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Ventilatory response to CO2 in children with obstructive sleep apnea from adenotonsillar hypertrophy
S G Strauss1, A M Lynn, S L Bratton
1Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
Insights
Children with obstructive sleep apnea (OSA) show a reduced ventilatory response to CO2. This impaired respiratory control may increase perioperative risks in children undergoing adenotonsillar surgery.
Area of Science:
- Pediatric Pulmonology
- Anesthesiology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is common in children undergoing adenotonsillectomy.
- Respiratory control dysfunction may contribute to perioperative complications in pediatric OSA.
Purpose of the Study:
- To measure the ventilatory response to CO2 in children with OSA.
- To compare respiratory control between children with and without OSA.
Main Methods:
- Ventilatory CO2 response was measured in unpremedicated children under anesthesia via endotracheal tube.
- Groups included children with OSA, children without OSA undergoing adenotonsillectomy, and controls.
- OSA was diagnosed based on historical data including snoring and apneic episodes.
Main Results:
- Children with OSA exhibited a significantly diminished ventilatory CO2 response slope compared to controls (539 vs. 828-850 mL.min-1.mm Hg ETCO2(-1).m-2).
- Obesity was more frequent in patients with OSA and depressed ventilatory responses.
- A diminished ventilatory response to CO2 stimulation was observed in children with OSA.
Conclusions:
- Children with OSA undergoing adenotonsillar surgery have impaired ventilatory responses to CO2.
- This diminished response may increase the risk of perioperative respiratory complications in pediatric OSA patients.
Unlabelled:
We measured the ventilatory response to CO2 as an indicator of respiratory control dysfunction in children with obstructive sleep apnea (OSA) scheduled for adenotonsillectomy. Measurements were performed in unpremedicated children via an endotracheal tube under 0.4%-0.5% end-tidal halothane anesthesia. Mean ventilatory CO2 response slopes for 11 children with OSA requiring adenotonsillectomy (Group I) were compared with those for 14 children without OSA requiring adenotonsillectomy (Group II) and 15 children without OSA requiring nonairway surgery (Group III). The mean ventilatory slope corrected for body surface area for Groups I, II, and III were 539 +/- 338, 828 +/- 234, and 850 +/- 380 mL.min-1.mm Hg ETCO2(-1).m-2, respectively (P < 0.05, Group I versus Groups II and III). Historical data--including snoring, apneic episodes > 10 s, daytime hypersomnolence, and nocturnal enuresis--defined those with OSA. Obesity occurred more frequently in patients with OSA and with depressed ventilatory responses (P < 0.001). Children with OSA from adenotonsillar hypertrophy have a diminished ventilatory response to CO2 stimulation, compared with those without OSA symptoms. The depressed response may account, in part, for the reported increased risk of perioperative respiratory complications in this population.
Implications:
Children with obstructive sleep apnea undergoing adenotonsillar surgery are at risk of postoperative respiratory compromise. We found that patients with a clinical history suggesting obstructive sleep apnea have a diminished ventilatory response to CO2 rebreathing, compared with controls.