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Özkars MY, Çevik S, Ata S, Sarısaltık A, Altaş U. Evaluation of Sleep Quality in Asthmatic Children with the Paediatric Sleep Questionnaire (PSQ). CHILDREN (BASEL, SWITZERLAND) 2024; 11:728. [PMID: 38929307 PMCID: PMC11202190 DOI: 10.3390/children11060728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
Considering the high prevalence of sleep-related breathing disorders (SRBD) in asthmatic patients, we aimed to compare asthmatic children and healthy children in terms of SRBD according to Paediatric Sleep Questionnaire (PSQ) scores. A questionnaire covering sociodemographic characteristics of the patients and the PSQ, which evaluates sleep quality and consists of 22 questions, was administered. During the data collection process, 180 patients in the patient group and 170 patients in the control group were included. The patient group showed statistically significantly higher total scores and subscale scores for snoring, sleepiness, and inattention compared to the control group. Statistically significant correlations were found between the sleepiness subscale and body mass index z score in a negative direction and between age at presentation and duration of asthma in a positive direction. Our findings endorse employing the PSQ as a screening instrument in the outpatient environment to ensure timely referral of asthma patients to a sleep specialist for SRBD evaluation. Considering the widespread occurrence of snoring and asthma, this tool could aid in identifying patients with an elevated risk of SRBD and expedite the scheduling of nocturnal polysomnography for these children.
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Affiliation(s)
- Mehmet Yaşar Özkars
- Department of Pediatric Allergy and Immunology, Ümraniye Training and Research Hospital, University of Health Sciences, 34764 Ümraniye, Türkiye; (S.Ç.); (U.A.)
| | - Seda Çevik
- Department of Pediatric Allergy and Immunology, Ümraniye Training and Research Hospital, University of Health Sciences, 34764 Ümraniye, Türkiye; (S.Ç.); (U.A.)
| | - Serap Ata
- Department of Pediatrics, Ümraniye Training and Research Hospital, University of Health Sciences, 34764 Ümraniye, Türkiye;
| | | | - Uğur Altaş
- Department of Pediatric Allergy and Immunology, Ümraniye Training and Research Hospital, University of Health Sciences, 34764 Ümraniye, Türkiye; (S.Ç.); (U.A.)
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Gayoso-Liviac MG, Nino G, Montgomery AS, Hong X, Wang X, Gutierrez MJ. Infants hospitalized with lower respiratory tract infections during the first two years of life have increased risk of pediatric obstructive sleep apnea. Pediatr Pulmonol 2024; 59:679-687. [PMID: 38153215 PMCID: PMC10901459 DOI: 10.1002/ppul.26810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE Lower respiratory tract infections (LRTI) during the first 2 years of life increase the risk of pediatric obstructive sleep apnea (OSA), but whether this risk varies by LRTI severity is unknown. METHODS We analyzed data from 2962 children, aged 0-5 years, with early-life LRTI requiring hospitalization (severe LRTI, n = 235), treated as outpatients (mild LRTI, n = 394) and without LRTI (reference group, n = 2333) enrolled in the Boston Birth Cohort. Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariables were used to evaluate the risk of pediatric OSA. RESULTS Compared to children without LRTI, those with mild LRTI were at a higher risk of having OSA (hazard ratio [HR] 1.44, 95% confidence interval [CI]: 1.01-2.05), and those with severe LRTI were at the highest risk (HR 2.06, 95% CI: 1.41-3.02), independently of relevant covariables (including maternal age, race, gestational age, and type of delivery). Additional risk factors linked to a higher risk of OSA included prematurity (HR 1.34, 95% CI 1.01-1.77) and maternal obesity (HR 1.82, 95% CI 1.32-2.52). The time elapsed between LRTI and OSA diagnosis was similar in mild and severe LRTI cases, with medians of 23 and 25.5 months, respectively (p = .803). CONCLUSION Infants with severe early-life LRTI have a higher risk of developing OSA, and surveillance strategies to identify OSA need to be particularly focused on this group. OSA monitoring should continue throughout the preschool years as it may develop months or years after the initial LRTI hospitalization.
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Affiliation(s)
- Mirtha G Gayoso-Liviac
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Agnes S Montgomery
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wang D, Zhou Y, Chen R, Zeng X, Zhang S, Su X, Luo Y, Tang Y, Li S, Zhuang Z, Zhao D, Ren Y, Zhang N. The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis. Eur J Med Res 2023; 28:139. [PMID: 36998095 PMCID: PMC10062016 DOI: 10.1186/s40001-023-01097-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa. METHODS We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I2 statistics. We also performed subgroup analysis, Meta-regression, and Egger's test for bias analysis. RESULTS 34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763-0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16-1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49-7.64). CONCLUSION OSA was associated with more severe or difficult-to-control asthma with decreased %FEV1 in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.
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Affiliation(s)
- Donghao Wang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yanyan Zhou
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Riken Chen
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Xiangxia Zeng
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Sun Zhang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Xiaofen Su
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yateng Luo
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yongkang Tang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Shiwei Li
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Zhiyang Zhuang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Dongxing Zhao
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yingying Ren
- Medical Records Management Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
| | - Nuofu Zhang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
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Nino G, Aziz J, Weiss M, Allen M, Lew J, Manrique M, Mantilla-Rivas E, McGrath JL, Rogers GF, Oh AK. Defining Age-related OSA Features in Robin Sequence Using Polysomnographic-based Analyses of Respiratory Arousal Responses and Gas-exchange Parameters. Cleft Palate Craniofac J 2023; 60:142-150. [PMID: 34787016 DOI: 10.1177/10556656211055017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Robin sequence (RS) is a leading cause of obstructive sleep apnea (OSA) in newborns. Most studies have focused on understanding anatomic factors leading to OSA and changes in apnea-hypopnea index (AHI) on polysomnography (PSG) beyond the neonatal period. This study aims to define age-related OSA features between patients with RS, without RS and healthy controls using PSG-based analyses of respiratory arousal responses and gas-exchange parameters. DESIGN Retrospective comparison of PSG features in a total of 48 children encompassing three groups: (a) infants with RS (n = 24, <1-year old), (b) non-RS older children (1-2 years old) with severe OSA (obstructive AHI (OAHI) of ≥10 events; n = 12), and (c) control infants and children (0-2 years old) without sleep apnea (OAHI ≤1.5/h, n = 12). We examined OSA sleep-stage specific and position-specific indexes, and the relationship between OSA severity and respiratory arousal indexes (OAHI/respiratory arousal indexes). RESULTS OSA sleep-stage specific indexes (rapid eye movement [REM] vs non-REM[NREM]) as well as position-specific indexes (supine vs nonsupine) were similar in individuals with and without RS. Relative to the non-RS groups, infants with RS have more sustained hypoxemia (time with SpO2 < 90%) and reduced arousal responses to OSA demonstrated by higher OAHI/respiratory arousal indexes. OAHI/respiratory arousal indexes significantly correlated with the severity of hypoxemia in infants with RS. CONCLUSION Infants with RS and OSA show reduced arousal responses to apneic events, which correlates with higher hypoxemia severity. OAHI/respiratory arousal indexes in RS may identify high-risk individuals with upper airway obstruction and reduced arousal protective responses.
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Affiliation(s)
- Gustavo Nino
- Division of Pulmonary and Sleep Medicine, 8404Children's National Hospital, Washington, DC, USA
| | - Julia Aziz
- Division of Pulmonary and Sleep Medicine, 8404Children's National Hospital, Washington, DC, USA
| | - Miriam Weiss
- Division of Pulmonary and Sleep Medicine, 8404Children's National Hospital, Washington, DC, USA
| | - Michelle Allen
- Division of Pulmonary and Sleep Medicine, 8404Children's National Hospital, Washington, DC, USA
| | - Jenny Lew
- Division of Pulmonary and Sleep Medicine, 8404Children's National Hospital, Washington, DC, USA
| | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, 8404Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, 8404Children's National Hospital, Washington, DC, USA
| | - Jennifer L McGrath
- Division of Plastic and Reconstructive Surgery, 8404Children's National Hospital, Washington, DC, USA
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, 8404Children's National Hospital, Washington, DC, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, 8404Children's National Hospital, Washington, DC, USA
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Duong-Quy S, Nguyen-Hoang Y, Nguyen-Ngoc-Quynh L, Nguyen-Thi-Phuong M, Nguyen-Thi-Bich H, Le-Thi-Minh H, Nguyen-Thi-Dieu T. Clinical and functional characteristics of OSA in children with comorbid asthma treated by leukotriene receptor antagonist: A descriptive study. Front Neurol 2023; 13:1065038. [PMID: 36686503 PMCID: PMC9846608 DOI: 10.3389/fneur.2022.1065038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is the most common form of respiratory disorders during sleep in children, especially those with severe asthma. However, optimal treatment of asthma might significantly improve OSA severity. Methods It was a cohort study including children aged >5 years old and diagnosed with asthma according to GINA (Global Initiative for Asthma). The data related to age, gender, height, weight, body mass index (BMI), clinical symptoms and medical history of asthma, spirometry (FEV1: forced expiratory in 1 s), and exhaled nitric oxide (FENO) were recorded for analysis. Respiratory polygraphy (RPG) was done for each study subject to diagnose OSA and its severity. Results Among 139 asthmatic children, 99 patients with OSA (71.2%) were included in the present study (9.3 ± 0.2 years): 58.6% with uncontrolled asthma and 32.3% with partial controlled asthma. The mean ACT (asthma control testing) score was 19.0 ± 3.4. The most frequent night-time symptoms were restless sleep (76.8%), snoring (61.6%), sweating (52.5%), and trouble breathing during sleep (48.5%). The common daytime symptoms were irritable status (46.5%) and abnormal behavior (30.3%). The mean AHI (apnea-hypopnea index) was 3.5 ± 4.0 events/h. There was a significant correlation between BMI and snoring index (R = 0.189 and P = 0.027), bronchial and nasal FENO with AHI (R = 0.046 and P < 0.001; R = 0.037 and P < 0.001; respectively). There was no significant correlation between asthma level, FEV1 and AHI. The severity of asthma and respiratory function were improved significantly after 3 months and 6 months of asthma treatment in combination with leukotriene receptor antagonist (LRA) treatment. The symptoms related to OSA were significantly improved after treatment with LRA. The severity of OSA was decreased significantly after 3 months and 6 months of treatment. Conclusion The treatment of asthmatic children with comorbid OSA by LRA in combination with standard therapy for asthma could improve the control of asthma and the symptoms and severity of OSA.
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Affiliation(s)
- Sy Duong-Quy
- Biomedical Research Centre, Lam Dong Medical College, Dalat, Vietnam,Division of Immuno-Allergology, Penn State Medical College, Hershey Medical Center, Hershey, PA, United States,Department of Outpatient, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Yen Nguyen-Hoang
- Department of Pediatrics, Lac Viet Friendly Hospital, Vinh Yên, Vinh Phuc, Vietnam
| | - Le Nguyen-Ngoc-Quynh
- Department of Immuno-Allergology, Asthma and Rheumatology, National Children's Hospital, Hanoi, Vietnam
| | - Mai Nguyen-Thi-Phuong
- Department of Immuno-Allergology, Asthma and Rheumatology, National Children's Hospital, Hanoi, Vietnam
| | - Hanh Nguyen-Thi-Bich
- Department of Immuno-Allergology, Asthma and Rheumatology, National Children's Hospital, Hanoi, Vietnam
| | - Huong Le-Thi-Minh
- Pediatric Centre, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Thuy Nguyen-Thi-Dieu
- Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam,*Correspondence: Thuy Nguyen-Thi-Dieu ✉
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Garza N, Witmans M, Salud M, Lagera PGD, Co VA, Tablizo MA. The Association between Asthma and OSA in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101430. [PMID: 36291366 PMCID: PMC9601179 DOI: 10.3390/children9101430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/02/2023]
Abstract
Obstructive sleep apnea (OSA) and asthma are two of the most prevalent and commonly co-existing respiratory conditions seen in the pediatric population. Studies linking asthma and OSA in children are limited but indicate that there is a bi-directional relationship between them with significant overlap in the symptoms, risk factors, pathophysiology, comorbidities, and management. It is suggested that there is a reciprocal association between asthma predisposing to OSA, and OSA worsening symptom control and outcomes from asthma. It stands to reason that inflammation in the upper and/or lower airways can influence each other. Most of the pediatric literature that is available evaluates each aspect of this relationship independently such as risk factors, mechanisms, and treatment indications. This article highlights the relationship between OSA and asthma in the context of shared risk factors, pathophysiology, and available management recommendations in the pediatric population. Early recognition of the co-existence and association between OSA and asthma could ideally improve the treatment outcomes for these two conditions. Gaining a better understanding of the mechanism of this relationship can help identify nuances for medical management, optimize treatment and protect this population at risk from associated morbidity.
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Affiliation(s)
| | - Manisha Witmans
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Martina Salud
- Ateneo University School of Medicine and Public Health, Pasig 1604, Philippines
| | - Pamela Gail D. Lagera
- University of California San Francisco Parnassus Campus, San Francisco, CA 94143, USA
| | - Vince Aaron Co
- Department of Biology, California State University Fresno, Fresno, CA 93740, USA
| | - Mary Anne Tablizo
- Valley Children’s Hospital, Madera, CA 93636, USA
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA
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7
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Sattaratpaijit N, Kulalert P, Wongpradit W. Characteristics of rapid eye movement-related obstructive sleep apnea in Thai patients. Sci Rep 2022; 12:11360. [PMID: 35790775 PMCID: PMC9256692 DOI: 10.1038/s41598-022-13382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder that has been associated with cardiovascular consequences. Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is a subtype of OSA which is characterized by apneas or hypopneas predominately during REM sleep. The factors associated with REM-related OSA are still unclear. We aimed to determine the prevalence and associated characteristics of REM-related OSA in Thai patients. A total of 408 patients’ charts were retrospectively reviewed. Demographic and anthropometric characteristics, comorbidities and polysomnographic data were obtained. The patients were divided into two groups: REM-related OSA and non-stage specific OSA. REM-related OSA was defined as an apnea–hypopnea index (AHI) ≥ 5 per hour, with a ratio of REM-AHI to NREM-AHI > 2, and NREM-AHI < 15 per hour. The prevalence of REM-related OSA was 21.6%. AHI and arousal index were both lower in REM-related OSA than in non-stage specific OSA. REM-related OSA was significantly associated with females (OR 2.35, 95% CI 1.25–4.42, p = 0.008), age < 60 years (OR 2.52, 95% CI 1.15–5.55, p = 0.021), and mild OSA (OR 17.46, 95% CI 9.28–32.84, p < 0.001). In conclusion, age < 60 years, female gender, and mild severity of OSA were associated with REM-related OSA.
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Affiliation(s)
- Nithita Sattaratpaijit
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Thammasat University, 99/209 Paholyotin Road, Khlong Luang, Pathum Thani, Thailand, 12120
| | - Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, 99/209 Paholyotin Road, Khlong Luang, Pathum Thani, Thailand, 12120.,Center of Excellence in Applied Epidemiology, Thammasat University, 99/209 Paholyotin Road, Khlong Luang, Pathum Thani, Thailand, 12120
| | - Wadee Wongpradit
- Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, 99/209 Paholyotin Road, Khlong Luang, Pathum Thani, Thailand, 12120.
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8
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Chamnanpet S, Tovichien P, Tanphaichitr A, Chotinaiwattarakul W. Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children. Front Pediatr 2022; 10:869986. [PMID: 35573955 PMCID: PMC9097965 DOI: 10.3389/fped.2022.869986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Different pathophysiological mechanisms and the distribution of respiratory events among rapid eye movement (REM) and non-rapid eye movement (NREM) sleep modulate the effect of obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for REM-related OSA in children. STUDY DESIGN Retrospective, cross-sectional study. METHODS We recruited 366 children with OSA confirmed by polysomnography (PSG) over a 5-year period. REM-related OSA is defined by an obstructive apnea-hypopnea index (OAHI) in the REM sleep ≥2× than during NREM sleep. RESULTS The prevalence of REM-related OSA in children was 50.3%. Children with REM-related OSA were more likely to be female (P = 0.042), and had lower prevalence of adenotonsillar hypertrophy (P = 0.043) compared with children with other OSA subtypes. Children with REM-related OSA slept longer in the supine position (P = 0.003), had shorter duration of NREM1 sleep (P = 0.018), lower nadir SpO2 (P = 0.005), and a higher oxygen desaturation index 3% (ODI3%) (P = 0.014), and lower arousal index (P = 0.034) compared with other OSA subtypes. Female gender and supine sleep was the independent risk factors for REM-related OSA. CONCLUSION The prevalence of REM-related OSA was 50.3%. OAHIREM should be considered as an important parameter in future clinical research studies done in children with OSA.
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Affiliation(s)
- Surisa Chamnanpet
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archwin Tanphaichitr
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wattanachai Chotinaiwattarakul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Gutierrez MJ, Nino G, Landeo-Gutierrez JS, Weiss MR, Preciado DA, Hong X, Wang X. Lower respiratory tract infections in early life are associated with obstructive sleep apnea diagnosis during childhood in a large birth cohort. Sleep 2021; 44:zsab198. [PMID: 34522958 PMCID: PMC8664572 DOI: 10.1093/sleep/zsab198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Several birth cohorts have defined the pivotal role of early lower respiratory tract infections (LRTI) in the inception of pediatric respiratory conditions. However, the association between early LRTI and the development of obstructive sleep apnea (OSA) in children has not been established. METHODS To investigate whether early LRTIs increase the risk of pediatric OSA, we analyzed clinical data in children followed during the first 5 years in the Boston Birth Cohort (n = 3114). Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariates were used to evaluate the risk of OSA by the age of 5 years between children with LRTI during the first 2 years of life in comparison to those without LRTI during this period. RESULTS Early life LRTI increased the risk of pediatric OSA independently of other pertinent covariates and risk factors (hazard ratio, 1.53; 95% CI, 1.15 to 2.05). Importantly, the association between LRTI and pediatric OSA was limited to LRTIs occurring during the first 2 years of life. Complementarily to this finding, we observed that children who had severe respiratory syncytial virus bronchiolitis during infancy had two times higher odds of OSA at 5 years in comparison with children without this exposure (odds ratio, 2.09; 95% CI, 1.12 to 3.88). CONCLUSIONS Children with severe LRTIs in early life have significantly increased risk of developing OSA during the first 5 years of life. Our results offer a new paradigm for investigating novel mechanisms and interventions targeting the early pathogenesis of OSA in the pediatric population.
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Affiliation(s)
- Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, USA
| | - Jeremy S Landeo-Gutierrez
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, USA
| | - Miriam R Weiss
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, USA
| | - Diego A Preciado
- Division of Pediatric Otorhinolaryngology, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Xiumei Hong
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaobin Wang
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach. Curr Opin Pulm Med 2021; 27:514-522. [PMID: 34620787 DOI: 10.1097/mcp.0000000000000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls. RECENT FINDINGS Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes. SUMMARY Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.
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11
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Dooley AA, Jackson JH, Gatti ML, Fanous H, Martinez C, Prue DC, Phull G, Richmond M, Weinstein NA, Chorvinsky E, Shukla PJ, Pillai DK. Pediatric sleep questionnaire predicts more severe sleep apnea in children with uncontrolled asthma. J Asthma 2020; 58:1589-1596. [PMID: 32878527 DOI: 10.1080/02770903.2020.1818775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE While up to 35% of children with asthma have evidence of sleep disordered breathing (SDB), it is unclear if nocturnal symptoms stem from asthma itself or SDB. The Pediatric Sleep Questionnaire (PSQ) is a validated tool for identifying SDB in childhood asthma. We hypothesize children with asthma and abnormal PSQ demonstrate decreased asthma control and are at higher risk of obstructive sleep apnea (OSA). METHODS We performed a retrospective, chart review of children and young adults referred to our tertiary children's hospital severe asthma clinic. Data collection included age, gender, BMI percentile, spirometry, PSQ, asthma control questionnaires, asthma severity, control, and impairment. These data were evaluated in the context of polysomnography, when available. RESULTS 205 inner-city children were included; 37.2% female, median age 6.4 y, and mean BMI of 71.3%ile. Rhinitis (p = 0.028), eczema (p = 0.002), and reflux (p = 0.046) were associated with abnormal PSQ; however, overweight/obese status, spirometry, asthma severity, and serologic markers were not. After correcting for comorbidities, abnormal PSQ score was associated with poor asthma control based on validated measures (p < 0.001). In patients with polysomnography, we confirmed abnormal PSQ was associated with increased OSA severity (apnea-hypopnea index 9.1/hr vs. 3.6/hr; p = 0.027). CONCLUSIONS In pediatric asthma, positive PSQ was associated with significantly decreased asthma control. Additionally, children with normal PSQ demonstrated mild OSA, while children with abnormal PSQ had increased severity of OSA. This demonstrates that PSQ can be used to screen children for more severe sleep apnea.
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Affiliation(s)
- Amy A Dooley
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - J Hunter Jackson
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Meagan L Gatti
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Hani Fanous
- Division of Pediatric Pulmonology, University of Miami, Miami, FL, USA
| | - Claudia Martinez
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dominique C Prue
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Gurpreet Phull
- Division of Pulmonary and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Miller Richmond
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Noa A Weinstein
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Elizabeth Chorvinsky
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Prateek J Shukla
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dinesh K Pillai
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA.,Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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12
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de Benedictis FM, Bush A. Janus looks both ways: How do the upper and lower airways interact? Paediatr Respir Rev 2020; 34:59-66. [PMID: 31422898 DOI: 10.1016/j.prrv.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Abstract
Our understanding of the relationship between the upper and lower airways has greatly increased as a consequence of epidemiologic and pharmacologic studies. A consistent body of scientific evidence supports the concept that rhinitis, rhinosinusitis and asthma may be the expression of a common inflammatory process, which manifests at different sites of the respiratory tract, at different times. This paradigm states that allergic reactions may begin at the local mucosa, but tend to propagate along the airway. Central to the allergic diathesis is the eosinophil and its interaction with the airway epithelium. The implications of the interplay between upper and lower airway are not only academic, but also important for diagnostic and therapeutic reasons. Furthermore, there is significant overlap in symptomatology and pathophysiology for childhood sleep disordered breathing (SDB) and asthma. Recent evidence supports an association between these two conditions, but causality has not been demonstrated. Regardless, it is important to recognize the overlap and evaluate for the other condition when one is present. In children with poorly controlled asthma, the presence of SDB may significantly contribute to asthma morbidity and, as such, should be actively excluded. On the other hand, clinical evaluation for asthma should be considered in children with SDB. Future robust longitudinal research is needed to explore the association between upper and lower airway diseases using objective measures in children.
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Affiliation(s)
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
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13
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Bahammam RA, Al-Qahtani KM, Aleissi SA, Olaish AH, Almeneessier AS, Bahammam AS. The Associations of Gender, Menopause, Age, and Asthma with REM-Predominant Obstructive Sleep Apnea: A Prospective Observational Study. Nat Sci Sleep 2020; 12:721-735. [PMID: 33117008 PMCID: PMC7568609 DOI: 10.2147/nss.s275051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/22/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The study sought to assess demographics, clinical features, comorbidities, and polysomnographic features of a large cohort of clinic-based patients with rapid eye movement-predominant obstructive sleep apnea (REM-predominant-OSA) in both genders, while assessing the relationship between REM-predominant OSA in one hand and menopausal status and age on the other. METHODS This prospective observational study was conducted between January 2003 and December 2017. REM-predominant OSA diagnostic criteria included an AHI of ≥5/h, with REM-AHI/non-REM-AHI of >2, a non-REM-AHI of <15/h, and a minimum of 15 min of REM sleep. Patients who had an AHI>5 events/h and did not meet the criteria for REM-predominant OSA were included in the non-stage-specific OSA group (NSS). RESULTS The study consisted of 1346 men and 823 women (total=2169). REM-predominant OSA was diagnosed in 17% (n=369). The prevalence of REM-predominant OSA in women was 25% compared with 12% in men. Several independent associations of REM-predominant OSA were identified in the whole group, including age (OR: 0.97 [0.95-0.98], p<0.01), female sex (OR: 6.95 [4.86-9.93], p>0.01), REM sleep duration (min) (OR: 1.02 [1.02-1.03], < 0.01), and time with SpO2 <90% (mins) (OR: 0.97 [0.95-0.99], < 0.01), hypertension (OR:0.67 [0.45-0.99], 0.04) and asthma (OR: 2.19 [1.56-3.07], < 0.01). The prevalence of REM-predominant OSA in premenopausal and postmenopausal women was 35% and 18.6% (p< 0.01), respectively. Among women, age was an independent correlate (OR: 0.97 [0.94-0.99], p=0.03; however, menopausal status was not. CONCLUSION REM-predominant OSA is prevalent among clinic-based patients with OSA. A younger age and female sex were independent correlates of REM-predominant OSA. Among women, a younger age but not menopausal status was a correlate of REM-predominant OSA. Asthma was independently associated with REM-predominant OSA.
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Affiliation(s)
- Rakan A Bahammam
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Al-Qahtani
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
| | - Salih A Aleissi
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.,Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S Bahammam
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
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14
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Kilaikode S, Weiss M, Megalaa R, Perez G, Nino G. Asthma is associated with increased probability of needing CPAP in children with severe obstructive sleep apnea. Pediatr Pulmonol 2019; 54:342-347. [PMID: 30632298 DOI: 10.1002/ppul.24245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Initiation of continuous positive airway pressure (CPAP) in children with severe obstructive sleep apnea syndrome (OSAS) is challenging and the distinct features of the subset of children requiring CPAP are poorly defined. Asthma often coexists with OSAS in children. The goal of this study was to explore the influence of asthma in the need for CPAP therapy in children with severe OSAS. HYPOTHESIS Asthmatic children with severe OSAS have higher probability of needing CPAP than children with severe OSAS without asthma. METHODS Cross-sectional study of clinical presentation, individual risk factors, and initial overnight polysomnogram (PSG) parameters in children with severe OSAS. Severe OSAS was defined as an obstructive apnea hypopnea index ≥10/h. The association between asthma and CPAP initiation was studied individually and adjusted by pertinent covariates. RESULTS Four hundred eligible children (mean age 7 years, ±SD 5.3) with severe OSAS were enrolled and 133 individuals (33%) were identified to have asthma. The proportion of children needing CPAP was significantly higher in asthmatics with severe OSAS (29%) compared to those with OSAS alone (14%) (P < 0.01). Multivariate analysis demonstrated that the association between asthma and the need of CPAP in pediatric severe OSAS was independent of demographics, OSAS severity, obesity, and history of adenotonsillectomy (P < 0.01). CONCLUSION Asthmatic children with severe OSAS have higher probability of needing CPAP independent of relevant covariables. This study further substantiates the link between OSAS and asthma in children and suggests the diagnosis of asthma may influence the need of CPAP therapy for severe OSAS.
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Affiliation(s)
- Sasikumar Kilaikode
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, District of Columbia
| | - Miriam Weiss
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, District of Columbia
| | - Rosemary Megalaa
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, District of Columbia
| | - Geovanny Perez
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, District of Columbia
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, District of Columbia
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15
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Tzeng NS, Chung CH, Chang HA, Chang CC, Lu RB, Yeh HW, Chiang WS, Kao YC, Chang SY, Chien WC. Obstructive Sleep Apnea in Children and Adolescents and the Risk of Major Adverse Cardiovascular Events: A Nationwide Cohort Study in Taiwan. J Clin Sleep Med 2019; 15:275-283. [PMID: 30736877 DOI: 10.5664/jcsm.7632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/15/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES This study has investigated the risk of major adverse cardiovascular events (MACEs), including acute myocardial infarction, coronary artery disease, peripheral artery disease, and acute stroke, among children and adolescents (age younger than 20 years) with obstructive sleep apnea (OSA). METHODS In this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients in whom OSA had been first diagnosed between 2000 and 2015. Children and adolescents with OSA (n = 6,535) were included with 1:3 ratio by age, sex, and index year of control participants without OSA (n = 19,605). The Cox proportional regression model was used to evaluate the risk of MACEs in this cohort study. RESULTS After a 15-year follow-up, the incidence rate of MACEs was higher in the OSA cohort when compared with the non-OSA control cohort (15.97 and 8.20 per 100,000 person-years, respectively). After adjusting for covariates, the risk of MACEs among children and adolescents with OSA was still significantly higher (hazard ratio = 2.050; 95% confidence interval = 1.312-3.107; P = .010). No MACEs were found in the children and adolescents with OSA who received continuous airway positive pressure treatment or pharyngeal surgery. CONCLUSIONS This study found a significantly higher risk of MACEs in children and adolescents with OSA. These findings strongly suggest that clinicians should provide careful follow-up and medical treatment for children and adolescents with OSA.
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Affiliation(s)
- Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Band Lu
- Department of Psychiatry, College of Medicine and Hospital, National Cheng-Kung University, Tainan, Taiwan, ROC.,Institute of Behavioral Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan, ROC
| | - Hui-Wen Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, ROC.,Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Nursing, Kang-Ning University (Taipei Campus), Taipei, Taiwan, ROC
| | - Wei-Shan Chiang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Life Sciences, National Defense Medical Center, Taiwan, ROC
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16
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Rogers VE, Bollinger ME, Tulapurkar ME, Zhu S, Hasday JD, Pereira KD, Scharf SM. Inflammation and asthma control in children with comorbid obstructive sleep apnea. Pediatr Pulmonol 2018; 53:1200-1207. [PMID: 29862666 DOI: 10.1002/ppul.24074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/16/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES A bi-directional relationship exists between asthma and obstructive sleep apnea (OSA) in which presence of one is associated with increased prevalence and severity of the other. Our objective was to determine whether OSA accounted for differences in airway and systemic inflammation in asthmatic children and whether inflammation was associated with asthma control. We hypothesized that greater severity of SDB would correlate with increased upper airway and systemic inflammation and result in reduced asthma control. METHODS Non-obese children aged 4-12 years with persistent asthma, with or without OSA were recruited. Asthma control was measured with the Childhood Asthma Control Test. Children underwent polysomnography and blood sampling, and children with OSA underwent clinically indicated adenotonsillectomy. Tonsils and sera were analyzed for 11 cytokines. RESULTS Twenty-seven children (20 with OSA, seven without OSA) participated, mean age 7.9 years, 55.6% female, 92.6% African American. Levels did not differ for any cytokine between children with and without OSA. Lower nadir oxygen saturation was associated with higher levels of tonsil TNF-α (P < 0.001) and IL-10 (P < 0.05). Higher REM-related apnea-hypopnea index was associated with higher levels of tonsil TNF-α (P < 0.05). Children with uncontrolled asthma had significantly higher levels of serum IL-10, IL-13, and TNF-α, and tonsil TNF-α (all P < 0.05) than well-controlled asthmatic children. There was no association between OSA, or any polysomnography variable, and asthma control. CONCLUSIONS Despite the presence of OSA-associated airway inflammation, and asthma control-associated airway and systemic inflammation, OSA was not related to level of asthma control in this non-obese, largely minority, low income sample.
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Affiliation(s)
- Valerie E Rogers
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland
| | - Mary E Bollinger
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Mohan E Tulapurkar
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Shijun Zhu
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland
| | - Jeffrey D Hasday
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Kevin D Pereira
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Steven M Scharf
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
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17
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Obstructive sleep apnea syndrome and olfactory perception: An OERP study. Respir Physiol Neurobiol 2018; 259:37-44. [PMID: 30006255 DOI: 10.1016/j.resp.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 12/23/2022]
Abstract
Obstructive Sleep Apnea Syndrome (OSA) is characterized by snoring associated with repeated apnea and/or obstructive hypopnea. The nasal airways of OSA patients, measured via acoustic rhinometry, could be significantly narrower than healthy subjects and this reduced nasal structure can impair olfactory function. The relationship between nasal structure and olfactory function, assessed via behavioral test results, indicates that there is a high prevalence of nasal airflow problems. Based on these assumptions, the purpose of this study was to carry out an assessment of olfactory perception in OSA patients through the Chemosensory Event-Related Potentials (CSERP), investigating the N1 component and the Late Positive Component (LPC). Twelve OSA patients, non-smokers, were recruited in the Pulmonary Rehabilitation Unit, scored with the Epworth Sleepiness Scales, after Polygraphic Recording, Apnea Hypopnea Index and Body Mass Index evaluation. The control group consisted of twelve healthy controls, non-smokers, recruited as volunteers. Subjects, during an EEG recording, performed an oddball olfactory recognition task based on two scents: rose and eucalyptus. Main results highlighted differences in N1 and LPC between OSA and controls. OSA patients presented faster N1 latencies and greater amplitude. The same trend was found in LPC, where OSA showed decreased latency and increased amplitude during rose stimulation, in the right inferior frontal cortex. and faster latencies in left centroparietal cortex OERP results can suggest an impairment in endogenous components. This result could be the consequence of the exogenous perceptual difficulty highlighted in N1 component. The increased arousal could also be related to the respiratory activity involved during the olfactory task.
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18
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Berson SR, Klimczak J, Prezio EA, Hu S, Abraham M. Clinical associations between allergies and rapid eye movement sleep disturbances. Int Forum Allergy Rhinol 2018; 8:817-824. [PMID: 29461689 PMCID: PMC6055599 DOI: 10.1002/alr.22099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
Background Allergic rhinitis, an immunoglobulin E inflammatory condition including nasal congestion, obstruction, sneezing, pruritus, and fatigue symptoms, has significant impact on quality of life and impairs sleep. Sleep‐disordered breathing (SDB) patients often have normal all‐night apnea‐hypopnea (AHI) or respiratory‐disturbance (RDI) indices on polysomnography (PSG). We hypothesized that the rapid eye motion–respiratory disturbance index (REM‐RDI) may be a novel predictor of allergic status. Methods A retrospective analysis of 100 patients compared REM‐RDI results in 67 allergen‐positive patients with 33 nonallergic patients who presented with nasal blockage. Subjects completed STOP‐Bang©, 22‐item Sino‐Nasal Outcome Test (SNOT‐22)©, and Epworth Sleepiness Scale© questionnaires and underwent skin‐prick testing (SPT) and PSGs including REM‐RDI values. Using multivariate logistic regression models, we evaluated relationships between allergic status and sleep parameters while controlling for possible confounders including body mass index (BMI). Results Using REM‐RDI as the outcome of interest, allergen‐positive patients were 3.92 times more likely to have REM‐RDI values in a moderate/severe range (≥15 events/hour); and patients with moderate/severe REM‐RDI values were more likely to be allergen positive (p < 0.05). Allergic status was not significantly related to all‐night AHI, RDI, or REM‐AHI. BMI was not significantly related to REM‐RDI. STOP‐Bang© was related to allergy status (p = 0.02) and REM‐RDI (p < 0.01). Allergic patients had increased REM latency and less total amount of REM. Conclusion We revealed significant bidirectional associations between allergen positivity and increased REM‐RDI values independent of BMI, AHI, RDI, and REM‐AHI. Allergic inflammation and REM‐RDI data may play important roles in diagnosing and treating fatigued SDB patients and as objective perioperative safety and outcomes measures.
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Affiliation(s)
- Shelley R Berson
- Department of Otolaryngology, School of Medicine, New York Medical College, Valhalla, NY
| | - Jaclyn Klimczak
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
| | | | - Shirley Hu
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
| | - Manoj Abraham
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mt. Sinai, New York, NY
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19
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The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep 2017; 7:46615. [PMID: 28418014 PMCID: PMC5394537 DOI: 10.1038/srep46615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/22/2017] [Indexed: 11/21/2022] Open
Abstract
Adenotonsillar regrowth in children after adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) is often seen in clinical treatment, however, the relationship between allergic disease and adenotonsillar regrowth remains unclear. In this retrospective study, children were assigned to either the recurrence or control group, and subdivided by age at operation. Among children over 36 months, those in the recurrence group had more allergic disease and higher IgE, IL-4, and IL-5 levels than the same-aged children in control group. The Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores for nasal symptoms and activity were higher in children older than 36 months in recurrence group. The results of immunohistochemistry and immunofluorescence showed that FoxP3+ cells (Tregs) were less, while GATA3+ cells (Th2 cells) were more in recurrence group for all ages. Allergic status and low levels of FoxP3 were proved as independent risk factors for adenotonsillar regrowth by multivariate logistic regression. These results indicate that allergic disease is a risk factor for adenotonsillar regrowth in children following T&A for OSA, and this risk increases with age. The decreased level of Tregs and subsequent changes in immune function play an important role in the pathogenesis of adenotonsillar regrowth.
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20
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Ehsan Z, Kercsmar CM, Collins J, Simakajornboon N. Validation of the pediatric sleep questionnaire in children with asthma. Pediatr Pulmonol 2017; 52:382-389. [PMID: 27787950 DOI: 10.1002/ppul.23568] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/25/2016] [Accepted: 08/19/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The prevalence of obstructive sleep apnea (OSA) is higher in children with poorly controlled asthma. We aimed to determine the validity of the Pediatric Sleep Questionnaire (PSQ) to screen for OSA in children with asthma. METHODS This retrospective review encompassed sleep studies and medical records of asthmatic children evaluated in the sleep center at CCHMC over 13 years. Measures of validity were calculated using various cut-off values for obstructive apnea-hypopnea index (OI; >1, >2, >5) and PSQ scores (>0.33, >0.5). Correlation between PSQ and OI, PSQ and spirometry, and OI and spirometry was assessed using Spearman's correlation coefficient. RESULTS One-hundred and sixty children were included (mean age 11 ± 4 years; 64% males). The mean OI was 4.2 ± 14.3 and the mean PSQ score was 0.57 ± 0.19. Thirty-eight percent of patients had a diagnosis of allergic rhinitis. A total of 70 children (43%) were obese (BMI ≥95th percentile). The correlation between OI and PSQ was statistically significant (r = 0.19, P = 0.015). Using a PSQ cutoff of 0.33, and OI cutoffs of 1, 2, and 5, the sensitivities were 81.6%, 81.6%, and 76.2%, and the specificities were 13.1%, 14.4%, and 14.4%, respectively. When the cutoff for PSQ was raised to 0.5 and using an OI of 1, the sensitivity decreased to 71.1%, but the specificity increased to 36.9%. CONCLUSIONS The sensitivity of PSQ in asthmatic children is high and comparable to previous studies, but the specificity is low. The PSQ may be considered a reasonable first-line screening tool for OSA in asthmatic children. Pediatr Pulmonol. 2017;52:382-389. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zarmina Ehsan
- Department of Pediatric Pulmonology and Sleep Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Carolyn M Kercsmar
- Department of Pediatric Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Collins
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Narong Simakajornboon
- Department of Pediatric Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Castro-Rodriguez JA, Brockmann PE, Marcus CL. Relation between asthma and sleep disordered breathing in children: is the association causal? Paediatr Respir Rev 2017; 22:72-75. [PMID: 27818068 DOI: 10.1016/j.prrv.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Abstract
Over the last few decades, asthma and sleep disordered breathing (SDB) in children have experienced similar increases in prevalence, and have both been shown to have airway inflammation, leading investigators to postulate an association between asthma and SDB. However, whether this relationship is causal or not needs to be proven. In this manuscript, we use the most widely accepted epidemiologic criteria for causality, the Bradford Hill criteria, to test step-by-step whether the relation between asthma and SBD in children is causal or not. We found studies supporting 8 of the 9 criteria (strength, consistency, specificity, biological gradient, coherence and biological plausibility, experiment, and analogy) for association between asthma and SDB. However, we did not find any study showing temporality or directionality between asthma and SDB. Therefore, establishing a causal association between asthma and SDB is not yet possible.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Department of Pediatric Cardiology and Respiratory, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Respiratory, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Sleep Medicine Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carole L Marcus
- Sleep Center, Children's Hospital of Philadelphia. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Ginis T, Akcan FA, Capanoglu M, Toyran M, Ersu R, Kocabas CN, Civelek E. The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control. J Asthma 2017; 54:403-410. [PMID: 28060556 DOI: 10.1080/02770903.2016.1220012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The presence of sleep-disordered breathing (SDB) in children with asthma may cause difficult to control asthma. OBJECTIVES The aim of this study was to determine the frequency of SDB in children with asthma, to evaluate its effects on asthma control and to assess the risk factors associated with the presence of SDB. METHODS Parents of children who Sleep Questionnaire (PSQ) and the Childhood Asthma Control Test (C-ACT). Asthma control level was assessed according to Global Initiative for Asthma (GINA). Same ear-nose-throat (ENT) specialist evaluated all patients. A 4-point tonsil grading method and adenoid-nasopharynx ratio were used to categorize tonsil and adenoid size, respectively. RESULTS A total of 408 children (275 male, 67.4%) with a mean age of 8.1 ± 3.2 years were included. Nearly 40% of asthmatic children were not-well-controlled according to GINA and 34.6% of all patients had SDB according to PSQ. Multivariate logistic regression analysis revealed that coexistence of SDB [OR: 6.62, 95% CI (4.21-10.41); p < 0.001)] and tonsillar hypertrophy [OR: 3.47; 95% CI (1.05-11.5); p < 0.041] were independent risk factors for not-well-controlled asthma in asthmatic children after other established contributors to asthma control were adjusted. CONCLUSIONS Our study showed that SDB is a strong risk factor for not-well-controlled asthma in asthmatic children independent of other confounders. In addition, tonsillar hypertrophy may have a role in the association between SDB and not-well-controlled asthma in childhood.
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Affiliation(s)
- Tayfur Ginis
- a Department of Pediatric Allergy and Immunology , Ankara Children's Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Fatih Alper Akcan
- b Department of Ear, Nose and Throat , Ankara Children's Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Murat Capanoglu
- a Department of Pediatric Allergy and Immunology , Ankara Children's Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Muge Toyran
- a Department of Pediatric Allergy and Immunology , Ankara Children's Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Refika Ersu
- c Department of Pediatric Pulmonology Marmara University Faculty of Medicine , Istanbul , Turkey
| | - Can Naci Kocabas
- d Department of Pediatric Allergy and Immunology , Faculty of Medicine, Mugla Sitki Kocman University , Mugla , Turkey
| | - Ersoy Civelek
- a Department of Pediatric Allergy and Immunology , Ankara Children's Hematology Oncology Training and Research Hospital , Ankara , Turkey
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Ferrando M, Bagnasco D, Roustan V, Canonica GW, Braido F, Baiardini I. Sleep complaints and sleep breathing disorders in upper and lower obstructive lung diseases. J Thorac Dis 2016; 8:E716-25. [PMID: 27621908 DOI: 10.21037/jtd.2016.07.82] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Upper and lower obstructive lung diseases can induce sleep complaints and can be part of the pathogenesis of sleep breathing disorders. In fact, the physiological changes of the pattern of respiration during sleep, added to the airways disease can lead to symptomatic worsening of rhinitis, asthma and chronic obstructive pulmonary diseases (COPD); moreover, their functional and anatomical features can lead to sleep breathing disorders such as obstructive sleep apnea syndrome (OSAS). This review highlights the above-mentioned relationships and the effect of disease management on its comorbidities and the patient's quality of life. Rhinitis, asthma and COPD represent causes of sleep complaints that may be reduced with optimal management of these obstructive airways diseases. Continuous positive airway pressure (CPAP) treatment of sleep apnea needs to be tailored after optimization of the therapy of concomitant diseases, but it can often ameliorate comorbid disease.
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Affiliation(s)
- Matteo Ferrando
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Diego Bagnasco
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - Giorgio Walter Canonica
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Fulvio Braido
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Ilaria Baiardini
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Sánchez T, Castro-Rodríguez JA, Brockmann PE. Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment. J Asthma Allergy 2016; 9:83-91. [PMID: 27143940 PMCID: PMC4844256 DOI: 10.2147/jaa.s85624] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background The objective was to perform a systematic review in order to describe the relationship between asthma and sleep-disordered breathing (SDB) in children, especially regarding the impact of treatment and management. Methods We performed an electronic search in MEDLINE, EMBASE, and LILACS database. Study inclusion criteria were the following: 1) studies that examined the relationship between asthma/wheezing and SDB/obstructive sleep apnea (OSA); and 2) studies conducted in children <18 years of age. Primary outcomes were the prevalence of asthma and SDB, the tests used for diagnosis, and the influence of their treatment and management. Results One thousand and twenty studies were identified, among which 32 were selected (n=143,343 children; 51% males; age [mean ± standard deviation] 8.4±2.5 years). Most studies (n=26) diagnosed SDB using questionnaires or clinical history. Nine studies performed a sleep study for diagnosing OSA. The diagnosis of asthma was based on clinical history (n=16), previous medical diagnosis (n=4), questionnaires (n=12), and spirometry (n=5). Children with asthma were more likely to develop habitual snoring and OSA, and children with SDB were more likely to develop asthma. Moreover, asthma was associated with more severe OSA, and the presence of SDB was associated with severe asthma. Treatment of SDB with adenotonsillectomy was associated with significant asthma improvement. Conclusion The relationship between asthma and SDB appears to be bidirectional, and adenotonsillectomy appears to improve asthma control. Future trials on how asthma treatment could impact on SDB are needed.
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Affiliation(s)
- Trinidad Sánchez
- Division of Pediatrics, School of Medicine, Division of Pediatrics, School of Medicine, Santiago, Chile
| | - José A Castro-Rodríguez
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Santiago, Chile
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Santiago, Chile; Sleep Medicine Center, Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Pancham K, Sami I, Perez GF, Huseni S, Kurdi B, Rose MC, Rodriguez-Martinez CE, Nino G. Human Metapneumovirus Infection is Associated with Severe Respiratory Disease in Preschool Children with History of Prematurity. Pediatr Neonatol 2016; 57:27-34. [PMID: 26117550 PMCID: PMC5544944 DOI: 10.1016/j.pedneo.2015.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/12/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Human metapneumovirus (HMPV) is a recently discovered respiratory pathogen of the family Paramyxoviridae, the same family as that of respiratory syncytial virus (RSV). Premature children are at high risk of severe RSV infections, however, it is unclear whether HMPV infection is more severe in hospitalized children with a history of severe prematurity. METHODS We conducted a retrospective analysis of the clinical respiratory presentation of all polymerase chain reaction-confirmed HMPV infections in preschool-age children (≤5 years) with and without history of severe prematurity (<32 weeks gestation). Respiratory distress scores were developed to examine the clinical severity of HMPV infections. Demographic and clinical variables were obtained from reviewing electronic medical records. RESULTS A total of 571 preschool children were identified using polymerase chain reaction-confirmed viral respiratory tract infection during the study period. HMPV was identified as a causative organism in 63 cases (11%). Fifty-eight (n = 58) preschool-age children with HMPV infection were included in this study after excluding those with significant comorbidities. Our data demonstrated that 32.7% of children admitted with HMPV had a history of severe prematurity. Preschool children with a history of prematurity had more severe HMPV disease as illustrated by longer hospitalizations, new or increased need for supplemental O2, and higher severity scores independently of age, ethnicity, and history of asthma. CONCLUSION Our study suggests that HMPV infection causes significant disease burden among preschool children with a history of prematurity leading to severe respiratory infections and increasing health care resource utilization due to prolonged hospitalizations.
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Affiliation(s)
- Krishna Pancham
- Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA
| | - Iman Sami
- Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA
| | - Geovanny F Perez
- Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA
| | - Shehlanoor Huseni
- Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA
| | - Bassem Kurdi
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mary C Rose
- Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, USA; Center for Genetic Research Medicine, Children's National Medical Center, Washington, DC, USA
| | - Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia; Research Unit, Military Hospital of Colombia, Bogota, Colombia
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, USA; Center for Genetic Research Medicine, Children's National Medical Center, Washington, DC, USA.
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Madama D, Silva A, Matos MJ. Overlap syndrome--Asthma and obstructive sleep apnea. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 22:6-10. [PMID: 26603307 DOI: 10.1016/j.rppnen.2015.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Asthma is a chronic inflammatory disease with multiple phenotypes. There is still a major gap in the understanding of its complex causality. Obstructive sleep apnea (OSA) is a common condition that has been implicated as a risk factor for asthma exacerbations. OBJECTIVES This study aims to characterize patients with the diagnosis of asthma and suspected OSA; identify the presence of OSA and review, on the current literature, the association between asthma and OSA, as an overlap syndrome. MATERIALS AND METHODS The authors present a retrospective study that included patients diagnosed with asthma that underwent sleep study in a 3 year period. Demographic, clinical data, body mass index (BMI), sleep study parameters and treatments were analyzed. RESULTS The sample consisted of 47 patients. The majority of population was females (68%) and the mean age was 55.65 ± 13.04 years. The most common nighttime symptom was snoring (93.6%). Regarding BMI, values above the normal limit were observed in 89.36% of the patients. 68% underwent polysomnography and the others cardiorespiratory polygraphy. In 57.4% of the patients, OSA was confirmed with a higher prevalence in males (73.3%) compared to females (50%). The therapeutic approach in 81.8% of these patients was home ventilation therapy. CONCLUSION The combination of asthma and OSA has become increasingly more frequent. In the described study, the prevalence of OSA was 57.4%, value that is in fact higher than in general population. After the therapeutic approach, all patients referred improvement of symptoms. It is therefore essential that OSA is investigated in patients with asthma when there is poor control of symptoms, in order to achieve a better control.
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Affiliation(s)
- D Madama
- Pulmonology Department, Coimbra Hospital and University Centre, Portugal.
| | - A Silva
- Pulmonology Department, Coimbra Hospital and University Centre, Portugal
| | - M J Matos
- Pulmonology Department, Coimbra Hospital and University Centre, Portugal
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Li L, Xu Z, Jin X, Yan C, Jiang F, Tong S, Shen X, Li S. Sleep-disordered breathing and asthma: evidence from a large multicentric epidemiological study in China. Respir Res 2015; 16:56. [PMID: 25958333 PMCID: PMC4472264 DOI: 10.1186/s12931-015-0215-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/24/2015] [Indexed: 11/12/2022] Open
Abstract
Background Previous studies have postulated that sleep-disordered breathing (SDB) may be associated with the occurrence and exacerbation of asthma. However, there was limited quantitative evidence on the topic. This study aimed at investigating the prevalence and predisposing factors of asthma, and quantifying the association between SDB and asthma among school-aged children in China. In addition, a comprehensive meta-analysis of the published evidences and our findings were further conducted. Methods To test the hypothesis, we conducted a multicentric cross-sectional study involving 22,478 children aged 5–12 years recruited from eight cities in China. Furthermore, a meta-analysis based on both previously published studies and our cross-sectional study was performed. Results The prevalence rate of SDB and asthma was 12.0% and 3.5% among our cross-sectional study sample. It was demonstrated that symptoms of SDB, such as habitual snoring (OR = 1.28, 95%CI: 1.01-1.62), and obstructive sleep apnea (OSA) (OR = 1.92, 95%CI: 1.34-2.76), were significantly associated with asthma, after adjusting for potential confounding factors. In the meta-analysis, SDB was correlated with the prevalence of asthma in both children (OR = 1.58, 95%CI: 1.35-1.80) and adults (OR = 1.55, 95%CI: 1.42-1.67). Conclusions Our results provide further evidence for the independent association between SDB and asthma. The clinical significance of our findings lies in the emphasis that children undergoing examination or treatment for asthma should be routinely screened for sleep problems. Further systematic study is required to illuminate the underlying mechanism.
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Affiliation(s)
- Liwen Li
- Xin Hua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200127, PR China.
| | - Zhiwei Xu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia.
| | - Xingming Jin
- Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Chonghuai Yan
- Xin Hua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Fan Jiang
- Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia.
| | - Xiaoming Shen
- MOE - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200127, PR China. .,MOE - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
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Huseni S, Gutierrez MJ, Rodriguez-Martinez CE, Rodriguez CE, Nino CL, Perez GF, Pancham K, Nino G. The link between rhinitis and rapid-eye-movement sleep breathing disturbances in children with obstructive sleep apnea. Am J Rhinol Allergy 2015; 28:56-61. [PMID: 24717885 DOI: 10.2500/ajra.2014.28.3994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we examined OSA severity and polysomnogram (PSG) features in children with rhinitis and OSA. Given that rapid-eye-movement (REM) sleep is characterized by nasal congestion, we hypothesized that children with rhinitis have more REM-related breathing abnormalities. METHODS We conducted a retrospective cross-sectional analysis of 145 children with PSG-diagnosed OSA. Outcomes included PSG parameters and obstructive apnea-hypopnea index (OAHI) during REM and non-REM. Linear multivariable models examined the joint effect of rhinitis and OSA parameters with control for potential confounders. RESULTS Rhinitis was present in 43% of children with OSA (n = 63) but overall OAHI severity was unaffected by the presence of rhinitis. In contrast, OAHI during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/hr; SE = 6.4) compared with those with OSA alone (28.2/hr; SE = 3.8). CONCLUSION Rhinitis is highly prevalent in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA. Further research is needed to delineate the link between REM-sleep and the physiology of the nose during health and disease.
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Affiliation(s)
- Shehlanoor Huseni
- Divivsion of Pediatric Pulmonology and Sleep Medicine, Children's National Medical Center, Washington D.C., USA
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Shanley LA, Lin H, Flores G. Factors associated with length of stay for pediatric asthma hospitalizations. J Asthma 2014; 52:471-7. [DOI: 10.3109/02770903.2014.984843] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sleep apneas and epilepsy comorbidity in childhood: a systematic review of the literature. Sleep Breath 2014; 19:421-32. [DOI: 10.1007/s11325-014-1076-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/24/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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Salles C, Terse-Ramos R, Souza-Machado A, Cruz ÁA. Obstructive sleep apnea and asthma. J Bras Pneumol 2014; 39:604-12. [PMID: 24310634 PMCID: PMC4075889 DOI: 10.1590/s1806-37132013000500011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/14/2013] [Indexed: 12/12/2022] Open
Abstract
Symptoms of sleep-disordered breathing, especially obstructive sleep apnea
syndrome (OSAS), are common in asthma patients and have been associated with
asthma severity. It is known that asthma symptoms tend to be more severe at
night and that asthma-related deaths are most likely to occur during the night
or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are
markers of inadequate control of the disease. Various pathophysiological
mechanisms are related to the worsening of asthma symptoms, OSAS being one of
the most important factors. In patients with asthma, OSAS should be investigated
whenever there is inadequate control of symptoms of nocturnal asthma despite the
treatment recommended by guidelines having been administered. There is evidence
in the literature that the use of continuous positive airway pressure
contributes to asthma control in asthma patients with obstructive sleep apnea
and uncontrolled asthma.
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Oximetry Signal Processing Identifies REM Sleep-Related Vulnerability Trait in Asthmatic Children. SLEEP DISORDERS 2013; 2013:406157. [PMID: 24288619 PMCID: PMC3832976 DOI: 10.1155/2013/406157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/06/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022]
Abstract
Rationale. The sleep-related factors that modulate the nocturnal worsening of asthma in children are poorly understood. This study addressed the hypothesis that asthmatic children have a REM sleep-related vulnerability trait that is independent of OSA. Methods. We conducted a retrospective cross-sectional analysis of pulse-oximetry signals obtained during REM and NREM sleep in control and asthmatic children (n = 134). Asthma classification was based on preestablished clinical criteria. Multivariate linear regression model was built to control for potential confounders (significance level P ≤ 0.05). Results. Our data demonstrated that (1) baseline nocturnal respiratory parameters were not significantly different in asthmatic versus control children, (2) the maximal % of SaO2 desaturation during REM, but not during NREM, was significantly higher in asthmatic children, and (3) multivariate analysis revealed that the association between asthma and REM-related maximal % SaO2 desaturation was independent of demographic variables. Conclusion. These results demonstrate that children with asthma have a REM-related vulnerability trait that impacts oxygenation independently of OSA. Further research is needed to delineate the REM sleep neurobiological mechanisms that modulate the phenotypical expression of nocturnal asthma in children.
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