Sleep By C.L. Taylor !LINK!

We did not perform polysomnography in this study because these examinations are costly and time-consuming and because the main goal of this study was to evaluate the pharyngeal space. Pediatric sleep questionnaires have been established to be superior to polysomnography in showing improvements in symptoms after AT 15.

Sleep by C.L. Taylor

Download Zip: https://www.google.com/url?q=https%3A%2F%2Fgohhs.com%2F2udQSs&sa=D&sntz=1&usg=AOvVaw3Hn-ikqZmSkHF_M28BjRMu

We included children with snoring resulting from grades 3 and 4 adenoid and tonsil hypertrophy on the Brodsky scale because the size of the tonsil should be considered when determining the need for surgical treatment 16. The subjective tonsil size is known to be very weakly (at best) associated with the severity of SDB. Therefore, we chose to measure the objective volume of the tonsils. Although this measure was associated with the pharyngeal volume, it was not correlated with the increase in pharyngeal volume, in contrast to our expectation. Our results demonstrated that the increase in pharyngeal volume was not proportional to the tonsil size and one possible explanation for this finding may be the presence of obesity. Indeed, our results demonstrated an indirect correlation between the pharyngeal volume and BMI: the lower the BMI, the greater the increase in pharyngeal volume. This finding could be explained by the presence of adipose tissue deposits near the pharynx and neck, which generally contribute to obstructive sleep syndromes in obese children 17, as well as by increased circulating levels of inflammatory mediators 18. Although the observed correlation was only fair, this finding is reasonable given the small sample size and the existence of several other factors that may be involved in determining airway width and collapse. Airway collapse occurs as a result of the combined effects of internal airway pressure, passive tissue compliance and airway muscle activation 19.

Computational fluid dynamic end points have been determined for the assessment of AT outcomes in obese children with obstructive sleep apnea syndrome, and the airway dimensions are known to be influenced by adipose tissue 19. Ulualp and Szmuk reported that children with 3+ and 4+ grade tonsils were more likely to experience lateral wall collapse than children with 1+ and 2+ grade tonsils 20. The combinations of abnormalities in soft tissue mass and adiposity, facial anatomy and neuromuscular function might also play a role in snoring and SDB 21. The role of the tongue in determining the pharyngeal area is uncertain 22; however, after tonsillectomy, the dorsum of the tongue must adapt its position and might be displaced to the previous site of the tonsil. Such a displacement would explain why increase in pharyngeal volume may not occur in all patients and why craniofacial morphology may also be involved.

Several limitations of this study should be recognized. First, there might be some concern that the study population was biased because we included only patients with tonsil grades 3+ and 4+ and because the pharyngeal measurements were collected (by necessity) while the children were awake in a sitting position, which might not reflect the actual dimensions that are relevant to snoring in a sleeping child 2. Further studies including the mouth structures and craniofacial morphology as factors should be developed.

POLYSOMNOGRAPHYPolysomnography, the recording of multiple physiologic parameters during sleep, is thefundamental laboratory tool of sleep physicians. The technique evolved from electroencephalogram (EEG) recordings and made possible the discovery of rapid eye movement (REM)sleep by Aserinsky and Kleitman in 1953. By the 1970s, the technique had been adapted to thediagnosis of disease, and when the first examinations in sleep medicine were offered in theUnited States in 1978, successful candidates were known as accredited clinical polysomnographers. Today polysomnography is the major activity of clinical sleep laboratories. 041b061a72