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Wu J, Lu Y, Cai X, Chen Y, Shen Z, Lyv Q. Gut microbiota dysbiosis in 4- to 6-year-old children with obstructive sleep apnea-hypopnea syndrome. Pediatr Pulmonol 2022; 57:2012-2022. [PMID: 35580999 DOI: 10.1002/ppul.25967] [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: 03/11/2022] [Revised: 04/16/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Several experiments on animals have reported the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and gut microbiota. We investigated the gut microbiota composition of children aged 4-6 years with OSAHS to complement the pathogenesis and clinical screening methods of OSAHS. METHODS We collected feces from 43 children with OSAHS and 45 controls aged 4-6 years. We extracted total bacterial DNA from feces and analyzed the composition of gut microbiota through 16S ribosomal RNA sequencing. RESULTS There were significant differences in bacteria producing short-chain fatty acids (SCFAs) between OSAHS children and controls, including Faecalibacterium, Roseburia, and a member of Ruminococcaceae. A gut microbiota model for pediatric OSAHS screening showed that the receiver operating characteristic-area under the curve (ROC-AUC) was 0.794 with 79.1% and 80.0% sensitivity and specificity, respectively. Functional analysis of the gut microbiota revealed several alterations in metabolism. CONCLUSION The composition of gut microbiota in OSAHS children is partially changed. The altered intestinal flora may provide a new screening method for the diagnosis of children with OSAHS. The prediction of gut microbiota function suggests that intestinal metabolic function may be altered in OSAHS children.
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Affiliation(s)
- Junhua Wu
- Medical School of Ningbo University, Ningbo, Zhejiang, China.,Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Yanbo Lu
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Xiaohong Cai
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Yuanyuan Chen
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Zhisen Shen
- Department of Otorhinolaryngology, Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qin Lyv
- Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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Qiao Y, Chen J. Efficacy of Low-Temperature Plasma-Assisted Unilateral/Bilateral Tonsillectomy and Adenoidectomy in Children with Obstructive Sleep Apnea Hypopnea Syndrome. Med Sci Monit 2021; 27:e930792. [PMID: 34497259 PMCID: PMC8439120 DOI: 10.12659/msm.930792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to investigate the efficacy of low-temperature plasma-assisted bilateral or unilateral tonsillectomy (LTPABT or LTPAUT) and adenoidectomy in treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS). Material/Methods The present observational cohort study included a total of 244 children with OSAHS during December 2017 to December 2018. The patients were divided into the LTPABT group, the LTPAUT group, and the control group that received traditional bilateral tonsillectomy and adenoidectomy. The apnea hypopnea index (AHI) and the lowest oxygen saturation (LSaO2) were measured. The patients’ pain condition was determined using the Visual Analog Score (VAS) and intraoperative indices were collected. Patients’ quality of life was assessed by OSA-18 scale and patients’ immune function was determined. Results The postoperative VAS scores were remarkably lower in the LTPABT and LTPAUT groups. At 6 months after surgery, the AHI significantly had decreased and LSaO2 levels were significantly enhanced for all groups, and the AHI was significantly lower and LSaO2 was markedly higher in the LTPABT group. The ratio of patients with efficacy of cured and remarkably effective was remarkably higher in the LTPABT group. The rates of postoperative hemorrhage and infection were significantly lower in the LTPABT and LTPAUT groups, and 4 cases showed tonsillar hyperplasia. OSA-18 scores were lowest in the LTPABT group. No significant difference was found in levels of IgM, IgA and IgG, and T lymphocyte subtypes. Conclusions The low-temperature plasma-assisted bilateral tonsillectomy combined with adenoidectomy had the best efficacy. None of the surgery methods influenced the patients’ immune function.
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Affiliation(s)
- Yi Qiao
- Department of Otorhinolaryngology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Jie Chen
- Department of Otorhinolaryngology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
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Zaffanello M, Antoniazzi F, Tenero L, Nosetti L, Piazza M, Piacentini G. Sleep-disordered breathing in paediatric setting: existing and upcoming of the genetic disorders. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:343. [PMID: 30306082 PMCID: PMC6174189 DOI: 10.21037/atm.2018.07.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Childhood obstructive sleep apnea syndrome (OSAS) is characterized by anatomical and functional upper airway abnormalities as pathophysiological determinants, and clinical symptoms are frequently clear. OSAS is widely described in rare genetic disorders, such as achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, and mucopolysaccharidosis. Craniofacial and upper airway involvement is frequently morbid conditions. In children with genetic diseases, the clinical symptoms of OSAS are often slight or absent, and related morbidities are usually more severe and can be observed at any age. The present review is aimed to updating the discoveries regarding OSAS on Achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, Sickle cell disease, or encountered in our clinical practice (Ehlers-Danlos syndrome, Ellis-van Creveld syndrome, Noonan syndrome). Two additional groups of genetic disorders will be focused (mucopolysaccharidoses and osteogenesis imperfecta). The flowing items are covered for each disease: (I) what is the pathophysiology of OSAS? (II) What is the incidence/prevalence of OSAS? (III) What result from the management and prognosis? (IV) What are the recommendations? Considering the worries of OSAS, such as inattention and behavioural problems, daytime sleepiness, failure to thrive, cardiological and metabolic complications, the benefit of a widespread screening and the treatment in children with genetic diseases is undoubtful. The goals of the further efforts can be the inclusion of various genetic diseases into guidelines for the screening of OSAS, updating the shreds of evidence based on the research progression.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Collu MA, Esteller E, Lipari F, Haspert R, Mulas D, Diaz MA, Dwivedi RC. A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications. Int J Pediatr Otorhinolaryngol 2018; 108:113-119. [PMID: 29605338 DOI: 10.1016/j.ijporl.2018.02.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. METHODS A case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan. Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. RESULTS 150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population. Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6-26.4). CONCLUSIONS DISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent OSAS.
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Affiliation(s)
| | - Eduard Esteller
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain; Universitat Internacional de Catalunya, San Cugat del Vallès, Barcelona, Spain.
| | - Fiorella Lipari
- Otorhinolaryngology Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Raul Haspert
- Anestesia Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Demetrio Mulas
- Anestesia Department, Hospital Universitari General de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Miguel Angel Diaz
- Hospital Universitario General de Catalunya, EAP Sant Ildefons Cornellà Institut Català de la Salut, San Cugat del Vallès, Barcelona, Spain
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Liu F, Wang X. Diagnosis and treatment of epilepsy and sleep apnea comorbidity. Expert Rev Neurother 2016; 17:475-485. [PMID: 27866428 DOI: 10.1080/14737175.2017.1262259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Feng Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
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Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision. The Journal of Laryngology & Otology 2016; 130:1120-1124. [PMID: 27786148 DOI: 10.1017/s0022215116009129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess cardiac functions in adenotonsillar or tonsillar hypertrophy. METHODS A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy. RESULTS There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement. CONCLUSION Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical Treatment for Childhood Obstructive Sleep Apnoea: Cold-Knife Tonsillar Dissection Versus Bipolar Radiofrequency Thermal Ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Esteller E, Mulas D, Haspert R, Matiñó E, López R, Girabent-Farrés M. Drug-Induced Sleep-Endoscopy in Children's Sleep Related Breathing Disorders. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:212-9. [DOI: 10.1016/j.otorri.2015.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/07/2015] [Accepted: 09/01/2015] [Indexed: 12/19/2022]
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:261-7. [PMID: 26992775 DOI: 10.1016/j.otorri.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). METHOD A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. RESULT The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. CONCLUSION In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España.
| | - Juan Carlos Villatoro
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Gabriel Pedemonte
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Adriana Agüero
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Joan Manel Ademà
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Montserrat Girabent-Farrés
- Unidad de Bioestadística, Departamento de Fisioterapia, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
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Abstract
Orthopedic surgeons frequently encounter short statured patients. A systematic approach is needed for proper evaluation of these children. The differential diagnosis includes both proportionate and disproportionate short stature types. A proper history and physical examination and judicious use of plain film radiography will establish the diagnosis in most cases. In addition to the orthopedic surgeon, most of these patients will also be evaluated by other specialists, including endocrinologists and geneticists. This article provides an overview of the evaluation of the child with short stature and offers several illustrative examples.
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Affiliation(s)
- Charles T Mehlman
- Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, MLC 2017, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michael C Ain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 1800 Orleans street, Baltimore, MD 21287, USA
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