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[Alveolar hypoventilation during sleep in pharyngeal obstruction caused by lymphoid hypertrophy in children]
Insights
Nocturnal polygraphy revealed obstructive sleep apnea in children with pharyngeal obstruction, causing hypoxemia and hypercapnia. Marked hypoxemia indicates the need for surgical removal of the obstruction.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Otolaryngology
Context:
- Obstructive sleep apnea (OSA) in children is often linked to lymphoid pharyngeal obstruction.
- Nocturnal polygraphy is a key diagnostic tool for evaluating sleep-disordered breathing.
Purpose:
- To investigate the cardiorespiratory effects of obstructive sleep apnea in children with pharyngeal obstruction using nocturnal polygraphy.
- To assess the utility of transcutaneous blood gas monitoring in diagnosing and managing this condition.
Summary:
- Twenty-four children with suspected pharyngeal obstruction underwent nocturnal polygraphy, monitoring cardiac frequency, respiratory effort, airflow, and transcutaneous blood gases (PO2 and PCO2).
- Nineteen children exhibited obstructive apneas, leading to significant hypoxemia (mean lowest PtcO2 58.4 mmHg during sleep vs. 85 mmHg awake) and hypercapnia (mean highest PtcCO2 50 mmHg during sleep vs. 40 mmHg awake).
- Six children experienced severe hypoxemia (PtcO2 ≤ 50 mmHg), suggesting a strong indication for surgical intervention.
Impact:
- Transcutaneous blood gas monitoring is recommended for all children with sleep disorders due to pharyngeal obstruction.
- Identifying marked hypoxemia warrants consideration for surgical removal of the obstructing lymphoid tissue.
Abstract:
Twenty-four children suspected of having apnea induced by lymphoid pharyngeal obstruction were studied by nocturnal polygraphy. The data recorded were: instantaneous cardiac frequency, thoracic movements, naso-oral flux, transcutaneous PO2 and PCO2. Episodes of hypoxemia and of hypercapnia related to obstructive apneas were found in 19 children; the mean of the lowest values of PtcO2 during sleep was 58.4 mmHg versus 85 mmHg during wakefulness. The mean od the highest values of PtcCO2 was 50 mmHg during sleep versus 40 mmHg during wakefulness. Six children presented with marked hypoxemia (PtcO2 less than or equal to 50 mmHg). Transcutaneous blood gas monitoring is indicated in all children presenting with sleep disorders due to pharyngeal obstruction. The finding of a marked hypoxemia should suggest removal of the obstacle concerned.