Diagnosis, management and pathophysiology of central sleep apnea in children

McLaren, Anya T.; Bin-Hasan, Saadoun; Narang, Indra

doi:10.1016/j.prrv.2018.07.005

Cited by 49 publications

(97 citation statements)

References 49 publications

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“…Trisomy 21 (TS21), also known as Down syndrome, is the most common genetic syndrome in the United States 1,2 . Children with TS21 have a higher prevalence of sleep‐related breathing disorders including obstructive sleep apnea (OSA), nocturnal hypoventilation, as well as central sleep apnea (CSA) 2–10 . Most sleep‐related research in children with TS21 has focused on investigating the pathogenesis of OSA 2–10 .…”

Section: Introductionmentioning

confidence: 99%

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Central breathing abnormalities in children with trisomy 21: Effect of age, sex, and concomitant OSA

Naime

Weiss

Lew

et al. 2020

Pediatric Pulmonology

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Background: Trisomy 21 (TS21) is a condition with a high risk for sleep apnea. In the pediatric population, the risk also includes central breathing disorders. The aim of this study was to define the clinical and polysomnographic characteristics of central apnea in infants, children, and adolescents with TS21. Methods: Retrospective review of baseline polysomnograms (PSGs) in children with TS21 in the sleep center at Children's National Medical Center in Washington DC. Results: We included a total of 158 infants, children, and adolescents (0-18 years) with TS21 in this study. The median age was 4.82 years and 62% were male. The primary findings of the study are that (1) 12% of all pediatric subjects with TS21 included had a central apnea index (CAI) > 2/h; (2) the proportion of TS21 individuals with central breathing abnormalities progressively decreased with age being common in young individuals (≤2 years of age) but rare after 10 years of age; (3) additional sleep breathing disturbances (e.g., OSA and/or hypoxemia) are often present in children with TS21 and central apnea; and (4) the prevalence of central breathing abnormalities in TS21 is influenced by sex, being more likely to persist beyond early childhood (>2 years of age) in females than in males. Conclusion: Central breathing abnormalities are common in TS21 among young children (≤2 years of age) and in females older than 2 years of age. Central apnea is often associated with concomitant obstructive sleep apnea and/or hypoxemia in children with TS21.

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Section: Introductionmentioning

confidence: 99%

“…Many anatomical and functional factors may underlie the high incidence of OSA in individuals with Down syndrome. Some of those factors include generalized hypotonia and multiple sites of airway obstruction due to flattened nasal bridge, maxillary hypoplasia, macroglossia, and obesity 2–10 …”

Section: Introductionmentioning

confidence: 99%

Central breathing abnormalities in children with trisomy 21: Effect of age, sex, and concomitant OSA

Naime

Weiss

Lew

et al. 2020

Pediatric Pulmonology

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“…CSA is present in newborn children, is inversely related to conceptional age, and is more prevalent among younger children . CSA presents more frequently in patients with certain diseases, including syndromes such as Prader‐Willi or Down syndrome and diseases causing compression of the central nervous system (eg, Chiari malformation) .…”

Section: Introductionmentioning

confidence: 99%

“…CSA is present in newborn children, is inversely related to conceptional age, and is more prevalent among younger children. [2][3][4][5] CSA presents more frequently in patients with certain diseases, including syndromes such as Prader-Willi or Down syndrome 6,7 and diseases causing compression of the central nervous system (eg, Chiari malformation). 8 There is also evidence of central events in patients with upper airway obstruction caused by laryngomalacia 9 and in obstructive sleep apnea-hypopnea syndrome (OSAS).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, most of the literature has focused on reporting obstructive events, while there have been surprisingly few publications regarding the diagnosis and management of central sleep apnea (CSA) . With the exception of a recent review on the diagnosis, management, and pathophysiology of CSEA in children, there still remains a gap in the knowledge of the importance of central events in children, the central apnea index (CAI) threshold to be considered abnormal, and the range of CSA severity.…”

Section: Introductionmentioning

confidence: 99%

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Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy

Camacho

Castillo

Rodríguez-Catalán

et al. 2019

Pediatric Pulmonology

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Background Although the pathogenesis of central and obstructive events seems to be different, these two entities may somehow be related. We aimed to determine whether, as reported in previous research, the number of central sleep apnea (CSA) cases in a population of children with obstructive sleep apnea syndrome (OSAS) was greater than in patients without obstructive events, and if CSA worsens with increasing OSAS severity. As a second objective, we analyzed changes in central apnea index (CAI) after adenotonsillar surgery compared to changes when no surgery has been performed. Methods We retrospectively reviewed nocturnal polysomnography (PSG) data from children between 1 and 14 years of age with no neurological conditions or syndromes. Patients with CAI values greater than 5 per hour were diagnosed as having CSA. Improvements of greater than 50% in CAI on repeat PSG were considered to represent a real change. Results Data were available from 1279 PSG studies, resulting in 72 children with a CAI greater than 5 per hour (5.6%). Patients with OSAS showed a higher CAI (2.16) compared with those without OSAS (1.17), and this correlation increased with higher degrees of obstructive apnea severity. When adenotonsillectomy was performed due to OSAS, the CAI decreased by 1.37. The average decrease in PSG values was only 0.38 in cases where no surgery was performed. Conclusion The results of this study suggest that although CSA is perceived to be mostly associated with central nervous system ventilatory control, there may be a connection with airway obstruction and in children with CSA and OSA diagnosis adenotonsillectomy may improve both conditions.

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Evaluation of sleep‐disordered breathing and its relationship with respiratory parameters in children with mucopolysaccharidosis Type IVA and VI

Tural

Emiralioğlu

Özsezen

et al. 2021

American J of Med Genetics Pt A

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The aims of the study were to evaluate the prevalence of sleep-disordered breathing (SDB) by using polysomnography (PSG) in children with MPS IVA and MPS VI who underwent enzyme replacement therapy (ERT) and to analyze the effect on SDB of having upper airway surgery, pulmonary functions, and exercise capacity. A retrospective cross-sectional study was conducted on patients with MPS IVA (n:17) and MPS VI (n:11) aged under 19 years who underwent polysomnography. Descriptive and nonparametric analyses were performed for demographic, PSG, pulmonary function and exercise capacity variables. The frequency of sleep apnea in the study sample was 85.7% (24/28). Four patients (14.3%) had no sleep apnea, 15 (53.6%) had mild, and nine (32.1%) had moderate-to-severe sleep apnea. Two patients (7.1%) had central sleep apnea and 22 had obstructive sleep apnea (OSA) (78.6%). Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were negatively correlated to apnea-hypopnea index (AHI) (r = À0.594, p = .009; r = À0.636, p = .005, respectively). Despite ERT and previous upper airway surgery, the prevalence of OSA was high in patients with MPS IVA-MPS IV, emphasizing the importance of PSG screening for sleep disorders. Pulmonary function tests may be useful for predicting sleep apnea in patients with MPS IVA and MPS VI.

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Diagnosis, management and pathophysiology of central sleep apnea in children

Cited by 49 publications

References 49 publications

Central breathing abnormalities in children with trisomy 21: Effect of age, sex, and concomitant OSA

Central breathing abnormalities in children with trisomy 21: Effect of age, sex, and concomitant OSA

Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy

Evaluation of sleep‐disordered breathing and its relationship with respiratory parameters in children with mucopolysaccharidosis Type IVA and VI

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