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Pharyngeal collapsibility and reduced muscle compensation drive higher REM sleep apnea in children, revealing key mechanisms behind pediatric obstructive sleep apnea.
Pediatric obstructive sleep apnea (pOSA) in children with adenotonsillar hypertrophy shows wide variability, influenced by key physiological factors including airway collapsibility, muscle compensation, arousal threshold, and chemoreflex sensitivity. This study investigated whether these traits differed across patient characteristics, related to pOSA severity, and were altered after adenotonsillectomy.
Researchers carried out an endotype trait estimation from sleep recordings, focusing primarily on rapid eye movement (REM) sleep, using baseline polysomnography data (N=1117; mean age 6.9±1.5 years; body mass index (BMI)-z 0.89±1.23; total apnea hypopnea index (AHI) 5.1±9.1 events/hr; REM-AHI 11.0±20.1 events/hr) and post-intervention polysomnography (N=360) following adenotonsillectomy or watchful waiting.
In this secondary analysis of CHAT clinical trial, associations between each trait (per standard deviation) and AHI, as well as participant characteristics including race/ethnicity, age, sex, and BMI-z, were evaluated by the multivariable regression. The impact of adenotonsillectomy on AHI and pathophysiological traits was also assessed. The study sample included 52% female participants and encompassed children from diverse racial, ethnic, and geographic backgrounds. Analysis displayed that:
Sex and BMI-z showed no connection with any endotype. Across the cohort, higher REM-AHI was related to greater collapsibility (13.64±1.73 events/hour/SD) and diminished compensation (-4.22 ±0.98), while loop gain remained unaffected. The combination of augmented collapsibility and declined compensation partially accounted for elevated REM-AHI. Following adenotonsillectomy, reductions in AHI were accompanied by notable improvement in pharyngeal collapsibility during REM sleep (Δ =16.88±1.94%). Investigators concluded that heightened pharyngeal collapsibility and reduced muscle compensation contributed to elevated REM-AHI in kids, yielding a mechanistic explanation for the variability in pOSA severity. These findings underscore the central role of specific physiological traits in disease progression.
Annals of the American Thoracic Society
Pathophysiological Traits in Pediatric Obstructive Sleep Apnea. Associations with Patient Characteristics and Responses to Therapy: A Secondary Analysis of CHAT Clinical Trial
Po-Yang Tsou et al.
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