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Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med 2023; 19:1027-1033. [PMID: 36727478 PMCID: PMC10235720 DOI: 10.5664/jcsm.10468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. METHODS This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. RESULTS The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. CONCLUSIONS STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. CITATION Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Quang L. Nguyen
- Deaconess Health, Division of Pulmonary Critical Care and Sleep Medicine, University of Louisville, Louisville, Kentucky
| | | | - Yana B. Feygin
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Rajaneeshankar Palani
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Karim El-Kersh
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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D'Elia C, Gozal D, Bruni O, Goudouris E, Meira E Cruz M. Allergic rhinitis and sleep disorders in children - coexistence and reciprocal interactions. J Pediatr (Rio J) 2022; 98:444-454. [PMID: 34979134 PMCID: PMC9510807 DOI: 10.1016/j.jped.2021.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To review, critically analyze and synthesize knowledge from the international literature regarding the association between allergic rhinitis (AR) and sleep disorders, the impact of AR treatment on children's sleep, and lay the foundation for future research on this topic. SOURCE OF DATA A literature search using PubMed database including original and review articles, systematic reviews and meta-analyses using keywords related to AR, sleep disorders and sleep-disordered breathing. SYNTHESIS OF DATA Sleep is fundamental to health, and its assessment and control of conditions that trigger or aggravate disturbances are of the uttermost importance. Allergic rhinitis (AR) is common in children and may interfere with both their quality of life and quality of sleep. It has emerged as one of the most important risk factors for habitual snoring in children and appeared to increase the risk of Obstructive Sleep Apnea (OSA), with AR severity exhibiting a significant and independent association with pediatric OSA severity. However, in some studies, those associations between AR and OSA in children are not very consistent. CONCLUSIONS A substantial level of controversy exists regarding the interactions between AR and OSA in children. Notwithstanding, identifying and treating AR in clinical settings is probably an important step toward improving symptoms and preventing deterioration of sleep quality in children and may improve the severity of underlying OSA. Considering the high prevalence, morbidity, economic and social implications of both AR and sleep problems, it is crucial that healthcare providers improve their understanding of the relationships between those conditions among children.
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Affiliation(s)
- Cláudio D'Elia
- Hospital Lusíadas, Departamento de Pediatria, Lisbon, Portugal; Centro Europeu do Sono, Portugal.
| | - David Gozal
- The University of Missouri School of Medicine, Child Health Research Institute, Department of Child Health, Columbia, United States
| | - Oliviero Bruni
- La Sapienza University, Department of Social Development and Psychology, Rome, Italy
| | - Ekaterini Goudouris
- Universidade Federal do Rio de Janeiro, Instituto Martagão Gesteira de Puericultura e Pediatria (IPPMG), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Miguel Meira E Cruz
- Centro Europeu do Sono, Portugal; Lisbon School of Medicine, Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal
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Tan SN, Abdullah B. The Association Between Obstructive Sleep Apnea and Allergic Rhinitis: Current Literature Review. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210304100358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
:
Sleep-disordered breathing (SDB) is now a significant health problem in today's culture.
It ranges from a spectrum of abnormal conditions during sleep from the primary snorer to mild,
moderate, or severe obstructive sleep apnea (OSA). SDB also comprises other conditions, such as
sleep-related hypoventilation, sleep-related hypoxemia, and central sleep apnea syndromes.
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One of the components of the pathophysiology of OSA that remain unclear is the association of allergic
rhinitis (AR) in the evolution of OSA. Several studies relate the co-existence of OSA and
AR in the common clinical practice, but its correlation was not clear. This review article aimed to
review the pathophysiological relationship between OSA and AR in terms of the role of chemical
mediators and the effect of AR treatment in support of OSA.
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The symptoms of AR further accelerate the clinical progression to OSA development. Inflammatory
mediators such as histamine, cysteinyl leukotrienes, and interleukins are found at a high level in
AR, which can aggravate AR symptoms such as nasal obstruction, rhinorrhea, and itchiness, which
can then lead to sleep disruption in OSA patients. In addition, OSA patients also have increased
chemical mediators such as tumor necrosis factor, interleukin 6, and 1, which would activate the T
helper 2 phenotypes that can aggravate AR symptoms. This vicious cycle can potentiate each other
and worsen the condition. Few studies have shown that treatment of AR can improve OSA, especially
the use of intranasal steroid and leukotriene receptor antagonists.
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A detailed evaluation of rhinitis symptoms should be made for OSA patients so that they can benefit
not only from the improvement of AR but also the good sleep quality.
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Affiliation(s)
- Shi Nee Tan
- School of Medicine, KPJ University College, Lot PT 17010 Persiaran Seriemas, Kota Seriemas, 71800 Nilai, Negeri Sembilan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology, Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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Van Meter AR, Anderson EA. Evidence Base Update on Assessing Sleep in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 49:701-736. [PMID: 33147074 DOI: 10.1080/15374416.2020.1802735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic. METHOD We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018). RESULTS Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains. CONCLUSION Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.
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Affiliation(s)
- Anna R Van Meter
- Department of Psychiatry, Zucker Hillside Hospital.,Feinstein Institutes for Medical Research, Institute for Behavioral Science.,Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Liu J, Wu Y, Wu P, Xu Z, Ni X. Analysis of the impact of allergic rhinitis on the children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2020; 138:110380. [PMID: 33152971 DOI: 10.1016/j.ijporl.2020.110380] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We assessed the influence of allergic rhinitis (AR) on sleep disordered breathing (SDB) in children with adenotonsillar hypertrophy (ATH), and compared sleep quality and polysomnographic data in habitually snoring children with or without AR. METHODS Children with snoring resulting from adenoid/tonsils hypertrophy were recruited between Jan 1st, 2018 and Jun 30th, 2018. The exclusion criteria were congenital disorders, metabolic disorders, neurological disorders and pulmonary diseases, such as, asthma etc. Overnight polysomnography (PSG) and Sleep Questionnaire (SQ) were assessed on each participant to identify children with obstructive sleep apnea (OSA). Cross-sectional study design was used to examine PSG and SQ data. The diagnosis of AR was based upon history of allergies and positive clinical examinations, then confirmed by allergen test. Participants were categorized into four groups (AR and Non-OSA group; AR and OSA group; Non-AR and Non-OSA group; Non-AR and OSA group). Non-parametric rank sum test was used for statistical analysis. RESULTS Six hundred and sixty children (age between 3yrs and 14yrs) with SDB were enrolled in the study (mean age 6.7 ± 2.1yrs, 67.4% male). The number of children diagnosed with OSA was 495 (74.3%). The prevalence of AR among all participating SDB children was 25.8%, and AR with OSA was19.4%. The behavioral problems scores in SQ showed significant difference among SDB children with AR (P<.0001). No difference was observed in the OAHI (obstructive apnea-hypopnea index) and AHI (apnea-hypopnea index) between the groups of children with and without AR regardless whether OSA was coexisting. The percentage of time spent in the rapid eye movement (REM) sleep stage was shortened among children with AR without OSA (P = 0.031), however, the percentage of time spent in the REM sleep stage was not different among children with OSA (P = 0.98). The total sleep time was shorter among children with AR (OSA P = 0.02; without OSA P = 0.03). CONCLUSIONS Despite the high prevalence of AR in patients with SDB, AR is not an aggravating factor for the severity of AHI. High risk behavioral problems link to SDB with AR. AR is associated with shortened REM sleep stage in children with SDB without sleep apnea, and shortened total sleep time in children with SDB.
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Affiliation(s)
- Jianhui Liu
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China
| | - Yunxiao Wu
- Beijing Key Laboratory of Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China
| | - Panting Wu
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China
| | - Zhifei Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China.
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, People's Republic of China.
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Impact of allergic rhinitis on quality of life after powered intracapsular tonsillectomy and adenoidectomy. Am J Otolaryngol 2020; 41:102165. [PMID: 31739999 DOI: 10.1016/j.amjoto.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) has been reported to worsen quality of life (QoL) after adenotonsillectomy. Although powered intracapsular tonsillectomy and adenoidectomy (PITA) has been widely performed, it is not clear whether comorbid AR may worsen QoL in patients who undergo PITA. PURPOSE To evaluate QoL after PITA in relation to AR. METHODS Children undergoing PITA for sleep-disordered breathing were enrolled and divided into AR and non-AR groups. QoL was evaluated using serial applications of the Obstructive Sleep Apnea-18 (OSA-18) questionnaire and compared between the two groups. RESULTS Of 151 enrolled patients, 73 were categorized into the AR and 78 into non-AR groups. After surgery, patients exhibited marked improvement in OSA-18 scores in both groups, with similar results at each follow-up. The degree of improvement in OSA-18 scores was less in the AR group 3 months after surgery; however, this difference was not significant 6 months after surgery. CONCLUSIONS Although comorbid AR may initially appear to impede improvement in QoL after PITA, QoL was improved similarly 6 months after PITA, irrespective of AR status. In children with comorbid AR, PITA could be safely performed to treat sleep-disordered breathing without concerns regarding worsening of QoL.
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Walter LM, Tamanyan K, Nisbet L, Weichard AJ, Davey MJ, Nixon GM, Horne RSC. Pollen levels on the day of polysomnography influence sleep disordered breathing severity in children with allergic rhinitis. Sleep Breath 2019; 23:651-657. [PMID: 30838494 DOI: 10.1007/s11325-019-01819-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Allergic rhinitis (AR) is a common risk factor for sleep disordered breathing (SDB) in children. Allergy to pollen is a trigger for allergic rhinitis, causing nasal inflammation, upper airway congestion and obstruction. We aimed to determine if the pollen count on the day of diagnostic polysomnography for SDB affected the result. METHODS Children (3-18 years; n = 90) who participated in research studies between 1 October and 31 December, when daily regional pollen counts were available, in the years 2005-2016 were eligible for inclusion. All children underwent overnight polysomnography for assessment of SDB severity. Pollen was categorised as grass or other pollen. Multiple stepwise linear regression was performed to determine whether the pollen count for that day, a diagnosis of asthma, age, and BMI-z-score were determinants of respiratory parameters measured on polysomnography, including the obstructive apnoea hypopnoea index (OAHI), SpO2 nadir, average SpO2 drop, SpO2 < 90%, oxygen desaturation index > 4% (ODI4), and average transcutaneous CO2 (TCM). RESULTS Sixteen/90 children had AR. In children with AR, an increase in grass pollen of 1 grain/m3 predicted an increase in OAHI of 0.2 events/h, ODI4 of 0.18 times/h, SpO2 < 90% of 0.03 times/h, and TCM of 0.07 mmHg. None of the factors were determinants of SDB severity in children without AR. CONCLUSION Our findings highlight that daily pollen counts may be an important factor influencing the severity of SDB on a single night of polysomnography in children with clinical allergic rhinitis and should be taken into account when determining treatment options.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Lauren Nisbet
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Aidan J Weichard
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
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Sleep disordered breathing in children seeking orthodontic care. Am J Orthod Dentofacial Orthop 2018; 154:65-71. [PMID: 29957322 DOI: 10.1016/j.ajodo.2017.11.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Our objective was to evaluate the prevalence of high-risk factors for sleep disordered breathing (SDB) in an orthodontic population of children. SDB is a spectrum of breathing disorders ranging from primary snoring to obstructive sleep apnea. METHODS The sample included 303 healthy children between the ages of 9 and 17. High risk of SDB was assessed using the Pediatric Sleep Questionnaire, a validated instrument that consists of 22 questions, and high risk is defined as positive answers to 33% or more of the questions answered. Sixteen randomly selected patients repeated the questionnaire 1 month after the initial survey for reliability. RESULTS In this sample, high-risk status on the Pediatric Sleep Questionnaire was not associated with sex, age, or race. The percentage of patients who were screened as high risk was 7.3% (95% confidence interval, 4.7%-10.6%). CONCLUSIONS The results of this study suggest that approximately 7% of adolescent orthodontic patients may be at a significant risk for some form of SDB.
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Meyer C, Ferrari GJ, Barbosa DG, Andrade RD, Pelegrini A, Felden ÉPG. ANALYSIS OF DAYTIME SLEEPINIESS IN ADOLESCENTS BY THE PEDIATRIC DAYTIME SLEEPINESS SCALE: A SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2017; 35:351-360. [PMID: 28977300 PMCID: PMC5606183 DOI: 10.1590/1984-0462/;2017;35;3;00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/26/2017] [Indexed: 01/25/2023]
Abstract
Objective: To systematically review the use of the Pediatric Daytime Sleepiness Scale (PDSS) in the analysis of daytime sleepiness in children and adolescents. Data source: The electronic databases PubMed and SciELO were consulted between 2003 and 2015. As inclusion criterion, studies were considered in English, Spanish and Portuguese, original articles of any type of design, articles with a sample of children and/or adolescents, articles that used the PDSS. Duplicate articles, articles with no relation to the theme, articles with another investigated population, and articles that the parents answered the instrument for their children were excluded. To find the material with these features, the terms “Daytime sleepiness” AND “adolescents” and “Daytime sleepiness” AND “children” were used in the searches. In addition, the descriptor “Pediatric Daytime Sleepiness Scale” was used to filter more specifically. Data synthesis: Initially, 986 studies related to daytime sleepiness were identified. Considering the inclusion criteria, we analyzed 26 studies composed of 18,458 subjects aged 0 to 37 years. The diurnal sleepiness score ranged from 6.7±0.6 to 25.7±0.6 points. In general, all included studies investigated other sleep variables in addition to daytime sleepiness, such as: sleep duration, sleep quality, sleep hygiene or sleep disorders (narcolepsy and cataplexy), respiratory disorders, neurological and developmental disorders. Conclusions: There was a moderate use of PDSS to evaluate daytime sleepiness. This instrument allows the monitoring of factors that influence excessive daytime sleepiness in children and adolescents.
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Affiliation(s)
- Carolina Meyer
- Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
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The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep 2017; 7:46615. [PMID: 28418014 PMCID: PMC5394537 DOI: 10.1038/srep46615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/22/2017] [Indexed: 11/21/2022] Open
Abstract
Adenotonsillar regrowth in children after adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) is often seen in clinical treatment, however, the relationship between allergic disease and adenotonsillar regrowth remains unclear. In this retrospective study, children were assigned to either the recurrence or control group, and subdivided by age at operation. Among children over 36 months, those in the recurrence group had more allergic disease and higher IgE, IL-4, and IL-5 levels than the same-aged children in control group. The Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores for nasal symptoms and activity were higher in children older than 36 months in recurrence group. The results of immunohistochemistry and immunofluorescence showed that FoxP3+ cells (Tregs) were less, while GATA3+ cells (Th2 cells) were more in recurrence group for all ages. Allergic status and low levels of FoxP3 were proved as independent risk factors for adenotonsillar regrowth by multivariate logistic regression. These results indicate that allergic disease is a risk factor for adenotonsillar regrowth in children following T&A for OSA, and this risk increases with age. The decreased level of Tregs and subsequent changes in immune function play an important role in the pathogenesis of adenotonsillar regrowth.
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Shusterman D, Baroody FM, Craig T, Friedlander S, Nsouli T, Silverman B. Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:628-639. [PMID: 27923646 DOI: 10.1016/j.jaip.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance. OBJECTIVES To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps. METHODS Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources. RESULTS Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity. CONCLUSIONS Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing.
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Othman MN, Bee See G, Abdul Latif H. Impact of adenotonsillectomy on the quality of life in children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2016; 91:105-107. [PMID: 27863621 DOI: 10.1016/j.ijporl.2016.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mohd Nazir Othman
- ORL-HNS Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Goh Bee See
- ORL-HNS Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hasniah Abdul Latif
- Paediatric Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Telephone Screening to Identify Children at Risk for Persistent Obstructive Sleep Apnea After Adenotonsillectomy. J Pediatr Health Care 2016; 30:e17-e25. [PMID: 27450191 DOI: 10.1016/j.pedhc.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/04/2016] [Accepted: 06/13/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pediatric obstructive sleep apnea (OSA) is a common condition that can result in a range of adverse health outcomes if left untreated. A significant number of children who undergo adenotonsillectomy (T&A) for OSA will have persistent symptoms. METHODS This prospective, descriptive, pilot study utilized a telephone screening method with the Pediatric Sleep Questionnaire (PSQ) Sleep-Disordered Breathing (SRBD) questionnaire to identify children with residual symptoms of OSA after T&A. Risk factors for persistent OSA were also investigated. RESULTS The percentage of children identified with symptoms of persistent OSA was 33% (n = 28). No significant variables were associated with increased PSQ-SRBD scores. DISCUSSION This study found a number of children with persistent symptoms of sleep-disordered breathing after T&A, suggesting that these children may be at high risk for persistent OSA. Telephone screening using the PSQ-SRBD is a useful approach to identify children who may require a polysomnogram or referral to pediatric sleep specialist, particularly in settings where postoperative follow-up is poor.
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Zhang J, Zhao J, Chen M, Liu S, Zhang X, Zhang F, Zhang Y, Chen H, Ni X. Airway resistance and allergic sensitization in children with obstructive sleep apnea hypopnea syndrome. Pediatr Pulmonol 2016; 51:426-30. [PMID: 26284311 DOI: 10.1002/ppul.23264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the airway resistance in Chinese children with obstructive sleep apnea hypopnea syndrome (OSAHS) by impulse oscilloetry (IOS) and investigate the association of the severity of OSAHS with the airway resistance and allergic sensitization. METHOD A total of 120 children (92 boys) treated for snoring in Beijing Children's Hospital between October 2010 and March 2011 were included in this study. Ninety-three children were diagnosed with OSAHS and 27 did not show OSAHS. Total airway resistance (R5), proximal airway resistance (R20), and peripheral airway resistance (X5) were determined by IOS. Serum levels of total IgE and allergen-specific IgE (sIgE) were also determined. RESULTS R5 in the OSAHS group was significantly higher than that in the non-OSAHS group (P = 0.0025), whereas R20 and X5 were similar in the two groups. R5 was positively correlated with apnea hypopnea index and obstructive apnea index and negatively correlated with the lowest arterial oxygen saturation significantly (all P < 0.05). The percentage of children with abnormal serum levels of total IgE or abnormal allergen-specific IgEs was comparable in OSAHS and non-OSAHS groups. The proportions of abnormal R5 and of abnormal serum levels of total IgE were significantly higher in children with severe OSAHS compared with children with mild or moderate OSAHS (all P < 0.05). CONCLUSIONS Total airway resistance was significantly increased in Children with OSAHS. Allergic sensitization might contribute to the exacerbation of existing OSAHS in children. Large scale studies are required to further validate these findings.
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Affiliation(s)
- Jie Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Jing Zhao
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Min Chen
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Shilin Liu
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Xuexi Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Fengzhen Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Yamei Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, P. R. China
| | - Xin Ni
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
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Translation and validation of the Pediatric Daytime Sleepiness Scale (PDSS) into Brazilian Portuguese. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Felden ÉPG, Carniel JD, Andrade RD, Pelegrini A, Anacleto TS, Louzada FM. Translation and validation of the Pediatric Daytime Sleepiness Scale (PDSS) into Brazilian Portuguese. J Pediatr (Rio J) 2016; 92:168-73. [PMID: 26686097 DOI: 10.1016/j.jped.2015.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/14/2015] [Accepted: 05/27/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to translate and validate the Pediatric Daytime Sleepiness Scale (PDSS) into Brazilian Portuguese. METHODS The translation/validation process was carried out through translation, back translation, technical review, assessment of verbal comprehension/clarity of the scale by experts and a focus group, test-retest, and application of the tool. The reproducibility analysis was performed by applying the PDSS in test-retest; internal consistency was verified by applying the scale in 90 children and adolescents. RESULTS The mean score of the sum of PDSS questions was 15.6 (SD=5.0) points. The PDSS showed appropriate indicators of content validation and clarity for the Brazilian Portuguese version. The internal consistency analysis showed a Cronbach's alpha of 0.784. The PDSS showed adequate reproducibility. The PDSS scores showed a significant and negative correlation with time spent in bed (r=-0.214; p=0.023). CONCLUSION The Brazilian Portuguese version of the PDSS shows satisfactory indicators of validity and can be applied in clinical practice and scientific research.
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Affiliation(s)
- Érico P G Felden
- Post-graduate Program in Human Movement Science, Health Sciences Research Center, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Joana D Carniel
- Post-graduate Program in Human Movement Science, Health Sciences Research Center, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Rubian D Andrade
- Post-graduate Program in Human Movement Science, Health Sciences Research Center, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Andreia Pelegrini
- Post-graduate Program in Human Movement Science, Health Sciences Research Center, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Tâmile S Anacleto
- Post-graduate Program in Cell and Molecular Biology, Human Chronobiology Laboratory, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Fernando M Louzada
- Post-graduate Program in Cell and Molecular Biology, Human Chronobiology Laboratory, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Kim DK, Han DH. Impact of allergic rhinitis on quality of life after adenotonsillectomy for pediatric sleep-disordered breathing. Int Forum Allergy Rhinol 2015; 5:741-6. [DOI: 10.1002/alr.21529] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital, Hallym University College of Medicine; Chuncheon Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
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Huseni S, Gutierrez MJ, Rodriguez-Martinez CE, Rodriguez CE, Nino CL, Perez GF, Pancham K, Nino G. The link between rhinitis and rapid-eye-movement sleep breathing disturbances in children with obstructive sleep apnea. Am J Rhinol Allergy 2015; 28:56-61. [PMID: 24717885 DOI: 10.2500/ajra.2014.28.3994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we examined OSA severity and polysomnogram (PSG) features in children with rhinitis and OSA. Given that rapid-eye-movement (REM) sleep is characterized by nasal congestion, we hypothesized that children with rhinitis have more REM-related breathing abnormalities. METHODS We conducted a retrospective cross-sectional analysis of 145 children with PSG-diagnosed OSA. Outcomes included PSG parameters and obstructive apnea-hypopnea index (OAHI) during REM and non-REM. Linear multivariable models examined the joint effect of rhinitis and OSA parameters with control for potential confounders. RESULTS Rhinitis was present in 43% of children with OSA (n = 63) but overall OAHI severity was unaffected by the presence of rhinitis. In contrast, OAHI during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/hr; SE = 6.4) compared with those with OSA alone (28.2/hr; SE = 3.8). CONCLUSION Rhinitis is highly prevalent in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA. Further research is needed to delineate the link between REM-sleep and the physiology of the nose during health and disease.
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Affiliation(s)
- Shehlanoor Huseni
- Divivsion of Pediatric Pulmonology and Sleep Medicine, Children's National Medical Center, Washington D.C., USA
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Chan CCK, Au CT, Lam HS, Lee DLY, Wing YK, Li AM. Intranasal corticosteroids for mild childhood obstructive sleep apnea--a randomized, placebo-controlled study. Sleep Med 2015; 16:358-63. [PMID: 25650159 DOI: 10.1016/j.sleep.2014.10.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/10/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The use of non-surgical treatment for childhood obstructive sleep apnea (OSA) is gaining popularity, especially in children with mild disease. OBJECTIVE To test the hypothesis that intranasal corticosteroids reduce disease severity in children with mild OSA. STUDY DESIGN A randomized, double-blinded, placebo-controlled trial of intranasal mometasone furoate (MF) versus placebo in children aged 6 to 18 years with mild OSA. The primary outcome was the change from baseline obstructive apnea hypopnea index (OAHI), as documented by overnight polysomnography, after four months of treatment. RESULTS Sixty-two children were recruited but 12 dropped out. This left 24 and 26 children for final analysis in the MF and placebo group, respectively. The OAHI and oxygen desaturation index (ODI) improved significantly in the MF group only. The OAHI decreased from 2.7 ± 0.2 to 1.7 ± 0.3 in the MF group, but increased from 2.5 ± 0.2 to 2.9 ± 0.6 in the placebo group (p = 0.039). The mean changes in ODI in the MF group and placebo group were -0.6 ± 0.5 and +0.7 ± 0.4, respectively (p = 0.037). CONCLUSION Four months of treatment with intranasal mometasone furoate effectively reduces the severity of mild OSA in children.
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Affiliation(s)
- Ching Ching Kate Chan
- Department of Pediatrics, Otorhinolaryngology - Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Chun T Au
- Department of Pediatrics, Otorhinolaryngology - Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Hugh S Lam
- Department of Pediatrics, Otorhinolaryngology - Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Dennis L Y Lee
- Department of Pediatrics, Otorhinolaryngology - Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yun K Wing
- Department of Psychiatry, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Albert M Li
- Department of Psychiatry, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Gozal D, Kim J, Bhattacharjee R, Goldman JL, Kheirandish-Gozal L. Substance P and neurokinin 1 receptors as potential therapeutic targets in children with OSA. Chest 2014; 145:1039-1045. [PMID: 24356854 DOI: 10.1378/chest.13-2026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Increased substance P (SP) levels and abundant expression of neurokinin (NK) 1 receptor in adenotonsillar tissues of children with OSA but not recurrent tonsillar infection (RI) suggest that NK1 antagonists could be useful in treating OSA. METHODS The effects of SP and the NK1 antagonist GR-82334 were examined on mixed cell cultures prepared from dissociated tonsils harvested intraoperatively from children with OSA and RI. Proliferation was assessed by [3H]-thymidine or 5-ethynyl-2'-deoxyuridine incorporation, and inflammatory cytokine production (tumor necrosis factor [TNF]-α, IL-6, IL-1β) was assessed in supernatants by enzyme-linked immunosorbent assay. RESULTS SP elicited dose-dependent increases in tonsillar cell proliferation in mixed cell cultures from children with OSA but not with RI (P < .0001). The NK1 antagonist exhibited dose-dependent reductions in cellular proliferative rates in OSA-derived cell cultures but not in RI-derived mixed cell cultures (P < .00001). SP treatment was associated with increased TNF-α and IL-6 production, and GR-82334 abrogated SP effects, as well as reduced basal cytokine release (P < .0001). CONCLUSIONS SP pathways appear to underlie intrinsic proliferative and inflammatory signaling pathways in tonsillar tissues from children with OSA but not with RI. Selective disruption of these pathways may provide nonsurgical alternatives for prevention and treatment of pediatric OSA.
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Affiliation(s)
- David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Jinkwan Kim
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Rakesh Bhattacharjee
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Julie L Goldman
- Department of Surgery, Division of Otolaryngology, University of Louisville, Louisville, KY
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.
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Abstract
PURPOSE OF REVIEW An inconsistent link between sleep-disordered breathing (SDB) and allergic rhinitis has been reported in the literature for decades. This review attempts to highlight some of the recent epidemiological studies purporting and refuting this connection, discuss possible mechanisms for this relationship and discuss how treatment of allergic rhinitis can help ameliorate SDB. RECENT FINDINGS Recently, a large systematic review that included 18 studies and 27 000 individuals of the association between allergic rhinitis and SDB in children was published supporting a correlation between SDB and allergic rhinitis. SUMMARY Although the evidence generally supports a connection between SDB and allergic rhinitis, this connection is not definitive and the mechanism linking these two diseases remains poorly understood. In addition to epidemiological studies, several small studies have demonstrated an improvement in SDB upon treatment of allergic rhinitis; however, large studies using objective measures to quantify SDB and allergic rhinitis are needed.
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Zicari AM, Occasi F, Cesoni Marcelli A, Lollobrigida V, Celani C, Indinnimeo L, Tancredi G, De Castro G, Duse M. Habitual snoring in children with previous allergic sensitization. Int J Immunopathol Pharmacol 2013; 26:565-70. [PMID: 23755775 DOI: 10.1177/039463201302600233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Previous studies have reported a high prevalence of allergy in children with Habitual Snoring (HS), but the relationship between allergy in the early years of life and the subsequent development of this Sleep Disordered Breathing (SDB) is yet to be elucidated. The purpose of the present study was to determine the role of early, under 36 months of age, allergic sensitization to food (with or without sensitization to airborne allergens) in determining the development of HS 8-10 years after. One hundred and forty-eight children (10-14 years, mean age 12 years) with a history of food allergy were selected. Under the age of 36 months, atopic status was assessed by skin prick test for a panel of airborne and food allergens. Questionnaires filled in by parents were used to collect information on children's snoring and associated symptoms. HS was defined as snoring three or more times per week. At 1-3 years of age 54 children were positive to food allergens alone, and 94 were positive also to airborne allergens. After 8-10 years of life, when patients were aged between 10 and 14 years, habitual snoring was reported in 37 children. Furthermore, among the 54 children under three years of age sensitized only to food, 8 became HS while of the 94 children sensitized to both food and inhalants allergens 29 developed HS. The difference between those two groups was statistically significant (p=0.04). We reported a significant risk of developing HS in children with early allergic sensitization. Specifically this risk was higher when food allergy was associated with inhalant allergy. The onset of upper airway inflammation due to allergic triggers in subjects under three years of age may be related to the subsequent development of SDB after 8-10 years.
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Affiliation(s)
- A M Zicari
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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González-Núñez V, Valero AL, Mullol J. Impact of sleep as a specific marker of quality of life in allergic rhinitis. Curr Allergy Asthma Rep 2013; 13:131-41. [PMID: 23247762 DOI: 10.1007/s11882-012-0330-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Allergic rhinitis (AR) is a common disorder, which represents a considerable burden both on individual patients and society. It is associated with bothersome symptoms, which may impair usual daily activities, sleep quality, and productivity. Associated with impaired sleep, quality of life is significantly impaired in AR patients. AR significantly contributes to sleep-disordered breathing through multiple mechanisms, with the greatest impact mediated through nasal obstruction. Sleep impairment is very common in AR patients and has a significant impact on disease-specific measures of general health and quality of life. The degree of sleep disturbance is directly related to the severity of the disease. Nasal congestion also demonstrates circadian rhythm and positional variability, worsening during nighttime hours and in supine position. Increased sleep disordered events lead to poor sleep with fatigue and daytime somnolence, impaired performance, productivity and social functioning, and an increased risk of associated diseases.
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Lin SY, Melvin TAN, Boss EF, Ishman SL. The association between allergic rhinitis and sleep-disordered breathing in children: a systematic review. Int Forum Allergy Rhinol 2013; 3:504-9. [PMID: 23307785 DOI: 10.1002/alr.21123] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/11/2012] [Accepted: 10/16/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of this work was to systematically review existing literature on the association between allergic rhinitis (AR) and sleep-disordered breathing (SDB) in children. METHODS We performed a literature search encompassing the last 25 years in PubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria included English-language papers containing original human data, number of subjects ≥7, and age <18 years old. Data was systematically collected on study design, patient demographics, clinical characteristics/outcomes, and level-of-evidence. Two investigators independently reviewed all articles. RESULTS The initial search yielded 433 abstracts, of which 18 articles were included. Twelve (67%) of the 18 articles showed a statistically significant association between AR and SDB. All articles were either case-series or case-control studies. Based on the Newcastle-Ottawa scale, the quality of the articles was determined to be fair to good. For characterizing AR, 7 (39%) studies included skin-prick testing and/or in vitro testing. For determining presence of SDB, 7 (39%) of the studies used polysomnographic data, of which 1 study incorporated data from a home polysomnogram. Habitual snoring was the most common form of SDB studied, in 10 (56%) of the articles. Obstructive sleep apnea was studied in 6 (33%) articles. CONCLUSION Although the majority of the studies included in this review showed a significant association between AR and SDB, all of the studies were evidence level 3b and 4, for an overall grade of B- evidence (Oxford Evidence-Based Medicine Center). Further higher-quality studies should be performed in the future to better evaluate the relationship between AR and SDB in children.
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Affiliation(s)
- Sandra Y Lin
- Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD 21287, USA.
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Zicari AM, Marzo G, Rugiano A, Celani C, Carbone MP, Tecco S, Duse M. Habitual snoring and atopic state: correlations with respiratory function and teeth occlusion. BMC Pediatr 2012; 12:175. [PMID: 23134563 PMCID: PMC3506469 DOI: 10.1186/1471-2431-12-175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 11/03/2012] [Indexed: 12/12/2022] Open
Abstract
Background Allergy represents a risk factor at the base of sleep-disordered breathing in pediatric age. Among allergic diseases, the atopy is characterized by a tendency to be “hyperallergic.” Sleep-disordered breathing is also known in orthodontics as correlated with the morphology of craniofacial complex. The aim of this study was to investigate the relation between atopy and sleep-disordered breathing (oral breathers with habitual snoring), comparing atopic children with sleep-disordered breathing (test group) with nonatopic ones with sleep-disordered breathing (control group), in the prevalence of dento-skeletal alterations and other risk factors that trigger sleep-disordered breathing, such as adenotonsillar hypertrophy, turbinate hypertrophy, obesity, and alteration of oxygen arterial saturation. Methods In a group of 110 subjects with sleep-disordered breathing (6 to 12 years old), we grouped the subjects into atopic (test group, 60 subjects) and nonatopic (control group, 50 subjects) children and compared the data on the following: skin allergic tests, rhinoscopy, rhinomanometry, night home pulsoxymetry, body mass index, and dento-facial alterations. Results Even if our results suggest that atopy is not a direct risk factor for sleep-disordered breathing, the importance of a physiologic nasal respiration in the pathogenesis of sleep-disordered breathing seems to be demonstrated in our study by the higher prevalence of hypertrophy in the adenotonsillar lymphatic tissue, odontostomatological alterations, alterations of the oxygen saturation to pulsoxymetry, and higher prevalence of obesity observed in our children with sleep-disordered breathing, in percentages higher than that of the general pediatric population previously observed in the literature. Conclusions The importance of a physiologic nasal respiration in the pathogenesis of sleep-disordered breathing is demonstrated in our study.
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Affiliation(s)
- Anna Maria Zicari
- Department of Paediatric Science, University La Sapienza, Rome, Italy
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