title: The obstructive sleep apnoea syndrome in adolescents.
abstract: The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromotor factors; however, the relative contributions of these factors have not been studied during the important developmental phase of adolescence. We hypothesised that adenotonsillar volume (ATV), nasopharyngeal airway volume (NPAV), upper airway critical closing pressure (Pcrit) in the hypotonic and activated neuromotor states, upper airway electromyographic response to subatmospheric pressure and the ventilatory response to CO2during sleep would be major predictors of OSAS risk.
  
  
  
  42 obese adolescents with OSAS and 37 weight-matched controls underwent upper airway MRI, measurements of Pcrit, genioglossal electromyography and ventilatory response to CO2during wakefulness and sleep.
  
  
  
  ATV, NPAV, activated and hypotonic Pcrit, genioglossal electromyography and ventilatory response to CO2during sleep were all associated with OSAS risk. Multivariate models adjusted for age, gender, body mass index and race indicated that ATV, NPAV and activated Pcrit each independently affected apnoea risk in adolescents; genioglossal electromyography was independently associated in a reduced sample. There was significant interaction between NPAV and activated Pcrit (p=0.021), with activated Pcrit more strongly associated with OSAS in adolescents with larger NPAVs and NPAV more strongly associated with OSAS in adolescents with more negative activated closing pressure.
  
  
  
  OSAS in adolescents is mediated by a combination of anatomic (ATV, NPAV) and neuromotor factors (activated Pcrit). This may have important implications for the management of OSAS in adolescents.
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Carole L
authors: CL
authors: Marcus
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Brendan T
authors: BT
authors: Keenan
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Jingtao
authors: J
authors: Huang
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|The Division of Respiratory Diseases, The First Hospital of Jilin University, Changchun, Jilin, China.
authors: Haibo
authors: H
authors: Yuan
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Swaroop
authors: S
authors: Pinto
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Ruth M
authors: RM
authors: Bradford
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Christopher
authors: C
authors: Kim
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Sheila
authors: S
authors: Bagchi
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Francois-Louis
authors: FL
authors: Comyn
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Stephen
authors: S
authors: Wang
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Ignacio E
authors: IE
authors: Tapia
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|The Division of Sleep Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Greg
authors: G
authors: Maislin
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Christopher M
authors: CM
authors: Cielo
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Joel
authors: J
authors: Traylor
authors: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Drew A
authors: DA
authors: Torigian
authors: Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|The Division of Sleep Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Richard J
authors: RJ
authors: Schwab
mesh_terms: D000293:Adolescent; D002648:Child; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009765:Obesity / Q000150:complications*; D010160:Palate, Soft / Q000000981:diagnostic imaging; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*
keywords: Sleep apnoea