Upper airway reflexes are preserved during dexmedetomidine sedation in children with down syndrome and obstructive sleep apnea

Mohamed Mahmoud, Stacey L. Ishman, Keith McConnell, Robert Fleck, Sally Shott, Goutham Mylavarapu, Ephraim Gutmark, Yuanshu Zou, Rhonda Szczesniak, Raouf S. Amin

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Study Objectives: The assessment of pharyngeal collapsibility is diffcult to perform in children under normal sleep. An alternative is to perform the assessment under an anesthetic, such as dexmedetomidine (DEX), that induces non-rapid eye movement (NREM) sleep. The objectives of this study were to compare critical closing airway pressure (Pcrit) obtained during natural sleep to that obtained under DEX in patients with Down syndrome (DS) and persistent obstructive sleep apnea (OSA) and determine whether Pcrit measured under sedation predicts the severity of OSA. Methods: The passive and active Pcrit, which represent airway passive mechanical properties and active dynamic responses to airway obstruction, respectively, were measured. Upper airway re?ex activity was estimated by calculating the difference between active and passive Pcrit. Subjects underwent overnight polysomnography during which Pcrit was measured during normal sleep. Pcrit was also measured during DEX sedation at a dose of 2 μg/kg/h. Results: The study included 50 patients with median age of 11.4 years (interquartile range: 7.0-13.9) and median body mass index of 23.0 kg/m2 (interquartile range: 18.4-29.1), 66% male and 80% Caucasian. Passive Pcrit was signifcantly higher than active Pcrit when measured during normal sleep and DEX-induced sleep. There was a positive association between apnea-hypopnea index and passive Pcrit (Spearman r = 0.53, P = .0001) and active Pcrit (r = 0.55, P = .0002) under DEX-induced sleep. There were no signifcant differences between the Pcrit measurements during natural sleep and during DEX sedation. Conclusion: Patients with OSA can compensate for airway obstruction under DEX-induced sleep. The close association between Pcrit and apnea-hypopnea index suggests that airway responses with DEX sedation parallel those seen during natural sleep.

Original languageEnglish (US)
Pages (from-to)721-727
Number of pages7
JournalJournal of Clinical Sleep Medicine
Issue number5
StatePublished - 2017


  • Airway collapsibility
  • Critical closing pressure
  • Dexmedetomidine
  • Sedation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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