Intermittent Catheters - Foly Catheter, Self Catheter

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Intermittent

Intermittent, Coloplast, Mentor Corporation, Bard, Invacare

Habituation of Arousal Responses after Intermittent Hypercapnic Hypoxia in Piglets

Rationale: Clinical studies have demonstrated arousal deficits in infants suffering obstructive sleep apnea, and some infant deaths have been attributed to such an arousal deficit. Objectives: To evaluate whether arousal deficits can be induced by intermittent asphyxia during normal development. Methods and Measurements: Young piglets were exposed to intermittent hypercapnic hypoxia for 4 days from age 9.55 � 0.5 days. Arousal responses were compared between control animals and animals exposed to intermittent hypercapnic hypoxia. Outcome measures included time to arouse after onset of the respiratory stimulus and frequency of arousals during recovery. Main Results: Arousal deficits emerged after successive exposures to hypercapnic hypoxia on Day 1, and were exacerbated on Day 4, although after overnight recovery, the deficit only became evident during the second and subsequent episode of hypercapnic hypoxia. On Day 1, time to arouse increased from 16.9 � 7.1 seconds in the first epoch to 41.7 � 28.6 seconds in the fourth epoch (p = 0.004 between cycles, one-way analysis of variance). In the recovery periods after hypercapnic hypoxia, there were 64% fewer arousals than baseline on Day 1 and 90% fewer arousals on Day 4. Respiratory effort, measured by VT across 10 breaths before the arousal, increased from 25.7 � 7.6 on Day 1 to 29.1 � 6.8 ml/kg on Day 4 (p

Clinical conditions such as obstructive sleep apnea (OSA) may be associated with significant sequelae in young infants. OSA is defined as complete cessation of airflow at the mouth and nose during sleep, despite ongoing diaphragmatic efforts, and is characterized by rapid and repeated onset of perturbations in O2 and CO2 levels as well as sleep disruption (1). The most common signs of OSA in infants are snoring, labored breathing, and profuse sweating (2). Although not well defined for infants, sequelae documented in older children include subtle behavioral changes and secondary phenomena, such as metabolic alkalosis, growth and developmental failure, chronic respiratory failure, and cardiovascular complications (3-7).

Intermittent Catheters, Self Catheter, Foly Catheter, Urological Catheters, Intermittent.

In infants, OSA is correlated with depression of the arousal response to ventilatory compromise, but treatment to alleviate OSA can reverse this depression (8-10). Recent studies also suggest that OSA may be linked with the sudden infant death syndrome (SIDS) (11-13). The most compelling hypothesis regarding SIDS is a failure in the neuroregulation of cardiorespiratory control because of a brainstem abnormality. Neuropathologic studies and more recent genetic studies support the concept that SIDS victims possess underlying vulnerabilities that put them at risk for sudden death (14-20). It is hypothesized that victims of SIDS, who are believed to die quietly in their sleep, suffer as much from a defect in arousal as from a defect in ventilatory control. The vulnerability of these infants is also believed to be latent until other factors occur, such as a critical period of development and/or an environmental stressor (13, 14, 16, 21, 22). Such a deficit in arousal responses is considered a necessary abnormality for an infant to succumb to SIDS, and it is hypothesized that a brainstem abnormality is responsible for this dysfunction (14, 15). The underlying cause of the brainstem abnormality is not known and may be congenital, caused by a delay in normal maturation, or it may be induced by environmental factors (22).

Intermittent, Coloplast, Mentor Corporation, Bard, Invacare