1
|
Voltan C, Concer F, Pecoraro L, Pietrobelli A, Piacentini G, Zaffanello M. Exploring the Complex Interplay of Obesity, Allergic Diseases, and Sleep-Disordered Breathing in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:595. [PMID: 38790590 PMCID: PMC11120164 DOI: 10.3390/children11050595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
This narrative review study investigates the correlations between obesity, allergies, and sleep-disordered breathing in pediatric populations. Searches for pertinent articles were conducted on the Medline PubMed Advanced Search Builder, Scopus, and Web of Science databases from unlimited to April 2024. Sleep-disordered breathing causes repeated upper airway obstructions, leading to apneas and restless sleep. Childhood obesity, which affects around 20% of children, is often associated with sleep-disordered breathing and allergies such as asthma and allergic rhinitis. It is distinguished between diet-induced obesity (resulting from excess of diet and physical inactivity) and genetic obesity (such as is seen in Down syndrome and Prader-Willi syndrome). In children with diet-induced obesity, chronic inflammation linked to weight can worsen allergies and increase the risk and severity of asthma and rhinitis. Furthermore, the nasal congestion typical of rhinitis can contribute to upper respiratory tract obstruction and obstructive sleep apnea. A vicious circle is created between asthma and sleep-disordered breathing: uncontrolled asthma and sleep-disordered breathing can worsen each other. In children with genetic obesity, despite alterations in the immune system, fewer allergies are observed compared to the broader population. The causes of this reduced allergenicity are unclear but probably involve genetic, immunological, and environmental factors. Additional research is necessary to elucidate the underlying mechanisms. The present narrative review study emphasizes the importance of jointly evaluating and managing allergies, obesity, and obstructive sleep apnea in children considering their close interconnection.
Collapse
Affiliation(s)
| | | | | | | | | | - Marco Zaffanello
- Pediatric Clinic, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy (A.P.)
| |
Collapse
|
2
|
Armañac-Julián P, Martín-Montero A, Lázaro J, Hornero R, Laguna P, Kheirandish-Gozal L, Gozal D, Gil E, Bailón R, Gutiérrez-Tobal G. Persistent sleep-disordered breathing independently contributes to metabolic syndrome in prepubertal children. Pediatr Pulmonol 2024; 59:111-120. [PMID: 37850730 DOI: 10.1002/ppul.26720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor for metabolic syndrome (MetS) in adults, but its association in prepubertal children is still questionable due to the relatively limited cardiometabolic data available and the phenotypic heterogeneity. OBJECTIVE To identify the role of OSA as a potential mediator of MetS in prepubertal children. METHODS A total of 255 prepubertal children from the Childhood Adenotonsillectomy Trial were included, with standardized measurements taken before OSA treatment and 7 months later. MetS was defined if three or more of the following criteria were present: adiposity, high blood pressure, elevated glycemia, and dyslipidemia. A causal mediation analysis was conducted to assess the effect of OSA treatment on MetS. RESULTS OSA treatment significantly impacted MetS, with the apnea-hypopnea index emerging as mediator (p = .02). This mediation role was not detected for any of the individual risk factors that define MetS. We further found that the relationship between MetS and OSA is ascribable to respiratory disturbance caused by the apnea episodes, while systemic inflammation as measured by C-reactive protein, is mediated by desaturation events and fragmented sleep. In terms of evolution, patients with MetS were significantly more likely to recover after OSA treatment (odds ratio = 2.56, 95% confidence interval [CI] 1.20-5.46; risk ratio = 2.06, 95% CI 1.19-3.54) than the opposite, patients without MetS to develop it. CONCLUSION The findings point to a causal role of OSA in the development of metabolic dysfunction, suggesting that persistent OSA may increase the risk of MetS in prepubertal children. This mediation role implies a need for developing screening for MetS in children presenting OSA symptoms.
Collapse
Affiliation(s)
- Pablo Armañac-Julián
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Adrián Martín-Montero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Jesús Lázaro
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Roberto Hornero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Pablo Laguna
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Leila Kheirandish-Gozal
- Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri, United States
| | - David Gozal
- Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, Virginia, United States
| | - Eduardo Gil
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Raquel Bailón
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Gonzalo Gutiérrez-Tobal
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| |
Collapse
|
3
|
van der Plas PPJM, van Heesch GGM, Koudstaal MJ, Pullens B, Mathijssen IMJ, Bernard SE, Wolvius EB, Joosten KFM. Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study. Cleft Palate Craniofac J 2023:10556656231199840. [PMID: 37728101 DOI: 10.1177/10556656231199840] [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: 09/21/2023] Open
Abstract
OBJECTIVE To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. DESIGN Prospective study. SETTING Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS/ PARTICIPANTS 36 patients with Robin Sequence who were treated between 2011 and 2021. INTERVENTIONS Positional therapy and respiratory support. MAIN OUTCOME MEASURE(S) Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). RESULTS Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from -0.40 to -0.33 to -1.03, respectively. CONCLUSIONS Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.
Collapse
Affiliation(s)
- Pleun P J M van der Plas
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gwen G M van Heesch
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas Pullens
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Hand Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen F M Joosten
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Marciuc D, Morarasu S, Morarasu BC, Marciuc EA, Dobrovat BI, Pintiliciuc-Serban V, Popescu RM, Bida FC, Munteanu V, Haba D. Dental Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1447. [PMID: 37629737 PMCID: PMC10456847 DOI: 10.3390/medicina59081447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and objectives: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving functional outcomes with good compliance rates. Herein, we aimed to perform a meta-analysis comparing clinical outcomes between OSA children treated with dental appliances versus controls. Materials Methods: The study was registered with PROSPERO. A systematic search was performed for all comparative studies examining outcomes in pediatric patients who underwent treatment of OSA with oral appliances versus controls. Data was extracted and analyzed using a random effects model via Rev Man 5.3. Results: Six studies including 180 patients were analyzed split into two groups: patients treated with dental appliances (n = 123) and the controls (n = 119). Therapy with dental appliances was shown to significantly improve the apnea-hypopnea index (p = 0.009) and enlarge the superior posterior airway space (p = 0.02). Maxilla-to-mandible measurements were not significantly different between the two groups, nor was the mean SO2 (p = 0.80). Conclusions: This is the most updated meta-analysis assessing the role of dental appliances for OSA in children; it shows that such devices can improve functional outcomes by decreasing the apnea-hypopnea index.
Collapse
Affiliation(s)
- Daniel Marciuc
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Bianca Codrina Morarasu
- Department of Internal Medicine and Toxicology, “Saint Spiridon” University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Emilia Adriana Marciuc
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Bogdan Ionut Dobrovat
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Veronica Pintiliciuc-Serban
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Roxana Mihaela Popescu
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Florinel Cosmin Bida
- Department of Implantology, Removable Prostheses, Dental Prostheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Valentin Munteanu
- Department of Intensive Care Unit, “Saint Mary” Emergency Children Hospital, 700309, Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Danisia Haba
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| |
Collapse
|
5
|
Ergenekon AP, Gokdemir Y, Ersu R. Medical Treatment of Obstructive Sleep Apnea in Children. J Clin Med 2023; 12:5022. [PMID: 37568423 PMCID: PMC10419369 DOI: 10.3390/jcm12155022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent complete or partial obstruction of the upper airway. The prevalence is 1-4% in children aged between 2 and 8 years and rising due to the increase in obesity rates in children. Although persistent OSA following adenotonsillectomy is usually associated with obesity and underlying complex disorders, it can also affect otherwise healthy children. Medical treatment strategies are frequently required when adenotonsillectomy is not indicated in children with OSA or if OSA is persistent following adenotonsillectomy. Positive airway pressure treatment is a very effective modality for persistent OSA in childhood; however, adherence rates are low. The aim of this review article is to summarize medical treatment options for OSA in children.
Collapse
Affiliation(s)
- Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey; (A.P.E.); (Y.G.)
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey; (A.P.E.); (Y.G.)
| | - Refika Ersu
- Division of Respirology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|
6
|
Piotto M, Gambadauro A, Rocchi A, Lelii M, Madini B, Cerrato L, Chironi F, Belhaj Y, Patria MF. Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors. CHILDREN (BASEL, SWITZERLAND) 2023; 10:955. [PMID: 37371187 DOI: 10.3390/children10060955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase "sleep-disordered breathing (SDB)" indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy ("classic phenotype") is the main cause of OSA in preschool age (3-5 years), obesity ("adult phenotype") is the most common cause in adolescence. There is also a "congenital-structural" phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.
Collapse
Affiliation(s)
- Marta Piotto
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Antonella Gambadauro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mara Lelii
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Barbara Madini
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lucia Cerrato
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Federica Chironi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Youssra Belhaj
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maria Francesca Patria
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
7
|
Chiner E, Sancho-Chust JN, Pastor E, Esteban V, Boira I, Castelló C, Celis C, Vañes S, Torba A. Features of Obstructive Sleep Apnea in Children with and without Comorbidities. J Clin Med 2023; 12:jcm12062418. [PMID: 36983418 PMCID: PMC10054579 DOI: 10.3390/jcm12062418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/11/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND To compare the clinical and polysomnographic features of obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy (Group A) and comorbidities (Group B). METHODS A five-year prospective study using nocturnal polysomnography before and after treatment. RESULTS We included 168 patients: 121 in Group A and 47 in Group B, with differences in age (6.5 ± 3 vs. 8.6 ± 4 years; p < 0.001), body mass index (BMI) (18 ± 4 vs. 20 ± 7 kg/m2; p < 0.05), neck circumference (28 ± 4 vs. 30 ± 5 cm; p < 0.05), and obesity (17% vs. 30%; p < 0.05). Group B patients were more likely to have facial anomalies (p < 0.001), macroglossia (p < 0.01), dolichocephaly (p < 0.01), micrognathia (p < 0.001), and prognathism (p < 0.05). Adenotonsillectomy was performed in 103 Group A patients (85%) and 28 Group B patients (60%) (p < 0.001). In B, 13 children (28%) received treatment with continuous positive airway pressure (CPAP) and 2 (4%) with bilevel positive airway pressure (BiPAP), compared with 7 in Group A (6%) (p < 0.001). Maxillofacial surgery was more common in Group B (p < 0.01). Clinical and polysomnography parameters improved significantly in both groups after therapeutic intervention, though Group A showed better results. CONCLUSIONS Obesity and facial anomalies are more frequent in childhood OSA patients with comorbidities, who often require combination therapy, such as ventilation and surgery.
Collapse
Affiliation(s)
- Eusebi Chiner
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Jose N Sancho-Chust
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Esther Pastor
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Violeta Esteban
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Ignacio Boira
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Carmen Castelló
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Carly Celis
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Sandra Vañes
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| | - Anastasiya Torba
- Pulmonology Department, Multidisciplinary Sleep Clinic, San Juan de Alicante University Hospital, 03550 Alicante, Spain
| |
Collapse
|
8
|
Barbosa DF, Bana LF, Michel MCB, Meira E Cruz M, Zancanella E, Machado Júnior AJ. Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review. Braz J Otorhinolaryngol 2023; 89:494-502. [PMID: 36894478 DOI: 10.1016/j.bjorl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/26/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. METHODS The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. RESULTS We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. CONCLUSION Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.
Collapse
Affiliation(s)
- Denise Fernandes Barbosa
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Laura Fernandes Bana
- Universidade de Campinas (FOP-UNICAMP), Faculdade de Odontologia, Departamento de Morfologia, Piracicaba, SP, Brazil
| | | | - Miguel Meira E Cruz
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Unidade de Sono, Lisboa, Portugal
| | - Edilson Zancanella
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Almiro José Machado Júnior
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| |
Collapse
|
9
|
Neagos A, Dumitru M, Neagos CM, Mitroi M, Vrinceanu D. Correlations between Morphology, the Functional Properties of Upper Airways, and the Severity of Sleep Apnea. J Clin Med 2022; 11:jcm11185347. [PMID: 36142994 PMCID: PMC9502432 DOI: 10.3390/jcm11185347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of 152 Romanian patients with OSA recording data obtained through polysomnography and cephalometric variables, recorded in lateral plain X-rays. The results confirmed some of the data available from previous studies worldwide, but some of the variables presented a positive statistical correlation specific to our study group. For example, the apnea-hypopnea index (AHI) correlated with the uvula length but surprisingly did not correlate with body mass index (BMI) because obesity tends to become endemic in Romania. To our knowledge, this is one of the first studies focusing on cephalometric data in Romanian OSA patients. The results obtained through this study will be further analyzed in research on larger groups of Romanian OSA patients.
Collapse
Affiliation(s)
- Adriana Neagos
- ENT Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Tirgu Mures, Romania
- Correspondence: (A.N.); (M.D.)
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
- Correspondence: (A.N.); (M.D.)
| | - Cristian Mircea Neagos
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
| | - Mihaela Mitroi
- ENT Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
| |
Collapse
|
10
|
Gutiérrez-Tobal GC, Álvarez D, Kheirandish-Gozal L, Del Campo F, Gozal D, Hornero R. Reliability of machine learning to diagnose pediatric obstructive sleep apnea: Systematic review and meta-analysis. Pediatr Pulmonol 2022; 57:1931-1943. [PMID: 33856128 DOI: 10.1002/ppul.25423] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Machine-learning approaches have enabled promising results in efforts to simplify the diagnosis of pediatric obstructive sleep apnea (OSA). A comprehensive review and analysis of such studies increase the confidence level of practitioners and healthcare providers in the implementation of these methodologies in clinical practice. OBJECTIVE To assess the reliability of machine-learning-based methods to detect pediatric OSA. DATA SOURCES Two researchers conducted an electronic search on the Web of Science and Scopus using term, and studies were reviewed along with their bibliographic references. ELIGIBILITY CRITERIA Articles or reviews (Year 2000 onwards) that applied machine learning to detect pediatric OSA; reported data included information enabling derivation of true positive, false negative, true negative, and false positive cases; polysomnography served as diagnostic standard. APPRAISAL AND SYNTHESIS METHODS Pooled sensitivities and specificities were computed for three apnea-hypopnea index (AHI) thresholds: 1 event/hour (e/h), 5 e/h, and 10 e/h. Random-effect models were assumed. Summary receiver-operating characteristics (SROC) analyses were also conducted. Heterogeneity (I 2 ) was evaluated, and publication bias was corrected (trim and fill). RESULTS Nineteen studies were finally retained, involving 4767 different pediatric sleep studies. Machine learning improved diagnostic performance as OSA severity criteria increased reaching optimal values for AHI = 10 e/h (0.652 sensitivity; 0.931 specificity; and 0.940 area under the SROC curve). Publication bias correction had minor effect on summary statistics, but high heterogeneity was observed among the studies.
Collapse
Affiliation(s)
- Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Zaragoza, Spain
| | - Daniel Álvarez
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Zaragoza, Spain.,Department of Pneumology, Río Hortega University Hospital, Valladolid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health, Child Health Research Institute, The University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Félix Del Campo
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Zaragoza, Spain.,Department of Pneumology, Río Hortega University Hospital, Valladolid, Spain
| | - David Gozal
- Department of Child Health, Child Health Research Institute, The University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Roberto Hornero
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Zaragoza, Spain.,Department of Pneumology, Río Hortega University Hospital, Valladolid, Spain
| |
Collapse
|
11
|
Damian A, Gozal D. Pediatric Obstructive Sleep Apnea: What’s in a Name? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:63-78. [PMID: 36217079 DOI: 10.1007/978-3-031-06413-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea is a highly prevalent disease across the lifespan and imposes substantial morbidities, some of which may become irreversible if the condition is not diagnosed and treated in a timely fashion. Here, we focus on the clinical and epidemiological characteristics of pediatric obstructive sleep apnea, describe some of the elements that by virtue of their presence facilitate the emergence of disrupted sleep and breathing and its downstream consequences, and also discuss the potential approaches to diagnosis in at-risk children.
Collapse
Affiliation(s)
- Allan Damian
- Departments of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
| |
Collapse
|