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Respiration during sleep in children with COPD
Insights
Children with chronic obstructive pulmonary disease (COPD) experience breathing pauses during sleep, most often obstructive. This leads to worsened gas exchange, particularly during REM sleep, impacting overall health.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Physiology
Background:
- Chronic obstructive pulmonary disease (COPD) can affect children, with potential impacts on respiratory function during sleep.
- Understanding sleep-related breathing patterns in pediatric COPD is crucial for managing the condition.
Purpose of the Study:
- To investigate sleep-related breathing abnormalities and gas exchange in children diagnosed with COPD.
- To determine the frequency and characteristics of breathing pauses and their relationship to lung function.
Main Methods:
- Polysomnography including electroencephalography, electrooculography, and electromyography.
- Measurement of airflow, respiratory movements (magnetometers), and transcutaneous partial pressures of oxygen (tcPO2) and carbon dioxide (tcPCO2).
- Analysis of breathing pauses (BP), obstructive breathing patterns (OBP), periodic breathing, and paradoxical rib cage motion.
Main Results:
- Children with COPD exhibited significant breathing pauses during sleep, with 46% being obstructive.
- Obstructive breathing patterns correlated with lung resistance during wakefulness.
- Gas exchange was impaired, evidenced by drops and rises in tcPCO2, especially during REM sleep.
Conclusions:
- Children with COPD demonstrate significant sleep-disordered breathing, including obstructive events.
- Worsened gas exchange during sleep is a key finding in pediatric COPD patients.
- Further research into sleep interventions for pediatric COPD is warranted.
Abstract:
Seventeen children (mean age, nine years) with chronic obstructive pulmonary disease (COPD) were studied during sleep. Electroencephalography, electrooculography, and electromyography were all recorded. Airflow was measured by nasal and oral thermistors, and abdominal and thoracic anteroposterior diameters by magnetometers. Transcutaneous partial pressure of O2 (tcPO2) and of CO2 (tcPCO2) were monitored. The average total sleep time was 283 min +/- 36 (1 SD). Breathing pauses (BP) five seconds or longer were measured. The mean time of BP expressed as a percentage of TST was 1.3 percent +/- 0.8 (1 SD). The BP occurred most frequently during REM sleep. Forty-six percent of BP were obstructive (OBP). The percentage of OBP was significantly related to the degree of lung resistance during wakefulness. Periodic breathing was observed with a mean frequency of 2.2 times per night (range: 0 to 7). Episodes with paradoxic inward rib cage motion were seen one to 29 times (mean 6.6). Drops in tcPCO2 greater than 5 mm Hg occurred one to eight times and 67 percent were observed during REM sleep. Compared to tcPCO2 during W the mean maximal decrease in tcPCO2 was 14 mm Hg (range 8 to 29). tcPCO2 rose with a mean maximal of 9.1 mm Hg (range 6 to 13). It was concluded that children with COPD had worsened gas exchange during sleep.