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Lam DJ, Hildebrand A, Nguyen T, Quintanilla-Dieck L, Tan GX, Hargunani CA, Macarthur CJ, Milczuk HA. Drug-Induced Sleep Endoscopy Predicts Subjective Outcomes of Adenotonsillectomy. Laryngoscope 2024. [PMID: 39166775 DOI: 10.1002/lary.31704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/19/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%-30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes. METHODS This was a prospective cohort study of children aged 2-18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes. RESULTS Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction. CONCLUSIONS Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Andrea Hildebrand
- Biostatistics and Design Program, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Thuan Nguyen
- Biostatistics and Design Program, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Grace X Tan
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Chris A Hargunani
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Carol J Macarthur
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Henry A Milczuk
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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Madini B, Khirani S, Vedrenne-Cloquet M, Galliani E, Tomat C, Célérier C, Patria MF, Griffon L, Kadlub N, Couloigner V, Picard A, Denoyelle F, Fauroux B. Management of sleep-disordered breathing in patients with syndromic hemifacial macrosomia. Sleep Breath 2024:10.1007/s11325-024-03032-1. [PMID: 38842644 DOI: 10.1007/s11325-024-03032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Patients with syndromic hemifacial microsomia (SHFM) are at risk of obstructive sleep apnea (OSA). The aim of the study was to describe the prevalence of OSA and its management, especially in patients with Goldenhar syndrome (GS). METHODS The respiratory polygraphies and clinical management of 15 patients, aged 2 to 23 years, evaluated at a national reference center, were analyzed. RESULTS Four (27%) patients had no OSA, 4 (27%) had mild OSA, and 7 (46%), of whom 5 were ≤ 2 years old, had severe OSA. None of the patients had central apneas. Only one patient had alveolar hypoventilation, and another one had nocturnal hypoxemia. Two patients had severe OSA despite prior adenoidectomy or mandibular distraction osteogenesis. Median duration of follow-up was 3.5 years (range 0.5-9 years). None of the patients without OSA or with mild OSA at baseline respiratory polygraphy developed OSA during the follow up. Among the 7 patients with severe OSA, 3 required continuous positive airway pressure or noninvasive ventilation, and one patient required a tracheostomy. CONCLUSION In conclusion, patients with SHFM are at high risk of severe OSA at any age, underlining the importance of systematic sleep studies to diagnose and evaluate the severity of OSA. Individualized treatment should be privileged, based on a careful examination of the entire upper airway, taking in account potential associated risk factors. All patients with SHFM should be managed by a pediatric expert multidisciplinary medical/surgical team until the end of post pubertal growth.
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Affiliation(s)
- Barbara Madini
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumo-Infettivologia, Milan, Italy
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- ASV Santé, Gennevilliers, France
| | - Meryl Vedrenne-Cloquet
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Eva Galliani
- Pediatric Maxillofacial and Plastic Surgery Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Catherine Tomat
- Pediatric Maxillofacial and Plastic Surgery Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Charlotte Célérier
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Maria Francesca Patria
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumo-Infettivologia, Milan, Italy
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris University, Paris, France
| | - Natacha Kadlub
- Pediatric Maxillofacial and Plastic Surgery Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Vincent Couloigner
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Arnaud Picard
- Pediatric Maxillofacial and Plastic Surgery Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.
- EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris University, Paris, France.
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3
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Abourjeili J, Salameh E, Noureddine M, Bou Khalil P, Eid AA. Obstructive sleep apnea: Beyond the dogma of obesity! Respir Med 2024; 222:107512. [PMID: 38158138 DOI: 10.1016/j.rmed.2023.107512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Obstructive sleep apnea (OSA) has long been studied in patients with obesity and type 2 diabetes mellitus (T2DM), due to the fact that both disorders are commonly associated with an increased body mass index (BMI). However, a link between OSA and non-obese diabetic patients is still not very elaborated, nor heavily explored. In this review, we elucidate some proposed mechanisms for the link between OSA and diabetic patients both with and beyond obesity, shedding the light on the latter case. One such mechanism is oxidative stress, a phenomenon of reactive oxygen species (ROS) imbalance seen in both of the previously mentioned disorders. A plausible explanation for the OSA-induced ROS production is the repeating episodes of hypoxia and reperfusion and their effect on the mitochondrial electron transport chain. This paper explores the literature regarding ROS imbalance as the possible missing link between OSA and Diabetes Mellitus beyond obesity, while still mentioning other possible proposed mechanisms such as a dysregulated autonomic nervous system (ANS), as well as mechanical and craniofacial abnormalities. This paper also suggests a link between OSA and diabetic complications, while exploring the clinical progress made in treating the former disorder with anti-oxidant and hypo-glycemic drugs. If further investigated, these findings could help identify novel therapeutic interventions for the treatment of OSA and Diabetic patients.
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Affiliation(s)
- Joseph Abourjeili
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Elio Salameh
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Maya Noureddine
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Pierre Bou Khalil
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Assaad A Eid
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon; AUB Diabetes, American University of Beirut, Faculty of Medicine, Medical Center, Lebanon.
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Ahsan M, Narala B, Ednick M, Kier C. Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients. Curr Opin Pediatr 2023; 35:710-715. [PMID: 37678405 DOI: 10.1097/mop.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW This review examines the potential of rapid palatal expansion (RPE) as a treatment for pediatric obstructive sleep apnea (OSA). The focus is on recent findings related to its efficacy, safety, patient selection, timing, appliance options, cost considerations, and long-term outcomes. RECENT FINDINGS Recent studies indicate that RPE can lead to significant improvements in pediatric OSA, with a 70% reduction in the Apnea Hypopnea Index (AHI) and increased oxygen saturation levels. It has been particularly effective in children with small or absent tonsils and has been found to reduce adenoid and tonsil size. Long-term follow-up studies suggest the need for ongoing monitoring, as some patients may experience relapse over time. SUMMARY RPE shows promise as an additional treatment for pediatric obstructive sleep apnea. It offers improvements in respiratory function and reduced symptoms in certain patients. However, long-term efficacy and safety require further investigation. Comparative studies and patient-reported outcomes are necessary to optimize treatment approaches. Collaboration between orthodontists, sleep specialists, and ear-nose-throat (ENT) specialists may be essential for optimal outcomes in pediatric OSA patients treated with RPE.
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Affiliation(s)
- Muhammad Ahsan
- Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital
| | - Bhavya Narala
- Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital
| | - Mathew Ednick
- Division of Pediatric Pulmonary, Pediatric Sleep Disorders Center, Stony Brook Children's Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Catherine Kier
- Division of Pediatric Pulmonary, Pediatric Sleep Disorders Center, Stony Brook Children's Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
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5
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Marincak Vrankova Z, Krivanek J, Danek Z, Zelinka J, Brysova A, Izakovicova Holla L, Hartsfield JK, Borilova Linhartova P. Candidate genes for obstructive sleep apnea in non-syndromic children with craniofacial dysmorphisms - a narrative review. Front Pediatr 2023; 11:1117493. [PMID: 37441579 PMCID: PMC10334820 DOI: 10.3389/fped.2023.1117493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Pediatric obstructive sleep apnea (POSA) is a complex disease with multifactorial etiopathogenesis. The presence of craniofacial dysmorphisms influencing the patency of the upper airway is considered a risk factor for POSA development. The craniofacial features associated with sleep-related breathing disorders (SRBD) - craniosynostosis, retrognathia and micrognathia, midface and maxillary hypoplasia - have high heritability and, in a less severe form, could be also found in non-syndromic children suffering from POSA. As genetic factors play a role in both POSA and craniofacial dysmorphisms, we hypothesize that some genes associated with specific craniofacial features that are involved in the development of the orofacial area may be also considered candidate genes for POSA. The genetic background of POSA in children is less explored than in adults; so far, only one genome-wide association study for POSA has been conducted; however, children with craniofacial disorders were excluded from that study. In this narrative review, we discuss syndromes that are commonly associated with severe craniofacial dysmorphisms and a high prevalence of sleep-related breathing disorders (SRBD), including POSA. We also summarized information about their genetic background and based on this, proposed 30 candidate genes for POSA affecting craniofacial development that may play a role in children with syndromes, and identified seven of these genes that were previously associated with craniofacial features risky for POSA development in non-syndromic children. The evidence-based approach supports the proposition that variants of these candidate genes could lead to POSA phenotype even in these children, and, thus, should be considered in future research in the general pediatric population.
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Affiliation(s)
- Zuzana Marincak Vrankova
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Jan Krivanek
- Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdenek Danek
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Jiri Zelinka
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Brysova
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lydie Izakovicova Holla
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - James K. Hartsfield
- E. Preston Hicks Professor of Orthodontics and Oral Health Research, University of Kentucky Center for the Biologic Basis of Oral/Systemic Diseases, Hereditary Genetics/Genomics Core, Lexington, KE, United States
| | - Petra Borilova Linhartova
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
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6
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Hirsch S, Gaultney J. Sleep disturbances in individuals with down syndrome: An overview. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231173011. [PMID: 37105757 DOI: 10.1177/17446295231173011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Down Syndrome, or Trisomy 21, is one of the most common birth defects, with 6,000 babies born annually with Down Syndrome in the U.S. One of many health risk factors individuals with Down Syndrome experience is sleep issues, ranging from poor sleep quality to high prevalence of obstructive sleep apnea. This literature review aims to review these sleep challenges in this population and explore consequences and treatment options.
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Affiliation(s)
- Sophie Hirsch
- Department of Psychological Science and Health Psychology PhD Program, University of North Carolina at Charlotte, USA
| | - Jane Gaultney
- Department of Psychological Science and Health Psychology PhD Program, University of North Carolina at Charlotte, USA
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7
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Tielemans B, De Herdt L, Pollenus E, Vanhulle E, Seldeslachts L, Marain F, Belmans F, Ahookhosh K, Vanoirbeek J, Vermeire K, Van den Steen PE, Vande Velde G. A Multimodal Imaging-Supported Down Syndrome Mouse Model of RSV Infection. Viruses 2023; 15:v15040993. [PMID: 37112973 PMCID: PMC10144178 DOI: 10.3390/v15040993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Individuals with Down syndrome (DS) are more prone to develop severe respiratory tract infections. Although a RSV infection has a high clinical impact and severe outcome in individuals with DS, no vaccine nor effective therapeutics are available. Any research into infection pathophysiology or prophylactic and therapeutic antiviral strategies in the specific context of DS would greatly benefit this patient population, but currently such relevant animal models are lacking. This study aimed to develop and characterize the first mouse model of RSV infection in a DS-specific context. Ts65Dn mice and wild type littermates were inoculated with a bioluminescence imaging-enabled recombinant human RSV to longitudinally track viral replication in host cells throughout infection progression. This resulted in an active infection in the upper airways and lungs with similar viral load in Ts65Dn mice and euploid mice. Flow cytometric analysis of leukocytes in lungs and spleen demonstrated immune alterations with lower CD8+ T cells and B-cells in Ts65Dn mice. Overall, our study presents a novel DS-specific mouse model of hRSV infection and shows that potential in using the Ts65Dn preclinical model to study immune-specific responses of RSV in the context of DS and supports the need for models representing the pathological development.
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Affiliation(s)
- Birger Tielemans
- Biomedical MRI Unit/Mosaic, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Lander De Herdt
- Biomedical MRI Unit/Mosaic, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Emilie Pollenus
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium
| | - Emiel Vanhulle
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium
| | - Laura Seldeslachts
- Biomedical MRI Unit/Mosaic, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Fopke Marain
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Flore Belmans
- Biomedical MRI Unit/Mosaic, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
- Radiomics (Oncoradiomics SA), 4000 Liege, Belgium
| | - Kaveh Ahookhosh
- Biomedical MRI Unit/Mosaic, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
| | - Kurt Vermeire
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium
| | - Philippe E Van den Steen
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium
| | - Greetje Vande Velde
- Biomedical MRI Unit/Mosaic, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
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Ho ACH, Savoldi F, Wong RWK, Fung SC, Li SKY, Yang Y, Gu M. Prevalence and Risk Factors for Obstructive Sleep Apnea Syndrome Among Children and Adolescents with Cleft lip and Palate: A Survey Study in Hong Kong. Cleft Palate Craniofac J 2023; 60:421-429. [PMID: 34939456 DOI: 10.1177/10556656211068306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) risk and related risk factors among children and adolescents of Hong Kong with cleft lip and/or palate (CL/P). DESIGN Retrospective survey study adopting three questionnaires, obstructive sleep apnea-18 (OSA-18), pediatric sleep questionnaire-22 (PSQ-22), and modified Epworth Sleepiness Scale (ESS). SETTINGS Multicenter study in two public hospitals. PATIENTS A total of 351 Chinese children and adolescents with non-syndromic CL/P (6-18-year-old, 57% males) visited between September 2017 and November 2019, with primary palatal repair surgery done before 3-year-old. MAIN OUTCOME MEASURE Positive OSAS risk was determined based on cut-off ≥60 for OSA-18, ≥8 for PSQ-22, and >8 for ESS. Age, sex, overweight presence, cleft type, embryonic secondary palate involvement, palatal repair surgery, palatal revision surgery, and orthodontic treatment were analyzed as possible risk factors. RESULTS A total of 9.5% of patients had positive OSAS risk based on OSA-18, 13.6% based on PSQ-22, and 13.2% according to ESS. A higher prevalence of patients with positive OSAS risk was of younger age (OSA-18, p = .034), had cleft involving embryonic secondary palate (PSQ-22, p = .009), and history of fixed orthodontic treatment (ESS, p = .002). The regression model identified only involvement of embryonic secondary palate as a risk factor (PSQ-22, odds ratio = 3.7, p = .015). CONCLUSIONS OSAS risk among children and adolescents of Hong Kong with CL/P was 9.5% to 13.6%. Patients at higher risk were those with cleft involving embryonic secondary palate. OSAS risk assessment may be influenced by different aspects of the disease spectrum, and a multimodal approach should be considered for such assessment.
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Affiliation(s)
- A C H Ho
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - F Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - R W K Wong
- 36621Department of Dentistry & Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR
| | - S C Fung
- 36621Department of Dentistry & Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR
| | - S K Y Li
- Clinical Research Center, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Y Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - M Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
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Li C, Kou YF, DeMarcantonio MA, Heubi CH, Fleck R, Kandil A, Smith DF, Ishman SL. Sleep Endoscopy and Cine Magnetic Resonance Imaging Evaluation of Children With Persistent Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2023; 168:848-855. [PMID: 35608914 PMCID: PMC10127993 DOI: 10.1177/01945998221097659] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare findings of same-day cine magnetic resonance imaging (MRI) and drug-induced sleep endoscopy (DISE) and examine how each technique uniquely contributes to the evaluation of persistent obstructive sleep apnea following adenotonsillectomy. STUDY DESIGN Retrospective cohort study. SETTING Quaternary care center. METHODS Chart review was performed for consecutive patients who underwent same-day cine MRI and DISE between 2015 and 2020. Descriptive statistics are reported, and Cohen kappa coefficients were calculated to evaluate the agreement between cine MRI and DISE for obstruction at the adenoids, lingual tonsils, and tongue base. RESULTS There were 137 patients, the mean age was 10.4 years (95% CI, 3.2-16.7), and 62.8% were male. The most common sites of obstruction on DISE were the tongue base (86.9%), velum (78.7%), epiglottis (74.5%), inferior turbinate (68.6%), and lingual tonsil (61.3%). The most common sites of obstruction on cine MRI were the hypopharynx (56.3%), tongue base (44.8%), lingual tonsil (38.0%), and macroglossia (37.6%). There was moderate agreement for adenoid hypertrophy (κ = 0.53) and poor agreement for lingual tonsil hypertrophy (κ = 0.15) and tongue base obstruction (κ = 0.09). DISE identified more instances of multilevel obstruction when compared with cine MRI (94.9% vs 48.2%). CONCLUSION DISE offered a better examination of nasal and supraglottic obstruction and is sensitive to partial vs complete collapse, while cine MRI offered better soft tissue resolution for lymphoid tissue hypertrophy and provided a global view of primary and secondary airway obstruction. Cine MRI and DISE are complementary modalities in the evaluation of children with persistent obstructive sleep apnea.
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Affiliation(s)
- Carol Li
- Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yann-Fuu Kou
- Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael A. DeMarcantonio
- Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine H. Heubi
- Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert Fleck
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali Kandil
- Division of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - David F. Smith
- Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Circadian Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stacey L. Ishman
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of HeathVine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Effect of Sleep Position on Sleep-Disordered Breathing in Young Children With Unrepaired Incomplete Cleft Palates. J Craniofac Surg 2023; 34:602-606. [PMID: 36731109 DOI: 10.1097/scs.0000000000008879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/04/2022] [Indexed: 02/04/2023] Open
Abstract
Children with cleft lip/palate are usually faced with upper airway problems after surgical repair. The severity of upper airway obstruction is more likely associated with the age and preoperative diagnosis of obstructive sleep apnea (OSA). This study aimed to investigate the severity of OSA in toddlers before palatoplasty from the perspective of polysomnography. In this retrospective cohort study, 97 children with unrepaired cleft palate and habitual prone sleeping were identified with a mean age of 1.6 years (SD 0.6) and divided into 2 age groups (1.5 year or younger and older than 1.5 year). Detailed information was collected including demographics, sleep parameters, and respiratory disturbances. Polysomnography results showed these children were at high risks of OSA with averagely moderate severity at night during their early childhood [apnea-hypopnea index 7.2±3.2 events/hour; obstructive apnea index (OAI) 6.5±2.8 events/hour]. Positional OAI was greatly lower in prone than that in laterals or in supine. Far more sleep time was spent in prone than in supine (42.9%±42.2% versus 8.5%±15.7%), which were consistent with parental reporting of prone sleeping habits. There were no significant differences found between the 2 age groups in respiratory disturbances such as apnea-hypopnea index, OAI, mean oxygen saturation, and nadir oxygen saturation ( P =0.097-0.988). Thus, prone sleeping with a history of snoring might be indicators for early screening for OSA in the cleft population. Adequate attention should be paid to their upper airway and, if available, overnight polysomnography should be performed to ascertain their potential respiratory problems before repair surgery.
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Kirkham EM. Pediatric Drug-Induced Sleep Endoscopy. Otolaryngol Clin North Am 2022; 55:1165-1180. [DOI: 10.1016/j.otc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Niu X, Moland J, Pedersen TK, Bilgrau AE, Cattaneo PM, Glerup M, Stoustrup P. Restricted upper airway dimensions in patients with dentofacial deformity from juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:32. [PMID: 35477405 PMCID: PMC9044879 DOI: 10.1186/s12969-022-00691-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This retrospective, cross-sectional study aimed to assess the pharyngeal airway dimensions of patients with juvenile idiopathic arthritis (JIA) and moderate/severe JIA-related dentofacial deformity (mandibular retrognathia/micrognathia), and compare the results with JIA patients with a normal mandibular appearance and a group of non-JIA patients. METHODS Seventy-eight patients were retrospectively included in a 1:1:1 manner as specified below. All patients had previously been treated at the Section of Orthodontics, Aarhus University, Denmark. All had a pretreatment cone beam computed tomography (CBCT). Group 1 (JIA+); 26 JIA patients with severe arthritis-related dentofacial deformity and mandibular retrognathia/micrognathia. Group 2 (JIA-); 26 JIA patients with normal mandibular morphology/position. Group 3 (Controls); 26 non-JIA subjects. Dentofacial morphology and upper airway dimensions, excluding the nasal cavity, were assessed in a validated three-dimensional (3D) fashion. Assessment of dentofacial deformity comprised six morphometric measures. Assessment of airway dimensions comprised nine measures. RESULTS Five morphometric measures of dentofacial deformity were significantly deviating in the JIA+ group compared with the JIA- and control groups: Posterior mandibular height, anterior facial height, mandibular inclination, mandibular occlusal inclination, and mandibular sagittal position. Five of the airway measurements showed significant inter-group differences: JIA+ had a significantly smaller nasopharyngeal airway dimension (ad2-PNS), a smaller velopharyngeal volume, a smaller minimal cross-sectional area and a smaller minimal hydraulic diameter than JIA- and controls. No significant differences in upper airway dimensions were seen between JIA- and controls. CONCLUSION JIA patients with severe arthritis-related dentofacial deformity and mandibular micrognathia had significantly restricted upper airway dimensions compared with JIA patients without dentofacial deformity and controls. The restrictions of upper airway dimension seen in the JIA+ group herein were previously associated with sleep-disordered breathing in the non-JIA background population. Further studies are needed to elucidate the role of dentofacial deformity and restricted airways in the development of sleep-disordered breathing in JIA.
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Affiliation(s)
- Xiaowen Niu
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Julianne Moland
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Thomas Klit Pedersen
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Ellern Bilgrau
- grid.5117.20000 0001 0742 471XDepartment of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Paolo M. Cattaneo
- grid.7048.b0000 0001 1956 2722Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia, Formerly, Section of Orthodontics, Aarhus University, Denmark, Aarhus, Denmark
| | - Mia Glerup
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Stoustrup
- Section of Orthodontics, Aarhus University, Aarhus, Denmark.
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Benedek P, Keserü F, Kiss G, Bella Z, Rovó L, Katona G, Bikov A, Csoma B, Lázár Z. Postoperative respiratory complications in children with obstructive sleep apnoea syndrome. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:162-168. [PMID: 35612508 PMCID: PMC9132002 DOI: 10.14639/0392-100x-n1803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
Objective We aimed to prospectively assess the effect of comorbidities on the occurrence of postoperative respiratory complications (PoRCs) after adenotonsillectomy in children with obstructive sleep apnoea syndrome (OSA) and whether otherwise healthy children need a higher level of postoperative monitoring. Methods 577 children who had OSA and underwent adenotonsillectomy were enrolled. The effects of demographics, comorbidities and OSA on PoRCs were investigated with logistic regression analysis. Results The PoRC rate was 4.3%. Postoperative oxygen desaturations were more marked in patients with comorbidities (p = 0.005). The presence of comorbidity increased the risk of PoRCs (odds ratio 4.234/3.226-5.241, 95% confidence intervals, p < 0.001). There was no difference in apnoea-hypopnoea index (AHI) values between comorbid patients with and without PoRCs [8.2 (3.8-50.2) vs 14.3 (11.7-23.3)]. (p = 0.37). In the group of patients without comorbidities, PoRCs were associated with a higher AHI [14.7 (3.4-51.3) vs 3.9 (2.0-8.0), p < 0.001]. Conclusions Comorbidities are more closely linked with PoRCs than OSA severity. In patients without comorbidity, PoRCs are associated with OSA severity and usually occur within the first 2 hours after the intervention.
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Rayasam SS, Abijay C, Johnson R, Mitchell RB. Outcomes of Adenotonsillectomy for Obstructive Sleep Apnea in Children Under 3 Years of Age. EAR, NOSE & THROAT JOURNAL 2022:1455613221086526. [PMID: 35324349 DOI: 10.1177/01455613221086526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To identify predictors of obstructive sleep apnea (OSA) after adenotonsillectomy (T&A) in children under 3 years of age and to describe the characteristics of children with OSA under 3 years of age undergoing T&A in an ethnically diverse population. Methods: We examined 87 children under 3 years with T&A and pre- and post-operative polysomnography (PSG) between 8/2012 and 3/2020 at a large tertiary care hospital. Differences were compared for covariates including demographics, comorbidities, and respiratory parameters. Regression was used to identify predictors of persistent severe OSA. Significance was set at P < .05. Results: Of the 87 children in the study, 64 (74%) were male, 26 (30%) were obese, 34 (39%) were Hispanic, and 35 (40%) were Black. Most children (94%) had improvements in OSA severity as measured by the apnea-hypopnea index (AHI) after T&A, but 78% had persistent OSA (AHI ≥1) after surgery. Children with persistent mild, compared to moderate-severe OSA, were more likely to have gastroesophageal reflux disease (GERD) (50% versus 24%, P = .025), a craniofacial disorder (30% versus 10%, P = .025), Down syndrome (20% versus 5%, P = .031), or pre-operative severe OSA. Conclusions: This study of an ethnically diverse population found that T&A is an effective procedure at improving, but not resolving, OSA in children under 3 years. Children with Down syndrome, craniofacial abnormalities, GERD, or pre-operative severe OSA who are under 3 years old are at high risk for persistent OSA and may benefit from post-operative PSG. Future study should examine complications and long-term outcomes of T&A in this age group.
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Affiliation(s)
| | - Claire Abijay
- 25989UT Southwestern Medical School, Dallas, TX, USA
| | - Romaine Johnson
- Department of Otolaryngology Head and Neck Surgery, 89063UT Southwestern and Children's Medical Center, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology Head and Neck Surgery, 89063UT Southwestern and Children's Medical Center, Dallas, TX, USA
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15
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Huerta J, Taleu H, Norton R, Gries H, Yun P, Lam D. Use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire to predict perioperative respiratory adverse events in children. J Clin Sleep Med 2022; 18:695-701. [PMID: 34823651 PMCID: PMC8883104 DOI: 10.5664/jcsm.9582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The Snoring, Trouble Breathing, Un-Refreshed (STBUR) screening questionnaire has been validated in identifying pediatric surgical patients with symptoms of sleep-disordered breathing who may be at risk of perioperative respiratory adverse events. We sought to assess the performance of the STBUR questionnaire when adjusting for potential confounders such as patient comorbidities or surgical service. METHODS This was a retrospective cohort study of children aged 2-18 years undergoing elective procedures under general anesthesia over a 3-month period. Procedure specialties included general surgery, urology, orthopedic surgery, neurosurgery, plastic surgery, otolaryngology, dentistry, and gastroenterology. Preoperative STBUR questionnaire responses and perioperative respiratory adverse events were documented prospectively. Multivariate logistic regression was used to quantify associations between preoperative questionnaire responses, other potential risk factors (including age, sex, surgical specialty, comorbidities), and risk of perioperative respiratory adverse events. RESULTS Of 555 children, 17% had a positive STBUR screen. The prevalence of perioperative respiratory adverse events with a positive questionnaire screen was significantly greater than with a negative screen (29% vs 9%, respectively; P < .001). A positive questionnaire screen was associated with a significantly increased risk of a perioperative respiratory adverse event (adjusted odds ratio 3.47 [95% confidence interval 1.53-7.84], P = .003). CONCLUSIONS A positive screen on the STBUR questionnaire was associated with a 3.5-fold increased risk of perioperative respiratory adverse events in pediatric surgical patients. The STBUR questionnaire should be considered as a routine preoperative screening tool in children undergoing elective procedures. CITATION Huerta J, Taleu H, Norton R, Gries H, Yun P, Lam D. Use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire to predict perioperative respiratory adverse events in children. J Clin Sleep Med. 2022;18(3):695-701.
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Affiliation(s)
- Javier Huerta
- Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Hannah Taleu
- Pediatric Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Rene Norton
- Nursing Professional Practice, Oregon Health and Science University, Portland, Oregon
| | - Heike Gries
- Pediatric Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Philip Yun
- Pediatric Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Derek Lam
- Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Esperanza RA, Evans A, Tucker D, Paranjothy S, Hurt L. Hospital admissions in infants with Down syndrome: a record-linked population-based cohort study in Wales. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:225-239. [PMID: 34859911 PMCID: PMC9376940 DOI: 10.1111/jir.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite recent advances, mortality in children with Down syndrome remains five times higher than in the general population. This study aims to describe the burden, patterns and causes of hospital admissions in infants with Down syndrome, and compare this with infants without Down syndrome in a population-based cohort. METHODS This study used data from the Wales Electronic Cohort for Children, a cohort of all children born in Wales between 1990 and 2012. The cohort was generated from routine administrative data, linked to create an anonymised data set within the Secure Anonymised Information Linkage databank. This analysis is based on all infants born between January 2003 and January 2012 who were followed to their first birthday, a move out of Wales, death, or until 31 October 2012 (end of follow-up). Infants with Down syndrome were identified using the Congenital Anomaly Register and Information Service in Wales. Multivariable Cox regression was used to compare the time to first hospital admission. Admission codes were used to identify the commonest indications for hospitalisation and to determine the presence of other congenital anomalies. RESULTS We included 324 060 children, 356 of whom had Down syndrome. Of infants with Down syndrome, 80.3% had at least one hospital inpatient admission during the first year of life, compared with 32.9% of infants without Down syndrome. These first admissions were earlier [median of 6 days interquartile range (IQR) (3, 72) compared with 45 days [IQR 6, 166)] and longer [median of 4 days (IQR 1, 15) compared with 1 day (IQR 0, 3)] than in infants without Down syndrome. The most common causes of admissions were congenital abnormalities, respiratory diseases, conditions originating in the perinatal period and infectious diseases. The presence of other congenital abnormalities increased hospitalisations in all infants, but more so in infants with Down syndrome who spent a median of 21 days in hospital (IQR 11, 47) during their first year of life. CONCLUSION Infants with Down syndrome are at high risk for early, more frequent and longer hospital admissions. Congenital heart disease and respiratory infections remain a major burden in this population. More research is needed to understand how to better manage these conditions particularly in the first month of life when most admissions occur.
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Affiliation(s)
- R. A. Esperanza
- School of MedicineCardiff UniversityCardiffUK
- Cwm Taf Morgannwg University Health BoardMerthyr TydfilUK
| | - A. Evans
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - D. Tucker
- Congenital Anomaly Register and Information ServicePublic Health WalesSwanseaUK
| | - S. Paranjothy
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
- Centre for Health Data ScienceUniversity of AberdeenAberdeenUK
| | - L. Hurt
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
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17
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Factors Affecting Outcomes of Craniofacial Clinical Trials. J Craniofac Surg 2021; 32:2484-2486. [PMID: 34705392 DOI: 10.1097/scs.0000000000007747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aims to provide a cross-sectional view of craniofacial trials and to identify factors associated with completion, publication, and trial longevity. MATERIALS AND METHODS This is a cross-sectional study of cleft and craniofacial clinical trials registered with ClinicalTrials.gov between September 1999 and April 2020. Predictor variables included funding source, trial design, trial location, number of recruitment sites, and investigator specialty.Study outcomes were completion status, publication status, and trial duration. Univariate comparisons and multivariate regression models were calculated for each outcome. RESULTS The final sample included 179 clinical trials pertaining to craniofacial care. Nearly all trials were single-center (86.5%), and roughly half of trials were interventional (57.0%) or conducted in the United States (40.5%). No single specialty predominated, although plastic surgery (13.4%) was the most common investigator specialty. The completion rate was 82.7%, the publication rate was 40.8%, and the mean trial duration was 39.1 months. Interventional design (odds ratio = 0.30, P = 0.02) and United States location (odds ratio = 0.15, P < 0.01) were each independently associated with lower odds of trial completion. Trial longevity was independently associated with the National Institute of Health-funding (P < 0.01) and multicenter design (P < 0.01). CONCLUSIONS Craniofacial trials are multidisciplinary and have a high rate of completion. Although most existing trials were conducted at only a single-center, multicenter efforts significantly increased trial longevity without compromising completion and publication rates. Given the diverse array of conditions and lines of inquiry that compose craniofacial care, it is reassuring that collaboration did not negatively affect trial outcomes.
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Moraleda-Cibrián M, Edwards SP, Kasten SJ, Warschausky SA, Buchman SR, Monasterio-Ponsa C, O'Brien LM. Impact of sleep-disordered breathing on behavior and quality of life in children aged 2 to 7 years with non-syndromic cleft lip and/or palate. Pediatr Pulmonol 2021; 56:3358-3365. [PMID: 34407324 DOI: 10.1002/ppul.25611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Children with cleft are at high risk for sleep-disordered breathing (SDB). However, little is known about the impact of SDB in this pediatric population. The aim of this study was to investigate whether SDB play a role in behavior and quality of life (QoL) in young children with cleft. METHODS Cross-sectional study of 95 children aged 2.0-7.9 years with cleft palate. Parents completed a sleep (Pediatric Sleep questionnaire), a behavior (Conners' Early Childhood scale), and a generic health-related QoL (KINDL questionnaire) assessment. Symptomatic children were referred for a polysomnography (PSG). RESULTS Overall, 14.7% of children (49.5% boys) screened positive for SDB and 27.4% had a PSG, which identified 84.6% with sleep apnea (apnea-hypopnea index [AHI] ≥1) and 27.2% with AHI ≥5. Positive screening for SDB was associated with elevated T-scores for anxiety and physical symptoms, significant differences in mean T-scores for inattention/hyperactivity (64.2 ± 15.7 vs. 53.9 ± 11.4, p = .02), social functioning/atypical behaviour, social functioning (60.6 ± 11.7 vs. 51.9 ± 7.3, p = .004 and 59.5 ± 10.9 vs. 51.2 ± 8.0, p = .01) and mood (57.5 ± 8.2 vs. 50.7 ± 8.2, p = .03). Lower QoL scores for emotional and family well-being were also reported in children with SDB (80.7 ± 13.4 vs. 90.0 ± 8.7, p = .01, 66.7 ± 15.8 vs. 76.9 ± 11.9, p = .04). Children with AHI ≥5 compared to those with AHI ≥1 and <5 showed significant differences in mean T-score for aggressive behaviour (65.2 ± 12.1 vs. 52.3 ± 11.3, p = .04), defiant temper (62.8 ± 9.2 vs. 51.6 ± 10.2, p = .03) and lower family QoL scores (59.4 ± 15.2 vs. 77.1 ± 9.6, p = .006). CONCLUSIONS In children with cleft palate the presence of SDB symptoms and moderate/severe sleep apnea was associated with behavioral (internalizing/externalizing) problems and lower family well-being.
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Affiliation(s)
- Marta Moraleda-Cibrián
- Michael S. Aldrich Sleep Disorders Laboratory and Sleep Disorders Clinic, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Sleep Disorders Center, Centro Médico Teknon, Barcelona, Spain
| | - Sean P Edwards
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven J Kasten
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Seth A Warschausky
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven R Buchman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carme Monasterio-Ponsa
- Unit of Sleep Disorders, Department of Neumology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Louise M O'Brien
- Michael S. Aldrich Sleep Disorders Laboratory and Sleep Disorders Clinic, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Obstructing Sleep Apnea in Children with Genetic Disorders-A Special Need for Early Multidisciplinary Diagnosis and Treatment. J Clin Med 2021; 10:jcm10102156. [PMID: 34067548 PMCID: PMC8156845 DOI: 10.3390/jcm10102156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO2 nadir, end-tidal CO2, and transcutaneous CO2. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life.
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顾 伟, 樊 悦, 霍 红, 陈 晓. [Obstructive sleep apnea in microtia children with maxillofacial dysostosis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:371-379. [PMID: 33794641 PMCID: PMC10128449 DOI: 10.13201/j.issn.2096-7993.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 06/12/2023]
Abstract
Children with microtia are often associated with maxillofacial dysostosis, such as Treacher Collins syndrome, Goldenhar syndrome, and Nager syndrome, and they are prone to suffer from obstructive sleep apnea(OSA). Obstruction widely occurred in the upper airway is the main mechanism of OSA in these children, and dysplasia of the pharynx and neurodevelopmental abnormalities may also participate. Early diagnosis requires symptom screening and polysomnography. Imaging techniques and endoscopy can be adopted to fully assess the upper airway status to guide further treatment. According to the child's condition and the main obstruction site, treatment methods include maxillofacial deformity correction, continuous positive pressure ventilation and tracheotomy. OSA in microtia children with maxillofacial dysostosis needs to be identified and treated in time to reduce the adverse effects on the growth and development of children.
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Affiliation(s)
- 伟 顾
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 悦 樊
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 红 霍
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 晓巍 陈
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
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21
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Kim J, Gueye-Ndiaye S, Mauer E, Modi VK, Perlman J, Veler H. Polysomnography use in complex term and preterm infants to facilitate evaluation and management in the neonatal intensive care unit. J Clin Sleep Med 2021; 17:1653-1663. [PMID: 33755011 DOI: 10.5664/jcsm.9264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES 1. To determine the characteristics of term and preterm infants for which polysomnography (PSG) was used as a primary diagnostic tool in infants with recurrent desaturation episodes, suspected obstructive apnea or both, and the prevalence of abnormal studies. 2. To identify the interventions following PSGs. 3. To assess the added value of airway and swallow evaluations. METHODS Retrospective cohort study of infants evaluated by PSG in the Neonatal Intensive Care Unit (NICU) at NYP-Weill Cornell from January 2012 to April 2018. RESULTS PSGs were performed on 31 infants; 15 (48%) term and 16 (52%) preterm infants. Indications for PSG were persistent desaturations (n=24), suspected obstructive apnea (n=15), and stridor (n=2). Primary comorbid conditions were respiratory (n=11), craniofacial (n=9), airway anomalies (n=6) and neurologic (n=5). The apnea-hypopnea index (AHI) was abnormal in 30 (97%) infants. Of those, 23 (74%) were severe, seven (23%) were moderate, and normal in one (3%). Apneic events were predominantly obstructive in 23 infants and predominantly central in 6. AHI improved in all but one follow-up PSG. The PSG findings resulted in interventions in 24 (77%) infants, in addition to concomitant otolaryngology evaluations (abnormal in 20/25) and swallow studies (abnormal in 9/14). Clinical signs completely resolved in 22 (71%) infants. CONCLUSIONS This is one of the first reports on the diagnostic value of inpatient PSGs in the NICU in infants with recurrent desaturation episodes, suspected obstructive apnea or both. Our findings indicate that PSG is an important tool in evaluating and targeting therapies in complex term and preterm infants with a wide variety of comorbidities.
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Affiliation(s)
- James Kim
- Division of Newborn Medicine, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
| | - Seyni Gueye-Ndiaye
- Pediatric Pulmonology, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
| | - Elizabeth Mauer
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York
| | - Vikash K Modi
- Department of Otolaryngology, Division of Pediatric Otolaryngology- Head & Neck Surgery, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, New York
| | - Jeffrey Perlman
- Division of Newborn Medicine, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
| | - Haviva Veler
- Pediatric Pulmonology, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
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Assessment of the Accuracy of Identification of Selected Disabilities and Conditions in Hospital Discharge Data for Pregnant Women. Epidemiology 2021; 31:687-691. [PMID: 32168020 DOI: 10.1097/ede.0000000000001185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Linked birth certificate-hospital discharge records are a valuable resource for examining pregnancy outcomes among women with disability conditions. Few studies relying on these data have been able to assess the accuracy of identification of preexisting disability conditions. We assessed the accuracy of International Classification of Diseases version 9 (ICD9) codes for identifying selected physical, sensory, and intellectual conditions that may result in disability. As ICD9 codes were utilized until recently in most states, this information is useful to inform analyses with these records. METHODS We reviewed 280 of 311 (90%) medical records of pregnant women with disabilities based on ICD9 codes and 390 of 8,337 (5%) records of pregnant women without disabilities who had deliveries at a large university medical center. We estimated sensitivity, specificity, and positive predictive values (PPV) using the medical record as gold standard. We adjusted for verification bias using inverse probability weighting and imputation. RESULTS The estimated sensitivity of ICD9 codes to identify women with disabilities with deliveries 2009-2012 was 44%; PPV was 98%, improving over time. Although sensitivity was <50% for some conditions, PPVs were 87%-100% for all conditions except intellectual disability (67%). Many physical conditions had complete verification and no underreporting. CONCLUSIONS These results are helpful for new studies using historical data comparing outcomes among women with and without these conditions and to inform interpretation of results from earlier studies. Assessment of the accuracy of disabilities as identified by ICD version 10 codes is warranted.
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Abstract
Sleep-disordered breathing (SDB) includes disorders of breathing that affect airway patency, which impair children's sleep and lead to negative consequences. Obstructive sleep apnea, hypoventilation and upper airway resistance syndrome are common causes of morbidity and mortality in childhood. These clinical practice guidelines, intended for use by pediatricians and primary care clinicians, provide a clear recommendation for the diagnosis and management of sleep-disordered breathing, focusing on the most serious disorder, obstructive sleep apnea syndrome (OSAS). These clinical guidelines formulate clear recommendations to identify patients with suspected OSAS. Further, the manuscript will highlight the potential consequences of SBD in children, and how to overcome such difficulties, what could be the therapeutic options, a 12 recommendations and what are the future direction for pediatric sleep medicine.
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Affiliation(s)
- Abdullah Al-Shamrani
- Pediatric Respiratory and Sleep Medicine, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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24
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Ali NES, Alyono JC, Kumar AR, Cheng H, Koltai PJ. Sleep surgery in syndromic and neurologically impaired children. Am J Otolaryngol 2020; 41:102566. [PMID: 32504854 DOI: 10.1016/j.amjoto.2020.102566] [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: 12/06/2019] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities. MATERIAL AND METHODS Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi. OUTCOME MEASURES Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings. RESULTS 228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p = 0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI. CONCLUSIONS Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.
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钟 建, 罗 向, 黄 振, 仇 书, 程 超, 杨 李, 易 新, 曾 锦, 刘 大. [The significance of evaluation of sleep respiration in infants with Pierre Robin sequence]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:496-498. [PMID: 32842177 PMCID: PMC10128329 DOI: 10.13201/j.issn.2096-7993.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Objective:This study aimed to evaluate the sleep disorders of infants with Pierre Robin sequence by PSG, and to understand the sleep breathing characteristics of them. Method:Seventeen patients with Pierre Robin sequence underwent polysomnography lasting over 7 hours. Sleep apnea and oxygen index was recorded and analyzed. Result:14(82.35%) patients with Pierre Robin sequence presented with apnea, hypopnea and hypoxemia with varying degree. The apnea-hypopnea index(12.39±9.86) and lowest arterial oxygen saturation(84.12±8.12) %were not significantly different between sexes. However, age showed a negative impact with apnea-hypopnea index, which was worse in younger infants. Conclusion:Most patients with the Pierre Robin sequence have sleep apnea and hypoxemia, and appropriate management should be implemented in an early age. Polysomnography can provide objective analysis of the treatment.
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Affiliation(s)
- 建文 钟
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 向前 罗
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 振云 黄
- 广州市妇女儿童医疗中心耳鼻咽喉科Department of Oto1aryngology, Guangzhou Women and Children's Medical Center
| | - 书要 仇
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 超 程
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 李强 杨
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 新华 易
- 广州市妇女儿童医疗中心耳鼻咽喉科Department of Oto1aryngology, Guangzhou Women and Children's Medical Center
| | - 锦鸿 曾
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
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26
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Munawar S, Marston AP, Patel T, Nguyen SA, White DR. Outcomes Assessment of Multi-Level Sleep Surgery in Syndromic Versus Non-Syndromic Children. Ann Otol Rhinol Laryngol 2020; 129:556-564. [PMID: 31920116 DOI: 10.1177/0003489419900201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Analyze the differences in length of stay, cost, disposition, and demographics between syndromic and non-syndromic children undergoing multi-level sleep surgery. METHODS Children with sleep disordered breathing or obstructive sleep apnea that had undergone sleep surgeries were isolated from the 1997 to 2012 editions of the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Children were then classified as syndromic or non-syndromic and stratified by level of sleep surgery (tonsillectomy & adenoidectomy, tonsillectomy & adenoidectomy plus other site surgery, other site surgery). Length of stay and cost were reported with Kruskal-Wallis one-way analysis of variance, disposition with binomial logistic regression, and demographics with chi-square. RESULTS Syndromic children compared to non-syndromic children were more likely to have surgery beyond just tonsillectomy & adenoidectomy and also had a longer length of stay, higher total cost and non-routine disposition (all P < .001). Syndromic children undergoing tonsillectomy and adenoidectomy plus other site surgery had a longer length of stay compared to syndromic children undergoing tonsillectomy & adenoidectomy (6.00 days vs 3.63 days, P < .001). However, no similar statistically significant difference in length of stay was found in non-syndromic children (2.01 days vs 2.87 days, P > .05). CONCLUSION The potential risks/benefits need to be weighed carefully before undertaking sleep surgery in syndromic children. They experience a longer length of stay, higher cost, and non-routine disposition when compared to non-syndromic children. This is especially true when considering the transition from tonsillectomy & adenoidectomy to tonsillectomy & adenoidectomy plus other site surgery, as syndromic children experience a longer length of stay and non-syndromic children do not.
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Affiliation(s)
- Suqrat Munawar
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander P Marston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Terral Patel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Vural M, Özdal M, Pancar Z. Effects of inspiratory muscle training on respiratory functions and respiratory muscle strength in Down syndrome: A preliminary study. ISOKINET EXERC SCI 2019. [DOI: 10.3233/ies-193127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Yap B, Kontos A, Pamula Y, Martin J, Kennedy D, Sampson W, Dreyer C. Differences in dentofacial morphology in children with sleep disordered breathing are detected with routine orthodontic records. Sleep Med 2019; 55:109-114. [DOI: 10.1016/j.sleep.2018.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/17/2022]
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Fernandes MDBL, Salgueiro AGNS, Bighetti EJB, Trindade-Suedam IK, Trindade IEK. Symptoms of Obstructive Sleep Apnea, Nasal Obstruction, and Enuresis in Children With Nonsyndromic Cleft Lip and Palate: A Prevalence Study. Cleft Palate Craniofac J 2018; 56:307-313. [PMID: 29775557 DOI: 10.1177/1055665618776074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of symptoms of obstructive sleep apnea (OSA), nasal obstruction, and enuresis in children with nonsyndromic unilateral cleft lip and palate. DESIGN Prospective cross-sectional study. SETTING Referral care center. PARTICIPANTS One hundred seventy-four children aged 6 to 12 years of both genders. INTERVENTIONS Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the Sleep Disturbance Scale for Children (SDSC) and Congestion Quantifier (CQ-5). Enuresis was considered as present when urinary loss was reported during sleep (at least 1 episode/month, last 3 months). To characterize the enuresis as mono- or polysymptomatic, symptoms of dysfunction of the lower urinary tract (DLUT) were investigated by the Dysfunctional Voiding Scoring System (DVSS). Statistical analysis was performed at a 5% level of significance. RESULTS Positive SDSC scores for OSA were observed in 60 (34%) children; positive CQ-5 scores for nasal obstruction in 45 (26%), positive DVSS scores for DLUT in 30 (17%), and enuresis was reported by 29 (17%), being categorized as primary in 66% and polysymptomatic in 72% of the children. Compared to the pediatric population, OSA, nasal obstruction, and enuresis prevalence ratios were up to 7 (95% confidence interval [CI] 5-9), 2 (95% CI 2-3), and 3 times (95% CI 2-5) higher, respectively. There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001). No correlation was seen between symptoms of OSA and enuresis. CONCLUSIONS Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA.
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Affiliation(s)
| | | | - Eliete Janaína Bueno Bighetti
- 1 Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru-SP, Brazil
| | - Ivy Kiemle Trindade-Suedam
- 2 Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru-SP, Brazil
| | - Inge Elly Kiemle Trindade
- 2 Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru-SP, Brazil
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30
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Davies K, Lin YL, Glenny AM, Callery P, Bruce IA. Parental Experience of Sleep-Disordered Breathing in Infants With Cleft Palate: Comparing Parental and Clinical Priorities. Cleft Palate Craniofac J 2018; 56:222-230. [PMID: 29665338 DOI: 10.1177/1055665618770196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To identify outcomes relating to sleep-disordered breathing (SDB) that are relevant to parents, during the early weeks of caring for infants with cleft palate (CP), and compare these with clinical outcomes identified in a systematic search of research literature. DESIGN A qualitative study using telephone/face-to-face interviews with parents explored their understanding of breathing and respiratory effort in infants with CP. SETTING Care provided by 3 specialist cleft centers in the United Kingdom, with study conducted in parents' homes. PARTICIPANTS Criteria for participation were parents of infants with isolated CP aged 12 to 16 weeks. Thirty-one parents of infants with CP (over 12 weeks) were invited to participate in the interview. Interviews were completed with 27 parents; 4 parents could not be contacted after completing the sleep monitoring. RESULTS Parents' description of infants' sleep suggests that breathing is not considered as a separate priority from their principal concerns of feeding and sleeping. They observe indicators of infants' breathing, but these are not perceived as signs of SDB. Parents' decision to use lateral or supine sleep positioning reflects their response to advice from specialists, observation of their infants' comfort, ease of breathing, and personal experience. Outcomes, identified in published research of SDB, coincide with parents' concerns but are expressed in medical language and fit into distinct domains of "snoring," "sleep," "gas exchange," and "apnea." CONCLUSIONS Parents' description of sleeping and respiration in infants with CP reflect their everyday experience, offering insight into their understanding, priorities, and language used to describe respiration. Understanding parents' individual priorities and how these are expressed could be fundamental to selecting meaningful outcomes for future studies of airway interventions.
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Affiliation(s)
- Karen Davies
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Yin-Ling Lin
- 2 Division of Dentistry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Anne-Marie Glenny
- 2 Division of Dentistry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Peter Callery
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Iain A Bruce
- 3 Paediatric ENT Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,4 Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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31
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Chua KP, Shrime MG, Conti RM. Effect of FDA Investigation on Opioid Prescribing to Children After Tonsillectomy/Adenoidectomy. Pediatrics 2017; 140:peds.2017-1765. [PMID: 29146621 DOI: 10.1542/peds.2017-1765] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In August 2012, the Food and Drug Administration investigated the safety of codeine use by children after tonsillectomy and/or adenoidectomy, culminating in a black box warning in February 2013. The objective of this study was to evaluate the association between the investigation and opioid prescribing to children undergoing these surgeries. METHODS We identified 362 992 privately insured children in the 2010-2015 Truven MarketScan Commercial Claims and Encounters database who underwent tonsillectomy and/or adenoidectomy. Using an interrupted time series design, we estimated level and slope changes in the proportion of children with ≥1 prescription fills for codeine and ≥1 fills for an alternative opioid, such as hydrocodone, within 7 days of surgery. RESULTS The investigation was associated with a significant -13.3 (95% confidence interval: -14.5 to -12.1) percentage point level change in the proportion of children with ≥1 prescription fills for codeine after tonsillectomy and/or adenoidectomy. Despite this drop, 5.1% of children had ≥1 prescription fills for codeine in December 2015. The investigation was not associated with significant level changes in alternative opioid prescribing, although the proportion of children receiving alternative opioids increased during the study period because of other factors. CONCLUSIONS The Food and Drug Administration investigation substantially decreased codeine prescribing to children after tonsillectomy and/or adenoidectomy. However, 1 in 20 children undergoing these surgeries were still prescribed codeine in December 2015 despite its well-documented safety and efficacy issues.
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Affiliation(s)
- Kao-Ping Chua
- Section of Academic Pediatrics, Departments of Pediatrics, .,Public Health Sciences and.,Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Mark G Shrime
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, and.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Rena M Conti
- Public Health Sciences and.,Pediatric Hematology/Oncology, University of Chicago, Chicago, Illinois
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Abstract
This article reviews the presentation of children with craniofacial anomalies by the most common sites of airway obstruction. Major craniofacial anomalies may be categorized into those with midface hypoplasia, mandible hypoplasia, combined midface and mandible hypoplasia, and midline deformities. Algorithms of airway interventions are provided to guide the initial management of these complex patients.
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Colvin KL, Yeager ME. What people with Down Syndrome can teach us about cardiopulmonary disease. Eur Respir Rev 2017; 26:26/143/160098. [DOI: 10.1183/16000617.0098-2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/13/2016] [Indexed: 12/19/2022] Open
Abstract
Down syndrome is the most common chromosomal abnormality among live-born infants. Through full or partial trisomy of chromosome 21, Down syndrome is associated with cognitive impairment, congenital malformations (particularly cardiovascular) and dysmorphic features. Immune disturbances in Down syndrome account for an enormous disease burden ranging from quality-of-life issues (autoimmune alopecia) to more serious health issues (autoimmune thyroiditis) and life-threatening issues (leukaemia, respiratory tract infections and pulmonary hypertension). Cardiovascular and pulmonary diseases account for ∼75% of the mortality seen in persons with Down syndrome. This review summarises the cardiovascular, respiratory and immune challenges faced by individuals with Down syndrome, and the genetic underpinnings of their pathobiology. We strongly advocate increased comparative studies of cardiopulmonary disease in persons with and without Down syndrome, as we believe these will lead to new strategies to prevent and treat diseases affecting millions of people worldwide.
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Durr ML, Meyer AK, Kezirian EJ, Mamlouk MD, Frieden IJ, Rosbe KW. Sleep-disordered breathing in pediatric head and neck vascular malformations. Laryngoscope 2017; 127:2159-2164. [DOI: 10.1002/lary.26468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/21/2016] [Accepted: 11/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Megan L. Durr
- Department of Otolaryngology-Head and Neck Surgery; Kaiser Permanente Medical Center; Oakland California U.S.A
| | - Anna K. Meyer
- Department of Otolaryngology Head and Neck Surgery; Univerisity of California San Francisco; San Francisco California U.S.A
| | - Eric J. Kezirian
- Department of Otolaryngology-Head and Neck Surgery; University of Southern California Caruso; Los Angeles California U.S.A
| | - Mark D. Mamlouk
- Department of Radiology; Kaiser Permanente Medical Center; Santa Clara California U.S.A
| | - Ilona J. Frieden
- Departments of Dermatology and Pediatrics; Univerisity of California San Francisco; San Francisco California U.S.A
| | - Kristina W. Rosbe
- Department of Otolaryngology Head and Neck Surgery; Univerisity of California San Francisco; San Francisco California U.S.A
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35
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Davies K, Bruce IA, Bannister P, Callery P. Safe sleeping positions: practice and policy for babies with cleft palate. Eur J Pediatr 2017; 176:661-667. [PMID: 28331972 PMCID: PMC5415579 DOI: 10.1007/s00431-017-2893-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/01/2022]
Abstract
UNLABELLED Guidance recommends 'back to sleep' positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in the UK to investigate current practice. Data were collected using semi-structured telephone interviews and analysed using content analysis. Over half the regional centres used lateral sleep positioning based on clinical judgement of the infants' respiratory effort and upper airway obstruction. Assessment relied upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen saturation, heart rate and respiration. CONCLUSION Specialist practitioners face a clinical dilemma between adhering to standard 'back to sleep' guidance and responding to clinical assessment of respiratory effort for infants with cleft palate. In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate. Further research is needed to determine the best sleep position for an infant with cleft palate. What is Known • Supine sleep positioning reduces the risk of sudden infant death in new born infants. • There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate. What is New • Variability exists in the information/advice provided to parents of infants with cleft palate regarding sleep positioning. • Over half the national specialist centres for cleft palate in the UK advise positioning infants with CP in the lateral position as a routine measure to reduce difficulties with respiration.
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Affiliation(s)
- Karen Davies
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean Mc Farlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Iain A Bruce
- 0000 0004 0417 0074grid.462482.ePaediatric ENT Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL UK ,0000000121662407grid.5379.8Respiratory and Allergy Centre, Institute of Inflammation and Repair, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Patricia Bannister
- 0000000121662407grid.5379.8Cleft and Craniofacial Clinical Research Centre, Division of Dentistry, University of Manchester, Manchester, M15 6FH UK
| | - Peter Callery
- 0000000121662407grid.5379.8Division of Nursing, Midwifery and Social Work, University of Manchester, Jean Mc Farlane Building, Oxford Road, Manchester, M13 9PL UK
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36
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Tamanyan K, Walter LM, Davey MJ, Nixon GM, Horne RS, Biggs SN. Risk factors for obstructive sleep apnoea in Australian children. J Paediatr Child Health 2016; 52:512-7. [PMID: 27329904 DOI: 10.1111/jpc.13120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/17/2015] [Accepted: 11/26/2015] [Indexed: 12/16/2022]
Abstract
AIM This study aims to determine whether demographic or clinical factors predict obstructive sleep apnoea (OSA) severity in Australian children. METHODS Demographic details and medical histories of 301 Australian children (3-17 years old) referred for assessment of OSA were examined retrospectively. Children underwent overnight polysomnography and were classified as having primary snoring (PS) (obstructive apnoea hypopnoea index (OAHI) ≤ 1 event per hour; n = 150), mild OSA (>1 OAHI ≤ 5 events per hour; n = 76) or moderate/severe (MS) OSA (OAHI > 5 events per hour; n = 75). Information obtained from parent-report questionnaire determined the predictive value of the following factors for determining OSA severity: gender, ethnicity, body mass index, asthma and/or allergic rhinitis, socio-economic status and parental smoking status (mother/father/both). Chi-squared analyses were used to compare the distribution of the demographic and clinical factors across the three groups. Statistically significant risk factors were subsequently entered into logistic regression analysis. RESULTS Ethnicity and parental smoking were significant risk factors for MS OSA. Children with non-Caucasian ethnicity were 36% more likely than Caucasian children to be diagnosed with MS OSA than PS (P = 0.002). Children with fathers who smoked were 53% more likely to have MS OSA than PS compared with those with fathers who did not smoke (P = 0.008). Obesity was associated with OSA severity in primary school-aged children only. Gender, socio-economic status and history of asthma and/or allergic rhinitis were not risk factors. CONCLUSIONS Non-Caucasian ethnicity, paternal smoking and obesity in older children were associated with an increased risk of polysomnography-confirmed MS OSA in Australian children.
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Affiliation(s)
- Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Rosemary Sc Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sarah N Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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Lewanda AF, Matisoff A, Revenis M, Harahsheh A, Futterman C, Nino G, Greenberg J, Myseros JS, Rosenbaum KN, Summar M. Preoperative evaluation and comprehensive risk assessment for children with Down syndrome. Paediatr Anaesth 2016; 26:356-62. [PMID: 26749540 DOI: 10.1111/pan.12841] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 01/24/2023]
Abstract
Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.
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Affiliation(s)
- Amy Feldman Lewanda
- Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA
| | - Andrew Matisoff
- Divisions of Anesthesiology, Sedation, and Perioperative Medicine, Children's National Health System, Washington, DC, USA
| | - Mary Revenis
- Division of Neonatology, Children's National Health System, Washington, DC, USA
| | - Ashraf Harahsheh
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Craig Futterman
- Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA
| | - Gustavo Nino
- Divisions of Pulmonary Medicine and Sleep Medicine, Children's National Health System, Washington, DC, USA
| | - Jay Greenberg
- Divisions of Hematology and Oncology, Children's National Health System, Washington, DC, USA
| | - John S Myseros
- Division of Neurosurgery, Children's National Health System, Washington, DC, USA
| | - Kenneth N Rosenbaum
- Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA
| | - Marshall Summar
- Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA
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Tawfik KO, Sedaghat AR, Ishman SL. Trends in Inpatient Pediatric Polysomnography for Laryngomalacia and Craniofacial Anomalies. Ann Otol Rhinol Laryngol 2015. [PMID: 26215726 DOI: 10.1177/0003489415596756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Increasingly, laryngomalacia and craniofacial anomalies are recognized as risk factors for obstructive sleep apnea. We sought to determine whether children with these diagnoses have become more likely to undergo inpatient polysomnogram (PSG) over time and to identify evolving trends in PSG utilization. METHODS Retrospective analysis of the Kids' Inpatient Database from 2003 to 2012. Children <21 years who underwent PSG were included. Weighted comparisons of clinical/demographic characteristics of patients undergoing PSG were performed, as were associations between clinical and demographic patient characteristics and performance of inpatient PSG. RESULTS Between 2003 and 2012, PSG procedures decreased from 1266 to 829 (P < .001). Among children who underwent PSG, mean age decreased from 3.9 ± 5.1 to 3.1 ± 5.2 years (P = .001), and the frequency of age <1 year increased from 47.8% to 59.5% (P < .001). The frequency of laryngomalacia increased from 2.5% to 14.3% (P < .001), while the frequency of craniofacial anomalies increased from 6.2% to 19.4% (P < .001). Laryngomalacia and craniofacial anomalies were predictive of undergoing inpatient PSG in both timeframes. CONCLUSION Despite decreasing PSG volumes, diagnoses of laryngomalacia and craniofacial anomalies comprised increasing fractions of children undergoing inpatient PSG between 2003 and 2012. Laryngomalacia and craniofacial anomalies were also predictive of inpatient PSG use in both timeframes.
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Affiliation(s)
- Kareem O Tawfik
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey L Ishman
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Cincinnati Children's Hospital Medical Center, Divisions of Otolaryngology-Head & Neck Surgery and Pulmonary Medicine, Cincinnati, Ohio, USA
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Mahant S, Hall M, Ishman SL, Morse R, Mittal V, Mussman GM, Gold J, Montalbano A, Srivastava R, Wilson KM, Shah SS. Association of National Guidelines With Tonsillectomy Perioperative Care and Outcomes. Pediatrics 2015; 136:53-60. [PMID: 26101361 DOI: 10.1542/peds.2015-0127] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the association of the 2011 American Academy of Otolaryngology Head and Neck Surgery guidelines with perioperative care processes and outcomes in children undergoing tonsillectomy. METHODS We conducted a retrospective cohort study of otherwise healthy children undergoing tonsillectomy between January 2009 and January 2013 at 29 US children's hospitals participating in the Pediatric Health Information System. We measured evidence-based processes suggested by the guidelines (perioperative dexamethasone and no antibiotic use) and outcomes (30-day tonsillectomy complication-related revisits). We analyzed rates aggregated over the preguideline and postguideline periods and then by month over time by using interrupted time series. RESULTS Of 111,813 children who underwent tonsillectomy, 54,043 and 57,770 did so in the preguideline and postguideline periods, respectively. Dexamethasone use increased from 74.6% to 77.4% (P < .001) in the preguideline to postguideline period, as did its rate of change in use (percentage change per month, -0.02% to 0.29%; P < .001). Antibiotic use decreased from 34.7% to 21.8% (P < .001), as did its rate of change in use (percentage change per month, -0.17% to -0.56%; P < .001). Revisits for bleeding remained stable; however, total revisits to the hospital for tonsillectomy complications increased from 8.2% to 9.0% (P < .001) because of an increase in revisits for pain. Hospital-level results were similar. CONCLUSIONS The guidelines were associated with some improvement in evidence-based perioperative care processes but no improvement in outcomes. Dexamethasone use increased slightly, and antibiotic use decreased substantially. Revisits for tonsillectomy-related complications increased modestly over time because of revisits for pain.
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Affiliation(s)
- Sanjay Mahant
- Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Management and Evaluation, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada;
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Stacey L Ishman
- Division of Otolaryngology, Head & Neck Surgery, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, and Department of Otolaryngology, Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Rustin Morse
- Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vineeta Mittal
- Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Jessica Gold
- New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, New York, New York
| | - Amanda Montalbano
- Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center, Institute for Healthcare Delivery Research, Intermountain Healthcare Inc., Salt Lake City, Utah; and
| | - Karen M Wilson
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Obstructive Sleep Apnea-Hypopnea Syndrome in Children: Beyond Adenotonsillar Hypertrophy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.05.024] [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]
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Biggs SN, Nixon GM, Horne RS. The conundrum of primary snoring in children: What are we missing in regards to cognitive and behavioural morbidity? Sleep Med Rev 2014; 18:463-75. [DOI: 10.1016/j.smrv.2014.06.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 12/11/2022]
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Screening for Obstructive Sleep Apnea in Children Treated at a Major Craniofacial Center. J Craniofac Surg 2014; 25:1762-5. [DOI: 10.1097/scs.0000000000001119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Esteller E. [Obstructive sleep apnea-hypopnea syndrome in children: beyond adenotonsillar hypertrophy]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 66:111-9. [PMID: 25107357 DOI: 10.1016/j.otorri.2014.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/10/2014] [Indexed: 01/01/2023]
Abstract
The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España.
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Ramgopal S, Kothare SV, Rana M, Singh K, Khatwa U. Obstructive sleep apnea in infancy: a 7-year experience at a pediatric sleep center. Pediatr Pulmonol 2014; 49:554-60. [PMID: 24039250 DOI: 10.1002/ppul.22867] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/21/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate the common indications for polysomnogram (PSG) associated co-morbid conditions, evaluation strategies, treatment options, and outcomes in a series of infants diagnosed with obstructive sleep apnea (OSA) by a PSG. METHODS Retrospective chart review of infants who underwent PSG over a 7-year period was done. Infants with PSG diagnosed OSA were included in this study. RESULTS A total of 97 infants (59 males, mean age 4.6 months, standard deviation 3.3 months) were diagnosed with OSA (AHI ≥ 1/hr) based on PSG. The most common indication for PSG in infants were excessive snoring (53%) followed by nocturnal desaturations (24%). Associated co-morbid conditions included gastro-esophageal reflux (30%), laryngomalacia (24%), and craniofacial abnormalities (16%). Genetic abnormalities were found in 53%, of which trisomy 21 was the most common. Surgical treatments were employed in 36% and oxygen therapy in 15%. Thirty-eight patients were followed up with a repeat sleep study after a median interval of 8 months (range 1-24 months), of whom 26/38 had resolution of symptoms. Twenty-seven patients (28%) were followed clinically after a mean interval of 5 months of intervention (range, 1-34.5 months), in whom the symptoms resolved in 23/27 patients. Seven patients were deceased at review. Causes of death included status epilepticus, respiratory failure, hepatic failure, kidney failure, or unknown causes. CONCLUSION The etiologies of OSA in infants are different when compared to older children. PSG is feasible and a valuable tool in the diagnosis of OSA in infants and may help determine timely and appropriate evaluation and interventions. Clinical improvement in symptoms and resolution of PSG parameters were noted following medical and/or surgical interventions. Prospective studies need to be done to ascertain the long-term outcome of infants diagnosed with OSA to assess the benefits of early intervention on their neurocognitive development.
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Affiliation(s)
- Sriram Ramgopal
- Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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Diaz K, Faverio P, Hospenthal A, Restrepo MI, Amuan ME, Pugh MJV. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients. Ann Thorac Med 2014; 9:92-8. [PMID: 24791172 PMCID: PMC4005168 DOI: 10.4103/1817-1737.128854] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/21/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA). MATERIALS AND METHODS This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED) visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA. RESULTS Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4%) were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF), pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05). The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05). CONCLUSION Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA. Early OSA recognition may reduce healthcare utilization in these patients.
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Affiliation(s)
- Karla Diaz
- Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center, Monza, Italy
| | - Paola Faverio
- Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center, Monza, Italy ; Department of Health Science, University of Milan-Bicocca, Respiratory Unit, San Gerardo Hospital, Monza, Italy
| | - Angela Hospenthal
- Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center, Monza, Italy
| | - Marcos I Restrepo
- Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center, Monza, Italy ; VERDICT/South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Megan E Amuan
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers VA Hospital, Bedford, MA 01730, England, USA
| | - Mary Jo V Pugh
- VERDICT/South Texas Veterans Health Care System, San Antonio, TX, USA ; Departments of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, USA ; Department of Medicine Bryan, Texas A&M Health Science Center, College of Medicine, TX, USA
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Moraleda-Cibrián M, Edwards SP, Kasten SJ, Berger M, Buchman SR, O'Brien LM. Symptoms of sleep disordered breathing in children with craniofacial malformations. J Clin Sleep Med 2014; 10:307-12. [PMID: 24634629 DOI: 10.5664/jcsm.3536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to investigate the frequency of sleep disordered breathing (SDB) symptoms in a clinical sample of children with congenital craniofacial malformations (CFM) followed at a tertiary medical center and non-selected for sleep problems. METHODS Cross-sectional study of 575 children aged 2-18 years followed at the Craniofacial Anomalies Program between March 2007 and May 2011. The Sleep-Related Breathing Disturbance scale of the Pediatric Sleep Questionnaire was used to screen for SDB, snoring, and sleepiness. A cutoff value ≥ 0.33 of the total answered questions identified children with positive screening for SDB symptoms. RESULTS Overall, 25% of children screened positive for SDB, 28% for snoring, and 20% for sleepiness. In children with non-syndromic CFM, those with Robin sequence had the highest frequency of SDB, snoring, and sleepiness (43%, 44%, and 38%, respectively). In children with syndromic CFM, velocardiofacial/ DiGeorge syndrome had the highest frequency of SDB and sleepiness (48% and 43%, respectively). Children with Treacher Collins had the highest frequency of snoring (83%). The presence of cleft palate was not associated with an increased frequency of SDB symptoms. Nevertheless, children with syndromic CFM, compared to those with non-syndromic CFM, had a higher SDB score (0.27 ± 0.21 vs.0.21 ± 0.19, p = 0.003) and were more likely to have sleepiness (26% vs. 18%, p = 0.05). CONCLUSIONS Congenital craniofacial malformations in children are associated with high risk for SDB symptoms. Our findings should encourage a high index of suspicion for SDB in children with CFM, with a low threshold for further testing and close follow-up. CITATION Moraleda-Cibrián M; Edwards SP; Kasten SJ; Berger M; Buchman SR; O'Brien LM. Symptoms of sleep disordered breathing in children with craniofacial malformations.
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Affiliation(s)
- Marta Moraleda-Cibrián
- Sleep Disorders Center, Department of Neurology ; Department of Oral & Maxillofacial Surgery
| | | | - Steven J Kasten
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Mary Berger
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Steven R Buchman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology ; Department of Oral & Maxillofacial Surgery
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Mahant S, Keren R, Localio R, Luan X, Song L, Shah SS, Tieder JS, Wilson KM, Elden L, Srivastava R. Dexamethasone and risk of bleeding in children undergoing tonsillectomy. Otolaryngol Head Neck Surg 2014; 150:872-9. [PMID: 24493786 DOI: 10.1177/0194599814521555] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether dexamethasone use in children undergoing tonsillectomy is associated with increased risk of postoperative bleeding. STUDY DESIGN Retrospective cohort study using a multihospital administrative database. SETTING Thirty-six US children's hospitals. SUBJECTS Children undergoing same-day tonsillectomy between the years 2004 and 2010. METHODS We used discrete time failure models to estimate the daily hazards of revisits for bleeding (emergency department or hospital admission) up to 30 days after surgery as a function of dexamethasone use. Revisits were standardized for patient characteristics, antibiotic use, year of surgery, and hospital. RESULTS Of 139,715 children who underwent same-day tonsillectomy, 97,242 (69.6%) received dexamethasone and 4182 (3.0%) had a 30-day revisit for bleeding. The 30-day cumulative standardized risk of revisits for bleeding was greater with dexamethasone use (3.11% vs 2.71%; standardized difference 0.40% [95% confidence interval, 0.13%-0.67%]; P = .003), and the increased risk was observed across all age strata. Dexamethasone use was associated with a higher standardized rate of revisits for bleeding in the postdischarge time periods of days 1 through 5 but not during the peak period for secondary bleeding, days 6 and 7. CONCLUSIONS In a real-world practice setting, dexamethasone use was associated with a small absolute increased risk of revisits for bleeding. However, the upper bound of this risk increase does not cross published thresholds for a minimal clinically important difference. Given the benefits of dexamethasone in reducing postoperative nausea and vomiting and the larger body of evidence from trials, these results support guideline recommendations for the routine use of dexamethasone.
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Affiliation(s)
- Sanjay Mahant
- Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
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Mahant S, Keren R, Localio R, Luan X, Song L, Shah SS, Tieder JS, Wilson KM, Elden L, Srivastava R. Variation in quality of tonsillectomy perioperative care and revisit rates in children's hospitals. Pediatrics 2014; 133:280-8. [PMID: 24446446 DOI: 10.1542/peds.2013-1884] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [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 describe the quality of care for routine tonsillectomy at US children's hospitals. METHODS We conducted a retrospective cohort study of low-risk children undergoing same-day tonsillectomy between 2004 and 2010 at 36 US children's hospitals that submit data to the Pediatric Health Information System Database. We assessed quality of care by measuring evidence-based processes suggested by national guidelines, perioperative dexamethasone and no antibiotic use, and outcomes, 30-day tonsillectomy-related revisits to hospital. RESULTS Of 139,715 children who underwent same-day tonsillectomy, 10,868 (7.8%) had a 30-day revisit to hospital. There was significant variability in the administration of dexamethasone (median 76.2%, range 0.3%-98.8%) and antibiotics (median 16.3%, range 2.7%-92.6%) across hospitals. The most common reasons for revisits were bleeding (3.0%) and vomiting and dehydration (2.2%). Older age (10-18 vs 1-3 years) was associated with a greater standardized risk of revisits for bleeding and a lower standardized risk of revisits for vomiting and dehydration. After standardizing for differences in patients and year of surgery, there was significant variability (P < .001) across hospitals in total revisits (median 7.8%, range 3.0%-12.6%), revisits for bleeding (median 3.0%, range 1.0%-8.8%), and revisits for vomiting and dehydration (median 1.9%, range 0.3%-4.4%). CONCLUSIONS Substantial variation exists in the quality of care for routine tonsillectomy across US children's hospitals as measured by perioperative dexamethasone and antibiotic use and revisits to hospital. These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts.
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Affiliation(s)
- Sanjay Mahant
- Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada
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Abstract
OBJECTIVES (1) Measure the association between the Functional Comorbidity Index (range, 0-18) and physical function health status (SF-36 Physical Function domain), general physical health status (SF-36 Physical Component Score), and general mental health status (SF-36 Mental Component Score) outcome measures in a cohort of sleep apnea patients. (2) Test if the Functional Comorbidity Index is more strongly associated (a better predictor) than the well-known Charlson Comorbidity Index (range, 0-37) with these SF-36 outcome measures. STUDY DESIGN Cross-sectional study. SETTING University of Washington Sleep Center. SUBJECTS AND METHODS In a cohort of newly diagnosed obstructive sleep apnea patients (N = 233), we obtained scores for the Functional Comorbidity Index, Charlson Comorbidity Index, and SF-36. We calculated Spearman correlations and adjusted coefficients of determination (R2) with multiple linear regression, adjusted for demographic and health covariates. Bootstrapping generated R2 distributions for statistical comparison. RESULTS Functional Comorbidity Index scores (mean ± standard deviation 2.4 ± 1.7) were more widely distributed than Charlson Comorbidity Index scores (0.7 ± 1.4). The Functional Comorbidity Index was significantly correlated with SF-36 Physical Function (-0.53, P < .001), Physical Component Score (-0.44, P < .001), and Mental Component Score (-0.38, P < .001). The Functional Comorbidity Index was a better predictor than the Charlson Comorbidity Index of SF-36 Physical Function (R (2) mean ± standard error 0.27 ± 0.05 vs. 0.17 ± 0.05, P < .001), Physical Component Score (0.23 ± 0.05 vs. 0.17 ± 0.05, P < .001), and Mental Component Score (0.23 ± 0.05 vs. 0.13 ± 0.05, P < .001). CONCLUSION The Functional Comorbidity Index is a more robust predictor of general health status than the Charlson Comorbidity Index in obstructive sleep apnea patients.
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Affiliation(s)
- Corinna G Levine
- Resident Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Ramirez JM, Garcia AJ, Anderson TM, Koschnitzky JE, Peng YJ, Kumar GK, Prabhakar NR. Central and peripheral factors contributing to obstructive sleep apneas. Respir Physiol Neurobiol 2013; 189:344-53. [PMID: 23770311 DOI: 10.1016/j.resp.2013.06.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 11/30/2022]
Abstract
Apnea, the cessation of breathing, is a common physiological and pathophysiological phenomenon. Among the different forms of apnea, obstructive sleep apnea (OSA) is clinically the most prominent manifestation. OSA is characterized by repetitive airway occlusions that are typically associated with peripheral airway obstructions. However, it would be an oversimplification to conclude that OSA is caused by peripheral obstructions. OSA is the result of a dynamic interplay between chemo- and mechanosensory reflexes, neuromodulation, behavioral state and the differential activation of the central respiratory network and its motor outputs. This interplay has numerous neuronal and cardiovascular consequences that are initially adaptive but in the long-term become major contributors to morbidity and mortality. Not only OSA, but also central apneas (CA) have multiple, and partly overlapping mechanisms. In OSA and CA the underlying mechanisms are neither "exclusively peripheral" nor "exclusively central" in origin. This review discusses the complex interplay of peripheral and central nervous components that characterizes the cessation of breathing.
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Affiliation(s)
- Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Department of Neurological Surgery and Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
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