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

Abstract

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...

Cardiometabolic correlates of sleep‐disordered breathing in renal transplant children

“…The amount of REM sleep is inversely correlated with age, and a schoolaged child spends 20.0% of the total sleep time in this sleep phase, 34 which is characterized by CV instability, decreased hypoxic and hypercapnic ventilatory drive, 35 and decreased muscle tone, even in the pharyngeal area. 36 The above characteristics of REM sleep explain why SDB is typically a REM-related condition at a young age and that REM is generally associated with a higher frequency of respiratory events. Nisbet et al 37 suggest that the event-related surges in BP during REM phase might represent the first step in developing high BP in children.…”

“…The relevance of our findings suggesting the importance of REM phase abnormalities is in keeping with other observations. The amount of REM sleep is inversely correlated with age, and a school‐aged child spends 20.0% of the total sleep time in this sleep phase, which is characterized by CV instability, decreased hypoxic and hypercapnic ventilatory drive, and decreased muscle tone, even in the pharyngeal area . The above characteristics of REM sleep explain why SDB is typically a REM‐related condition at a young age and that REM is generally associated with a higher frequency of respiratory events.…”

Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children: A Study Protocol of a Crossover Randomized Controlled Trial

“…The AHI will be calculated according to the American Academy of Sleep Medicine (AASM) criteria for scoring pediatric respiratory sleep studies (Berry et al, 2012 ). AHI is the main outcome of interest and sleep position will be considered in AHI scoring because sleep related obstructive respiratory events in children occur more commonly in the supine sleep position (El-Kersh et al, 2016 ).…”

Positional obstructive sleep apnea in an obese pediatric population

“…20 In children, obstructive events have been found to be more common during supine sleep as well as rapid eye movement (REM) sleep. 21 Sleeping in a supine position can result in reduced craniofacial volume, 22 reduced lung volume, 23 and an inability of airway dilator muscles to compensate for airway collapsibility during an obstruction. 24 Therefore, individuals with obesity may be more susceptible to upper airway obstruction during supine sleep due to increased fat deposits found within the pharyngeal space, which could contribute to a reduced upper airway.…”