Exhaled Nitric Oxide fraction in asthma and obstructive sleep apnea among children at high altitudes. A cross-sectional study.

INTRODUCTION: Exhaled nitric oxide fraction (FeNO) is employed for the diagnosis and phenotyping of asthma as an inflammatory biomarker of the airway. Limited evidence exists regarding its behavior in the presence of asthma and obstructive sleep apnea (OSA). Our objective was to determine whether FeNO levels are associated with the severity of OSA or the coexistence of asthma and OSA in residents at high altitudes. MATERIALS AND METHODS: Observational, analytical, cross-sectional study in children aged 5-16 years residing at 2600 m above sea level treated at a Sleep Study Center between 2019 and 2021. We conducted a medical history, polysomnogram, and measurement of FeNO levels. The children were categorized into four groups: OSA, asthma, asthma with OSA, and controls (without asthma or OSA). FeNO levels among the groups were compared using the Kruskal-Wallis test, and correlations were explored using the Spearman correlation coefficient. Analyses considered statistical significance at a two-tailed p-value <0.05. RESULTS: Among the 261 included children, 68 (26.1 %) had OSA, 42 (16.1 %) were diagnosed with asthma, 109 (41.8 %) had both asthma and OSA, and 42 (16.1 %) were controls. Their FeNO medians were 10 ppb, 18.5 ppb, 15 ppb, and 14 ppb, respectively, with no significant differences between the evaluated groups (p = 0.263). We found no correlation between FeNO and apnea-hypopnea index and obstructive apnea index even for the groups of patients with FeNO >20 ppb and FeNO >35 ppb (>75th percentile). In the adjusted model, a significant association was observed between asthma and FeNO levels. CONCLUSIONS: Our findings suggest that FeNO measurements in children would not allow establishing this biomarker as part of the diagnosis of OSA. However, these findings may be related to high altitude.

Intermittent hypoxia and respiratory patterns during sleep of preterm infants aged 3 to 18 months residing at high altitude.

STUDY OBJECTIVES: The aim of this study was to determine the impact of apneas on oxygen saturation and the presence of intermittent hypoxia, during sleep of preterm infants (PTIs) born at high altitudes and compare with full-term infants (FTIs) at the same altitude. METHODS: PTIs and FTIs from 3 to 18 months were included. They were divided into three age groups: 3-4 months (Group 1); 6-7 months (Group 2), and 10-18 months (Group 3). Polysomnography parameters and oxygenation indices were evaluated. Intermittent hypoxia was defined as brief, repetitive cycles of decreased oxygen saturation. Kruskal-Wallis test for multiple comparisons, t-test or Mann-Whitney U-test were used. RESULTS: 127 PTI and 175 FTI were included. Total apnea-hypopnea index (AHI) was higher in PTI that FTI in all age groups (Group 1: 33.5/h vs. 12.8/h, p = 0.042; Group 2: 27.0/h vs. 7.4/h, p < 0.001; and Group 3: 11.6/h vs. 3.1/h, p < 0.001). In Group 3, central-AHI (8.0/h vs. 2.3/h, p < 0.001) and obstructive-AHI (1.8/h vs. 0.6/h, p < 0.008) were higher in PTI than FTI. T90 (7.0% vs. 0.5, p < 0.001), oxygen desaturation index (39.8/h vs. 11.3, p < 0.001) were higher in PTI than FTI, nadir SpO2 (70.0% vs. 80.0, p<0.001) was lower in PTI. CONCLUSION: At high altitude, compared to FTI, PTI have a higher rate of respiratory events, greater desaturation, and a delayed resolution of these conditions, suggesting the persistence of intermittent hypoxia during the first 18 months of life. This indicates the need for follow-up of these infants for timely diagnosis and treatment of respiratory disturbances during sleep.

Hernia diafragmática congénita de presentación tardía / Late-presenting congenital diaphragmatic hernia

La hernia diafragmática congénita de presentación tardía (HDCT) es una entidad infrecuente, representa del 5 a 20 % de todos los casos de hernia diafragmática congénita. La presentación clínica, diagnóstico y tratamiento difiere de la hernia de presentación neonatal, dada la ausencia de hipoplasia e hipertensión pulmonar. El amplio espectro clínico de la presentación tardía o su hallazgo radiológico incidental, pueden plantear un desafío diagnóstico; la demora en su detección y abordaje aumentan la morbimortalidad y ensombrecen el pronóstico. Presentamos el caso de una escolar de 8 años de edad a quien se le diagnostica una hernia diafragmática congénita izquierda y se hace revisión del diagnóstico, tratamiento y pronóstico de la enfermedad.

The late-presenting congenital diaphragmatic hernia is a rare entity that corresponds to the 5 - 20% of all congenital diaphragmatic hernia cases. The clinical manifestations ,diagnosis and treatment differ from the neonatal presentation in the absence of pulmonary hypoplasia and pulmonary hypertension. The wide clinical spectrum of the late-presenting diaphragmatic hernia or its incidental finding on radiological images can lead to a challenging diagnosis. The delay in the detection and approach increases the morbidity and mortality, and darkens the prognosis. We are presenting a case of an eighth year-old scholar who is diagnosed with a congenital left diaphragmatic hernia, as well as a review of the diagnosis, treatment and prognosis of this pathology.