European Journal of Pediatrics

, Volume 148, Issue 4, pp 353–359 | Cite as

Detection of sleep associated dysfunctional pharyngeal obstruction in infants

  • D. P. Southall
  • C. B. Croft
  • V. A. Stebbens
  • H. Ibrahim
  • A. Gurney
  • R. Buchdahl
  • J. O. Warner


Six infants were referred with symptoms and clinical signs suggesting airway obstruction during sleep. In each case, overnight recordings of arterial oxygen saturation, respiratory movements and end tidal expired carbon dioxide (ETCO2) showed the presence of abnormal episodes of hypoxaemia related to partial or complete airway obstruction and associated with a specific pattern of the inspiratory movement waveforms. These events and patterns were not found on recordings from 20 age-matched healthy infants and young children. ETCO2 levels were also abnormally elevated in all six patients when asleep. Fiber-optic upper airway endoscopy excluded structural abnormalities, including significant tonsillar or adenoidal enlargement, but showed an intermittent dysfunctional inspiratory obstruction in the pharynx. Continuous positive airways pressure and tracheostomy were effective in treating this obstruction.

Key words

Sleep apnoea syndromes Failure to thrive 



continuous positive airways pressure


end tidal carbon dioxide


arterial oxygen saturation


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brouillette RT, Thach BT (1979) A neuromuscular mechanism maintaining extrathoracic airway patency. J Appl Physiol 46:772–779Google Scholar
  2. 2.
    Brouillette RT, Fernbach SK, Hunt CE (1982) Obstructive sleep apnea in infants and children. J Pediatr 100:31–40Google Scholar
  3. 3.
    Bryan AC, Wohl MEB: Respiratory mechanics in children. In: Cherniak NS, Widdicombe JG (eds) Handbook of physiology, vol 3. The respiratory system, pp 180–183Google Scholar
  4. 4.
    Carse EA, Wilkinson AR, Whyte PL, Henderson Smart DJ, Johnson P (1981) Oxygen and carbon dioxide tensions, breathing and heart rate in normal infants during the first six months of life. J Dev Physiol 3:85–100Google Scholar
  5. 5.
    Findley LJ, Wilhoit SC, Suratt PM (1985) Apnea duration and hypoxaemia during REM sleep in patients with obstructive sleep apnea. Chest 87:432–436Google Scholar
  6. 6.
    Furlonger BJ (1982) High kV filtered beam technique for demonstrating bronchial situs. Radiography 48:197–199Google Scholar
  7. 7.
    Guilleminault C, Hill MW, Blair Simmons F, Dement WC (1978) Obstructive sleep apnea: electromyographic and fiber optic studies. Exp Neurol 62:48–67Google Scholar
  8. 8.
    Guilleminault C, Blair Simmons F, Motta J, Cummiskey J, Rosekind M, Schroeder JS, Dement WC (1981) Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience. Arch Intern Med 141:985–988Google Scholar
  9. 9.
    Hoffstein V, Zamel N, Phillipson EA (1984) Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis 130:175–178Google Scholar
  10. 10.
    Jeffries B, Brouillette RT, Hunt CE (1984) Electromyographic study of some accessory muscles of respiration in children with obstructive sleep apnea. Am Rev Respir Dis 129:696–702Google Scholar
  11. 11.
    Martin RJ, Pennock BE, Orr WC, Sanders MH, Rogers RM (1980) Respiratory mechanics and timing during sleep in occlusive sleep apnea. J Appl Physiol 48:432–437Google Scholar
  12. 12.
    Onal E, Lopata M, O'Connor T (1982) Pathogenesis of apneas in hypersomnia — sleep apnea syndrome. Am Rev Respir Dis 125: 167–174Google Scholar
  13. 13.
    Onal E, Lopata M (1982) Periodic breathing and the pathogenesis of occlusive sleep apneas. Am Rev Respir Dis 126:676–680Google Scholar
  14. 14.
    Onal E, Leech JA, Lopata M (1985) Relationship between pulmonary function and sleep-induced respiratory abnormalities. Chest 87:437–441Google Scholar
  15. 14a.
    Pack RJ, Widdicombe JG (1984) Amine-containing cells of the lung. Eur J Respir Dis 65:559–578Google Scholar
  16. 15.
    Prechtl HFR (1974) The behavioural states of the newborn infant (a review). Brain Res 76:185–212Google Scholar
  17. 16.
    Remmers JE, Groot WJ de, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44:931–938Google Scholar
  18. 17.
    Richards JM, Alexander JR, Shinebourne EA, Swiet M de, Wilson AJ, Southall DP (1984) Sequential 22 hour profiles of breathing pattern and heart rate in 110 full-term infants during their first 6 months of life. Pediatrics 74:763–777Google Scholar
  19. 18.
    Sanders MH, Rogers RM, Pennock BE (1985) Prolonged expiratory phase in sleep apnea. A unifying hypothesis. Am Rev Respir Dis 131:401–408Google Scholar
  20. 19.
    Southall DP, Talbert DG (1987) Sudden alveolar atelectasis apnoea braking syndrome. In: Hollinger MA (ed) Current topics in pulmonary pharmacology and toxicology. Elsevier, New York, pp 210–281Google Scholar
  21. 20.
    Southall DP, Bignall S, Stebbens VA, Alexander JR, Rivers RPA, Lissauer T (1987) Pulse oximeter and transcutaneous arterial oxygen measurements in neonatal and paediatric intensive care. Arch Dis Child 62:882–888Google Scholar
  22. 21.
    Sullivan CE, Issa FG, Bethon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet I:862–965Google Scholar
  23. 22.
    Wilson AJ (1985) A tape recorder multiplexer for 16 channels. Electronic Eng 57:40–47Google Scholar
  24. 23.
    Wilson SL, Thach BT, Brouillette RT, Abu-Osba YK (1980) Upper airway patency in the human infant: influence of airway pressure and posture. J Appl Physiol 48:500–504Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • D. P. Southall
    • 1
  • C. B. Croft
    • 1
  • V. A. Stebbens
    • 1
  • H. Ibrahim
    • 1
  • A. Gurney
    • 1
  • R. Buchdahl
    • 1
  • J. O. Warner
    • 1
  1. 1.Department of Paediatrics, Cardiothoracic InstituteBrompton HospitalLondonUK

Personalised recommendations