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Current Sleep Medicine Reports
Erschienen in:

01.06.2019 | Sleep and Sleep Apnea at the Extremes (D Gozal, Section Editor)

The Impact of Altitude on Sleep-Related Breathing Disorders in Infants and Children

verfasst von: Benjamin H. Hughes

Erschienen in: Current Sleep Medicine Reports | Ausgabe 2/2019

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Abstract

Purpose of Review

Millions of children worldwide reside at or sojourn to high-altitude locales and are therefore subjected to hypobaric hypoxic conditions. Such exposure is known to impact respiratory physiology including determinants of sleep-related breathing disorders (SRBDs). This review aims to summarize emerging data on the effects of high altitude on SRBDs in infants and children, to highlight possible pathophysiologic consequences of these effects, and to outline specific topics requiring further investigation.

Recent Findings

Recent findings demonstrate that intermediate and high-altitude conditions increase central and obstructive respiratory event frequency both in healthy infants and children and in those with symptoms of sleep-disordered breathing. These changes are most pronounced in infancy and in symptomatic children. Exposure to high altitude degrades cognitive performance and increases cardiovascular morbidity. Genetic factors which vary between specific populations modulate the high-altitude response and therefore limit the generalizability of these findings.

Summary

High-altitude exposure worsens SRBD prevalence and severity when implementing scoring rules and diagnostic criteria developed at low altitude. Whether these changes in polysomnographic parameters contribute to the adverse cardiovascular and neurocognitive outcomes observed in high-altitude residents is of critical importance and requires further study.
Literatur
1.
American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014.
2.
Hunter SJ, Gozal D, Smith DL, Philby MF, Kaylegian J, Kheirandish-Gozal L. Effect of sleep-disordered breathing severity on cognitive performance measures in a large community cohort of young school-aged children. Am J Respir Crit Care Med. 2016;194(6):739–47.CrossRefPubMedPubMedCentral
3.
Gottlieb DJ, Chase C, Vezina RM, Heeren TC, Corwin MJ, Auerbach SH, et al. Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children. J Pediatr. 2004;145(4):458–64.CrossRefPubMed
4.
Smith DL, Gozal D, Hunter SJ, Philby MF, Kaylegian J, Kheirandish-Gozal L. Impact of sleep disordered breathing on behaviour among elementary school-aged children: a cross-sectional analysis of a large community-based sample. Eur Respir J. 2016;48(6):1631–9.CrossRefPubMed
5.
Beebe DW, Ris MD, Kramer ME, Long E, Amin R. The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep. 2010;33(11):1447–56.CrossRefPubMedPubMedCentral
6.
O’Driscoll DM, Horne RS, Davey MJ, Hope SA, Anderson V, Trinder J, et al. Increased sympathetic activity in children with obstructive sleep apnea: cardiovascular implications. Sleep Med. 2011;12(5):483–8.CrossRefPubMed
7.
Goldbart AD, Levitas A, Greenberg-Dotan S, Ben Shimol S, Broides A, Puterman M, et al. B-type natriuretic peptide and cardiovascular function in young children with obstructive sleep apnea. Chest. 2010;138(3):528–35.CrossRefPubMed
8.
Zhang XM, Shi J, Meng GZ, Chen HS, Zhang LN, Wang ZY, et al. The effect of obstructive sleep apnea syndrome on growth and development in nonobese children: a parallel study of twins. J Pediatr. 2015;166(3):646–50.CrossRefPubMed
9.
Biggs SN, Vlahandonis A, Anderson V, Bourke R, Nixon GM, Davey MJ, et al. Long-term changes in neurocognition and behavior following treatment of sleep disordered breathing in school-aged children. Sleep. 2014;37(1):77–84.CrossRefPubMedPubMedCentral
10.
Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics. 2002;109(4):e55.CrossRefPubMed
11.
Bass JL, Corwin M, Gozal D, Moore C, Nishida H, Parker S, et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics. 2004;114(3):805–16.CrossRefPubMed
12.
13.
West JB, Luks AM. West’s respiratory physiology: the essentials. 10th ed. Philadelphia: Wolters Kluwer; 2016.
14.
Niermeyer S, Yang P, Shanmina D, Zhuang J, Moore LG. Arterial oxygen saturation in Tibetan and Han infants born in Lhasa, Tibet. N Engl J Med. 1995;333(19):1248–52.CrossRefPubMed
15.
Niermeyer S, Shaffer EM, Thilo E, Corbin C, Moore LG. Arterial oxygenation and pulmonary arterial pressure in healthy neonates and infants at high altitude. J Pediatr. 1993;123(5):767–72.CrossRefPubMed
16.
Thilo EH, Park-Moore B, Berman ER, Carson BS. Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child. 1991;145(10):1137–40.CrossRefPubMed
17.
• Hill CM, Baya A, Gavlak J, Carroll A, Heathcote K, Dimitriou D, et al. Adaptation to life in the high Andes: nocturnal oxyhemoglobin saturation in early development. Sleep. 2016;39(5):1001–8. This study of healthy Bolivian children dwelling at high altitude demonstrates hypoxemia and respiratory instability that is most pronounced in infants and improves, but does normalize, through childhood and adolescence.
18.
Edwards BA, White DP. Control of the pharyngeal musculature during wakefulness and sleep: implications in normal controls and sleep apnea. Head Neck. 2011;33(Suppl 1):S37–45.CrossRefPubMedPubMedCentral
19.
Edwards BA, Sands SA, Owens RL, White DP, Genta PR, Butler JP, et al. Effects of hyperoxia and hypoxia on the physiological traits responsible for obstructive sleep apnoea. J Physiol. 2014;592(20):4523–35.CrossRefPubMedPubMedCentral
20.
Deacon NL, Catcheside PG. The role of high loop gain induced by intermittent hypoxia in the pathophysiology of obstructive sleep apnoea. Sleep Med Rev. 2015;22:3–14.CrossRefPubMed
21.
Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. The AASM Manual for the scoring of sleep and associated events: rules, terminology, and technical specifications, version 2.2. www.​aasmnet.​org. American Academy of Sleep Medicine: Darien; 2015.
22.
Montgomery-Downs HE, O’Brien LM, Gulliver TE, Gozal D. Polysomnographic characteristics in normal preschool and early school-aged children. Pediatrics. 2006;117:741–53.CrossRefPubMed
23.
Scholle S, Wiater A, Scholle HC. Normative values of polysomnographic parameters in childhood and adolescence: cardiorespiratory parameters. Sleep Med. 2011;12:988–96.CrossRefPubMed
24.
Daftary AS, Jalou HE, Shively L, Slaven JE, Davis SD. Polysomnography reference values in healthy newborns. J Clin Sleep Med. 2019;15(3):437-443.
25.
•• Duenas-Meza E, Bazurto-Zapata MA, Gozal D, González-García M, Durán-Cantolla J, Torres-Duque CA. Overnight polysomnographic characteristics and oxygen saturation of healthy infants, 1 to 18 months of age, born and residing at high altitude (2,640 meters). Chest. 2015;148(1):120–7. This normative study of healthy Colombian infants residing at high altitude examines the natural history of breathing patterns during sleep. The authors report very frequent central and obstructive respiratory events in early infancy that substantially lessen by 12–18 months of age.
26.
Ucrós S, Granados C, Parejo K, Guillén F, Ortega F, Restrepo S, et al. Oxygen saturation, periodic breathing and apnea during sleep in infants 1 to 4 month old living at 2,560 meters above sea level. Arch Argent Pediatr. 2015;113(4):341–4.PubMed
27.
Ucrós S, Granados C, Parejo K, Ortega F, Guillén F, Restrepo S, et al. Oxygen saturation, periodic breathing, and apnea in infants aged 1-4 months old living at 3200 meters above sea. Arch Argent Pediatr. 2017;115(1):54–7.PubMed
28.
•• Hill CM, Carroll A, Dimitriou D, Gavlak J, Heathcote K, L’Esperance V, et al. Polysomnography in Bolivian children native to high altitude compared to children native to low altitude. Sleep. 2016;39(12):2149–55. This is the only study to date comparing respiratory parameters during sleep in healthy children residing at high altitude with age-matched controls dwelling at low altitude. The authors report a slight increase in the apnea-hypopnea index, driven primarily by obstructive hypopneas, in the high-altitude group.
29.
Burg CJ, Montgomery-Downs HE, Mettler P, Gozal D, Halbower AC. Respiratory and polysomnographic value in 3- to 5-year-old normal children at higher altitude. Sleep. 2013;36(11):1707–14.CrossRefPubMedPubMedCentral
30.
Accinelli RA, Llanos O, López LM, Matayoshi S, Oros YP, Kheirandish-Gozal L, et al. Caregiver perception of sleep-disordered breathing-associated symptoms in children of rural Andean communities above 4000 masl with chronic exposure to biomass fuel. Sleep Med. 2015;16(6):723–8.CrossRefPubMed
31.
Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep. 1997;20(12):1185–92.CrossRefPubMed
32.
Schwartz NG, Rattner A, Schwartz AR, Mokhlesi B, Gilman RH, Bernabe-Ortiz A, et al. Sleep-disordered breathing in four resource-limited settings in Peru: prevalence, risk factors, and association with chronic diseases. Sleep. 2015;38(9):1451–9.CrossRefPubMedPubMedCentral
33.
•• Hughes BH, Brinton JT, Ingram DG, Halbower AC. The impact of altitude on sleep-disordered breathing in children dwelling at high altitude: a crossover study. Sleep. 2017;40(9). https://​doi.​org/​10.​1093/​sleep/​zsx120. This study demonstrates that, in children with symptoms of sleep-disordered breathing who reside at high altitude, polysomnography at a lower altitude underestimates obstructive sleep apnea, central sleep apnea, and hypoxemia compared to polysomnography conducted at the higher home altitude. This finding is particularly relevant for children who reside at a higher altitude than the nearest pediatric sleep laboratory.
34.
• Rimoldi SF, Rexhaj E, Duplain H, Urben S, Billieux J, Allemann Y, et al. Acute and chronic altitude-induced cognitive dysfunction in children and adolescents. J Pediatr. 2016;1369:238–43. This study demonstrates that acute ascent to high altitude in non-acclimatized children causes neurocognitive impairment and, notably, that chronic high-altitude exposure in children permanently living at high altitude is associated with even further degradation of cognitive function.
35.
Hill CM, Dimitriou D, Baya A, Webster R, Gavlak-Dingle J, Lesperance V, et al. Cognitive performance in high-altitude Andean residents compared with low-altitude populations: from childhood to older age. Neuropsychology. 2014;28(5):752–60.CrossRefPubMed
36.
Sime F, Banchero N, Penaloza D, Gamboa R, Cruz J, Marticorena E. Pulmonary hypertension in children born and living at high altitudes. Am J Cardiol. 1963;11:143–9.CrossRefPubMed
37.
Huicho L, Niermeyer S. Cardiopulmonary pathology among children resident at high altitude in Tintaya, Peru: a cross-sectional study. High Alt Med Biol. 2006;7(2):168–79.CrossRefPubMed
38.
Qi H, Xu S, Ma R, Jiang L, Li S, Mai S, et al. Comparison of echocardiographic parameters in healthy Chinese children born and living at high altitude or sea level. Zhonghua Xin Xue Guan Bing Za Zhi. 2015;43(9):774–81.PubMed
39.
• Latshang TD, Furian M, Aeschbacher SS, Ulrich S, Osmonov B, Mirrakhimov EM, et al. Association between sleep apnoea and pulmonary hypertension in Kyrgyz highlanders. Eur Respir J. 2017;49(2). This study demonstrates that high-altitude residents with pulmonary arterial hypertension (PAH) have a significantly higher apnea-hypopnea index than high-altitude residents without PAH. Although this study enrolled adult subjects, its principal finding offers a key link between sleep-related breathing disorders and high-altitude morbidities.
40.
41.
Gavlak JC, Stocks J, Laverty A, Fettes E, Bucks R, Sonnappa S, et al. The young Everest study: a preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children. Arch Dis Child. 2013;98(5):356–62.CrossRefPubMedPubMedCentral
42.
Li C, Li X, Liu J, Fan X, You G, Zhao L, et al. Investigation of the differences between the Tibetan and Han populations in the hemoglobin-oxygen affinity of red blood cells and in the adaptation to high-altitude environments. Hematology. 2018;23(5):309–13.CrossRefPubMed
43.
Beall CM, Strohl KP, Blangero J, Williams-Blangero S, Almasy LA, Decker MJ, et al. Ventilation and hypoxic ventilatory response of Tibetan and Aymara high altitude natives. Am J Phys Anthropol. 1997;104(4):427–47.CrossRefPubMed
44.
Lorenzo FR, Huff C, Myllym äki M, Olenchock B, Swierczek S, Tashi T, et al. A genetic mechanism for Tibetan high-altitude adaptation. Nat Genet. 2014;46:951–6.CrossRefPubMedPubMedCentral
45.
Metadaten
Titel
The Impact of Altitude on Sleep-Related Breathing Disorders in Infants and Children
verfasst von
Benjamin H. Hughes
Publikationsdatum
01.06.2019
Verlag
Springer International Publishing
Erschienen in
Current Sleep Medicine Reports / Ausgabe 2/2019
Elektronische ISSN: 2198-6401
DOI
https://doi.org/10.1007/s40675-019-00137-y

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