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Published on: December 6, 2016
Pupillometric findings in children with obstructive sleep apnea
Mona F Philby1, Secil Aydinoz2, David Gozal3
1Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA.
Insights
Pupillometry does not reliably detect autonomic nervous system dysfunction in children with obstructive sleep apnea (OSA). While severe OSA shows some blood pressure and norepinephrine changes, pupillary responses are not a sensitive indicator in this population.
Area of Science:
- Pediatric Pulmonology
- Autonomic Neurology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) in children is linked to intermittent hypoxia and sympathetic nervous system activation, contributing to cardiovascular issues.
- Autonomic nervous system (ANS) dysfunction is implicated in OSA-related morbidities, observed in some pediatric cases.
Purpose of the Study:
- To assess if pupillometry, a noninvasive bedside test, can identify ANS dysfunction in children with OSA.
- To evaluate the utility of pupillometry as a diagnostic tool for ANS alterations in pediatric OSA.
Main Methods:
- Children aged 2-12 years were categorized into Habitual Snoring (HS) and Obstructive Sleep Apnea (OSA) groups based on polysomnography (PSG).
- Pupillometric measurements were conducted in a dark room using an automated pupillometer.
- OSA group was further stratified by apnea-hypopnea index (AHI) severity.
Main Results:
- No significant differences in pupillary reflexes were found between severe OSA and HS groups.
- Mild increases in systolic blood pressure and morning plasma norepinephrine levels were observed in the severe OSA group.
- Overall, pupillometry did not reveal significant ANS dysfunction across OSA severity groups.
Conclusions:
- Pupillary responses are not a sensitive method for detecting ANS dysfunction in children with OSA.
- While ANS perturbations exist in some children with OSA, particularly severe cases, pupillometry is not an effective diagnostic tool for this specific purpose.
Background:
Obstructive sleep apnea (OSA) leads to intermittent hypoxia, activation of the sympathetic nervous system, and eventually cardiovascular morbidity. Alterations in autonomic nervous system (ANS) tone and reflexes are likely to play major roles in OSA-associated morbidities, and have been identified in a subset of children with OSA.
Objectives:
To evaluate whether pupillometry, a noninvasive and rapid bedside test for the assessment of autonomic nervous system dysfunction (ANS), would detect abnormal ANS function in children with OSA.
Methods:
Children ages 2-12 years underwent polysomnography (PSG), and were divided based on PSG findings into two groups; Habitual Snorers (HS; AHI < 1 h/TST, n = 17) and OSA (AHI > 1 h/TST, n = 49), the latter then sub-divided into AHI severity categories (>1 but <5, >5 but <10, and >10 h/TST). Pupillometric measurements were performed during the clinic visit in a dark room using an automated pupillometer device.
Results:
A total of 66 subjects with a mean age of 7.3 ± 2.6 years were recruited. There were no statistically significant differences between any of the groups, even when comparing severe OSA (n = 15) and HS in any of the measures related to pupillary reflexes. However, mild, yet significant increases in systolic blood pressure and morning plasma norepinephrine levels were detected in the severe OSA group.
Conclusion:
Although ANS perturbations are clearly present in a proportion of children with OSA, particularly those with severe disease, pupillary responses do not appear to provide a sensitive method for the detection of ANS dysfunction in OSA children.
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