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Asynchronous breathing during sleep
J Kohyama1, T Shiiki, M Shimohira
1Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan. jkohyama.ped@tmd.ac.jp
Insights
Paradoxical inward rib cage movement (PIRCM) can help detect sleep disordered breathing (SDB) in children. PIRCM decreases with age, becoming minimal by 3.3 years, but remains a useful indicator of SDB in older children.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Physiology
Background:
- Children seldom report symptoms of sleep disordered breathing (SDB).
- Paradoxical inward rib cage movement (PIRCM) during sleep may aid in SDB detection.
- PIRCM is a physiological occurrence in neonatal REM sleep, absent in adolescents.
Purpose of the Study:
- To correlate PIRCM degree with other sleep disordered breathing measures.
- To investigate age-related changes in PIRCM degree.
Main Methods:
- Quantified PIRCM using the laboured breathing index (LBI).
- Employed respiratory inductive plethysmography to determine LBI.
- Analyzed sleep recordings from 101 subjects (3.5 months to 19 years).
Main Results:
- In subjects with SaO2 ≥ 90% and no prolonged apneas, LBI during REM sleep significantly decreased with age, reaching a low by 3.3 years.
- In the remaining subjects, LBI correlated strongly with obstructed breathing indicators.
- PIRCM, indicated by high LBI, is associated with obstructed breathing during sleep.
Conclusions:
- Increased attention to PIRCM may improve the detection of obstructed breathing in children over 3 years old.
- PIRCM serves as a valuable, non-invasive marker for sleep disordered breathing in pediatric populations.
Background:
Children rarely complain of symptoms associated with sleep disordered breathing (SDB). Paradoxical inward rib cage movement (PIRCM) during sleep might prove useful for detecting SDB.
Aims:
(1) To determine the correlation between the degree of PIRCM and other measures of disordered breathing during sleep. PIRCM occurs physiologically throughout rapid eye movement sleep in neonates, while no PIRCM has been reported during sleep in adolescents. (2) To determine the chronological changes in the degree of PIRCM.
Methods:
PIRCM was quantified by means of the laboured breathing index (LBI). LBI was determined by respiratory inductive plethysmography; PIRCM accompanies a high LBI. Sleep recordings obtained for 101 subjects for various reasons (aged from 3.5 months to 19 years) were analysed.
Results:
In 22 records, the minimum SaO2 value was 90% or more and no obstructive apnoea of more than 10 seconds was observed. In these 22 records, LBI during rapid eye movement sleep decreased significantly with age, reaching the mature low level at 3.3 years of age. In the other 79 records, LBI correlated well with measures of obstructed breathing during sleep.
Conclusions:
By paying more attention to PIRCM, more obstructed breathing during sleep might be found among children aged 3 years or more.