Celide Koerner

Determinants of growth in children with the obstructive sleep apnea syndrome.

Failure to thrive is a common complication of childhood obstructive sleep apnea syndrome (OSAS). To further evaluate its cause, we obtained 3-day dietary records, anthropometric measurements, polysomnography, and measurements of energy expenditure during sleep (SEE) in children with OSAS before and after tonsillectomy and adenoidectomy. Fourteen children were studied (mean age, 4 +/- 1 (SD) years). During initial polysomnography, patients had 6 +/- 3 episodes of obstructive apnea/hr, an arterial oxygen saturation nadir of 85% +/- 8%, and peak end-tidal carbon dioxide tension of 52 +/- 6 mm Hg. After surgery, OSAS resolved in all patients. The standard deviation score (z score) for weight increased from -0.30 +/- 1.47 to 0.04 +/- 1.34 (p < 0.005), despite unaltered caloric intake (91 +/- 30 vs 90 +/- 27 kcal/kg per day; not significant). The initial SEE (averaged over all sleep states) was 51 +/- 6 kcal/kg per day; postoperatively, it decreased to 46 +/- 7 kcal/kg per day (p < 0.005). Although SEE decreased during all sleep stages, the greatest decrease occurred during rapid eye movement sleep. The patients with the highest SEE on initial study had the lowest z scores (r = -0.62; p < 0.05). We conclude that SEE decreases and weight improves after resolution of OSAS. We speculate that the poor growth seen in some children with OSAS is secondary to increased caloric expenditure caused by increased work of breathing during sleep.

Evaluation of pulmonary function and polysomnography in obese children and adolescents

Obese adults have an increased prevalence of pulmonary disorders. Although childhood obesity is a common problem, few studies have evaluated the pulmonary complications of obesity in the pediatric population. We, therefore, performed pulmonary function tests (PFTs), polysomnography, and multiple sleep latency tests (MSLTs) in 22 obese children and adolescents [mean age, 10 ± 5 (SD) years; 73% female; 184 ± 36% ideal body weight], none of whom presented because of sleep or respiratory complaints. PFTs were normal in all but two subjects. Ten (46%) subjects had abnormal polysomnograms. There was a positive correlation between the degree of obesity and the apnea index (r = 0.47, P < 0.05), and an inverse correlation between the degree of obesity and the S2O2 nadir (r = −0.60, P < 0.01). The degree of sleepiness on MSLT correlated with the degree of obesity (r = −0.50, P < 0.05). We conclude that obese children and adolescents have a high prevalence of sleep‐disordered breathing, although in many cases it is mild. Obstructive sleep apnea syndrome (OSAS) improved following tonsillectomy and adenoidectomy. We recommend that pediatricians have a high index of suspicion for OSAS when evaluating obese patients, and that polysomnography be considered for these patients. Pediatr Pulmonol. 1996; 21:176–183.

Oropharyngeal dysphagia and aspiration in patients with ataxia-telangiectasia

OBJECTIVES To determine whether patients with ataxia-telangiectasia exhibit oropharyngeal dysphagia with concomitant aspiration and to examine the relationships among swallowing function, age, and nutritional status. STUDY DESIGN Seventy patients (mean age, 10.7 years; range, 1.8 to 30 years) had feeding/swallowing and nutritional evaluations. Fifty-one patients, in whom there were concerns about swallowing safety, were examined with a standardized videofluoroscopic swallow study. RESULTS Fourteen of the 51 patients (27%) with histories suggestive of dysphagia demonstrated aspiration. Of these, silent aspiration (aspiration without a cough) occurred in 10 (71%) patients. Aspirators were significantly older than non-aspirators (mean age, 16.9 vs 10.8 years; P =.002). Advancing age was the strongest factor associated with aspiration during continuous drinking (P =.01). In patients with ataxia-telangiectasia, weight and weight/height were abnormally low at all ages and most compromised in older patients. Patients who aspirated had significantly lower mean weight (P <.002) and weight/height z scores (P <.001) than did patients who did not aspirate. CONCLUSIONS Oropharyngeal dysphagia is common and appears to be progressive in patients with ataxia-telangiectasia. Older patients also have a higher incidence of poorer nutritional status. The relationship between dysphagia and nutritional status deserves further investigation.