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Role of ventilatory control instability in children with sleep-disordered breathing
Leon S Siriwardhana1,2, Aidan Weichard1,2, Gillian M Nixon1,2,3
1The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Insights
Ventilatory control instability (LG) does not correlate with obstructive sleep-disordered breathing (SDB) severity in children. However, lower LG was found in children with larger tonsils and more severe airway obstruction.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Physiology
Background:
- Obstructive sleep-disordered breathing (SDB) in children is common.
- Non-anatomical factors, like ventilatory control instability, are not well understood in SDB pathogenesis.
- Investigating ventilatory control sensitivity (LG) is crucial for understanding SDB development.
Purpose of the Study:
- To determine the relationship between ventilatory control instability (LG) and SDB severity in children.
- To explore associations between LG and demographic, anthropometric, and anatomical factors.
- To identify potential non-anatomical contributors to SDB in pediatric populations.
Main Methods:
- A cohort of 110 children with SDB and 36 controls (aged 3-18 years) were studied.
- Polysomnography was used to assess SDB severity (OAHI).
- Ventilatory control sensitivity (LG) was estimated using a mathematical model of ventilatory control post-spontaneous sigh.
Main Results:
- No significant difference in LG was observed between SDB severity groups and controls.
- LG was significantly lower in children with larger tonsils (grade 4) compared to those with smaller tonsils (grade 1).
- Children with higher Mallampati scores (class III/IV) exhibited significantly lower LG compared to class I.
Conclusions:
- Paediatric SDB severity is not directly related to ventilatory control sensitivity (LG).
- Altered ventilatory control sensitivity may contribute to SDB in specific subgroups of children.
- Anatomical compromise of the airway, particularly tonsil size and Mallampati score, influences ventilatory control sensitivity in children with SDB.
Background And Objective:
The contribution of non-anatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children.
Methods:
Children (aged 3-18 years) with various severities of SDB (n = 110) and non-snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern.
Results:
There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009).
Conclusion:
A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway.
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