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Hasuneh MM, Toubasi AA, Khraisat B, Aldabbas H, Al-Iede M. Risk Factors of Obstructive Sleep Apnea (OSA) in Pediatric Patients: A Systematic Review and Meta-analysis. J Pediatr Health Care 2024; 38:717-726. [PMID: 38980242 DOI: 10.1016/j.pedhc.2024.05.008] [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: 01/28/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION This review aimed to assess the risk factors of Obstructive Sleep Apnea (OSA) in pediatric children, a common condition with serious long-term sequela. METHODS PubMed, CENTRAL, Scopus, and Google Scholar were searched using the keywords "Apnea", "Obstructive Sleep" OR "Obstructive Sleep Apnea Syndrome" AND "Child" OR "Children" OR "Pediatrics". Data from 35 studies involving 497,688 pediatric patients diagnosed with OSA using polysomnography were reviewed. Risk factors examined included sex, obesity, neck circumference, tonsillar/adenoid hypertrophy, respiratory infections, nasal stenosis, parental OSA/smoking, ethnicity, preterm birth, and breastfeeding history. Relative Risk (RR) with 95% Confidence Intervals (95% CI) were calculated, using Cochrane Q and I² statistics to estimate heterogeneity. RESULTS Tonsillar hypertrophy (RR = 3.55), adenoid hypertrophy (RR = 1.63), respiratory tract infection (RR = 2.59), obesity (RR = 1.74), and family history of OSA (RR = 3.03) were significantly associated with pediatric OSA. White ethnicity was protective (RR = 0.77). DISCUSSION Recognizing these risk factors aids in early diagnosis and treatment of pediatric OSA.
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Affiliation(s)
- Manar M Hasuneh
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Bann Khraisat
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hamdi Aldabbas
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Montaha Al-Iede
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan.; Montaha AL-Iede, Division of Respiratory and Sleep Medicine, Pediatric Department, Jordan University Hospital, Amman, Jordan..
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Gorikapudi PK, Chhabria V, Kaur K, Ramasamy P, Jeeboy S, Venkatesh R, P A. Evaluation of Orthodontic Treatment Modalities for Obstructive Sleep Apnoea: A Systematic Review. Cureus 2024; 16:e65161. [PMID: 39176375 PMCID: PMC11341081 DOI: 10.7759/cureus.65161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/21/2024] [Indexed: 08/24/2024] Open
Abstract
Obstructive sleep apnoea (OSA) poses a significant health burden globally, necessitating effective intervention strategies to mitigate its adverse consequences. Orthodontic treatment modalities offer promising avenues for addressing OSA by targeting the underlying anatomical abnormalities and restoring unobstructed airflow during sleep. This systematic search was conducted across multiple electronic databases using predefined search terms and inclusion criteria. Studies eligible for inclusion encompassed a range of study designs, including randomized controlled trials, prospective and retrospective studies, clinical trials, and observational studies. Outcome measures included changes in apnoea-hypopnoea index (AHI), oxygen saturation levels, polysomnographic variables, skeletal/cephalometric changes, nasal parameters, upper airway morphology, and clinical symptoms. Initially, 756 records were identified through database searches, with 21 studies meeting the inclusion criteria after meticulous screening and selection. Orthodontic interventions, including rapid maxillary expansion (RME), personalized oral appliances, mandibular positioning devices, and comprehensive orthodontic protocols, demonstrated significant promise in ameliorating OSA symptoms among paediatric populations. Improvements in AHI, nasal resistance, sleep parameters, and upper airway dimensions were consistently observed across various studies, highlighting the potential of orthodontic treatments in mitigating OSA severity. This systematic review underscores the efficacy of orthodontic treatment modalities in addressing OSA among paediatric populations. Despite certain limitations in study design and outcome measures, the review emphasizes the need for further well-designed randomized controlled trials to validate and optimize these interventions for paediatric patients with OSA. Enhanced understanding and implementation of orthodontic treatments hold promise for alleviating the burden of OSA on global health and well-being.
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Affiliation(s)
| | - Vedant Chhabria
- Orthodontics and Dentofacial Orthopaedics, Practicing Orthodontist, Chhabria Dental Clinic, Thane, IND
| | - Kirandeep Kaur
- Orthodontics and Dentofacial Orthopaedics, Gian Sagar Dental College and Hospital, Jansla, IND
| | - Padmanathan Ramasamy
- Orthodontics and Dentofacial Orthopaedics, Specialist Orthodontist, Smile Dental Center, Kuwait, KWT
| | - Sherin Jeeboy
- Orthodontics and Dentofacial Orthopaedics, R. R. Dental College and Hospital, Udaipur, IND
| | | | - Aishwarrya P
- Orthodontics, Sri Ramakrishna Dental College, Jaunpur, IND
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Ferati K, Bexheti-Ferati A, Palermo A, Pezzolla C, Trilli I, Sardano R, Latini G, Inchingolo AD, Inchingolo AM, Malcangi G, Inchingolo F, Dipalma G, Mancini A. Diagnosis and Orthodontic Treatment of Obstructive Sleep Apnea Syndrome Children-A Systematic Review. Diagnostics (Basel) 2024; 14:289. [PMID: 38337805 PMCID: PMC10855184 DOI: 10.3390/diagnostics14030289] [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: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a respiratory illness that is associated with recurrent episodes of either partial or full obstruction of the upper airways, or apnea, among other sleep disorders. This study aims to analyze, through a literature review, whether orthodontic treatment can be a good treatment strategy for this type of disorder. We performed a database search on Scopus, Web of Science, and Pubmed with the keywords OSA(S) and orthodontics to select the papers under evaluation. The criteria for inclusion were articles related to OSA(S) children undergoing an orthodontic treatment and clinical studies or case series, excluding systematic reviews, narrative reviews, meta-analyses, adult studies, animal models, and in vitro studies. The screening phase ended with the selection of 16 publications for this work. RME, or rapid maxillary expansion, turned out to be the preferred orthodontic treatment in cases of pediatric OSAS. The goal of this orthodontic procedure is to increase the hard palate's transverse diameter by reopening the mid-palatal suture. Children with maxillary contraction and dental malocclusion typically undergo such a procedure and have excellent results. However, OSAS is a multifactorial disorder; it does not seem related to the morphology of the oral cavity, and therefore, it is not always possible to cope with this problem exclusively through orthodontic treatment.
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Affiliation(s)
- Kenan Ferati
- Faculty of Medicine, University of Tetovo, 1220 Tetovo, North Macedonia; (K.F.); (A.B.-F.)
| | | | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Carmen Pezzolla
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Irma Trilli
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Roberta Sardano
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Giulia Latini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Alessio Danilo Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Angelo Michele Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Giuseppina Malcangi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Gianna Dipalma
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
| | - Antonio Mancini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.P.); (I.T.); (R.S.); (G.L.); (A.D.I.); (A.M.I.); (G.D.); (A.M.)
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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.
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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.)
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Esposito S, Ricci G, Gobbi R, Vicini C, Caramelli F, Pizzi S, Fadda A, Ferro S, Plazzi G. Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy. Life (Basel) 2022; 12:739. [PMID: 35629406 PMCID: PMC9146195 DOI: 10.3390/life12050739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. Paediatric OSA is characterised by daytime and night-time symptoms. Unfortunately, there are few data on shared diagnostic-therapeutic pathways that address OSA with a multidisciplinary approach in paediatric age. This document summarizes recommendations from the Emilia-Romagna Region, Italy, developed in order to provide the most appropriate tools for a multidisciplinary approach in the diagnosis, treatment and care of paediatric patients with OSA. The multidisciplinary group of experts distinguished two different 'step' pathways, depending on the age group considered (i.e., under or over two years). In most cases, these pathways can be carried out by the primary care paediatrician, who represents the first filter for approaching the problem. For this reason, it is essential that the primary care paediatrician receives adequate training on how to formulate the diagnostic suspicion of OSA and on what criteria to use to select patients to be sent to the hospital centre. The relationship between the paediatrician of the patient and her/his parents must see a synergy of behaviour between the various players in order to avoid uncertainty about the diagnostic and therapeutic decisions as well as the follow-up phase. The definition and evaluation of the organizational process and outcome indicators of the developed flow-chart, and the impact of its implementation will remain fundamental.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy
| | - Giampiero Ricci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Riccardo Gobbi
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forlì, Italy; (R.G.); (C.V.)
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forlì, Italy; (R.G.); (C.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Pizzi
- Dentistry Unit, Department of Medicine and Surgery, Centro Universitario di Odontoiatria, University of Parma, 43126 Parma, Italy;
| | - Agatina Fadda
- Direzione Generale Cura della Persona, Salute e Welfare, Emilia-Romagna Region, 40128 Bologna, Italy; (A.F.); (S.F.)
| | - Salvatore Ferro
- Direzione Generale Cura della Persona, Salute e Welfare, Emilia-Romagna Region, 40128 Bologna, Italy; (A.F.); (S.F.)
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Jungbauer WN, Poupore NS, Nguyen SA, Carroll WW, Pecha PP. Obstructive sleep apnea in children with non-syndromic cleft palate: a systematic review. J Clin Sleep Med 2022; 18:2063-2068. [PMID: 35459445 PMCID: PMC9340587 DOI: 10.5664/jcsm.10020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To characterize obstructive sleep apnea (OSA) in children with non-syndromic cleft palate based on polysomnographic parameters relative to primary palatoplasty. METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched: PubMed, Scopus, CINAHL, and Cochrane. Studies were only considered for inclusion if they examined exclusively non-syndromic cleft palate patients and reported polysomnogram data. RESULTS Seven studies met inclusion criteria, providing information on a total of 151 patients with a weighted mean age of 5.2 ± 5.0 years old (range 0.1- 12 years). Five studies presented data from either the pre- or post-operative period. Two studies investigated both pre- and post-palatoplasty polysomnogram data, and neither observed a significant change in apnea hypopnea index (AHI) values following surgery (mean pre-operative AHI of 2.7, mean improvement of 0.6 events/hour). The entire cohort had a pre-palatoplasty weighted mean AHI of 11.4 (range 1.5 -16.1) and post-palatoplasty AHI of 1.5 (range 0.2 - 5.2). Interpretation of polysomnographic data was limited by heterogeneity; however, the AHI values of children with non-syndromic cleft palate largely demonstrated mild to moderate OSA following palatoplasty. CONCLUSIONS The full effect of cleft palate repair on OSA in children with non-syndromic cleft palate remains understudied. While published data are heterogenous, few studies support the worsening of obstructive AHI after palatoplasty in children with non-syndromic cleft palate. Further studies with standardized polysomnographic parameters are needed to provide guidance for management of this population.
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Affiliation(s)
- W Nicholas Jungbauer
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - Phayvanh P Pecha
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
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YILDIZ MG, KARAKAYA AE, GÜLER AG, ORHAN İ, KARA İ, SAĞIROĞLU S, BİLAL N, DOĞANER A. THE EFFECT OF ADENOTONSİLLECTOMY SURGERY İN PEDİATRİC ENUREZİS NOCTURNA PATİENTS. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1025885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: The aim of this study was to investigate the effect of tonsillectomy and adenoidectomy on EN in patients with tonsil hypertrophy and adenoid hypertrophy.
Material and Method: Data of 94 patients was retrospectively valuated. The frequency of EN of the patients and whether they improved after the operation were investigated.
Results: The mean age was 9.59 ± 2.04. EN patients was higher in the group with Adenoid Vegetation. EN was detected in 73 of the patients before surgery. There was a complete improvement in 63 patients and partial improvement in 10 patients after the operation. There was no statistically significant difference in EN improvement between the groups.
Conclusion: In a multidisciplinary approach, the surgical procedures can be effective in the treatment of EN. Therefore the patients admitting with EN symptomsshould be questioned for complaints about upper airway obstruction and The correct surgical procedure for children with symptoms may constitute an important step in their treatment.
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Affiliation(s)
| | | | | | - İsrafil ORHAN
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
| | - İrfan KARA
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
| | | | - Nagihan BİLAL
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
| | - Adem DOĞANER
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
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Wu D, Au VH, Yang B, Horne SJ, Weedon J, Bernstein MJ, Goldstein NA. Impact of Adenotonsillectomy on Homework Performance in Children With Obstructive Sleep-Disordered Breathing. Ann Otol Rhinol Laryngol 2021; 131:1231-1240. [PMID: 34872386 DOI: 10.1177/00034894211062543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE As a first line treatment for pediatric obstructive sleep-disordered breathing (SDB), adenotonsillectomy (AT) has been shown to confer physiologic and neurocognitive benefits to a child. However, there is a scarcity of data on how homework performance is affected postoperatively. Our objective was to evaluate the impact of AT on homework performance in children with SDB. METHODS Children in grades 1 to 8 undergoing AT for SDB based on clinical criteria with or without preoperative polysomnography along with a control group of children undergoing surgery unrelated to the treatment of SDB were recruited. The primary outcome of interest was the differential change in homework performance between the study group and control at follow-up as measured by the validated Homework Performance Questionnaire (HPQ-P). Adjustments were made for demographics and Pediatric Sleep Questionnaire (PSQ) scores. RESULTS 116 AT and 47 control subjects were recruited, and follow-up data was obtained in 99 AT and 35 control subjects. There were no significant differences between the general (total) HPQ-P scores and subscale scores between the AT and control subjects at entry and there were no significant differences in the change scores (follow-up minus initial scores) between the groups. Regression modeling also demonstrated that there were no group (AT vs control) by time interactions that predicted differential improvements in the HPQ-P (P > .10 for each model) although initial PSQ score was a significant predictor of lower HPQ-P scores for all models. CONCLUSIONS Children with SDB experienced improvement in HPQ-P scores postoperatively, but the degree of change was not significant when compared to controls. Further studies incorporating additional educational metrics are encouraged to assess the true scholastic impact of AT in children with SDB.
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Affiliation(s)
- Derek Wu
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Vivienne H Au
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Billy Yang
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sylvia J Horne
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jeremy Weedon
- Medical Research Library, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michelle J Bernstein
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nira A Goldstein
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Obstructing Sleep Apnea in Children with Genetic Disorders-A Special Need for Early Multidisciplinary Diagnosis and Treatment. J Clin Med 2021; 10:jcm10102156. [PMID: 34067548 PMCID: PMC8156845 DOI: 10.3390/jcm10102156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO2 nadir, end-tidal CO2, and transcutaneous CO2. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life.
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Villalobos-Aguirre MC, Restrepo-Gualteros SM, Peña-Valenzuela A, Sossa-Briceño MP, Rodriguez-Martinez CE. Validation of a Spanish version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in children living in a high-altitude city. Pediatr Pulmonol 2021; 56:1077-1084. [PMID: 33373497 DOI: 10.1002/ppul.25231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to validate a Spanish version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (SRBD-PSQ) in children living in a high-altitude Colombian city. METHODS In a prospective cohort validation study, patients aged between 2 and 17 years who attended the Ear, Nose, and Throat pediatric department of our institution for symptoms related to sleep-related breathing disorders had a baseline visit at enrollment, a second visit the day scheduled for the surgical intervention, and a follow-up visit at least 3 months after the surgical intervention. In these three visits, we gathered the necessary data for assessing the criterion validity, construct validity, test-retest reliability, internal consistency, and sensitivity to change of the Spanish version of the SRBD-PSQ. RESULTS In total, 121 patients were included in the analyses. The exploratory factor analysis (generalized least squares method, varimax rotation) yielded a four-factor structure, explaining 65.93% of the cumulative variance. The intraclass correlation coefficient (ICC) of the measurements was 0.887 (95% CI: 0.809-0.934), and the Lin concordance correlation coefficient was 0.882 (95% CI, 0.821-0.943). SRBD-PSQ scores at baseline were significantly higher than those obtained after adenotonsillectomy surgery (median [IQR] 11.0 [9.0- 14.0] vs. 4.00 [1.50-7.0]; p < 0.0001). Cronbach's α was 0.7055 for the questionnaire as a whole. CONCLUSIONS The Spanish version of the SRBD-PSQ has acceptable construct validity, excellent test-retest reliability and sensitivity to change, and adequate internal consistency-reliability when used in pediatric patients living at high altitude with symptoms related to sleep-related breathing disorders.
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Affiliation(s)
| | - Sonia M Restrepo-Gualteros
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology, Fundacion Hospital de La Misericordia, Bogota, Colombia
| | - Alberto Peña-Valenzuela
- Ear, Nose and Throat Department, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
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Ali NES, Alyono JC, Kumar AR, Cheng H, Koltai PJ. Sleep surgery in syndromic and neurologically impaired children. Am J Otolaryngol 2020; 41:102566. [PMID: 32504854 DOI: 10.1016/j.amjoto.2020.102566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities. MATERIAL AND METHODS Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi. OUTCOME MEASURES Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings. RESULTS 228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p = 0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI. CONCLUSIONS Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.
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Imani MM, Sadeghi M, Khazaie H, Sanjabi A, Brand S, Brühl A, Sadeghi Bahmani D. Associations Between Morning Salivary and Blood Cortisol Concentrations in Individuals With Obstructive Sleep Apnea Syndrome: A Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:568823. [PMID: 33542703 PMCID: PMC7851085 DOI: 10.3389/fendo.2020.568823] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) may be associated with an increase in hypothalamic-pituitary-adrenocortical axis activity (HPA AA). We reviewed research comparing morning salivary and blood (serum and plasma) cortisol concentrations of individuals with OSAS to those of healthy controls. METHODS We made a systematic search without any restrictions of the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases for relevant articles published up to August 25, 2019. RESULTS Sixteen studies were analyzed in this meta-analysis; five studies compared morning salivary concentrations, five compared serum concentrations, four compared plasma cortisol concentrations, and two compared both salivary and plasma concentrations. In pediatric samples, compared to healthy controls, those with OSAS had significantly lower saliva morning cortisol concentrations (MD = -0.13 µg/dl; 95% CI: 0.21, -0.04; P = 0.003). In contrast, no significant differences were observed for serum cortisol concentrations, plasma cortisol concentrations, or salivary morning cortisol concentrations between adults with and without OSAS (p = 0.61, p = 0.17, p = 0.17). CONCLUSION Cortisol concentrations did not differ between adults with OSAS and healthy controls. In contrast, morning salivary cortisol concentrations were lower in children with OSAS, compared to healthy controls. Given that a reduced HPA AA is observed among individuals with chronic stress, it is conceivable that children with OSAS are experiencing chronic psychophysiological stress.
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Affiliation(s)
- Mohammad Moslem Imani
- Kermanshah University of Medical Sciences, Department of Orthodontics, Kermanshah, Iran
| | - Masoud Sadeghi
- Kermanshah University of Medical Sciences, Medical Biology Research Center, Kermanshah, Iran
| | - Habibolah Khazaie
- Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran
| | - Arezoo Sanjabi
- Kermanshah University of Medical Sciences, Students Research Committee, Kermanshah, Iran
| | - Serge Brand
- Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
- University of Basel, Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, Basel, Switzerland
- Kermanshah University of Medical Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran
- Tehran University of Medical Sciences, School of Medicine, Tehran, Iran
- *Correspondence: Serge Brand,
| | - Annette Brühl
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
- Kermanshah University of Medical Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran
- University of Basel, Psychiatric Clinics, Old Age Department, Basel, Switzerland
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Hua F, Zhao T, Walsh T, Sun Q, Chen X, Worthington H, Jiang F, He H. Effects of adenotonsillectomy on the growth of children with obstructive sleep apnoea-hypopnea syndrome (OSAHS): protocol for a systematic review. BMJ Open 2019; 9:e030866. [PMID: 31427343 PMCID: PMC6701597 DOI: 10.1136/bmjopen-2019-030866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea-hypopnea syndrome (OSAHS) is characterised by recurring episodes of complete or partial upper airway collapse during sleep. Persistent OSAHS is associated with long-term consequences, such as growth failure, cardiovascular and neurocognitive problems in children. Different from the aetiology of OSAHS in adults, the most common cause of paediatric OSAHS is adenotonsillar hypertrophy. Adenotonsillectomy (AT) has been recommended as the first-line treatment of paediatric OSAHS. Several studies have suggested that retarded growth caused by OSAHS can improve after AT during the prepubertal period. This review will systematically search and summarise the available evidence on the effects of AT on children's growth. METHODS AND ANALYSIS We will conduct electronic searches in MEDLINE (via PubMed), Embase, Google Scholar and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) or cohort studies that included a control group. Additional records will be searched by checking the references included in the selected studies and relevant reviews. At least two authors will undertake selection of studies and data extraction independently and in duplicate. The Cochrane Risk of Bias tool and Risk Of Bias In Non-randomised Studies-of Interventions will be used to assess the risk of bias of RCT and cohort studies, respectively. A random-effects model will be used for meta-analyses. Data synthesis and other analyses will be carried out using the RevMan V.5.3 software. The Grades of Recommendation, Assessment, Development and Evaluation will be used to assess the quality of the supporting evidence behind each main comparison. ETHICS AND DISSEMINATION There is no ethical issue in this systematic review given that we will only include published studies. The results will be disseminated via peer-reviewed publications and social networks. PROSPERO REGISTRATION NUMBER CRD42019125882.
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Affiliation(s)
- Fang Hua
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Centre for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tingting Zhao
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tanya Walsh
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Qiao Sun
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Helen Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Hong He
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Links AR, Callon W, Wasserman C, Walsh J, Beach MC, Boss EF. Surgeon use of medical jargon with parents in the outpatient setting. PATIENT EDUCATION AND COUNSELING 2019; 102:1111-1118. [PMID: 30744965 PMCID: PMC6525640 DOI: 10.1016/j.pec.2019.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/13/2018] [Accepted: 02/01/2019] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Unexplained medical terminology impedes clinician/parent communication. We describe jargon use in a pediatric surgical setting. METHODS We evaluated encounters between parents of children with sleep-disordered breathing (SDB; n = 64) and otolaryngologists (n = 8). Participants completed questionnaires evaluating demographics, clinical features, and parental role in decision-making via a 4-point categorical item. Two coders reviewed consultations for occurrence of clinician and parent utterance of medical jargon. Descriptive statistics established a profile of jargon use, and logistic regression evaluated associations between communication factors with jargon use. RESULTS Unexplained medical jargon was common (mean total utterances per visit = 28.9,SD = 19.5,Range = 5-100), including SDB-specific jargon (M = 8.3,SD = 8.8), other medical terminology (M = 13.9,SD = 12) and contextual terms (M = 3.8,SD = 4). Parents used jargon a mean of 4.3 times (SD = 4.6). Clinicians used more jargon in consults where they perceived parents as having greater involvement in decision-making (OR = 3.4,p < 0.05) and when parents used more jargon (OR = 1.2,p < 0.05). CONCLUSIONS Jargon use in pediatric surgical consultations is common and could serve as a barrier to informed or shared parent decision-making. This study provides a foundation for further research into patterns of jargon use across surgical populations. PRACTICE IMPLICATIONS Results will be integrated into communication training to enhance clinician communication, foster self-awareness in language use, and create strategies to evaluate parental understanding.
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Affiliation(s)
- A R Links
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, United States
| | - W Callon
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - C Wasserman
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - J Walsh
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, United States
| | - M C Beach
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - E F Boss
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, United States.
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Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea in the Pediatric Population. SLEEP DISORDERS 2018; 2018:1968985. [PMID: 30515336 PMCID: PMC6236928 DOI: 10.1155/2018/1968985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/28/2018] [Accepted: 09/26/2018] [Indexed: 11/17/2022]
Abstract
Objective To determine the prevalence of respiratory complications in the early postoperative period of children with sleep apnea who required adenotonsillectomy at a tertiary pediatric hospital and to establish recommendations for postoperative monitoring. Methods Retrospective cohort study of children with obstructive sleep apnea (OSA) diagnosed by polysomnogram (PSG), who underwent adenotonsillectomy for treatment of OSA. The prevalence of respiratory complications in the first 24 postoperative hours was measured. Patients with craniofacial malformations, obesity, and severe cardiovascular comorbidities were excluded. The prevalence of postoperative respiratory complications was compared with the severity of OSA according to the Apnea Hypopnea Index (AHI) and NADIR. All data were taken in patients residing in Bogotá city, Colombia, at 2.640 meters above sea level (m.a.s.l). Results Between May 2014 and February 2017, 167 patients (108 males) required adenotonsillectomy for OSA, with an age range of 1 and 15 years (mean 5.3 years +/- 2.7). The prevalence of postoperative respiratory complications was 3.59% (6/167). There was a statistically significant relationship between the presence of respiratory complication and AHI greater than 44/h (p <0.04). There was an inverse correlation between the AHI and NADIR values. Risk groups of patients younger than 3 years and NADIR less than 70% had a higher prevalence of respiratory complications; however, this correlation was not statistically significant (p <0.08 and 0.89, respectively). Conclusions The prevalence of respiratory complications in OSA patients undergoing adenotonsillectomy in high altitudes is similar to that reported in other heights. Preoperative AHI greater than 44/h could be considered a risk factor for early respiratory complication. We suggest ambulatory management after 6 hours in Postanesthetic Care Unit (PACU) observation in patients older than 3 years, with AHI less than 44/h and NADIR greater than 70% in altitudes higher than 2.500 m.a.s.l. Further research must be done to confirm this hypothesis.
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O'Brien DC, Desai Y, Swanson RT, Parekh U, Schubart J, Carr MM. Sleep study indices and early post-tonsillectomy outcomes. Am J Otolaryngol 2018; 39:623-627. [PMID: 30017372 DOI: 10.1016/j.amjoto.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the relationships between preoperative sleep study findings of children undergoing adenotonsillectomy anesthesia emergence time, recovery room time, and length of stay. STUDY DESIGN Retrospective case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS All children aged 1-17 years who had undergone adenotonsillectomy between 2013 and 2016 were included. Apnea-hypopnea index (AHI), central apnea index (CAI), oxygen saturation nadir, and end-tidal carbon dioxide were compared with the in-operating room times, recovery room time, and length of stay. RESULTS Three hundred and fourteen patients with a mean age of 6.67 (95% CI 6.25-7.09) years were included. Mean AHI was 9.14 (95% CI 7.33-10.95), mean CI was 0.88 (95% CI 0.50-1.26), mean oxygen saturation nadir was 82.9% (95% CI 81.41-84.32), mean end-tidal carbon dioxide was 50.3 (95% CI 49.39-51.15). Mean emergence time was 16 min (95% CI 15:11-17:13 min), recovery room time was 66 min (95% CI 1:00-1:11 h), and length of stay was 25.7 h (95% CI 21:43-30:00 h). When controlled for age, gender and BMI, linear regression showed that children with a higher AHI had a significantly longer operating room and operative times (p < 0.001), emergence time (p < 0.001) and length of stay (p = 0.01). CAI was related to shorter total operating room times (p = 0.03). AHI, oxygen saturation nadir, CAI and end-tidal carbon dioxide were not associated with recovery room time. CONCLUSION Preoperative sleep study indices are associated with longer in-operating room times and length of stay, and can be useful in planning operating room and hospital flow.
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Affiliation(s)
- Daniel C O'Brien
- Department of Otolaryngology-Head and Neck Surgery, 4520 Health Science Center South, PO Box 9200, West Virginia University, Morgantown, WV, USA
| | - Yuti Desai
- Drexel University, 3141 Chestnut St, Philadelphia, PA 19104, USA
| | - Robert T Swanson
- Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Uma Parekh
- Penn State Department of Anesthesia, 500 University Drive, Hershey, PA 17033, USA
| | - Jane Schubart
- Penn State Departments of Surgery and Public Health, 500 University Drive, Hershey, PA 17033, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, 4520 Health Science Center South, PO Box 9200, West Virginia University, Morgantown, WV, USA.
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Abstract
No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone.A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 ± 1.7) and at the end of active treatment (T1; mean age, 9.2 ± 2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system.The study group was divided into 2 samples according to the age at T0: Group A (age < 6 years) and Group B (age ≥ 6 years). A statistical comparison of the treatment effects between the 2 samples was performed.Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P<0.001), intermolar distance (7.2 mm versus 5 mm; P = 0.06), and Huddart/Bodenham score (7.1 versus 3; P < 0.05) when compared with patients in Group B.Early orthodontic treatment strongly improved the dental arch relationship, since subjects starting the therapy before the age of 6 had a better response in terms of anterior maxillary expansion.
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Brunetto DP, Sant'Anna EF, Machado AW, Moon W. Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE). Dental Press J Orthod 2018; 22:110-125. [PMID: 28444019 PMCID: PMC5398849 DOI: 10.1590/2177-6709.22.1.110-125.sar] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). OBJECTIVE The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA). METHODS All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained. CONCLUSION It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.
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Affiliation(s)
- Daniel Paludo Brunetto
- Department of Restorative Dentistry, Dental School, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Eduardo Franzzotti Sant'Anna
- Department of Pediatric Dentistry and Orthodontics, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andre Wilson Machado
- Department of Orthodontics, Dental School, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Won Moon
- Dental School, University of California, Los Angeles, CA, USA
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Boss EF, Links AR, Saxton R, Cheng TL, Beach MC. Physician Perspectives on Decision Making for Treatment of Pediatric Sleep-Disordered Breathing. Clin Pediatr (Phila) 2017; 56:993-1000. [PMID: 28429620 PMCID: PMC6460467 DOI: 10.1177/0009922817702939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep-disordered breathing (SDB) is prevalent in children and most commonly treated by surgery with adenotonsillectomy. We aimed to learn physician perspectives of social and communication factors that influence decision making for treatment of pediatric SDB. Purposive sampling identified 10 physician key informants across disciplines and practice settings, who participated in semistructured interviews regarding SDB care experiences and communication with parents. Interviews were analyzed using directed qualitative content analysis. Physicians provided a variety of perspectives on decision making for treatment that fell into 3 overarching themes: approach to surgery and alternatives, communication and decision making with families, and sociocultural factors/barriers to care. Perspectives were moderately heterogeneous, suggesting that individual social and relational elements may significantly influence how physicians refer patients and recommend treatment, and how parents choose surgery for this prevalent condition. These findings will inform development of culturally competent communication strategies and support tools to enhance shared decision making for physicians treating children with SDB.
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Affiliation(s)
- Emily F. Boss
- Johns Hopkins University School of Medicine Department of Otolaryngology—Head and Neck Surgery Baltimore, USA
| | - Anne R. Links
- Johns Hopkins University School of Medicine Department of Otolaryngology—Head and Neck Surgery Baltimore, USA
| | - Ron Saxton
- Johns Hopkins University School of Medicine Department of Otolaryngology—Head and Neck Surgery Baltimore, USA
| | - Tina L. Cheng
- Johns Hopkins University School of Medicine Department of Pediatrics, Baltimore, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Wu J, Gu M, Chen S, Chen W, Ni K, Xu H, Li X. Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups. Medicine (Baltimore) 2017; 96:e8281. [PMID: 29049225 PMCID: PMC5662391 DOI: 10.1097/md.0000000000008281] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 12/14/2022] Open
Abstract
This study aimed to retrospectively investigate the factors related to pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) with attention deficit hyperactivity disorder (ADHD) in children younger than 6 years and those older than 6 years.A total of 437 children who were hospitalized due to OSAHS between January 2014 and December 2014 were retrospectively reviewed. The children were further divided into OSAHS group and OSAHS + ADHD group. The general characteristics, OSA-18 quality of life, intention-hyperactivity score, and polysomnographic parameters (apnea-hypopnea index and the lowest oxygen saturation) were collected and compared between groups.There were 298 boys and 139 girls with the male to female ratio of 2.14:1. ADHD was found in 146 children including 105 boys and 41 girls with the male to female ratio of 2.56:1. Of these children, 31.62% and 35.46% had concomitant ADHD in children aged 4 to 5 years and those aged 6 to 11 years, respectively. In children aged 4 to 5 years, the incidence of allergic rhinitis was significantly higher (P = .016) and the adenoid hypertrophy was more severe (P = .001) in those with concomitant ADHD. In children aged 6 to 11 years, the tonsil hypertrophy was more severe in those with concomitant ADHD (P = .019). In children with concomitant ADHD, OSA-18 score was higher than in those with OSAHS alone (P < .001). Higher frequency of respiratory events (P < .001) and more severe hypoxia (P < .001) were found in children with concomitant ADHD than in those with OSAHS alone.As high as 30% of OSAHS children have concomitant ADHD, and the incidence of ADHD in OSAHS children is increasing over age. Boys are more likely to develop OSAHS and incidence of ADHD in OSAHS boys is higher than in OSAHS girls. In addition, risk factors of ADHD also vary between age groups. The ADHD is related to the severity of allergic rhinitis and adenoid hypertrophy in children aged 4 to 5 years, and to the severity of tonsil hypertrophy in children aged 6 to 11 years. Hypoxia may be an important factor causing ADHD. OSAHS should be treated as early as possible to reduce the incidence of ADHD in children.
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Boss EF, Links AR, Saxton R, Cheng TL, Beach MC. Parent Experience of Care and Decision Making for Children Who Snore. JAMA Otolaryngol Head Neck Surg 2017; 143:218-225. [PMID: 27560831 PMCID: PMC5798224 DOI: 10.1001/jamaoto.2016.2400] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Sleep-disordered breathing (SDB) is prevalent and has an impact on the physical and behavioral health of children. Adenotonsillectomy (AT), the primary treatment, is subject to unexplained variation in utilization, which may be reduced by improving physician-patient communication and decision quality for this elective procedure. Objective To identify factors are associated with parental experience and decision making in pediatric SDB and AT surgery. Design, Setting, and Participants In this qualitative study, parents of children with prior SDB evaluation participated in semistructured, audiorecorded interviews. Open-ended questions regarded experiences of having a child with SDB, communication with pediatric clinicians and surgeons, and experiences with AT surgery. Recordings were transcribed and analyzed for emergent themes using grounded theory methodology. Eleven parents of children ages 2 to 17 years who had previously been diagnosed or treated for SDB were identified via purposive sampling and interviewed between January and April 2015. Interviews were conducted at locations convenient for the participants and separate from the pediatric clinic. A goal of this study was to ascertain how parents perceived sharing decisions with their physicians. Main Outcomes and Measures Themes of parental experiences and treatment decision-making processes with pediatric SDB. Results Overarching themes were inclusive of (1) clinical factors of SDB and AT and (2) clinician interpersonal behaviors and communication. Parents described an urgency that led them to seek evaluation or treatment, including fear that the child would stop breathing, or behavioral and/or cognitive delays. Parents often viewed surgery as a "last resort" and had explored alternate therapies prior to seeing the surgeon. Nearly all parents feared anesthesia more than AT surgery itself. Parents described satisfaction when physicians provided them with options, engaged their child in conversation, depicted SDB visually, and were responsive or accessible to questions. Parents regarded a trusting relationship with their pediatrician, confidence in the surgeon, and inclusion in decision making as important. Conclusions and Relevance While clinical factors were influential for decision making, interpersonal factors helped parents feel comfortable and influenced their overall experience. Shared decision making, in which parents receive evidence-based information allowing them to accurately perceive risks, benefits, and alternatives about SDB treatment in the setting of trusting clinician-family relationships, may reduce parental decision conflict and improve decision quality toward AT surgery.
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Affiliation(s)
- Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron Saxton
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tina L Cheng
- Department of Pediatrics, Johns Hopkins University Children's Center, Baltimore, Maryland
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Earley MA, Pham LT, April MM. Scoping review: Awareness of neurotoxicity from anesthesia in children in otolaryngology literature. Laryngoscope 2017; 127:1930-1937. [DOI: 10.1002/lary.26485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Marisa A. Earley
- Department of Otolaryngology Head and Neck Surgery; Division of Pediatric Otolaryngology, New York University, New York University; New York New York U.S.A
| | - Liem T. Pham
- Department of Anesthesia; Division of Pediatric Anesthesia, New York University; New York New York U.S.A
| | - Max M. April
- Department of Otolaryngology Head and Neck Surgery; Division of Pediatric Otolaryngology, New York University; New York New York U.S.A
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Links AR, Tunkel DE, Boss EF. Stakeholder-Engaged Measure Development for Pediatric Obstructive Sleep-Disordered Breathing: The Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents. JAMA Otolaryngol Head Neck Surg 2017; 143:46-54. [PMID: 27631116 PMCID: PMC6492028 DOI: 10.1001/jamaoto.2016.2681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Parental decision making about adenotonsillectomy (AT) for obstructive sleep-disordered breathing (oSDB) is associated with decisional conflict that may be alleviated with improved knowledge about symptoms and treatments. Objective To develop a measure of parental knowledge about oSDB and AT. Design, Setting, and Participants A sequential design was used for scale development. A prototype measure containing 9 oSDB and AT themes and 85 items was administered in survey format via an online platform. Participants included 19 clinician experts (otolaryngologists and pediatricians) and 13 laymen (parents of children who snore or do not snore, and other adults). Quantitative and qualitative responses were used to modify the measure and create the knowledge scale. Content validity of the scale was established through expert feedback and evaluation. Criterion validity was established with t test comparisons of experts with laymen. Reliability of the responses was assessed with Cronbach α testing. Main Outcomes and Measures An 85-item prototype measure and 39-item modified measure were evaluated for consensus/approval and psychometric integrity. Results Of 45 potential participants, 32 individuals (71%) responded to the prototype scale. Respondents included 19 clinician experts (59%) (otolaryngologists and pediatricians) and 13 laymen (41%) (parents of children who snore [n = 8] or do not snore [n = 2] and other adults [n = 3]); demographic data were not collected. Content analysis and qualitative feedback were largely rated positively: 27 respondents (84%) stated that the measure was a good evaluation of knowledge, 30 respondents (94%) commented that the items were clear, and 31 individuals (97%) approved of its organization, although there were several suggestions for rewording and/or addition of response options. Experts identified themes most important for assessing oSDB (symptoms) and AT (experiences: risks and benefits) knowledge. These qualitative comments were used to modify the scale, and items were eliminated if more than 2 were reported as misleading or less than 85% of clinicians provided correct responses. Five themes (oSDB symptoms, treatment options, AT risks, anesthesia, and AT benefits) and 39 items composed the final scale. Experts scored higher than laymen on the oSDB and AT Knowledge Scale for Parents overall (17 [94%] vs 12 [67%]; Cohen d = 1.96; 95% CI, 1.05-2.86) and within all themes, including experiences of children with oSDB (19 [88%] vs 13 [62%]; Cohen d = 1.53; 95% CI, 0.71-2.32), treatment options (19 [97%] vs 12 [68%]; Cohen d = 1.74; 95% CI, 0.88-2.57), AT risks (17 [97%] vs 12 [59%]; Cohen d = 1.94; 95% CI, 1.03-2.83), anesthesia (17 [97%] vs 12 [79%]; Cohen d = 1.09; 95% CI, 0.29-1.88), and AT benefits (17 [95%] vs 12 [67%]; Cohen d = 1.28; 95% CI, 0.46-2.09), demonstrating criterion validity. All responses demonstrated high reliability (Cronbach α = 0.94). Conclusions and Relevance The oSDB and AT Knowledge Scale for Parents is psychometrically sound for use in the assessment of parental knowledge.
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Affiliation(s)
- Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
Adenotonsillectomy is widely considered to be an effective treatment for sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) in the pediatric population. However, in some patients, SDB and OSA can persist despite surgical treatment with adenotonsillectomy. Options to manage persistent SDB/OSA depend on symptoms and severity. Many patients with mild residual OSA can be managed with nasal steroids and observed. Those with more moderate-to-severe residual pathology often can be managed with conservative measures that usually include continuous positive airway pressure (CPAP) therapy. However, some patients cannot tolerate CPAP, and are therefore candidates to be evaluated for addition surgical therapies. [Pediatr Ann. 2016;45(5):e180-e183.].
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Park S, Lee JM, Sim CS, Kim JG, Nam JG, Lee TH, Han MW, Kwon JK, Lee JC. Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study. Laryngoscope 2016; 126:1241-5. [PMID: 26928519 DOI: 10.1002/lary.25934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/25/2015] [Accepted: 01/27/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the relationship between sleep-disordered breathing (SDB) and nocturnal enuresis (NE) in children and to prospectively evaluate the effectiveness of adenotonsillectomy on resolving enuresis in indicated SDB patients with NE. METHODS We prospectively collected data from 183 children (121 males, mean age 8.17 ± 2.84 years) who underwent adenotonsillectomy to treat SDB between July 2011 and July 2013, and analyzed the prevalence of NE. Before and 3 months after surgery, all parents were requested to answer a self-reported SDB scale questionnaire (22 questions, 0-22 points) and a NE questionnaire (episodes of enuresis per month). Paired t test, Student t test, and Chi-square test were used to analyze the data. RESULTS Overall prevalence of NE was 9.3% (17 patients) preoperatively and 1.5% postoperatively (four patients). After adenotonsillectomy, prevalence of NE and the mean SDB scale were significantly decreased (both P values < 0.001). After adenotonsillectomy, 13 of the 17 NE patients (76.5%) showed complete resolution. There was significantly higher prevalence of NE in patients with obstructive sleep apnea (OSA) than those without OSA (13.1%, 14 of 107 vs. 3.9%, 3 of 76; P = 0.036). CONCLUSION There is strong association between NE and SDB, and adenotonsillectomy can markedly improve enuresis in the majority of children with NE and SDB. LEVELS OF EVIDENCE 4. Laryngoscope, 126:1241-1245, 2016.
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Affiliation(s)
- Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jung Min Lee
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chang Sun Sim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jae Gi Kim
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jung Gwon Nam
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Tae-Hoon Lee
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Myung Woul Han
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Joong Keun Kwon
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jong Cheol Lee
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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DelRosso LM. Epidemiology and Diagnosis of Pediatric Obstructive Sleep Apnea. Curr Probl Pediatr Adolesc Health Care 2016; 46:2-6. [PMID: 26573241 DOI: 10.1016/j.cppeds.2015.10.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Lourdes M DelRosso
- Division of Pulmonary Medicine, The Children׳s Hospital of Philadelphia, Philadelphia, PA.
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McNamara JA, Lione R, Franchi L, Angelieri F, Cevidanes LHS, Darendeliler MA, Cozza P. The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 2015; 16:33. [PMID: 26446931 PMCID: PMC4596248 DOI: 10.1186/s40510-015-0105-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Abstract
Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life.
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Affiliation(s)
- James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Cell and Developmental Biology, School of Medicine, The University of Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development, The University of Michigan, Ann Arbor, MI, USA
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Lorenzo Franchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.
- Department of Surgery and Translational Medicine, University of Florence, Via del Ponte di Mezzo, 46-48, Florence, 50127, Italy.
| | - Fernanda Angelieri
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Department of Orthodontics, São Paulo Methodist University, São Bernardo do Campo, Brazil
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
- Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Dentistry, UNSBC, Tirana, Albania
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Outcomes after adenotonsillectomy using a fixed anesthesia protocol in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2015; 79:638-43. [PMID: 25727307 DOI: 10.1016/j.ijporl.2015.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To document the effects of a fixed anesthesia protocol on peri-operative events in children undergoing adenotonsillectomy for obstructive sleep apnea (OSA). METHODS A non-randomized prospective study was conducted during the years 2011-2013 within a setting of a tertiary-level university hospital. Sixty five children with polysomnographically proven OSA undergoing adenotonsillectomy were enrolled in the study and stratified into three groups based on severity. The relationship between severity of OSA as determined by apnea-hypopnea index (AHI) and oxygen saturation (SpO2) nadir were compared with time taken to (i) extubation following emergence and (ii) discharge from the post-anesthesia care unit. Adjustments were made in the dosages of premedication (midazolam) and opioid analgesic administered following induction (hydromorphone) depending on the severity of OSA. A non-validated but fixed anesthesia protocol tailored to the severity of OSA was used in all patients. In addition, all adverse events were also monitored. RESULTS A paradoxical, yet significant reduction in emergence time was observed among patients with severe OSA following surgery (ANOVA, Tukey-Kramer post hoc tests, P<0.001). There were also fewer adverse events in this group. CONCLUSIONS Emergence from anesthesia after adenotonsillectomy may be positively influenced by an anesthetic technique titrated according to the severity of OSA. Adverse respiratory events due to the severity of sleep apnea and attendant hypoxemia may be minimized and outcomes improved with similarly tailored protocols.
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Treptow E, Oliveira MG, Moreira GA, Togeiro S, Nery LE, Tufik S, Bittencourt L. Update on the use of portable monitoring system for the diagnosis of sleep apnea in specific population. World J Respirol 2015; 5:17-27. [DOI: 10.5320/wjr.v5.i1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/10/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
The prevalence and severity of obstructive sleep apnea (OSA) is higher in specific population: children, elderly, obese and patients with pulmonary and cardiovascular diseases, compared to the general population. OSA is associated with greater morbidity and mortality in these patients. Although full-night polysomnography is still the gold standard diagnostic sleep study for OSA, it is a time consuming, expensive and technically demanding exam. Over the last few years, there is growing evidence on the use of portable monitors (PM) as an alternative for the diagnosis of OSA. These devices were developed specially for sleep evaluation at home, at a familiar environment, with easy self-application of monitoring, unattended. The use of PM is stablished for populations with high pre-test probability of OSA. However, there is a lack of studies on the use of PM in age extremes and patients with comorbidities. The purpose of this review is to present the studies that evaluated the use of PM in specific population, as well as to describe the advantages, limitations and applications of these devices in this particular group of patients. Although the total loss rate of recordings is variable in different studies, the agreement with full-night polysomnography justifies the use of PM in this population.
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Orthodontics treatments for managing obstructive sleep apnea syndrome in children: A systematic review and meta-analysis. Sleep Med Rev 2015; 25:84-94. [PMID: 26164371 DOI: 10.1016/j.smrv.2015.02.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/20/2022]
Abstract
A small maxilla and/or mandible may predispose children to sleep-disordered breathing, which is a continuum of severity from snoring to obstructive sleep apnea. Preliminary studies have suggested that orthodontic treatments, such as orthopedic mandibular advancement or rapid maxillary expansion, may be effective treatments. The aim is to investigate the efficacy of orthopedic mandibular advancement and/or rapid maxillary expansion in the treatment of pediatric obstructive sleep apnea. Pubmed, Medline, Embase, and Internet were searched for eligible studies published until April 2014. Articles with adequate data were selected for the meta-analysis; other articles were reported in the qualitative assessment. Data extraction was conducted by two independent authors. A total of 58 studies were identified. Only eight studies were included in the review; of these, six were included in the meta-analysis. The research yielded only a small number of studies. Consequently, any conclusions from the pooled diagnostic parameters and their interpretation should be treated carefully. Although the included studies were limited, these orthodontic treatments may be effective in managing pediatric snoring and obstructive sleep apnea. Other related health outcomes, such as neurocognitive and cardiovascular functions have not yet been systematically addressed. More studies are needed with larger sample size, specific inclusion and exclusion criteria and standardized data reporting to help establish guidelines for the orthodontic treatment of pediatric obstructive sleep apnea.
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