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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

Published on: December 6, 2016

Upper airway collapsibility during REM sleep in children with the obstructive sleep apnea syndrome

Jingtao Huang1, Laurie R Karamessinis, Michelle E Pepe

  • 1Sleep Center, Children s Hospital of Philadelphia, University of Pennsylvania School ofMedicine, Philadelphia, PA, USA.

Sleep
|September 16, 2009
PubMed

Insights

Children with obstructive sleep apnea syndrome (OSAS) experience reduced airflow during REM sleep due to a more collapsible airway. However, they can maintain breathing by increasing respiratory rate.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Respiratory Physiology

Background:

  • Obstructive events in children predominantly occur during rapid eye movement (REM) sleep.
  • Understanding upper airway dynamics during sleep is crucial for diagnosing and managing obstructive sleep apnea syndrome (OSAS).

Purpose of the Study:

  • To investigate the hypothesis that children with OSAS exhibit impaired upper airway stability during REM sleep compared to controls.
  • To compare airflow maintenance during inspiratory pressure drops in REM and slow wave sleep (SWS) between children with OSAS and healthy controls.

Main Methods:

  • Utilized a sleep laboratory setting to monitor 14 children with OSAS and 23 age-matched control subjects.
  • Measured airflow, respiratory rate, tidal volume, and ventilation during SWS and REM sleep under varying inspiratory pressures.
  • Assessed airflow limitation by comparing measurements at a holding pressure and at 5 cm H2O below the holding pressure.

Main Results:

  • Children with OSAS demonstrated a significant decrease in airflow during REM sleep when faced with inspiratory pressure drops, unlike control subjects.
  • While tidal volume decreased, minute ventilation was maintained in OSAS patients through increased respiratory rate.
  • Increased inspiratory time and inspiratory time to total respiratory cycle time ratio were observed in children with OSAS during REM sleep.

Conclusions:

  • Children with OSAS exhibit a more collapsible upper airway during REM sleep, leading to airflow instability.
  • Compensatory mechanisms, including increased respiratory rate, help maintain adequate minute ventilation despite upper airway collapse.
  • Further research into local reflexes and central control mechanisms is needed to elucidate the pathophysiology and compensation strategies in pediatric OSAS.
Abstract

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