End-Tidal Carbon Dioxide Measurement during Pediatric Polysomnography: Signal Quality, Association with Apnea Severity, and Prediction of Neurobehavioral Outcomes

Paruthi, Shalini; Rosen, Carol L.; Wang, Rui; Weng, Jia; Marcus, Carole L.; Chervin, Ronald D.; Stanley, Jeffrey J.; Katz, Eliot S.; Amin, Raouf S.; Redline, Susan

doi:10.5665/sleep.5150

Cited by 31 publications

(33 citation statements)

References 11 publications

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“…17,18 Additionally, the Childhood Adenotonsillectomy, or CHAT, trial did not report any correlation of percentage of total sleep time (TST) with ETCO 2 > 50 mm Hg with changes on the cognitive and behavioral assessment at median age of 7.1 years. The median ETCO 2 , while asleep, of that study sample was 45 mm Hg, 34 which is a little lower than in our study. However, our study did show a significant association between nocturnal hypercarbia and cognitive composite scores.…”

Section: Discussioncontrasting

confidence: 46%

“…Paruthi et al demonstrated that percentage TST ETCO 2 > 50 mm Hg did not correlate with changes in cognitive or behavioral measures at 5 to 9.9 years of age. 34 Data on prematurity were not available for this study sample. 34 Based on our study results, mean ETCO 2 may be a more sensitive marker to detect cognitive outcome and its role should be explored further, particularly in the neonatal age group.…”

Section: Discussionmentioning

confidence: 99%

“…AHI and mean ETCO 2 did not correlate significantly in our study, which is consistent with existing literature. 34 It has been suggested that the utility of nocturnal capnometry may go beyond apnea detection and quantification of hypoventilation syndromes. Instead it may reflect the balance of apnea and postapnea duration, which are not captured by AHI.…”

Section: Discussionmentioning

confidence: 99%

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Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Bandyopadhyay

Harmon

Slaven

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown. Methods: A retrospective chart review was performed for all preterm infants (< 37 weeks) who had neonatal polysomnography (PSG) and completed neurodevelopmental assessment with the Bayley Scales of Infant and Toddler Development, 3rd Edition, between 2006 to 2015 at Riley Hospital. Exclusion criteria included grade IV intraventricular hemorrhage, tracheostomy, cyanotic heart disease, severe retinopathy of prematurity, craniofacial anomalies, or central and mixed apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores. Results: Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO2 (median 47 mm Hg ) negatively correlated with cognitive scores (P = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores. Conclusions: The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO2, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA. Commentary: A commentary on this article appears in this issue on page 1233. Keywords: obstructive sleep apnea, polysomnography, infant, newborn Citation: Bandyopadhyay A, Harmon H, Slaven JE, Daftary AS. Neurodevelopmental outcomes at two years of age for premature infants diagnosed with neonatal obstructive sleep apnea.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Bandyopadhyay

Harmon

Slaven

et al. 2017

Journal of Clinical Sleep Medicine

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“…However, overnight end-tidal carbon dioxide levels are only weakly correlated with other polysomnographic measures. In addition, obstructive hypoventilation usually improves with T&A, but such improvements are not as predictive of the clinical response as AHI, and the degree of improvement in hypoventilation is not associated with either cognitive or behavioral changes after surgery [130]. As such, the issue of risk and benefit of treating isolated obstructive hypoventilation is completely unaddressed in the field and will have to await future studies.…”

Section: Isolated Obstructive Hypoventilationmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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“…In otherwise healthy children participating in the Childhood Adenotonsillectomy Trial (CHAT), percent total sleep time with end-tidal carbon dioxide partial pressure >50 mm Hg (%TST with EtCO 2 >50 mm Hg) in the exhaled air correlated significantly with the obstructive apnoea–hypopnoea index (OAHI) and the frequency of hypoventilation increased progressively with OSAS severity 12. Indeed, participants in the early adenotonsillectomy group had significantly larger decrease in %TST with EtCO 2 >50 mm Hg compared with the watchful-waiting group.…”

Section: Introductionmentioning

confidence: 99%

Hypoventilation disproportionate to OSAS severity in children with Prader-Willi syndrome

et al. 2018

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End-Tidal Carbon Dioxide Measurement during Pediatric Polysomnography: Signal Quality, Association with Apnea Severity, and Prediction of Neurobehavioral Outcomes

Abstract: Childhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTrials.gov Identifier #NCT00560859.

Cited by 31 publications

References 11 publications

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Hypoventilation disproportionate to OSAS severity in children with Prader-Willi syndrome

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