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

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

Published on: December 6, 2016

Cross-sectional study of loop gain abnormalities in childhood obstructive sleep apnea syndrome

Plamen Bokov¹, Boris Matrot², Noria Medjahdi³

¹Service de Physiologie Pédiatrique - Centre Pédiatrique des Pathologies Du Sommeil, AP-HP, Hôpital Robert Debré, F-75019, Paris, France; Université de Paris, UMR1141, Equipe NeoPhen, INSERM Co-tutelle, F-75019, Paris, France.

|February 25, 2020

Insights

Children with obstructive sleep apnea (OSA) exhibit higher plant gain, a measure of ventilatory control stability. This finding suggests plant gain may play a role in pediatric OSA, warranting further investigation into targeted therapies.

Area of Science:

Pediatric Pulmonology
Sleep Medicine
Respiratory Physiology

Background:

Obstructive sleep apnea (OSA) is a common condition in children.
Understanding the physiological mechanisms underlying pediatric OSA is crucial for effective management.
Ventilatory control plays a significant role in respiratory regulation during sleep.

Purpose of the Study:

To investigate ventilatory control differences in children with and without obstructive sleep apnea (OSA).
To analyze specific parameters of ventilatory control, including loop gain (LG), controller gain (CG), and plant gain (PG).
To determine the correlation between plant gain and the severity of OSA in children.

Main Methods:

Recruited otherwise healthy children with suspected OSA.
Conducted polysomnography and analyzed tidal breathing recordings during wakefulness.
Utilized bivariate and trivariate models to assess ventilatory control parameters and chemosensitivity.

Main Results:

Children with OSA (n=19) demonstrated significantly higher plant gain compared to controls (n=35).
Plant gain positively correlated with the apnea-hypopnea index (AHI) (r²=0.10, p<0.020).
Increased steady-state plant gain was observed in children with an AHI ≥5 events/hour.

Conclusions:

Elevated plant gain may contribute to the pathophysiology of pediatric obstructive sleep apnea.
Therapeutic strategies aimed at reducing plant gain should be explored for treating childhood OSA.
Further research is needed to elucidate the precise role of plant gain in OSA development and progression.

Read full analysis

Abstract

Study Objectives:

We aimed to assess ventilatory control in typically developing children with and without obstructive sleep apnea (OSA).

Methods:

Otherwise healthy children referred for suspicion of OSA were recruited. In addition to polysomnography, we analyzed loop, controller and plant gains (ie, LG, CG, and PG), which reflect the stability of control, chemoreceptor sensitivity and the pulmonary control of blood gases in response to changes in ventilation, respectively, from tidal breathing recordings during wakefulness. Two bivariate (ventilation, end-tidal CO₂: one unconstrained and one constrained) and one trivariate (plus end-tidal oxygen) unconstrained model were used to assess model consistency and oxygen chemosensitivity.

Results:

In sum, 54 children (median age 11.6 years) were included. Children with OSA (n = 19, [obstructive apnea-hypopnea index] OAHI ≥2.h^-1) had a higher plant gain compared with those without OSA (n = 35), and it was positively correlated with apnea hypopnea index (AHI) (r² = 0.10, p < 0.020). The two models showed consistent results. The bivariate constrained model showed that children with OAHI ≥5.h^-1 showed an increased steady-state plant gain compared with children with OAHI <5.h^-1. The trivariate model did not show evidence of any abnormality of oxygen chemosensitivity.

Conclusion:

Plant gain may contribute to OSA pathophysiology in children, and therapies directed at its reduction should be tested.

Keywords:

Childhood Loop gain Sleep apnea Ventilatory control

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