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Wachsmuth L, Bieli C, Grehten P, Moehrlen T, Moehrlen U, Bernet V, Hagmann C, Grass B. Sleep-disordered breathing on respiratory polygraphy in neonates with spina bifida. Pediatr Pulmonol 2024. [PMID: 38888157 DOI: 10.1002/ppul.27137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/15/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Studies have shown a high prevalence of sleep-disordered breathing (SDB) in children with spina bifida. International standards for regular testing for SDB in this population are lacking. While there are studies investigating the prevalence of SDB in children with spina bifida, there are close to no studies in neonates. AIM AND OBJECTIVE To evaluate if routine respiratory polygraphy (RPG) testing is indicated for neonates with spina bifida and if yes, with what therapeutic consequence. METHODS We conducted a retrospective cohort study of all neonates with spina bifida at the University (Children's) Hospital Zurich after fetal spina bifida repair born between 2017 and 2022, who had undergone at least 1 RPG evaluation during hospitalization on the neonatal ward. RPG were evaluated by a blinded group of experienced pediatric pulmonologists. Based on the neonatal RPG results and pediatric pulmonologist's recommendation for caffeine therapy the spina bifida cohort was divided into two groups. Neonatal baseline RPG and follow-up RPG at the age of the 3 months were evaluated. RESULTS 48 neonates with RPG were included. Compared to the standard values in healthy neonates, the RPG results of this spina bifida cohort showed findings of SDB with central apnea and hypopnea. 22 (45.8%) neonatal RPG evaluations detected central SDB, prompting caffeine therapy. Follow-up RPG conducted after 3 months showed significant improvement of SDB with (almost) no need for continuation of caffeine. CONCLUSION We recommend the implementation of routine RPG testing in neonates with spina bifida to detect SDB and facilitate early targeted treatment.
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Affiliation(s)
- Lorine Wachsmuth
- Division of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christian Bieli
- Department of Pediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Patrice Grehten
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Theres Moehrlen
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Vera Bernet
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Neonatology, Hospital Zollikerberg, Zurich, Switzerland
| | - Cornelia Hagmann
- Division of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Beate Grass
- Division of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Sırtbaş-Işık G, Porsnok D, Yardımcı-Lokmanoğlu BN, Mutlu A. Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period. Sleep Med 2024; 114:151-158. [PMID: 38184924 DOI: 10.1016/j.sleep.2023.12.016] [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: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9-20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics. METHODS Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). RESULTS The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001). CONCLUSIONS Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.
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Affiliation(s)
- Gülsen Sırtbaş-Işık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
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Sırtbaş-Işık G, Yardımcı-Lokmanoğlu BN, Livanelioğlu A, Mutlu A. Sensory processing and sleep characteristics in preterm infants in the early period of life. Sleep Med 2023; 106:78-83. [PMID: 37054558 DOI: 10.1016/j.sleep.2023.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The present study aimed to investigate the following: (i) differences in sensory processing and sleep characteristics between preterm infants born at < 32 weeks', vs. those born at ≥ 32 weeks' gestation; (ii) differences in sleep characteristics between preterm infants with typical vs. atypical sensory processing; and (iii) relationship between sensory processing and sleep characteristics in preterm infants at 3 months of age. METHODS A total of 189 preterm infants, 54 born at < 32 weeks' gestation (26 females; mean gestational age [standard deviation (SD)], 30.1 [1.7] weeks), and 135 born at ≥ 32 weeks' gestation (78 females; mean gestational age [SD], 34.9 [0.9] weeks) were included in the present study. Sleep characteristics were evaluated using the Brief Infant Sleep Questionnaire, and sensory processing was assessed using the Infant Sensory Profile-2. RESULTS There were no significant differences in sensory processing (P > 0.05) or sleep characteristics (P > 0.05) between the preterm groups; however, more infants snored in the <32 weeks' gestation group (P = 0.035). Preterm infants with atypical sensory processing showed lower nighttime (P = 0.027) and total sleep durations (P = 0.032), and higher rates of nocturnal wakefulness (P = 0.038) and snoring (P = 0.001) than preterm infants with typical sensory processing. A significant relationship, therefore, was observed between sensory processing and sleep characteristics (P < 0.05). CONCLUSIONS Sensory processing patterns may play an important role in understanding sleep problems in preterm infants. The early detection of sleep problems and sensory processing difficulties are necessary for early intervention.
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Horne RSC. The natural history of obstructive sleep apnea in infancy. Pediatr Pulmonol 2023; 58:670-671. [PMID: 36517986 DOI: 10.1002/ppul.26280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
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Ehsan Z, Glynn EF, Hoffman MA, Ingram DG, Al-Shawwa B. Small sleepers, big data: leveraging big data to explore sleep-disordered breathing in infants and young children. Sleep 2021; 44:5905265. [PMID: 32926133 DOI: 10.1093/sleep/zsaa176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Infants represent an understudied minority in sleep-disordered breathing (SDB) research and yet the disease can have a significant impact on health over the formative years of neurocognitive development that follow. Herein we report data on SDB in this population using a big data approach. METHODS Data were abstracted using the Cerner Health Facts database. Demographics, sleep diagnoses, comorbid medication conditions, healthcare utilization, and economic outcomes are reported. RESULTS In a cohort of 68.7 million unique patients, over a 9-year period, there were 9,773 infants and young children with a diagnosis of SDB (obstructive sleep apnea [OSA], nonobstructive sleep apnea, and "other" sleep apnea) who met inclusion criteria, encompassing 17,574 encounters, and a total of 27,290 diagnoses across 62 U.S. health systems, 172 facilities, and 3 patient encounter types (inpatient, clinic, and outpatient). Thirty-nine percent were female. Thirty-nine percent were ≤1 year of age (6,429 infants), 50% were 1-2 years of age, and 11% were 2 years of age. The most common comorbid diagnoses were micrognathia, congenital airway abnormalities, gastroesophageal reflux, chronic tonsillitis/adenoiditis, and anomalies of the respiratory system. Payor mix was dominated by government-funded entities. CONCLUSIONS We have used a novel resource, large-scale aggregate, de-identified EHR data, to examine SDB. In this population, SDB is multifactorial, closely linked to comorbid medical conditions and may contribute to a significant burden of healthcare costs. Further research focusing on infants at highest risk for SDB can help target resources and facilitate personalized management.
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Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Earl F Glynn
- Research Informatics, Children's Mercy Research Institute, Children's Mercy-Kansas City, Kansas City, MO
| | - Mark A Hoffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO.,Research Informatics, Children's Mercy Research Institute, Children's Mercy-Kansas City, Kansas City, MO
| | - David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Baha Al-Shawwa
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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Mehta B, Waters K, Fitzgerald D, Badawi N. Survey of the practices of neonatologists in managing neonates believed to be at high risk of sleep disordered breathing. BMJ Paediatr Open 2021; 5:e000979. [PMID: 33681476 PMCID: PMC7898842 DOI: 10.1136/bmjpo-2020-000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the practices of neonatologists in managing high-risk neonates believed to be at risk of sleep disordered breathing (SDB). DESIGN An electronic web-based questionnaire assessing awareness of and current practices for managing neonates predisposed to SDB with conditions like craniofacial anomalies, neuromuscular disorders or airway problems was emailed to 232 neonatologists and neonatal fellows working in Australia and New Zealand (NZ). Additionally, neonatologists were approached directly during the annual Australia and NZ perinatal conference in 2019. RESULTS 93 neonatologists (40%) responded to the survey. The majority (85%) of the respondents stated that there were no written protocols/criteria for sleep consultation in their unit. We found considerable variations in the threshold for performing tests including oximetry or referring for polysomnography. Most respondents would perform oximetry before referring for a sleep consultation. However, the duration of oximetry varied from 6 to 24 hours and there was no consensus about what is considered abnormal on an oximetry study. CONCLUSION Management of SDB is gaining importance in neonatal care because of prolonged length of hospital stay and possible long-term effects of SDB. Responses received suggest a lack of clarity regarding thresholds for referral for treatment of SDB. Likely contributory factors are concerns regarding a lack of long-term outcome data from treatment perceived to be onerous for the family, unsettling to some infants and delaying hospital discharge. To overcome inconsistencies in practice, standardised guidelines for assessing and managing SDB in neonates are needed.
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Affiliation(s)
- Bhavesh Mehta
- Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Karen Waters
- Sleep Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dominic Fitzgerald
- Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nadia Badawi
- Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Horne RSC. Consequences of paediatric sleep disordered breathing: contributions from Australian and New Zealand investigators. Sleep Med 2020; 77:147-160. [PMID: 33373901 DOI: 10.1016/j.sleep.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
AIMS To highlight the contributions of Australian and New Zealand researchers to the identification of the consequences of paediatric sleep disordered breathing (SDB). METHODS A search was conducted in PubMed using the terms "sleep disordered breathing" "child" and "Australia or New Zealand". All abstracts were reviewed and those which focused on the consequences of SDB have been included. RESULTS Australasian research into the consequences of SDB has grown exponentially over the last 35 years. SDB has significant adverse consequences for quality of life, behaviour, neurocognition and the cardiovascular system and the Australasian research studies investigating these are summarised. CONCLUSIONS Australian and New Zealand researchers have played a significant role in understanding the consequences of paediatric SDB and the mechanisms which underpin these. The research conducted "Downunder" has led the world in this field of research and will continue to provide evidence to improve the lives of children not only in Australasia but around the world.
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Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Level 5, Monash Children's Hospital, 246 Clayton Rd, Melbourne, 3168, Victoria, Australia.
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Isiekwe IG, Ligali TO, Abdullahi MAS, Adeyemo WL. Oral Habits in Children With Orofacial Clefts: A Comparative Study. Cleft Palate Craniofac J 2020; 58:984-989. [PMID: 33176476 DOI: 10.1177/1055665620969570] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Children with cleft lip and palate present with a wide range of dental and occlusal anomalies as a result of the cleft defect. These patients also present with oral habits which may affect their quality of life. The aim of this study was to compare the prevalence of oral habits in these children, with children without orofacial clefts. METHODOLOGY This was a cross-sectional comparative study comparing children with repaired cleft lip and/or palate aged 3 to 12 years, with children without orofacial clefts. Ethical approval for the study was obtained from the institutional review boards of both centers. Data collection was via interviewer administered questionnaires given to the parents/guardians of the children in each group. Data analysis was carried out using SPSS version 23. The level of significance was set at P < .05. RESULTS A total of 107 respondents participated in the study, comprising 53 children with repaired cleft lip and/or palate 54 children without orofacial clefts. The mean age for the children with Cleft lip and/or palate/ was 6.81 (standard deviation [SD] 1.898) years, while that for the control group was 7.78 (SD 1.68) years. Two oral habits recorded a significantly higher prevalence (P < .05) in the children with repaired clefts as compared to controls and these were lip sucking and bruxism. No significant difference in prevalence was recorded for all the other oral habits surveyed. CONCLUSION A significantly higher prevalence (P < .05) was observed in lip sucking and bruxism among children with cleft lip and palate, as compared to the children without orofacial clefts.
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Affiliation(s)
- Ikenna Gerald Isiekwe
- Department of Child Dental Health, Faculty of Dental Sciences, 98002College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Taofeek Olalekan Ligali
- Department of Preventive and Child Health, Faculty of Dentistry, College of Medical Sciences, 312957University of Maiduguri/ University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Mohammed Adam Sheikh Abdullahi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medical Sciences, 312957University of Maiduguri, Borno State, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, 98002College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
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Ehsan Z, He S, Huang G, Hossain MM, Simakajornboon N. Can overnight portable pulse oximetry be used to stratify obstructive sleep apnea risk in infants? A correlation analysis. Pediatr Pulmonol 2020; 55:2082-2088. [PMID: 32501635 DOI: 10.1002/ppul.24887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/03/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There is limited evidence on the accuracy of oximetry in the evaluation of infant obstructive sleep apnea (OSA). We aimed to determine the utility of overnight oximetry to stratify infants at risk for OSA, to determine urgency for definitive screening with an overnight in-laboratory polysomnogram (PSG). METHODS Retrospective single-institution cohort study of infants undergoing PSG and a separate overnight oximetry over an 8-year period. Correlations, using oximetry in both in-hospital (attended) or at-home (unattended) settings, for ODI410 (decrease in oxygen saturation ≥ 4% from baseline, duration ≥ 10 seconds) and ODI40 (duration > 0 second) with the obstructive apnea-hypopnea index (AHIo) were obtained. The area under the curve was calculated, and sensitivity and specificity values have been presented as receiver operating characteristic curves. RESULTS Thirty-eight infants were included. The mean (SD) age (months) was 5.7 (3.9) at diagnostic PSG and 5.5 (3.7) at the time of oximetry. The mean AHIo for the entire cohort was 6.7 (6.2). The mean (SD) ODI40 was 8.6 (9.0) and the mean (SD) ODI410 was 5.4 (5.1).The correlation between ODI and AHIo was statistically significant for the cohort (ODI40 vs. AHIo [r = .59, P < .001] and ODI410 vs AHIo [r = .55, P = .0003]). Using an ODI40 cutoff of 3, the sensitivity, specificity, negative predictive value and positive predictive value for diagnosing OSA was: 86%, 40%, 50%, and 80% respectively for an AHIo greater than 2, and 100%, 35%, 100%, and 58% respectively for an AHIo greater than or equal to 5. CONCLUSION There is a significant positive correlation between the ODI4 obtained from oximetry and the AHIo obtained from PSG in infants at risk for OSA. An ODI40 greater than 3 may be useful to stratify infants at risk for moderate to severe OSA when used in attended (in-hospital) or unattended (in-home) settings.
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Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Shan He
- Department of Otolaryngology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Bandyopadhyay A, Daftary AS. Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know. Clin Pediatr (Phila) 2020; 59:752-759. [PMID: 32274936 DOI: 10.1177/0009922820915733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103531. [PMID: 32443526 PMCID: PMC7277641 DOI: 10.3390/ijerph17103531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.
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Sadras I, Reiter J, Fuchs N, Erlichman I, Gozal D, Gileles-Hillel A. Prematurity as a Risk Factor of Sleep-Disordered Breathing in Children Younger Than Two Years: A Retrospective Case-Control Study. J Clin Sleep Med 2019; 15:1731-1736. [PMID: 31855158 PMCID: PMC7099182 DOI: 10.5664/jcsm.8072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is a highly prevalent condition affecting 2% to 4% of children. However, the prevalence and characteristics of SDB in children younger than 2 years and the effect of prematurity as a risk factor remains unclear. METHODS Children younger than 24 months referred for PSG at two medical centers between the years 2014 to 2018 were included in this retrospective analysis. We excluded children with genetic syndromes. Polysomnography (PSG) was performed and scored according to American Academy of Sleep Medicine guidelines. RESULTS Ninety-eight children were included (age 14.1 ± 6.4 [2-23] months), with 31 born prematurely (PRETERM; 24 to 34 weeks gestational age). PRETERM had increased odds of SDB (age and sex adjusted), using a cutoff of AHI ≥ 5 events/h with an odds ratio of 4.3 (95% confidence interval 1.5-12.9). Gestational age was the only significant predictor for SDB in this cohort, every additional week of gestation reducing the odds of SDB by 12.5%. PRETERM SDB was also characterized by more severe nocturnal hypoxemia, increased frequency of central apnea, and altered sleep architecture. CONCLUSIONS Current findings underscore the importance of prematurity antecedents as a risk factor for SDB in young symptomatic children younger than 2 years referred for a PSG. Future studies focused on improved estimates of the prevalence of SDB among nonreferral young children appear warranted.
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Affiliation(s)
- Ido Sadras
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joel Reiter
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Pediatric Pulmonology, Sleep and CF Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Nitzan Fuchs
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Ira Erlichman
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
- Neonatal Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Gozal
- Department of Child Health, MU Women’s and Children’s Hospital, University of Missouri School of Medicine, Columbia, Missouri
| | - Alex Gileles-Hillel
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Pediatric Pulmonology, Sleep and CF Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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Abstract
Children have differences in their physiology, anatomy and they are continuing to grow and develop. The management of pathology, trauma, deformity and upper airway obstruction in the young growing patient has to take into account these factors in the treatment planning for these conditions. It is important for Oral & Maxillofacial Surgeons to understand the potential impact of disease or injury on the developing facial skeleton and dentition. This chapter will provide an overview of the some of the major components of paediatric maxillofacial surgery and their management.
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Affiliation(s)
- J M Shand
- Department of Plastic & Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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14
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Sleep in infants with myelomeningocele-an opportunity to improve outcomes? J Perinatol 2019; 39:1325-1326. [PMID: 31420583 DOI: 10.1038/s41372-019-0468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/08/2022]
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15
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Katila M, Saarenpää‐Heikkilä O, Saha M, Vuorela N, Paavonen EJ. Parental reports showed that snoring in infants at three and eight months associated with snoring parents and smoking mothers. Acta Paediatr 2019; 108:1686-1694. [PMID: 30791132 DOI: 10.1111/apa.14758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/06/2023]
Abstract
AIM This prospective study examined the prevalence of snoring during infancy and the prenatal and postnatal risk factors for this condition. METHODS The study population comprised 1388 infants from the CHILD-SLEEP birth cohort, who were recruited in the Pirkanmaa Hospital District, Finland, between 2011 and 2013. Sleep and background factor questionnaires were filled out prenatally by parents and when the infant was three and eight months old. RESULTS The prevalence of habitual snoring was 3.2% at the age of three months and 3.0% at eight months, and snoring infants had more sleeping difficulties at those ages, with odds ratios (ORs) of 3.11 and 4.63, respectively. At three months, snoring infants slept for a shorter length of time (p = 0.001) and their sleep was more restless (p = 0.004). In ordinal logistic regression models, parental snoring (adjusted OR = 1.65 and 2.60) and maternal smoking (adjusted OR = 2.21 and 2.17) were significantly associated with infant snoring at three and eight months, while formula feeding and dummy use (adjusted OR = 1.48 and 1.56) were only associated with infant snoring at three months. CONCLUSION Parental snoring and maternal smoking increased the risk of snoring. Infants who snored also seemed to suffer more from other sleep difficulties.
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Affiliation(s)
- Maija Katila
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Outi Saarenpää‐Heikkilä
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Marja‐Terttu Saha
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | | | - E. Juulia Paavonen
- Pediatric Research Center Child Psychiatry University of Helsinki and Helsinki University Hospital Helsinki Finland
- National Institute for Health and Welfare Helsinki Finland
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16
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Shellhaas RA, Burns JW, Barks JD, Hassan F, Chervin RD. Maternal Voice and Infant Sleep in the Neonatal Intensive Care Unit. Pediatrics 2019; 144:peds.2019-0288. [PMID: 31409691 PMCID: PMC6855818 DOI: 10.1542/peds.2019-0288] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Approximately 10% of US newborns require a NICU. We evaluated whether the NICU acoustic environment affects neonatal sleep and whether exposure to the mother's voice can modulate that impact. METHODS In a level IV NICU with single-infant rooms, 47 neonates underwent 12-hour polysomnography. Their mothers were recorded reading children's books. Continuous maternal voice playback was randomized to either the first or second 6 hours of the polysomnogram. Regression models were used to examine sleep-wake stages, entropy, EEG power, and the probability of awakening in response to ambient noise during and without voice playback. RESULTS After epochs with elevated noise, the probability was higher with (versus without) maternal voice exposure of neonates staying asleep (P = .009). However, the 20 neonates born at ≥35 weeks' gestation, in contrast to those born at 33 to 34 weeks, showed an age-related increase in percent time awake (R 2 = 0.52; P < .001), a decrease in overall sleep (R 2 = 0.52; P < .001), a reduction in rapid eye movement sleep bouts per hour (R 2 = 0.35; P = .003), and an increase in sleep-wake entropy (R 2 = 0.52; P < .001) all confined solely to the 6 hours of maternal voice exposure. These associations remained significant (P = .02 to P < .001) after adjustment for neurologic examination scores and ambient noise. CONCLUSIONS Hospitalized newborns born at ≥35 weeks' gestation but not at 33 to 34 weeks' gestation show increasing wakefulness in response to their mother's voice. However, exposure to the mother's voice during sleep may also help protect newborns from awakening after bursts of loud hospital noise.
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Affiliation(s)
| | - Joseph W. Burns
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, Michigan; and
| | | | - Fauziya Hassan
- Departments of Pediatrics and,Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan; and
| | - Ronald D. Chervin
- Neurology and,Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan; and
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17
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Matlen LB, Hassan F, Shellhaas RA. Associations between age and sleep apnea risk among newborn infants. Pediatr Pulmonol 2019; 54:1297-1303. [PMID: 31081260 DOI: 10.1002/ppul.24354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Among older children, sleep-disordered breathing (SDB) is associated with measurable neurocognitive consequences. However, diagnostic SDB thresholds are lacking for infants < 12 months. We sought to evaluate the relationship between SDB indices, gestational age (GA), and postmenstrual age (PMA) for infants who underwent clinically-indicated polysomnograms at a tertiary care center. METHODS Every infant < 3-months chronological age whose first clinically-indicated polysomnogram was between 2/2012 and 2/2017 was included. Linear regression was used to evaluate associations between apnea-hypopnea index (AHI), obstructive-apnea index (OAI), and GA and PMA for infants with and without obvious clinical risk factors for SDB (eg, micrognathia and cleft palate). RESULTS For 53 infants without obvious SDB risk factors (GA 35.6 ± 4.5 weeks; PMA 41.2 ± 4.0 weeks), mean AHI was 27 ± 18 and OAI 2.9 ± 4.5. There was a weak inverse relationship between AHI and PMA (r 2 = 0.12, P = 0.01), but AHI was not predicted by GA (r 2 = 0.04, P = 0.13). Conversely, OAI was more strongly associated with GA (r 2 = 0.33, P < 0.0001) than PMA (r 2 = 0.08, P = 0.036). For 28 infants with congenital structural anomalies that predispose to SDB (GA 38.0 ± 3.1 weeks, PMA 43.1 ± 3.3 weeks, AHI 37.7 ± 30, OAI 8.2 ± 11.8), neither AHI nor OAI were related to PMA or GA. CONCLUSIONS Among infants who received clinically-indicated polysomnograms but did not have obvious structural risk for SDB, AHI declined with advancing PMA, but obstructive-apnea was best predicted by prematurity. In contrast, the SDB risk did not improve with increasing GA or PMA for infants with congenital structural risk factors; such infants may not outgrow their risk for SDB.
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Affiliation(s)
- Lisa B Matlen
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.,Michael S. Aldrich Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Fauziya Hassan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.,Michael S. Aldrich Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Renée A Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.,Michael S. Aldrich Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
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18
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Meerkov MS, Hassan F, Chervin RD, Barks JD, Carlson MD, Shellhaas RA. Sleep-disordered breathing is common among term and near term infants in the NICU. Pediatr Pulmonol 2019; 54:557-562. [PMID: 30688037 PMCID: PMC6486415 DOI: 10.1002/ppul.24266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/09/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Among older infants and children, sleep-disordered breathing (SDB) has negative neurocognitive consequences. We evaluated the frequency and potential impact of SDB among newborns who require intensive care. STUDY DESIGN Term and near-term newborns at risk for seizures underwent 12-h attended polysomnography in the neonatal intensive care unit (NICU). Bayley Scales of Infant Development, third edition (Bayley-III) were administered at 18-22 months. RESULT The 48 newborns (EGA 39.3 ± 1.6) had a median pediatric apnea-hypopnea index (AHI) of 10.1 (3.3-18.5) and most events were central (vs obstructive). Maternal and prenatal factors were not associated with AHI. Moreover, neonatal PSG results were not associated with Bayley-III scores (P > 0.05). CONCLUSION SDB is common among term and near-term newborns at risk for seizures. Follow-up at ages when more nuanced testing can be performed may be necessary to establish whether neonatal SDB is associated with long-term neurodevelopmental disability.
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Affiliation(s)
- Meera S Meerkov
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Fauziya Hassan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.,Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - John D Barks
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Martha D Carlson
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Renée A Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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19
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Morais‐Almeida M, Wandalsen GF, Solé D. Growth and mouth breathers. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Morais-Almeida M, Wandalsen GF, Solé D. Growth and mouth breathers. J Pediatr (Rio J) 2019; 95 Suppl 1:66-71. [PMID: 30611649 DOI: 10.1016/j.jped.2018.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the relationship between mouth breathing and growth disorders among children and teenagers. DATA SOURCE Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive". DATA SUMMARY A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). CONCLUSIONS Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.
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Affiliation(s)
- Mario Morais-Almeida
- Centro de Alergia dos Hospitais CUF, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
| | - Gustavo Falbo Wandalsen
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Pediatria, São Paulo, SP, Brazil
| | - Dirceu Solé
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Pediatria, São Paulo, SP, Brazil.
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21
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Sun W, Li SX, Jiang Y, Xu X, Spruyt K, Zhu Q, Tseng CH, Jiang F. A Community-Based Study of Sleep and Cognitive Development in Infants and Toddlers. J Clin Sleep Med 2018; 14:977-984. [PMID: 29852903 DOI: 10.5664/jcsm.7164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/06/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the prevalence and correlates of nighttime awakenings and to explore the association between sleep and cognitive development in a community sample of infants and toddlers. METHODS A total of 590 healthy infants (aged 2-11 months) and 512 toddlers (aged 12-30 months) from 8 provinces of China were assessed for their sleep and cognitive development. Data on sleep duration and nighttime awakenings were collected through the Brief Infant Sleep Questionnaire. Cognitive development was assessed by trained pediatricians using the Bayley Scales of Infant Development. RESULTS Prevalence of no nighttime awakening, and nighttime awakening(s) for 1×/night, 2×/night, and ≥ 3×/night was 6.8%, 20.2%, 33.2%, and 39.3% in infants, and was 25.8%, 34.6%, 23.8%, and 15.8% in toddlers, respectively. Nighttime awakenings were generally associated with younger age, lower maternal education level, and being currently breastfed. In addition, nighttime awakenings were associated with being boys in toddlers. After controlling for potential confounders, infants with nighttime awakenings for 2×/night were found to have significantly higher Mental Development Index (MDI) score, as compared to those without and those with more frequent nighttime awakenings. However, toddlers with nighttime awakenings for ≥ 3×/night had significantly lower MDI, as compared to those with fewer nighttime awakenings. Total sleep duration was not associated with any developmental indices in both infants and toddlers. CONCLUSIONS Frequent nighttime awakenings are associated with poor cognitive functions in toddlers. Meanwhile, a nonlinear association between nighttime awakenings and cognitive performance was found among infants. The findings provide a developmental context for the effect of sleep on cognitive abilities in young children. Further longitudinal studies and interventional studies on the effects of parent-based sleep-focused intervention on cognitive abilities among young children are warranted.
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Affiliation(s)
- Wanqi Sun
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China.,Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Yanrui Jiang
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Xiaojuan Xu
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Karen Spruyt
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China.,Laboratory of Integrative Physiology of Brain Arousal Systems, Center of Research in Neuroscience of Lyon, School of Medicine, Claude Bernard University, France
| | - Qi Zhu
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Chia-Huei Tseng
- Research Institute of Electrical Communication, Tohoku University, Sendai, Japan
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
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22
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Shellhaas RA, Burns JW, Hassan F, Carlson MD, Barks JDE, Chervin RD. Neonatal Sleep-Wake Analyses Predict 18-month Neurodevelopmental Outcomes. Sleep 2018; 40:4096871. [PMID: 28958087 DOI: 10.1093/sleep/zsx144] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objectives The neurological examination of critically ill neonates is largely limited to reflexive behavior. The exam often ignores sleep-wake physiology that may reflect brain integrity and influence long-term outcomes. We assessed whether polysomnography and concurrent cerebral near-infrared spectroscopy (NIRS) might improve prediction of 18-month neurodevelopmental outcomes. Methods Term newborns with suspected seizures underwent standardized neurologic examinations to generate Thompson scores and had 12-hour bedside polysomnography with concurrent cerebral NIRS. For each infant, the distribution of sleep-wake stages and electroencephalogram delta power were computed. NIRS-derived fractional tissue oxygen extraction (FTOE) was calculated across sleep-wake stages. At age 18-22 months, surviving participants were evaluated with Bayley Scales of Infant Development (Bayley-III), 3rd edition. Results Twenty-nine participants completed Bayley-III. Increased newborn time in quiet sleep predicted worse 18-month cognitive and motor scores (robust regression models, adjusted r2 = 0.22, p = .007, and 0.27, .004, respectively). Decreased 0.5-2 Hz electroencephalograph (EEG) power during quiet sleep predicted worse 18-month language and motor scores (adjusted r2 = 0.25, p = .0005, and 0.33, .001, respectively). Predictive values remained significant after adjustment for neonatal Thompson scores or exposure to phenobarbital. Similarly, an attenuated difference in FTOE, between neonatal wakefulness and quiet sleep, predicted worse 18-month cognitive, language, and motor scores in adjusted analyses (each p < .05). Conclusions These prospective, longitudinal data suggest that inefficient neonatal sleep-as quantified by increased time in quiet sleep, lower electroencephalogram delta power during that stage, and muted differences in FTOE between quiet sleep and wakefulness-may improve prediction of adverse long-term outcomes for newborns with neurological dysfunction.
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Affiliation(s)
- Renée A Shellhaas
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.,Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Joseph W Burns
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI
| | - Fauziya Hassan
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.,Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Martha D Carlson
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - John D E Barks
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI
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23
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Shellhaas RA, Kenia PV, Hassan F, Barks JD, Kaciroti N, Chervin RD. Sleep-Disordered Breathing among Newborns with Myelomeningocele. J Pediatr 2018; 194:244-247.e1. [PMID: 29221695 PMCID: PMC5826838 DOI: 10.1016/j.jpeds.2017.10.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023]
Abstract
In a matched cohort study, we report that the apnea-hypopnea index is significantly higher in neonates with myelomeningocele (34 ± 22) compared with age-matched controls (19 ± 11; P = .021). Assessment of newborns with myelomeningocele for sleep-disordered breathing may facilitate early treatment; the impact on long-term neurodevelopment is unknown.
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Affiliation(s)
- Renée A. Shellhaas
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI USA,Sleep Disorders Center, University of Michigan, Ann Arbor, MI USA
| | - Payal V. Kenia
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Fauziya Hassan
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI USA,Sleep Disorders Center, University of Michigan, Ann Arbor, MI USA
| | - John D.E. Barks
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Niko Kaciroti
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Ronald D. Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI USA,Department of Neurology, University of Michigan, Ann Arbor, MI USA
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24
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Abel F, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Tan HL, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50:50/6/1700985. [PMID: 29217599 DOI: 10.1183/13993003.00985-2017] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Abstract
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
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Affiliation(s)
- Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Francois Abel
- Dept of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Paediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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25
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Barrios CS, Jay SY, Smith VC, Alfano CA, Dougherty LR. Stability and Predictive Validity of the Parent-Child Sleep Interactions Scale: A Longitudinal Study Among Preschoolers. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:382-396. [PMID: 28816508 DOI: 10.1080/15374416.2017.1357125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little research has examined the processes underlying children's persistent sleep problems and links with later psychopathology. The current study examined the stability of parent-child sleep interactions as assessed with the parent-reported Parent-Child Sleep Interactions Scale (PSIS) and examined whether sleep interactions in preschool-age children predict sleep problems and psychiatric symptoms later in childhood. Participants included 108 preschool-age children (50% female) and their parents. Parents completed the PSIS when children were 3-5 years (T1) and again when they were 6-9 years (T2). The PSIS includes three subscales-Sleep Reinforcement (reassurance of child sleep behaviors), Sleep Conflict (parent-child conflict at bedtime), Sleep Dependence (difficulty going to sleep without parent)-and a total score. Higher scores indicate more problematic bedtime interactions. Children's sleep problems and psychiatric symptoms at T1 and T2 were assessed with a clinical interview. PSIS scores were moderately stable from T1 to T2, and the factor structure of the PSIS remained relatively consistent over time. Higher total PSIS scores at T1 predicted increases in children's sleep problems at T2. Higher PSIS Sleep Conflict scores at T1 predicted increases in oppositional defiant disorder symptoms at T2. Children with more sleep problems and higher PSIS Sleep Reinforcement scores at T1 showed increases in attention deficit/hyperactivity disorder, depressive, and anxiety symptoms at T2. These findings provide evidence for the predictive validity of the PSIS and highlight the importance of early parent-child sleep interactions in the development of sleep and psychiatric symptoms in childhood. Parent-child sleep interactions may serve as a useful target for interventions.
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26
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Tham EKH, Schneider N, Broekman BFP. Infant sleep and its relation with cognition and growth: a narrative review. Nat Sci Sleep 2017; 9:135-149. [PMID: 28553151 PMCID: PMC5440010 DOI: 10.2147/nss.s125992] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Infant sleep development is a highly dynamic process occurring in parallel to and in interaction with cognitive and physical growth. This narrative review aims to summarize and discuss recent literature and provide an overview of the relation between infant sleep and cognitive development as well as physical growth. METHODS We conducted online literature search using MEDLINE, Embase, and Cochrane Library databases. We considered original research on humans published in the English language from January 2005 to December 2015. Search terms included "sleep" AND "infant" AND "cognition" OR "memory" OR "executive functioning", OR "growth" OR "obesity" OR "growth hormone" OR "stunting", and combinations thereof. RESULTS Ten studies on infant sleep and cognition were included in this review. Overall, findings indicated a positive association between sleep, memory, language, executive function, and overall cognitive development in typically developing infants and young children. An additional 20 studies support the positive role of infant sleep in physical growth, with the current literature focusing largely on weight gain and obesity rather than healthy growth. Existing evidence in both the domains is mainly based on cross-sectional designs, on association studies, and on parental reports. In contrast, there were limited studies on longitudinal sleep trajectories and intervention effects, or studies have not used more objective sleep measures such as actigraphy and polysomnography. CONCLUSION The reviewed studies support a critical and positive role of infant sleep in cognition and physical growth. Future studies should consider key environmental and parental confounders, include a combination of more objective (actigraphy) and subjective measures (sleep diaries and questionnaires), and move towards longitudinal trajectory designs of infant sleep and development.
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Affiliation(s)
- Elaine KH Tham
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Nora Schneider
- Nestec Ltd., Nestlé Research Center, Lausanne, Switzerland
| | - Birit FP Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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Plancoulaine S, Stagnara C, Flori S, Bat-Pitault F, Lin JS, Patural H, Franco P. Early features associated with the neurocognitive development at 36 months of age: the AuBE study. Sleep Med 2017; 30:222-228. [DOI: 10.1016/j.sleep.2016.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/30/2016] [Accepted: 10/01/2016] [Indexed: 11/16/2022]
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28
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Mindell JA, Lee C. Sleep, mood, and development in infants. Infant Behav Dev 2015; 41:102-7. [DOI: 10.1016/j.infbeh.2015.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
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29
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Kohyama J. The possible long-term effects of early-life circadian rhythm disturbance on social behavior. Expert Rev Neurother 2014; 14:745-55. [PMID: 24902476 DOI: 10.1586/14737175.2014.927735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sleep loss impairs brain function. As late sleep onset can reduce sleep, this sleep/circadian rhythm disturbance may cause brain impairment. Specific data on the long-term effects of sleep/circadian rhythm disturbance on subsequent brain function are lacking. Japan, a sleep-deprived society from infancy to adulthood, provides an ideal platform to investigate the association of these disturbances in early life with subsequent functioning. In this article, several current problematic behaviors among youth in Japan (dropping out from high school, school absenteeism, early resignation from employment, and suicide) are discussed in relation to early life sleep/circadian rhythm patterns. We hypothesize that daily habits of modern society during early stages of life produce unfavorable effects on brain function resulting in problematic behaviors in subsequent years.
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Affiliation(s)
- Jun Kohyama
- Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu 279-0001, Japan
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30
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Yorbik O, Mutlu C, Koc D, Mutluer T. Possible negative effects of snoring and increased sleep fragmentation on developmental status of preschool children. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ozgur Yorbik
- Department of Child Development; Division of Child and Adolescent Psychiatry; Faculty of Health Science; Uskudar University; Istanbul Turkey
| | - Caner Mutlu
- Department of Child and Adolescent Psychiatry; Bakirkoy Dr Mazhar Osman Psychiatric and Neurological Diseases Teaching and Research Hospital; Istanbul Turkey
| | - Derya Koc
- Developmental Psychology Program; Department of Guidance and Psychological Counseling; Faculty of Education; Maltepe University; Istanbul Turkey
| | - Tuba Mutluer
- Department of Child and Adolescent Psychiatry; Istanbul University Faculty of Medicine; Istanbul Turkey
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31
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Shellhaas RA, Burns JW, Barks JDE, Chervin RD. Quantitative sleep stage analyses as a window to neonatal neurologic function. Neurology 2014; 82:390-5. [PMID: 24384644 DOI: 10.1212/wnl.0000000000000085] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that neonatal sleep physiology reflects cerebral dysfunction, we compared neurologic examination scores to the proportions of recorded sleep/wake states, sleep depth, and sleep fragmentation in critically ill neonates. METHODS Newborn infants (≥35 weeks gestation) who required intensive care and were at risk for seizures were monitored with 8- to 12-hour polysomnograms (PSGs). For each infant, the distribution of sleep-wake states, entropy of the sequence of state transitions, and delta power from the EEG portion of the PSG were quantified. Standardized neurologic examination (Thompson) scores were calculated. RESULTS Twenty-eight infants participated (mean gestational age 39.0 ± 1.6 weeks). An increased fraction of quiet sleep correlated with worse neurologic examination scores (Spearman rho = 0.54, p = 0.003), but the proportion of active sleep did not (p > 0.1). Higher state entropy corresponded to better examination scores (rho = -0.43, p = 0.023). Decreased delta power during quiet sleep, but not the power at other frequencies, was also associated with worse examination scores (rho = -0.48, p = 0.009). These findings retained significance after adjustment for gestational age or postmenstrual age at the time of the PSG. Sleep stage transition probabilities were also related to examination scores. CONCLUSIONS Among critically ill neonates at risk for CNS dysfunction, several features of recorded sleep-including analyses of sleep stages, depth, and fragmentation-showed associations with neurologic examination scores. Quantitative PSG analyses may add useful objective information to the traditional neurologic assessment of critically ill neonates.
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Affiliation(s)
- Renée A Shellhaas
- From the Department of Pediatrics and Communicable Diseases (R.A.S., J.D.E.B.) and the Michael S. Aldrich Sleep Disorders Center, Department of Neurology (R.D.C.), University of Michigan; and the Michigan Tech Research Institute (J.W.B.), Ann Arbor
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33
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Parental-reported snoring from the first month of life and cognitive development at 12months of age. Sleep Med 2011; 12:975-80. [DOI: 10.1016/j.sleep.2011.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/04/2011] [Accepted: 07/14/2011] [Indexed: 11/20/2022]
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