Thoracoabdominal asynchrony correlates with peripheral vascular resistance changes in a cohort of obese children.

Yıl 2018, , 169 - 173, 30.04.2018

Marco Zaffanello , Franco Antoniazzi Laura Tenero Michele Piazza Angelo Pietrobelli Giuseppe Lippi , Emma Gasperi Giorgio Piacentini

https://doi.org/10.17546/msd.411431

Öz

Objective: The purpose of this study was to assess the relationship between the thoracoabdominal asynchrony (phase angle), as an index of inspiratory airflow resistance, pulse transit time arousal index (PTT Ar/I), as changes in peripheral vascular resistance and intrathoracic pressure, and obstructive apnea index (OA), Oxygen Desaturation Index (ODI), snoring (% estimated Total Sleep Time - eTST) and apnea-hypopnea index (AHI) in a cohort of exogenous obese children. Material and Methods: Body mass index (BMI) and BMI z-scores were calculated according to age and sex in 36 consecutive obese children. Nasal patency, tonsil size, Friedman palate position scoring were also recorded. An overnight sleep respiratory recording was performed using an polygraphic ambulatory device. Results:  Subjects studies had normal to mild sleep respiratory involvement (assessed by respiratory polysomnographic scoring). Phase angle correlated significantly with PTT Ar/I, but not with AHI (n/hr), OA (n/hr), ODI (n/hr) and snoring (% eTST), even adjusting for nasal patency, tonsil hypertrophy, palate position and BMI (z-score). Conclusion: Thoracoabdominal asynchrony (phase angle) is correlated with peripheral vascular resistance changes (PTT Ar/I), suggesting a subclinical upper respiratory airflow anomaly with autonomic activation in obese subjects.

Anahtar Kelimeler

phase angle, pulse transit time, obesity, children, overnight respiratory polygraphy.

Kaynakça

• 1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576-84.
• 2. Xu Z, Jiaqing A, Yuchuan L, Shen K. A case-control study of obstructive sleep apnea-hypopnea syndrome in obese and nonobese chinese children. Chest. 2008;133(3):684-9.
• 3. Van Eyck A, Van Hoorenbeeck K, De Winter BY, Van Gaal L, De Backer W, Verhulst SL. Sleep-disordered breathing and pulmonary function in obese children and adolescents. Sleep Med. 2014;15(8):929-33.
• 4. de Sousa Caixêta JA, Saramago AM, Moreira GA, Fujita RR. Otolaryngologic findings in prepubertal obese children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol. 2013;77(10):1738-41.
• 5. Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, et al. Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome. Thorax. 2011;66(7):567-73.
• 6. Alonso-Álvarez ML, Terán-Santos J, Ordax Carbajo E, Cordero-Guevara JA, Navazo-Egüia AI, Kheirandish-Gozal L, et al. Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children. Chest. 2015;147(4):1020-8.
• 7. Schechter MS, Section on Pediatric Pulmonology SboOSAS. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109(4):e69.
• 8. Reisch S, Timmer J, Steltner H, Rühle KH, Ficker JH, Guttmann J. Detection of obstructive sleep apnea by analysis of phase angle using the forced oscillation signal. Respir Physiol. 2000;123(1-2):87-99.
• 9. Horemuzova E, Katz-Salamon M, Milerad J. Increased inspiratory effort in infants with a history of apparent life-threatening event. Acta Paediatr. 2002;91(3):280-6; discussion 60-1.
• 10. Smith RP, Argod J, Pépin JL, Lévy PA. Pulse transit time: an appraisal of potential clinical applications. Thorax. 1999;54(5):452-7.
• 11. Schwartz DJ. The pulse transit time arousal index in obstructive sleep apnea before and after CPAP. Sleep Med. 2005;6(3):199-203.
• 12. Liistro G, Rombaux P, Belge C, Dury M, Aubert G, Rodenstein DO. High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J. 2003;21(2):248-52.
• 13. Cahali MB, Soares CF, Dantas DA, Formigoni GG. Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation? Clinics (Sao Paulo). 2011;66(8):1347-52.
• 14. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002;127(1):13-21.
• 15. Moss D, Urschitz MS, von Bodman A, Eitner S, Noehren A, Urschitz-Duprat PM, et al. Reference values for nocturnal home polysomnography in primary schoolchildren. Pediatr Res. 2005;58(5):958-65.
• 16. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619.
• 17. Katz ES, Lutz J, Black C, Marcus CL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res. 2003;53(4):580-8.
• 18. Alonso-Álvarez ML, Cordero-Guevara JA, Terán-Santos J, Gonzalez-Martinez M, Jurado-Luque MJ, Corral-Peñafiel J, et al. Obstructive sleep apnea in obese community-dwelling children: the NANOS study. Sleep. 2014;37(5):943-9.
• 19. Alonso-Álvarez ML, Terán-Santos J, Ordax Carbajo E, Cordero-Guevara JA, Navazo-Egüia AI, Kheirandish-Gozal L, et al. Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children. Chest. 2015;147(4):1020-8.
• 20. Alonso Alvarez MeL, Terán Santos J, Cordero Guevara J, González Martínez M, Rodríguez Pascual L, Viejo Bañuelos JL, et al. [Reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome: analysis of costs]. Arch Bronconeumol. 2008;44(1):22-8.
• 21. García-Díaz E, Quintana-Gallego E, Ruiz A, Carmona-Bernal C, Sánchez-Armengol Á, Botebol-Benhamou G, et al. Respiratory polygraphy with actigraphy in the diagnosis of sleep apnea-hypopnea syndrome. Chest. 2007;131(3):725-32.
• 22. Lam YY, Chan EY, Ng DK, Chan CH, Cheung JM, Leung SY, et al. The correlation among obesity, apnea-hypopnea index, and tonsil size in children. Chest. 2006;130(6):1751-6.
• 23. Verhulst SL, Schrauwen N, Haentjens D, Suys B, Rooman RP, Van Gaal L, et al. Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child. 2007;92(3):205-8.
• 24. Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One. 2013;8(10):e78666.
• 25. Kohler MJ, Thormaehlen S, Kennedy JD, Pamula Y, van den Heuvel CJ, Lushington K, et al. Differences in the association between obesity and obstructive sleep apnea among children and adolescents. J Clin Sleep Med. 2009;5(6):506-11.
• 26. Mitchell RB, Garetz S, Moore RH, Rosen CL, Marcus CL, Katz ES, et al. The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2015;141(2):130-6.
• 27. Hwang SH, Guilleminault C, Park CS, Kim TW, Hong SC. Usefulness of adenotonsillar size for prediction of severity of obstructive sleep apnea and flow limitation. Otolaryngol Head Neck Surg. 2013;149(2):326-34.
• 28. Dayyat E, Kheirandish-Gozal L, Sans Capdevila O, Maarafeya MM, Gozal D. Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest. 2009;136(1):137-44.
• 29. Katz S, Murto K, Barrowman N, Clarke J, Hoey L, Momoli F, et al. Neck circumference percentile: A screening tool for pediatric obstructive sleep apnea. Pediatr Pulmonol. 2015;50(2):196-201.