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Pamula Y, Nixon GM, Edwards E, Teng A, Verginis N, Davey MJ, Waters K, Suresh S, Twiss J, Tai A. Australasian Sleep Association clinical practice guidelines for performing sleep studies in children. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gruber R, Constantin E, Frappier JY, Brouillette RT, Wise MS. Training, knowledge, attitudes and practices of Canadian health care providers regarding sleep and sleep disorders in children. Paediatr Child Health 2017; 22:322-327. [PMID: 29479245 DOI: 10.1093/pch/pxx069] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Sleep disorders are prevalent in children and are associated with significant comorbidity. Objective To assess the training, knowledge, attitudes and practices of Canadian health care providers (HCPs) regarding sleep disorders in children. Method A 42-item survey, designed to collect information on frequency of paediatric sleep disorders-related screening and diagnosis, implementation of evidence-based interventions and related knowledge base, was completed by HCPs. Results Ninety-seven HCPs completed the survey. One per cent obtained training in paediatric sleep during undergraduate training and 3% obtained such training during their residencies, yet 34.9% estimated that 25 to 50% of their patients suffered from sleep disorders. Most HCPs thought that sleep disorders significantly impacted children's health and daytime function. Most HCPs screened for developmental sleep issues, but not consistently for sleep disorders. Most recommended evidence-based behavioural interventions for behavioural sleep disorders, but some also reported behavioural interventions that were not first-line or recommended. Inadequate knowledge regarding melatonin use was evident. Most participants reported rarely/never ordering a sleep study for a child with suspected obstructive sleep apnea (OSA). Most were familiar with surgical and weight loss management options for OSA; many were unfamiliar with benefits of continuous positive airway pressure. Participants' knowledge scores were highest on developmental and behavioural aspects of sleep, and lowest on sleep disorders. Conclusions HCPs exhibit significant gaps in their knowledge, screening, evaluation and treatment practices for paediatric sleep disorders. Training at the undergraduate, graduate and postgraduate levels, as well as Continuing Medical Education are needed to optimize recognition, treatment and follow-up of paediatric sleep disorders.
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Affiliation(s)
- Reut Gruber
- Department of Psychiatry, Faculty of Medicine, Attention, Behavior and Sleep Laboratory, Douglas Research Institute, McGill University, Montreal, Quebec
| | - Evelyn Constantin
- Department of Pediatrics, Pediatric Sleep Laboratory, Montreal Children's Hospital of the McGill University Health Centre, McGill University, Montreal, Quebec
| | - Jean Yves Frappier
- Department of Paediatrics, University of Montreal and CHU Sainte-Justine, Montreal, Quebec
| | - Robert T Brouillette
- Department of Pediatrics, Pediatric Sleep Laboratory, Montreal Children's Hospital of the McGill University Health Centre, McGill University, Montreal, Quebec
| | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, Tennessee, USA
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Duraccio KM, Carbine KA, Barnett KA, Stevens KS, Jensen CD. The utility of the Children’s Sleep Habits Questionnaire: Associations between parental report and an objective measure of sleep behavior. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1316198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | - Chad D. Jensen
- Psychology Department, Brigham Young University, Provo, UT
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Plotkin SR, Davis SD, Robertson KA, Akshintala S, Allen J, Fisher MJ, Blakeley JO, Widemann BC, Ferner RE, Marcus CL. Sleep and pulmonary outcomes for clinical trials of airway plexiform neurofibromas in NF1. Neurology 2017; 87:S13-20. [PMID: 27527645 DOI: 10.1212/wnl.0000000000002933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/06/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Plexiform neurofibromas (PNs) are complex, benign nerve sheath tumors that occur in approximately 25%-50% of individuals with neurofibromatosis type 1 (NF1). PNs that cause airway compromise or pulmonary dysfunction are uncommon but clinically important. Because improvement in sleep quality or airway function represents direct clinical benefit, measures of sleep and pulmonary function may be more meaningful than tumor size as endpoints in therapeutic clinical trials targeting airway PN. METHODS The Response Evaluation in Neurofibromatosis and Schwannomatosis functional outcomes group reviewed currently available endpoints for sleep and pulmonary outcomes and developed consensus recommendations for response evaluation in NF clinical trials. RESULTS For patients with airway PNs, polysomnography, impulse oscillometry, and spirometry should be performed to identify abnormal function that will be targeted by the agent under clinical investigation. The functional group endorsed the use of the apnea hypopnea index (AHI) as the primary sleep endpoint, and pulmonary resistance at 10 Hz (R10) or forced expiratory volume in 1 or 0.75 seconds (FEV1 or FEV0.75) as primary pulmonary endpoints. The group defined minimum changes in AHI, R10, and FEV1 or FEV0.75 for response criteria. Secondary sleep outcomes include desaturation and hypercapnia during sleep and arousal index. Secondary pulmonary outcomes include pulmonary resistance and reactance measurements at 5, 10, and 20 Hz; forced vital capacity; peak expiratory flow; and forced expiratory flows. CONCLUSIONS These recommended sleep and pulmonary evaluations are intended to provide researchers with a standardized set of clinically meaningful endpoints for response evaluation in trials of NF1-related airway PNs.
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Affiliation(s)
- Scott R Plotkin
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK.
| | - Stephanie D Davis
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Kent A Robertson
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Srivandana Akshintala
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Julian Allen
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Michael J Fisher
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Jaishri O Blakeley
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Brigitte C Widemann
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Rosalie E Ferner
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
| | - Carole L Marcus
- From the Neurology Department and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston; Section of Pediatric Pulmonology, Allergy and Sleep Medicine (S.D.D.), and Stem Cell Transplantation Program (K.A.R.), Riley Children's Hospital, Indiana University School of Medicine, Indianapolis; Pediatric Oncology Branch (S.A., B.C.W.), National Cancer Institute, Bethesda, MD; Division of Pulmonary Medicine (J.A.), Division of Oncology (M.J.F.), and Sleep Center (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.) and Sleep Center (C.L.M.), The Perelman School of Medicine at the University of Pennsylvania (J.A.), Philadelphia; Department of Neurology (J.O.B.), John Hopkins Medical Institute, Baltimore, MD; and Department of Neurology (R.E.F.), Guy's and St. Thomas' NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
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Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:709-757. [PMID: 28359099 PMCID: PMC6283429 DOI: 10.1210/jc.2016-2573] [Citation(s) in RCA: 620] [Impact Index Per Article: 88.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
COSPONSORING ASSOCIATIONS The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSION Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
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Affiliation(s)
- Dennis M Styne
- University of California Davis, Sacramento, California 95817
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Diagnostic du syndrome d’apnée obstructive du sommeil chez l’enfant (2–18 ans) : place de la polysomnographie et de la polygraphie ventilatoire. Arch Pediatr 2017; 24 Suppl 1:S16-S27. [DOI: 10.1016/j.arcped.2016.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/27/2016] [Indexed: 11/21/2022]
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Ng DK, Huang YS, Teoh OH, Preutthipan A, Xu ZF, Sugiyama T, Wong KS, Kwok KL, Fung BY, Lee RP, Ng JH, Leung SY, Che DT, Li A, Wong TK, Khosla I, Nathan A, Leopando MT, Al Kindy H. The Asian Paediatric Pulmonology Society (APPS) position statement on childhood obstructive sleep apnea syndrome. ACTA ACUST UNITED AC 2017. [DOI: 10.4103/prcm.prcm_13_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lammers AE, Apitz C, Zartner P, Hager A, Dubowy KO, Hansmann G. Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart 2016; 102 Suppl 2:ii1-13. [PMID: 27053692 DOI: 10.1136/heartjnl-2015-307792] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 06/30/2015] [Indexed: 12/16/2022] Open
Abstract
Pulmonary hypertension (PH) is a condition of multiple aetiologies with underestimated prevalence and incidence. Indeed, despite access to modern therapies, pulmonary hypertensive vascular disease (PHVD) remains a progressive, usually life-limiting condition, severely impacting on the patients' well-being. We herein provide practical, expert consensus recommendations on the initial diagnostic work-up, clinical management and follow-up of children and adolescents with PH/PHVD, including a diagnostic algorithm. The major topics and methods that need to be tailored and put into context of the individual patient include PH classification, clinical signs and symptoms, basic diagnostic and advanced imaging measures (ECG, chest X-ray, transthoracic echocardiography, cardiac magnetic resonance, chest CT angiography, cardiac catheterisation, ventilation-perfusion lung scan, abdominal ultrasound), lung function tests, 6 min walk and cardiopulmonary exercise testing, sleep study (polysomnography), laboratory/immunological tests, considerations for elective surgery/ general anaesthesia, physical education and exercise, flying on commercial airplanes, vaccinations, care of central intravenous lines and palliative care. Due to the complexity of PH/PHVD, the clinical care has to be multidisciplinary and coordinated by a dedicated specialist paediatric PH centre, not only to decrease mortality but to allow children with PH/PHVD to reach a reasonable quality of life.
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Affiliation(s)
- Astrid E Lammers
- Department of Paediatric Cardiology, University of Münster, Münster, Germany
| | - Christian Apitz
- Division of Paediatric Cardiology, University Children's Hospital Ulm, Germany
| | - Peter Zartner
- Department of Paediatric Cardiology, German Paediatric Heart Centre, Sankt Augustin, Germany
| | - Alfred Hager
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich and Technical University, Munich, Germany
| | - Karl-Otto Dubowy
- Department of Paediatric Cardiology and Congenital Heart Disease, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Georg Hansmann
- Department of Paediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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Noninvasive Positive Airway Pressure Treatment in Children Less Than 12 Months of Age. Can Respir J 2016; 2016:7654631. [PMID: 27445563 PMCID: PMC4925978 DOI: 10.1155/2016/7654631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022] Open
Abstract
Study Objectives. We identified the associated conditions of patients less than 12 months of age who were referred for polysomnogram (PSG) studies. We collated PSG findings and physician interpretation. We determined the correlation between the recommended treatment by the PSG interpreting physician and actual prescribed treatment by the referring or subjects' physician. We determined adherence with noninvasive positive airway pressure (PAP) treatment. Methods. This was a retrospective cohort study. Participants included children less than 12 months of age referred for PSG studies between 2007 and 2012. Results. 92 patients under the age of 12 months were included in the study analysis. Mean (standard deviation, SD) age in days at time of the PSG study was 208.5 (101.2). 35 (38%) patients had a diagnosis of Trisomy 21. Seven (8%) patients had no prior diagnosis. Median (Q1, Q3) apnea hypopnea index (AHI) was 22.5 (11.3–37.0). Agreement between the PSG interpreting physician's recommendation and actual prescribed treatment by the referring or subjects' physician was 85.9% [95% CI 77.1–91.6]. Mean (SD) percentage days with PAP therapy usage more than 4 hours was 25.2% (32). Conclusions. In our experience, despite consistent physician messaging to families, adherence with noninvasive PAP treatment is low.
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Kaditis A, Kheirandish-Gozal L, Gozal D. Pediatric OSAS: Oximetry can provide answers when polysomnography is not available. Sleep Med Rev 2016; 27:96-105. [DOI: 10.1016/j.smrv.2015.05.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 11/29/2022]
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Treacher Collins Syndrome: A Systematic Review of Evidence-Based Treatment and Recommendations. Plast Reconstr Surg 2016; 137:191-204. [PMID: 26710023 DOI: 10.1097/prs.0000000000001896] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No reviews or guidelines are available on evidence-based treatment for the multidisciplinary approach in Treacher Collins syndrome. The authors' aim is to provide an evidence-based review of multidisciplinary treatment of Treacher Collins syndrome based on levels of evidence and supported with graded recommendations. METHODS A systematic search was performed by means of the PubMed, Web-of-Science, Embase, and Cochrane Central databases (1985 to January of 2014). Included were clinical studies (with five or more Treacher Collins syndrome patients) related to therapy, diagnosis, or risk of concomitant diseases. Level of evidence of the selected articles was rated according to the American Society of Plastic Surgeons evidence-based clinical practice guidelines. After two panelists had reviewed each abstract separately, a consensus method was used to solve any disagreements concerning article inclusion. RESULTS Of the 2433 identified articles, 63 studies (Level of Evidence II through V) were included. Conclusions and recommendations were extracted consecutively for the following items: upper airway; ear, hearing, and speech; the eye, eyelashes, and lacrimal system; growth, feeding, and swallowing; the nose; psychosocial factors; and craniofacial reconstruction. CONCLUSIONS In this systematic review, current evidence for the multidisciplinary treatment of Treacher Collins syndrome is provided, recommendations for treatment are made, and a proposed algorithm for treatment is presented. Although some topics are well supported, others, especially ocular, nasal, speech, feeding, and swallowing problems, lack sufficient evidence. In addition, craniofacial surgical reconstruction lacks a sufficient level of evidence to provide a sound basis for a full treatment protocol. Despite the rarity of the syndrome, more research is needed to compare outcomes of several surgical treatments, especially in orbitozygomatic/maxillary regions.
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Abstract
Adenotonsillectomy is widely considered to be an effective treatment for sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) in the pediatric population. However, in some patients, SDB and OSA can persist despite surgical treatment with adenotonsillectomy. Options to manage persistent SDB/OSA depend on symptoms and severity. Many patients with mild residual OSA can be managed with nasal steroids and observed. Those with more moderate-to-severe residual pathology often can be managed with conservative measures that usually include continuous positive airway pressure (CPAP) therapy. However, some patients cannot tolerate CPAP, and are therefore candidates to be evaluated for addition surgical therapies. [Pediatr Ann. 2016;45(5):e180-e183.].
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Amin R, Al-Saleh S, Narang I. Domiciliary noninvasive positive airway pressure therapy in children. Pediatr Pulmonol 2016; 51:335-48. [PMID: 26663667 DOI: 10.1002/ppul.23353] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/09/2015] [Accepted: 11/21/2015] [Indexed: 12/28/2022]
Abstract
There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.
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Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
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[Diagnostic criteria for obstructive sleep apnea syndrome]. Arch Pediatr 2016; 23:432-6. [PMID: 26968302 DOI: 10.1016/j.arcped.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/01/2016] [Indexed: 11/22/2022]
Abstract
The prevalence of obstructive sleep apnea syndrome (OSAS) is 1-4 % in school-aged children. Adenotonsillar hypertrophy is the most common etiology of OSAS in children. Other causes are obesity; facial or skeletal malformations; and neuromuscular, respiratory, or metabolic diseases. OSAS has been associated with sleep quality disturbance (frequent arousals) and nocturnal gas exchange abnormalities (hypoxemia and sometimes hypercapnia), which can both result in negative health outcomes. The analysis of clinical symptoms and physical examination cannot always distinguish between children with primary snoring and children with OSAS. However, the association of at least one sign of nocturnal upper airway obstruction with other diurnal or nocturnal symptoms can be sufficient to establish OSAS diagnosis in a child more than 3 years of age with clear enlarged tonsils but who is otherwise healthy. In all other cases, polysomnography (the gold standard for the diagnosis of sleep-disordered breathing) must be performed either to declare the diagnosis when clinical assessment is not conclusive or when risk factors are present, or to follow up children with an associated health condition or initial severe OSAS. The equipment used to record sleep and the interpretation criteria are all pediatric-specific. Other methods, such as respiratory polygraphy, are simpler to implement, but further studies are warranted to validate the interpretation criteria of these methods in children. However, in centers with experienced personnel, polygraphy can be used in place of polysomnography. In all cases, the analysis of sleep traces must be manual and performed by personnel under the supervision of medical staff trained to interpret pediatric sleep studies.
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Basart H, König A, Bretschneider J, Hoekstra C, Oomen K, Pullens B, Rinkel R, van Gogh C, van der Horst C, Hennekam R. Awake Flexible Fiberoptic Laryngoscopy to diagnose glossoptosis in Robin Sequence patients. Clin Otolaryngol 2016; 41:467-71. [DOI: 10.1111/coa.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Basart
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - A.M. König
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | | | - C.E.L. Hoekstra
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | - K.P.Q. Oomen
- Department of Otolaryngology; Utrecht Medical Center/Wilhelmina Children's Hospital; Utrecht Netherlands
| | - B. Pullens
- Department of Otolaryngology; Erasmus Medical Center/Sophia Pediatric Hospital; Rotterdam Netherlands
| | - R.N.P.M. Rinkel
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.D.L. van Gogh
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.M.A.M. van der Horst
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - R.C. Hennekam
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
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DeHaan KL, Seton C, Fitzgerald DA, Waters KA, MacLean JE. Polysomnography for the diagnosis of sleep disordered breathing in children under 2 years of age. Pediatr Pulmonol 2015; 50:1346-53. [PMID: 25777054 PMCID: PMC6680200 DOI: 10.1002/ppul.23169] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/03/2015] [Accepted: 01/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To describe clinical polysomnography (PSG) results, sleep physicians' diagnosis, and treatment of sleep disorder breathing in children less than 2 years of age. STUDY DESIGN Retrospective clinical chart review at a pediatric tertiary care center, pediatric sleep laboratory. SUBJECT SELECTION Children less than 2 years of age who underwent clinical PSG over a 3-year period. METHODOLOGY PSG results and physician interpretations were identified for inclusions. Children were excluded if either PSG results or physician interpretations were unavailable for review. Infants were classified in three age groups for comparison: <6 months, 6-12 months, and >12 months. RESULTS Matched records were available for 233 PSGs undertaken at a mean age 11.1 ± 7.0 months; 31% were <6 months, 23% were 6-12 months, and 46% were 12-24 months of age. Infants <6 months showed significant differences on sleep parameters and respiratory indicators compared to other groups. Compared to physician sleep disordered breathing (SDB) classification, current pediatric apnea-hypopnea index (AHI)-based SDB severity classification overestimated SDB severity. Age and obstructive-mixed AHI (OMAHI) were most closely associated with physician identification of SDB. CONCLUSION Children <6 months of age appear to represent a distinct group with respect to PSG. Experienced sleep physicians appear to incorporate age and respiratory event frequently when determining the presence of SDB. Further information about clinical significance of apnea in infancy is required, assisted by identification of factors that sleep physicians use to identify SDB in children <6 months of age.
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Affiliation(s)
- Kristie L DeHaan
- Department of Paediatrics, Division of Respiratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Chris Seton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen A Waters
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Physiology, University of Sydney, Sydney, New South Wales, Australia
| | - Joanna E MacLean
- Department of Paediatrics, Division of Respiratory Medicine, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2015; 47:69-94. [PMID: 26541535 DOI: 10.1183/13993003.00385-2015] [Citation(s) in RCA: 462] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).
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Affiliation(s)
- Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Pediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Chawla J, Waters KA. Snoring in children. J Paediatr Child Health 2015; 51:847-50; quiz 850-1. [PMID: 26333074 DOI: 10.1111/jpc.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/30/2022]
Abstract
Chronic snoring (≥4 nights per week) is not benign. Otherwise healthy children with chronic snoring and evidence of adenotonsillar hypertrophy can be referred directly for adenotonsillectomy. Snoring children <30 months or with significant medical comorbidities should be referred for specialist sleep evaluation. Older children with intermittent snoring or without significant medical comorbidities can be managed with a combination of medical and surgical interventions listed herein.
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Affiliation(s)
- Jasneek Chawla
- Paediatric Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Karen Ann Waters
- Paediatric Respiratory & Sleep Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Gachelin E, Reynaud R, Dubus JC, Stremler-Le Bel N. [Detection and treatment of respiratory disorders in obese children: Obstructive sleep apnea syndrome and obesity hypoventilation syndrome]. Arch Pediatr 2015; 22:908-15. [PMID: 26251053 DOI: 10.1016/j.arcped.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 04/20/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Pediatric obesity may induce multiple complications, including cardiovascular and metabolic problems in adulthood. It may also cause respiratory disorders, which are not usually the first-intention diagnosis by physicians. The aim of this study was to evaluate how investigations had been performed in obese children referred to Timone Pediatric Hospital. PATIENTS AND METHODS A retrospective study of children referred to our department for severe non-syndromic obesity was conducted. The clinical features comprised history, anthropometric parameters, dietary habits, acanthosis nigricans, symptoms of obstructive sleep apnea syndrome (OSAS) as well as the paraclinical endocrine markers, blood gases, and sleep recordings. RESULTS Of 102 patients (mean age, 10.5±3.3 years; BMI Z-score, 4.52±1.5), 29.4% had OSAS symptoms (n=30). Nine had a pathological polysomnography confirming OSAS. Eight of them required ventilation: these children were the most severe with an earlier weight gain (2.17±1.2 years vs. 4.0±2.2 years; P=0.01) and a higher BMI Z-score (7.2±2.3 vs. 4.3±1.1; P=0.027). Obesity hypoventilation syndrome (OHS) was diagnosed in 3.9% of these children (n=4). CONCLUSION Diagnosis of OSAS and OHS, often overlooked in obese children, requires a systematic approach and early clinical detection of respiratory disorders. Better accessibility to sleep respiratory explorations would improve quality of care for these children.
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Affiliation(s)
- E Gachelin
- Service de pédiatrie spécialisée et médecine infantile, hôpital d'enfants de la Timone, Aix-Marseille université, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - R Reynaud
- Service de pédiatrie multidisciplinaire, hôpital d'enfants de la Timone, Aix-Marseille université, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - J-C Dubus
- Service de pédiatrie spécialisée et médecine infantile, hôpital d'enfants de la Timone, Aix-Marseille université, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - N Stremler-Le Bel
- Service de pédiatrie spécialisée et médecine infantile, hôpital d'enfants de la Timone, Aix-Marseille université, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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71
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Adeleye A, Ho AW, Nettel-Aguirre A, Kirk V, Buchhalter J. Prevalence of Interictal Epileptiform Discharges in Children Less Than One Year of Age Referred for Polysomnography. Neurodiagn J 2015; 55:122-32. [PMID: 26173350 DOI: 10.1080/21646821.2015.1043224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to identify the prevalence of interictal epileptiform discharges (IEDs) in patients less than one year of age referred for polysomnogram (PSG), to quantify the number of IEDs and characterize sleep stage(s) during which IEDs occur, and to relate the reason for PSG referral and IED frequency. This was a retrospective cohort study of children less than 12 months of age referred for PSG studies. Fifty study participants had sufficient EEG data, and 49 were included in the study analysis. We identified an IED prevalence rate of 28% over the 2-year study period. The mean number (Standard Deviation; SD) of IEDs per hour of total sleep time was 0.4 (1.2). IEDs occurred most frequently in non-rapid eye movement (NREM) stages 2 and 3 of sleep. The most common reason for PSG referral in this patient cohort was for obstructive sleep apnea (OSA) (42/50). We concluded that patients less than 12 months of age referred for PSG may have abnormal brain activity. The relationship of that activity to PSG findings is unclear. This study offers a systematic process of identifying IEDs that should prompt referral to a neurologist for further evaluation.
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Alonso-Álvarez ML, Terán-Santos J, Ordax Carbajo E, Cordero-Guevara JA, Navazo-Egüia AI, Kheirandish-Gozal L, Gozal D. Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children. Chest 2015; 147:1020-1028. [PMID: 25539419 PMCID: PMC4388115 DOI: 10.1378/chest.14-1959] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/25/2014] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date, same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. The apnea-hypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coefficients, Bland-Altman plots, and receiver operator curves (ROCs). RESULTS Twenty-seven boys and 23 girls, with a mean age of 5.3 ± 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defined obstructive respiratory disturbance index ≥ 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defined OSAS criterion was established as ≥ 5.6/h The latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specificity of 94.1% (95% CI, 80%-100%). CONCLUSIONS HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children.
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Affiliation(s)
| | | | | | | | | | - Leila Kheirandish-Gozal
- Instituto Carlos III, CIBERES, and the Hospital Universitario de Burgos, Burgos, Spain; Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - David Gozal
- Instituto Carlos III, CIBERES, and the Hospital Universitario de Burgos, Burgos, Spain; Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
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Kothare SV, Rosen CL, Lloyd RM, Paruthi S, Thomas SM, Troester MM, Carden KA. Quality measures for the care of pediatric patients with obstructive sleep apnea. J Clin Sleep Med 2015; 11:385-404. [PMID: 25700879 DOI: 10.5664/jcsm.4558] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/13/2022]
Abstract
ABSTRACT The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: insomnia, obstructive sleep apnea in adults, obstructive sleep apnea in children, restless legs syndrome, and narcolepsy. This paper describes the rationale, background, general methods development, and considerations in implementation of these quality measures in obstructive sleep apnea (OSA) in children. This document describes measurement methods for five desirable process measures: assessment of symptoms and risk factors of OSA, initiation of an evidence-based action plan, objective evaluation of high-risk children with OSA by obtaining a polysomnogram (PSG), reassessment of signs and symptoms of OSA within 12 months, and documentation of objective assessment of positive airway pressure adherence. When these five process measures are met, clinicians should be able to achieve the two defined outcomes: improve detection of childhood OSA and reduce signs and symptoms of OSA after initiation of a management plan. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with childhood OSA.
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Affiliation(s)
| | - Carol L Rosen
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
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75
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Karimzadeh P. Psycho-cognitive behavioral problems in sleep disordered children. Neural Regen Res 2015; 7:635-9. [PMID: 25745456 PMCID: PMC4346990 DOI: 10.3969/j.issn.1673-5374.2012.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 01/22/2012] [Indexed: 12/21/2022] Open
Abstract
Sleep disturbances are common in childhood and adolescence. Sleep problems in early infants tend to be persistent and prominent in preschool and school-aged children. Chronic sleep disorders, especially in young children may lead to neurobehavioral problems and psycho-cognitive impairment. Sleep difficulties may be the result of underlying medical conditions, (breathing disorders) or psychological problems. Research studies have shown the association between sleep disorders and day time cognitive impairment, behavioral problems, poor school performance and inattention in children. Appropriate diagnosis and early management of sleep disorders in children lead to improvement of neurocognitive function and behavioral problems in these children.
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Affiliation(s)
- Parvaneh Karimzadeh
- Research Center of Pediatric Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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76
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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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Bandla H, D'Andrea LA. Natural history and management of pediatric obstructive sleep apnea—emerging concepts. Sleep 2015; 38:11-2. [PMID: 25515112 DOI: 10.5665/sleep.4314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 01/20/2023] Open
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Polygraphic respiratory events during sleep in children treated with home continuous positive airway pressure: description and clinical consequences. Sleep Med 2015; 16:107-12. [DOI: 10.1016/j.sleep.2014.07.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/25/2014] [Accepted: 07/26/2014] [Indexed: 11/19/2022]
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Thongyam A, Marcus CL, Lockman JL, Cornaglia MA, Caroff A, Gallagher PR, Shults J, Traylor JT, Rizzi MD, Elden L. Predictors of perioperative complications in higher risk children after adenotonsillectomy for obstructive sleep apnea: a prospective study. Otolaryngol Head Neck Surg 2014; 151:1046-54. [PMID: 25301788 DOI: 10.1177/0194599814552059] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Retrospective studies have limitations in predicting perioperative risk following adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Few prospective studies exist. We hypothesized that demographic and polysomnographic (PSG) variables would predict respiratory and general perioperative complications. STUDY DESIGN Prospective, observational cohort study. SETTING Pediatric tertiary center. SUBJECTS AND METHODS Consecutive children undergoing adenotonsillectomy for OSAS within 12 months of PSG were evaluated for complications occurring within 2 weeks of surgery. RESULTS There were 329 subjects, with 27% <3 years old, 24% obese, 16% preterm, and 29% with comorbidities. In this higher risk population, 28% had respiratory complications (major and/or minor), and 33% had nonrespiratory complications. Significant associations were found between PSG parameters and respiratory complications as follows: apnea hypopnea index (rank-biserial correlation coefficient [r] = 0.174, P = .017), SpO2 nadir (r = -0.332, P < .0005), sleep time with SpO2 <90% (r = 0.298, P < .0005), peak end-tidal CO2 (r = 0.354, P < .0005), and sleep time with end-tidal CO2 >50 mm Hg (r = 0.199, P = .006). Associations were also found between respiratory complications and age <3 years (r = -0.174, P = .003) or black race (r = 0.123, P = .039). No significant associations existed between PSG parameters and nonrespiratory complications. A model using age <3 years, SpO2 nadir, and peak CO2 predicted respiratory complications better than the American Academy of Pediatrics or American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines but was imperfect (area under the curve = 0.72). CONCLUSION Thus, PSG predicted perioperative respiratory, but not nonrespiratory, complications in children with OSAS. Age <3 years or black race are high-risk factors. Present guidelines have limitations in determining the need for postoperative admission.
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Affiliation(s)
- Anchana Thongyam
- Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA Bangkok Pattaya Hospital, Chonburi, Thailand Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Carole L Marcus
- Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justin L Lockman
- Anesthesia and Critical Care Medicine Department, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mary Anne Cornaglia
- Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Aviva Caroff
- Division of Otolaryngology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul R Gallagher
- Clinical and Translational Research Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Clinical and Translational Research Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joel T Traylor
- Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark D Rizzi
- Division of Otolaryngology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa Elden
- Division of Otolaryngology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Smith BK, Goddard M, Childers MK. Respiratory assessment in centronuclear myopathies. Muscle Nerve 2014; 50:315-26. [PMID: 24668768 DOI: 10.1002/mus.24249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/23/2022]
Abstract
The centronuclear myopathies (CNMs) are a group of inherited neuromuscular disorders classified as congenital myopathies. While several causative genes have been identified, some patients do not harbor any of the currently known mutations. These diverse disorders have common histological features, which include a high proportion of centrally nucleated muscle fibers, and clinical attributes of muscle weakness and respiratory insufficiency. Respiratory problems in CNMs may manifest initially during sleep, but daytime symptoms, ineffective airway clearance, and hypoventilation predominate as more severe respiratory muscle dysfunction evolves. Respiratory muscle capacity can be evaluated using a variety of clinical tests selected with consideration for the age and baseline motor function of the patient. Similar clinical tests of respiratory function can also be incorporated into preclinical CNM canine models to offer insight for clinical trials. Because respiratory problems account for significant morbidity in patients, routine assessments of respiratory muscle function are discussed.
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Affiliation(s)
- Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
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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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82
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Sleep studies in children on long-term non-invasive respiratory support. Sleep Breath 2014; 18:885-9. [DOI: 10.1007/s11325-014-0960-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 01/16/2014] [Accepted: 02/14/2014] [Indexed: 12/26/2022]
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Tan HL, Gozal D, Ramirez HM, Bandla HPR, Kheirandish-Gozal L. Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. Sleep 2014; 37:255-60. [PMID: 24497654 DOI: 10.5665/sleep.3392] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Substantial discrepancies exist in the type of sleep studies performed to diagnose pediatric obstructive sleep apnea (OSA) in different countries. Respiratory polygraphic (RP) recordings are primarily performed in sleep laboratories in Europe, whereas polysomnography (PSG) constitutes the majority in the US and Australia. Home RP show consistent apnea-hypopnea index (AHI) underscoring, primarily because the total recording time is used as the denominator when calculating the AHI compared to total sleep time (TST). However, laboratory-based RP are less likely affected, since the presence of sleep technicians and video monitoring may enable more accurate TST estimates. We therefore examined differences in AHI in PSG and in-lab RP, and whether RP-based AHI may impact clinical decision making. METHODS Of all the children assessed for possible OSA who underwent PSG evaluation, 100 were identified and divided into 4 groups: (A) those with AHI < 1/h TST (n = 20), (B) 1 ≤ AHI < 5/h TST (n = 40), (C) 5 ≤ AHI < 10/h TST (n = 20), and (D) AHI ≥ 10/h TST (n = 20). Electroencephalography, electrooculography, and electromyography channels were deleted from the original unscored recordings to transform them into RP, and then rescored in random sequence. AHI-RP were compared to AHI-PSG, and therapeutic decisions based on AHI-RP and AHI-PSG were formulated and analyzed using clinical details derived from the patient's clinic letter. RESULTS Bland Altman analysis showed that in lab RP underestimated the AHI despite more accurate estimates of TST. This underestimation was due to missed hypopneas causing arousals without desaturation. Basing the therapeutic management decision on RP instead of PSG results changed the clinical management in 23% of all patients. The clinical management for patients in groups A and D was unaffected. However, 27.5% of patients in group B would have been given no treatment, as they would be diagnosed as having no OSA (AHI < 1/h TST) when they should have received a trial of anti-inflammatory therapy or been referred for ear, nose, and throat (ENT) review. Sixty percent of patients in group C would have received either a trial of medical treatment to treat mild OSA or no treatment, instead of referral to ENT services or commencement of continuous positive airway pressure. CONCLUSION Apnea-hypopnea index (AHI) is underestimated in respiratory polygraphy (RP), and the disparity in AHI-RP and AHI-polysomnography can significantly affect clinical management decisions, particularly in children with mild and moderate obstructive sleep apnea (1 < AHI < 10/h total sleep time).
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Affiliation(s)
- Hui-Leng Tan
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL ; Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Helena Molero Ramirez
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Hari P R Bandla
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
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The utility of a portable sleep monitor to diagnose sleep-disordered breathing in a pediatric population. Can Respir J 2013; 21:31-5. [PMID: 24083303 DOI: 10.1155/2014/271061] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central and⁄or obstructive sleep-disordered breathing (SDB) in children represents a spectrum of abnormal breathing during sleep. SDB is diagnosed using the gold standard, overnight polysomnography (PSG). The limited availability and access to PSG prevents its widespread use, resulting in significant delays in diagnosis and treatment of SDB. As such, portable sleep monitors are urgently needed. OBJECTIVE To evaluate the utility of a commercially available portable sleep study monitor (PSS-AL) (ApneaLink, ResMed, USA) to diagnose SDB in children. METHODS Children referred to a pediatric sleep facility were simultaneously monitored using the PSS-AL monitor and overnight PSG. The apnea-hypopnea index (AHI) was calculated using the manual and autoscoring function of the PSS-AL, and PSG. Sensitivity and specificity were compared with the manually scored PSS-AL and PSG. Pearson correlations and Bland-Altman plots were constructed. RESULTS Thirty-five children (13 female) completed the study. The median age was 11.0 years and the median body mass index z-score was 0.67 (range -2.3 to 3.8). SDB was diagnosed in 17 of 35 (49%) subjects using PSG. The AHI obtained by manually scored PSS-AL strongly correlated with the AHI obtained using PSG (r=0.89; P<0.001). Using the manually scored PSS-AL, a cut-off of AHI of >5 events⁄h had a sensitivity of 94% and a specificity of 61% to detect any SDB diagnosed by PSG. CONCLUSIONS Although PSG is still recommended for the diagnosis of SDB, the ApneaLink sleep monitor has a role for triaging children referred for evaluation of SDB, but has limited ability to determine the nature of the SDB.
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Aubertin G. [Obstructive sleep apnea syndrome in children]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:229-236. [PMID: 23870386 DOI: 10.1016/j.pneumo.2013.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/20/2013] [Indexed: 06/02/2023]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent in school-aged children. Tonsillar and/or adenoids hypertrophy is the most common etiology of OSA in children. OSA has been associated with sleep quality disturbance (frequent arousals) and nocturnal gas-exchange abnormalities (hypoxemia and sometimes hypercapnia), complicated with a large array of negative health outcomes. The clinical symptoms are not able to distinguish primary snoring from OSA. Polysomnography remains the gold standard for the diagnosis of sleep disordered breathing, but the demand is increasing for this highly technical sleep test. So, some other simpler diagnostic methods are available, as respiratory polygraphy, but need to be validated in children. Treatment of OSA in children must be based on a mutlidisciplinary approach with pediatricians, ENT surgeons and orthodontists.
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Affiliation(s)
- G Aubertin
- Service de pneumologie pédiatrique, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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86
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Wooten WI, Muenzer J, Vaughn BV, Muhlebach MS. Relationship of sleep to pulmonary function in mucopolysaccharidosis II. J Pediatr 2013; 162:1210-5. [PMID: 23305961 PMCID: PMC3665636 DOI: 10.1016/j.jpeds.2012.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/04/2012] [Accepted: 11/08/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the sleep characteristics, pulmonary function, and their relationships in an enzyme naive population of patients with mucopolysaccharidoses (MPS) II (Hunter syndrome). STUDY DESIGN The analyzed subjects (30 patients with MPS II with a median age of 9 years) had been enrolled in an MPS II natural history study and a phase I/II enzyme replacement clinical study in which they underwent standard polysomnography including spirometry and plethysmography, if cooperative. Descriptive statistics and nonparametric correlation were performed for demographic, sleep, and pulmonary function variables. RESULTS Median apnea-hypopnea index was 6.4, with obstructive sleep apnea observed in 27/30 subjects. Sleep architecture was characterized by diminished rapid-eye movement sleep duration (median 13%), and decline in sleep efficiency and slow-wave sleep duration in older individuals. Oxygen desaturation below 90% occurred in 26/30 subjects, and hypoventilation above 50 Torr occurred in 11/23 subjects with accurate end-tidal carbon dioxide recordings. Of 15 subjects with reliable spirometry, median forced expiratory volume in 1 second was below 80% predicted in 12/15 subjects. Forced expiratory volume in 1 second in percent-predicted was inversely related to apnea-hypopnea index and increase from baseline end-tidal carbon dioxide (P=.023, rs=-0.58), (P<.001, rs=-0.82). CONCLUSION Sleep in MPS II is characterized by obstructive sleep apnea, altered sleep architecture, and impaired gas exchange. Sleep disruption is related to daytime pulmonary function, thus both systems should be evaluated when sleep abnormalities are suspected.
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Affiliation(s)
- William I. Wooten
- Department of Pediatrics, Division of Pulmonology, University of North Carolina at Chapel Hill. Address: 450 MacNider Hall, Campus Box #7217, Chapel Hill, NC 27599-7217. Phone: 919-966-1055. Fax: 919-966-6179
| | - Joseph Muenzer
- Department of Pediatrics, Division of Genetics and Metabolism, University of North Carolina at Chapel Hill
| | - Bradley V. Vaughn
- Department of Neurology, Division of Sleep Medicine, University of North Carolina at Chapel Hill
| | - Marianne S. Muhlebach
- Department of Pediatrics, Division of Pulmonology, University of North Carolina at Chapel Hill
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87
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Parikh SR, Sadoughi B, Sin S, Willen S, Nandalike K, Arens R. Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea. Laryngoscope 2013; 123:2043-9. [PMID: 23666635 DOI: 10.1002/lary.23748] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/16/2012] [Accepted: 08/24/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy. STUDY DESIGN Prospective case control study. METHODS A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data. RESULTS Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m(2)). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2 , and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm(3), P < 0.001), upper jugular region (22202 vs. 16819 mm(3), P < 0.005), and adenotonsillar region (18994 vs. 12675 mm(3), P < 0.0001). CONCLUSIONS Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care.
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Affiliation(s)
- Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital-University of Washington School of Medicine, Seattle, Washington 98105, USA.
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88
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Addo NK, Javadpour S, Kandasamy J, Sillifant P, May P, Sinha A. Central sleep apnea and associated Chiari malformation in children with syndromic craniosynostosis: treatment and outcome data from a supraregional national craniofacial center. J Neurosurg Pediatr 2013; 11:296-301. [PMID: 23240845 DOI: 10.3171/2012.11.peds12297] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The association of Chiari malformation Type I (CM-I) with syndromic craniosynostosis (SC) in children is well established. Central sleep apnea (CSA) may subsequently occur. However, sleep studies performed in these patients have been focused mainly on assessing the severity of obstructive sleep apnea. Therefore, the incidence and management of CSA in these patients remains poorly defined. Authors of this study aimed to assess the efficacy of foramen magnum decompression (FMD) in resolving CSA, initially detected incidentally, in a small cohort of patients with CM-I and SC. METHODS The clinical data for 5 children who underwent FMD for CSA at Alder Hey Children's Hospital between December 2007 and December 2009 were retrospectively analyzed. Outcomes were evaluated with respect to FMDs by utilizing pre- and postdecompression sleep studies. Of the 5 patients, 2 had Crouzon syndrome and 3 had Pfeiffer syndrome. RESULTS Patient age at the time of surgery ranged from 1.1 to 12.6 years (median 4.1 years). The median postoperative follow-up was 3.6 years. Sleep studies revealed that 2 children experienced a > 80% reduction in CSAs at 1.5 and 21 months after decompression. The remaining 3 children experienced a > 60% reduction in CSAs when reevaluated between 2 and 10 months after decompression. The associated central apnea index improved for all patients. CONCLUSIONS Findings suggested that FMD is an effective treatment modality for improving CSA in patients with SC and associated CM-I. The use of multimodal polysomnography technology may improve the evaluation and management of these patients.
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Affiliation(s)
- Nii K Addo
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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89
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Clinical and Polysomnographic Correlation in Sleep-related Breathing Disorders in Children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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90
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Full-night versus 4h evening polysomnography in children less than 2years of age. Sleep Med 2013; 14:177-82. [DOI: 10.1016/j.sleep.2012.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 10/09/2012] [Accepted: 10/10/2012] [Indexed: 11/22/2022]
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Abstract
OPINION STATEMENT Dyssomnias are sleep disorders associated with complaints of insomnia or hypersomnia. The daytime sleepiness of narcolepsy is treated by a combination of planned daytime naps, regular exercise medications such as modafinil, or salts of methylphenidate, or amphetamine. Cataplexy that accompanies narcolepsy is treated with anticholinergic agents, selective serotonin reuptake inhibitors, or sodium oxybate. Children with neurodevelopmental disabilities such as autism have sleep initiation and maintenance difficulties on a multifactorial basis, with favorable response to melatonin in some patients. Childhood onset restless legs syndrome is often familial, associated with systemic iron deficiency, and responsive to iron supplementation and gabapentin. Parasomnias are episodic phenomena events which occur at the sleep -- wake transition or by intrusion on to sleep. Arousal parasomnias such as confusional arousals and sleep walking can sometimes be confused with seizures. A scheme for differentiating arousal parasomnias from nocturnal seizures is provided. Since arousal parasomnias are often triggered by sleep apnea, restless legs syndrome, or acid reflux, treatment measures directed specifically at these disorders often helps in resolution. Clonazepam provided in a low dose at bedtime can also alleviate sleep walking and confusional arousals. Obstructive sleep apnea affects about 2 percent of children. Adeno-tonsillar hypertrophy, cranio-facial anomalies, and obesity are common predisposing factors. Mild obstructive sleep apnea can be treated using a combination of nasal corticosteroids and a leukotriene antagonist. Moderate to severe obstructive sleep apnea are treated with adeno-tonsillectomy, positive airway pressure breathing devices, or weight reduction as indicated. This paper provides an overview of the topic, with an emphasis on management steps. Where possible, the level of evidence for treatment recommendations is indicated.
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Affiliation(s)
- Suresh Kotagal
- Neurology, Pediatrics and the Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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92
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Luna-Paredes C, Antón-Pacheco JL, García Hernández G, Martínez Gimeno A, Romance García AI, García Recuero II. Screening for symptoms of obstructive sleep apnea in children with severe craniofacial anomalies: assessment in a multidisciplinary unit. Int J Pediatr Otorhinolaryngol 2012; 76:1767-70. [PMID: 22980525 DOI: 10.1016/j.ijporl.2012.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the incidence of airway obstruction symptoms and the presence of obstructive sleep apnea in children with severe craniofacial anomalies by a proactive screening program using a standard questionnaire and cardiorespiratory polygraphy. PATIENTS AND METHODS Children with severe craniofacial anomalies referred to our paediatric airway unit from February 2001 to June 2011 were eligible to be included in this retrospective, single centre study. Symptoms of airway obstruction were proactively investigated using the shorter version of the Pediatric Sleep Questionnaire (PSQ). Obstructive sleep apnea was assessed by means of cardiorespiratory polygraphy. Demographic data and reason for referral were also recorded. Primary outcomes were the prevalence of symptoms of airway obstruction and OSA. RESULTS 44 children (24 girls) with severe craniofacial anomalies (15 Crouzon, 13 Apert, 9 Goldenhar, 5 Treacher-Collins, 2 Pfeiffer) were included, at a mean age of 5 years (range 8 months to 14 years). Reason for referral was routine follow up in 30 patients and overt OSA symptoms and signs in the remaining 14. PSQ results showed symptoms of airway obstruction in 82% of patients, being snoring the most frequent symptom (64.1%) followed by apneas (33.3%). Polygraphic studies showed inconclusive results in 8 children (18.2%), normal apnea-hypopnea index (AHI) in 16 (36.4%), mild obstructive sleep apnea in 9 (20.4%), moderate in 4 (9.1%) and severe obstructive sleep apnea in 7 (15.9%). CONCLUSIONS Children with craniofacial anomalies have a high prevalence of symptoms of airway obstruction and obstructive sleep apnea that support a proactive screening strategy in this highly selected population.
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Affiliation(s)
- Carmen Luna-Paredes
- Pediatric Airway Unit, Division of Pediatric Pulmonology and Division of Pediatric Surgery, Hospital Universitario "12 de Octubre", Universidad Complutense de Madrid, Madrid, Spain.
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Esteller E, Santos P, Segarra F, Estivill E, Lopez R, Matiñó E, Ademà JM. Clinical and polysomnographic correlation in sleep-related breathing disorders in children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:108-14. [PMID: 23141633 DOI: 10.1016/j.otorri.2012.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/30/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. OBJECTIVE To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. MATERIAL AND METHODS We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. RESULTS Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047). CONCLUSION Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, San Cugat del Vallès, Barcelona, Spain.
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Kotagal S, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, D'Andrea LA, Hoban TF. Non-respiratory indications for polysomnography and related procedures in children: an evidence-based review. Sleep 2012; 35:1451-66. [PMID: 23115394 DOI: 10.5665/sleep.2188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This evidence-based review provides a systematic and comprehensive review of the literature regarding the utility of polysomnography for the evaluation of non-respiratory sleep disorders in children including hypersomnias, parasomnias, sleep-related movement disorders, and sleep in other special populations. METHODS A task force of pediatric sleep medicine experts performed a systematic review of the literature regarding the use of polysomnography for non-respiratory sleep disorders in children. They identified and graded 76 papers as evidence. RESULTS The main results include (1) polysomnography combined with the multiple sleep latency test is useful for evaluating disorders of excessive somnolence to objectively quantify sleepiness. The results have to be interpreted with consideration of the pubertal stage and regularity of the sleep patterns of the child; (2) polysomnography is indicated in children with parasomnias or sleep related movement disorders who have a high likelihood of having obstructive sleep apnea (OSA); (3) polysomnography is not routinely indicated in children with enuresis unless there is a high likelihood of OSA; (4) polysomnography can be helpful in evaluating children with restless legs syndrome (RLS) and when periodic limb movement disorder (PLMD) is suspected. CONCLUSIONS These findings suggest that, in children with non-respiratory sleep disorders, polysomnography should be a part of a comprehensive sleep evaluation in selected circumstances to determine the nature of the events in more detail or when the suspicion of OSA is relatively high.
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97
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Aurora RN, Lamm CI, Zak RS, Kristo DA, Bista SR, Rowley JA, Casey KR. Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. Sleep 2012; 35:1467-73. [PMID: 23115395 DOI: 10.5665/sleep.2190] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although a level 1 nocturnal polysomnogram (PSG) is often used to evaluate children with non-respiratory sleep disorders, there are no published evidence-based practice parameters focused on the pediatric age group. In this report, we present practice parameters for the indications of polysomnography and the multiple sleep latency test (MSLT) in the assessment of non-respiratory sleep disorders in children. These practice parameters were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine (AASM). METHODS A task force of content experts was appointed by the AASM to review the literature and grade the evidence according to the American Academy of Neurology grading system. RECOMMENDATIONS FOR PSG AND MSLT USE PSG is indicated for children suspected of having periodic limb movement disorder (PLMD) for diagnosing PLMD. (STANDARD)The MSLT, preceded by nocturnal PSG, is indicated in children as part of the evaluation for suspected narcolepsy. (STANDARD)Children with frequent NREM parasomnias, epilepsy, or nocturnal enuresis should be clinically screened for the presence of comorbid sleep disorders and polysomnography should be performed if there is a suspicion for sleep-disordered breathing or periodic limb movement disorder. (GUIDELINE)The MSLT, preceded by nocturnal PSG, is indicated in children suspected of having hypersomnia from causes other than narcolepsy to assess excessive sleepiness and to aid in differentiation from narcolepsy. (OPTION)The polysomnogram using an expanded EEG montage is indicated in children to confirm the diagnosis of an atypical or potentially injurious parasomnia or differentiate a parasomnia from sleep-related epilepsy (OPTION)Polysomnography is indicated in children suspected of having restless legs syndrome (RLS) who require supportive data for diagnosing RLS. (OPTION) RECOMMENDATIONS AGAINST PSG USE: Polysomnography is not routinely indicated for evaluation of children with sleep-related bruxism. (STANDARD) CONCLUSIONS: The nocturnal polysomnogram and MSLT are useful clinical tools for evaluating pediatric non-respiratory sleep disorders when integrated with the clinical evaluation.
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Affiliation(s)
- R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Gozal D. CON: Specific pediatric accreditation is not critical for integrated pediatric and adult sleep medicine programs. J Clin Sleep Med 2012; 8:477-9. [PMID: 23066357 DOI: 10.5664/jcsm.2134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David Gozal
- Department of Pediatrics, Section of Pediatric Sleep Medicine, The Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA.
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Prevalence and factors associated with snoring in 3-year olds: Early links with behavioral adjustment. Sleep Med 2012; 13:1191-7. [DOI: 10.1016/j.sleep.2012.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/27/2012] [Accepted: 05/01/2012] [Indexed: 02/07/2023]
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100
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Abstract
The classification of sleep disorders is necessary to discriminate between disorders and to facilitate an understanding of symptoms, etiology, and pathophysiology that allows for appropriate treatment. The earliest classification systems, largely organized according to major symptoms (insomnia, excessive sleepiness, and abnormal events that occur during sleep), were unable to be based on pathophysiology because the cause of most sleep disorders was unknown. These 3 symptom-based categories are easily understood by physicians and are therefore useful for developing a differential diagnosis. The International Classification of Sleep Disorders, version 2, published in 2005 and currently undergoing revision, combines a symptomatic presentation (e.g., insomnia) with 1 organized in part on pathophysiology (e.g., circadian rhythms) and in part on body systems (e.g., breathing disorders). This organization of sleep disorders is necessary because of the varied nature and because the pathophysiology for many of the disorders is still unknown. The International Classification of Sleep Disorders, version 2 provides relevant diagnostic and epidemiological information on sleep disorders to more easily differentiate between the disorders.
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Affiliation(s)
- Michael J Thorpy
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, NY, USA.
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