Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae

Quality of life and sleep in obese adolescents

Obesity and sleep disorders in adolescence are strongly associated, and they impact both on the health and on quality of life (QL) in this age group.

OBJECTIVE

To comparatively assess QL and sleep in obese and eutrophic adolescents, who are older than ten years of age.

METHODS

Cross-sectional study including obese adolescents. This analysis was carried out between August 2009 and August 2010. The Control (eutrophic) Group comprised schoolchildren recruited from State schools in the city of Americana, in São Paulo State, Brazil. Instruments applied included a standardized questionnaire, the Sleep Behavior Questionnaire (SBQ), and the Pediatric QL Inventory (PedsQL TM 4.0).

RESULTS

The obese adolescents had poorer QL on physical (p<0.001), emotional (p=0.03), and social (p=0.002) functioning domains. A difference in mean psychosocial functioning was found between the groups (p=0.009) with obese subjects having a mean score of 69.5 (±16.0) and in eutrophic individuals of 76.2 (±16.7). A greater number of sleep problems was evident in the Obese Group (p=0.03).

CONCLUSIONS

The obese adolescents had an impaired QL and a higher frequency of sleep problems compared to the eutrophic subjects.

Apnea and oxygen desaturations in children treated with opioids after adenotonsillectomy for obstructive sleep apnea syndrome: a prospective pilot study

BACKGROUND

Recent case reports have alerted the medical community of fatality in children receiving codeine after tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome.

OBJECTIVE

The objective of this study was to compare the rates of oxygen desaturation before and after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS), and to examine the relationship between cytochrome P450 2D6 (CYP2D6) genotype and respiratory events.

STUDY DESIGN

This was a prospective observational study.

METHODS

Twenty-six children with OSAS (mean age 78 months, range 1.8-17 years) who underwent adenotonsillectomy were studied. CYP2D6 genotype was characterized in 21 of these children. The primary endpoints of the study were the change in the rate of desaturation and in the nadir oxygen saturation values before and in the first 24 hours after surgery as measured by pulse oximetry.

RESULTS

Twenty-two children received codeine and four were managed with hydrocodone. There was no post-operative improvement in the mean rate of desaturation (1.84 ± 1.45/hour pre-operative vs 2.97 ± 3.3/hour post-operative; p = 0.119; 95% CI -2.56, 0.313), or the post-operative nadir of oxygen saturation (85.2 ± 5.8% pre-operative vs 84.0 ± 6.8% post-operative; p = 0.632; 95% CI -3.00, 4.84) on the night after surgery. Prior to surgery, six children had an oxygen saturation nadir <80%, while post-surgery, the number increased to eight children. Ten children improved their parameters after surgery. CYP2D6 genotype by itself did not predict the changes in desaturation or nadir.

CONCLUSION

Post-operative use of opioids following OSAS may not be safe for all children. It is conceivable that if the child is among the significant proportion that experiences increased oxygen desaturations, the CNS depressing effects of codeine or hydrocodone and their respectively potent morphine or hydromorphone metabolites can further compromise respiratory drive. Larger studies are needed to investigate the potential contribution of CYP2D6 genotype.

Pulmonary hypertension due to obstructive sleep apnea in a child with Rubinstein-Taybi syndrome

Rubinstein-Taybi syndrome (RTS) is characterized by peculiar facies, mental retardation, broad thumbs, and great toes. Approximately one-third of the affected individuals have a variety of congenital heart diseases. They can also have upper airway obstruction during sleep, due to hypotonia and the anatomy of the oropharynx and airway, which make these patients susceptible to obstructive sleep apnea (OSA). In our case, pulmonary hypertension was caused, successively, by congenital heart defects (a large patent ductus arteriosus and arch hypoplasia) and obstructive sleep apnea during early infancy. The congenital heart defects were surgically corrected, but persistent pulmonary hypertension was identified 2 months after the operation. This pulmonary hypertension was due to OSA, and it was relieved by nasal continuous positive airway pressure. This case is the first report of pulmonary hypertension from OSA in a young infant with RTS.

Ginkgo biloba protects against intermittent hypoxia-induced memory deficits and hippocampal DNA damage in rats

The aim of the present study was to explore the potential protective effect of Ginkgo biloba extract (EGb 761) on intermittent hypoxia (IH)-induced memory deficits and oxidative stress in rats.

METHODS

The passive avoidance reflex (PAR) test was employed to assess the effect of concurrent EGb 761 treatment in different dose levels on the memory deficits that were induced by concurrent long-term exposure to IH (21 days). The levels of hippocampal malondialdehyde (MDA), nitric oxide (NO), and intracellular glutathione (GSH) and the activity of glutathione peroxidase (GSH-Px) were estimated. In addition, serum and hippocampal 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels were assessed to study the effect of EGb 761 on hippocampal oxidative DNA damage induced by IH.

RESULTS

Exposure to long-term IH in rats induced marked memory impairment that was indicated by a significant decrease in the retention latency in the PAR test. This effect was accompanied by a significant increase in hippocampal oxidative stress and DNA damage. EGb 761 that was administered in either 50- or 100-mg/kg doses per day reversed IH-induced memory deficits, an effect that was accompanied by a significant decrease in hippocampal MDA and NO levels. The antioxidant defence (GSH and GSH-Px) that was depressed by IH was significantly reactivated by EGb 761. Furthermore, serum and hippocampal levels of 8-OHdG that were elevated by IH were significantly reduced.

CONCLUSIONS

EGb 761 can protect against IH-induced memory impairment, oxidative stress and neuronal DNA damage, possibly through multiple mechanisms involving its potential anti-oxidative effect.

Need for standard outcome reporting systems in craniosynostosis

Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no parameters or guidelines of care. Establishing such parameters was an important step forward in the treatment of patients with craniosynostosis, but results are still assessed using radiographic measurements, complication rates, and ad hoc reporting scales. Therefore, clinical outcome reporting in the treatment of craniosynostosis is inconsistent and lacks methodological rigor.

Today, most reported evidence in the treatment of craniosynostosis is level 5 (expert opinion) or level 4 (case series) data. Challenges in obtaining higher quality level 1 or level 2 data include randomizing patients in a clinical trial as well as selecting the appropriate outcome measure for the trial. Therefore, determining core outcome sets that are important to both patients and health care professionals is an essential step in the evolution of caring for patients with craniosynostosis.

Traditional clinical outcomes will remain important, but patient-reported outcomes, such as satisfaction, body image, functional results, and aesthetic outcomes, must also be incorporated if the selected outcomes are to be valuable to patients and families making decisions about treatment. In this article, the authors review the most commonly used tools to assess craniosynostosis outcomes and propose a list of longitudinal parameters of care that should be considered in the evaluation, diagnosis, and treatment evaluation of a patient with craniosynostosis.