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Nosetti L, Angriman M, Zaffanello M, Salvatore S, Riggi L, Niespolo AC, Salvatoni A, Agosti M. Increased parental perception of sleep disordered breathing in a cohort of infants with ALTE/BRUE events. Minerva Pediatr (Torino) 2023; 75:490-495. [PMID: 30299025 DOI: 10.23736/s2724-5276.18.05276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND An apparent life-threatening event (ALTE) describes an acute, unexpected change in an infant's breathing, aspect, or behavior frightening to the parent or caretaker. According to the new recent terminology, clinicians should use the term brief resolved unexplained event (BRUE) to describe an event occurring in an infant <1 year of age when the observer reports a sudden, brief, and now resolved episode. The aims of the present study in infants were to investigate sleep disturbances in both ALTE event and after their classification according the new BRUE criteria. METHODS We enrolled (from April to May 2016) 32 consecutive infants referred to our ambulatory for sleep disorders for follow-up after an ALTE episode and 32 pair healthy controls. We administered to parents the adapted questionnaire "Sleep Disturbance Scale for Children - SDSC." RESULTS Among enrolled infants with ALTE, there were 26 infants in line with the new BRUE definition, of which 10 at low risk and 16 at the high-risk event. CONCLUSIONS Infants with ALTE and BRUE had more referred-by-parents' sleep symptoms than controls. In particular, sleep disordered breathing wa prevalent in both, requiring a longer follow-up for this disturbance.
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Affiliation(s)
- Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Marco Angriman
- Department of Pediatrics, Unit of Child Neurology and Neurorehabilitation, Hospital of Bolzano, Bolzano, Italy
| | - Marco Zaffanello
- Division of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | | | - Letizia Riggi
- Department of Pediatrics, University of Insubria, Varese, Italy
| | | | | | - Massimo Agosti
- Department of Pediatrics, University of Insubria, Varese, Italy
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2
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Morse E, Pereira N, Liu K, Veler H, Maresh A. Management and outcomes of obstructive sleep apnea in infants. Int J Pediatr Otorhinolaryngol 2023; 168:111558. [PMID: 37075592 DOI: 10.1016/j.ijporl.2023.111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/03/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To characterize the clinical characteristics of infants with obstructive sleep apnea (OSA), define the resolution rate of infant OSA, and identify factors associated with OSA resolution. METHODS We identified infants diagnosed with OSA via retrospective chart review at less than one year of age at a tertiary care center. We identified patient comorbidities, flexible or rigid airway evaluations, surgical procedures, and oxygen/other respiratory support administration. We identified infants as having resolved OSA based on clinical or polysomnogram resolution. We compared the frequency of comorbid diagnoses and receipt of interventions in infants with resolved versus non-resolved OSA by χ2 analysis. RESULTS 83 patients were included. Prematurity was found in 35/83 (42%), hypotonia-related diagnoses in 31/83 (37%), and craniofacial abnormalities in 34/83 (41%). Resolution was observed in 61/83 (74%), either clinically or by polysomnogram, during follow up. On χ2 analysis, surgical intervention was not associated with likelihood of resolution (73% versus 74% in those without surgical intervention, p = 0.98). Patients with airway abnormalities on flexible or rigid evaluation were less likely to have OSA resolution than those without (63% versus 100%, p = 0.010), as were patients with hypotonia-related diagnoses (58% versus 83%, p = 0.014). In patients with laryngomalacia, there was no association of supraglottoplasty with increased resolution (88% with supraglottoplasty versus 80% without, p = 1.00). CONCLUSIONS We identified a group of infants with OSA with diverse comorbidities. There was a high rate of resolution. This data can assist with treatment planning and family counselling for infants with OSA. A prospective clinical trial is needed to better assess consequences of OSA in this age.
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Affiliation(s)
- Elliot Morse
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
| | - Nicola Pereira
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
| | - Katie Liu
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
| | - Haviva Veler
- Weill Cornell Medicine, Department of Pediatrics, 1305 York Avenue, New York, NY, 10065, USA.
| | - Alison Maresh
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
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Kukkola HL, Kirjavainen T. Obstructive sleep apnea is position dependent in young infants. Pediatr Res 2023; 93:1361-1367. [PMID: 35974159 PMCID: PMC10132964 DOI: 10.1038/s41390-022-02202-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obstructive sleep apnea in infants with Pierre Robin sequence is sleep-position dependent. The influence of sleep position on obstructive events is not established in other infants. METHODS We re-evaluated ten-year pediatric sleep center data in infants aged less than six months, with polysomnography performed in different sleep positions. We excluded infants with syndromes, genetic defects, or structural anomalies. RESULTS Comparison of breathing between supine and side sleeping positions was performed for 72 infants at the median corrected age of 4 weeks (interquartile range (IQR) 2-8 weeks). Of the infants, 74% were male, 35% were born prematurely, and 35% underwent study because of a life-threatening event or for being a SIDS sibling. Upper airway obstruction was more frequent (obstructive apnea-hypopnea index (OAHI), p < 0.001), 95th-percentile end-tidal carbon dioxide levels were higher (p = 0.004), and the work of breathing was heavier (p = 0.002) in the supine than in the side position. Median OAHI in the supine position was 8 h-1 (IQR 4-20 h-1), and in the side position was 4 h-1 (IQR 0-10 h-1). CONCLUSIONS Obstructive upper airway events in young infants are more frequent when supine than when sleeping on the side. IMPACT The effect of sleep position on obstructive sleep apnea is not well established in infants other than in those with Pierre Robin sequence. A tendency for upper airway obstruction is position dependent in most infants aged less than 6 months. Upper airway obstruction is more common, end-tidal carbon dioxide 95th-percentile values higher, and breathing more laborious in the supine than in the side-sleeping position. Upper airway obstruction and obstructive events have high REM sleep predominance. As part of obstructive sleep apnea treatment in young infants, side-sleeping positioning may prove useful.
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Affiliation(s)
- Hanna-Leena Kukkola
- Department of Pediatrics, New Children's Hospital, Helsinki, Finland
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Turkka Kirjavainen
- Department of Pediatrics, New Children's Hospital, Helsinki, Finland.
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Children's Hospital Department of Clinical Neurophysiology and Neurological Sciences, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
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4
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Joshi SS, Sivapalan D, Leclerc MJ, Kapur N. Home continuous positive airway pressure therapy in infants: a single-center experience. J Clin Sleep Med 2023; 19:473-477. [PMID: 36458731 PMCID: PMC9978439 DOI: 10.5664/jcsm.10366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 12/04/2022]
Abstract
STUDY OBJECTIVES There are limited data on indications and outcomes of home continuous positive airway pressure (CPAP) therapy in the first year of life. We aimed to analyze the clinical, demographic, and polysomnographic characteristics of a cohort of children initiated on home CPAP for treatment of sleep-disordered breathing and as respiratory support in the first year of life. METHODS Children started on CPAP in the first year of life at the Queensland Children's Hospital were retrospectively evaluated for clinical and demographic parameters, underlying diagnoses, respiratory support, airway surgical intervention, and polysomnography results at baseline and on CPAP. RESULTS Twenty-nine infants (median age [interquartile range] at CPAP initiation, 182 days [126-265.5 days]) were included. The underlying etiology included Trisomy 21 (n = 6), craniofacial syndromes (n = 5), hypotonia (n = 8; 5 with noncraniofacial syndrome), airway malacia (n = 5), skeletal dysplasia (n = 2), nonsyndromic upper airway obstruction (n = 2), and chronic neonatal lung disease (n = 1). The median (interquartile range) obstructive apnea-hypopnea index was 14 events/h (6.2-31 events/h) at CPAP initiation, which improved on CPAP to 3.4 events/h (1.4-6.4 events/h). The median (interquartile range) transcutaneous CO2 max remained unchanged on CPAP (56.6 mm Hg [49-66.5 mm Hg] pre-CPAP vs 54.9 mm Hg [47-62 mm Hg] on CPAP). Fifteen children needed surgical airway intervention (11 pre-CPAP and 4 post-CPAP). CPAP therapy could be successfully stopped in 9 children, 2 children needed tracheostomy, and 1 child died during the follow-up period. CONCLUSIONS Home CPAP as respiratory support is an effective long-term therapy in infancy, and these patients can be weaned from CPAP therapy even if it was initiated early. Prospective studies with predefined criteria for CPAP initiation and cessation would help ascertain long-term outcomes in this poorly researched group. CITATION Joshi SS, Sivapalan D, Leclerc M-J, Kapur N. Home continuous positive airway pressure therapy in infants: a single-center experience. J Clin Sleep Med. 2023;19(3):473-477.
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Affiliation(s)
- Shambhavi Sahotra Joshi
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Dasheni Sivapalan
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Marie-Josee Leclerc
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of medicine, University of Queensland, South Brisbane, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, School of Medicine, University of Queensland, South Brisbane, Queensland, Australia
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5
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Kukkola HL, Kirjavainen T. Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement. Pediatr Pulmonol 2023; 58:794-803. [PMID: 36437560 DOI: 10.1002/ppul.26255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The natural evolution of obstructive sleep apnea (OSA) in young infants is not established. METHODS We re-evaluated 10-year pediatric sleep center infant polysomnography (PSG) data, excluding infants with syndromes, genetic defects, structural anomalies or periodic breathing > 5% of sleep time. RESULTS Obstructive events > 1 h-1 were evident in 255 infants, of which 91 were eligible for the study. Of the 38 infants in a follow-up study, 30 (79%) were male, 15 (40%) were born prematurely, 25 (66%) had observed apneas, and 13 (33%) had experienced a brief, unexplained event or had a sibling of the infant died suddenly. The first PSG was performed at a median corrected age of 4 weeks (interquartile range [IQR] 2-7) and the second at 11 weeks (IQR 9-14). The obstructive apnea and hypopnea index (OAHI) was greater in the supine compared to side-sleeping position in both recordings (p < 0.001), whereas OAHI dropped from 10 h-1 (IQR 6-24) in the first PSG to 3 h-1 (IQR 1-9) in the second PSG (p < 0.001). OSA alleviation was also observable as a decrease in the number of oxygen desaturations (p < 0.001), as a decrease in transcutaneous (p = 0.001) and end-tidal carbon dioxide (p = 0.01) 95th percentile levels, and work of breathing (p = 0.002). Seven infants had a third PSG to verify a satisfactory improvement of OSA. CONCLUSIONS OSA in young infants without a clear syndrome or structural anomaly is sleep position dependent and shows improvement during the following few months.
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Affiliation(s)
- Hanna-Leena Kukkola
- Department of Pediatrics, New Children's Hospital, Helsinki, Finland.,Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Turkka Kirjavainen
- Department of Pediatrics, New Children's Hospital, Helsinki, Finland.,Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Children's Hospital Department of Clinical Neurophysiology and Neurological Sciences, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
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6
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Seither K, Helm BM, Heubi C, Swarr D, Suhrie KR. Sleep Apnea in Children With Down Syndrome. Pediatrics 2023; 151:190642. [PMID: 36762410 DOI: 10.1542/peds.2022-058771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE The authors of this study aimed to evaluate the use of polysomnography (PSG) in children with Down syndrome (DS) between ages 0 and 7 years, to assess the prevalence and severity of obstructive sleep apnea (OSA) and associated comorbidities, and to describe interventions used for OSA. METHODS A retrospective cohort study was performed at Cincinnati Children's Hospital Medical Center for children with DS born between 2013 and 2019. Data were extracted from the electronic medical record, including demographics, age at PSG, PSG results, and interventions after an abnormal PSG. Statistical analysis included unadjusted bivariate association testing and multivariable logistic regression modeling to investigate associations with OSA severity. RESULTS Among 397 patients in the cohort, 59% (n = 235) had a documented PSG and 94% (n = 221) had an abnormal study with 60% (n = 141) demonstrating moderate or severe OSA. There was an inverse relationship between age and OSA severity (P < .001). In a multiple regression model, OSA severity was associated with increased rates of failure to thrive (P < .01), aspiration (P = .02), and laryngomalacia (P < .01). After medical or surgical intervention, 73% of patients experienced the resolution of OSA or an improvement in OSA severity. CONCLUSION In this study of pediatric patients with DS, OSA was identified most frequently in the first year of life. In addition, to prompt evaluation of symptomatic infants, our data support earlier PSG screening for patients requiring neonatal ICU care and those with feeding difficulties, airway abnormalities, and/or pulmonary hypertension given their increased risk for severe OSA.
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Affiliation(s)
| | | | - Christine Heubi
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel Swarr
- Perinatal Institute, Division of Neonatology.,University of Cincinnati Department of Pediatrics, Cincinnati, Ohio
| | - Kristen R Suhrie
- Department of Medical & Molecular Genetics.,Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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7
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Ratanakorn W, Brockbank J, Ishman S, Tadesse DG, Hossain MM, Simakajornboon N. The maturation changes of sleep-related respiratory abnormalities in infants with laryngomalacia. J Clin Sleep Med 2021; 17:767-777. [PMID: 33295276 DOI: 10.5664/jcsm.9046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in infants with laryngomalacia. The purpose of this study was to evaluate developmental changes in sleep-related breathing disorders over time in infants with laryngomalacia and understand the effect of supraglottoplasty (SGP) and nonsurgical treatment. METHODS This is a retrospective review of infants with laryngomalacia who had at least 2 diagnostic polysomnography studies performed from January 2000 and May 2015. We included infants who had either OSA or CSA. Comparison of sleep and respiratory parameters by age group (0-6, 6-12, and >12 months old) was performed in both SGP and non-SGP groups using a mixed-effect regression model. A log-normal mixed model was used to explore the changes in sleep and respiratory parameters with age. The time to resolution of CSA and OSA was analyzed using nonparametric survival analysis. RESULTS A total of 102 infants were included; 57 had only OSA and 45 had both CSA and OSA. There were significant decreases in apnea-hypopnea index, obstructive index, central apnea index, and arousal index with increasing age in both SGP and non-SGP groups. The mean age at resolution of CSA (central apnea index < 5) was 7.60 months old for SGP and 12.57 months old for non-SGP (P < .05). There were no significant differences in the mean age at resolution of OSA (obstructive index < 1; 35.18 [SGP] vs 41.55 months [non-SGP]; P = .60) between SGP and non-SGP groups. Infants with neurologic disease, congenital anomalies, or genetic syndromes required significantly more time to resolve OSA (28.12 [normal] vs 53.13 [neurological] vs 59.53 months [congenital anomalies and genetic]; P < .01). CONCLUSIONS Both OSA and CSA improve in infants with laryngomalacia with increasing age regardless of SGP. The mechanism underlying these changes may involve airway growth and maturation of respiratory control. Time to resolution of OSA is affected by the presence of neurologic diseases, congenital anomalies, and genetic syndromes. Further studies are needed to confirm these findings and to evaluate long-term outcomes in this population.
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Affiliation(s)
- Woranart Ratanakorn
- Sleep Center, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, Chonburi Hospital, Chonburi, Thailand
| | - Justin Brockbank
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Stacey Ishman
- Sleep Center, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dawit G Tadesse
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md Monir Hossain
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Narong Simakajornboon
- Sleep Center, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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8
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Kim J, Gueye-Ndiaye S, Mauer E, Modi VK, Perlman J, Veler H. Polysomnography use in complex term and preterm infants to facilitate evaluation and management in the neonatal intensive care unit. J Clin Sleep Med 2021; 17:1653-1663. [PMID: 33755011 DOI: 10.5664/jcsm.9264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES 1. To determine the characteristics of term and preterm infants for which polysomnography (PSG) was used as a primary diagnostic tool in infants with recurrent desaturation episodes, suspected obstructive apnea or both, and the prevalence of abnormal studies. 2. To identify the interventions following PSGs. 3. To assess the added value of airway and swallow evaluations. METHODS Retrospective cohort study of infants evaluated by PSG in the Neonatal Intensive Care Unit (NICU) at NYP-Weill Cornell from January 2012 to April 2018. RESULTS PSGs were performed on 31 infants; 15 (48%) term and 16 (52%) preterm infants. Indications for PSG were persistent desaturations (n=24), suspected obstructive apnea (n=15), and stridor (n=2). Primary comorbid conditions were respiratory (n=11), craniofacial (n=9), airway anomalies (n=6) and neurologic (n=5). The apnea-hypopnea index (AHI) was abnormal in 30 (97%) infants. Of those, 23 (74%) were severe, seven (23%) were moderate, and normal in one (3%). Apneic events were predominantly obstructive in 23 infants and predominantly central in 6. AHI improved in all but one follow-up PSG. The PSG findings resulted in interventions in 24 (77%) infants, in addition to concomitant otolaryngology evaluations (abnormal in 20/25) and swallow studies (abnormal in 9/14). Clinical signs completely resolved in 22 (71%) infants. CONCLUSIONS This is one of the first reports on the diagnostic value of inpatient PSGs in the NICU in infants with recurrent desaturation episodes, suspected obstructive apnea or both. Our findings indicate that PSG is an important tool in evaluating and targeting therapies in complex term and preterm infants with a wide variety of comorbidities.
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Affiliation(s)
- James Kim
- Division of Newborn Medicine, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
| | - Seyni Gueye-Ndiaye
- Pediatric Pulmonology, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
| | - Elizabeth Mauer
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York
| | - Vikash K Modi
- Department of Otolaryngology, Division of Pediatric Otolaryngology- Head & Neck Surgery, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, New York
| | - Jeffrey Perlman
- Division of Newborn Medicine, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
| | - Haviva Veler
- Pediatric Pulmonology, New York-Presbyterian Hospital - Weill Cornell Medical Center, Komansky Children's Hospital, New York, New York
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9
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Mehta B, Waters K, Fitzgerald D, Badawi N. Survey of the practices of neonatologists in managing neonates believed to be at high risk of sleep disordered breathing. BMJ Paediatr Open 2021; 5:e000979. [PMID: 33681476 PMCID: PMC7898842 DOI: 10.1136/bmjpo-2020-000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the practices of neonatologists in managing high-risk neonates believed to be at risk of sleep disordered breathing (SDB). DESIGN An electronic web-based questionnaire assessing awareness of and current practices for managing neonates predisposed to SDB with conditions like craniofacial anomalies, neuromuscular disorders or airway problems was emailed to 232 neonatologists and neonatal fellows working in Australia and New Zealand (NZ). Additionally, neonatologists were approached directly during the annual Australia and NZ perinatal conference in 2019. RESULTS 93 neonatologists (40%) responded to the survey. The majority (85%) of the respondents stated that there were no written protocols/criteria for sleep consultation in their unit. We found considerable variations in the threshold for performing tests including oximetry or referring for polysomnography. Most respondents would perform oximetry before referring for a sleep consultation. However, the duration of oximetry varied from 6 to 24 hours and there was no consensus about what is considered abnormal on an oximetry study. CONCLUSION Management of SDB is gaining importance in neonatal care because of prolonged length of hospital stay and possible long-term effects of SDB. Responses received suggest a lack of clarity regarding thresholds for referral for treatment of SDB. Likely contributory factors are concerns regarding a lack of long-term outcome data from treatment perceived to be onerous for the family, unsettling to some infants and delaying hospital discharge. To overcome inconsistencies in practice, standardised guidelines for assessing and managing SDB in neonates are needed.
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Affiliation(s)
- Bhavesh Mehta
- Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Karen Waters
- Sleep Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dominic Fitzgerald
- Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nadia Badawi
- Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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10
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Selvadurai S, Voutsas G, Propst EJ, Wolter NE, Narang I. Obstructive sleep apnea in children aged 3 years and younger: Rate and risk factors. Paediatr Child Health 2020; 25:432-438. [PMID: 33173554 PMCID: PMC7606157 DOI: 10.1093/pch/pxz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/25/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Undiagnosed and untreated obstructive sleep apnea (OSA) can predispose children to neurobehavioural consequences. However, there is a lack of data identifying rate of, and risk factors for, OSA in very young healthy children. The objective of this study was to determine the rate of OSA and identify risk factors associated with the presence and severity of OSA in children aged 3 years and younger. METHODS This was a retrospective chart review of healthy children between 1 and 3 years old who had a baseline polysomnogram (PSG) between January 2012 and June 2017. Patient demographics, referral history, and PSG data were recorded. RESULTS One hundred and thirteen children were referred for a PSG, of which 66 (58%) were diagnosed with OSA and 47 (42%) did not have OSA. In the OSA group, 13 (20%) were mild and 53 (80%) were moderate-severe. Nasal congestion (P=0.001), adenoid hypertrophy (P=<0.001), and tonsillar hypertrophy (P=0.04) reported at the time of referral were more common in the OSA group compared to the no-OSA group. Binary logistic regression analysis showed that referral from an otolaryngologist (odds ratio=2.6, 95% confidence interval=1.1 to 6.0) were associated with moderate-severe OSA. CONCLUSION A high rate of OSA was found among children aged 3 years and younger. Children referred by an otolaryngologist are more likely to be diagnosed with moderate-severe OSA. Children aged 3 years and younger with symptoms of OSA should be considered high-risk for OSA and be prioritized for early PSG and management.
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Affiliation(s)
- Sarah Selvadurai
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Giorge Voutsas
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - Evan J Propst
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Nikolaus E Wolter
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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11
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Brockbank J, Astudillo CL, Che D, Tanphaichitr A, Huang G, Tomko J, Simakajornboon N. Supplemental Oxygen for Treatment of Infants With Obstructive Sleep Apnea. J Clin Sleep Med 2020; 15:1115-1123. [PMID: 31482833 DOI: 10.5664/jcsm.7802] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Supplemental oxygen has been shown to decrease the frequency of obstructive respiratory events during sleep, but may result in alveolar hypoventilation. Limited information exists on the effect of supplemental oxygen on sleep and respiratory events in infants with obstructive sleep apnea (OSA). METHODS We conducted a retrospective study of infants with OSA who had sleep studies performed from 2007-2012. All infants underwent a room air diagnostic sleep study (RA-PSG), followed by a sleep study while breathing supplemental oxygen via nasal cannula (O₂-PSG) on a separate night. Infants with split-night studies or with inadequate sleep time were excluded. RESULTS Fifty-nine infants met criteria for entry into analysis. The mean age of infants at the time of RA-PSG was 13.0 ± 11.7 weeks and at O₂-PSG was 15.4 ± 13.0 weeks. The obstructive AHI decreased from 19.7 ± 13.0 during RA-PSG to 10.6 ± 11.7 during O₂-PSG (P < .001). The duration of longest obstructive apnea increased from 11.0 ± 4.2 seconds to 13.4 ± 7.4 seconds (P = .01). The lowest saturation associated with obstructive apneas increased from 80.7 ± 6.8% to 90.0 ± 6.7% (P < .001). Carbon dioxide data showed no difference in ventilation after supplemental oxygen administration. There was no significant change in the spontaneous arousal index, however, the percentage of respiratory events associated with arousal increased from 20.7 ± 11.1% to 35.7 ± 19.7% (P < .001). CONCLUSIONS Infants with OSA who received supplemental oxygen had a significant decrease in the frequency of obstructive respiratory events and improved oxygenation without adverse effect on alveolar ventilation. These data suggest that supplemental oxygen may be an effective treatment for infants with OSA who are not good candidates for continuous positive airway pressure or surgery. CITATION Brockbank J, Astudillo CL, Che D, Tanphaichitr A, Huang G, Tomko J, Simakajornboon N. Supplemental oxygen for treatment of infants with obstructive sleep apnea. J Clin Sleep Med. 2019;15(8):1115-1123.
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Affiliation(s)
- Justin Brockbank
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | - Datian Che
- Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | | | - Guixia Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jaime Tomko
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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12
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Sarber KM, von Allmen DC, Tikhtman R, Howard J, Simakajornboon N, Yu W, Smith DF, Ishman SL. Polysomnographic Outcomes After Observation for Mild Obstructive Sleep Apnea in Children Younger Than 3 Years. Otolaryngol Head Neck Surg 2020; 164:427-432. [PMID: 32988267 DOI: 10.1177/0194599820954383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mild obstructive sleep apnea (OSA), particularly in young children, is often treated with observation. However, there is little evidence regarding the outcomes with this approach. Our aim was to assess the impact of observation on sleep for children aged <3 years with mild OSA. STUDY DESIGN Case-control study. SETTING Pediatric tertiary care center. METHODS We reviewed cases of children (<3 years old) diagnosed with mild OSA (obstructive apnea-hypopnea index, 1-5 events/h) who were treated with observation between 2012 and 2017 and had at least 2 polysomnograms performed 3 to 12 months apart. Demographic data and comorbid diagnoses were collected. RESULTS Twenty-six children met inclusion criteria; their median age was 7.2 months (95% CI, 1.2-22.8). Nine (35%) were female and 24 (92%) were White. Their median body mass index percentile was 39 (95% CI, 1-76). Comorbidities included cardiac disease (42.3%), laryngomalacia (42.3%), allergies (34.6%), reactive airway disease (23.1%), and prematurity (7.7%). The obstructive apnea-hypopnea index significantly decreased from 2.7 events/h (95% CI, 1-4.5) to 1.3 (95% CI, 0-4.5; P = .013). There was no significant improvement in median saturation nadir (baseline, 86%; P = .76) or median time with end-tidal carbon dioxide >50 mm Hg (baseline, 0 minutes; P = .34). OSA resolved in 8 patients (31%) and worsened in 1 (3.8%). Only race was a significant predictor of resolution per regression analysis; however, only 2 non-White children were included. CONCLUSION In our cohort, resolution of mild OSA occurred in 31% of patients treated with 3 to 12 months of observation. The presence of laryngomalacia, asthma, and allergies did not affect resolution. Larger studies are needed to better identify factors (including race) associated with persistent OSA and optimal timing of intervention for these children. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Kathleen M Sarber
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Douglas C von Allmen
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Raisa Tikhtman
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Javier Howard
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Narong Simakajornboon
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Wenwen Yu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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13
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Cielo CM, Hernandez P, Ciampaglia AM, Xanthopoulos MS, Beck SE, Tapia IE. Positive Airway Pressure for the Treatment of OSA in Infants. Chest 2020; 159:810-817. [PMID: 32805239 DOI: 10.1016/j.chest.2020.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Positive airway pressure (PAP) is a standard therapy for the treatment of OSA in children, but objective data on the effectiveness of PAP in infants are sparse. The aim of this study was to compare the effectiveness of PAP in infants younger than 6 months of age with that in school-aged children. RESEARCH QUESTION Compared with PAP in school-aged children, can PAP be titrated as successfully in infants, and is adherence to PAP similar in both age groups? STUDY DESIGN AND METHODS Single-center retrospective study. For consecutive infants younger than 6 months of age and school-aged children 5 to 10 years of age with OSA treated with PAP, baseline and titration polysomnography data, PAP adherence data, and parent-reported barriers to adherence were compared between groups. RESULTS Forty-one infants and 109 school-aged children were included. Median obstructive apnea hypopnea index (OAHI) in infants was 25.7/h (interquartile range [IQR], 17.8-35.9/h) and was greater than that in school-aged children (12.1/hr; IQR, 7.6-21.5/h; P < .0001). After PAP titration, OAHI was reduced by a median of 92.1% in infants, similar to the median 93.4% reduction in school-aged children (P = .67). PAP was used in infants on 94.7% of nights, which was more than the 83% in school-aged children (P = .003). No differences were found in barriers to adherence between infants and school-aged children, with behavioral barriers being most common in both groups. INTERPRETATION Objective data demonstrate that PAP is both highly effective at treating OSA and well-tolerated in infants. Like older patients, PAP should be considered along with other therapies for the treatment of OSA in even the youngest children.
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Affiliation(s)
- Christopher M Cielo
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Patricia Hernandez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Melissa S Xanthopoulos
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Suzanne E Beck
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ignacio E Tapia
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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14
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Bandyopadhyay A, Daftary AS. Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know. Clin Pediatr (Phila) 2020; 59:752-759. [PMID: 32274936 DOI: 10.1177/0009922820915733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103531. [PMID: 32443526 PMCID: PMC7277641 DOI: 10.3390/ijerph17103531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.
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16
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Howard JJM, Sarber KM, Yu W, Smith DF, Tikhtman RO, Simakajornboon N, Ishman SL. Outcomes in children with down syndrome and mild obstructive sleep apnea treated non-surgically. Laryngoscope 2019; 130:1828-1835. [PMID: 31603543 DOI: 10.1002/lary.28325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Nasal steroids, oral anti-leukotrienes and supplemental oxygen are effective in the treatment of mild obstructive sleep apnea (OSA) in otherwise healthy children. However, their efficacy is unknown in children with Down syndrome (DS). Here we examine the effect of single medication therapy versus observation versus oxygen on polysomnographic outcomes in these children. METHODS We reviewed children (<18 years) diagnosed with DS and mild OSA (obstructive apnea-hypopnea index [oAHI] ≥1 to <5 events/hour) treated non-surgically (with supplemental oxygen, one medication, or observation) between 2012 and 2017. Demographic data, comorbid diagnoses, and pre- and posttreatment polysomnograms were analyzed. We assessed pre- and posttreatment oAHI, oxyhemoglobin saturation nadir, percent total sleep time (%TST) in rapid eye movement (REM), and end-tidal carbon dioxide (ETCO2 ) >50 mmHg. RESULTS Twenty-four children met inclusion criteria; 10 treated with medication, one with oxygen, and 13 with observation (baseline oAHI was 3.5, 3.3, and 2.9 events/hour, respectively). There was no significant change in oAHI, oxyhemoglobin saturation nadir, ETCO2 , or percent TST in REM after treatment for any treatment group (P = .21-.94). There was no association between reported symptoms and AHI severity or change in AHI. OSA resolved in one patient treated with observation and two treated with medication, but worsened in two each in the medication and observation groups. Resolution of OSA occurred in 20% treated with medication, 7.7% with observation, and 0% with oxygen (P = .82). CONCLUSION In our cohort, resolution of mild OSA was low. This suggests that consideration should be given to multimodality treatments in children with DS and mild OSA. Prospective studies will help establish effectiveness in this cohort. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1828-1835, 2020.
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Affiliation(s)
- Javier J M Howard
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Kathleen M Sarber
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Wenwen Yu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - David F Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Raisa O Tikhtman
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Narong Simakajornboon
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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17
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Powell J, Powell S. Obstructive Sleep Apnea in the Very Young. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Abel F, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Tan HL, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50:50/6/1700985. [PMID: 29217599 DOI: 10.1183/13993003.00985-2017] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Abstract
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
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Affiliation(s)
- Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Francois Abel
- Dept of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Paediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Abstract
Whereas apnea of prematurity has been well defined and its pathophysiology extensively studied, apnea in the term infant remains a greater challenge. Unfortunately, clear diagnostic criteria are lacking and pathogenesis and management vary widely. In this review we have arbitrarily organized the discussion chronologically into earlier and later postnatal periods. In the first days of life, presumed apnea may reflect physiologic events such as positional or feeding etiologies, or may be a manifestation of serious pathophysiology, such as a seizure disorder. Beyond the neonatal period, presumed apnea may be characterized as a BRUE event (brief resolved unexplained event; formerly referred to as ALTE: apparent life-threatening event) and most frequently a precipitating event cannot be identified. Medical providers are left with somewhat of a dilemma regarding the need to hospitalize and/or work up such patients.
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20
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Grigg-Damberger MM. The Visual Scoring of Sleep in Infants 0 to 2 Months of Age. J Clin Sleep Med 2017; 12:429-45. [PMID: 26951412 DOI: 10.5664/jcsm.5600] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/13/2015] [Indexed: 11/13/2022]
Abstract
UNLABELLED In March 2014, the American Academy of Sleep Medicine (AASM) Board of Directors requested the Scoring Manual Editorial Board develop rules, terminology, and technical specifications for scoring sleep/wake states in full-term infants from birth to 2 mo of age, cognizant of the 1971 Anders, Emde, and Parmelee Manual for Scoring Sleep in Newborns. On July 1, 2015, the AASM published rules for scoring sleep in infants, ages 0-2 mo. This evidence-based review summarizes the background information provided to the Scoring Manual Editorial Board to write these rules. The Anders Manual only provided criteria for coding physiological and behavioral state characteristics in polysomnograms (PSG) of infants, leaving specific sleep scoring criteria to the individual investigator. Other infant scoring criteria have been published, none widely accepted or used. The AASM Scoring Manual infant scoring criteria incorporate modern concepts, digital PSG recording techniques, practicalities, and compromises. Important tenets are: (1) sleep/wake should be scored in 30-sec epochs as either wakefulness (W), rapid eye movement, REM (R), nonrapid eye movement, NREM (N) and transitional (T) sleep; (2) an electroencephalographic (EEG) montage that permits adequate display of young infant EEG is: F3-M2, F4-M1, C3-M2, C4-M1, O1-M2, O2-M1; additionally, recording C3-Cz, Cz-C4 help detect early and asynchronous sleep spindles; (3) sleep onsets are more often R sleep until 2-3 mo postterm; (4) drowsiness is best characterized by visual observation (supplemented by later video review); (5) wide open eyes is the most crucial determinant of W; (6) regularity (or irregularity) of respiration is the single most useful PSG characteristic for scoring sleep stages at this age; (7) trace alternant (TA) is the only relatively distinctive EEG pattern, characteristic of N sleep, and usually disappears by 1 mo postterm replaced by high voltage slow (HVS); (8) sleep spindles first appear 44-48 w conceptional age (CA) and when present prompt scoring N; (9) score EEG activity in an epoch as "continuous" or "discontinuous" for inter-scorer reliability; (10) score R if four or more of the following conditions are present, including irregular respiration and rapid eye movement(s): (a) low chin EMG (for the majority of the epoch); (b) eyes closed with at least one rapid eye movement (concurrent with low chin tone); (c) irregular respiration; (d) mouthing, sucking, twitches, or brief head movements; and (e) EEG exhibits a continuous pattern without sleep spindles; (11) because rapid eye movements may not be seen on every page, epochs following an epoch of definite R in the absence of rapid eye movements may be scored if the EEG is continuous without TA or sleep spindles, chin muscle tone low for the majority of the epoch; and there is no intervening arousal; (12) Score N if four or more of the following conditions are present, including regular respiration, for the majority of the epoch: (a) eyes are closed with no eye movements; (b) chin EMG tone present; (c) regular respiration; and (d) EEG patterns of either TA, HVS, or sleep spindles are present; and (13) score T sleep if an epoch contains two or more discordant PSG state characteristics (either three NREM and two REM characteristics or two NREM and three REM characteristics). These criteria for ages 0-2 mo represent far more than baby steps. Like all the other AASM Manual rules and specifications none are fixed in stone, all open for debate, discussion and revision with the fundamental goal to provide standards for comparison of methods and results. COMMENTARY A commentary on this article appears in this issue on page 291.
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Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis. Int J Pediatr Otorhinolaryngol 2016; 87:18-27. [PMID: 27368437 DOI: 10.1016/j.ijporl.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/20/2016] [Accepted: 05/15/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA. METHODS The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities. RESULTS Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166). CONCLUSIONS Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
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Affiliation(s)
- Chia-Fan Lee
- Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan, ROC.
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC.
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Cielo CM, Taylor JA, Vossough A, Radcliffe J, Thomas A, Bradford R, Lioy J, Tapia IE, Assadsangabi R, Shults J, Marcus CL. Evolution of Obstructive Sleep Apnea in Infants with Cleft Palate and Micrognathia. J Clin Sleep Med 2016; 12:979-87. [PMID: 27092700 PMCID: PMC4918999 DOI: 10.5664/jcsm.5930] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 03/03/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Children with craniofacial anomalies are a heterogeneous group at high risk for obstructive sleep apnea (OSA). However, the prevalence and structural predictors of OSA in this population are unknown. We hypothesized that infants with micrognathia would have more significant OSA than those with isolated cleft palate ± cleft lip (ICP), and those with ICP would have more significant OSA than controls. We postulated that OSA severity would correlate with reduced mandibular size, neurodevelopmental scores, and growth. METHODS Prospective cohort study. 15 infants with ICP, 19 with micrognathia, and 9 controls were recruited for polysomnograms, neurodevelopmental testing, cephalometrics (ICP and micrognathia groups) at baseline and a follow-up at 6 mo. RESULTS Baseline apnea-hypopnea index (AHI) [median (range)] of the micrognathia group [20.1 events/h (0.8, 54.7)] was greater than ICP [3.2 (0.3, 30.7)] or controls [3.1 (0.5, 23.3)] (p = 0.001). Polysomnographic findings were similar between ICP and controls. Controls had a greater AHI than previously reported in the literature. Cephalometric measures of both midface hypoplasia and micrognathia correlated with OSA severity. Neurodevelopment was similar among groups. OSA improved with growth in participants with ICP and postoperatively in infants with micrognathia. CONCLUSIONS Micrognathia, but not ICP, was associated with more significant OSA compared to controls. Both midface and mandibular hypoplasia contribute to OSA in these populations. OSA improved after surgical correction in most infants with micrognathia, and improved without intervention before palate repair in infants with ICP.
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Affiliation(s)
- Christopher M. Cielo
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jesse A. Taylor
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Arastoo Vossough
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jerilynn Radcliffe
- Division of Child Development, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Allison Thomas
- Research Institute, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ruth Bradford
- Sleep Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Janet Lioy
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Ignacio E. Tapia
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Reza Assadsangabi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justine Shults
- Department of Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Carole L. Marcus
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Abstract
EDUCATIONAL AIMS The reader will be able to: Understand normal sleep patterns in infancyAppreciate disorders of breathing in infancyAppreciate disorders of respiratory control. Normal sleep in infancy is a time of change with alterations in sleep architecture, sleep duration, sleep patterns and respiratory control as an infant grows older. Interactions between sleep and respiration are key to the mechanisms by which infants are vulnerable to sleep disordered breathing. This review discusses normal sleep in infancy, as well as normal sleep breathing in infancy. Sleep disordered breathing (obstructive and central) as well as disorders of ventilatory control and infant causes of hypoventilation are all reviewed in detail.
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Affiliation(s)
- Don S. Urquhart
- Dept of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
- Dept of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory and Sleep Medicine, Royal Brompton Hospital, London, UK
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Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SYC, Chan DK, Certal V, Cable BB. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2015; 126:1246-55. [PMID: 26691675 DOI: 10.1002/lary.25827] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. STUDY DESIGN Systematic review and meta-analysis. METHODS Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015. RESULTS A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data). CONCLUSION Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016.
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Affiliation(s)
- Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.,Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Brandyn Dunn
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Carlos Torre
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Jodie Sasaki
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Raymond Gonzales
- Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF, University of Porto, Porto, Portugal
| | - Stanley Yung-Chuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A
| | - Dylan K Chan
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Victor Certal
- CINTESIS-Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
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Tawfik KO, Sedaghat AR, Ishman SL. Trends in Inpatient Pediatric Polysomnography for Laryngomalacia and Craniofacial Anomalies. Ann Otol Rhinol Laryngol 2015. [PMID: 26215726 DOI: 10.1177/0003489415596756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Increasingly, laryngomalacia and craniofacial anomalies are recognized as risk factors for obstructive sleep apnea. We sought to determine whether children with these diagnoses have become more likely to undergo inpatient polysomnogram (PSG) over time and to identify evolving trends in PSG utilization. METHODS Retrospective analysis of the Kids' Inpatient Database from 2003 to 2012. Children <21 years who underwent PSG were included. Weighted comparisons of clinical/demographic characteristics of patients undergoing PSG were performed, as were associations between clinical and demographic patient characteristics and performance of inpatient PSG. RESULTS Between 2003 and 2012, PSG procedures decreased from 1266 to 829 (P < .001). Among children who underwent PSG, mean age decreased from 3.9 ± 5.1 to 3.1 ± 5.2 years (P = .001), and the frequency of age <1 year increased from 47.8% to 59.5% (P < .001). The frequency of laryngomalacia increased from 2.5% to 14.3% (P < .001), while the frequency of craniofacial anomalies increased from 6.2% to 19.4% (P < .001). Laryngomalacia and craniofacial anomalies were predictive of undergoing inpatient PSG in both timeframes. CONCLUSION Despite decreasing PSG volumes, diagnoses of laryngomalacia and craniofacial anomalies comprised increasing fractions of children undergoing inpatient PSG between 2003 and 2012. Laryngomalacia and craniofacial anomalies were also predictive of inpatient PSG use in both timeframes.
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Affiliation(s)
- Kareem O Tawfik
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey L Ishman
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Cincinnati Children's Hospital Medical Center, Divisions of Otolaryngology-Head & Neck Surgery and Pulmonary Medicine, Cincinnati, Ohio, USA
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Noah TL, Yilmaz O, Nicolai T, Birnkrant D, Praud JP. Pediatric Pulmonology year in review 2014: Part 1. Pediatr Pulmonol 2015; 50:621-9. [PMID: 25891206 DOI: 10.1002/ppul.23202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 11/08/2022]
Abstract
Our discipline and our journal cover an extremely broad range of research and scholarly topics related to children's respiratory disorders. To better meet the needs of our readership for updated perspectives on the rapidly expanding knowledge in our field, we here summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | | | - David Birnkrant
- MetroHealth Medical Center Department of Pediatrics, Cleveland, Ohio
| | - Jean-Paul Praud
- University Sherbrooke Pediatrics, Sherbrooke, Quebec, Canada
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Kacenelenbogen N, Dramaix-Wilmet M, Schetgen M, Roland M. Not living with both parents is associated with more health- and developmental problems in infants aged 7 to 11 months: a cross sectional study. BMC Public Health 2015; 15:159. [PMID: 25884161 PMCID: PMC4340291 DOI: 10.1186/s12889-015-1505-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/04/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Western countries, many children are affected by the separation of their parents. Our main objective was to assess the possible impact of parental separation family structure on certain aspects of somatic health in low-age children. METHODS We conducted a cross-sectional study based on data collected in the framework of free preventive medicine consultations in the French Community of Belgium. The data was derived from assessments conducted, between 2006 and 2012, on children 7 to 11 months after birth during which information of 79701 infants was collected regarding the risk of sudden infant death, psychomotor development, and development in terms of height and weight. The main outcome measures were: episode of risk of sudden infant death, polysomnography, home monitoring, psychomotor development, and body mass index. RESULTS The parents of 6.6% of the infants were separated. We established multivariable models, based on the presence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably at night, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by home monitoring were thus respectively 1.3 (1.1-1.6), 1.1 (0.9-1.3), 1.8 (1.3-2.4), and 1.3 (1.1-1.6). The adjusted ORs (95% CI) for psychomotor delay and for a body mass index above the 97(th) percentile were respectively 1.3 (1.0-1.6) and 1.2 (1.1-1.3) in the event of separation. CONCLUSIONS This study confirms the possibility that not living with both parents is an independent risk factor for the somatic health and psychomotor development of infants. This observation should be verified because it would have a major impact on the actions of family doctors and other first-line healthcare providers, in particular with regard to information and targeted prevention.
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Affiliation(s)
- Nadine Kacenelenbogen
- Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, 1070, Bruxelles, Belgium.
| | - Michèle Dramaix-Wilmet
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Campus Erasme CP598, Route de Lennik 808, 1070, Bruxelles, Belgium.
| | - Marco Schetgen
- Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, 1070, Bruxelles, Belgium.
| | - Michel Roland
- Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, 1070, Bruxelles, Belgium.
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