The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia.
The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia.
Sleep Med. 2021 Jan;77:161-169. doi: 10.1016/j.sleep.2020.12.005. Epub 2020 Dec 8.
To investigate the role of ventilatory control instability (i.e. loop gain) in children with Down syndrome and sleep disordered breathing.
Children (3-19 years) with Down syndrome and sleep disordered breathing (n = 14) were compared with typically developing children (n = 14) matched for age, sex and sleep disordered breathing severity. All children underwent overnight polysomnography. Spontaneous sighs were identified and a 180s analysis window (60s pre-sigh to 120s post-sigh) containing flow measurements and oxygen saturation were created. Loop gain, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern. Results; Loop gain was significantly higher in children with Down syndrome compared to matched typically developing children (median loop gain [interquartile range]: 0.36 [0.33, 0.55] vs 0.32 [0.24, 0.38]; P = 0.0395). While children with Down syndrome also had significantly lower average oxygen saturation associated within each analysis window compared to typically developing children (mean ± standard deviation: 96.9 ± 1.3% vs 98.0 ± 1.0%; P = 0.0155), loop gain was not related to polysomnographic measures of hypoxia.
Higher loop gain in children with Down syndrome and sleep disordered breathing indicates that these children have more unstable ventilatory control, compared to age, sex and sleep disordered breathing severity matched typically developing children. This may be due to an inherent impairment in ventilatory control in children with Down syndrome contributing to their increased risk of sleep disordered breathing which may inform alternative treatment options for this population.
研究通气控制不稳定（即环路增益）在唐氏综合征合并睡眠呼吸障碍患儿中的作用。
将 14 例唐氏综合征合并睡眠呼吸障碍患儿（n=14）与年龄、性别和睡眠呼吸障碍严重程度相匹配的 14 例典型发育儿童进行比较。所有儿童均行夜间多导睡眠图检查。识别自发性叹息，并创建一个包含流量测量和氧饱和度的 180s 分析窗口（60s 前叹息至 120s 后叹息）。环路增益是衡量控制通气的负反馈环路灵敏度的指标，通过将通气控制的数学模型拟合到后叹息通气模式来估计。结果：唐氏综合征患儿的环路增益明显高于匹配的典型发育儿童（中位数[四分位数范围]：0.36 [0.33，0.55]比 0.32 [0.24，0.38]；P=0.0395）。虽然唐氏综合征患儿在每个分析窗口内的平均氧饱和度也明显低于典型发育儿童（平均值±标准差：96.9±1.3%比 98.0±1.0%；P=0.0155），但环路增益与多导睡眠图缺氧测量值无关。
唐氏综合征合并睡眠呼吸障碍患儿的环路增益较高，表明与年龄、性别和睡眠呼吸障碍严重程度相匹配的典型发育儿童相比，这些患儿的通气控制更不稳定。这可能是由于唐氏综合征患儿的通气控制固有受损，导致其睡眠呼吸障碍风险增加，这可能为该人群提供替代治疗选择。
