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Obstructive hypopnea and gastroesophageal reflux as factors associated with residual obstructive sleep apnea syndrome.
Int J Pediatr Otorhinolaryngol. 2011 May; 75(5):657-63.IJ

Abstract

OBJECTIVE

The mechanism of persisting obstructive sleep apnea (OSA) after adenotonsillectomy is not fully explained. The purpose of this study was to evaluate factors associated with residual OSA. The primary outcome measures were metabolic tests and polysomnographic respiratory indices in children with residual disease compared with children who were diagnosed with OSA but were untreated. Secondary outcome measures were acid gastroesophageal reflux indices recorded parallel to the sleep study.

METHODS

In the one-year study consecutive series of patients with sleep disordered breathing hospitalized in a tertiary pediatric center were evaluated. Following the study protocol a sleep interview, physical examination, metabolic blood tests (serum leptin and the homeostasis model assessment index for insulin resistance, HOMA-IR) and an overnight polysomnography with pH-metry recording were performed. Children diagnosed with OSA were analyzed in two groups: I - residual OSA (after surgery), II - non-residual OSA (newly diagnosed). Logistic regression analysis was applied to obtain significant risk factors for prediction of OSA.

RESULTS

Fifty-seven children (mean age ± SE, 6.9 ± 0.5 years; 66.7% boys) met the inclusion criteria and were enrolled in the study as residual (n=19) or non-residual OSA (n=38). The groups differed significantly in mean oxygen saturation, SpO₂ (94.3% vs. 96.2%; p=0.018 respectively), in the Apnea Hypopnea Index, (20.6/h vs. 9.1/h; p<0.03), the number of respiratory arousals with desaturation (2.2/h vs. 0.8/h; p<0.03); mean intraluminal esophageal pH (5.36 vs. 5.86; p=0.007) and the Reflux Index (9.61% vs. 4.35%; p=0.003). The groups did not differ in total sleep time, tonsil size, BMI z-score and blood metabolic indices. Logistic regression analysis showed that residual OSA was significantly predicted by two polygraphic findings: the obstructive hypopnea index (OR 1.15; 95% CI 1.02-1.28; p=0.014) and by the Reflux Index (OR 1.01; 95% CI 1.00-1.34; p=0.042).

CONCLUSIONS

1. Obstructive hypopneas, rather than obstructive apneas, persist after adenotonsillar surgery resulting in residual OSA. 2. Children with residual OSA are at higher risk of acid gastroesophageal reflux and should be evaluated for gastroesophageal reflux disease.

Authors+Show Affiliations

Department of Paediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21377218

Citation

Wasilewska, Jolanta, et al. "Obstructive Hypopnea and Gastroesophageal Reflux as Factors Associated With Residual Obstructive Sleep Apnea Syndrome." International Journal of Pediatric Otorhinolaryngology, vol. 75, no. 5, 2011, pp. 657-63.
Wasilewska J, Kaczmarski M, Debkowska K. Obstructive hypopnea and gastroesophageal reflux as factors associated with residual obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol. 2011;75(5):657-63.
Wasilewska, J., Kaczmarski, M., & Debkowska, K. (2011). Obstructive hypopnea and gastroesophageal reflux as factors associated with residual obstructive sleep apnea syndrome. International Journal of Pediatric Otorhinolaryngology, 75(5), 657-63. https://doi.org/10.1016/j.ijporl.2011.02.004
Wasilewska J, Kaczmarski M, Debkowska K. Obstructive Hypopnea and Gastroesophageal Reflux as Factors Associated With Residual Obstructive Sleep Apnea Syndrome. Int J Pediatr Otorhinolaryngol. 2011;75(5):657-63. PubMed PMID: 21377218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstructive hypopnea and gastroesophageal reflux as factors associated with residual obstructive sleep apnea syndrome. AU - Wasilewska,Jolanta, AU - Kaczmarski,Maciej, AU - Debkowska,Katarzyna, Y1 - 2011/03/04/ PY - 2010/11/22/received PY - 2011/01/30/revised PY - 2011/02/02/accepted PY - 2011/3/8/entrez PY - 2011/3/8/pubmed PY - 2014/4/29/medline SP - 657 EP - 63 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 75 IS - 5 N2 - OBJECTIVE: The mechanism of persisting obstructive sleep apnea (OSA) after adenotonsillectomy is not fully explained. The purpose of this study was to evaluate factors associated with residual OSA. The primary outcome measures were metabolic tests and polysomnographic respiratory indices in children with residual disease compared with children who were diagnosed with OSA but were untreated. Secondary outcome measures were acid gastroesophageal reflux indices recorded parallel to the sleep study. METHODS: In the one-year study consecutive series of patients with sleep disordered breathing hospitalized in a tertiary pediatric center were evaluated. Following the study protocol a sleep interview, physical examination, metabolic blood tests (serum leptin and the homeostasis model assessment index for insulin resistance, HOMA-IR) and an overnight polysomnography with pH-metry recording were performed. Children diagnosed with OSA were analyzed in two groups: I - residual OSA (after surgery), II - non-residual OSA (newly diagnosed). Logistic regression analysis was applied to obtain significant risk factors for prediction of OSA. RESULTS: Fifty-seven children (mean age ± SE, 6.9 ± 0.5 years; 66.7% boys) met the inclusion criteria and were enrolled in the study as residual (n=19) or non-residual OSA (n=38). The groups differed significantly in mean oxygen saturation, SpO₂ (94.3% vs. 96.2%; p=0.018 respectively), in the Apnea Hypopnea Index, (20.6/h vs. 9.1/h; p<0.03), the number of respiratory arousals with desaturation (2.2/h vs. 0.8/h; p<0.03); mean intraluminal esophageal pH (5.36 vs. 5.86; p=0.007) and the Reflux Index (9.61% vs. 4.35%; p=0.003). The groups did not differ in total sleep time, tonsil size, BMI z-score and blood metabolic indices. Logistic regression analysis showed that residual OSA was significantly predicted by two polygraphic findings: the obstructive hypopnea index (OR 1.15; 95% CI 1.02-1.28; p=0.014) and by the Reflux Index (OR 1.01; 95% CI 1.00-1.34; p=0.042). CONCLUSIONS: 1. Obstructive hypopneas, rather than obstructive apneas, persist after adenotonsillar surgery resulting in residual OSA. 2. Children with residual OSA are at higher risk of acid gastroesophageal reflux and should be evaluated for gastroesophageal reflux disease. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/21377218/Obstructive_hypopnea_and_gastroesophageal_reflux_as_factors_associated_with_residual_obstructive_sleep_apnea_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(11)00069-3 DB - PRIME DP - Unbound Medicine ER -