Cited by 326Obstructive Sleep Apnea ResearchNeuroscience of respiration and sleepSleep and related disorders

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Pathophysiology of Pediatric Obstructive Sleep Apnea

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Katz, Eliot S., D'Ambrosio, Carolyn M.·2008·Proceedings of the American Thoracic Society

DOI 10.1513/pats.200707-111mgPMC PMC2645256

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Abstract

Sleep-disordered breathing is a common and serious cause of metabolic, cardiovascular, and neurocognitive morbidity in children. The spectrum of obstructive sleep-disordered breathing ranges from habitual snoring to partial or complete airway obstruction, termed obstructive sleep apnea (OSA). Breathing patterns due to airway narrowing are highly variable, including obstructive cycling, increased respiratory effort, flow limitation, tachypnea, and/or gas exchange abnormalities. As a consequence, sleep homeostasis may be disturbed. Increased upper airway resistance is an essential component of OSA, including any combination of narrowing/retropositioning of the maxilla/mandible and/or adenotonsillar hypertrophy. However, in addition to anatomic factors, the stability of the upper airway is predicated on neuromuscular activation, ventilatory control, and arousal threshold. During sleep, most children with OSA intermittently attain a stable breathing pattern, indicating successful neuromuscular activation. At sleep onset, airway muscle activity is reduced, ventilatory variability increases, and an apneic threshold slightly below eupneic levels is observed in non-REM sleep. Airway collapse is offset by pharyngeal dilator activity in response to hypercapnia and negative lumenal pressure. Ventilatory overshoot results in sudden reduction in airway muscle activation, contributing to obstruction during non-REM sleep. Arousal from sleep exacerbates ventilatory instability and, thus, obstructive cycling. Paroxysmal reductions in pharyngeal dilator activity related to central REM sleep processes likely account for the disproportionate severity of OSA observed during REM sleep. Understanding the pathophysiology of pediatric OSA may permit more precise clinical phenotyping, and therefore improve or target therapies related to anatomy, neuromuscular compensation, ventilatory control, and/or arousal threshold.

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Authors: Katz, E. S., & D'Ambrosio, C. M.
Affiliations: Boston Children's Hospital (US)
Division of Pulmonary Diseases, Department of Medicine, Tufts-New England Medical Center, and Tufts Medical School, Boston, Massachusetts
ORCID: Katz, Eliot S.
Venue: Proceedings of the American Thoracic Society
Publisher: Oxford University Press (OUP)
Published: 2008-02
Volume: 5
Issue: 2
Pages: 253-262
ISSN: 1546-3222 (ISSN-L)
1943-5665
DOI: 10.1513/pats.200707-111mg
PMC: PMC2645256
OpenAlex: W2054680308
Cited by: 326
References: 87
Citations by year: 2026: 14 · 2025: 23 · 2024: 23 · 2023: 26 · 2022: 21 · 2021: 29 · 2020: 28 · 2019: 19 · 2018: 10 · 2017: 17 · 2016: 12 · 2015: 17 · 2014: 15 · 2013: 13 · 2012: 18
FWCI: 1.40
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations: Proceedings of the American Thoracic Society (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health
National Heart, Lung, and Blood Institute (HL073238, K23HL073238)
National Center for Research Resources (M01-RR02172, M01RR002172, RR02172)
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: pediatric obstructive sleep apnea, sleep-disordered breathing, upper airway resistance, airway collapse, ventilation control, arousal threshold, REM sleep, NREM sleep, adenotonsillar hypertrophy, neuromuscular activation, sleep homeostasis, snoring
MeSH terms: Child, Electromyography, Humans, Obesity, Pharynx, Risk Factors, Snoring, Craniofacial Abnormalities, Sleep Apnea, Obstructive

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