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Lin SY, Su YX, Wu YC, Chang JZC, Tu YK. Management of paediatric obstructive sleep apnoea: A systematic review and network meta-analysis. Int J Paediatr Dent 2020; 30:156-170. [PMID: 31680340 DOI: 10.1111/ipd.12593] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. AIM Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta-analysis. DESIGN Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea-hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2 ). Frequentist approach to network meta-analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. RESULTS Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta-analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2 . No comparisons showed statistical significance in reducing ODI. CONCLUSIONS Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.
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Affiliation(s)
- Shih-Ying Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Xuan Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Jenny Zwei-Chieng Chang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Nita SA, Teleanu RI, Bajenaru OA. The Role of Polysomnography in Identifying Sleep Disorders in Children with Migraine. J Med Life 2020; 13:64-67. [PMID: 32341703 PMCID: PMC7175440 DOI: 10.25122/jml-2020-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migraine pathophysiology and sleep share common neural pathways, and there are clinical as well as paraclinical observations, which lead to the hypothesis of an association between migraine and sleep disorders. The objective of this study consisted of the evaluation of a possible correlation between migraine and sleep disorders in children, as reflected by sleep architecture and electroencephalographic patterns. Eighteen patients aged five to seventeen were recruited for the migraine group, and sixteen age-matched patients with no criteria for migraine or any underlying organic disorder, diagnosed with emotional disorders, were enrolled in the control group. All patients underwent inpatient full night polysomnographic recordings, the results of which were analyzed using appropriate statistical methods. Patients in the migraine group had decreased REM sleep (p = 0.049) and increased N1 sleep (p = 0.018) percentages, compared to the control group. Also, more arousals (p = 0.011) and lower sleep latency (p = 0.029) were noted in the migraine group. A statistically significant association was observed between migraine and sleep disorders when the latter was defined with respect to normal values of polysomnographic parameters published in studies conducted on healthy children. Polysomnography can be a useful tool for studying sleep in pediatric migraine patients. The results of this study can be regarded as a starting point for a better understanding of the complex role of sleep in the developing brain and of eventual intricacies with migraine pathophysiological mechanisms.
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Affiliation(s)
- Smaranda Antonia Nita
- Clinical Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Neurology Department, University Emergency Hospital, Bucharest, Romania,Corresponding author: Smaranda Antonia Nita MD, PhD student, University Emergency Hospital, 169 Splaiul Independentei, 050098, Bucharest, Romania E-mail: , Phone: +40766214513
| | - Raluca Ioana Teleanu
- Clinical Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Pediatric Neurology Department, “Dr. Victor Gomoiu” Children's Hospital, Bucharest, Romania
| | - Ovidiu Alexandru Bajenaru
- Clinical Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Neurology Department, University Emergency Hospital, Bucharest, Romania
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Daftary AS, Shively L, Slaven JE, Jalou HE. Can estimated time in airway obstruction be a useful measure for infant obstructive sleep apnea? Int J Pediatr Otorhinolaryngol 2019; 124:208-209. [PMID: 31228711 DOI: 10.1016/j.ijporl.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ameet S Daftary
- Department of Pediatrics, Indiana University School of Medicine, United States.
| | - Lori Shively
- Department of Pediatrics, Indiana University School of Medicine, United States
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, United States
| | - Hasnaa E Jalou
- Department of Pediatrics, Indiana University School of Medicine, United States
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54
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Nehme J, LaBerge R, Pothos M, Barrowman N, Hoey L, Kukko M, Monsour A, Katz SL. Treatment and persistence/recurrence of sleep-disordered breathing in children with Down syndrome. Pediatr Pulmonol 2019; 54:1291-1296. [PMID: 31172656 DOI: 10.1002/ppul.24380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is common in children with Down syndrome, but the trajectory and long-term outcomes are not well-described. In a retrospective longitudinal cohort of children with Down syndrome, study objectives were to (1) characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB and (2) explore predictors of SDB persistence/recurrence. METHODS A retrospective cohort study was conducted of children who underwent PSGs between 2004 and 2014. SDB was defined as obstructive sleep apnea (OSA)-mixed (apnea-hypopnea index [AHI] >5 events/hour), central sleep apnea or hypoventilation. PSGs, interventions, and trajectory of SDB were described. Age, body mass index (BMI) Z-score and AHI at first SDB diagnosis were evaluated as predictors of persistent/recurrent SDB. RESULTS Of 506 children, 120 had ≥1 PSG; 54 had subsequent PSGs. Children with ≥2 PSGs were more likely to have higher total AHI (P = .02) and obstructive-mixed AHI (P = .01). Thirty-five of fifty-four (65%) were initially diagnosed with OSA-mixed SDB. After first PSG, 67 of 120 had OSA-mixed SDB, of whom 25 (37.3%) underwent adenotonsillectomy (T&A), 13 (19.4%) received positive airway pressure (PAP). Those who underwent T&A after PSG were significantly younger than those who received PAP (median age 6.2 vs 12.5 years; P = .005). OSA-mixed SDB persisted/recurred in 33 of 54 (73.3%) with ≥2 PSGs. Persistence/recurrence was not associated with age, AHI or BMI Z-score at first SDB. CONCLUSION Children with Down syndrome undergoing T&A for SDB were significantly younger than those treated with PAP. SDB persisted/recurred in three of four and was not predicted by age, SDB severity or BMI Z-score. Longitudinal PSG assessment for persistence/recurrence of SDB is required in this population.
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Affiliation(s)
- Joy Nehme
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Robert LaBerge
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Mary Pothos
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Nicholas Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lynda Hoey
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Madelaine Kukko
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Sherri L Katz
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.,Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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55
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Koehne T, Müller-Stöver S, Köhn A, Stumpfe K, Lezius S, Schmid C, Lukacs Z, Kahl-Nieke B, Muschol N. Obstructive sleep apnea and craniofacial appearance in MPS type I-Hurler children after hematopoietic stem cell transplantation. Sleep Breath 2019; 23:1315-1321. [PMID: 31332621 DOI: 10.1007/s11325-019-01900-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disorder characterized by severe multi-systemic organ manifestations including obstructive sleep apnea syndrome (OSAS). Hematopoietic stem cell transplantation (HSCT) is the treatment of choice in severe MPS I (MPS IH, Hurler syndrome). However, the effect of HSCT on OSAS in MPS IH still remains unclear. The purpose of this study was to analyze respiratory patterns during sleep following HSCT in MPS IH children and to relate these findings to craniofacial abnormalities. METHODS Overnight polysomnographies of nine MPS IH children (mean age: 8.2 years) previously treated with HSCT were retrospectively analyzed. Magnetic resonance images of the head were assessed with regard to soft and hard tissue abnormalities of the upper respiratory tract. RESULTS The mean apnea hypopnea index (AHI) was 5.3 events/h (range, 0.3-12.2), and the majority of apnea/hypopneas were obstructive. Whereas two patients had severe OSAS (AHI > 10) and two moderate OSAS (5 > AHI < 10), five patients had no evidence of OSAS (AHI < 2.0). Donor cell chimerism was significantly lower in MPS IH patients with OSAS as compared to patients without OSAS (p < 0.001). The upper airway space and the maxilla were significantly smaller and the adenoids larger in MPS IH patients with OSAS as compared to those of non-OSAS patients. CONCLUSION OSAS was only observed in MPS IH patients with graft failure or low donor cell chimerism. Conversely, successful HSCT seems to ameliorate adenoid hyperplasia and maxillary constriction in MPS IH patients and thereby minimizes the risk of OSAS at least at younger ages.
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Affiliation(s)
- Till Koehne
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Sarah Müller-Stöver
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Köhn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Stumpfe
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carmen Schmid
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bärbel Kahl-Nieke
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Temporomandibular Joint Ankylosis Leading to Obstructive Sleep Apnea. J Craniofac Surg 2019; 30:e714-e717. [PMID: 31261319 DOI: 10.1097/scs.0000000000005689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Temporomandibular joint ankylosis in children commonly lead to difficulty in feeding, poor oral hygiene, retrognathic mandible and obstructive sleep apnea. Surgical release of the ankylosis has always been the standard treatment. The authors report a 12 year old boy with unilateral temporomandibular joint ankylosis and obstructive sleep apnea underwent surgical release of the ankylosis with successful gain in mouth opening. However, he continued to suffer from obstructive sleep apnea as confirmed by post-operative polysomnography. Orthognathic surgery for mandibular advancement is not favorable due to his young age and mandibular distraction osteogenesis was not a choice. A mandibular advancement device similar to orthodontic myofunctional appliance was the preferred choice in the post-operative period while waiting for definitive retrognathia surgical treatment after skeletal maturity. Surgical release of temporomandibular joint ankylosis corrects the oral problem but does not adequately address the narrow pharyngeal airway space. Assessment of pharyngeal airway with a high suspicion of obstructive sleep apnea is mandatory in the management of TMJ ankylosis.
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Daftary AS, Jalou HE, Shively L, Slaven JE, Davis SD. Polysomnography Reference Values in Healthy Newborns. J Clin Sleep Med 2019; 15:437-443. [PMID: 30853051 DOI: 10.5664/jcsm.7670] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) is increasingly used in the assessment of infants. Newborn PSG reference values based on recent standardization are not available. This study provides reference values for PSG variables in healthy newborn infants. METHODS Cross-sectional study of normal term newborn infants using standardized PSG collection and American Academy of Sleep Medicine interpretation criteria. RESULTS Thirty infants born between 37 and 42 weeks gestation underwent PSG testing before 30 days of age (mean 19.6 days). The infants had a mean sleep efficiency of 71% with average proportions of transitional, NREM and REM sleep estimated at 16.1%, 43.3% and 40.6% respectively. Mean arousal index was 14.7 events/h with respiratory arousal index of 1.2 events/h. Mean apnea-hypopnea index (AHI) was 14.9 events/h. Central, obstructive, and mixed apnea indices were 5.4, 2.3, and 1.2 events/h respectively. Mean oxygen saturation in sleep was 97.9% with a nadir of 84.4%. Mean end tidal CO2 was 35.4 mmHg with an average of 6.2% of sleep time spent above end-tidal CO2 45 mmHg and 0.6% above 50 mmHg. CONCLUSIONS The sleep efficiency was significantly lower and the AHI was significantly higher compared to healthy children older than 1 year. The AHI was also higher than reported in healthy infants older than 1 month. These findings suggest current severity classifications of sleep apnea may not apply to newborn infants.
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Affiliation(s)
- Ameet S Daftary
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Hasnaa E Jalou
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Lori Shively
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
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Objective sleep quality and metabolic risk in healthy weight children results from the randomized Childhood Adenotonsillectomy Trial (CHAT). Sleep Breath 2019; 23:1197-1208. [PMID: 30798410 DOI: 10.1007/s11325-019-01802-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesized that cardiopulmonary coupling (CPC) sleep quality reflects cardiovascular and cardiometabolic health, in healthy weight children. METHODS Retrospective signal analysis of existing ECG data utilizing CPC, FDA cleared, software as medical device (SaMD). ECG signals were extracted from baseline polysomnography studies in the prospective Childhood Adenotonsillectomy Trial database, multicenter, single-blind, randomized controlled trial of 5.0-9.9-year-old children identified with obstructive sleep apnea syndrome without severe hypoxemia. Healthy weight was defined as age- and gender-specific BMI in the 5th-85th percentile range and overweight above the 85th percentile. The cohort was stratified based on CPC sleep quality Index (SQI) defined as high sleep quality (SQI ≥ 80) or low sleep quality (SQI < 60). Cardiovascular, cardiometabolic, quality of life, and cognition were compared between the sleep quality groups. RESULTS Healthy weight children with low sleep quality had more fragmented sleep with significantly higher arousal index (10.0 ± 4.3 vs.7.2 ± 3.1; p = 0.00) and eLFCBB (12.4 ± 4.9 vs. 0.9 ± 1.0; p < 0.001) CPC indicator of sleep fragmentation, higher average heart rate during sleep (84.5 ± 10.6 vs. 79.4 ± 7.1; p = 0.03) and worse insulin/glucose ratio (1.7 ± 1.6 vs. 1.1 ± 1.1; p = 0.03) and fasting insulin levels (7.9 ± 7.2 vs.5.3 ± 5.5; p = 0.05) when compared to healthy weight children with high sleep quality. SQI significantly correlates with average heart rate during sleep, insulin and triglyceride levels; for a unit increase in SQI, there is 0.154 unit decrease in average heart rate during sleep, 0.109 unit in insulin levels and 0.332 unit in triglyceride levels, respectively. CONCLUSION CPC sleep quality offers insights into pediatric sleep and how it affects cardiovascular and cardiometabolic health. ECG is simple signal to collect, which makes this method practical for testing sleep, over multiple nights, and on multiple occasions providing information on sleep dynamics not possible before. TRIAL REGISTRATION NCT00560859.
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Kohn JL, Cohen MB, Patel P, Levi JR. Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review. Otolaryngol Head Neck Surg 2019; 160:1101-1105. [DOI: 10.1177/0194599819829019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway and is commonly caused by adenotonsillar hypertrophy in children. Accordingly, adenotonsillectomy is considered first-line treatment. However, in cases of mild OSA, nonsurgical management has been proposed as an alternative. The purpose of this study was to determine the outcomes of pediatric patients with mild obstructive sleep apnea (OSA) treated without surgical intervention. Study Design Case series with chart review. Setting Tertiary care university medical center. Subjects and Methods The medical records of children ages 2 to 18 years with OSA at Boston Medical Center from January 2000 to April 2017 were reviewed. Children with mild OSA (apnea- hypopnea index [AHI] between 1 and 5), who were managed nonsurgically and had serial polysomnograms, were included. Serial sleep studies were compared to assess for patterns of change. Results Of the 201 patients with mild OSA who were identified, 104 (52%) opted for initial nonsurgical management. Of those, 91 had a follow-up sleep study to reassess their OSA. Forty-two (46 %) had a greater than 20% decrease in AHI and 38 (41%) had a greater than 20% increase on the second sleep study. The remaining 11 had changes less than 20% in either direction. There was not a significant difference in the proportion of patients with an increase vs decrease in AHI on follow-up sleep study ( P > .05). Conclusions Mild pediatric OSA has approximately equal chances of worsening or improvement over time without surgical intervention, which is useful for counseling parents on treatment options.
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Affiliation(s)
- Jocelyn L. Kohn
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael B. Cohen
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, VA Boston Medical Center, Boston, Massachusetts, USA
| | - Prachi Patel
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience. Eur J Pediatr 2019; 178:189-197. [PMID: 30382346 DOI: 10.1007/s00431-018-3276-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 01/20/2023]
Abstract
Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38-65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms. What is known? • Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential. • Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough. What is new? • We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores. • We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.
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Procaskey A, White H, Simoneau T, Traeger N, Lahiri T, Abu Jawdeh EG, Kremer T, Sheils C, Meyer K, Rosenkrantz T, Krishnan S, Hartman T, Feldman H, Rhein L. The optimization of home oxygen weaning in premature infants trial: Design, rationale, methods, and lessons learned. Contemp Clin Trials 2018; 75:72-77. [PMID: 30107239 DOI: 10.1016/j.cct.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 11/15/2022]
Abstract
Improved survival among preterm infants has led to an increase in diagnosis of chronic lung disease and infants discharged home from the NICU on supplemental oxygen. Despite this increased prevalence, no clearly defined guidelines for the management of home oxygen therapy (HOT) exist. This lack of consensus leads to significant variability in the duration of home oxygen therapy and a general paucity of evidence-based practice. Our team has identified recorded home oxygen therapy (RHO) as a potential new resource to guide clinical decision making in the outpatient pulmonology clinic. By recording extended O2 saturation data during the weaning process, RHO has the potential to save cost and improve the processes of HOT management. Our team is currently supporting a prospective, multi-center, randomized, controlled trial of RHO guided HOT weaning with the aims of determining effect upon duration of HOT, perceived parent quality of life and effect upon growth and respiratory outcomes. We plan to randomize 196 infants into one of two study arms evaluating standard HOT management versus RHO guided oxygen weaning. Our primary outcomes are total HOT duration and parental quality of life. This trial represents an unprecedented opportunity to test a novel home monitoring intervention for weaning within a vulnerable yet quickly growing population. If effective, the use of RHO may provide clinicians a tool for safe weaning.
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Affiliation(s)
- Alexander Procaskey
- University of Massachusetts Memorial Medical Center, Division of Neonatology, Worcester, MA, United States
| | - Heather White
- University of Massachusetts Memorial Medical Center, Division of Neonatology, Worcester, MA, United States
| | - Tregony Simoneau
- University of Connecticut, Children's Medical Center, Division of Pediatric Pulmonology, Hartford, CT, United States
| | - Nadav Traeger
- Maria Fareri Children's Medical Center, Division of Pediatric Pulmonology, Valhalla, NY, United States
| | - Thomas Lahiri
- University of Vermont College of Medicine, Division of Pediatric Pulmonology, Burlington, VT, United States
| | - Elie G Abu Jawdeh
- University of Kentucky, Division of Neonatology, Department of Pediatrics, Lexington, KY, United States
| | - Ted Kremer
- University of Massachusetts Memorial Medical Center, Division of Pediatric Pulmonology, Worcester, MA, United States
| | - Catherine Sheils
- Boston Children's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Kathleen Meyer
- Baystate Health Center, Division of Neonatology, Springfield, MA, United States
| | - Ted Rosenkrantz
- University of Connecticut Health Center, Dept. of Pediatrics/Neonatology, Farmington, CT, United States
| | - Sankaran Krishnan
- Maria Fareri Children's Medical Center, Division of Pediatric Pulmonology, Valhalla, NY, United States
| | - Tyler Hartman
- Dartmouth Geisel School of Medicine, Division of Neonatology, Manchester, NH, United States
| | - Henry Feldman
- Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Boston, MA, United States
| | - Lawrence Rhein
- University of Massachusetts Memorial Medical Center, Division of Neonatology, Worcester, MA, United States; University of Massachusetts Memorial Medical Center, Division of Pediatric Pulmonology, Worcester, MA, United States.
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Galeotti A, Festa P, Viarani V, D'Antò V, Sitzia E, Piga S, Pavone M. Prevalence of malocclusion in children with obstructive sleep apnoea. Orthod Craniofac Res 2018; 21:242-247. [PMID: 30188002 DOI: 10.1111/ocr.12242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the prevalence of malocclusions in 2- to 10-year-old children suffering from obstructive sleep apnoea (OSA) and to evaluate the association between occlusal variables and OSA. SETTING AND SAMPLE POPULATION A total of 2101 consecutive patients referred to an otorhinolaryngology unit were considered for the study. One hundred and fifty-six children (range 2-10 years) with suspected OSA were selected for a sleep study. The final sample consisted of 139 children suffering from OSA and a control group of 137 children. MATERIALS AND METHODS All patients included in the study underwent a clinical orthodontic examination to record the following occlusal variables: primary canine relationship, presence of a posterior crossbite, overjet and overbite. Odds ratios and 95% confidence intervals, comparing the demographic characteristics and dental parameters in OSA vs non-OSA children, were computed. Multivariable logistic regression models were developed to compare independent variables associated with OSA to non-OSA children. RESULTS The prevalence of malocclusions in children with OSA was 89.9% compared to 60.6% in the control group (P < 0.001). Factors independently associated with OSA compared to the control group were posterior crossbite (OR = 3.38; 95%CI:1.73-6.58), reduced overbite (OR = 2.43; 95%CI:1.15-5.15.), increased overbite (OR = 2.19; 95%CI:1.12-4.28) and increased overjet (OR = 4.25; 95%CI:1.90-9.48). CONCLUSIONS This study showed a high prevalence of malocclusion in children with OSA compared to the control group. The posterior crossbite and deviations in overjet and overbite were significantly associated with OSA. The presence of these occlusal features shows the importance of an orthodontic evaluation in screening for paediatric OSA.
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Affiliation(s)
- Angela Galeotti
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Paola Festa
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Valeria Viarani
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Vincenzo D'Antò
- Section of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples "Federico II", Naples, Italy
| | - Emanuela Sitzia
- Otorhinolaryngology Unit, Department of Pediatric Surgery, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Simone Piga
- Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Research Hospital, Rome, Italy
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Yang L, Huang Z, Zhong J, Qiu S, Liu D. The characteristics and clinical significance of REM<10% in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2018; 110:53-56. [PMID: 29859587 DOI: 10.1016/j.ijporl.2018.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Fractional time in REM sleep <20% ('little REM sleep') is indicative of more severe sleep-disordered breathing (SDB) in adults. We examined if other REM% is predictive of more severe SDB in children. METHODS In this retrospective study of 616 pediatric SDB patients, age, sex ratio, BMI, sleep efficiency, awakening frequency, sleep latency, apnea-hypopnea index (AHI), obstructive apnea index (OAI), and lowest oxygen pulse saturation (LSpO2) were compared among groups stratified according to REM%: REM≥20%, REM<20%, 15% ≤ REM<20%, 10% ≤ REM<15%, and REM<10%. Correlations with AHI, OAI, LSpO2, sleep efficiency, and awakening frequency were examined in REM<20% and REM<10% groups. Associations of these parameters with REM<10% were examined by single- and multifactor regression. RESULTS Pediatric SDB patients with little REM sleep demonstrated poorer sleep quality than patients with REM≥20%, while patients with REM<10% also exhibited more severe SDB. Specifically, the REM<20% group exhibited higher number of awakenings and lower sleep efficiency than the REM≥20% group (both P ≤ 0.001), as did each REM%<20% subgroup (lower sleep efficiency: all P < 0.05; higher awakening frequency: all P < 0.001). Moreover, compared to the REM≥20% group, the REM<10% also exhibited higher AHI (P = 0.025) and lower LSpO2 (P = 0.019). In the REM<10% group, individual REM% was negatively correlated with AHI (r = -0.216, P = 0.031) and positively with LSpO2 (r = 0.2, P = 0.046). Multifactor logistic regression correcting for age and BMI identified AHI as an independent predictor of REM<10% (P = 0.012, OR = 1.016, 95% CI [1.004,1.029]). CONCLUSION REM% <10% is associated with poor sleep quality and SDB severity in children, suggesting that this threshold should define "little REM sleep" in pediatric patients.
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Affiliation(s)
- Liqiang Yang
- Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, Guangdong, China
| | - Zhenyun Huang
- Guangzhou Women and Children's Medical Centre, Guangzhou, 510030, Guangdong, China
| | - Jianwen Zhong
- Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, Guangdong, China
| | - Shuyao Qiu
- Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, Guangdong, China
| | - Dabo Liu
- Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, Guangdong, China.
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Koretsi V, Eliades T, N. Papageorgiou S. Oral Interventions for Obstructive Sleep Apnea. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:200-207. [PMID: 29642990 PMCID: PMC5963600 DOI: 10.3238/arztebl.2018.0200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/03/2017] [Accepted: 11/22/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The effectiveness of intraoral appliances (IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) in the treatment of children and adults with obstructive sleep apnea (OSA) has not yet been adequately assessed. METHODS An umbrella review was performed based on established guidelines for evidence-based medicine. Data synthesis was performed only from randomized controlled trials with Paule-Mandel random-effects meta-analyses / meta-regressions using mean differences (MDs) and 95% confidence intervals (CIs) and was followed by the qualitative evaluation of the meta-evidence. RESULTS 29 systematic reviews were included, 7 of which provided quantitative data. IOA were effective in improving apnea hypopnea index (AHI) compared to both, placebo appliances (12 trials; 525 patients; MD = -11.70; 95% CI: [-15.38; -8.01]; p<0.001) and no treatment (1 trial; 24 patients; MD = -14.30; [-21.59; -7.01]; p<0.001). Only the former comparison was supported by robust meta-evidence. Effectiveness of IOA as measured by the Epworth Sleepiness Scale, on the other hand, was not supported by robust meta-evidence. No randomized or prospective controlled trials were found on the effectiveness of ME (conventional or surgically assisted) and MMA. CONCLUSION Intraoral appliances are effective in reducing AHI and their use is substantiated by robust evidence. There is no evidence from high-quality research to support treatment with ME (conventional or surgically assisted) or MMA in patients with OSA.
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Affiliation(s)
| | - Theodore Eliades
- Klinik für Kieferorthopädie und Kinderzahnmedizin, Zentrum für Zahnmedizin, Universität Zürich
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65
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Sobral DS, Faller GJ, Collares MVM. Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 55:287-291. [DOI: 10.1177/1055665617726538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.
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Affiliation(s)
- Davi Sandes Sobral
- Otorhinolaringology Division, Santo Antonio Hospital (OSID—Nun Dulce`s Beneficent Institution), Salvador, BA, Brasil
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Nehme J, LaBerge R, Pothos M, Barrowman N, Hoey L, Monsour A, Kukko M, Katz SL. Predicting the presence of sleep-disordered breathing in children with Down syndrome. Sleep Med 2017; 36:104-108. [PMID: 28735906 DOI: 10.1016/j.sleep.2017.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is highly prevalent in children with Down syndrome. Given the scarcity of resources and the presence of risk factors for SDB in this population, the objective of this study is to identify the clinical predictors of SDB, which would assist prioritization of children with Down syndrome for SDB evaluation. METHODS A retrospective cohort study was conducted on children enrolled in the Down syndrome clinic at CHEO who underwent polysomnography in 2004-2014. Total apnea-hypopnea index (AHI) or obstructive AHI (OAHI) > 5 events/hour was considered clinically significant. Associations between SDB and concurrent diagnoses, referral reasons, and sleep symptoms assessed by questionnaire were examined using Pearson's chi-square test or Fisher's exact test as appropriate. Univariate and multivariate logistic regression analyses were used to examine the predictors of SDB. RESULTS SDB was present in 42.9% of 119 children, with its highest prevalence at age 8 years. Symptoms were not significantly associated with AHI > 5 events/hour or OAHI > 5 events/hour. Gastroesophageal reflux was associated with lower odds of OAHI > 5 events/hour on univariate testing (odds ratio 0.16, 95% CI 0.04-0.72; p = 0.02) and multivariate analysis (odds ratio 0.05, 95% CI 0.0006-0.50; p = 0.002). CONCLUSIONS SDB is highly prevalent at all ages in children with Down syndrome. Symptoms did not predict SDB in this population, although gastroesophageal reflux may mimic SDB, which indicates that clinicians should continue to perform ongoing surveillance for SDB throughout the lifespan of children with Down syndrome.
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Affiliation(s)
- Joy Nehme
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert LaBerge
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Pothos
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Andrea Monsour
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Madelaine Kukko
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
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67
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Glicksman A, Hadjiyannakis S, Barrowman N, Walker S, Hoey L, Katz SL. Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity. J Clin Sleep Med 2017; 13:545-550. [PMID: 28095969 DOI: 10.5664/jcsm.6538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/19/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obesity and regional fat distribution, measured by neck fat mass percentage using dual-energy X-ray absorptiometry (DXA), correlate with obstructive sleep apnea (OSA) severity in adults. In obese children, neck-to-waist-circumference ratio predicts OSA. This study examined associations between body fat percentage and distribution and sleep-disordered breathing (SDB) severity in obese youth, measured with DXA. METHODS Cross-sectional retrospective study conducted at a tertiary children's hospital. Participants were aged 6 to 18 years with obesity (body mass index [BMI] > 99th percentile [BMI z-score 2.35] or > 95th percentile with comorbidity). They underwent polysomnography and DXA to quantify body fat percentage and distribution ratios (neck-to-abdominal fat percentage [NAF % ratio]). SDB was defined as apnea-hypopnea index (AHI) > 5 and OSA as obstructive AHI (OAHI) > 1 event/h. Relationships of BMI z-score and NAF % ratio to log AHI and log OAHI were evaluated. RESULTS Thirty individuals participated; 18 male; median age 14.1 years. Twenty-four individuals had BMI z-scores > 2.35. Ten had AHI > 5 events/h. NAF % ratio was significantly associated with log AHI in males and with log OAHI in all, whereas total fat mass percent was not. The association between log OAHI and NAF % ratio was significant in males, but not females. NAF % ratio was significantly associated with log OAHI in those with BMI z-score above 2.35. CONCLUSIONS NAF % ratio was associated with OSA severity in males and youth with BMI > 99th percentile; however, total fat mass percentage was not, suggesting that body fat distribution is associated with OSA risk in youth.
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Affiliation(s)
- Amy Glicksman
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Barrowman
- University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Scott Walker
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
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68
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Kannan JA, Brokamp C, Bernstein DI, LeMasters GK, Hershey GKK, Villareal MS, Lockey JE, Ryan PH. Parental Snoring and Environmental Pollutants, but Not Aeroallergen Sensitization, Are Associated with Childhood Snoring in a Birth Cohort. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2017; 30:31-38. [PMID: 28465864 DOI: 10.1089/ped.2016.0681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/09/2016] [Indexed: 11/12/2022]
Abstract
The objective of this study was to determine whether atopy and other clinical and environmental variables predict the risk of childhood habitual snoring (HS) in a birth cohort born to atopic parents. Participants completed clinical evaluations and questionnaires at ages 1-4 and age 7. HS was defined as snoring ≥3 nights/week. Traffic-related air pollution (TRAP) exposure was estimated using land-use regression. The association between early (≤age 4) and current (age 7) allergic disease, environmental exposures, and snoring at age 7 was examined using adjusted logistic regression. Of the 609 children analyzed the prevalence of HS at age 7 was 21%. Early tobacco smoke exposure [environmental tobacco smoke (ETS)] [odds ratio (OR) 1.79, 95% CI (confidence interval) 1.12-2.84], rhinitis (OR 1.74, 95% CI 1.06-2.92), wheezing (OR 1.63, 95% CI 1.05-2.53), maternal HS (OR 2.08, 95% CI 1.36-3.18), and paternal HS (OR 1.83, 95% CI 1.14-3.00) were significantly associated with HS at age 7. Current TRAP (OR 1.93, 95% CI 1.13-3.26), respiratory infections (OR 1.16, 95% 1.03-1.35), maternal HS (OR 2.86, 95% CI 1.69-4.84), and paternal HS (OR 3.01, 95% CI 1.82-5.09) were significantly associated with HS at age 7. To our knowledge, this is the largest birth cohort examining longitudinal predictors of snoring in children born to atopic parents. Parental HS was the only variable consistently associated with childhood HS from ages 1 to 7. Early rhinitis, early ETS exposure, and concurrent traffic pollution exposure increased the risk of HS at age 7, while aeroallergen sensitization did not. Children with these characteristics should be considered for screening of sleep disorders.
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Affiliation(s)
- Jennifer A Kannan
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David I Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Grace K LeMasters
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Manuel S Villareal
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James E Lockey
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Farhood Z, Isley JW, Ong AA, Nguyen SA, Camilon TJ, LaRosa AC, White DR. Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea. Laryngoscope 2017; 127:1465-1470. [DOI: 10.1002/lary.26398] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Zachary Farhood
- Department of Otolaryngology-Head & Neck Surgery; Saint Louis University; St. Louis MO U.S.A
| | - Jonathan W. Isley
- Department of Otolaryngology-Head & Neck Surgery; Saint Louis University; St. Louis MO U.S.A
| | - Adrian A. Ong
- Department of Otolaryngology-Head & Neck Surgery; Medical University of South Carolina; Charleston SC U.S.A
| | - Shaun A. Nguyen
- Department of Pediatrics; Medical University of South Carolina; Charleston SC U.S.A
| | - Terence J. Camilon
- Department of Otolaryngology-Head & Neck Surgery; Saint Louis University; St. Louis MO U.S.A
| | - Angela C. LaRosa
- Department of Otolaryngology; University at Buffalo, The State University of New York; Buffalo NY U.S.A
| | - David R. White
- Department of Otolaryngology-Head & Neck Surgery; Saint Louis University; St. Louis MO U.S.A
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Abara S. EL NIÑO QUE RONCA: IMPORTANCIA Y MANEJO. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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71
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Medical Devices for Pediatric Apnea Monitoring and Therapy: Past and New Trends. IEEE Rev Biomed Eng 2017; 10:199-212. [DOI: 10.1109/rbme.2017.2757899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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72
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Gomes C, Oliveira L, Ferreira R, Simão C. Sleep disturbance in pediatric patients on automated peritoneal dialysis. Sleep Med 2016; 32:87-91. [PMID: 28366347 DOI: 10.1016/j.sleep.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/25/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are few reports describing sleep disturbance (SD) in children on automated peritoneal dialysis (APD), and they are mostly based on the application of questionnaires. As far as we know, only two studies used polysomnography (PSG), the gold standard for the diagnosis of SD. This is the first study assessing SD in children with chronic kidney disease (CKD) on APD in our country. METHODS This was an observational and descriptive study. Children up to 18 years of age who had undergone APD for a minimum of three months were considered eligible. Exclusion criteria were diabetes, neurologic disorders and sedative/hypnotic therapy. PSG was performed while the children were on their usual cycler nocturnal dialysis regimen. A questionnaire was completed on the same day. Informed, written consent was provided by all participants. RESULTS Eight children on APD were studied. The median age was 10 years (range, 1-18 years) and the mean body mass index z-score was -0.35 (±0.71). The average duration on dialysis was 8.4 months. SD was noted in five (62.5%) patients. The results of PSG showed decreased sleep efficiency (81.05 ± 0.09%) and latency (13.6 ± 11.6 min), increased awake time (23.08% of total sleep time (TST) ± 14.3), apnea/hypopnea index (1.8/h ± 1.9) and desaturation index (4.5 ± 3.7). Periodic leg movements index average was normal (0.78/h ± 0.77). Subjective data obtained by the sleep questionnaire underestimated PSG findings. CONCLUSION Our study shows that SD was present in more than half of children on PD. This result, in a small sample of patients, alerts to the need for systematic screening for sleep problems in children with CKD with a low threshold for a formal PSG.
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Affiliation(s)
- Cláudia Gomes
- Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal.
| | - Lia Oliveira
- Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal
| | - Rosário Ferreira
- Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal; Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal
| | - Carla Simão
- Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal; Nephrology and Renal Transplantation Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal
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Abstract
There is more information on a sleep study report than just the Apnea-Hypopnea Index or Respiratory Disturbance Index. This article explains how to evaluate any sleep study report to get the most information out of it. Maximum information allows the optimal treatment of patients with obstructive sleep apnea and some other sleep disorders.
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Affiliation(s)
- Lee Shangold
- ENT and Allergy Associates, 1500 Route 112, Port Jefferson Station, NY 11776, USA.
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75
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Central apneas in children with obstructive sleep apnea syndrome: prevalence and effect of upper airway surgery. Sleep Med 2016; 25:93-97. [DOI: 10.1016/j.sleep.2016.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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Silva AM, Descalço A, Salgueiro M, Pereira L, Barreto C, Bandeira T, Ferreira R. Respiratory sleep disturbance in children and adolescents with cystic fibrosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:202-8. [PMID: 27052354 DOI: 10.1016/j.rppnen.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/22/2015] [Accepted: 02/06/2016] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED Sleep disturbance has been described in cystic fibrosis (CF) patients as relevant to clinical and lung function predictive factors helping to improve the diagnosis and early intervention. Related paediatric studies are scarce. OBJECTIVE To describe respiratory sleep disturbance (RSD) and its association with spirometric indices in a population of CF children. A second aim was to determine if spirometric indices and wake-time SpO2 are predictors of sleep disturbance. METHODS A cross-sectional study involving 33CF paediatric patients. All participants underwent in-lab polysomnography (PSG), pulse oximetry and spirometry. A standardized sleep questionnaire was completed for each patient. Two subgroups were considered: I - Normal (FEV1>-1.64 z-score); II - Obstructed (FEV1≤-1.64 z-score). RESULTS Participant's median age was 12 (6-18) years, 16 (48.5%) were male. Twenty-nine patients (87.9%) presented sleep complaints. Sleep efficiency was reduced; sleep latency and waking after sleep onset (WASO) increased. N1 increased, N2, N3, REM and awakenings were normal. The apnoea-hypopnoea index was 0.6/h (sd 0.9); respiratory disturbance index (RDI) was 6.6/h (sd 5.2). Mean awaking (97% (sd 1.1)) and sleep SpO2 (95% (sd 2.7)) were normal; mean nocturnal oximetry desaturation index was 2.36/h; minimal nocturnal SpO2 was 89% (sd 4.1). We found associations between mean nocturnal SPO2 and mean values of FEV1 (r=0.528; p=0.002) and FEF25-75 (r=0.426; p=0.013). There were significant differences in nocturnal SpO2 between normal and obstructed patients (p<0.000). PSG data correlated with the questionnaire answers for night awakenings and WASO (p=0.985) and difficult breathing during sleep and RDI (p=0.722). This study points to most CF children having sleep complaints, and highlights the correlation between subjective assessment of sleep and PSG and spirometric results. Awake-time SpO2 and spirometric values are possible risk predictors for nocturnal desaturation.
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Affiliation(s)
- A M Silva
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - A Descalço
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - M Salgueiro
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - L Pereira
- Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - C Barreto
- Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - T Bandeira
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal; Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - R Ferreira
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal; Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
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Pavone M, Caldarelli V, Khirani S, Colella M, Ramirez A, Aubertin G, Crinò A, Brioude F, Gastaud F, Beydon N, Boulé M, Giovannini-Chami L, Cutrera R, Fauroux B. Sleep disordered breathing in patients with Prader-Willi syndrome: A multicenter study. Pediatr Pulmonol 2015; 50:1354-9. [PMID: 25851435 DOI: 10.1002/ppul.23177] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/05/2015] [Accepted: 02/20/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Sleep disordered breathing (SDB) is common in patients with Prader-Willi syndrome (PWS) and systematic screening is recommended, especially before growth hormone treatment. The aim of the study was to describe the baseline SDB and therapeutic interventions in a large cohort of patients. STUDY DESIGN Retrospective study. SUBJECT SELECTION Eighty-eight patients with PWS, median [interquartile range] age of 5.1 [1.0-14.5] years old (range 0.3-44.3), who were followed in three centers (France, Italy). METHODOLOGY Anthropometrics, polygraphy (PG), and gas exchange data were analyzed. RESULTS Median body mass index (BMI) was 20 [16-34] kg/m(2), BMI z-score for patients aged 2-20 years old was 2.1 [1.2-2.8] SD, mixed-obstructive apnea-hypopnea index (MOAHI) 1.8 [0.6-5.0] events/hr, and central apnea index (CAI) 0.1 [0.0-0.6] events/hr. Minimum pulse oximetry (SpO2) was 88 [84-91]%, percentage of time with SpO2 <90% 0.1 [0.0-1.0]%, and oxygen desaturation index 2 [1-4]/hr. An apnea-hypopnea index (AHI) ≥ 1.5 and ≥ 5 events/hr was observed in 53% of children and 41% of adults, respectively. No correlations were observed between MOAHI and anthropometrics data (age, BMI, BMI z-score), while MOAHI significantly correlated with SpO2 indexes. Age and BMI only weakly correlated with SpO2 indexes. Growth hormone could be initiated in 48 patients. Regarding post-PG therapy, 9 patients had upper airway surgery, and noninvasive CPAP/bilevel ventilation was started in 16 patients. CONCLUSIONS Patients with PWS exhibit a high prevalence of SDB. The lack of association between obesity and SDB leads to hypothesize that hypotonia and/or facial dysmorphic features may play a major role in the occurrence of SDB.
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Affiliation(s)
- Martino Pavone
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy
| | - Valeria Caldarelli
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy.,Pediatric Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,ASV Santé, Gennevilliers, France
| | | | - Adriana Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,ADEP Assistance, Suresnes, France
| | - Guillaume Aubertin
- Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Antonino Crinò
- Endocrinology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Frédéric Brioude
- Endocrinology Unit, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Frédérique Gastaud
- Endocrinology Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Nicole Beydon
- Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Michèle Boulé
- Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, Paris, France.,Pierre et Marie Curie University - Paris 6, Paris, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonary-Allergy Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Renato Cutrera
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,Paris Descartes University, Paris, France.,INSERM U 955, Equipe 13, Créteil, France
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78
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Sleep-disordered breathing in children with chronic kidney disease. Pediatr Nephrol 2015; 30:2135-43. [PMID: 26156709 DOI: 10.1007/s00467-015-3155-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of our study was to ascertain the prevalence and type of sleep-disordered breathing (SDB) in paediatric patients with severe chronic kidney disease (CKD) based on the results of polysomnograms (PSGs). METHODS Overnight PSGs were conducted on children with CKD stages 3-5 (dialysis dependent). Data were collected on patient demographics from the medical records. Study participants and/or their caregivers completed the paediatric modification of the Epworth Sleepiness Scale Score, the Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory at the time of the PSG. RESULTS Nineteen children were included in the study, of whom seven were on dialysis. The median (interquartile range) age at the time of the PSG was 13.5 (5.4-16.5) years, and eight (42%) of the children were male. There was a 37% (n = 7) prevalence of SDB in this cohort based on the PSG results. Central sleep apnea and obstructive sleep apnea were found in three children each. The PSQ scores did not correlate with the obstructive apnea-hypopnea index. CONCLUSIONS There was a high prevalence of SDB in this cohort of children with CKD. The PSG and validated sleep questionnaires yielded discordant results, reinforcing the limitations of diagnosing SDB in the CKD population based solely on sleep questionnaires.
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Saeki K, Baba Y, Takatori F, Inoue M, Kobayashi N, Yamamori S. A novel mainstream capnometer system for polysomnography integrated with measurement of nasal pressure and thermal airflow. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2139-43. [PMID: 25570408 DOI: 10.1109/embc.2014.6944040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Capnometry is a method to measure carbon dioxide (CO(2)) in exhaled gas and its use during polysomnography (PSG) for diagnostic of sleep apnea-hypopnea syndrome is expanding. However, some problems exist for using capnometer in combination with other respiratory monitoring devices because capnometry requires additional sampling cannula or airway adapter attached to patients. To resolve these problems, we developed a novel mainstream capnometer system for PSG, which is designed to integrate multiple devices for measuring respiratory parameters. This system may provide comfortable and stable PSG including capnometry. We evaluated the basic performance of this system using a spontaneous breathing model. The result indicates that this newly developed system works adequately in PSG and moreover has superior characteristics of capnography signal and measurement stability against displacement of sensors, compared to conventional devices.
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Com G, Carroll JL, Tang X, Melguizo MS, Bower C, Jambhekar S. Characteristics and surgical and clinical outcomes of severely obese children with obstructive sleep apnea. J Clin Sleep Med 2015; 11:467-74. [PMID: 25665695 PMCID: PMC4365461 DOI: 10.5664/jcsm.4608] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/17/2014] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA). METHODS At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Presurgery and postsurgery OPSG indices were compared. We defined cure as an apneahypopnea index (AHI) < 1.5/h on the postsurgery OPSG, and we compared the cure rates of different surgeries. RESULTS A total of 143 children, median age 12.4 y (interquartile range [IQR] 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 y [IQR 9-15]) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT + turbinate trim ± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor. CONCLUSIONS Surgery improved OPSG indices in the majority of obese children with OSA.
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Affiliation(s)
- Gulnur Com
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR
| | - John L. Carroll
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR
| | - Xinyu Tang
- Department of Pediatrics, Biostatistics Program, University of Arkansas Medical Sciences, Little Rock, AR
| | - Maria S. Melguizo
- Department of Pediatrics, Biostatistics Program, University of Arkansas Medical Sciences, Little Rock, AR
| | - Charles Bower
- Department of Otolaryngology, University of Arkansas Medical Sciences, Little Rock, AR
| | - Supriya Jambhekar
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR
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82
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Affiliation(s)
- Avi Sadeh
- The Adler Center for Research in Child Development and Psychopathology; School of Psychological Sciences, Tel Aviv University; Israel
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83
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Goffinski A, Stanley MA, Shepherd N, Duvall N, Jenkinson SB, Davis C, Bull MJ, Roper RJ. Obstructive sleep apnea in young infants with Down syndrome evaluated in a Down syndrome specialty clinic. Am J Med Genet A 2015; 167A:324-30. [PMID: 25604659 DOI: 10.1002/ajmg.a.36903] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 11/12/2014] [Indexed: 02/01/2023]
Abstract
Children with Down syndrome (DS) experience congenital and functional medical issues that predispose them to obstructive sleep apnea (OSA). Research utilizing stringent age criteria among samples of infants with DS and OSA is limited. This study examines clinical correlates of OSA among infants with DS. A retrospective chart review was conducted of infants ≤6 months of age referred to a DS clinic at a tertiary children's hospital over five-years (n = 177). Chi-square tests and binary logistic regression models were utilized to analyze the data. Fifty-nine infants underwent polysomnography, based on clinical concerns. Of these, 95% (56/59) had studies consistent with OSA. Among infants with OSA, 71% were identified as having severe OSA (40/56). The minimum overall prevalence of OSA among the larger group of infants was 31% (56/177). Significant relationships were found between OSA and dysphagia, congenital heart disease (CHD), prematurity, gastroesophageal reflux disease (GERD), and other functional and anatomic gastrointestinal (GI) conditions. Results indicate that odds of OSA in this group are higher among infants with GI conditions in comparison to those without. Co-occurring dysphagia and CHD predicted the occurrence of OSA in 36% of cases with an overall predictive accuracy rate of 71%. Obstructive sleep apnea is relatively common in young infants with DS and often severe. Medical factors including GI conditions, dysphagia and CHD may help to identify infants who are at greater risk and may warrant evaluation. Further studies are needed to assess the impact of OSA in infants with DS.
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Affiliation(s)
- Alida Goffinski
- Leadership Education in Neurodevelopmental Disorders Program, Riley Hospital for Children, Indianapolis, Indiana
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84
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Avis KT, Gamble KL, Schwebel DC. Obstructive sleep apnea syndrome increases pedestrian injury risk in children. J Pediatr 2015; 166:109-14. [PMID: 25444002 PMCID: PMC4274212 DOI: 10.1016/j.jpeds.2014.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/11/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate pedestrian behavior, including reaction time, impulsivity, risk-taking, attention, and decision-making, in children with obstructive sleep apnea syndrome (OSAS) compared with healthy controls. STUDY DESIGN Using a case control design, 8- to 16-year-olds (n = 60) with newly diagnosed and untreated OSAS engaged in a virtual reality pedestrian environment. Sixty-one healthy children matched using a yoke-control procedure by age, race, sex, and household income served as controls. RESULTS Children with OSAS were riskier pedestrians than healthy children of the same age, race, and sex. Children with OSAS waited less time to cross (P < .01). The groups did not differ in looking at oncoming traffic or taking longer to decide to cross. CONCLUSIONS Results suggest OSAS may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Children with OSAS appeared to have greater impulsivity when crossing streets. Results highlight the need for heightened awareness of the consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.
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Affiliation(s)
- Kristin T Avis
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
| | - Karen L Gamble
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
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85
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Ishman SL, Yang CJ, Cohen AP, Benke JR, Meinzen-Derr JK, Anderson RM, Madden ME, Tabangin ME. Is the OSA-18 predictive of obstructive sleep apnea: comparison to polysomnography. Laryngoscope 2014; 125:1491-5. [PMID: 25545468 DOI: 10.1002/lary.25098] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 11/05/2014] [Accepted: 11/20/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine the ability of the OSA-18 to predict Obstructive Sleep Apnea (OSA) in a racially diverse population when compared to overnight polysomnography (PSG). STUDY DESIGN Cross-sectional retrospective. METHODS Children 2 to 12 years of age diagnosed with OSA who were treated at a tertiary care institution between 2008 and 2013 and had complete PSG and OSA-18 data were included. We performed logistic regression with OSA as the dependent variable and the OSA-18 total symptom score (TSS), age, gender, race, asthma, and body mass index (BMI) as independent variables. RESULTS Seventy-nine children (32 females) were included (mean age 5.2 ± 2.4 years). The positive predictive value (PPV) was greater than 90 for an obstructive apnea-hypopnea index (oAHI) ≥ 1. The PPV and specificity were higher for white than for nonwhite children; however, sensitivity and negative predictive value (NPV) of OSA-18 TSS were low for mild, moderate, and severe OSA regardless of race. Age, race, and BMI were not significantly associated with oAHI. CONCLUSIONS This study, conducted in a racially diverse cohort, examined the ability of the OSA-18 to predict OSA when compared to PSG-the gold standard-and found that sensitivity and NPV were extremely low for both white and nonwhite children. This suggests that the OSA-18 is not sufficiently sensitive to detect OSA nor sufficiently specific to determine the absence of OSA. The OSA-18 should be used as a quality-of-life indicator and is not a reliable substitute for PSG. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christina J Yang
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James R Benke
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Jareen K Meinzen-Derr
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rebecca M Anderson
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Marie E Madden
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Meredith E Tabangin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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86
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Lamprecht ML, Bradley AP, Tran T, Boynton A, Terrill PI. Multisite accelerometry for sleep and wake classification in children. Physiol Meas 2014; 36:133-47. [DOI: 10.1088/0967-3334/36/1/133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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87
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Abstract
Obstructive sleep apnea is a common condition in childhood and has a significant impact on health, learning, academic performance, and quality of life. The purpose of this article is to review the epidemiology, etiology, risk factors, clinical presentation, diagnostic procedures, and treatment of obstructive sleep apnea.
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Affiliation(s)
- Miriam Weiss
- Judith Owens is Director of Sleep Medicine at Children's National Medical Center in Washington, D.C. Miriam Weiss is a CPNP at Children's National Medical Center in Washington, D.C
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88
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Rosen CL, Debaun MR, Strunk RC, Redline S, Seicean S, Craven DI, Gavlak JC, Wilkey O, Inusa B, Roberts I, Goodpaster RL, Malow B, Rodeghier M, Kirkham FJ. Obstructive sleep apnea and sickle cell anemia. Pediatrics 2014; 134:273-81. [PMID: 25022740 PMCID: PMC4187233 DOI: 10.1542/peds.2013-4223] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To ascertain the prevalence of and risk factors for obstructive sleep apnea syndrome (OSAS) in children with sickle cell anemia (SCA). METHODS Cross-sectional baseline data were analyzed from the Sleep and Asthma Cohort Study, a multicenter prospective study designed to evaluate the contribution of sleep and breathing abnormalities to SCA-related morbidity in children ages 4 to 18 years, unselected for OSAS symptoms or asthma. Multivariable logistic regression assessed the relationships between OSAS status on the basis of overnight in-laboratory polysomnography and putative risk factors obtained from questionnaires and direct measurements. RESULTS Participants included 243 children with a median age of 10 years; 50% were boys, 99% were of African heritage, and 95% were homozygous for β(S) hemoglobin. OSAS, defined by obstructive apnea hypopnea indices, was present in 100 (41%) or 25 (10%) children at cutpoints of ≥1 or ≥5, respectively. In univariate analyses, OSAS was associated with higher levels of habitual snoring, lower waking pulse oxygen saturation (Spo2), reduced lung function, less caretaker education, and non-preterm birth. Lower sleep-related Spo2 metrics were also associated with higher obstructive apnea hypopnea indices. In multivariable analyses, habitual snoring and lower waking Spo2 remained risk factors for OSAS in children with SCA. CONCLUSIONS The prevalence of OSAS in children with SCA is higher than in the general pediatric population. Habitual snoring and lower waking Spo2 values, data easily obtained in routine care, were the strongest OSAS risk factors. Because OSAS is a treatable condition with adverse health outcomes, greater efforts are needed to screen, diagnose, and treat OSAS in this high-risk, vulnerable population.
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Affiliation(s)
- Carol L. Rosen
- Department of Pediatrics and Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael R. Debaun
- Vanderbilt University School of Medicine and Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Robert C. Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sinziana Seicean
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel I. Craven
- Department of Pediatrics and Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Johanna C.D. Gavlak
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, United Kingdom
| | - Olu Wilkey
- North Middlesex Hospital National Health Service Trust, London, United Kingdom
| | - Baba Inusa
- Evelina Children’s Hospital, Guy’s and St Thomas Hospital, London, United Kingdom
| | - Irene Roberts
- Department of Paediatrics, Imperial College and Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - R. Lucas Goodpaster
- Vanderbilt University School of Medicine and Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Beth Malow
- Vanderbilt University School of Medicine and Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | | | - Fenella J. Kirkham
- University College London Institute of Child Health, London, United Kingdom
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Cohen M, Hamilton J, Narang I. Clinically important age-related differences in sleep related disordered breathing in infants and children with Prader-Willi Syndrome. PLoS One 2014; 9:e101012. [PMID: 24979549 PMCID: PMC4076199 DOI: 10.1371/journal.pone.0101012] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 06/02/2014] [Indexed: 12/12/2022] Open
Abstract
Background Sleep related disordered breathing (SDB) in pediatric Prader-Willi Syndrome is gaining increased attention due to the possible association of growth hormone therapy, SDB and sudden death. However data on the patterns of SDB and their management, particularly in infants in this population, is lacking. Objective The aim of this study was to 1) describe patterns of SDB in growth hormone naive infants with PWS and the management of these disorders in our institution 2) Compare the patterns of sleep disorders between infants and children with PWS. Methods and Design Polysomnograms of infants and children (0–18 years of age) with Prader-Willi Syndrome were reviewed. Age, sex, anthropometrics, sleep architecture, obstructive and central apnea indices and oxygen saturations were recorded. Data of infants with central sleep apnea treated with oxygen were analyzed to evaluate the efficacy of this treatment. The main outcome measures were obstructive and central apnea indices on a polysomnogram. Results Data of 44 patients, 23 under 2 years of age and 21 older children were included. Infants when compared with older children were more likely to experience central sleep apnea (43% vs. 5%; p = 0.003). In older children obstructive was significantly more prevalent than central sleep apnea. Supplemental oxygen was used to treat 9/23 infants with central sleep apnea. Oxygen therapy resulted in a significant decrease in the median central apnea index from 14 (5,68) to 1 (0,6; p = 0.008) events/hour and an improvement in the oxygen saturation nadir from 70% (52, 92) to 81% (64, 95; p = 0.080). Conclusions Central sleep apnea with associated oxygen desaturations is more prevalent in infants compared with older children with Prader-Willi Syndrome. Supplemental oxygen was efficacious in treating central sleep apnea in infants. Routine sleep surveillance for all children with Prader-Willi Syndrome and treatment with oxygen for central sleep apnea should be considered.
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MESH Headings
- Adolescent
- Age Factors
- Child
- Child, Preschool
- Female
- Humans
- Infant
- Infant, Newborn
- Male
- Oxygen Inhalation Therapy
- Polysomnography
- Prader-Willi Syndrome/complications
- Prader-Willi Syndrome/diagnosis
- Prader-Willi Syndrome/physiopathology
- Prader-Willi Syndrome/therapy
- Sleep Apnea, Central/complications
- Sleep Apnea, Central/diagnosis
- Sleep Apnea, Central/physiopathology
- Sleep Apnea, Central/therapy
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/physiopathology
- Sleep Apnea, Obstructive/therapy
- Treatment Outcome
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Affiliation(s)
- Michal Cohen
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Jill Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
| | - Indra Narang
- The University of Toronto, Toronto, Ontario, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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90
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Konka A, Weedon J, Goldstein NA. Cost-benefit Analysis of Polysomnography versus Clinical Assessment Score-15 (CAS-15) for Treatment of Pediatric Sleep-disordered Breathing. Otolaryngol Head Neck Surg 2014; 151:484-8. [DOI: 10.1177/0194599814536844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine the cost of medical care using the Clinical Assessment Score-15 (CAS-15) scale versus polysomnography (PSG) for children with sleep-disordered breathing in terms of benefit. Study Design Cost-benefit analysis. Setting Hospital-based pediatric otolaryngology practice. Subjects and Methods Ninety-three patients from our original CAS-15 study were included. Four clinical measures were used and payment data were obtained. Cost-benefit analysis was performed for 2 clinical pathways. In pathway 1, all children had PSG; those with positive studies were referred for adenotonsillectomy. In pathway 2, children with CAS-15 ≥ 32 were referred for adenotonsillectomy regardless of PSG. Paired t test compared intrasubject mean total cost (pathway 1 vs pathway 2). Further analyses computed a change score for the clinical measures (follow-up minus baseline); these were divided by estimated treatment cost, producing 4 cost-benefit ratios for each pathway. Paired t tests compared the mean of these ratios between the pathways. Results Of 65 PSG+ (15 CAS–), 54 underwent surgery; of 28 PSG– (17 CAS–), 7 underwent surgery. Model estimated costs demonstrate a mean cost benefit of $US1172 (SE = $214) for pathway 2 versus pathway 1 ( P < .001). CAS-15 is also cost-beneficial versus PSG in 3 of 4 clinical measures (Child Behavior Checklist total problem T score, P = .008, mean OSA-18 survey score, P < .001, apnea hypopnea index, P < .001). Conclusions We present evidence that a CAS-15–based treatment decision criterion is superior to PSG in terms of monetary cost and in benefit per unit cost for 3 of 4 clinical measures evaluated.
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Affiliation(s)
- Anita Konka
- Division of Pediatric Otolaryngology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Jeremy Weedon
- Scientific Computing Center, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Nira A. Goldstein
- Division of Pediatric Otolaryngology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
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Carbon dioxide levels during polygraphy in children with sleep-disordered breathing. Sleep Breath 2014; 19:149-57. [DOI: 10.1007/s11325-014-0980-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/10/2014] [Accepted: 03/31/2014] [Indexed: 11/28/2022]
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92
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Lamprecht ML, Terrill PI, Parsley CL, Bradley AP. Characterization of movements during restless sleep in children: a pilot study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:274-277. [PMID: 25569950 DOI: 10.1109/embc.2014.6943582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Actigraphy is effective at monitoring circadian rhythms, but often misidentifies periods of restless sleep (defined here as sleep periods with movement) as wake, and periods of quiet wake as sleep. This limitation restricts the effectiveness of actigraphy for investigating sleep disorders. Our objective in this study was to investigate a time-frequency representation of movement during sleep and wake which could ultimately aid in improving classification performance by reducing false wake detections. As a pilot study, we investigate the characteristics of manually labelled movements from six patients (aged 6-12 years, 3 male) during sleep and wake using the over complete discrete wavelet decomposition. The difference between the median wavelet coefficients were analyzed for 30 movement segments from six movement categories during sleep and wake. We found that, in general, the temporal location of high energy coefficients and the energy of the high frequency bands differed between movements during sleep and wake. This indicates that we are able to differentiate movement during sleep and wake with a time-frequency representation. This representation may improve the sleep and wake classification performance by identifying movements specific to sleep and wake. This will likely improve the poor specificity inherent in conventional actigraphy.
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93
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Crockett DJ, Goudy SL, Chinnadurai S, Wootten CT. Obstructive sleep apnea syndrome in children with 22q11.2 deletion syndrome after operative intervention for velopharyngeal insufficiency. Front Pediatr 2014; 2:84. [PMID: 25157342 PMCID: PMC4127662 DOI: 10.3389/fped.2014.00084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Surgical treatment of velopharyngeal insufficiency (VPI) in 22q11.2 deletion syndrome is often warranted. In this patient population, VPI is characterized by poor palatal elevation and muscular hypotonia with an intact palate. We hypothesize that 22q11.2 deletion patients are at greater risk of obstructive sleep apnea (OSA) after surgical correction of VPI, due, in part, to their functional hypotonia, large velopharyngeal gap size, and the need to surgically obstruct the velopharynx. METHODS We performed a retrospective analysis of patients with 22q11.2 deletion syndrome treated at a tertiary pediatric hospital between the years of 2002 and 2012. The incidence of VPI, need for surgery, post-operative polysomnogram, post-operative VPI assessment, and OSA treatments were evaluated. RESULTS Forty-three patients (18 males, 25 females, ages 1-14 years) fitting the inclusion criteria were identified. Twenty-eight patients were evaluated by speech pathology due to hypernasality. Twenty-one patients had insufficient velopharyngeal function and required surgery. Fifteen underwent pharyngeal flap surgery, three underwent sphincter pharyngoplasty, two underwent Furlow palatoplasty, and one underwent combined sphincter pharyngoplasty with Furlow palatoplasty. Of these, eight had post-operative snoring. Six of these underwent polysomnography (five underwent pharyngeal flap surgeries and one underwent sphincter pharyngoplasty). Four patients were found to have OSA based on the results of the polysomnography (average apnea/hypopnea index of 4.9 events/h, median = 5.1, SD = 2.1). Two required continuous positive airway pressure (CPAP) due to moderate OSA. CONCLUSION Surgery is often necessary to correct VPI in patients with 22q11.2 deletion syndrome. Monitoring for OSA should be considered after surgical correction of VPI due to a high occurrence in this population. Furthermore, families should be counseled of the risk of OSA after surgery and the potential need for treatment with CPAP.
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Affiliation(s)
- David Jeffrey Crockett
- Department of Otolaryngology, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Steven L Goudy
- Department of Otolaryngology, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Sivakumar Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center , Nashville, TN , USA
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94
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Dawson NC, Padoa KA, Bucks RS, Allen P, Evans H, McCaughey E, Hill CM. Ventilatory function in children with severe motor disorders using night-time postural equipment. Dev Med Child Neurol 2013; 55:751-7. [PMID: 23582011 DOI: 10.1111/dmcn.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2013] [Indexed: 11/28/2022]
Abstract
AIM Night-time postural equipment (NTPE) can prevent hip subluxation in children with severe motor disorders (SMDs). However, it is unclear how it affects ventilatory function. The aims of the study were to determine how NTPE use affects ventilatory function and to compare night-to-night variability of ventilatory function in children with SMDs and typically developing healthy children. METHOD Fifteen NTPE users (six males, nine females), aged 1 to 19 years (mean age 8y 7mo) alternated sleep condition between NTPE and sleeping unsupported for 14 nights. In all but two participants, gross motor function was classified as Gross Motor Function Classification System (GMFCS) level V; in the other two it was level IV. Oxyhaemoglobin saturation (SpO2 ) was monitored each night and transcutaneous CO2 (PtcCO2 ) for one night in each sleep condition. In 17 healthy children of similar age, home SpO2 only was monitored for seven nights. RESULTS In 13 of 15 NTPE users and 12 of the 17 typically developing children, SpO2 monitoring was satisfactorily completed. Of the children with SMDs, two had mean SpO2 levels below the treatment threshold for supplemental oxygen, which was uniquely associated with use of NTPE in only one participant, and three had nocturnal hypoventilation, which was uniquely associated with NTPE use in only one case. Night-to-night SpO2 variability was higher in children with SMDs than in typically developing children. INTERPRETATION NTPE may impair or enhance ventilatory function in a minority of children. Owing to night-to-night variability in SpO2 , at least three nights of monitoring are recommended to determine optimal positioning for effective ventilation before and after NTPE introduction.
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Affiliation(s)
- Nicola C Dawson
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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95
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Jaimchariyatam N, Dweik RA, Kaw R, Aboussouan LS. Polysomnographic determinants of nocturnal hypercapnia in patients with sleep apnea. J Clin Sleep Med 2013; 9:209-15. [PMID: 23493528 DOI: 10.5664/jcsm.2480] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Identify polysomnographic and demographic factors associated with elevation of nocturnal end-tidal CO2 in patients with obstructive sleep apnea. METHODS Forty-four adult patients with obstructive sleep apnea were selected such that the maximal nocturnal end-tidal CO2 was below 45 mm Hg in 15 studies, between 45 and 50 mm Hg in 14, and above 50 mm Hg in 15. Measurements included mean event (i.e., apneas or hypopneas) and mean inter-event duration, ratio of mean post- to mean pre-event amplitude, and percentage of total sleep time spent at an end-tidal CO2 < 45, 45-50, and > 50 mm Hg. An integrated nocturnal CO2 was calculated as the sum of the products of average end-tidal CO2 at each time interval by percent of total sleep time spent at the corresponding time interval. RESULTS The integrated nocturnal CO2 was inversely correlated with mean post-apnea duration, with lesser contributions from mean apnea duration and age (R (2) = 0.56), but did not correlate with the apnea-hypopnea index, or the body mass index. Mean post-event to mean pre-event amplitude correlated with mean post-apnea duration (r = 0.88, p < 0.001). Mean apnea duration did not correlate with mean post-apnea duration. CONCLUSIONS Nocturnal capnometry reflects pathophysiologic features of sleep apnea, such as the balance of apnea and post-apnea duration, which are not captured by the apnea-hypopnea index. This study expands the indications of capnometry beyond apnea detection and quantification of hypoventilation syndromes.
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Affiliation(s)
- Nattapong Jaimchariyatam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
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96
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Owens J, Kothare S, Sheldon S. PRO: "Not just little adults": AASM should require pediatric accreditation for integrated sleep medicine programs serving both children (0-16 years) and adults. J Clin Sleep Med 2012; 8:473-6. [PMID: 23066356 DOI: 10.5664/jcsm.2132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Judith Owens
- Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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97
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Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8:597-619. [PMID: 23066376 DOI: 10.5664/jcsm.2172] [Citation(s) in RCA: 3346] [Impact Index Per Article: 278.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Academy of Sleep Medicine (AASM) Sleep Apnea Definitions Task Force reviewed the current rules for scoring respiratory events in the 2007 AASM Manual for the Scoring and Sleep and Associated Events to determine if revision was indicated. The goals of the task force were (1) to clarify and simplify the current scoring rules, (2) to review evidence for new monitoring technologies relevant to the scoring rules, and (3) to strive for greater concordance between adult and pediatric rules. The task force reviewed the evidence cited by the AASM systematic review of the reliability and validity of scoring respiratory events published in 2007 and relevant studies that have appeared in the literature since that publication. Given the limitations of the published evidence, a consensus process was used to formulate the majority of the task force recommendations concerning revisions.The task force made recommendations concerning recommended and alternative sensors for the detection of apnea and hypopnea to be used during diagnostic and positive airway pressure (PAP) titration polysomnography. An alternative sensor is used if the recommended sensor fails or the signal is inaccurate. The PAP device flow signal is the recommended sensor for the detection of apnea, hypopnea, and respiratory effort related arousals (RERAs) during PAP titration studies. Appropriate filter settings for recording (display) of the nasal pressure signal to facilitate visualization of inspiratory flattening are also specified. The respiratory inductance plethysmography (RIP) signals to be used as alternative sensors for apnea and hypopnea detection are specified. The task force reached consensus on use of the same sensors for adult and pediatric patients except for the following: (1) the end-tidal PCO(2) signal can be used as an alternative sensor for apnea detection in children only, and (2) polyvinylidene fluoride (PVDF) belts can be used to monitor respiratory effort (thoracoabdominal belts) and as an alternative sensor for detection of apnea and hypopnea (PVDFsum) only in adults.The task force recommends the following changes to the 2007 respiratory scoring rules. Apnea in adults is scored when there is a drop in the peak signal excursion by ≥ 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative apnea sensor, for ≥ 10 seconds. Hypopnea in adults is scored when the peak signal excursions drop by ≥ 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for ≥ 10 seconds in association with either ≥ 3% arterial oxygen desaturation or an arousal. Scoring a hypopnea as either obstructive or central is now listed as optional, and the recommended scoring rules are presented. In children an apnea is scored when peak signal excursions drop by ≥ 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative sensor; and the event meets duration and respiratory effort criteria for an obstructive, mixed, or central apnea. A central apnea is scored in children when the event meets criteria for an apnea, there is an absence of inspiratory effort throughout the event, and at least one of the following is met: (1) the event is ≥ 20 seconds in duration, (2) the event is associated with an arousal or ≥ 3% oxygen desaturation, (3) (infants under 1 year of age only) the event is associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds or less than 60 beats per minute for 15 seconds. A hypopnea is scored in children when the peak signal excursions drop is ≥ 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for ≥ the duration of 2 breaths in association with either ≥ 3% oxygen desaturation or an arousal. In children and adults, surrogates of the arterial PCO(2) are the end-tidal PCO(2) or transcutaneous PCO(2) (diagnostic study) or transcutaneous PCO(2) (titration study). For adults, sleep hypoventilation is scored when the arterial PCO(2) (or surrogate) is > 55 mm Hg for ≥ 10 minutes or there is an increase in the arterial PCO(2) (or surrogate) ≥ 10 mm Hg (in comparison to an awake supine value) to a value exceeding 50 mm Hg for ≥ 10 minutes. For pediatric patients hypoventilation is scored when the arterial PCO(2) (or surrogate) is > 50 mm Hg for > 25% of total sleep time. In adults Cheyne-Stokes breathing is scored when both of the following are met: (1) there are episodes of ≥ 3 consecutive central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude with a cycle length of at least 40 seconds (typically 45 to 90 seconds), and (2) there are five or more central apneas and/or central hypopneas per hour associated with the crescendo/decrescendo breathing pattern recorded over a minimum of 2 hours of monitoring.
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Affiliation(s)
- Richard B Berry
- University of Florida Health Science Center, Gainesville, FL 32610, USA.
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98
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Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Ward SLD, Tangredi MM. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012. [PMID: 23066376 PMCID: PMC3459210 DOI: 10.5664/jcsm.2172;10.5664/jcsm.2172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The American Academy of Sleep Medicine (AASM) Sleep Apnea Definitions Task Force reviewed the current rules for scoring respiratory events in the 2007 AASM Manual for the Scoring and Sleep and Associated Events to determine if revision was indicated. The goals of the task force were (1) to clarify and simplify the current scoring rules, (2) to review evidence for new monitoring technologies relevant to the scoring rules, and (3) to strive for greater concordance between adult and pediatric rules. The task force reviewed the evidence cited by the AASM systematic review of the reliability and validity of scoring respiratory events published in 2007 and relevant studies that have appeared in the literature since that publication. Given the limitations of the published evidence, a consensus process was used to formulate the majority of the task force recommendations concerning revisions.The task force made recommendations concerning recommended and alternative sensors for the detection of apnea and hypopnea to be used during diagnostic and positive airway pressure (PAP) titration polysomnography. An alternative sensor is used if the recommended sensor fails or the signal is inaccurate. The PAP device flow signal is the recommended sensor for the detection of apnea, hypopnea, and respiratory effort related arousals (RERAs) during PAP titration studies. Appropriate filter settings for recording (display) of the nasal pressure signal to facilitate visualization of inspiratory flattening are also specified. The respiratory inductance plethysmography (RIP) signals to be used as alternative sensors for apnea and hypopnea detection are specified. The task force reached consensus on use of the same sensors for adult and pediatric patients except for the following: (1) the end-tidal PCO(2) signal can be used as an alternative sensor for apnea detection in children only, and (2) polyvinylidene fluoride (PVDF) belts can be used to monitor respiratory effort (thoracoabdominal belts) and as an alternative sensor for detection of apnea and hypopnea (PVDFsum) only in adults.The task force recommends the following changes to the 2007 respiratory scoring rules. Apnea in adults is scored when there is a drop in the peak signal excursion by ≥ 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative apnea sensor, for ≥ 10 seconds. Hypopnea in adults is scored when the peak signal excursions drop by ≥ 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for ≥ 10 seconds in association with either ≥ 3% arterial oxygen desaturation or an arousal. Scoring a hypopnea as either obstructive or central is now listed as optional, and the recommended scoring rules are presented. In children an apnea is scored when peak signal excursions drop by ≥ 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative sensor; and the event meets duration and respiratory effort criteria for an obstructive, mixed, or central apnea. A central apnea is scored in children when the event meets criteria for an apnea, there is an absence of inspiratory effort throughout the event, and at least one of the following is met: (1) the event is ≥ 20 seconds in duration, (2) the event is associated with an arousal or ≥ 3% oxygen desaturation, (3) (infants under 1 year of age only) the event is associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds or less than 60 beats per minute for 15 seconds. A hypopnea is scored in children when the peak signal excursions drop is ≥ 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for ≥ the duration of 2 breaths in association with either ≥ 3% oxygen desaturation or an arousal. In children and adults, surrogates of the arterial PCO(2) are the end-tidal PCO(2) or transcutaneous PCO(2) (diagnostic study) or transcutaneous PCO(2) (titration study). For adults, sleep hypoventilation is scored when the arterial PCO(2) (or surrogate) is > 55 mm Hg for ≥ 10 minutes or there is an increase in the arterial PCO(2) (or surrogate) ≥ 10 mm Hg (in comparison to an awake supine value) to a value exceeding 50 mm Hg for ≥ 10 minutes. For pediatric patients hypoventilation is scored when the arterial PCO(2) (or surrogate) is > 50 mm Hg for > 25% of total sleep time. In adults Cheyne-Stokes breathing is scored when both of the following are met: (1) there are episodes of ≥ 3 consecutive central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude with a cycle length of at least 40 seconds (typically 45 to 90 seconds), and (2) there are five or more central apneas and/or central hypopneas per hour associated with the crescendo/decrescendo breathing pattern recorded over a minimum of 2 hours of monitoring.
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Affiliation(s)
- Richard B. Berry
- University of Florida, Gainesville, FL,Address correspondence to: Richard B. Berry, Division of Pulmonary Medicine, University of Florida Health Science Center, PO Box 100225, Gainesville, FL 32610(352) 376-1611(352) 379-4155
| | | | | | - David Gozal
- Department of Pediatrics, University of Chicago, Chicago, IL
| | | | - Vishesh K. Kapur
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA
| | | | | | | | | | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | | | - Sally L. Davidson Ward
- Division of Pediatric Pulmonology, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
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99
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Central apnea after adenotonsillectomy in childhood: case report. Sleep Breath 2012; 16:961-6. [DOI: 10.1007/s11325-011-0634-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 12/02/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
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100
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Powitzky R, Stoner J, Fisher T, Digoy GP. Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia. Int J Pediatr Otorhinolaryngol 2011; 75:1234-9. [PMID: 21816491 DOI: 10.1016/j.ijporl.2011.06.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 06/25/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the clinical and polysomnography outcomes in infants with laryngomalacia undergoing supraglottoplasty. METHODS Infants (<1 year old) who underwent polysomnography pre- and post-supraglottoplasty at our tertiary referral center between 2003 and 2009 were reviewed retrospectively. Outcome measures included changes in stridor, sleep disordered breathing, swallowing, and polysomnography parameters before and after surgery. Pre- and postoperative distributions were compared using a Wilcoxon signed-rank test. RESULTS 20 children met inclusion criteria. Statistically significant improvements were found in pre- to postoperative median values for apnea-hypopnea index (AHI) (median change: -6.4 points, p=0.02) and obstructive apnea index (median change: -2.9 points, p=0.01) values. Obstructive AHI, O₂ saturation nadir, and percentage of sleep spent with <90% O₂ saturation improved, although not significantly. Postoperative AHI scores correlated with improvements in stridor in 80% of patients. Stratification showed similar improvements in AHI after supraglottoplasty regardless of reflux treatment, secondary airway lesions, age at supraglottoplasty, or time lag between supraglottoplasty and postoperative polysomnography. Secondary airway lesions are the only potential confounders shown to have significantly better improvements in O₂ nadir. While the sleep study improved in patients with AHI >5, infants with AHI <5 had worse polysomnography parameter values postoperatively. Five patients had dysphagia that resolved within one month postoperatively; otherwise, supraglottoplasty resulted in no complications. CONCLUSION Supraglottoplasty may be an effective and safe option to improve moderate to severe obstructive sleep apnea in infants with laryngomalacia. In addition, polysomnography may be useful in infants with laryngomalacia to identify obstructive sleep apnea and/or to objectively measure outcomes after supraglottoplasty. This pilot study warrants a larger, prospective, and controlled study to validate these findings.
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Affiliation(s)
- Rosser Powitzky
- Oklahoma University Health Science Center, Oklahoma City, OK, USA.
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