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Tao M, Zhang Y, Ding L, Peng D. Risk factors of sleep-disordered breathing and poor asthma control in children with asthma. BMC Pediatr 2024; 24:288. [PMID: 38689232 PMCID: PMC11059673 DOI: 10.1186/s12887-024-04762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) may lead to poor asthma control in children. OBJECTIVE To identify risk factors of SDB in children with asthma and assess its impact on asthma control. METHODS In this cross-sectional study, we collected data of outpatients with asthma at the Children's Hospital of Chongqing Medical University from June 2020 to August 2021. The Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder and the age-appropriate asthma control tests Childhood Asthma Control Test and Test for Respiratory and Asthma Control in Kids were completed. RESULTS We enrolled 397 children with a male-to-female ratio of 1.7:1 and a mean age of 5.70 ± 2.53 years. The prevalence of SDB was 21.6%. Allergic rhinitis (odds ratio OR = 3.316), chronic tonsillitis (OR = 2.246), gastroesophageal reflux (OR = 7.518), adenoid hypertrophy (OR = 3.479), recurrent respiratory infections (OR = 2.195), and a family history of snoring (OR = 2.048) were risk factors for the development of combined SDB in children with asthma (p < 0.05). Asthma was poorly controlled in 19.6% of the children. SDB (OR = 2.391) and irregular medication use (OR = 2.571) were risk factors for poor asthma control (p < 0.05). CONCLUSIONS Allergic rhinitis, chronic tonsillitis, gastroesophageal reflux, adenoid hypertrophy, recurrent respiratory infections, and a family history of snoring were independent risk factors for the development of SDB in children with asthma. SDB and irregular medication use were independent risk factors for poor asthma control.
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Affiliation(s)
- Minghui Tao
- Chongqing University FuLing Hospital, No.2 Gaosuntang Road, Fuling District, Chongqing, 408000, P.R. China
| | - Yanping Zhang
- The Children's Hospital of Chongqing Medical University, 136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Ling Ding
- The Children's Hospital of Chongqing Medical University, 136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China.
| | - Donghong Peng
- The Children's Hospital of Chongqing Medical University, 136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China.
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Gueye-Ndiaye S, Tully M, Amin R, Baldassari CM, Chervin RD, Cole M, Ibrahim S, Kirkham EM, Mitchell RB, Naqvi K, Ross K, Rueschman M, Tapia IE, Williamson AA, Wei Z, Rosen CL, Wang R, Redline S. Neighborhood Disadvantage, Quality of Life, and Symptom Burden in Children with Mild Sleep-disordered Breathing. Ann Am Thorac Soc 2024; 21:604-611. [PMID: 38241286 PMCID: PMC10995551 DOI: 10.1513/annalsats.202307-653oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024] Open
Abstract
Rationale: Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied.Objectives: To evaluate associations between ND with SDB symptom burden and QOL.Methods: Cross-sectional analyses were performed on 453 children, ages 3-12.9 years, with mild SDB (habitual snoring and apnea-hypopnea index < 3/h) enrolled in the PATS (Pediatric Adenotonsillectomy Trial for Snoring) multicenter study. The primary exposure, neighborhood disadvantage, was characterized by the Child Opportunity Index (COI) (range, 0-100), in which lower values (specifically COI ⩽ 40) signify less advantageous neighborhoods. The primary outcomes were QOL assessed by the obstructive sleep apnea (OSA)-18 questionnaire (range, 18-126) and SDB symptom burden assessed by the Pediatric Sleep Questionnaire-Sleep-related Breathing Disorder (PSQ-SRBD) scale (range, 0-1). The primary model was adjusted for age, sex, race, ethnicity, maternal education, recruitment site, and season. In addition, we explored the role of body mass index (BMI) percentile, environmental tobacco smoke (ETS), and asthma in these associations.Results: The sample included 453 children (16% Hispanic, 26% Black or African American, 52% White, and 6% other). COI mean (standard deviation [SD]) was 50.3 (29.4), and 37% (n = 169) of participants lived in disadvantaged neighborhoods. Poor SDB-related QOL (OSA-18 ⩾ 60) and high symptom burden (PSQ-SRBD ⩾ 0.33) were found in 30% (n = 134) and 75% (n = 341) of participants, respectively. In adjusted models, a COI increase by 1 SD (i.e., more advantageous neighborhood) was associated with an improvement in OSA-18 score by 2.5 points (95% confidence interval [CI], -4.34 to -0.62) and in PSQ-SRBD score by 0.03 points (95% CI, -0.05 to -0.01). These associations remained significant after adjusting for BMI percentile, ETS, or asthma; however, associations between COI and SDB-related QOL attenuated by 23% and 10% after adjusting for ETS or asthma, respectively.Conclusions: Neighborhood disadvantage was associated with poorer SDB-related QOL and greater SDB symptoms. Associations were partially attenuated after considering the effects of ETS or asthma. The findings support efforts to reduce ETS and neighborhood-level asthma-related risk factors and identify other neighborhood-level factors that contribute to SDB symptom burden as strategies to address sleep-health disparities.Clinical trial registered with www.clinicaltrials.gov (NCT02562040).
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meg Tully
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raouf Amin
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia
- Department of Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, Virginia
| | | | - Melissa Cole
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sally Ibrahim
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | | | - Ron B. Mitchell
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kamal Naqvi
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kristie Ross
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | - Michael Rueschman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariel A. Williamson
- The Ballmer Institute for Children’s Behavioral Health, University of Oregon, Eugene, Oregon
| | - Zhuoran Wei
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Rui Wang
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Solano-Pérez E, Coso C, Romero-Peralta S, Castillo-García M, López-Monzoni S, Ortigado A, Mediano O. New Approaches to the Management of Cardiovascular Risk Associated with Sleep Respiratory Disorders in Pediatric Patients. Biomedicines 2024; 12:411. [PMID: 38398013 PMCID: PMC10887096 DOI: 10.3390/biomedicines12020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Exposure to risk factors in youth can exacerbate the development of future cardiovascular disease (CVD). Obstructive sleep apnea (OSA), characterized by repetitive episodes of airway obstructions, could trigger said CVD acting as a modifiable risk factor. Measurements from echocardiography have shown impairments in the anatomy and function of the heart related to the severity of OSA. Therefore, the aim of this review was to propose a new clinical approach to the management of cardiovascular risk (CVR) in children based on treating OSA. The review includes studies assessing echocardiographic parameters for cardiac function and structure in pediatric OSA diagnosed using the apnea-hypopnea index (AHI) ≥ 1/h using polysomnography (PSG) and conducted within a year. Based on the reviewed evidence, in addition to PSG, echocardiography should be considered in OSA children in order to indicate the need for treatment and to reduce their future CVR. A follow-up echocardiography after treatment could be performed if impairments in the anatomy and function were found. Prioritizing parameters intimately connected to comorbidity could propel more effective patient-centered care. In conclusion, a reevaluation of pediatric OSA strategies should be considered, emphasizing comorbidity-related parameters in the cardiovascular field. Further studies are needed to assess this approach, potentially leading to enhanced protocols for more effective pediatric OSA treatment and CVR prevention.
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Affiliation(s)
- Esther Solano-Pérez
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Carlota Coso
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Sofía Romero-Peralta
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - María Castillo-García
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Sleep Research Institute, 28036 Madrid, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
| | - Sonia López-Monzoni
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Alfonso Ortigado
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
- Paediatric Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Olga Mediano
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
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Paracha H, Parker Davidson K, Dixon C, Wilde Z. A Novel Intervention to Simultaneously Address the Dual Pathologies of Breathing Disorders During Sleep and Undiagnosed Attention Deficit Hyperactivity Disorder in School-Aged Children Ages 5-12. J Atten Disord 2024; 28:293-301. [PMID: 38031843 DOI: 10.1177/10870547231211024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE To evaluate the improvement of ADHD related symptoms in school-aged children ages 5 to 12 in treatment with a monobloc appliance (MOA) for Sleep Disordered Breathing (SDB). METHODS A retrospective review of questionnaire scores of ADHD symptoms from school-aged children being treated with a MOA for SDB. Data was obtained from parent survey questionnaires of 40 school-aged children in three dental offices in treatment with an MOA for SDB showing symptoms of ADHD yet to be confirmed with a formal diagnosis between 2019 and 2021. ADHD symptom scores were ascertained by a parent survey questionnaire completed at the initial visit before MOA treatment, and 2 to 6 months, and 7+ months during MOA treatment. RESULTS At the 7+ month endpoint, 17 of the 28 (61%) children ages 5 to 12 saw at least a 1-point drop in the sum of their questionnaire scores indicating an improvement in ADHD symptoms after initiating treatment with an MOA. Although there was a reduction of the overall average symptom score from the initial visit to 2 to 6 months (M = 4.06, SD ± 1.55), a statistically significant improvement in ADHD symptoms occurred at the 7+ month endpoint (M = 15.29, SD ± 4.50) during MOA treatment. CONCLUSIONS Treatment with an MOA may be highly effective in addressing the dual pathologies of SDB and ADHD in school-age children ages 5 to 12.
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Gueye-Ndiaye S, Hauptman M, Yu X, Li L, Rueschman M, Castro-Diehl C, Sofer T, Owens J, Gold DR, Adamkiewicz G, Metwali N, Thorne PS, Phipatanakul W, Redline S. Multilevel Risk Factors for Sleep-Disordered Breathing-Related Symptom Burden in an Urban Pediatric Community-Based Sample. CHEST PULMONARY 2023; 1:100019. [PMID: 38222082 PMCID: PMC10786403 DOI: 10.1016/j.chpulm.2023.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Pediatric sleep-disordered breathing (SDB) disproportionately affects children with low socioeconomic status (SES). The multilevel risk factors that drive these associations are not well understood. RESEARCH QUESTION What are the associations between SDB risk factors, including individual health conditions (obesity, asthma, and allergies), household SES (maternal education), indoor exposures (environmental tobacco smoke [ETS] and pests), and neighborhood characteristics (neighborhood disadvantage), and pediatric SDB symptoms? STUDY DESIGN AND METHODS Cross-sectional analyses were performed on 303 children (aged 6-12 years) enrolled in the Environmental Assessment of Sleep Youth study from 2018 to 2022. Exposures were determined by caregiver reports, assays of measured settled dust from the child's bedroom, and neighborhood-level Census data (deriving the Childhood Opportunity Index to characterize neighborhood disadvantage). The primary outcome was the SDB-related symptom burden assessed by the OSA-18 questionnaire total score. Using linear regression models, we calculated associations between exposures and SDB-related symptom burden, adjusting for sociodemographic factors, then health conditions, indoor environment, and neighborhood factors. RESULTS The sample included 303 children (39% Hispanic, Latino, Latina, or Spanish origin; 30% Black or African American; 22% White; and 11% other). Increasing OSA-18 total scores were associated with low household SES after adjustment for demographic factors, and with asthma, allergies, ETS, pests (mouse, cockroach, and rodents), and an indoor environmental index (sum of the presence of pests and ETS; 0-2) after adjusting for sociodemographic factors. Even after further adjusting for asthma, allergies, and neighborhood disadvantage, ETS and pest exposure were associated with OSA-18 (ETS: β = 12.80; 95% CI, 7.07-18.53, also adjusted for pest; pest exposure: β = 3.69; 95% CI, 0.44-6.94, also adjusted for ETS). INTERPRETATION In addition to associations with ETS, a novel association was observed for indoor pest exposure and SDB symptom burden. Strategies to reduce household exposure to ETS and indoor allergens should be tested as approaches for reducing sleep health disparities.
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Marissa Hauptman
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Xinting Yu
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Le Li
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Michael Rueschman
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Cecilia Castro-Diehl
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Tamar Sofer
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Judith Owens
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Diane R Gold
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Gary Adamkiewicz
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Nervana Metwali
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Peter S Thorne
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Wanda Phipatanakul
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Susan Redline
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
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6
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Zhou F, Liu F, Wu T, Zhang K, Pan M, Wang X, Chen Z, Tong J, Yan Y, Xiang H. Exposures to ambient air pollutants increase prevalence of sleep disorder in adults: Evidence from Wuhan Chronic Disease Cohort Study (WCDCS). ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 263:115226. [PMID: 37441944 DOI: 10.1016/j.ecoenv.2023.115226] [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: 02/13/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Sleep disorder contributes to memory dysfunction and chronic diseases. Clear evidence of environment disturbance, such as residential noise, are associated with an increased risk of sleep disorder. However, not enough studies have been conducted on association between residential air pollutants and sleep disorder. We sought to determine whether exposures to residential air pollutants associated with risk of sleep disorder among adults. METHODS Using the dataset of the Wuhan Chronic Disease Cohort Study (WCDCS), we investigated the prevalence of sleep disorder and five sleep disorder symptoms in the study. The data of air pollutants (including PM10, PM2.5, NO2, SO2 and O3) were obtained from 10 air quality monitoring stations in Wuhan. We utilized logistic regression model to evaluate the associations of five types of air pollutants with odds ratio (OR) of sleep disorder and symptoms. The potential moderating effects of socio-demographic factors in the associations were explored using the interaction effects model. RESULTS Of the study participants, 52.1 % had sleep disorder. Exposures to higher concentrations of air pollutants were associated with increased prevalence of sleep disorder. For example, per interquartile range (IQR) increases in concentrations of PM10, PM2.5 or SO2 corresponded to the increase of sleep disorder increased prevalence at 14.7 % (adjusted odds ratio (aOR) = 1.147, 95 %CI:1.062, 1.240), 8.9 % (aOR = 1.089, 95 %CI: 1.003, 1.182) and 15.8 % (aOR = 1.158, 95 %CI: 1.065, 1.260). For symptoms specific analyses, significant linkages of PM10, PM2.5, SO2 with difficulty in falling asleep, wake up after falling asleep and early awaken were observed. Moderating effects of age and place of residence on the linkages of PM10 with increased prevalence of sleep disorder were identified. CONCLUSION Higher level of air pollution exposure could increase the prevalence of sleep disorder. Middle-aged and elderly population, as well as the rural residents are more likely to suffer from sleep disorder.
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Affiliation(s)
- Feng Zhou
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Feifei Liu
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Tingting Wu
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Ke Zhang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Mengnan Pan
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Xiangxiang Wang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Zhongyang Chen
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Jiahui Tong
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Yaqiong Yan
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan, China.
| | - Hao Xiang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
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7
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Gueye-Ndiaye S, Williamson AA, Redline S. Disparities in Sleep-Disordered Breathing: Upstream Risk Factors, Mechanisms, and Implications. Clin Chest Med 2023; 44:585-603. [PMID: 37517837 PMCID: PMC10513750 DOI: 10.1016/j.ccm.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Sleep-disordered breathing (SDB) refers to a spectrum of disorders ranging from habitual snoring without frank episodes of obstructed breathing or desaturation during sleep to obstructive sleep apnea, where apneas and hypopneas repetitively occur with resultant intermittent hypoxia, arousal, and sleep disruption. Disparities in SDB reflect its overall high prevalence in children and adults from racially and ethnically minoritized or low socioeconomic status backgrounds coupled with high rates of underdiagnosis and suboptimal treatment.
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, 2716 South Street Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Redline
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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8
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Wallace DA, Gallagher JP, Peterson SR, Ndiaye-Gueye S, Fox K, Redline S, Johnson DA. Is exposure to chemical pollutants associated with sleep outcomes? A systematic review. Sleep Med Rev 2023; 70:101805. [PMID: 37392613 PMCID: PMC10528206 DOI: 10.1016/j.smrv.2023.101805] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/03/2023]
Abstract
Environmental exposures may influence sleep; however, the contributions of environmental chemical pollutants to sleep health have not been systematically investigated. We conducted a systematic review to identify, evaluate, summarize, and synthesize the existing evidence between chemical pollutants (air pollution, exposures related to the Gulf War and other conflicts, endocrine disruptors, metals, pesticides, solvents) and dimensions of sleep health (architecture, duration, quality, timing) and disorders (sleeping pill use, insomnia, sleep-disordered breathing)). Of the 204 included studies, results were mixed; however, the synthesized evidence suggested associations between particulate matter, exposures related to the Gulf War, dioxin and dioxin-like compounds, and pesticide exposure with worse sleep quality; exposures related to the Gulf War, aluminum, and mercury with insomnia and impaired sleep maintenance; and associations between tobacco smoke exposure with insomnia and sleep-disordered breathing, particularly in pediatric populations. Possible mechanisms relate to cholinergic signaling, neurotransmission, and inflammation. Chemical pollutants are likely key determinants of sleep health and disorders. Future studies should aim to evaluate environmental exposures on sleep across the lifespan, with a particular focus on developmental windows and biological mechanisms, as well as in historically marginalized or excluded populations.
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Affiliation(s)
- Danielle A Wallace
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Jayden Pace Gallagher
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shenita R Peterson
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Seyni Ndiaye-Gueye
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kathleen Fox
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Dayna A Johnson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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9
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Çimen İD, Çetin E, Fındık H, Çakın Memik N. Sleep Disorders and Associated Factors in Children Who Admitted to the Child and Adolescent Psychiatry Outpatient Clinics During the Pandemic. JOURNAL OF TURKISH SLEEP MEDICINE 2023. [DOI: 10.4274/jtsm.galenos.2022.22043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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10
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Sleep problems in low income, urban pediatric populations living at different altitudes in Colombia. Sleep Med 2022; 100:64-70. [PMID: 36027664 DOI: 10.1016/j.sleep.2022.07.017] [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: 05/18/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the frequency of sleep problems in low-income, urban pediatric populations in cities at different altitudes in Colombia. METHODS A descriptive, cross-sectional population-based observational study was conducted in children aged between 2 and 12 years in the low income, urban areas of three cities in Colombia (Santa Marta, Bucaramanga, and Bogotá) located at 15, 959, and 2640 m above sea level, respectively. Sociodemographic data were collected, and the Spanish version of the Pediatric Sleep Questionnaire was used. RESULTS 1989 children were surveyed, distributed as follows: Santa Marta (32.0%), Bucaramanga (33.4%), and Bogotá (34.6%). The overall prevalence of sleep problems was 39.0%. Children from Santa Marta had the highest frequency of parasomnias (58.0%); those from Bucaramanga had the highest frequency of attention deficit symptoms (4.0%) and apneic pauses witnessed by parents or caregivers (5.7%). Finally, Bogotá, the only high-altitude location, had the highest frequency of sleep disordered breathing (17.2%). CONCLUSIONS The study found a high frequency of sleep problems in the pediatric population, especially at higher altitudes when compared to lower altitude settings. Sleep disorders warrant early detection and timely therapeutic intervention.
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Oceja E, Rodríguez P, Jurado MJ, Luz Alonso M, del Río G, Villar MÁ, Mediano O, Martínez M, Juarros S, Merino M, Corral J, Luna C, Kheirandish-Gozal L, Gozal D, Durán-Cantolla J. Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology. Methods Protoc 2021; 4:9. [PMID: 33477929 PMCID: PMC7838960 DOI: 10.3390/mps4010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.
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Affiliation(s)
- Esther Oceja
- Domiciliary Hospitalization, Sleep Unit, OSI Araba University Hospital, 01004 Vitoria, Spain;
| | - Paula Rodríguez
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
| | - María José Jurado
- Sleep Unit, Hospital Universitario Valle de Hebrón, 08035 Barcelona, Spain;
| | - Maria Luz Alonso
- Sleep Unit, Complejo Hospitalario de Burgos, 09006 Burgos, Spain
| | | | | | - Olga Mediano
- Sleep Unit, Hospital de Guadalajara, 19002 Guadalajara, Spain;
| | - Marian Martínez
- Sleep Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Santiago Juarros
- Sleep Unit, Hospital Universitario de Valladolid, 47012 Valladolid, Spain;
| | - Milagros Merino
- Sleep Unit, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Jaime Corral
- Sleep Unit, Complejo Hospitalario de Cáceres, 100003 Cáceres, Spain;
| | - Carmen Luna
- Sleep Unit, Hospital Universitario 12 de Octubre, 280035 Madrid, Spain;
| | - Leila Kheirandish-Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - Joaquín Durán-Cantolla
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
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