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Carbon dioxide levels during polygraphy in children with sleep-disordered breathing
Jade Pautrat1, Sonia Khirani, Michèle Boulé
1Paediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, 75012, Paris, France, jadepautrat@hotmail.com.
Sleep & Breathing = Schlaf & Atmung
|April 29, 2014
Summary
Nocturnal hypoventilation is common in children with sleep-disordered breathing (SDB). More sensitive criteria reveal higher prevalence than the American Academy of Sleep Medicine (AASM) definition, suggesting carbon dioxide (CO2) is a key SDB indicator.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Physiology
Background:
- The American Academy of Sleep Medicine (AASM) scoring rules define pediatric hypoventilation as partial pressure of carbon dioxide (PCO2) >50 mmHg for >25% of total sleep time.
- There is a lack of validated nocturnal hypoventilation thresholds linked to end-organ damage in children.
- Evaluating hypoventilation prevalence using various CO2 thresholds is crucial for understanding its impact in children with sleep-disordered breathing (SDB).
Purpose of the Study:
- To assess the prevalence of nocturnal hypoventilation in children with SDB using the AASM definition and more sensitive criteria.
- To investigate the relationship between different hypoventilation definitions and the apnoea-hypopnoea index (AHI) and oxygenation indices.
Main Methods:
- Transcutaneous carbon dioxide (PtcCO2) was monitored during overnight polygraphy (PG) in 221 children.
- Hypoventilation was defined by four criteria: AASM (PCO2 >50 mmHg for >25% of sleep), PtcCO2 >50 mmHg (peak), PtcCO2 >50 mmHg for >2% of sleep, and PtcCO2 >10 mmHg above baseline.
- PtcCO2 indices were correlated with AHI and oxygenation parameters.
Main Results:
- Hypoventilation prevalence varied significantly by definition: 16% (AASM), 27% (PtcCO2 >50 mmHg peak), 31% (PtcCO2 >50 mmHg for >2%), and 52% (PtcCO2 >10 mmHg above baseline).
- Prevalence did not differ across diagnostic groups (obstructive sleep apnoea, neuromuscular, lung diseases).
- Weak but significant correlations were found between hypoventilation and AHI/oxygenation indices.
Conclusions:
- Nocturnal hypoventilation is prevalent in children referred for SDB, irrespective of the underlying condition, particularly when using stricter criteria than the AASM.
- The limited correlation between hypoventilation and AHI/oxygenation suggests that CO2 monitoring provides valuable, complementary information for diagnosing SDB in children.
- Further research is needed to establish definitive thresholds for hypoventilation related to end-organ damage in pediatric SDB.
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