Cause Of Obstructive Sleep Apnea Research Articles

Micrognathia and cleft palate as a cause of obstructive sleep apnoea in infants.

Obstructive sleep apnoea (OSA) is common in Robin sequence (RS). We investigated the significance of micrognathia, cleft palate and sleep positioning on OSA in infants. We analysed our 13-year national reference centre polysomnography (PSG) dataset. PSG was performed as daytime recordings (97%) in the supine-, side- and prone sleeping position at the median age of 5 weeks (interquartile range 3-8 weeks). Our study included 113 infants with RS and cleft palate, 10 infants with RS but intact palate and 32 infants with cleft palate without micrognathia. The degree of OSA in infants with cleft palate without micrognathia was less severe than in infants with RS in terms of obstructive events (median OAHI 4 vs. 32 h-1, respectively), SpO2 desaturations (ODI≥3OAH 0.4 vs. 3 h-1), transcutaneous pCO2 levels (TcCO2P95, 41 vs. 46 mmHg) (p < 0.0001) and work of breathing (p = 0.01). In the RS group, OSA was sleep-position dependent, with fewer obstructive events apparent in the side (18 vs. 24 h-1, p = 0.005) and prone (39 vs. 27 h-1, p = 0.003) sleeping positions than when supine. The degree of OSA in RS infants is more dependent on micrognathia than on cleft palate.

Predicting OSA Using Radiographs of the Airway Anatomy.

This study aims to analyze the tongue body shape and upper airway anatomical parameters in patients with Obstructive Sleep Apnea (OSA) and to explore the anatomical causes of OSA. A total of 345 subjects participated in this study. Lateral pharyngeal images of the upper respiratory tract were captured in both normal and mandibular advancement states using X-ray plain film. Measurements were taken for the following parameters: Tongue Length, Tongue Thickness, Distance from the Mandibular Plane to the Hyoid, Soft Palate Length, Posterior Oropharyngeal Depth, Palatal Airway Space, Tongue Depth Space, and Mental Posterior Space. The correlation between the Apnea-Hypopnea Index (AHI) and these upper airway anatomical factors was analyzed using both univariate and multivariate analyses to develop a predictive model for OSA. The anatomical structure of the upper airway in patients with OSA is narrower compared to non-OSA individuals, and these patients exhibit a longer and thicker tongue. During mandibular advancement, the pharyngeal airway widens; however, the tongue length decreases while its thickness increases. Univariate correlation analysis revealed that the severity of OSA was significantly associated with tongue length, the ratio of tongue length to tongue thickness, the distance from the mandibular plane to the hyoid, soft palate length, and body mass index (BMI) in both the normal position and during mandibular advancement (p < 0.001). Multivariate linear analysis indicated that the severity of OSA is linked with the mandibular plane to hyoid distance in the normal position (MPH(N)) and BMI. A nomogram was utilized to develop a predictive model for OSA, achieving an area under the receiver operating characteristic curve of 0.838. The pathogenesis of OSA is related to pharyngeal anatomy and tongue length in the state of mandibular advancement, which can be predicted by the measurement indexes of normal and anterior mandibular displacement lateral pharyngeal radiograph. This may potentially aid in early screening and diagnosis of OSA.

MTOR in the Development of Hypoxic Pulmonary Hypertension Associated with Cardiometabolic Risk Factors.

The pathophysiology of pulmonary hypertension is complex and multifactorial. It is a disease characterized by increased pulmonary vascular resistance at the level due to sustained vasoconstriction and remodeling of the pulmonary arteries, which triggers an increase in the mean pulmonary artery pressure and subsequent right ventricular hypertrophy, which in some cases can cause right heart failure. Hypoxic pulmonary hypertension (HPH) is currently classified into Group 3 of the five different groups of pulmonary hypertensions, which are determined according to the cause of the disease. HPH mainly develops as a product of lung diseases, among the most prevalent causes of obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), or hypobaric hypoxia due to exposure to high altitudes. Additionally, cardiometabolic risk factors converge on molecular mechanisms involving overactivation of the mammalian target of rapamycin (mTOR), which correspond to a central axis in the development of HPH. The aim of this review is to summarize the role of mTOR in the development of HPH associated with metabolic risk factors and its therapeutic alternatives, which will be discussed in this review.

Classification of Childhood Obstructive Sleep Apnea based on X-ray images analysis by Quasi-conformal Geometry

Craniofacial profile is one of the anatomical causes of obstructive sleep apnea (OSA). By medical research, cephalometry provides information on patients’ skeletal structures and soft tissues. In this work, a novel approach to cephalometric analysis using quasi-conformal geometry based local deformation information was proposed for OSA classification. Our study was a retrospective analysis based on 60 case-control pairs with accessible lateral cephalometry and polysomnography (PSG) data (mean age: 8.9 ± 2.3 years). By using the quasi-conformal geometry to study the local deformation around 15 landmark points, and combining the results with three linear distances between landmark points, a total of 1218 information features were obtained per subject. A L2 norm based classification model was built. Under experiments, our proposed model achieves high testing accuracy. The accurate classification tool provides us with a reliable and accurate screening tool for childhood OSA.

Automatic Measurement of Loop Gain Based on Pseudorandom Binary Sequence CO2 Stimulation.

Measurement of loop gain in patients with obstructive sleep apnea (OSA) is of great importance for determining the cause of OSA and realizing precision medicine. In this study, automatic measurement of loop gain is carried out during wakefulness based on the pseudorandom binary sequence (PRBS) CO2 stimulation method. A respiratory data acquisition platform is designed and constructed to automate the processes of gas configuration, ventilatory stimulation with CO2 and data acquisition. The respiratory data are substituted into the model of the ventilatory control system for parameter identification, and the loop gain values are calculated and then compared with the apnea-hypopnea index (AHI) measured in a hypoxia chamber. A positive correlation is found between loop gain and AHI measured in the hypoxia chamber, with the linear correlation coefficient of approximately 0.65. The feasibility of automatic measurement of loop gain using the respiratory data acquisition platform based on the PRBS CO2 stimulation method is validated, and the measured loop gain values can be used to assess the stability of ventilatory control. This study provides an automated, rapid, and instrumented solution for loop gain measurement, laying the foundation for wide-scale clinical application of the PRBS CO2 stimulation method.

Effect of Prosthetic Rehabilitation on Airway Space in Edentulous Patients with Obstructive Sleep Apnea- a Preliminary Observational Study.

The common causes of obstructive sleep apnea (OSA) are identified as anatomic and/or functional abnormality in the oral cavity, oropharynx, velopharynx, and hypopharynx leading to compromised airway space and increased collapsibility. This study was conducted to evaluate the effect of implant-supported mandibular complete denture in improving the airway space among completely edentulous patients with OSA and compare it with conventional complete denture. In this observational study, completely edentulous individuals were screened with snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and gender (STOP-Bang) questionnaire to evaluate the incidence of OSA. Ten mild-moderate patients were included as study participants. Lateral cephalograms (L1) made at the edentulous state was considered baseline. They were rehabilitated with complete denture prosthesis. One week after denture insertion, two implants were placed in the edentulous mandibular arch. Delayed loading protocol was followed. Lateral cephalogram (L2) was made 6 months after complete denture insertion and 6 months after implant-supported prosthesis (L3). Cephalometric tracings were used to evaluate change in upper airway space (UAS), middle airway space (MAS), and lower airway space (LAS). Repeated measures ANOVA was used to evaluate statistical significance in the airway measurements made at the three intervals. Post hoc Tukey HSD and Bonferroni test were used to assess if the differences obtained were truly significant. Statistical analysis revealed significant differences in UAS, MAS and LAS between L1, L2 and L3 (p< 0.05). Post hoc Tukey HSD indicated that UAS increased significantly at all three intervals followed by LAS and MAS respectively (α=.05). Post hoc Bon-ferroni test indicated that implant-supported mandibular complete dentures had a significant improvement in airway space when compared to conventional complete dentures (α=.05). Implant-supported mandibular complete denture could be effective in edentulous patients with mild-moderate OSA.

Anatomical Basis of Obstructive Sleep Apnoea: A Review of Randomized Controlled Trials.

Repeated obstruction and closure of the upper airway, sporadic hypoxic episodes, and sympathetic activity are symptoms of obstructive sleep apnea (OSA). Obstructive sleep apnoea is due to a combination of altered upper airway structure and muscular function, a low arousal threshold and increased loop gain.Although recurrent upper airway (UA) collapse during sleep is the most frequent clinical hallmark of OSA, the exact cause of this collapse is unknown. Furthermore, while continuous positive airway pressure aids in the management of OSA, many patients find it intolerable. As a result, a better knowledge of the causes of OSA may result in more effective treatments. We did a review of randomized controlled trials that were done in this regard in the last 10 years and whose full-text version is available on the PubMed database. A total of 20 articles were finalized for review after applying our criteria. The articles have proposed different theories regarding the anatomical basis responsible for obstructive sleep apnoea. The theories proposed by different studies in the last decade include reduced genioglossus and hypoglossal nerve activity, the pharyngeal muscles' failure to keep the airway open or tighten it, tonsils and adenoid hypertrophy, an oversensitive ventilatory control system and low respiratory arousal threshold, mandibular position, pharyngeal muscles' high sympathetic drive, cephalometric alterations such as mandibular and hyoid bone position and the length of the soft palate, obesity, and neck fat and fluid re-distribution in the body, from the lower to the upper parts while reclining. Given the diverse etiological characteristics of OSA patients and to increase our knowledge of the condition, additional study into this group is required. Filling any knowledge gaps that may exist in the anatomical basis of the onset of OSA is the main objective of this review paper.

Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors

Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase “sleep-disordered breathing (SDB)” indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy (“classic phenotype”) is the main cause of OSA in preschool age (3–5 years), obesity (“adult phenotype”) is the most common cause in adolescence. There is also a “congenital–structural” phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.

Adenoid lymphocyte heterogeneity in pediatric adenoid hypertrophy and obstructive sleep apnea.

Adenoid hypertrophy is the main cause of obstructive sleep apnea in children. Previous studies have suggested that pathogenic infections and local immune system disorders in the adenoids are associated with adenoid hypertrophy. The abnormalities in the number and function of various lymphocyte subsets in the adenoids may play a role in this association. However, changes in the proportion of lymphocyte subsets in hypertrophic adenoids remain unclear. To identify patterns of lymphocyte subsets in hypertrophic adenoids, we used multicolor flow cytometry to analyze the lymphocyte subset composition in two groups of children: the mild to moderate hypertrophy group (n = 10) and the severe hypertrophy group (n = 5). A significant increase in naïve lymphocytes and a decrease in effector lymphocytes were found in severe hypertrophic adenoids. This finding suggests that abnormal lymphocyte differentiation or migration may contribute to the development of adenoid hypertrophy. Our study provides valuable insights and clues into the immunological mechanism underlying adenoid hypertrophy.

Obstructive Sleep Apnea and Alzheimer’s Disease: A Two-way Street.

Background:- Obstructive sleep apnea syndrome (OSAS) and Alzheimer’s disease (AD) are really widespread chronic diseases with increasing impact on the elderly group in our society. Nowadays, many causes of obstructive sleep apnea are well identified, while Alzheimer’s disease related mechanism are still not recognized, challenging the arrival to an actual treatment. Cognitive impairment is a clinical recognized consequence of obstructive sleep apnea, which is a result of intermittent hypoxia, disruptions of sleep architecture, oxidative stress, hemodynamic and transthoracic pressure changes, all of these factors increase the Alzheimer’s disease risk in patients with obstructive sleep apnea. On the other hand, Alzheimer’s disease can aid the emergence of obstructive sleep apnea by revealing serotonin and acetylcholine deficit; which are vital neurotransmitters for upper airway patency.

Epiglottopexy Is a Treatment of Choice for Obstructive Sleep Apnea Caused by a Collapsing Epiglottis.

Drug-induced sleep endoscopy (DISE) reveals epiglottic collapse to be a frequent cause of obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP). These patients require different management. This prospective study aimed to compare transoral laser epiglottopexy outcomes in patients with OSA caused by epiglottic collapse with the patients’ previous PAP outcomes. Fifteen consecutive adult patients with OSA and epiglottic collapse during DISE were included; ten were analyzed. Before inclusion, PAP was indicated and ineffective in six patients, one of whom underwent unsuccessful uvulopalatopharyngoplasty. PAP was performed during DISE in all patients before epiglottopexy and was uniformly ineffective. ENT control was performed at 1 week and 1 month, and control limited polygraphy to 6 months after surgery. The apnea–hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) were significantly improved (p < 0.001 and p = 0.003, respectively) in all patients after epiglottopexy. Surgery was successful in 9/10 patients; the remaining patient had a significantly decreased AHI and could finally tolerate PAP. Transoral laser epiglottopexy is used to treat OSA in patients with epiglottic collapse. Unlike other methods, it significantly reduces both AHI and ESS and should be considered for these patients. An active search for OSA patients with epiglottic collapse is recommended to prevent treatment failure.

Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases

Background: Obstructive sleep apnea (OSA) is a breathing disorder that occurs during sleep and results in decreased or complete cessation of airflow despite attempts to breathe. Specific populations, such as children with certain craniofacial or other genetic syndromes and who are obese have a higher prevalence of OSA than the general population. Craniofacial abnormalities are one of the causes of OSA in the upper airway. Craniofacial morphologies that may predispose to OSA include retrognathia, anterior open bite, midface deficiency, and lower hyoid position. Therefore, interceptive orthodontic treatment in children is needed as one of the treatment options that can be chosen. Purpose: this study aimed to describe the interceptive orthodontic treatments and their effects on OSA cases in children. Review: Interceptive orthodontic treatment has various types depending on how the dentocraniofacial abnormality occurs. Orthodontic treatment aims to reduce the severity of OSA through maxillary and mandibular expansion, thereby increasing air space and airflow. Conclusion: Interceptive orthodontic treatment in pediatric OSA cases include; Rapid Maxillary Expansion, Twin-block, Propulsor Universal Light appliance, Planas appliance modified, Fränkel-II appliance, and BioAJustax oral appliance.

Effect of an Interdisciplinary Weight Loss and Lifestyle Intervention on Obstructive Sleep Apnea Severity

Obesity is the leading cause of obstructive sleep apnea (OSA); however, the effects of weight loss and lifestyle interventions on OSA and comorbidities remain uncertain. To evaluate the effect of an interdisciplinary weight loss and lifestyle intervention on OSA and comorbidities among adults with moderate to severe OSA and overweight or obesity. The Interdisciplinary Weight Loss and Lifestyle Intervention for OSA (INTERAPNEA) study was a parallel-group open-label randomized clinical trial conducted at a hospital-based referral center in Granada, Spain, from April 1, 2019, to October 23, 2020. The study enrolled 89 Spanish men aged 18 to 65 years with moderate to severe OSA and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater who were receiving continuous positive airway pressure (CPAP) therapy. The sole inclusion of men was based on the higher incidence and prevalence of OSA in this population, the differences in OSA phenotypes between men and women, and the known effectiveness of weight loss interventions among men vs women. Participants were randomized to receive usual care (CPAP therapy) or an 8-week weight loss and lifestyle intervention involving nutritional behavior change, aerobic exercise, sleep hygiene, and alcohol and tobacco cessation combined with usual care. The primary end point was the change in the apnea-hypopnea index (AHI) from baseline to the intervention end point (8 weeks) and 6 months after intervention. Secondary end points comprised changes in other OSA sleep-related outcomes, body weight and composition, cardiometabolic risk, and health-related quality of life. Among 89 men (mean [SD] age, 54.1 [8.0] years; all of Spanish ethnicity; mean [SD] AHI, 41.3 [22.2] events/h), 49 were randomized to the control group and 40 were randomized to the intervention group. The intervention group had a greater decrease in AHI (51% reduction; change, -21.2 events/h; 95% CI, -25.4 to -16.9 events/h) than the control group (change, 2.5 events/h; 95% CI, -2.0 to 6.9 events/h) at the intervention end point, with a mean between-group difference of -23.6 events/h (95% CI, -28.7 to -18.5 events/h). At 6 months after intervention, the reduction in AHI was 57% in the intervention group, with a mean between-group difference of -23.8 events/h (95% CI, -28.3 to -19.3 events/h). In the intervention group, 18 of 40 participants (45.0%) no longer required CPAP therapy at the intervention end point, and 6 of 40 participants (15.0%) attained complete OSA remission. At 6 months after intervention, 21 of 34 participants (61.8%) no longer required CPAP therapy, and complete remission of OSA was attained by 10 of 34 participants (29.4%). In the intervention vs control group, greater improvements in body weight (change, -7.1 kg [95% CI, -8.6 to -5.5 kg] vs -0.3 kg [95% CI, -1.9 to 1.4 kg]) and composition (eg, change in fat mass, -2.9 kg [95% CI, -4.5 to -1.3 kg] vs 1.4 kg [95% CI, -0.3 to 3.1 kg]), cardiometabolic risk (eg, change in blood pressure, -6.5 mm Hg [95% CI, -10.3 to -2.6 mm Hg] vs 2.2 mm Hg [95% CI, -2.1 to 6.6 mm Hg]), and health-related quality of life (eg, change in Sleep Apnea Quality of Life Index, 0.8 points [95% CI, 0.5-1.1 points] vs 0.1 points [95% CI, -0.3 to 0.4 points]) were also found at the intervention end point. In this study, an interdisciplinary weight loss and lifestyle intervention involving Spanish men with moderate to severe OSA and had overweight or obesity and were receiving CPAP therapy resulted in clinically meaningful and sustainable improvements in OSA severity and comorbidities as well as health-related quality of life. This approach may therefore be considered as a central strategy to address the substantial impact of this increasingly common sleep-disordered breathing condition. ClinicalTrials.gov Identifier: NCT03851653.

Computational Fluid Dynamic Study of the Pharyngeal Airway Characteristics Before and After Mandibular Setback Surgery in Patients with Mandibular Prognathism

Mandibular prognathism had been one of the most inconvenienced deformities developed in humans. This type of deformity possesses a protruded mandible jaw, and it can cause inconvenience in talking chewing and affect the aesthetic of the person diagnosed with this problem. However, this problem can be solved through mandibular setback surgery. This surgery will reposition the mandible jaw backward. The main concern of this surgery is, by repositioning the mandible jaw backward, the cross-sectional area of the airway will also be reduced. This condition might induce the iatrogenic of Obstructive Sleep Apnea (OSA). Thus, this study analyzed the characteristic of the pharyngeal airway in pre-treatment and post-virtual-operative conditions. This analysis simulates the pharyngeal airway with the Computational Fluid Dynamic (CFD) method. The respondent's data was obtained from computed tomography (CT) scan and was modeled into a 3-dimensional (3D) model. The simulation process takes place using the 3D model, mesh generation, and boundary conditions set-up. The flow pattern, pressure drop, airway wall shear stress, and turbulent kinetic energy were compared between both simulations. The simulations result present that, after the surgery, the pharyngeal airway decreases significantly. The pressure drop, flow pattern, airway wall shear stress (WSS), and turbulent kinetic energy (TKE) seem more significant around the critical plane in the post-treatment condition. However, these factors did not contribute to the OSA as it is not large enough to become the cause of OSA.

Nocturnal pulse oximetry as a possible screening method for obstructive sleep apnea in infants with laryngomalacia

ObjectiveLaryngomalacia can be an important cause of obstructive sleep apnea (OSA) in infants. Nocturnal oximetry is a cheap and safe method in comparison to polysomnography for the detection of sleep-disordered breathing. The aim of this study is to evaluate the validity of nocturnal oximetry as a diagnostic tool for OSA in infants with laryngomalacia. MethodsThis retrospective study included infants with laryngomalacia and a clinical suspicion of OSA who underwent a polysomnography at the Antwerp University Hospital. The oximetry was rescored manually, blinded to the polysomnography results, according to four different scoring methods. An obstructive apnea–hypopnea index (oAHI) ≥ 2/h on polysomnography was used to define OSA. ResultsThis study included 53 patients with laryngomalacia (51% boys, mean age 3.72 ± 0.26 months). A diagnosis of OSA was established in 46 patients (87%) by polysomnography. Among the four different scoring methods, the scoring according to Brouillette et al., yielded the highest diagnostic accuracy with a sensitivity and specificity of 91% and 25% respectively and with a negative and positive predictive value of 25% and 91%, respectively. Correlations and the Bland–Altman plot showed a wide limit of agreement for laboratory polysomnography oAHI and nocturnal oximetry ODI. ConclusionOur data show that overnight pulse oximetry has a high sensitivity and PPV to diagnose OSA in infants with laryngomalacia. However, the low specificity and NPV indicate that PSG is still needed to exclude OSA in cases with normal oximetry.

ASSESSMENT OF KNOWLEDGE AND ATTITUDES REGARDING OBSTRUCTIVE SLEEP APNEA AMONG INTERNS, RESIDENTS AND MEDICAL DOCTORS OF KATHMANDU MEDIAL COLLEGE

Background: Obstructive sleep apnea (OSA) is a global health problem observed mostly among children and adults resulting in poor quality of life and increased cost of health care. Medical doctors should be familiar with OSA and be able to screen, diagnose and manage this condition. This study was aimed to assess the knowledge and attitudes regarding Obstructive Sleep Apnea among interns, residents and medical doctors of Kathmandu Medial College. Methods: A descriptive cross-sectional study was conducted among interns, residents and medical doctors of Kathmandu Medial College. The study was conducted from September 2021 to October 2021.The previously validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire was administered to the participants. The data obtained from the study was analyzed using descriptive statistics with SPSS 21. Results: Among the study respondents, females comprised of 105 (55 %) and rest were males. Almost 178 (93.2%) of participants were aware of snoring habits of majority of OSA patients, while 173 (90.6%) of respondents knew that the large tonsils and adenoids was the most common cause of OSA in children. Majority of the respondents agreed on OSA as a clinical disorder and that it was important to be able to identify patients with possible OSA. More than half of the respondents felt confident to identify patients at risk for OSA. Conclusions: This study showed that the participants lack adequate knowledge. However, they agreed that OSA is a clinical disorder. They need to update the knowledge about OSA. There is also a need of special training programs on OSA.

Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea?

ObjectivesHypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures). MethodsThis retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery. ResultsA significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm3 was linked to success during pharyngeal surgery. ConclusionA correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA. Level of evidenceLevel 3, non-randomized cohort study.

Diagnosis and correction of the obstructive sleep apnea syndrome in children with tonsillar ring pathological conditions

To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.

Defining Age-related OSA Features in Robin Sequence Using Polysomnographic-based Analyses of Respiratory Arousal Responses and Gas-exchange Parameters.

Robin sequence (RS) is a leading cause of obstructive sleep apnea (OSA) in newborns. Most studies have focused on understanding anatomic factors leading to OSA and changes in apnea-hypopnea index (AHI) on polysomnography (PSG) beyond the neonatal period. This study aims to define age-related OSA features between patients with RS, without RS and healthy controls using PSG-based analyses of respiratory arousal responses and gas-exchange parameters. Retrospective comparison of PSG features in a total of 48 children encompassing three groups: (a) infants with RS (n = 24, <1-year old), (b) non-RS older children (1-2 years old) with severe OSA (obstructive AHI (OAHI) of ≥10 events; n = 12), and (c) control infants and children (0-2 years old) without sleep apnea (OAHI ≤1.5/h, n = 12). We examined OSA sleep-stage specific and position-specific indexes, and the relationship between OSA severity and respiratory arousal indexes (OAHI/respiratory arousal indexes). OSA sleep-stage specific indexes (rapid eye movement [REM] vs non-REM[NREM]) as well as position-specific indexes (supine vs nonsupine) were similar in individuals with and without RS. Relative to the non-RS groups, infants with RS have more sustained hypoxemia (time with SpO2 < 90%) and reduced arousal responses to OSA demonstrated by higher OAHI/respiratory arousal indexes. OAHI/respiratory arousal indexes significantly correlated with the severity of hypoxemia in infants with RS. Infants with RS and OSA show reduced arousal responses to apneic events, which correlates with higher hypoxemia severity. OAHI/respiratory arousal indexes in RS may identify high-risk individuals with upper airway obstruction and reduced arousal protective responses.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).