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Kumar G, Chalipat S, Malwade S, Chavan S, Pimparkar S. Congenital Central Hypoventilation Syndrome: A Case Report. Cureus 2024; 16:e64884. [PMID: 39156448 PMCID: PMC11330568 DOI: 10.7759/cureus.64884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Congenital central hypoventilation syndrome (CCHS) is a rare cause of apnea and hypoventilation requiring long-term multidisciplinary care. In this article, we report the case of a two-month-old female child who presented with recurrent apnea and cyanosis, requiring long-term ventilation. After ruling out other common causes of apnea like sepsis, metabolic disorders, and neuromuscular disorders, a genetic study was done, which confirmed the diagnosis of CCHS. The child was discharged on home oxygen therapy, and the parents were counseled about genetic testing and informed about the prognosis and requirement for home ventilation therapy, as well as parental testing.
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Affiliation(s)
- Gaurav Kumar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shiji Chalipat
- Pediatric Neurology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sudhir Malwade
- Pediatrics and Neonatology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sanjay Chavan
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sanika Pimparkar
- Pediatrics and Neonatology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Herrera-Flores EH, Rodríguez-Tejada A, Reyes-Zúñiga MM, Torres-Fraga MG, Castorena-Maldonado A, Carrillo-Alduenda JL. [Congenital central alveolar hypoventilation syndrome]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:262-270. [PMID: 29421146 DOI: 10.1016/j.bmhimx.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital central alveolar hypoventilation syndrome (CCAHS) is a rare sleep-related breathing disorder. Although increasingly frequently diagnosed in sleep clinics and pediatric pulmonology services, its epidemiology is not known. There are about 300 reported cases reported in the literature with an incidence of 1 case per 200,000 live births. CCAHS is characterized by alveolar hypoventilation that occurs or worsens during sleep and is secondary to a reduction/absence of the ventilatory response to hypercapnia and/or hypoxemia. In 90% of the cases it is due to a PARM-type mutation of the PHOX2B gene. Treatment includes mechanical ventilation and diaphragmatic pacemaker. If therapy is not initiated promptly the patient can evolve to chronic respiratory failure, pulmonary hypertension, cor pulmonale and death. CASE REPORTS In this paper we present three cases of CCAHS diagnosed, treated and followed up at the Sleep Disorders Clinic of the National Institute of Respiratory Diseases in Mexico. CONCLUSIONS Early diagnosis is important to initiate ventilatory support so as to prevent any complications and to reduce mortality.
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Affiliation(s)
- Edwin Hernando Herrera-Flores
- Clínica de Trastornos Respiratorios del Dormir, Instituto Nacional de Enfermedades Respiratorias, México D.F., México
| | - Alfredo Rodríguez-Tejada
- Clínica de Trastornos Respiratorios del Dormir, Instituto Nacional de Enfermedades Respiratorias, México D.F., México
| | - Martha Margarita Reyes-Zúñiga
- Clínica de Trastornos Respiratorios del Dormir, Instituto Nacional de Enfermedades Respiratorias, México D.F., México
| | - Martha Guadalupe Torres-Fraga
- Clínica de Trastornos Respiratorios del Dormir, Instituto Nacional de Enfermedades Respiratorias, México D.F., México
| | - Armando Castorena-Maldonado
- Clínica de Trastornos Respiratorios del Dormir, Instituto Nacional de Enfermedades Respiratorias, México D.F., México
| | - José Luis Carrillo-Alduenda
- Clínica de Trastornos Respiratorios del Dormir, Instituto Nacional de Enfermedades Respiratorias, México D.F., México.
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The Effect of Development in Respiratory Sensory Gating Measured by Electrocortical Activations. Neural Plast 2015; 2015:389142. [PMID: 26137323 PMCID: PMC4468290 DOI: 10.1155/2015/389142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/20/2015] [Indexed: 11/25/2022] Open
Abstract
The perception of respiratory sensations can be of significant importance to individuals for survival and greatly impact quality of life. Respiratory sensory gating, similar to somatosensory gating with exteroceptive stimuli, is indicative of brain cortices filtering out repetitive respiratory stimuli and has been investigated in adults with and without diseases. Respiratory gating can be tested with the respiratory-related evoked potential (RREP) method in the electroencephalogram with a paired inspiratory occlusion paradigm. Here, the RREP N1 component elicited by the second stimulus (S2) shows reduced amplitudes compared to the RREP N1 component elicited by the first stimulus (S1). However, little is known regarding the effect of development on respiratory sensory gating. The present study examined respiratory sensory gating in 22 typically developed school-aged children and 22 healthy adults. Paired inspiratory occlusions of 150-ms each with an inter-stimulus-interval of 500-ms were delivered randomly every 2–4 breaths during recording. The main results showed a significantly larger RREP N1 S2/S1 ratio in the children group than in the adult group. In addition, children compared to adults demonstrated significantly smaller N1 peak amplitudes in response to S1. Our results suggest that school-aged children, compared to adults, display reduced respiratory sensory gating.
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Tapia IE, McDonough JM, Huang J, Marcus CL, Gallagher PR, Shults J, Davenport PW. Respiratory cortical processing to inspiratory resistances during wakefulness in children with the obstructive sleep apnea syndrome. J Appl Physiol (1985) 2014; 118:400-7. [PMID: 25539930 DOI: 10.1152/japplphysiol.00582.2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Children with the obstructive sleep apnea syndrome (OSAS) have impaired respiratory afferent cortical processing during sleep that persists after treatment of OSAS. However, it is unknown whether this impairment is present during wakefulness and, if so, whether it improves after OSAS treatment. We hypothesized that children with OSAS, during wakefulness, have abnormal cortical processing of respiratory stimuli manifested by blunted respiratory-related evoked potentials (RREP) and that this resolves after OSAS treatment. We measured RREP during wakefulness in 26 controls and 21 children with OSAS before and after treatment. Thirteen participants with OSAS repeated testing 3-6 mo after adenotonsillectomy. RREP were elicited by interruption of inspiration by total occlusion and 30 and 20 cmH2O/l per s resistances. Nf at Fz latency elicited by occlusion was longer in children with OSAS at baseline compared with controls (78.8 ± 24.8 vs. 63.9 ± 19.7 ms, P = 0.05). All other peak amplitudes and latencies were similar between the two groups. After OSAS treatment, Nf at Fz latency elicited by 30 cmH2O/l per s decreased significantly (before, 88 ± 26 vs. after, 71 ± 25 ms, P = 0.02), as did that elicited by 20 cmH2O/l per s (85 ± 27 vs. 72 ± 24 ms, P = 0.004). The amplitude of N1 at Cz elicited by occlusion increased from -3.4 ± 5.6 to -7.4 ± 3 μV (P = 0.049) after treatment. We concluded that children with OSAS have partial delay of respiratory afferent cortical processing during wakefulness that improves after treatment.
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Affiliation(s)
- Ignacio E Tapia
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Joseph M McDonough
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jingtao Huang
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carole L Marcus
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul R Gallagher
- Biostatistics Core, Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Justine Shults
- Biostatistics Core, Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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Immanuel SA, Pamula Y, Kohler M, Martin J, Kennedy D, Nalivaiko E, Saint DA, Baumert M. Heartbeat Evoked Potentials during Sleep and Daytime Behavior in Children with Sleep-disordered Breathing. Am J Respir Crit Care Med 2014; 190:1149-57. [DOI: 10.1164/rccm.201405-0920oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Affiliation(s)
- Christopher Cielo
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Colket Translational Research Building, 11th Floor Pulmonary Medicine, 3501 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Carole L Marcus
- Sleep Center, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, 9 Northwest 50 Main Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
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Emotions and neural processing of respiratory sensations investigated with respiratory-related evoked potentials. Psychosom Med 2013; 75:244-52. [PMID: 23460722 DOI: 10.1097/psy.0b013e31828251cf] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with respiratory diseases such as asthma and chronic obstructive pulmonary disease frequently experience respiratory sensations, which are often perceived as unpleasant or threatening. However, the accurate perception of respiratory sensations is important for the management and treatment of these diseases. Emotions can substantially influence the perception of respiratory sensations and might affect the course of respiratory diseases, but the underlying neural mechanisms are poorly understood. The respiratory-related evoked potential (RREP) recorded from the electroencephalogram is a noninvasive technique that allowed first studies to examine the impact of emotions on the neural processing of respiratory sensations. METHODS In this review, we will briefly introduce the importance of the perception of respiratory sensations and the influence of emotions on respiratory perception. We then provide an overview on the technique of RREP and present a systematic review on recent findings using this technique in the context of emotions. RESULTS AND CONCLUSIONS The evidence currently available from studies in healthy individuals suggests that short-lasting emotional states and anxiety affect the later RREP components (N1, P2, P3) related to higher-order neural processing of respiratory sensations, but not the earlier RREP components (Nf, P1) related to first-order sensory processing. We conclude with a discussion of the implications of this work for future research that needs to focus on respiratory patient groups and the associated clinical outcomes.
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Yuan H, Pinto SJ, Huang J, McDonough JM, Ward MB, Lee YN, Bradford RM, Gallagher PR, Shults J, Konstantinopoulou S, Samuel JM, Katz ES, Hua S, Tapia IE, Marcus CL. Ventilatory responses to hypercapnia during wakefulness and sleep in obese adolescents with and without obstructive sleep apnea syndrome. Sleep 2012; 35:1257-67. [PMID: 22942504 DOI: 10.5665/sleep.2082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Abnormal ventilatory drive may contribute to the pathophysiology of the childhood obstructive sleep apnea syndrome (OSAS). Concomitant with the obesity epidemic, more adolescents are developing OSAS. However, few studies have specifically evaluated the obese adolescent group. The authors hypothesized that obese adolescents with OSAS would have a blunted hypercapnic ventilatory response (HCVR) while awake and blunted ventilatory responses to carbon dioxide (CO(2)) during sleep compared with obese and lean adolescents without OSAS. DESIGN CVR was measured during wakefulness. During nonrapid eye movement (NREM) and rapid eye movement (REM) sleep, respiratory parameters and genioglossal electromyogram were measured during CO(2) administration in comparison with room air in obese adolescents with OSAS, obese control study participants, and lean control study participants. SETTING Sleep laboratory. PARTICIPANTS Twenty-eight obese patients with OSAS, 21 obese control study participants, and 37 lean control study participants. RESULTS The obese OSAS and obese control groups had a higher HCVR compared with the lean control group during wakefulness. During both sleep states, all 3 groups had a response to CO(2); however, the obese OSAS group had lower percentage changes in minute ventilation, inspiratory flow, inspiratory time, and tidal volume compared with the 2 control groups. There were no significance differences in genioglossal activity between groups. CONCLUSIONS HCVR during wakefulness is increased in obese adolescents. Obese adolescents with OSAS have blunted ventilatory responses to CO(2) during sleep and do not have a compensatory prolongation of inspiratory time, despite having normal CO(2) responsivity during wakefulness. Central drive may play a greater role than upper airway neuromotor tone in adapting to hypercapnia.
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Affiliation(s)
- Haibo Yuan
- Division of Respiratory Diseases, First Hospital of Jilin University, Changchun, Jilin, China
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Abstract
Congenital central hypoventilation syndrome (CCHS) is a rare, lifelong condition wherein control of breathing is abnormal and patients present with symptoms of alveolar hypoventilation. The severity of hypoventilation varies and although most patients present in the neonatal period, late onset cases have been reported. In 2003, it was discovered that mutations in the PHOX2B gene were responsible for CCHS. This gene also plays a role in neural crest cell migration, and many patients present with symptoms of autonomic dysfunction in addition to hypoventilation. The pathophysiology responsible for hypoventilation remains unclear although a unifying hypothesis is that the abnormality is located in areas of the brain involved in integration of chemoreceptor afferent pathways for ventilation. The goal of treatment for CCHS is to ensure adequate ventilation during wakefulness and sleep. A variety of ventilation modalities are available including positive pressure ventilation via tracheostomy, non-invasive ventilation via nasal mask, and diaphragmatic pacing. With close monitoring and support, children with CCHS can be expected to function well in society and have a good quality of life.
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Affiliation(s)
- F Healy
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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von Leupoldt A, Chan PYS, Bradley MM, Lang PJ, Davenport PW. The impact of anxiety on the neural processing of respiratory sensations. Neuroimage 2011; 55:247-52. [PMID: 21111831 PMCID: PMC3031667 DOI: 10.1016/j.neuroimage.2010.11.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022] Open
Abstract
Previous studies demonstrated that anxiety considerably impacts the reported perceptions of respiratory sensations. A novel feature of the current study is exploring the impact of anxiety on the neural processing of respiratory sensations elicited by short inspiratory occlusions during different affective contexts. Using high-density EEG, respiratory-related evoked potentials (RREP) were recorded in 23 low and 23 matched higher anxious individuals when viewing unpleasant or neutral picture series. Low anxious individuals showed the expected pattern of reduced magnitudes of later RREP components P2 and P3 during the unpleasant compared to the neutral affective context (p<0.05 and p<0.01). In contrast, higher anxious individuals showed greater magnitudes of P2 and P3 during the unpleasant compared to the neutral affective context (p's<0.05). Moreover, higher anxiety levels were correlated with greater magnitudes for P2 (r=0.44, p<0.01) and P3 (r=0.54, p<0.001) during the unpleasant relative to the neutral affective context. Earlier components of the RREP (Nf, P1, N1) were not affected by anxiety. This study demonstrates that anxiety affects the later, higher-order neural processing of respiratory sensations, but not its earlier, first-order sensory processing. These findings might represent a neural mechanism that underlies the increased perception of respiratory sensations in anxious individuals.
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Affiliation(s)
- Andreas von Leupoldt
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA.
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Eckert DJ, Elgar NJ, McEvoy RD, Catcheside PG. Alcohol alters sensory processing to respiratory stimuli in healthy men and women during wakefulness. Sleep 2010; 33:1389-95. [PMID: 21061862 DOI: 10.1093/sleep/33.10.1389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Alcohol can cause sleep-disordered breathing in healthy men, increase O2 desaturation in men who snore, and worsen obstructive sleep apnea (OSA) severity in men with OSA. These findings are less consistent among women, and the underlying mechanisms are incompletely understood. Respiratory-load sensory processing, which underpins upper-airway and respiratory responses to increased breathing load, is potentially impaired by alcohol. Using respiratory-related evoked potentials (RREPs) during wakefulness, this study aimed to test the hypothesis that alcohol impairs respiratory-load sensory processing and to explore potential sex differences. DESIGN Within-subjects cross-over design in men versus women. SETTING Sleep physiology laboratory. PARTICIPANTS Twenty healthy individuals (9 women) aged 18 to 38 years. INTERVENTIONS Within each subject, RREP waveform components were generated by approximately 60 brief early-inspiratory negative-pressure pulses (-13 cm H2O mask pressure, 200 ms) before and after acute alcohol administration (1.5 mL/kg body weight). Choanal and epiglottic pressures were recorded to monitor stimulus magnitude and upper-airway resistance. MEASUREMENTS AND RESULTS The latency of several RREP waveform components increased after the administration of alcohol (deltaN1 = 11 +/- 5 ms, deltaN2 = 6 +/- 3 ms, deltaP3 = 26 +/- 10 ms), and P2 amplitude decreased (3.4 +/- 1.5 microV vs 1.2 +/- 0.8 microV). There were no changes in P1 latency or amplitude. During relaxed breathing, nasal resistance increased after alcohol ingestion (1.38 +/- 0.16 vs 1.86 +/- 0.18 cm H2O x l(-1) x s(-1)), but pharyngeal and supraglottic resistances remained unchanged. RREP waveform components and upper-airway resistance measures were not different in men versus women before or after alcohol ingestion. CONCLUSIONS These data demonstrate that alcohol alters sensory processing of respiratory neural information, but not early neural transmission (P1), to a similar extent in healthy men and women. Altered sensory processing to respiratory stimuli, as well as nasal congestion, may be important mechanisms contributing to alcohol-related sleep disordered breathing.
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Affiliation(s)
- Danny J Eckert
- Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia.
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Horner RL, Bradley TD. Update in Sleep and Control of Ventilation 2008. Am J Respir Crit Care Med 2009; 179:528-32. [DOI: 10.1164/rccm.200901-0067up] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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