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Nocturnal hypoventilation in children with obesity
Dorottya Antics1, Judit N Kelemen2, Eszter Muzslay1
1Semmelweis University Pediatric Center, MTA Center of Excellence, Bókay János street 53-54, 1083, Budapest, Hungary; Semmelweis University Doctoral School, Üllői street 26, 1085, Budapest, Hungary.
Insights
Sleep-disordered breathing (SDB) in obese children often involves hypoventilation, which can occur without obstructive sleep apnea (OSA). Transcutaneous carbon-dioxide monitoring (tcCO2) during polysomnography (PSG) helps identify this hypoventilation and the need for non-invasive ventilation (NIV).
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Obesity Medicine
Background:
- Sleep-disordered breathing (SDB) is a significant comorbidity in childhood obesity, potentially exacerbating weight gain.
- Current diagnostic and treatment strategies for pediatric SDB, particularly hypoventilation, remain underexplored.
- Obstructive sleep apnea (OSA) is commonly studied, but isolated nocturnal hypoventilation may also play a critical role.
Purpose of the Study:
- To investigate the utility of transcutaneous carbon-dioxide monitoring (tcCO2) within polysomnography (PSG) for identifying nocturnal hypoventilation in overweight and obese children.
- To assess the need for non-invasive ventilation (NIV) in this pediatric population using tcCO2-assisted PSG.
- To differentiate between OSA, hypoventilation, and obesity hypoventilation syndrome (OHS) in pediatric SDB.
Main Methods:
- Retrospective analysis of clinical, PSG, and tcCO2 data from children (5-18 years) with overweight/obesity (BMI Z-score ≥1) between 2021-2024.
- Evaluation of PSG recordings incorporating tcCO2 monitoring according to established guidelines.
- Determination of the prevalence of OSA, nocturnal hypoventilation, OHS, and the requirement for long-term NIV.
Main Results:
- Of 41 participants, 39% had mild, 17% moderate, and 24% severe OSA.
- Twenty-three children (56%) exhibited nocturnal hypoventilation, with four cases occurring independently of OSA.
- Seventeen children were diagnosed with OHS, and 18 children required initiation of NIV.
Conclusions:
- SDB is a frequent consequence of childhood obesity, and hypoventilation can manifest independently of OSA.
- Continuous tcCO2 monitoring during PSG effectively identifies nocturnal hypoventilation, even in the absence of severe OSA.
- TcCO2-assisted PSG is crucial for accurate diagnosis, determining NIV necessity, and mitigating adverse health outcomes in pediatric SDB.
Study Objectives:
Sleep-disordered breathing (SDB) is an increasingly recognized co-morbidity in childhood obesity. SDB may contribute to the excessive weight gain; however, diagnosis and treatment strategies are not well-defined during childhood. Most pediatric studies focus solely on obstructive sleep apnea (OSA), although hypoventilation may play a separate but pivotal role in the course of the condition. This study aimed to explore the role of transcutaneous carbon-dioxide monitoring (tcCO2) as a part of the polysomnographic assessment (PSG) in identifying nocturnal hypoventilation and non-invasive ventilation (NIV) need for overweight and obese children with SDB.
Methods:
In this retrospective study clinical, PSG and tcCO2 data of children with overweight and obesity (BMI Z-score ≥1; 5-18 yrs) were collected between 2021 and 2024. PSG recordings, including tcCO2 monitoring, were analyzed according to current guideline. The frequency of OSA, nocturnal hypoventilation and obesity hypoventilation syndrome (OHS), along with the need for long-term NIV treatment were determined.
Results:
Out of 41 children involved, sixteen (39 %) had mild, seven (17 %) had moderate and ten (24 %) had severe OSA. Twenty-three children met the criteria for nocturnal hypoventilation. In four patients hypoventilation was present without OSA. Seventeen children were diagnosed with OHS; NIV was initiated in 18 children.
Conclusions:
SDB is a possible consequence of childhood obesity and hypoventilation can be present without OSA. As our results suggest, concurrent continuous monitoring of tcCO2 can identify hypoventilation, which can be present without severe OSA. TcCO2-assisted polysomnography may be essential for identifying the need for NIV and for preventing adverse outcomes.
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