ABSTRACT
Background: Obstructive sleep apnea (OSA) in pediatric population is associated with cardiac, respiratory, metabolic, neurocognitive, and behavioral dysfunctions. Adenotonsillectomy (AT) is the treatment of choice in children who have hypertrophied adenoid and/or palatine tonsils. However, there is paucity of literature on the impact of AT on cardiorespiratory and sleep parameters in these cases. Methods: We did a retrospective study on children who had undergone AT from July 2016 to December 2018 at a tertiary hospital in north India. Only those children, whose polysomnography (PSG) was available both before and after AT were enrolled in this study. � Cardiac parameters: Mean heart rate (MHR) and highest heart rate (HHR), number and duration of arrhythmias, and pulse transit time (PTT) drops. � Respiratory parameters: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (MOS). � Sleep parameters: Time spent in different stages, sleep efficiency (SE), and arousal index (AI) on PSG were compared before and after AT. Results: A total of 56 children had undergone AT for OSA. Also, PSG, both before and after AT, was available in 37 children. After excluding children having undergone other surgeries for OSA and those with comorbidities, 32 children were enrolled. AT led to significant positive change in AHI (from 7.86 � 7.91 to 2.03 � 3.10, p = 0.01), RDI (from 16.319 � 15.64 to 7.38 � 3.72, p < 0.01), AI (from 22.10 � 14.93 to 15.90 � 8.48, p = 0.012), SE (from 91.47 � 6.31 to 95.866 � 3.03, p < 0.01), ODI (from 6.7959 � 5.03 to 1.865 � 2.09, p < 0.01), MOS (from 95.59 � 2.19 to 97.28 � 1.27), HHR (from 141.68 � 17.93 to 120.93 � 16.98, p < 0.01), MHR (86.68 � 12.95 to 80.29 � 8.81, p = 0.01), and PTT AI (from 36.67 � 27.72 to 26.93 � 24.86, p < 0.01). There was no non-sinus wide or narrow complex tachyarrhythmia in any child before or after AT. There was no statistically significant change in rapid eye movement (REM) sleep duration or number and duration of bradycardia episodes in these children (p > 0.05). Conclusion: Adenotonsillectomy improved SE and oxygenation, and decreased the number of obstructive events, arousals, heart rate, and PTT AI during sleep in children with OSA. Some children had residual disease after surgery. Heart rate and PTT can be excellent non-invasive parameters for detecting obstructive events during sleep in children and monitoring the impact of various therapeutic modalities.
ABSTRACT
Introduction: Status epilepticus is a common pediatricneurological emergency. Study aimed to compare changes inhemodynamic parameters during the management of pediatricstatus epilepticus using different first line anticonvulsants.Material and Methods: This prospective, randomized, studywas done on Pediatric patients in the age group of 2 monthsto 16 years who present actively convulsing to the emergencydepartment of pediatrics.Results: The mean time to regain consciousness in phenytoin,levetiracetam and valproate groups was 122.3(± 45.4) minutes,120.8(±42.8) minutes and 75.0(±30.7) minutes (mean±S.D)respectively. There was no significant difference in the threegroups in various vital parameters like heart rate, systolicblood pressure, spo2 and respiratory rate recorded at regularintervals in the acute stage (p value > 0.05).Conclusion: All the three anticonvulsants studied are safeand efficacious, and there is no significant difference inthe cardiorespiratory parameters of three groups, and thetime to regain consciousness was less in valproate group incomparison to other groups
ABSTRACT
Surya Namaskar (SN), a popular traditional Indian yogic practice called “Sun Salutations”, includes practice of twelve physical postures involving alternate backward bending and forward bending postures. The practice of twelve postures in succession makes one round of its practice. Many people practise it as part of their daily physical fitness regimen. No study is available to compare cardiorespiratory responses of SN with bicycle exercise (BE). 20 healthy Yoga instructors practicing various Yogic practices including SN since last 7-8 years participated in the study. They performed SN in the laboratory according to their customary daily practice routine. The subject also performed incremental load bicycle exercise test till exhaustion on their second visit for measuring their V O2 max. SN and BE were compared at three similar exercise intensity levels in terms of % of V O2 max. The exercise intensities were light (10-20% V O2 max), moderate (21-40% V O2 max) and high intensities (41-50% V O2 max). Heart rate at high work intensity was significantly higher in BE than SN (P<.001). Ventilation and carbon dioxide output were significantly higher in BE than SN at high exercise intensity (P<0.001). Overall, cardiorespiratory stress is less in SN than BE at similar work intensities