The conventional measure of sleep fragmentation is via polysomnographic evaluation of sleep architecture. Adults with OSA have disruption in their sleep cycles and spend less time in deep sleep stages. However, there is no available evidence to suggest that this is also true for children and published results have been inconclusive.
Objective:
To determine polysomnographic characteristics of sleep architecture in children with OSA and investigate effects relative to OSA severity.
Methods:
Overnight polysomnograms (PSG) of children referred for suspected OSA were reviewed. Subjects were classified by apnea hypopnea index (AHI). PSG parameters of sleep architecture were recorded and analyzed according to OSA severity.
Results:
Two hundred and eleven children were studied (median age of 7.0 years, range 4-10 years) Stage N1 sleep was longer while stage N2 sleep and REM sleep was reduced in the OSA group when compared to those without OSA (6.10 vs 2.9, P < .001; 42.0 vs 49.7, P < .001; 14.0 vs 15.9, P = .05). The arousal index was also higher in the OSA group (12.9 vs 8.2, P < .001). There was a reduction in sleep efficiency and total sleep time and an increase in wake after sleep onset noted in the OSA group (83.90 vs 89.40, P = .003; 368.50 vs 387.25, P = .001; 40.1 ± 35.59 vs 28.66 ± 24.14, P = .007; 29.00 vs 20.50; P = .011). No significant difference was found in N3 sleep stage (33.60 vs 30.60, P = .14).
Conclusion:
We found evidence that children with OSA have a disturbance in their sleep architecture. The changes indicate greater sleep fragmentation and more time spent in lighter stages of sleep. Future research is needed and should focus on more effective methods to measure alterations in sleep architecture.
MarcusCLBrooksLJWardSD, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714-e755. doi:10.1542/peds.2012-1672
2.
BixlerEOVgontzasANLinHM, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32(6):731-736.
3.
LumengJCChervinRD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242-252. doi:10.1513/pats.200708-135MG
4.
SmithDFAminRS. OSA and cardiovascular risk in pediatrics. Chest. 2019;156(2):402-413. doi:10.1016/j.chest.2019.02.011
5.
ChervinRDDillonJEBassettiCGanoczyDAPituchKJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep. 1997;20(12):1185-1192. doi:10.1093/sleep/20.12.1185
6.
GozalDPopeDW. Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics. 2001;107(6):1394-1399. doi:10.1542/peds.107.6.1394
7.
BlundenSLushingtonKKennedyD. Cognitive and behavioural performance in children with sleep-related obstructive breathing disorders. Sleep Med Rev. 2001;5(6):447-461. doi:10.1053/smrv.2001.0165
8.
BourkeRSAndersonVYangJSC, et al. Neurobehavioral function is impaired in children with all severities of sleep disordered breathing. Sleep Med. 2011;12(3):222-229. doi:10.1016/j.sleep.2010.08.011
9.
CollardPDuryMDelgustePAubertGRodensteinDO. Movement arousals and sleep-related disordered breathing in adults. Am J Respir Crit Care Med. 1996;154(2):454-459. doi:10.1164/ajrccm.154.2.8756822
10.
WeitzmanEDKahnEPollakCP. Quantitative analysis of sleep and sleep apnea before and after tracheostomy in patients with the hypersomnia-sleep apnea syndrome. Sleep. 1980;3(3-4):407-423. doi:10.1093/sleep/3.3-4.407
11.
GohDYTGalsterPMarcusCL. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2000;162(2):682-686. doi:10.1164/ajrccm.162.2.9908058
12.
ScholleSRiegerBKemperG, et al. Characteristics of sleep-related obstructive respiratory disturbances in childhood. Sleep Breath. 2000;4(1):15-20. doi:10.1007/s11325-000-0023-z
13.
DurdikPSujanskaASuroviakovaSEvangelistiMBanovcinPVillaMP. Sleep architecture in children with common phenotype of obstructive sleep apnea. JCSM. 2018;14(1):9-14. doi:10.5664/jcsm.6868
14.
ZhuYAuCTLamHS, et al. Sleep architecture in school-aged children with primary snoring. Sleep Med. 2014;15(3):303-308. doi:10.1016/j.sleep.2013.08.801
15.
TaumanRO’BrienLMHolbrookCRGozalD. Sleep pressure score: a new index of sleep disruption in snoring children. Sleep. 2004;27(2):274-278. doi:10.1093/sleep/27.2.274
16.
WalterLMNixonGMDaveyMJO’DriscollDMTrinderJHorneRSC. Sleep disturbance in pre-school children with obstructive sleep apnoea syndrome. Sleep Med. 2011;12(9):880-886. doi:10.1016/j.sleep.2011.07.007
17.
KuczmarskiRJOgdenCLGuoSS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002;(246):1-190.
BerryRBBudhirajaRGottliebDJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012;8(5):597-619. doi:10.5664/jcsm.2172
20.
McNamaraFIssaFGSullivanCE. Arousal pattern following central and obstructive breathing abnormalities in infants and children. J Appl Physiol. 1996;81(6):2651-2657. doi:10.1152/jappl.1996.81.6.2651
21.
YangJSCNicholasCLNixonGM, et al. Determining sleep quality in children with sleep disordered breathing: EEG spectral analysis compared with conventional polysomnography. Sleep. 2010;33(9):1165-1172. doi:10.1093/sleep/33.9.1165
22.
ChervinRDFetterolfJLRuzickaDLThelenBJBurnsJW. Sleep stage dynamics differ between children with and without obstructive sleep apnea. Sleep. 2009;32(10):1325-1332.
23.
WuYZhengLWuPTangYXuZNiX. Clinical and PSG characteristics of children with mild OSA and respiratory events terminated predominantly with arousal. Can Respir J. 2021;2021:5549423. doi:10.1155/2021/5549423
24.
LüthiA. Sleep spindles: where they come from, what they do. Neuroscientist. 2014;20(3):243-256. doi:10.1177/1073858413500854
25.
TamminenJPayneJDStickgoldRWamsleyEJGaskellMG. Sleep spindle activity is associated with the integration of new memories and existing knowledge. J Neurosci. 2010;30(43):14356-14360. doi:10.1523/JNEUROSCI.3028-10.2010
26.
BrockmannPEDamianiFPincheiraE, et al. Sleep spindle activity in children with obstructive sleep apnea as a marker of neurocognitive performance: a pilot study. Eur J Paediatr Neurol. 2018;22(3):434-439. doi:10.1016/j.ejpn.2018.02.003
27.
RatnavadivelRChauNStadlerDYeoAMcEvoyRDCatchesidePG. Marked reduction in obstructive sleep apnea severity in slow wave sleep. J Clin Sleep Med. 2009;5(6):519-524.
CarberryJCJordanASWhiteDPWellmanAEckertDJ. Upper airway collapsibility (Pcrit) and pharyngeal dilator muscle activity are sleep stage dependent. Sleep. 2016;39(3):511-521. doi:10.5665/sleep.5516
30.
AckermannSRaschB. Differential effects of non-REM and REM sleep on memory consolidation?Curr Neurol Neurosci Rep. 2014;14(2):430. doi:10.1007/s11910-013-0430-8
31.
Van CauterESpiegelKTasaliELeproultR. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008;9:S23-S28. doi:10.1016/S1389-9457(08)70013-3
32.
BathoryETomopoulosS. Sleep regulation, physiology and development, sleep duration and patterns, and sleep hygiene in infants, toddlers, and preschool-age children. Curr Prob Pediatr Adolesc Health Care. 2017;47(2):29-42. doi:10.1016/j.cppeds.2016.12.001
33.
SpruytKGozalD. REM and NREM sleep-state distribution of respiratory events in habitually snoring school-aged community children. Sleep Med. 2012;13(2):178-184. doi:10.1016/j.sleep.2011.10.025
34.
VerginisNJolleyDHorneRSCDaveyMJNixonGM. Sleep state distribution of obstructive events in children: is obstructive sleep apnoea really a rapid eye movement sleep-related condition?J Sleep Res. 2009;18(4):411-414. doi:10.1111/j.1365-2869.2009.00760.x
35.
ChamnanpetSTovichienPTanphaichitrAChotinaiwattarakulW. Prevalence and risk factors for rapid eye movement-related obstructive sleep apnea in children. Front Pediatr. 2022;10:869986.. Accessed March 27, 2023. https://www.frontiersin.org/articles/10.3389/fped.2022.869986
36.
LeeSHChoiJHParkIH, et al. Measuring sleep quality after adenotonsillectomy in pediatric sleep apnea. Laryngoscope. 2012;122(9):2115-2121. doi:10.1002/lary.23356
37.
TaumanRGulliverTEKrishnaJ, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149(6):803-808. doi:10.1016/j.jpeds.2006.08.067
38.
BetavaniVMPDaveyMJNixonGMWalterLMHorneRSC. Effects of treatment of sleep disordered breathing on sleep macro- and micro-architecture in children with down syndrome. Children. 2022;9(7):984. doi:10.3390/children9070984
39.
LeeCHHsuWCChangWHLinMTKangKT. Polysomnographic findings after adenotonsillectomy for obstructive sleep apnoea in obese and non-obese children: a systematic review and meta-analysis. Clin Otolaryngol. 2016;41(5):498-510. doi:10.1111/coa.12549
40.
ShettyMPereraAKadarM, et al. The effects of sleep disordered breathing on sleep spindle activity in children and the relationship with sleep, behavior and neurocognition. Sleep Med. 2023;101:468-477. doi:10.1016/j.sleep.2022.11.028
41.
MianoSRizzoliAEvangelistiM, et al. NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. Sleep Med. 2009;10(4):471-478. doi:10.1016/j.sleep.2008.04.003
42.
ChristianszJALappinCRWeichardAJ, et al. Slow wave activity and executive dysfunction in children with sleep disordered breathing. Sleep Breath. 2018;22(2):517-525. doi:10.1007/s11325-017-1570-x
43.
O’BrienLMGozalD. Potential usefulness of noninvasive autonomic monitoring in recognition of arousals in normal healthy children. J Clin Sleep Med. 2007;3(1):41-47.
44.
KatzESLutzJBlackCMarcusCL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res. 2003;53(4):580-588. doi:10.1203/01.PDR.0000057206.14698.47
45.
TaumanRO’BrienLMMastBTHolbrookCRGozalD. Peripheral arterial tonometry events and electroencephalographic arousals in children. Sleep. 2004;27(3):502-506. doi:10.1093/sleep/27.3.502
