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Sayas J, Lalmolda C, Corral M, Flórez P, Hernández-Voth A, Janssens JP, Rabec C, Langevin B, Lofaso F, Carlucci A, Llontop C, Winck JC, Bermejo JG, Lujan M. Measurement of thoraco-abdominal synchrony using respiratory inductance plethysmography: technical aspects and a proposal to overcome its limitations. Expert Rev Respir Med 2024; 18:227-236. [PMID: 38829281 DOI: 10.1080/17476348.2024.2363058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/12/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Thoraco-abdominal asynchrony (TAA) is usually assessed by respiratory inductance plethysmography. The main parameter used for its assessment is the calculation of the phase angle based on Lissajous plots. However, there are some mathematical limitations to its use. RESEARCH DESIGN AND METHODS Sequences of five breaths were selected from a) normal subjects, b) COPD patients, both at rest and during exercise, and c) patients with obstructive apnea syndrome. Automated analysis was performed calculating phase angle, loop rotation (clockwise or counterclockwise), global phase delay and loop area. TAA severity was estimated quantitatively and in subgroups. RESULTS 2290 cycles were analyzed (55% clockwise rotation). Phase angle ranged from -86.90 to + 88.4 degrees, while global phase delay ranged from -179.75 to + 178.54. Despite a good correlation with global phase delay (p < 0.01, ANOVA test), phase angle and loop area were not able to correctly classify breaths with severe deviation and paradoxical movements (p=ns, Bonferroni post hoc test). CONCLUSIONS Global phase delay covers the whole spectrum of TAA situations in a single value. It may be a relevant parameter for diagnosis and follow-up of clinical conditions leading to TAA. CLINICAL TRIAL REGISTRATION The trial from which the traces were obtained was registered at ClinicalTrials.gov ;(identifier: NCT04597606).
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Affiliation(s)
- Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Lalmolda
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Marta Corral
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Flórez
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ana Hernández-Voth
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Jean Paul Janssens
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland
- Medicine, University of Geneva, Geneva, Switzerland
| | - Claudio Rabec
- Department of Pulmonary Medicine and Intensive Care Unit. Constitutive Reference Center for Rare Pulmonary Diseases, University Hospital of Dijon Bourgogne, Dijon, France
| | - Bruno Langevin
- Réanimation, Pôle Soins Aigus, Centre Hospitalier Alès, Alès, France
| | - Frédéric Lofaso
- INSERM-UMR 1179, Versailles Saint-Quentin University, Paris Saclay University, France
- Department of Physiology, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como. Pneumologia Riabilitativa. Istituti Clinici Scientifici Maugeri-Pavia, Pavia, Italy
| | - Claudia Llontop
- Unité ambulatoire d'appareillage respiratoire de domicile. Département R3S (Respiration Réanimation, Réhabilitation, Sommeil), Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Joao Carlos Winck
- UniC Cardiovascular R&D Centre, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Jesús González Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réadaptation respiratoire, Sommeil), Service de médecine de readaptation respiratoire, Paris, France
| | - Manel Lujan
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- CIBERES, Madrid, Spain
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Bronstein JZ, Xie L, Shaffer TH, Chidekel A, Heinle R. Quantitative Analysis of Thoracoabdominal Asynchrony in Pediatric Polysomnography. J Clin Sleep Med 2018; 14:1169-1176. [PMID: 29991414 DOI: 10.5664/jcsm.7218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Objective measurements of thoracoabdominal asynchrony (TAA), such as average phase angle (θavg), can quantify airway obstruction. This study demonstrates and evaluates use of θavg for predicting obstructive sleep apnea (OSA) in pediatric polysomnography (PSG). METHODS This prospective observational study recruited otherwise healthy 3- to 8-year-old children presenting for PSG due to snoring, behavioral problems, difficulty sleeping, and/or enlarged tonsils. Respiratory inductance plethysmography (RIP) was directly monitored and data were collected during each PSG. θavg and average labored breathing index (LBIavg) were calculated for earliest acceptable 5-minute periods of stage N3 sleep and stage R sleep. Associations between θavg and obstructive apnea index (OAI) and obstructive apnea-hypopnea index (OAHI), as well as between LBIavg and OAI and OAHI, were examined. RESULTS Forty patients undergoing PSG were analyzed. Thirty percent of patients had OSA, 57.5% had enlarged tonsils, and 17.5% were obese. θavg during stage N3 sleep and stage R sleep had significant positive correlations with OAI (Spearman r = .35 [P = .03] and .40 [P = .01], respectively) and θavg during stage N3 sleep with OAHI (r = .35 [P = .03]). LBIavg showed lower correlations. Median θavg during stage R sleep (33.1) was significantly greater than during stage N3 sleep (13.7, P = .0005). CONCLUSIONS Association of θavg with OAI and OAHI shows that θavg reflects airway obstruction and has potential use as a quantitative indicator of OSA. RIP provides valuable information that is readily available in PSG. The significant difference between θavg in stage N3 sleep and stage R sleep confirms the clinical observation that there is more asynchrony during rapid eye movement sleep than non-rapid eye movement sleep.
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Affiliation(s)
- Jason Z Bronstein
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Li Xie
- Biostatistics Core, Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Thomas H Shaffer
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Aaron Chidekel
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Robert Heinle
- Division of Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
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Liu X, Immanuel S, Pamula Y, Kennedy D, Martin J, Baumert M. Adenotonsillectomy for childhood obstructive sleep apnoea reduces thoraco-abdominal asynchrony but spontaneous apnoea−hypopnoea index normalisation does not. Eur Respir J 2016; 49:13993003.01177-2016. [DOI: 10.1183/13993003.01177-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/14/2016] [Indexed: 11/05/2022]
Abstract
The efficacy of adenotonsillectomy for treating obstructive sleep apnoea syndrome (OSAS) in children has been established, but its precise effects on inspiratory effort are not well documented.In 353 children enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo either early adenotonsillectomy (n=182) or a strategy of watchful waiting with supportive care (WWSC) (n=171), thoraco-abdominal asynchrony (TAA) was analysed during quiet, non-apnoeic and non-hypopnoeic breathing during sleep at baseline and at 7 months using overnight polysomnography.Children who underwent early adenotonsillectomy demonstrated a reduction in TAA post-surgery while the WWSC arm showed no change. On assessing TAA with regard to normalisation of clinical polysomnography findings at follow-up, TAA was reduced in children who had surgical resolution of OSAS (based on apnoea–hypopnoea index), but not in children who displayed spontaneous normalisation of apnoea–hypopnoea index. In the latter group, TAA was inversely correlated with quality of life.We conclude that adenotonsillectomy reduces TAA during quiet sleep. Monitoring of instantaneous TAA may yield additional insight in the dynamic changes of inspiratory effort. In combination with traditional indices of obstruction, TAA may more accurately characterise the degree of sleep-disordered breathing in children.
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Immanuel SA, Kohler M, Martin J, Kennedy D, Pamula Y, Kabir MM, Saint DA, Baumert M. Increased thoracoabdominal asynchrony during breathing periods free of discretely scored obstructive events in children with upper airway obstruction. Sleep Breath 2014; 19:65-71. [DOI: 10.1007/s11325-014-0963-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 02/15/2014] [Accepted: 02/22/2014] [Indexed: 11/29/2022]
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Le Boedec K, Arnaud C, Chetboul V, Trehiou-Sechi E, Pouchelon JL, Gouni V, Reynolds BS. Relationship between paradoxical breathing and pleural diseases in dyspneic dogs and cats: 389 cases (2001-2009). J Am Vet Med Assoc 2012; 240:1095-9. [PMID: 22515630 DOI: 10.2460/javma.240.9.1095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the strength of the relationship between paradoxical breathing (PB) and spontaneous pleural diseases in dyspneic dogs and cats. DESIGN Cross-sectional study. ANIMALS Dogs (n = 195) and cats (194) with a recorded diagnosis of dyspnea examined at the National Veterinary Schools of Alfort and Toulouse (France) between January 2001 and October 2009. PROCEDURES Dogs and cats were divided into 2 groups according to the presence or absence of PB. Stratified analysis by species was performed. Signalment of affected animals and occurrence of PB were recorded. The relationship between PB and pleural diseases among dyspneic dogs and cats was analyzed. RESULTS A strong relationship between PB and pleural diseases was highlighted in multivariate analysis (dogs, OR = 12.6 and 95% confidence interval = 4.6 to 31.2; cats, OR = 14.1 and 95% confidence interval = 6.0 to 33.5). Paradoxical breathing prevalence among dyspneic dogs and cats was 27% and 64%, respectively. Occurrence of pleural diseases in dyspneic animals with and without PB was 49% and 9% in dogs and 66% and 13% in cats, respectively. The sensitivity and specificity of PB as a predictor of pleural diseases were 0.67 and 0.83 in dyspneic dogs and 0.90 and 0.58 in dyspneic cats, respectively. The positive and negative predictive values of PB were 0.49 and 0.91 in dyspneic dogs and 0.66 and 0.87 in dyspneic cats, respectively. Age, sex, feline breeds, and canine morphotypes in patients with PB were not significantly different from those of other dyspneic animals. CONCLUSIONS AND CLINICAL RELEVANCE PB was strongly associated with pleural diseases in dyspneic dogs and cats. The presence of this clinical sign should prompt small animal practitioners to implement appropriate emergency procedures and guide their diagnostic strategy.
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Affiliation(s)
- Kevin Le Boedec
- Department of Clinical Sciences, Université de Toulouse, INP, Ecole Nationale Vétérinaire de Toulouse, F-31076 Toulouse cedex 03, France
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Immanuel S, Kohler M, Pamula Y, Kabir MM, Saint DA, Baumert M. Thoraco-abdominal asynchrony in children during quiet sleep using Hilbert transform. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:3448-3451. [PMID: 23366668 DOI: 10.1109/embc.2012.6346707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present a technique based on the Hilbert transform to quantify the thoraco-abdominal asynchrony (TAA) based on the phase shift between ribcage (RC) and abdomenal (AB) breathing signals acquired using respiratory inductive plethysmography (RIP). We employed this method to investigate RIP during overnight polysomnography (PSG) in 40 healthy children for analysis of their breathing patterns in various stages of sleep (ss 2, 3, 4 and REM) and in two common sleeping positions (supine and lateral). RIP signals free of respiratory or movement artifacts were segmented into 30 second epochs. Those epochs with maximum power in the quiet breathing frequency range and positional invariance throughout were included for further processing. TAA was calculated from corresponding RC and AB excursions. We found a statistically significant influence of sleep position on the level of TAA in all stages of non-REM sleep. In conclusion, the Hilbert transform provides a simple tool for the quantification of thoraco-abdominal asynchrony.
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Wang X, Reece S, Olmstead S, Wardle RL, Van Scott MR. Nocturnal thoracoabdominal asynchrony in house dust mite-sensitive nonhuman primates. J Asthma Allergy 2010; 3:75-86. [PMID: 21437042 PMCID: PMC3047915 DOI: 10.2147/jaa.s11781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Indexed: 11/23/2022] Open
Abstract
Nocturnal bronchoconstriction is a common symptom of asthma in humans, but is poorly documented in animal models. Thoracoabdominal asynchrony (TAA) is a noninvasive clinical indication of airway obstruction. In this study, respiratory inductive plethysmography (RIP) was used to document nocturnal TAA in house dust mite (HDM)-sensitive Cynomolgus macaques. Dynamic compliance (Cdyn) and lung resistance (RL) measured in anesthetized animals at rest and following exposure to HDM allergen, methacholine, and albuterol were highly correlated with three RIP parameters associated with TAA, ie, phase angle of the rib cage and abdomen waveforms (PhAng), baseline effort phase relation (eBPRL) and effort phase relation (ePhRL). Twenty-one allergic subjects were challenged with HDM early in the morning, and eBPRL and ePhRL were monitored for 20 hours after provocation. Fifteen of the allergic subjects exhibited gradual increases in eBPRL and ePhRL between midnight and 6 am, with peak activity at 4 am. However, as in humans, this nocturnal response was highly variable both between subjects and within subjects over time. The results document that TAA in this nonhuman primate model of asthma is highly correlated with Cdyn and RL, and demonstrate that animals exhibiting acute responses to allergen exposure during the day also exhibit nocturnal TAA.
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Affiliation(s)
- Xiaojia Wang
- Department of Physiology, East Carolina University, Greenville, North Carolina, USA
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Dellaca' RL, Ventura ML, Zannin E, Natile M, Pedotti A, Tagliabue P. Measurement of total and compartmental lung volume changes in newborns by optoelectronic plethysmography. Pediatr Res 2010; 67:11-6. [PMID: 19755932 DOI: 10.1203/pdr.0b013e3181c0b184] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study of respiratory mechanics in infants requires a noninvasive accurate measurement of the lung volume changes (DeltaVL). Optoelectronic plethysmography (OEP) allows the assessment of DeltaVL through the measurement of the chest wall surface motion and it has been proved to be accurate in adults. The aim of this study was to apply OEP to newborns and to validate it by comparison to pneumotachography. Twenty term and preterm newborns (GA = 34 +/- 5 wk) in stable condition were studied during 1 to 2 min periods of quiet breathing in supine position. Airway opening flow was measured by applying a facemask connected to a pneumotachograph (PNT) and integrated to provide the DeltaVL. Chest wall volume changes were simultaneously measured by OEP. The tidal volume values measured by pneumotachography and by OEP were compared for each breath. A total of 771 breaths from all patients were considered. Bland-Altmann analysis showed a mean difference of -0.08 mL and a limit of agreement ranging from -2.98 to 2.83 mL. Linear regression analysis demonstrated good correlation between the two techniques (r = 0.95, q = 1.00 mL, m = 0.96). OEP provides accurate measurements of DeltaVL in newborns and may be useful to study respiratory mechanics and breathing patterns during spontaneous breathing and mechanical ventilation.
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Abstract
To understand normal sleep pattern and physiological changes during sleep, sleep and breathing interaction, nomenclature and scales used in sleep study, discuss the effect of rapid eye movements and non-rapid eye movements while sleep and to review the effects of obstructive and restrictive lung disease on gas exchange during sleep and sleep architecture.
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Affiliation(s)
- Sumer S. Choudhary
- Department of Pulmonary Medicine, Sleep Medicine, Critical Care, Shree Ramjevan Choudhary Memorial Hospital and Research Centre, Nagpur - 02, India
| | - Sanjiw R. Choudhary
- Department of Pulmonary Medicine, Sleep Medicine, Critical Care, Shree Ramjevan Choudhary Memorial Hospital and Research Centre, Nagpur - 02, India
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Abstract
Thoraco-abdominal asynchrony is often observed in many respiratory disorders and/or respiratory muscle dysfunctions and clinically assessed as a sign of respiratory distress and increased work of breathing. This review describes the assessment of thoraco-abdominal asynchrony by respiratory inductance plethysmography. Visual inspection of the Konno-Mead plot yields information about the relative contribution of the RC and the ABD to respiration and about respiratory muscle dysfunction in selected patients. The monitoring of thoraco-abdominal asynchrony is a useful, non-invasive indicator of respiratory muscle load or respiratory muscle dysfunction and can be used to determine response to therapy in individual patients. The technique is limited by the fact that it does not detect respiratory muscle fatigue and that the occurrence of TAA does not always correspond to a clinically relevant respiratory problem, especially in the neonatal period.
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Affiliation(s)
- J Hammer
- Division of Intensive Care and Pulmonology, University Children's Hospital Basel, Römergasse, Basel 8 4005, Switzerland.
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Ng DK, Cheung JM, Chan CH, Chow PY, Kwok KL. Normal values of obstructive hyponea in children: still uncharted waters? Pediatr Pulmonol 2005; 40:554; author reply 555-6. [PMID: 16206152 DOI: 10.1002/ppul.20302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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KOHYAMA J, HASEGAWA T, OHINATA JS, FURUSHIMA W, MIYATA R, SUGAWARA H, ARAKI S. Obstructive sleep apnea and insulin resistance in Japanese children. Sleep Biol Rhythms 2005. [DOI: 10.1111/j.1479-8425.2005.00184.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Testa MBC, Pavone M, Bertini E, Petrone A, Pagani M, Cutrera R. Sleep-Disordered Breathing in Spinal Muscular Atrophy Types 1 and 2. Am J Phys Med Rehabil 2005; 84:666-70. [PMID: 16141743 DOI: 10.1097/01.phm.0000176362.24957.77] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our aim was to assess the respiratory pattern during sleep in patients affected by spinal muscular atrophy types 1 and 2 and to compare their apnea-hypopnea indices with those of controls. DESIGN All consecutively referred patients underwent polysomnography. Sleep stages were defined as either wake, quiet sleep (QS), or active sleep (AS). As measures of thoracoabdominal coordination, we measured: phase angle during QS and AS (Ph Angle QS and AS), phase relation during inspiration and expiration during QS and AS: (Ph RIB QS, Ph RIB AS, Ph REB QS; Ph REB AS) and the apnea-hypopnea index. RESULTS The 14 consecutively referred infants and small children (age, 11.7 +/- 11.4 mos) showed a higher apnea-hypopnea index (P < 0.001), Ph Angle QS (P < 0.001), Ph Angle AS (P < 0.001), Ph RIB QS (P < 0.001), Ph RIB AS (P < 0.001), Ph REB QS (P < 0.001), and Ph REB AS (P < 0.001) compared with 28 healthy controls (age, 10.1 +/- 8.9 mos). CONCLUSIONS Patients affected by types 1 and 2 spinal muscular atrophy had significantly higher apnea-hypopnea indices than controls. Thoracoabdominal asynchrony was present during the inspiratory and expiratory phases in both quiet and active sleep. Measures of thoracoabdominal coordination may be useful for the evaluation and monitoring of therapeutic interventions for these patients.
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Abstract
By the time children are 5 years old more of their life will have been spent asleep than awake. Sleep medicine is therefore especially relevant in paediatrics. However, one recent survey showed that paediatricians' knowledge of sleep medicine is poor and that few paediatricians enquire about sleep as part of their general consultation.1
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Affiliation(s)
- L Whiteford
- Bristol Royal Hospital for Children, Department of Paediatric Respiratory Medicine & Sebastian Diamond Mother & Baby Sleep Laboratory, Bristol, UK
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KOHYAMA J, HASEGAWA T, OHINATA JS, FURUSHIMA W. Glycosylated hemoglobin (HbA1c) in children with sleep-disordered breathing. Sleep Biol Rhythms 2004. [DOI: 10.1111/j.1479-8425.2003.00063.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIMS To investigate blood pressure (BP) in children with sleep disordered breathing (SDB). METHODS BP was measured during single night polysomnography in 23 suspected SDB child patients with adenotonsillar hypertrophy, but without respiratory or heart failure, or coma. The age related changes of the observed BP were normalised to the BP index. The BP indices were examined in relation to SDB measures, such as the desaturation time (percentage of time with oxygen saturation (SaO2) <90% against the total sleep time), SaO2 nadir, apnoea-hypopnoea index (AHI), and arousal index, in addition to age and body mass index (BMI). RESULTS The systolic BP index during rapid eye movement sleep (REMS) tended to correlate with AHI, while the diastolic index during REM sleep showed a significant correlation with AHI. The BP indices during non-REMS and wakefulness showed no correlation with the parameters obtained. Patients with an AHI of 10 or more (n = 7, AHIhigh) had significantly higher systolic and diastolic BP indices during both wakefulness and REMS, compared with those with an AHI of less than 10 (n = 16, AHIlow). Two patients in AHIhigh showed no sleep related dip of diastolic BP, and three patients in AHIlow lacked the sleep related dip in systolic BP. By means of multiple regression analysis, age, BMI, and AHI were found to be significant predictor variables of the systolic BP index during REMS. CONCLUSIONS BP in paediatric SDB patients is positively correlated with the degree of SDB.
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Affiliation(s)
- J Kohyama
- Division of Human Ontogeny and Childhood Development, Graduate School, Tokyo Medical & Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan.
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Abstract
OBJECTIVE The objective of this study is to assess subcortical arousal response (SCA) in child patients with obstructive sleep apnea syndrome (OSAS). METHODS A new index termed SCA was defined as a sigh associated with elevated chin muscle activity. According to the duration, SCAs were divided into three types; SCA short (1s or more and less than 3s), SCA intermediate (3s or more and less than 10s), and SCA long (10s or more). We scored SCAs in six child OSAS patients, aged 2-5 years, before and after adenotonsillectomy. SCAs were also counted in four age-matched controls. RESULTS In the pretreatment records, 45.5% of SCAs were associated with electroencephalographic arousals. In all patients, SCA short and SCA intermediate decreased after the treatment to the levels in the controls. SCA long exhibited no consistent changes after treatment. The incidence of SCAs was much higher than arousals previously reported in child OSAS patients as well as in normal children. CONCLUSIONS SCAs, especially SCA short and SCA intermediate, are sensitive and useful indices for assessing subcortical involvement in child OSAS patients.
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Affiliation(s)
- Jun Kohyama
- Department of Pediatrics, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan.
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