Literature Updates from January 2013

Toll-Like Receptor Activity in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea has been linked to chronic inflammation and cardiovascular diseases. This work demonstrated that OSA is associated with enhanced expression and signaling events downstream of TLR2 and TLR4 in circulating monocytes. These observations were mitigated by CPAP therapy, which suggest that TLR2 and TLR4 activation may be involved as a signaling mechanism in immune-mediated progression of atherosclerosis in OSA.

Adenosine A1 Receptors in Mouse Pontine Reticular Formation Depress Breathing, Increase Anesthesia Recovery Time, and Decrease Acetylcholine Release

Adenosine has several actions depending on the receptors targeted. This work supports the interpretation that an adenosinergic-cholinergic interaction within the –tailed hypothesis that adenosine A1 receptors in the pontine comprises one neurochemical mechanism underlying the wakefulness stimulus for breathing.

Direct Activation of Sleep-Promoting VLPO Neurons by Volatile Anesthetics Contributes to Anesthetic Hypnosis

This work demonstrated that volatile anesthetics are capable of directly activating endogenous sleep-promoting networks by activating VLPO nucleus.

Predictors of Positive Airway Pressure Therapy Adherence in Children: A Prospective Study

PAP adherence in children and adolescents is related primarily to family and demographic factors rather than severity of apnea or measures of psychosocial functioning. Further research is needed to determine the relative contributions of maternal education, socioeconomic status and cultural beliefs to PAP adherence in children, in order to develop better adherence programs.

Craniofacial Morphology and Sleep Apnea in Children With Obstructed Upper Airways: Differences Between Genders

Craniofacialmorphology may influence the severity of sleep apnea in boys but not in girls.

Measuring Sleep Quality After Adenotonsillectomy in Pediatric Sleep Apnea

The aim of this study was to demonstrate postoperative changes in sleepquality in children with obstructive sleep apnea (OSA), using both conventional sleep staging and electrocardiogram-based cardiopulmonary coupling (CPC) analysis. In pediatric OSA, postoperative improvement of sleepquality is more readily discernible by CPC analysis than EEG-based sleep staging.

Validation of a Clinical Assessment Score for Pediatric Sleep-Disordered Breathing

They concluded “The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.”

Clinical Assessment of Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

They concluded “Neither single nor combined symptoms and signs have satisfactory performance in predicting pediatric OSA. Alternative diagnostic models are necessary to improve the accuracy.”

Temporal Disorganization of Circadian Rhythmicity and Sleep-Wake Regulation in Mechanically Ventilated Patients Receiving Continuous Intravenous Sedation

The authors of this study sought to determine if sleep regulation as regulated by circadian and homeostatic processes remains organized in patients being mechanically ventilated. The authors discovered that circadian rhythm pacemaker function appears to be “free running” in most patients evaluated.