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Permalink Reply by RockRpsgt on April 30, 2011 at 11:01

Good question and one of much debate in the sleep world. A post sigh apnea would be a breathing event(OSA,CSA, or hypop) following an arousal. These are very common in people of all ages. They typically are central events that follow arousals. These arousals can be caused by sighing, yahning, swallowing, talking, teethgrinding, body movement or an actual breathing event such as apnea. These events are also very common at sleep onset and in transition from one sleep stage to another. For the most part I have been taught to ignore these events if they do not have an effect on the pathology of the sleep in question. Meaning that if an event causes an event which causes an event we would mark it as a pathological interruption or a sleep related breathing event. For the most part I believe these events to be benign in adults. Even if we were to mark them they typically do not happen enough to make a difference in the AHI.

 

The below study is on the same phenomenon in children. This study in particular concentrates on events caused by movement. Some researchers believe these post arousal events to be more serious in young children. Personally I believe that the arousal is more the problem than the post event. That however is for another discussion and will bring about a much larger debate. HMmm which is worse the desat or the arousal? We might just have to do that one soon. 

 

http://www.google.com/search?q=post+sigh+apnea&rls=com.microsof...

 

J Sleep Res. 2009 Dec;18(4):415-21. Epub 2009 Aug 31.

Central apnoeas have significant effects on blood pressure and heart rate in children.

O'Driscoll DM, Foster AM, Ng ML, Yang JS, Bashir F, Wong S, Nixon GM, Davey MJ, Anderson V, Walker AM, Trinder J, Horne RS.

Source

Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia. denise.odriscoll@med.monash.edu.au

Abstract

Brief central apnoeas (CAs) during sleep are common in children and are not usually considered clinically significant unless associated with oxygen desaturation. CAs can occur spontaneously or following a movement or sigh. The aim of this study was to investigate acute cardiovascular changes associated with CAs in children. Beat-by-beat mean arterial pressure (MAP) and heart rate (HR) were analysed across CAs, and spontaneous and movement-induced events were compared using two-way analysis of variance with post hoc analyses. Fifty-three children (28 male/25 female) aged 7-12 years referred for investigation of sleep-disordered breathing (SDB) and 21 age-matched healthy controls (8 male/13 female) were studied. Children underwent routine clinical polysomnography with continuous blood pressure (BP) recordings. Movement-induced, but not spontaneous, CAs were more frequent in children with mild or moderate/severe obstructive sleep apnoea (OSA) compared with healthy controls (P < 0.05 for both). Movement-induced CAs were associated with significantly larger MAP and HR changes across the event compared with spontaneous CAs. The percentage changes in MAP and HR between late-event and post-event were significantly greater for movement-induced compared with spontaneous CAs (MAP 20.6 +/- 2.3 versus 12.2 +/- 1.8%, P < 0.01; HR 28.2 +/- 2.6 versus 14.7 +/- 2.5%, P < 0.001). This study demonstrates that movement-induced CAs are more common in children with OSA, and are associated with significantly greater changes in HR and BP compared with spontaneous CAs. These data suggest that movement-induced CAs should be considered when assessing the cardiovascular impact of SDB.

PMID:

19732317

[PubMed - indexed for MEDLINE]

Free Article

Publication Types, MeSH Terms 

Publication Types

• Research Support, Non-U.S. Gov't

MeSH Terms

• Arousal/physiology
• Blood Pressure/physiology*
• Child
• Female
• Heart Rate/physiology*
• Humans
• Male
• Motor Activity/physiology
• Polysomnography
• Reference Values
• Sleep Apnea, Central/diagnosis
• Sleep Apnea, Central/physiopathology*

LinkOut - more resources 

Full Text Sources

• Blackwell Publishing
• EBSCO
• Ingenta plc
• OhioLINK Electronic Journal Center
• Ovid Technologies, Inc.
• Swets Information Services

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Permalink Reply by carol murphy on May 1, 2011 at 21:21

Hi Rock

 

Very Interesting thank you the reason for my question is we notice my 3 year old has central events frequently when moved or if he moves or when he takes a triple in breath ( a 3 stage inhale) he then takes a normal breath then pauses .  He also has a 2 second inhalation followed by a 11 second exhalation that sounds like a balloon loosing air or a soft moan.

 

So I now know that movement and central events are a normal thing in general will mention it to his sleep tech who does his psg and get there take on it also :)

 

Thank you

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Permalink Reply by RockRpsgt on May 2, 2011 at 1:55

I would not worry about these events as far as movement goes. Movement events are natural in my opinion. If they are happening when you move them then you are the source. If these events do not cause an arousal or an additional event I would not be to concerned. It's all about maintaining the cycles or pathology of the sleep.

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Permalink Reply by carol murphy on May 5, 2011 at 23:25

You know Rock I have learnt more from you in the short time I have been a member on here than I have through my sons consultants for the last 3 years ...... I so hope you do come work in the Uk paediatric field as you would be an asset to all those kiddies over here thanks so much for taking the time to give me information :)

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Permalink Reply by RockRpsgt on May 6, 2011 at 0:22

Thanks Carol, I truly appreciate your kind words. Sleepguide has been an amazing asset for my own knowledge base as well. These 2 sites have become an important aspect of my life and extended family.

 

I have 18 months till I hit 5 years in the sleep industry. I hope to be doing 100% pediatric studies by that time. My own daughter was my first true sleep patient. I was able to correct her sleep from A-Z. That experience was the catalyst for my passion.

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Permalink Reply by carol murphy on May 9, 2011 at 0:05

Fantastic that you have helped your little princess :) and so thankful you are dedicated to paediatrics

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