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Carbon dioxide levels during polygraphy in children with sleep-disordered breathing

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Abstract

Purpose

The recent scoring rules of the American Academy of Sleep Medicine (AASM) define hypoventilation in children as a carbon dioxide (CO2) level of >50 mmHg for >25 % of total sleep time (partial pressure of CO2 (PCO2) > 50[>25 %]). As there is no validated level of nocturnal hypoventilation with regard to end-organ damage in children, we evaluated the prevalence of hypoventilation with the AASM definition but also with a lesser degree of elevated CO2 in children with sleep-disordered breathing (SDB).

Methods

Transcutaneous CO2 (PtcCO2) was recorded during overnight polygraphy (PG). Hypoventilation was defined according to four definitions: the AASM score (PCO2 > 50[>25 %]), the peak value of PtcCO2 > 50 mmHg (PtcCO2 > 50[peak]), a percentage of PtcCO2 > 50 mmHg > 2 % of nighttime recording (PtcCO2 > 50[>2 %]) or a nocturnal PtcCO2 > 10 mmHg above waking baseline level (PtcCO2[>10 mmHg]). PtcCO2 indices were correlated to the apnoea–hypopnoea index (AHI) and oxygenation indices.

Results

PGs from 221 children with suspicion of obstructive sleep apnoea (72 %), neuromuscular diseases (21 %), and lung diseases (7 %) were analysed. The prevalence of hypoventilation according to PCO2 > 50[>25 %], PtcCO2 > 50[peak], PtcCO2 > 50[>2 %] and PtcCO2[>10 mmHg] were 16, 27, 31 and 52 %, respectively, and did not differ between the three diagnostic groups. Significant but weak correlations were observed between hypoventilation and AHI and oxygenation indices.

Conclusions

Nocturnal hypoventilation occurs in a large number of children referred for SDB, independent of the underlying disease, when more stringent criteria than those of the AASM are used. The poor correlation between hypoventilation and AHI or oxygenation indices is in favour of CO2 being a supplemental index of SDB.

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Acknowledgments

The research of Brigitte Fauroux is supported by the Association Française contre les Myopathies (AFM); ADEP Assistance, S2A Santé, Vaincre la Mucoviscidose (VLM); Assistance Publique-Hôpitaux de Paris, Inserm and Université Pierre et Marie Curie-Paris6.

Conflict of interest

None of the authors has any conflict of interest to disclose.

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Authors and Affiliations

  1. Paediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, 75012, Paris, France

    Jade Pautrat, Sonia Khirani, Adriana Ramirez & Brigitte Fauroux

  2. S2A Santé, 94200, Ivry sur Seine, France

    Sonia Khirani

  3. Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, 75012, Paris, France

    Michèle Boulé & Nicole Beydon

  4. Pierre et Marie Curie University, Paris 6, 75006, Paris, France

    Michèle Boulé & Brigitte Fauroux

  5. ADEP ASSISTANCE, 92150, Suresnes, France

    Adriana Ramirez

  6. Inserm, U955, Equipe 13, 94000, Créteil, France

    Brigitte Fauroux

  7. Paediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker, 149 rue de Sèvres, F-75015, Paris, France

    Brigitte Fauroux

Authors
  1. Jade Pautrat
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  2. Sonia Khirani
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  3. Michèle Boulé
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  4. Adriana Ramirez
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  5. Nicole Beydon
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  6. Brigitte Fauroux
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Correspondence to Brigitte Fauroux.

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Pautrat, J., Khirani, S., Boulé, M. et al. Carbon dioxide levels during polygraphy in children with sleep-disordered breathing. Sleep Breath 19, 149–157 (2015). https://doi.org/10.1007/s11325-014-0980-2

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  • DOI: https://doi.org/10.1007/s11325-014-0980-2

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