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The polysomnographic characteristics of central apnea are: (1) absence of nasal and oral airflow, and (2) absence of chest and abdominal movements (Figure 19.1).

Figure 19.1.Central apnea (cessation of airflow at the nose and mouth, and absence of thoracic and abdominal movements). Sleep stage: quiet sleep (tracé alternant and regular respiration), bradycardia, and desaturation.

Central apnea is due to failure of the diaphragm to generate negative intrathoracic pressure. Lesions at multiple levels in the ventilatory system can lead to central apnea (Figure 19.2 A-G).

Figure 19.2Sites of possible lesions producing central apnea. A: chemoreceptor; B: respiratory groups; C: cervico-medullary junction; D: anterior horn cells of the phrenic nerve; E: phrenic nerve; F: myoneural junction; G: diaphragm.

The polysomnographic characteristics of obstructive apnea are absence of nasal and oral airflow in the presence of thoracic or abdominal movements (Figure 19.3).

Figure 19.3.Obstructive apnea (cessation of nasal airflow despite thoracic and abdominal respiratory movements). EEG shows low-voltage irregular activity. The apnea is followed by tachycardia and desaturation.

Paradoxical chest/abdominal movement is a frequent polysomnographic finding during obstructive apnea. Normally the chest circumference increases during inspiration and decreases during expiration, and the abdominal circumference increases during inspiration and decreases during expiration. In obstructive apnea the chest circumference decreases during inspiration and increases during expiration. This situation is referred to as paradoxical breathing. Paradoxical breathing can occur without apnea (Figure 19.4).



Figure 19.4.Paradoxical breathing. Nasal air flow recording is in red. The thoracic and abdominal circumference movements are represented in blue. In the nasal lead: the raising phase of the wave represent inspiration (cold air going into the body) and the descending phase of the wave represent expiration (hot air going out from the body). By convention an increase in thoracic and abdominal circumference is represented as a raising phase of the wave (inspiration); whereas a decrease in thoracic and abdominal circumference is represented by a descending phase of the wave (expiration). In neonates with paradoxical breathing the chest circumference decreases during inspiration thus producing a descending phase of the wave during inspiration.

 

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60 seconds 50 seconds 40 seconds 30 seconds 20 seconds 10 seconds desaturation bradycardia central apnea (22 seconds) body movements saturation abdomimal movements thoracic movements nasal flow heart channels EMG channel eye movements EEG channels myoneural junction diaphragm phrenic nerve anterior horn cells (motor neurons) of the phrenic nerve fibers from the respiratory groups at the level of the cervico-medullary junction respiratory groups chemoreceptor bradycardia desaturation obstructive apnea abdominal channel thoracic channel airflow channel cardiac channels eye movements channels EEG channels Pause pointer on letters; figure must be centered. Pause pointer on figure (arrows) to show labels. Pause pointer on figure (arrows) to show labels. Figure must be centered.