Poor compensation, airway collapsibility tied to higher AHI in paediatric OSA

In children with obstructive sleep apnea (OSA), upper airway collapsibility and inadequate compensatory activity of the dilator muscles are associated with higher apnea-hypopnea index (AHI), suggests a study.

Specifically, poor compensation, along with worse collapsibility and high loop gain, significantly contribute to higher AHI, with compensation accounting for the largest variance (12.85 percent) among all endotypic traits.

Furthermore, patients aged >12 years showed a more compromised upper airway (V_min: 64.3 percent vs 71.4 percent eupnea) and higher loop gain (LG₁: 0.45 vs 0.34) than their younger counterparts, independent of AHI. Finally, there were no significant sex differences seen in endotypic traits.

“The age-related decrease in upper airway patency may result from the interplay between upper airway and craniofacial development,” the authors said.

This study, conducted between April 2020 and September 2024, prospectively enrolled 88 patients aged ≤18 years who were referred to a single clinical sleep centre in Taiwan for in-laboratory diagnostic polysomnography. Those with AHI ≥1 h⁻¹ were included.

The authors estimated endotypic traits using polysomnographic signals and performed a linear regression analysis to examine the relationship of these traits with AHI, age, and sex.

“Paediatric OSA has a distinct pathophysiology and management from that of adults, yet endotypic traits in this population remain underreported,” the authors said. “Understanding how these traits vary by age and sex could provide insights into respiratory system development.”