasive vs. invasive), age at ventilation onset, ventilation mode, and transcutaneous capnometry parameters. To assess the effectiveness of ventilation on central apneas, we compared the cAHI at baseline and on ventilation.ResultsSixty‐seven patients met the inclusion criteria for central apnea (cAHI > 1 events/h). Diagnoses included hypoxic‐ischemic encephalopathy, 15 (22.4%); Ondine syndrome, 14 (20.9%); polymalformative syndrome, 10 (14.9%); Prader‐Willi syndrome, 8 (11.9%); brain tumor, 6 (9.0%); Down syndrome, 4 (6.0%); ROHHAD syndrome, 2 (3.0%); other infrequent pathologies were, Arnold‐Chiari II, primary central apnea, epilepsy, lisosomal diseases, hydrocephalus, myopathy, obesity, Rett Syndrome. Pressure‐supported ventilation (PSV) was the most common mode used (45 out 67 patients, 67.2%), followed by pressure‐controlled ventilation (PCV) (15 out 67 patients, 22.4%) and continuous positive airway pressure (CPAP) (7 out 67 patients, 10.4%). Statistically significant improvement (p < 0.05) in cAHI was observed in patients with polymalformative syndrome (3.5 vs. 0.3, p = 0.01), hypoxic‐ischemic encephalopathy (3.1 vs. 0.1, p = < 0.01), and Prader‐Willi syndrome (3.5 vs. 0.1, p = 0.03), while there was no significant improvementn in children with brain tumor (6.2 vs. 1.5, p = 0.21).ConclusionCentral apneas are present in children with various underlying pathologies. Ventilatory strategies tailored to the specific diagnosis and severity of central apneas yield significant improvements in cAHI. PSV was the preferred ventilation mode in this study and there was notable effectiveness across different diagnostic categories. PCV was employed in most severe cases. CPAP was exclusively used in patients with predominantly obstructive sleep apneas.

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Central sleep apnoea syndrome with upper airway collapse

Cited by 12 publications

References 15 publications

The Improvement of Central Apnea Index after Adenotonsillectomy in Children: A Systematic Review and Meta-analysis

The Improvement of Central Apnea Index after Adenotonsillectomy in Children: A Systematic Review and Meta-analysis

Long term ventilation into pediatric central apneas: etiologies, profiles and therapeutic approaches over a decade

Long Term Ventilation in Pediatric Central Apnea: Etiologies and Therapeutic Approach over a Decade

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