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J Appl Physiol 87: 1448-1454, 1999;
8750-7587/99 $5.00
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Vol. 87, Issue 4, 1448-1454, October 1999

INVITED REVIEW
Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea

Carole L. Marcus, Gustavo A. Moreira, Owen Bamford, and Janita Lutz

The Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland 21287-2533

The response to inspiratory resistance loading (IRL) of the upper airway during sleep in children is not known. We, therefore, evaluated the arousal responses to IRL during sleep in children with the obstructive sleep apnea syndrome (OSAS) compared with controls. Children with OSAS aroused at a higher load than did controls (23 ± 8 vs. 15 ± 7 cmH2O · l-1 · s; P < 0.05). Patients with OSAS had higher arousal thresholds during rapid eye movement (REM) vs. non-REM sleep (P < 0.001), whereas normal subjects had lower arousal thresholds during REM (P < 0.005). Ventilatory responses to IRL were evaluated in the controls. There was a marked decrease in tidal volume both immediately (56 ± 17% of baseline at an IRL of 15 cmH2O · l-1 · min; P < 0.001) and after 3 min of IRL (67 ± 23%, P < 0.005). The duty cycle increased. We conclude that children with OSAS have impaired arousal responses to IRL. Despite compensatory changes in respiratory timing, normal children have a decrease in minute ventilation in response to IRL during sleep. However, arousal occurs before gas-exchange abnormalities.

arousal; ventilatory drive; sleep-disordered breathing


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