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Detection of sleep associated dysfunctional pharyngeal obstruction in infants
D P Southall1, C B Croft, V A Stebbens
1Department of Paediatrics, Cardiothoracic Institute, Brompton Hospital, London, United Kingdom.
Insights
Infants experiencing airway obstruction during sleep showed abnormal hypoxemia and elevated end-tidal expired carbon dioxide (ETCO2). This study identified a specific pattern of inspiratory obstruction in the pharynx, treatable with positive airway pressure or tracheostomy.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Physiology
Background:
- Airway obstruction during sleep in infants can present with diverse symptoms.
- Accurate diagnosis is crucial for effective management and preventing complications.
Observation:
- Six infants presented with clinical signs suggestive of sleep-related airway obstruction.
- Overnight polysomnography revealed abnormal hypoxemia and specific inspiratory waveform patterns.
Findings:
- Patients exhibited intermittent pharyngeal inspiratory obstruction, not explained by structural abnormalities.
- Elevated end-tidal expired carbon dioxide (ETCO2) was consistently observed during sleep.
- These findings were absent in healthy controls, highlighting a distinct pathological pattern.
Implications:
- This research identifies a specific functional airway obstruction in infants.
- Effective treatment options include continuous positive airway pressure and tracheostomy.
- Further research can refine diagnostic criteria and therapeutic strategies for pediatric airway disorders.
Abstract:
Six infants were referred with symptoms and clinical signs suggesting airway obstruction during sleep. In each case, overnight recordings of arterial oxygen saturation, respiratory movements and end tidal expired carbon dioxide (ETCO2) showed the presence of abnormal episodes of hypoxaemia related to partial or complete airway obstruction and associated with a specific pattern of the inspiratory movement waveforms. These events and patterns were not found on recordings from 20 age-matched healthy infants and young children. ETCO2 levels were also abnormally elevated in all six patients when asleep. Fiber-optic upper airway endoscopy excluded structural abnormalities, including significant tonsillar or adenoidal enlargement, but showed an intermittent dysfunctional inspiratory obstruction in the pharynx. Continuous positive airways pressure and tracheostomy were effective in treating this obstruction.