The DOI matches its Crossref record; 87 of the 87 references it cites were found in a registry or an index.
Pathophysiology of Pediatric Obstructive Sleep Apnea
Open accessAbstract
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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“in OSA patients, after overcoming the critical closing pressure (Pcrit), a partial or total airway collapse will happen.”
From Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review (2024) · cites this paper as [41]
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Cites
Redline, S. S., Tishler, P. V., SCHLUCHTER, M. D., Aylor, J. E., Clark, K., & Graham, G. C. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.5.9809079 · Cited by 1,167
A Cause of Excessive Daytime Sleepiness
Guilleminault, C., Stoohs, R. A., Clerk, A. A., Cetel, M. B., & Maistros, P. (1993) · CHEST Journal · doi:10.1378/chest.104.3.781 · Cited by 897
Snoring, sleep disturbance, and behaviour in 4-5 year olds.
Ali, N. J., Pitson, D., & Stradling, J. R. (1993) · Archives of Disease in Childhood · doi:10.1136/adc.68.3.360 · Cited by 881
Snoring, Apneic Episodes, and Nocturnal Hypoxemia Among Children 6 Months to 6 Years Old
Gíslason, Þ., & Benediktsdóttir, B. (1995) · CHEST Journal · doi:10.1378/chest.107.4.963 · Cited by 560
Neurobehavioral Implications of Habitual Snoring in Children
O'Brien, L. M., Mervis, C. Β., Holbrook, C. R., Bruner, J. L., Klaus, C. J., Rutherford, J., Raffield, T. J., & Gozal, D. (2004) · PEDIATRICS · doi:10.1542/peds.114.1.44 · Cited by 512
Polysomnographic Characteristics in Normal Preschool and Early School-Aged Children
Montgomery‐Downs, H. E., O’Brien, L. M., Gulliver, T. E., & Gozal, D. (2006) · PEDIATRICS · doi:10.1542/peds.2005-1067 · Cited by 489
Normal Polysomnographic Respiratory Values in Children and Adolescents
Uliel‐Sibony, S., Tauman, R., Greenfeld, M., & Sivan, Y. (2004) · CHEST Journal · doi:10.1378/chest.125.3.872 · Cited by 460
Role of Arousals in the Pathogenesis of Obstructive Sleep Apnea
Younes, M. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200307-1023oc · Cited by 456 · cited 1×
“However, arousal may also be considered an adverse epiphenomenon that potentiates obstructive cycling and interferes with sleep homeostasis (75).”
BackgroundThe Male Predisposition to Pharyngeal Collapse: Importance of Airway Length
Malhotra, A., Huang, Y., Fogel, R. B., Pillar, G., Edwards, J. K., Kikinis, R., Loring, S. H., & White, D. P. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2112072 · Cited by 441
Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy
Tauman, R., Gulliver, T. E., Krishna, J., Montgomery-Downs, H. E., O’Brien, L. M., Ivanenko, A., & Gozal, D. (2006) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2006.08.067 · Cited by 438
Research works printed but not linked: 16
- 1981, J Appl Phys, 51, 557
- 2004, Sleep, 27, 95
- 2003, J Appl Phys, 95, 2030
- 2007, Sleep, 30, A68
- 2007, Sleep, 30, A67
- 1980, J Appl Phys, 48, 500
- 1994, J Appl Phys, 77, 918
- 2006, Am J Respir Crit Care Med, 173, A734
- 2004, J Appl Phys, 97, 98
- 1998, J Appl Phys, 84, 1926
- 1979, J Appl Phys, 46, 1081
- 1988, J Appl Phys, 65, 2124
- 1999, J Appl Phys, 87, 1448
- 2005, J Appl Phys, 98, 1171
- 1989, J Appl Phys, 66, 2818
- 2002, J Appl Phys, 92, 1987, 10.1063/1.1494127 · DOI
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Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management
Kaditis, A. G., Álvarez, M. L. A., Boudewyns, A. N., Alexopoulos, E. Ι., Ersu, R. H., Joosten, K., Larramona, H., Miano, S., Narang, I., Trang, H., et al. (2015) · European Respiratory Journal · doi:10.1183/13993003.00385-2015 · Cited by 944
Kuan, V., Denaxas, S., Gonzalez-Izquierdo, A., Direk, K., Bhatti, O., Husain, S., Sutaria, S., Hingorani, M., Nitsch, D., Parisinos, C. A., et al. (2019) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30012-3 · Cited by 305
Obstructive Sleep Apnea in Children
Dayyat, E., Kheirandish-Gozal, L., Sans Capdevila, O., Maarafeya, M. M. A., & Gozal, D. (2009) · Chest · doi:10.1378/chest.08-2568 · Cited by 260
Childhood Obesity and Obstructive Sleep Apnea
Narang, I., & Mathew, J. L. (2012) · Journal of Nutrition and Metabolism · doi:10.1155/2012/134202 · Cited by 284
Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art
Gulotta, G., Iannella, G., Vicini, C., Polimeni, A., Greco, A., VINCENTIIS, M. D., Visconti, I. C., Meccariello, G., Cammaroto, G., Vito, A. D., et al. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16183235 · Cited by 223
Metadata
- 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
- 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
- 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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