Shalini Paruthi1, Carol L Rosen2, Rui Wang3,4, Jia Weng3, Carole L Marcus5, Ronald D Chervin6, Jeffrey J Stanley7, Eliot S Katz8, Raouf Amin9, Susan Redline10. 1. Department of Pediatrics, Saint Louis University, St. Louis, MO. 2. Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH. 3. Division of Sleep Medicine, Brigham and Women's Hospital; University of Pennsylvania, Philadelphia, PA. 4. Department of Biostatistics, Harvard School of Public Health; University of Pennsylvania, Philadelphia, PA. 5. Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA. 6. Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI. 7. Departments of Otolaryngology and Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI. 8. Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA. 9. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 10. Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Abstract
STUDY OBJECTIVES: To identify the role of end-tidal carbon dioxide (EtCO2) monitoring during polysomnography in evaluation of children with obstructive sleep apnea syndrome (OSAS), including the correlation of EtCO2 with other measures of OSAS and prediction of changes in cognition and behavior after adenotonsillectomy. DESIGN: Analysis of screening and endpoint data from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study comparing early adenotonsillectomy (eAT) to watchful waiting/supportive care (WWSC) in children with OSAS. SETTING: Multisite clinical referral settings. PARTICIPANTS: Children, ages 5.0 to 9.9 y with suspected sleep apnea. INTERVENTIONS:eAT or WWSC. MEASUREMENTS AND RESULTS:Quality EtCO2 waveforms were present for ≥ 75% of total sleep time (TST) in 876 of 960 (91.3%) screening polysomnograms. Among the 322 children who were randomized, 55 (17%) met pediatric criteria for hypoventilation. The mean TST with EtCO2 > 50 mmHg was modestly correlated with apnea-hypopnea index (AHI) (r = 0.33; P < 0.0001) and with oxygen saturation ≤ 92% (r = 0.26; P < 0.0001). After adjusting for AHI, obesity, and other factors, EtCO2 > 50 mmHg was higher in African American children than others. The TST with EtCO2 > 50 mmHg decreased significantly more after eAT than WWSC. In adjusted analyses, baseline TST with EtCO2 > 50 mmHg did not predict postoperative changes in cognitive and behavioral measurements. CONCLUSIONS: Among children with suspected obstructive sleep apnea syndrome, overnight end-tidal carbon dioxide (EtCO2) levels are weakly to modestly correlated with other polysomnographic indices and therefore provide independent information on hypoventilation. EtCO2 levels improve with adenotonsillectomy but are not as responsive as AHI and do not provide independent prediction of cognitive or behavioral response to surgery. CLINICAL TRIAL REGISTRATION: Childhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTrials.gov Identifier #NCT00560859.
RCT Entities:
STUDY OBJECTIVES: To identify the role of end-tidal carbon dioxide (EtCO2) monitoring during polysomnography in evaluation of children with obstructive sleep apnea syndrome (OSAS), including the correlation of EtCO2 with other measures of OSAS and prediction of changes in cognition and behavior after adenotonsillectomy. DESIGN: Analysis of screening and endpoint data from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study comparing early adenotonsillectomy (eAT) to watchful waiting/supportive care (WWSC) in children with OSAS. SETTING: Multisite clinical referral settings. PARTICIPANTS: Children, ages 5.0 to 9.9 y with suspected sleep apnea. INTERVENTIONS: eAT or WWSC. MEASUREMENTS AND RESULTS: Quality EtCO2 waveforms were present for ≥ 75% of total sleep time (TST) in 876 of 960 (91.3%) screening polysomnograms. Among the 322 children who were randomized, 55 (17%) met pediatric criteria for hypoventilation. The mean TST with EtCO2 > 50 mmHg was modestly correlated with apnea-hypopnea index (AHI) (r = 0.33; P < 0.0001) and with oxygen saturation ≤ 92% (r = 0.26; P < 0.0001). After adjusting for AHI, obesity, and other factors, EtCO2 > 50 mmHg was higher in African American children than others. The TST with EtCO2 > 50 mmHg decreased significantly more after eAT than WWSC. In adjusted analyses, baseline TST with EtCO2 > 50 mmHg did not predict postoperative changes in cognitive and behavioral measurements. CONCLUSIONS: Among children with suspected obstructive sleep apnea syndrome, overnight end-tidal carbon dioxide (EtCO2) levels are weakly to modestly correlated with other polysomnographic indices and therefore provide independent information on hypoventilation. EtCO2 levels improve with adenotonsillectomy but are not as responsive as AHI and do not provide independent prediction of cognitive or behavioral response to surgery. CLINICAL TRIAL REGISTRATION: Childhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTrials.gov Identifier #NCT00560859.
Authors: Susan Redline; Raouf Amin; Dean Beebe; Ronald D Chervin; Susan L Garetz; Bruno Giordani; Carole L Marcus; Renee H Moore; Carol L Rosen; Raanan Arens; David Gozal; Eliot S Katz; Ronald B Mitchell; Hiren Muzumdar; H G Taylor; Nina Thomas; Susan Ellenberg Journal: Sleep Date: 2011-11-01 Impact factor: 5.849
Authors: Carole L Marcus; Reneé H Moore; Carol L Rosen; Bruno Giordani; Susan L Garetz; H Gerry Taylor; Ron B Mitchell; Raouf Amin; Eliot S Katz; Raanan Arens; Shalini Paruthi; Hiren Muzumdar; David Gozal; Nina Hattiangadi Thomas; Janice Ware; Dean Beebe; Karen Snyder; Lisa Elden; Robert C Sprecher; Paul Willging; Dwight Jones; John P Bent; Timothy Hoban; Ronald D Chervin; Susan S Ellenberg; Susan Redline Journal: N Engl J Med Date: 2013-05-21 Impact factor: 91.245
Authors: Anchana Thongyam; Carole L Marcus; Justin L Lockman; Mary Anne Cornaglia; Aviva Caroff; Paul R Gallagher; Justine Shults; Joel T Traylor; Mark D Rizzi; Lisa Elden Journal: Otolaryngol Head Neck Surg Date: 2014-10-09 Impact factor: 3.497
Authors: Sivakumar Chinnadurai; Atia K Jordan; Nila A Sathe; Christopher Fonnesbeck; Melissa L McPheeters; David O Francis Journal: Pediatrics Date: 2017-01-17 Impact factor: 7.124