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J Appl Physiol 89: 2453-2462, 2000;
8750-7587/00 $5.00
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Vol. 89, Issue 6, 2453-2462, December 2000

Site and mechanics of spontaneous, sleep-associated obstructive apnea in infants

Garrick W. Don1, Turkka Kirjavainen2, Catherine Broome3, Chris Seton1, and Karen A. Waters1,4

1 David Read Sleep Unit, Department of Respiratory Medicine, The Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia; 2 Department of Pediatrics, University of Helsinki, Helsinki 00029 HYKS, and University of Turku, Turku, Finland; 3 Department of Medical Imaging, The Royal Alexandra Hospital for Children, Westmead, New South Wales 2124; and 4 Departments of Medicine, and Paediatrics and Child Health, University of Sydney, New South Wales 2006, Australia

To examine the mechanics of infantile obstructive sleep apnea (OSA), airway pressures were measured using a triple-lumen catheter in 19 infants (age 1-36 wk), with concurrent overnight polysomnography. Catheter placement was guided by correlations between measurements of magnetic resonance images and body weight of 70 infants. The level of spontaneous obstruction was palatal in 52% and retroglossal in 48% of all events. Palatal obstruction predominated in infants treated for OSA (80% of events), compared with 38.6% from infants with infrequent events (P = 0.02). During obstructive events, successive respiratory efforts increased in amplitude (mean intrathoracic pressures -11.4, -15.0, and -20.4 cmH2O; ANOVA, P < 0.05), with arousal after only 29% of the obstructive and mixed apneas. The soft palate is commonly involved in the upper airway obstruction of infants suffering OSA. Postterm, infant responses to upper airway obstruction are intermediate between those of preterm infants and older children, with infrequent termination by arousal but no persisting "upper airway resistance" and respiratory efforts exceeding baseline during the event.

airway obstruction; soft palate; arousal


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