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Gileles-Hillel A, Bhattacharjee R, Gorelik M, Narang I. Advances in Sleep-Disordered Breathing in Children. Clin Chest Med 2024; 45:651-662. [PMID: 39069328 DOI: 10.1016/j.ccm.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Pediatric sleep-disordered breathing disorders are a group of common conditions, from habitual snoring to obstructive sleep apnea (OSA) syndrome, affecting a significant proportion of children. The present article summarizes the current knowledge on diagnosis and treatment of pediatric OSA focusing on therapeutic and surgical advancements in the field in recent years. Advancements in OSA such as biomarkers, improving continuous pressure therapy adherence, novel pharmacotherapies, and advanced surgeries are discussed.
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Affiliation(s)
- Alex Gileles-Hillel
- Neonatal Pulmonology Service, Pediatric Pulmonary and Sleep Unit; Pediatric Division, Hadassah Medical Center, Jerusalem 911111, Israel; The Faculty of Medicine, Hebrew University of Jerusalem; The Wohl Translational Research Institute, Hadassah Medical Center, Kiryat Hadassah, Ein Kerem, Jerusalem 911111, Israel.
| | - Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, Rady Children's Hospital, UCSD, San Diego, CA 92123, USA
| | - Michael Gorelik
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Indra Narang
- Division of Respiratory Medicine, Faculty Development and EDI, Department of Paediatrics, Translational Medicine, Research Institute, Hospital for Sick Children; Department of Paediatrics, University of Toronto, 51 Banff Road, Toronto M4S2V6, Canada
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Shen C, Zong D, Peng Y, Zhou L, Liu T, Ouyang R. Effect of continuous positive airway pressure treatment on Th17/Treg imbalance in patients with obstructive sleep apnea and a preliminary study on its mechanism. Sleep Breath 2024; 28:1231-1243. [PMID: 38308751 DOI: 10.1007/s11325-024-02997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) can be considered a chronic inflammatory disease that impacts all bodily systems, including the immune system. This study aims to assess the Th17/Treg pattern in patients with OSA and the effect of continuous positive airway pressure (CPAP) treatment. METHODS OSA patients and healthy controls were recruited. OSA patients recommended for CPAP treatment were followed up for three months. Flow cytometry was employed to determine the proportion of Th17 and Treg cells. Real-time quantitative polymerase chain reaction (PCR) and western blotting were utilized to detect the mRNA and protein levels of receptor-related orphan receptor γt (RORγt) and forkhead/winged helix transcription factor (Foxp3), respectively, in peripheral blood mononuclear cells (PBMCs). Enzyme-linked immunosorbent assay (ELISA) was performed to measure the serum levels of interleukin-17 (IL-17), IL-6, transforming growth factor-β1 (TGF-β1), and hypoxia-induced factor-1α (HIF-1α). RESULTS A total of 56 OSA patients and 40 healthy controls were recruited. The proportion of Th17 cells, Th17/Treg ratio, mRNA and protein levels of RORγt, and serum IL-17, IL-6, and HIF-1α levels were higher in OSA patients. Conversely, the proportion of Treg cells, mRNA and protein levels of Foxp3, and serum TGF-β1 levels were decreased in OSA patients. The proportion of Th17 and Treg cells in OSA can be predicted by the apnea hypopnea index (AHI), IL-6, TGF-β1 and, HIF-1α. 30 moderate-to-severe OSA patients were adherent to three-month CPAP treatment, with improved Th17/Treg imbalance, IL-17, IL-6, TGF-β1, and HIF-1α levels compared to pre-treatment values. CONCLUSION There was a Th17/Treg imbalance in OSA patients. The prediction of Th17 and Treg cell proportions in OSA can be facilitated by AHI, as well as serum IL-6, TGF-β1, and HIF-1α levels. Furthermore, CPAP treatment can potentially improve the Th17/Treg imbalance and reduce proinflammatory cytokines in OSA patients.
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MESH Headings
- Humans
- Sleep Apnea, Obstructive/therapy
- Sleep Apnea, Obstructive/immunology
- Sleep Apnea, Obstructive/blood
- Continuous Positive Airway Pressure
- Th17 Cells/immunology
- Male
- T-Lymphocytes, Regulatory/immunology
- Female
- Middle Aged
- Adult
- Nuclear Receptor Subfamily 1, Group F, Member 3/genetics
- Nuclear Receptor Subfamily 1, Group F, Member 3/blood
- Interleukin-17/blood
- Hypoxia-Inducible Factor 1, alpha Subunit/blood
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Forkhead Transcription Factors/blood
- Forkhead Transcription Factors/genetics
- Transforming Growth Factor beta1/blood
- Transforming Growth Factor beta1/genetics
- Interleukin-6/blood
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Affiliation(s)
- Chong Shen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine, Changsha, 410011, Hunan Province, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Dandan Zong
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine, Changsha, 410011, Hunan Province, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine, Changsha, 410011, Hunan Province, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Li Zhou
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine, Changsha, 410011, Hunan Province, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Ting Liu
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine, Changsha, 410011, Hunan Province, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Ruoyun Ouyang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine, Changsha, 410011, Hunan Province, China.
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
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Herlihy R, Frasson Dos Reis L, Gvritishvili A, Kvizhinadze M, Dybas E, Malhotra A, Fenik VB, Rukhadze I. Chronic intermittent hypoxia attenuates noradrenergic innervation of hypoglossal motor nucleus. Respir Physiol Neurobiol 2024; 321:104206. [PMID: 38142024 PMCID: PMC10872249 DOI: 10.1016/j.resp.2023.104206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
The state-dependent noradrenergic activation of hypoglossal motoneurons plays an important role in the maintenance of upper airway patency and pathophysiology of obstructive sleep apnea (OSA). Chronic intermittent hypoxia (CIH), a major pathogenic factor of OSA, contributes to the risk for developing neurodegenerative disorders in OSA patients. Using anterograde tracer, channelrhodopsin-2, we mapped axonal projections from noradrenergic A7 and SubCoeruleus neurons to hypoglossal nucleus in DBH-cre mice and assessed the effect of CIH on these projections. We found that CIH significantly reduced the number of axonal projections from SubCoeruleus neurons to both dorsal (by 68%) and to ventral (by73%) subregions of the hypoglossal motor nucleus compared to sham-treated animals. The animals' body weight was also negatively affected by CIH. Both effects, the decrease in axonal projections and body weight, were more pronounced in male than female mice, which was likely caused by less sensitivity of female mice to CIH as compared to males. The A7 neurons appeared to have limited projections to the hypoglossal nucleus. Our findings suggest that CIH-induced reduction of noradrenergic innervation of hypoglossal motoneurons may exacerbate progression of OSA, especially in men.
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Affiliation(s)
- Rachael Herlihy
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Leonardo Frasson Dos Reis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Anzor Gvritishvili
- VA West Los Angeles Medical Center, VAGLAHS, West Los Angeles, CA 90073, USA
| | - Maya Kvizhinadze
- VA West Los Angeles Medical Center, VAGLAHS, West Los Angeles, CA 90073, USA
| | - Elizabeth Dybas
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA
| | - Atul Malhotra
- University of California San Diego, San Diego, CA 92093, USA
| | - Victor B Fenik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA; VA West Los Angeles Medical Center, VAGLAHS, West Los Angeles, CA 90073, USA.
| | - Irma Rukhadze
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, USA; VA West Los Angeles Medical Center, VAGLAHS, West Los Angeles, CA 90073, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Ferrari M, Sica E, De Bernardi F, Luini A, Legnaro M, Nosetti L, Castelnuovo P, Cosentino M, Marino F. Reduction of IL-6, IL-8 and β2-ADRENOCEPTOR mRNA levels in circulating polymorphonuclear leukocytes after adenotonsillectomy in children with Obstructive Sleep Apnea Syndrome. Sleep Med 2024; 114:82-85. [PMID: 38157624 DOI: 10.1016/j.sleep.2023.12.017] [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: 08/29/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) affects approximately 1-5% of children and is linked to cardiovascular, metabolic, and neurobehavioral complications. Dysregulation of inflammatory process and sympathetic nervous system overstimulation leading to increased catecholamine production may contribute to OSAS pathogenesis. Polymorphonuclear Neutrophils (PMN), key cells in the inflammatory process, express adrenergic receptors, including β2-adrenergic receptor (ADRB2), which modulate their functions through an autocrine/paracrine loop. In this pilot study, we aimed to investigate the relationship between OSAS severity, ADRB2 expression in PMN and patient's inflammatory profile before and after adenotonsillectomy. PATIENTS/METHODS In this pilot study we enrolled OSAS pediatric patients in which ADRB2, IL-6 and IL-8 mRNA expression levels were evaluated in circulating PMN by RT-PCR. RESULTS 9 OSAS pediatric patients, ranged from 3 to 8 years of age, were enrolled in the study. We found that adenotonsillectomy significantly reduced ADRB2 as well as IL-6, IL-8 mRNA expression levels in PMN. CONCLUSIONS These findings offer valuable insights into the underlying immune and inflammatory mechanisms of OSAS and open the way for the development of novel therapeutic approaches.
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Affiliation(s)
- Marco Ferrari
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy.
| | - Eleonora Sica
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy; Department of Paediatrics, University of Insubria, Varese, Italy
| | | | - Alessandra Luini
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Massimiliano Legnaro
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Luana Nosetti
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Marco Cosentino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Franca Marino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
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Koritala BSC, Gaspar LS, Bhadri SS, Massie KS, Lee YY, Paulose J, Smith DF. Murine Pro-Inflammatory Responses to Acute and Sustained Intermittent Hypoxia: Implications for Obstructive Sleep Apnea Research. Laryngoscope 2024; 134 Suppl 4:S1-S11. [PMID: 37540033 PMCID: PMC10838350 DOI: 10.1002/lary.30915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is characterized by chronic systemic inflammation; however, the mechanisms underlying these pathologic consequences are incompletely understood. Our objective was to determine the effects of short- versus long-term exposure to intermittent hypoxia (IH) on pro-inflammatory mediators within vulnerable organs impacted by OSA. STUDY DESIGN Experimental animal study. METHODS A total of 8-10 week old C57BL/6J mice were exposed to normoxic or IH conditions for 7 days (short-term) or 6 weeks (long-term) under 12 h light, 12 h dark cycles. After exposure, multiple tissues were collected over a 24 h period. These tissues were processed and evaluated for gene expression and protein levels of pro-inflammatory mediators from peripheral tissues. RESULTS We observed a global decrease in immune response pathways in the heart, lung, and liver compared with other peripheral organs after short-term exposure to IH. Although there were tissue-specific alterations in the gene expression of pro-inflammatory mediators, with down-regulation in the lung and up-regulation in the heart, we also observed reduced protein levels of pro-inflammatory mediators in the serum, lung, and heart following short-term exposure to IH. Long-term exposure to IH resulted in an overall increase in the levels of inflammatory mediators in the serum, lung, and heart. CONCLUSIONS We demonstrated novel, longitudinal changes in the inflammatory cascade in a mouse model of OSA. The duration of exposure to IH led to significant variability of inflammatory responses within blood and cardiopulmonary tissues. Our findings further elucidate how inflammatory responses change over the course of the disease in vulnerable organs. LEVEL OF EVIDENCE NA Laryngoscope, 134:S1-S11, 2024.
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Affiliation(s)
- Bala S. C. Koritala
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Laetitia S. Gaspar
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Shweta S. Bhadri
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kyla S. Massie
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- University of California San Diego, San Diego, California, 92093, USA
| | - Yin Yeng Lee
- Department of Pediatrics, Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Jiffin Paulose
- Department of Pediatrics, Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - David F. Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- The Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- The Center for Circadian Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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Wu J, Cai X, Lu Y, Shen Y, Shen Z, Lyv Q. Plasma tRF-16-79MP9PD and tRF-28-OB1690PQR304 as potential biomarkers for 4- to 7-year-old children with obstructive sleep apnea-hypopnea syndrome. Front Pediatr 2023; 11:1141348. [PMID: 37325347 PMCID: PMC10267831 DOI: 10.3389/fped.2023.1141348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background We investigated the expression and the potential value of plasma transfer RNA-derived fragments (tRFs) of children with obstructive sleep apnea-hypopnea syndrome (OSAHS) as screening biomarkers. Methods At first, we randomly selected five plasma samples from the case group and the control group for high-throughput RNA sequencing. Secondly, we screened two tRFs with different expression between the two groups, amplified it by quantitative reverse transcription-PCR (qRT-PCR) on all samples. Then we analyzed the diagnostic value of the tRFs and their correlation with the clinical data. Results A total of 50 OSAHS children and 38 healthy controls were included. Our results demonstrated that the plasma levels of tRF-16-79MP9PD and tRF-28-OB1690PQR304 were significantly down-regulated in OSAHS children. Receiver operating characteristic curve (ROC) showed that the area under the curve (AUC) of tRF-16-79MP9PD and tRF-28-OB1690PQR304 was 0.7945 and 0.8276. In addition, the AUC of the combination reached 0.8303 with 73.46% and 76.42% sensitivity and specificity. Correlation analysis showed that the degree of tonsil enlargement, hemoglobin (Hb) and triglyceride (TG). were related to the expression levels of tRF-16-79MP9PD and tRF-28-OB1690PQR304. Multivariable linear regression analysis showed that degree of tonsil enlargement, Hb and TG related to tRF-16-79MP9PD while degree of tonsil enlargement and Hb related to tRF-28-OB1690PQR304. Conclusions The expression levels of tRF-16-79MP9PD and tRF-28-OB1690PQR304 in the plasma of OSAHS children decreased significantly which were closely related to the degree of tonsil enlargement, Hb and TG, may become novel biomarkers for the diagnosis of pediatric OSAHS.
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Affiliation(s)
- Junhua Wu
- School of Medicine, Ningbo University, Ningbo, China
- Department of Pediatric, Ningbo Women and Children's Hospital, Ningbo, China
| | - Xiaohong Cai
- School of Medicine, Ningbo University, Ningbo, China
| | - Yanbo Lu
- School of Medicine, Ningbo University, Ningbo, China
| | - Yijing Shen
- Department of Pediatric, Ningbo Women and Children's Hospital, Ningbo, China
| | - Zhisen Shen
- Department of Otorhinolaryngology, Lihuili Hospital of Ningbo University, Ningbo, China
| | - Qin Lyv
- Department of Pediatric, Ningbo Women and Children's Hospital, Ningbo, China
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Schneider G. Obstructive Sleep Apnea - Influence on the Cardiovascular System and Cognition. Laryngorhinootologie 2023; 102:S101-S114. [PMID: 37130534 PMCID: PMC10184569 DOI: 10.1055/a-1963-9957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Kardiovaskuläre und kognitive Erkrankungen sind ebenso wie die obstruktive Schlafapnoe sehr häufige Krankheiten mit einer erheblichen Beeinträchtigung der Lebensqualität und einer deutlichen sozioökonomischen Bedeutung. Die Auswirkungen einer unbehandelten obstruktiven Schlafapnoe (OSA) auf das kardiovaskuläre und kognitive Erkrankungsrisiko und die Therapieeffekte einer OSA sind für die meisten kardiovaskulären und kognitiven Folgeerkrankungen wissenschaftlich nachgewiesen. Für die klinische Praxis besteht ein deutlicher Bedarf nach mehr Interdisziplinarität. Aus schlafmedizinischer Sicht müssen bei der Therapieindikation das individuelle kardiovaskuläre und kognitive Risiko berücksichtigt und kognitive Erkrankungen bei der Beurteilung der Therapieintoleranz und residuellen Symptomatik beachtet werden. Aus internistischer Sicht sollte bei Patienten mit schlecht einstellbarem Hypertonus, Vorhofflimmern, koronarer Herzkrankheit und Schlaganfall die Abklärung einer OSA in die Diagnostik integriert werden. Bei Patienten mit milder kognitiver Beeinträchtigung, Alzheimer-Krankheit und Depression können sich die typischen Symptome wie Fatigue, Tagesmüdigkeit und Reduktion der kognitiven Leistungen mit OSA-Symptomen überschneiden. Die Diagnostik einer OSA sollte in die Abklärung dieser Krankheitsbilder integriert werden, da eine Therapie der OSA die kognitiven Beeinträchtigungen reduzieren und die Lebensqualität verbessern kann.
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Lu Y, Fu Q, Cai X, Shen Y, Wu J, Qiu H. The potential of tRF-21-U0EZY9X1B plasmatic level as a biomarker of children with obstructive sleep apnea-hypopnea syndrome. BMC Pediatr 2023; 23:197. [PMID: 37101156 PMCID: PMC10134554 DOI: 10.1186/s12887-023-04020-2] [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: 07/18/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE We investigated changes in plasma transfer RNA related fragments (tRF) in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and the potential value as a disease marker. METHODS Firstly, we randomly selected five plasma samples from the case group and the control group for high-throughput RNA sequencing. Secondly, we screened one tRF with different expression between the two groups, amplified it by quantitative reverse transcription-PCR (qRT-PCR) and sequenced the amplified product. After confirming that the qRT-PCR results were consistent with the sequencing results and the sequence of the amplified product contained the original sequence of the tRF, we performed qRT-PCR on all samples. Then we analyzed the diagnostic value of the tRF and its correlation with some clinical data. RESULTS A total of 50 OSAHS children and 38 control children were included in this study. There were significant differences in height, serum creatinine (SCR) and total cholesterol (TC) between the two groups. The plasma expression levels of tRF-21-U0EZY9X1B (tRF-21) were significantly different between the two groups. Receiver operating characteristic curve (ROC) showed that it had valuable diagnostic index, with area under the curve (AUC) of 0.773, 86.71% and 63.16% sensitivity and specificity. CONCLUSIONS The expression levels of tRF-21 in the plasma of OSAHS children decreased significantly which were closely related to hemoglobin, mean corpuscular hemoglobin, triglyceride and creatine kinase-MB, may become novel biomarkers for the diagnosis of pediatric OSAHS.
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Affiliation(s)
- Yanbo Lu
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Qiang Fu
- Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Xiaohong Cai
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Yijing Shen
- Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Junhua Wu
- Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China.
| | - Haiyan Qiu
- Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China.
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Alterki A, Abu-Farha M, Al Shawaf E, Al-Mulla F, Abubaker J. Investigating the Relationship between Obstructive Sleep Apnoea, Inflammation and Cardio-Metabolic Diseases. Int J Mol Sci 2023; 24:ijms24076807. [PMID: 37047780 PMCID: PMC10095553 DOI: 10.3390/ijms24076807] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a prevalent underdiagnosed disorder whose incidence increases with age and weight. Uniquely characterised by frequent breathing interruptions during sleep-known as intermittent hypoxia (IH)-OSA disrupts the circadian rhythm. Patients with OSA have repeated episodes of hypoxia and reoxygenation, leading to systemic consequences. OSA consequences range from apparent symptoms like excessive daytime sleepiness, neurocognitive deterioration and decreased quality of life to pathological complications characterised by elevated biomarkers linked to endocrine-metabolic and cardiovascular changes. OSA is a well-recognized risk factor for cardiovascular and cerebrovascular diseases. Furthermore, OSA is linked to other conditions that worsen cardiovascular outcomes, such as obesity. The relationship between OSA and obesity is complex and reciprocal, involving interaction between biological and lifestyle factors. The pathogenesis of both OSA and obesity involve oxidative stress, inflammation and metabolic dysregulation. The current medical practice uses continuous positive airway pressure (CPAP) as the gold standard tool to manage OSA. It has been shown to improve symptoms and cardiac function, reduce cardiovascular risk and normalise biomarkers. Nonetheless, a full understanding of the factors involved in the deleterious effects of OSA and the best methods to eliminate their occurrence are still poorly understood. In this review, we present the factors and evidence linking OSA to increased risk of cardiovascular conditions.
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Affiliation(s)
- Abdulmohsen Alterki
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait
| | - Mohamed Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait
| | - Eman Al Shawaf
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait
| | - Fahd Al-Mulla
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman 15462, Kuwait
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait
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Ryu G, Kim YM, Lee KE, Choi SJ, Hong SD, Jung YG, Oh SY, Kim HY. Obstructive Sleep Apnea Is Associated With Late-Onset Preeclampsia in Overweight Pregnant Women in Korea. J Korean Med Sci 2023; 38:e8. [PMID: 36625172 PMCID: PMC9829509 DOI: 10.3346/jkms.2023.38.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is closely related to maternal obesity in pregnant women, and the association increases with later pregnancy. Obesity and OSA are risk factors of pregnancy-related complications, including gestational hypertension, gestational diabetes mellitus (GDM), and fetal morbidities. We aimed to determine the prevalence of OSA and to assess the impact of OSA on pregnancy-related disorders in overweight pregnant women. METHODS Eligible participants who were overweight [body mass index (BMI) ≥ 23 kg/m²] in gestational age 30 weeks or more, assessed OSA using a portable polysomnography at home. Clinical data were collected from pregnant women and their babies. RESULTS The average age of 51 participants was 34.5 years (27-44 years). The number of primipara was 25 (49%) and that of multipara was 26 (51%). Eight cases of GDM (15.7%) and five cases of preeclampsia (9.8%) were reported, and six patients (11.8%) experienced preterm delivery. In results of polysomnography, 14 patients (27.5%) were diagnosed as OSA. Apnea-hypopnea index moderately correlated with BMI (r = 0.515, P < 0.001). The BMI (P < 0.005) and preeclampsia rate (P < 0.017) were higher in the OSA group compared to the control group. Odds ratios (ORs) adjusting age, BMI, parity, and abortion history were calculated. The presence of OSA increased OR of preeclampsia (OR, 13.1; 95% confidence interval, 1.1-171.3). The majority of preeclampsia patients (4/5, 80%) underwent preterm delivery. CONCLUSION OSA is an important risk factor for preeclampsia, resulting in preterm delivery. For overweight pregnant women, an OSA evaluation should be mandatory.
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Affiliation(s)
- Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Min Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Eun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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11
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Neurocognitive Consequences in Children with Sleep Disordered Breathing: Who Is at Risk? CHILDREN 2022; 9:children9091278. [PMID: 36138586 PMCID: PMC9497121 DOI: 10.3390/children9091278] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
Sleep-disordered breathing (SDB) is a prevalent disease in children characterized by snoring and narrowing of the upper airway leading to gas exchange abnormalities during sleep as well as sleep fragmentation. SDB has been consistently associated with problematic behaviors and adverse neurocognitive consequences in children but causality and determinants of susceptibility remain incompletely defined. Since the 1990s several studies have enlightened these associations and consistently reported poorer academic performance, lower scores on neurocognitive tests, and behavioral abnormalities in children suffering from SDB. However, not all children with SDB develop such consequences, and severity of SDB based on standard diagnostic indices has often failed to discriminate among those children with or without neurocognitive risk. Accordingly, a search for discovery of markers and clinically useful tools that can detect those children at risk for developing cognitive and behavioral deficits has been ongoing. Here, we review the advances in this field and the search for possible detection approaches and unique phenotypes of children with SDB who are at greater risk of developing neurocognitive consequences.
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12
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Pevernagie D. Future Treatment of Sleep Disorders: Syndromic Approach Versus Management of Treatable Traits? Sleep Med Clin 2021; 16:465-473. [PMID: 34325823 DOI: 10.1016/j.jsmc.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep disorders are categorized in line with traditional taxonomy. This conventional approach allows adequate management of many patients. Failure of treatment, however, may be due to nonspecificity of symptoms, coincidental association between symptoms and pathophysiological endotype, as well as co-occurrence of different pathologic mechanisms affecting sleep. Complex phenotypes often do not respond well to standard therapeutic interventions. In these cases, the clinical workup should aim at identifying treatable traits that will likely improve under targeted therapy. The challenge for sleep medicine is to further develop this innovative approach that is driven by the principles of systems medicine.
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Affiliation(s)
- Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium.
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13
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Rivas-Echeverría CA, Thirlwell C, Molina LI, Rivas FI, Sánchez RE, González SB, Rivas CA. Sleep apnea, "the Ugly Duckling of the Cinderellas" in cardiovascular prevention and rehabilitation. Panminerva Med 2021; 63:133-145. [PMID: 33709678 DOI: 10.23736/s0031-0808.21.04273-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases are the leading cause of death and account for the largest share of health expenditure worldwide, mainly invested in hospital and secondary care. Prevention and rehabilitation strategies are nearly neglected, therefore "the Cinderellas," in the health-care budget. The World Health Organization has proposed cost-effective interventions to reduce the impact of cardiovascular diseases that include polydrug treatment for hypertension and diabetes, counselling, diet, exercise, and others. Obstructive sleep apnea is not even mentioned among these interventions; consequently, it could be "the Ugly Duckling of the Cinderellas." Obstructive sleep apnea (OSA) is characterized by the presence of obstructive apneas or hypopneas during sleep, accompanied by hypoxia; and it is a highly prevalent but under-diagnosed condition. Although awareness of sleep apnea has recently increased most facts about it remains ignored by many. Robust evidence suggests that OSA is associated with, or is an independent risk factor for, hypertension, cerebrovascular disease, ischemic heart disease, heart failure and arrhythmias and that its prevalence among some of these cardiovascular diseases is higher than 80%. The efficacy of continuous positive airway pressure treatment for obstructive sleep apnea has been established. If obstructive sleep apnea plays a significant role in cardiovascular diseases, then screening and timely appropriate treatment could reduce morbidity and mortality. Thus, the public health and economic impact of these conditions could be included in the "best buy" list of interventions. This narrative review discusses the relationship between OSA and cardiovascular diseases and how neglected the link is.
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Affiliation(s)
- Carlos A Rivas-Echeverría
- The Glenfield Surgery, NHS, Leicester, UK - .,SLEEPCARE Clinic of Respiratory and Sleep Medicine, Soria, Spain -
| | | | | | - Francklin I Rivas
- Department of Information Technology, Federico Santa María Technical University, Valparaíso, Chile
| | - Racely E Sánchez
- SLEEPCARE Clinic of Respiratory and Sleep Medicine, Soria, Spain
| | | | - Carlos A Rivas
- Faculty of Medicine, University of Navarra, Pamplona, Spain
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14
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Kotsiou OS, Papagiannis D, Papadopoulou R, Gourgoulianis KI. Calprotectin in Lung Diseases. Int J Mol Sci 2021; 22:ijms22041706. [PMID: 33567747 PMCID: PMC7915440 DOI: 10.3390/ijms22041706] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Calprotectin (CLP) is a heterodimer formed by two S-100 calcium-binding cytosolic proteins, S100A8 and S100A9. It is a multifunctional protein expressed mainly by neutrophils and released extracellularly by activated or damaged cells mediating a broad range of physiological and pathological responses. It has been more than 20 years since the implication of S100A8/A9 in the inflammatory process was shown; however, the evaluation of its role in the pathogenesis of respiratory diseases or its usefulness as a biomarker for the appropriate diagnosis and prognosis of lung diseases have only gained attention in recent years. This review aimed to provide current knowledge regarding the potential role of CLP in the pathophysiology of lung diseases and describe how this knowledge is, up until now, translated into daily clinical practice. CLP is involved in numerous cellular processes in lung health and disease. In addition to its anti-microbial functions, CLP also serves as a molecule with pro- and anti-tumor properties related to cell survival and growth, angiogenesis, DNA damage response, and the remodeling of the extracellular matrix. The findings of this review potentially introduce CLP in daily clinical practice within the spectrum of respiratory diseases.
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Affiliation(s)
- Ourania S. Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
- Department of Nursing, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
- Correspondence:
| | - Dimitrios Papagiannis
- Department of Nursing, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Rodanthi Papadopoulou
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK;
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15
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Oceja E, Rodríguez P, Jurado MJ, Luz Alonso M, del Río G, Villar MÁ, Mediano O, Martínez M, Juarros S, Merino M, Corral J, Luna C, Kheirandish-Gozal L, Gozal D, Durán-Cantolla J. Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology. Methods Protoc 2021; 4:9. [PMID: 33477929 PMCID: PMC7838960 DOI: 10.3390/mps4010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.
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Affiliation(s)
- Esther Oceja
- Domiciliary Hospitalization, Sleep Unit, OSI Araba University Hospital, 01004 Vitoria, Spain;
| | - Paula Rodríguez
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
| | - María José Jurado
- Sleep Unit, Hospital Universitario Valle de Hebrón, 08035 Barcelona, Spain;
| | - Maria Luz Alonso
- Sleep Unit, Complejo Hospitalario de Burgos, 09006 Burgos, Spain
| | | | | | - Olga Mediano
- Sleep Unit, Hospital de Guadalajara, 19002 Guadalajara, Spain;
| | - Marian Martínez
- Sleep Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Santiago Juarros
- Sleep Unit, Hospital Universitario de Valladolid, 47012 Valladolid, Spain;
| | - Milagros Merino
- Sleep Unit, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Jaime Corral
- Sleep Unit, Complejo Hospitalario de Cáceres, 100003 Cáceres, Spain;
| | - Carmen Luna
- Sleep Unit, Hospital Universitario 12 de Octubre, 280035 Madrid, Spain;
| | - Leila Kheirandish-Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - Joaquín Durán-Cantolla
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
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16
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Bencharit S, Redenz RG, Brody ER, Chiang H. Salivary biomarkers associated with obstructive sleep apnea: a systematic review. Expert Rev Mol Diagn 2021; 21:223-233. [PMID: 33404265 DOI: 10.1080/14737159.2021.1873132] [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: 10/22/2022]
Abstract
Introduction: This study aimed to define and characterize current literature describing salivary biomarker changes with the goal of improving diagnosis and treatment outcomes for sleep apnea.Area Covered: A search of six databases yielded 401 peer-reviewed articles published through October 2019 corresponded to 221 unique references following deduplication. Twenty studies were selected. The sample size ranged from 17 to 99. The samples were mostly whole saliva and selected glandular areas.Expert Opinion: Most targeted studies focused on the level of salivary cortisol and ɑ-amylase. One study used RNA transcriptome analysis of 96 genes. Only two explored novel targets using mass spectrometry. ɑ-amylase, myeloperoxidase, and IL-6 were among those biomarkers found associated with OSA. Cytokeratin, CystatinB, calgranulin A, and alpha-2-HS-glycoprotein are upregulated in OSA patients based on non-targeting mass spectrometry. Salivary cortisol and ɑ-amylase and others appeared to be associated with severity of OSA and OSA treatment. There were inconsistencies in saliva collection and processing protocols. More studies are needed in exploring novel biomarkers to examine if these biomarkers are capable of diagnosing and monitoring OSA through proteomics or transcriptomics. Salivary biomarkers have a potential to be a noninvasive measure for the disease diagnosis and treatment outcome monitoring for sleep apnea.
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Affiliation(s)
- Sompop Bencharit
- Department of General Practice and Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert G Redenz
- School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erica R Brody
- VCU Libraries
- Tompkins-McCaw Library for the Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Harmeet Chiang
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
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17
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O'Mahony AM, Garvey JF, McNicholas WT. Technologic advances in the assessment and management of obstructive sleep apnoea beyond the apnoea-hypopnoea index: a narrative review. J Thorac Dis 2020; 12:5020-5038. [PMID: 33145074 PMCID: PMC7578472 DOI: 10.21037/jtd-sleep-2020-003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Obstructive sleep apnoea (OSA) is a growing and serious worldwide health problem with significant health and socioeconomic consequences. Current diagnostic testing strategies are limited by cost, access to resources and over reliance on one measure, namely the apnoea-hypopnoea frequency per hour (AHI). Recent evidence supports moving away from the AHI as the principle measure of OSA severity towards a more personalised approach to OSA diagnosis and treatment that includes phenotypic and biological traits. Novel advances in technology include the use of signals such as heart rate variability (HRV), oximetry and peripheral arterial tonometry (PAT) as alternative or additional measures. Ubiquitous use of smartphones and developments in wearable technology have also led to increased availability of applications and devices to facilitate home screening of at-risk populations, although current evidence indicates relatively poor accuracy in comparison with the traditional gold standard polysomnography (PSG). In this review, we evaluate the current strategies for diagnosing OSA in the context of their limitations, potential physiological targets as alternatives to AHI and the role of novel technology in OSA. We also evaluate the current evidence for using newer technologies in OSA diagnosis, the physiological targets such as smartphone applications and wearable technology. Future developments in OSA diagnosis and assessment will likely focus increasingly on systemic effects of sleep disordered breathing (SDB) such as changes in nocturnal oxygen and blood pressure (BP); and may also include other factors such as circulating biomarkers. These developments will likely require a re-evaluation of the diagnostic and grading criteria for clinically significant OSA.
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Affiliation(s)
- Anne M O'Mahony
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John F Garvey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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18
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Alismail S, Olfman L. A Tailored Motivational Messages Library for a Mobile Health Sleep Behavior Change Support System to Promote Continuous Positive Airway Pressure Use Among Patients With Obstructive Sleep Apnea: Development, Content Validation, and Testing. JMIR Mhealth Uhealth 2020; 8:e18793. [PMID: 32784176 PMCID: PMC7450383 DOI: 10.2196/18793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/27/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is the most effective treatment for obstructive sleep apnea (OSA). Despite the reported benefits of CPAP therapy in treating OSA, its effectiveness is reduced by less-than-optimal adherence or use. Up to 50% of patients who accept CPAP therapy fail to adhere to it. As a lack of commitment to CPAP therapy is one of the most significant factors that hinder OSA treatment effectiveness, patient motivation and education are critical to help alleviate the problem of poor CPAP adherence or use. OBJECTIVE This study aims to support the development of mobile health interventions or information systems solutions to promote CPAP adherence and use among patients with OSA through development, content validation, and testing of tailored motivational messages. METHODS In phase 1, an initial library of 60 messages was developed to promote CPAP use among patients with OSA. In phase 2, draft messages were evaluated for content validation testing for relevance and clarity by research and clinical experts. In phase 3, patients with OSA (N=24) were recruited through a Qualtrics panel to rate the perceived persuasiveness of the messages in terms of threat and efficacy perceptions, as per their computed extended parallel process model (EPPM) response states. The average score of the ratings was calculated for each message. The messages were sorted according to their average (from highest to lowest) to select the best 12 messages for each tailored set based on the potential responses from the EPPM. RESULTS In phase 1, 60 messages were developed based on the existing literature and a review of existing materials. In phase 2, the enumerated content validity of the messages was established through the use of the content validity index for items. A total of 57 messages were found to have acceptable content relevance and clarity. In phase 3, patients with OSA perceived the final library of 48 messages to be persuasive. CONCLUSIONS After the process of content validation and testing, the final library of messages met the criteria for clarity, relevance, and perceived persuasiveness. This study emphasizes the importance of developing and validating the content of motivational messages, grounded in EPPM theory, across the 4 possible response states in terms of high or low efficacy and threat perceptions.
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Affiliation(s)
- Sarah Alismail
- Claremont Graduate University, Claremont, CA, United States
| | - Lorne Olfman
- Claremont Graduate University, Claremont, CA, United States
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19
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Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine. Chest 2020; 157:403-420. [PMID: 31539538 PMCID: PMC7005379 DOI: 10.1016/j.chest.2019.09.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/13/2019] [Accepted: 09/01/2019] [Indexed: 12/21/2022] Open
Abstract
Current strategies for the management of OSA reflect a one-size-fits-all approach. Diagnosis and severity of OSA are based on the apnea-hypopnea index and treatment initiated with CPAP, followed by trials of alternatives (eg, oral appliances) if CPAP "fails." This approach does not consider the heterogeneity of individuals with OSA, reflected by varying risk factors, pathophysiological causes, clinical manifestations, and consequences. Recently, studies using analytic approaches such as cluster analysis have taken advantage of this heterogeneity to identify OSA phenotypes, or subtypes of patients with unique characteristics, that may enable more personalized approaches to prognostication and treatment. Examples include symptom-based subtypes such as "excessively sleepy" and "disturbed sleep" with differing impact of CPAP on symptoms and health-related quality of life. Polysomnographic subtypes, distinguished by respiratory event association with hypoxemia, arousals, or both, exhibit varying risks of cardiovascular disease and response to therapy. This review summarizes the findings from recent cluster analysis studies in sleep apnea and synthesizes common themes to describe the potential role (and limitations) of phenotypic subtypes in precision medicine for OSA. It also highlights future directions, including linking of phenotypes to clinically relevant outcomes, rigorous and transparent assessment of phenotype reproducibility, and need for tools that categorize patients into subtypes, to prospectively validate phenotype-based prognostication and treatment approaches. Finally, we highlight the critical need to include women and more racially/ethnically diverse populations in this area of research if we are to leverage the heterogeneity of OSA to improve patient lives.
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Affiliation(s)
- Andrey Zinchuk
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
| | - Henry K Yaggi
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Health Care System, West Haven, CT
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20
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Mediano O, Cano-Pumarega I, Sánchez-de-la-Torre M, Alonso-Álvarez ML, Troncoso MF, García-Río F, Egea C, Durán-Cantolla J, Terán-Santos J, Barbé F, Fernando Masa J, Montserrat JM. Upcoming Scenarios for the Comprehensive Management of Obstructive Sleep Apnea: An Overview of the Spanish Sleep Network. Arch Bronconeumol 2020; 56:35-41. [DOI: 10.1016/j.arbres.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
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21
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Mohammadi H, Rezaei M, Sharafkhaneh A, Khazaie H, Ghadami MR. Serum testosterone/cortisol ratio in people with obstructive sleep apnea. J Clin Lab Anal 2019; 34:e23011. [PMID: 31549459 PMCID: PMC6977109 DOI: 10.1002/jcla.23011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/21/2019] [Accepted: 07/30/2019] [Indexed: 01/13/2023] Open
Abstract
Objectives Obstructive sleep apnea (OSA) is a major health problem that has been associated with endocrine dysfunction in the hypothalamic‐pituitary‐gonadal (HPG) and hypothalamic‐pituitary‐adrenal (HPA) axes. This study investigated cortisol, testosterone, and the testosterone/cortisol ratio in patients with OSA compared to normal sleepers. Methods Thirty‐nine OSA patients diagnosed by overnight polysomnography (PSG) were divided into three groups, including ten mild OSA patients, 16 patients with moderate OSA, and 13 patients with severe OSA according to the apnea‐hypopnea index (AHI). In addition, 13 normal sleepers with normal PSG findings were recruited as the control group. Serum levels of cortisol, testosterone, and sex hormone‐binding globulin (SHBG) were measured using enzyme‐linked immunosorbent assay (ELISA). Results There were no significant differences between the normal sleepers and the three subtypes of OSA in terms of total and free testosterone levels (P > .1). The results showed significantly higher levels of cortisol in the severe OSA group compared to the normal sleepers and the two other subtypes of OSA (P < .01). In addition, the testosterone/cortisol (T/C) ratio was significantly lower among the severe OSA compared to the moderate OSA patients (P = .01). A significant correlation was observed between minimal SpO2 and AHI (r=−0.69, P < .01), cortisol and AHI (r = .47, P < .01) and cortisol and minimal SpO2 (r = −.26, P = .06). Conclusion According to the findings, OSA is linked to HPA axis activity in severe OSA patients but not among the mild and moderate subtypes of the disorder.
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Affiliation(s)
- Hiwa Mohammadi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rezaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Sharafkhaneh
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rasoul Ghadami
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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22
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Ke D, Kitamura Y, Lejtenyi D, Mazer B, Brouillette RT, Brown K. Enhanced interleukin-8 production in mononuclear cells in severe pediatric obstructive sleep apnea. Allergy Asthma Clin Immunol 2019; 15:23. [PMID: 31015845 PMCID: PMC6469051 DOI: 10.1186/s13223-019-0338-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/30/2019] [Indexed: 02/05/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease, metabolic disorders, and cognitive dysfunction. Current thinking links chronic intermittent hypoxia (CIH) with oxidative stress and systemic inflammation. However, the sequence of events leading to the morbidities associated with OSA is poorly understood in children. Monocytes are known to be altered by chronic hypoxia. Thus in this prospective study, we investigated inflammatory cytokine profiles from cultures of peripheral blood mononuclear cells (PBMC) obtained from children with severe OSA and sleep-related CIH. Methods Ten children with OSA (cases) and 5 age-matched children without OSA (controls) were recruited for study. Samples of plasma and PBMC were obtained before and after adenotonsillectomy. The levels of the inflammatory cytokines, interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-α (TNFα), were measured in both plasma and ex vivo culture supernatants of PBMC incubated with lipopolysaccharide (LPS) using the cytometric bead assay. Results Upon activation of PBMC by LPS, the levels of IL-8 in the culture supernatants from cases were threefold higher than in controls. The levels of the other cytokines including IL-1β, IL-6, and TNFα, in culture supernatant of PBMC from cases showed no difference from controls; nor were there significant differences in plasma cytokine levels. Conclusion We speculate that in young children with sleep-related CIH, an enhanced production capacity of IL-8 precedes the development of systemic inflammatory markers. Future work should evaluate IL-8 production capacity as a potential biomarker for OSA severity.
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Affiliation(s)
- Danbing Ke
- 1Research Institute, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1 Canada
| | - Yuji Kitamura
- 2Department of Anesthesia, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1 Canada
| | - Duncan Lejtenyi
- 3Division of Pediatric Allergy and Immunology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1 Canada
| | - Bruce Mazer
- 3Division of Pediatric Allergy and Immunology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1 Canada
| | - Robert T Brouillette
- 4Department of Pediatrics, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1 Canada
| | - Karen Brown
- 2Department of Anesthesia, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1 Canada.,Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, 1001 Decarie Boulevard, Room B 04.2422, Montreal, QC H4A 3J1 Canada
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A scoping review describes methods used to identify, prioritize and display gaps in health research. J Clin Epidemiol 2019; 109:99-110. [PMID: 30708176 DOI: 10.1016/j.jclinepi.2019.01.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/10/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Different methods to examine research gaps have been described, but there are still no standard methods for identifying, prioritizing, or reporting research gaps. This study aimed to describe the methods used to identify, prioritize, and display gaps in health research. METHODS A scoping review using the Arksey and O'Malley methodological framework was carried out. We included all study types describing or reporting on methods to identify, prioritize, and display gaps or priorities in health research. Data synthesis is both quantitative and qualitative. RESULTS Among 1,938 identified documents, 139 articles were selected for analysis; 90 (65%) aimed to identify gaps, 23 (17%) aimed to determine research priorities, and 26 (19%) had both aims. The most frequent methods in the review were aimed at gap identification and involved secondary research, which included knowledge synthesis (80/116 articles, 69%), specifically systematic reviews and scoping reviews (58/80, 73%). Among 49 studies aimed at research prioritization, the most frequent methods were both primary and secondary research, accounting for 24 (49%) reports. Finally, 52 (37%) articles described methods for displaying gaps and/or priorities in health research. CONCLUSION This study provides a mapping of different methods used to identify, prioritize, and display gaps or priorities in health research.
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24
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MacLean JE. Assessment and treatment of pediatric obstructive sleep apnea in Canada: history and current state of affairs. Sleep Med 2019; 56:23-28. [PMID: 30745075 DOI: 10.1016/j.sleep.2019.01.011] [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: 07/30/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 02/07/2023]
Abstract
AIM To highlight Canada's contributions to the assessment and treatment of pediatric obstructive sleep apnea as well as outline the current state of pediatric obstructive sleep apnea in Canada. METHODS A search was conducted in MEDLINE (Ovid) using Medical Subject Headings (MeSH) and free-text terms for 'child' and 'obstructive sleep apnea' with subsequent 'human' limit. The results were reviewed to identify publications where any author's listed a Canadian institution. RESULTS Canadian contributions to the field of pediatric obstructive sleep apnea have grown over the last 30 years with an increase in number of contributors and centres. Much of the early work stemmed from McGill University with important contributions in examining alternatives to polysomnography and post-adenotonsillectomy respiratory compromise. Today, contributors from centres across the country are engaged in the field and come from a greater diversity of disciplines. With continued challenges and opportunities, Canada will continue to help advance the field of pediatric OSA. CONCLUSION Canada has a strong community of people invested in continuing to work to improve the lives of Canadian children with pediatric OSA.
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Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
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25
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Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci 2019; 20:ijms20030459. [PMID: 30678164 PMCID: PMC6387387 DOI: 10.3390/ijms20030459] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates. In adult patients, excessive daytime sleepiness (EDS) is the most frequent symptom leading to clinical referral for evaluation and treatment, but classic EDS features are less likely to be reported in children, particularly among those with normal body-mass index. The cumulative evidence collected over the last two decades supports a conceptual framework, whereby sleep-disordered breathing in general and more particularly OSAS should be viewed as low-grade chronic inflammatory diseases. Accordingly, it is assumed that a proportion of the morbid phenotypic signature in OSAS is causally explained by underlying inflammatory processes inducing end-organ dysfunction. Here, the published links between OSAS and systemic inflammation will be critically reviewed, with special focus on the pro-inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), since these constitute classical prototypes of the large spectrum of inflammatory molecules that have been explored in OSAS patients.
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26
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Rukhadze I, Fenik VB. Neuroanatomical Basis of State-Dependent Activity of Upper Airway Muscles. Front Neurol 2018; 9:752. [PMID: 30250449 PMCID: PMC6139331 DOI: 10.3389/fneur.2018.00752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 12/16/2022] Open
Abstract
Obstructive Sleep Apnea (OSA) is a common sleep-related respiratory disorder that is associated with cognitive, cardiovascular, and metabolic morbidities. The major cause of OSA is the sleep-related reduction of upper airway muscle tone that leads to airway obstructions in individuals with anatomically narrow upper airway. This reduction is mainly due to the suppressant effect of sleep on hypoglossal motoneurons that innervate upper airway muscles. The hypoglossal motoneurons have state-dependent activity, which is decreased during the transition from wakefulness to non-rapid eye movement sleep and is further suppressed during rapid eye movement sleep. Multiple neurotransmitters and their receptors have been implicated in the control of hypoglossal motoneuron activity across the sleep-wake states. However, to date, the results of the rigorous testing show that withdrawal of noradrenergic excitation and cholinergic inhibition essentially contribute to the depression of hypoglossal motoneuron activity during sleep. The present review will focus on origins of noradrenergic and cholinergic innervation of hypoglossal motoneurons and the functional role of these neurons in the state-dependent activity of hypoglossal motoneurons.
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Affiliation(s)
- Irma Rukhadze
- VA West Los Angeles Medical Center, West Los Angeles, CA, United States.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Victor B Fenik
- VA West Los Angeles Medical Center, West Los Angeles, CA, United States.,Websciences International, Los Angeles, CA, United States
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27
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Gozal D. The ageing brain in sleep apnoea: paradoxical resilience, survival of the fittest, or simply comparing apples and oranges? Eur Respir J 2018; 51:51/6/1800802. [PMID: 29903830 DOI: 10.1183/13993003.00802-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- David Gozal
- Dept of Pediatrics, Section of Sleep Medicine, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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28
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Smith DF, Hossain MM, Hura A, Huang G, McConnell K, Ishman SL, Amin RS. Inflammatory Milieu and Cardiovascular Homeostasis in Children With Obstructive Sleep Apnea. Sleep 2017; 40:2991813. [PMID: 28204724 DOI: 10.1093/sleep/zsx022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Biomarkers of atherosclerosis (pro-inflammatory cytokines and acute phase reactants) are elevated in children with obstructive sleep apnea (OSA). However, their association with cardiovascular endpoints in children are not understood. We hypothesized that biomarkers of atherosclerosis in children with OSA correlate with pulse transit time (PTT), a surrogate measure of vascular stiffness, with some positively influencing and others negatively influencing PTT. Methods Children with OSA and matched controls were recruited to the study. Pro-inflammatory cytokines and acute phase reactants were measured at 6:00 pm and 6:00 am. Polysomnography with beat-to-beat blood pressure was performed. PTT during wakefulness and stage 2 sleep was calculated. Diurnal variation of biomarkers and their associations with PTT was estimated. Factor analysis was used to determine the effect of groups of cytokines on PTT. Results One hundred fifty-five children participated in the study; 90 were healthy controls and 65 had OSA. Children with OSA exhibited a different diurnal variation of biomarkers than healthy controls, with pro-inflammatory cytokines peaking in the morning and acute phase reactants peaking in the afternoon. Structural equation modeling demonstrated that interleukins 6 and 8, tumor necrosis factor-α, and sCD40L had a shortening effect, while serum amyloid A, C-reactive protein, and adiponectin had a prolonging effect on PTT. As a result, there was no difference in PTT between the two groups. Conclusion The differential relationships of acute phase reactants and pro-inflammatory cytokines with PTT suggest that in children with OSA, these mediators may have opposing actions to maintain cardiovascular homeostasis.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Md M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arjan Hura
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Keith McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Bauça JM, Yañez A, Fueyo L, de la Peña M, Pierola J, Sánchez-de-la-Torre A, Mediano O, Cabriada-Nuño V, Masdeu MJ, Teran-Santos J, Duran-Cantolla J, Masa JF, Abad J, Sanchez-de-la-Torre M, Barbé F, Barceló A. Cell Death Biomarkers and Obstructive Sleep Apnea: Implications in the Acute Coronary Syndrome. Sleep 2017; 40:3737643. [PMID: 28419383 DOI: 10.1093/sleep/zsx049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
Study Objectives Nucleosomes and cell-free double-stranded DNA (dsDNA) have been suggested as promising biomarkers in cell death-related diseases, such as acute coronary syndrome (ACS). Currently, the impact of obstructive sleep apnea (OSA) in patients with ACS is unclear. Our aim was to evaluate the relationship between OSA, dsDNA, and nucleosomes and to assess their potential implication in the development of ACS. Methods Up to 549 patients were included in the study and divided into four groups (145 ACS; 290 ACS + OSA; 62 OSA; 52 controls). All patients underwent a sleep study, and serum concentrations of dsDNA and nucleosomes were measured. Results Nucleosome and dsDNA levels were higher in patients with OSA than in controls (nucleosomes: 1.47 ± 0.88 arbitary units [AU] vs. 1.00 ± 0.33 AU; p < .001, dsDNA: 315.6 ± 78.0 ng/mL vs. 282.6 ± 55.4 ng/mL; p = .007). In addition, both biomarker levels were higher in patients with ACS than in non-ACS, independently of the presence of OSA. Conclusions Both nucleosomes and dsDNA are increased in patients with OSA and might be related with the high cardiovascular risk seen in these patients. The extensive cell lysis during a myocardial infarction seems to be the major contributor to the high biomarker levels, and OSA does not seem to be implicated in such elevation when this acute event occurs. Clinical trial registration NCT01335087 (clinicaltrials.gov).
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Affiliation(s)
- Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain.,Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Aina Yañez
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Research Group on Evidence, Lifestyles and Health, Universitat Illes Balears, Palma, Spain
| | - Laura Fueyo
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - Mónica de la Peña
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Respiratory Department, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Javier Pierola
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Alicia Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain
| | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital Universitario de Guadalajara, Guadalajara, Castilla-La Mancha, Spain
| | | | - María José Masdeu
- Respiratory Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona. Sabadell, Catalonia, Spain
| | - Joaquin Teran-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital Universitario Burgos, Burgos, Castilla-León, Spain
| | - Joaquin Duran-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Research Department, OSI Araba University Hospital, UPV/EHU, Vitoria, Basque Country, Spain
| | - Juan Fernando Masa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital San Pedro de Alcántara, Cáceres, Extremadura, Spain
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital Germans Trias i Pujol, Barcelona, Catalonia, Spain
| | - Manuel Sanchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain
| | - Antònia Barceló
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain.,Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2017; 100:44-51. [PMID: 28802385 DOI: 10.1016/j.ijporl.2017.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) affects 1-5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA. METHODS A prospective study was conducted in children, ages 2-17. Subjects completed in-lab polysomnography simultaneously with ambulatory monitoring. Caregivers attempted home studies on two subsequent nights to compare the home monitor and the laboratory polysomnogram (PSG). RESULTS Thirty-three subjects completed simultaneous laboratory polysomnogram with portable monitoring. Twenty patients completed home studies, with 16 completing 2 nights of monitoring. The measurement of AHI by the portable monitor was different than that obtained by the PSG with statistical significance for the comparisons of PSG vs. In-Lab (p = 0.0026), PSG vs. Home 1 (p = 0.033), and PSG vs. Home 2 (p = 0.033). The sensitivity of the portable monitor for diagnosing OSA was best for the In-lab use at 81%, but only 69% and 70% for the uses at home on the 2 nights respectively. Interestingly, the comparison of AHI and lowest oxygen saturation measurements from the home sleep test in children age 6 and older did not differ significantly from the PSG. CONCLUSIONS This pilot study demonstrated differences between home sleep testing and in-lab polysomnography for the diagnosis of pediatric sleep apnea. These differences were predominantly found to exist in younger children. Larger prospective studies are needed prior to widespread use, but home studies may alleviate issues of access to care and higher costs of laboratory polysomnography.
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Rukhadze I, Carballo NJ, Bandaru SS, Malhotra A, Fuller PM, Fenik VB. Catecholaminergic A1/C1 neurons contribute to the maintenance of upper airway muscle tone but may not participate in NREM sleep-related depression of these muscles. Respir Physiol Neurobiol 2017; 244:41-50. [PMID: 28711601 DOI: 10.1016/j.resp.2017.07.001] [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] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 12/12/2022]
Abstract
Neural mechanisms of obstructive sleep apnea, a common sleep-related breathing disorder, are incompletely understood. Hypoglossal motoneurons, which provide tonic and inspiratory activation of genioglossus (GG) muscle (a major upper airway dilator), receive catecholaminergic input from medullary A1/C1 neurons. We aimed to determine the contribution of A1/C1 neurons in control of GG muscle during sleep and wakefulness. To do so, we placed injections of a viral vector into DBH-cre mice to selectively express the hMD4i inhibitory chemoreceptors in A1/C1 neurons. Administration of the hM4Di ligand, clozapine-N-oxide (CNO), in these mice decreased GG muscle activity during NREM sleep (F1,1,3=17.1, p<0.05); a similar non-significant decrease was observed during wakefulness. CNO administration had no effect on neck muscle activity, respiratory parameters or state durations. In addition, CNO-induced inhibition of A1/C1 neurons did not alter the magnitude of the naturally occurring depression of GG activity during transitions from wakefulness to NREM sleep. These findings suggest that A1/C1 neurons have a net excitatory effect on GG activity that is most likely mediated by hypoglossal motoneurons. However, the activity of A1/C1 neurons does not appear to contribute to NREM sleep-related inhibition of GG muscle activity, suggesting that A1/C1 neurons regulate upper airway patency in a state-independent manner.
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Affiliation(s)
- Irma Rukhadze
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | - Nancy J Carballo
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sathyajit S Bandaru
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Patrick M Fuller
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Victor B Fenik
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA; WebSience International, Los Angeles, CA, USA
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Ehsan Z, Ishman SL, Kimball TR, Zhang N, Zou Y, Amin RS. Longitudinal Cardiovascular Outcomes of Sleep Disordered Breathing in Children: A Meta-Analysis and Systematic Review. Sleep 2017; 40:2962446. [PMID: 28329042 DOI: 10.1093/sleep/zsx015] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives The presence of sleep disordered breathing (SDB) is known to impact long-term cardiovascular morbidity in adults; however, the long-term effects in children are poorly understood. We aimed to systematically review and synthesize studies published to date on the long-term effects of SDB in children. Study Design Meta-analysis and systematic review using PubMed, CINAHL, Embase, and Scopus (all indexed years). Methods We searched for English-language articles containing original human data from prospective studies, with ≥7 participants, in children ≤18 years of age. Data regarding study design, demographics, clinical characteristics, outcomes, level of evidence, and risk of bias were obtained. Articles were independently reviewed by three investigators. Retrospective and cross-sectional studies were excluded. Results Of 1701 identified abstracts, 25 articles (combined n = 1418) were ultimately included. All studies reported longitudinal outcomes following treatment of SDB, 21 studies exclusively reporting outcomes after adenotonsillectomy. Therefore, studies were combined to objectively assess the effect of SDB treatment on cardiovascular outcomes. Although all cardiovascular parameters were within the normal range at baseline, at follow-up there was a significant decrease in mean pulmonary artery pressure, right ventricular end diastolic diameter, heart rate, mitral Em/Am ratio, and C-reactive protein. There was no significant change in interventricular septum thickness, left ventricular parameters (shortening fraction, systolic and end diastolic diameters, ejection fraction, posterior wall thickness, isovolumetric relaxation time), left atrial diameter, and aortic and pulmonary valve peak velocities. Conclusions Studies assessing the long-term cardiovascular effects of SDB in children are limited. The available literature indicates effects on autonomic function, right, and left heart function following treatment for SDB. However, well-designed, large-scale, prospective cohort studies (using standardized outcomes) are needed to better understand the relationship of cardiovascular morbidity in the context of pediatric SDB.
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Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas R Kimball
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nanhua Zhang
- Department of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Yuanshu Zou
- Department of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Ingram DG, Singh AV, Ehsan Z, Birnbaum BF. Obstructive Sleep Apnea and Pulmonary Hypertension in Children. Paediatr Respir Rev 2017; 23:33-39. [PMID: 28185814 DOI: 10.1016/j.prrv.2017.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 11/03/2016] [Accepted: 01/04/2017] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is a common pediatric breathing disorder, affecting 1-5% of all children. Pulmonary hypertension (PH), a severe complication of OSA, is associated with significant morbidity and mortality. Despite this important relationship between OSA and PH, there is sparse literature addressing this subject in children. This review will examine the putative relationship between OSA and PH, synthesize the available literature in children, and suggest a reasonable approach, despite limited data, for clinicians. We conclude that available evidence suggests many children with OSA have evidence of PH (estimates ranging from 0% to 85%) and vice versa (estimates ranging from 6% to 24%). Furthermore, previous studies demonstrate that treatment of the OSA, either with surgery or non-invasive ventilation, ameliorates pulmonary artery pressures to the extent of cure in a substantial number of cases. Future studies are required to better delineate the true co-occurrence of these diseases and help predict which patients are at greater risk for this serious complication. Clinicians who maintain a healthy vigilance for this important interaction of disease states will likely recognize opportunities to intervene and improve prognoses in these patients.
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Affiliation(s)
- David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO.
| | - Alvin V Singh
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO
| | - Brian F Birnbaum
- Division of Cardiology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO
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34
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Ayas NT, Bhattacharjee R, Pack AI. AJRCCM: 100-Y ear A nniversary.Sleep-Disordered Breathing: Still the New Kid on the Block. Am J Respir Crit Care Med 2017; 195:1107-1111. [DOI: 10.1164/rccm.201701-0199ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Najib T. Ayas
- Department of MedicineUniversity of British ColumbiaVancouver, British Columbia, Canada
| | - Rakesh Bhattacharjee
- Department of PediatricsUniversity of California, San DiegoSan Diego, Californiaand
| | - Allan I. Pack
- Department of MedicineUniversity of PennsylvaniaPhiladelphia, Pennsylvania
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35
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Mehra R. Building Evidence Implicating Novel Cardiovascular Biomarkers in Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:361-362. [PMID: 28212699 DOI: 10.5664/jcsm.6476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Reena Mehra
- Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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36
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Abstract
Sleep disordered breathing (SDB) in childhood is linked with significant end-organ dysfunction across various systems, particularly with cardiovascular, neurocognitive and metabolic consequences. If we understand the pathophysiology of SDB, diagnose it promptly and treat appropriately, we may be able to prevent morbidity associated with SDB and also save health resources around the world. In this article, we highlight articles on this topic published in medical journals in the past year. Prematurity, obesity and adenotonsillar hypertrophy are risk factors for sleep disordered breathinghttp://ow.ly/W47FU
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Affiliation(s)
- Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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Micheu MM, Rosca AM, Deleanu OC. Stem/progenitor cells and obstructive sleep apnea syndrome - new insights for clinical applications. World J Stem Cells 2016; 8:332-341. [PMID: 27822340 PMCID: PMC5080640 DOI: 10.4252/wjsc.v8.i10.332] [Citation(s) in RCA: 2] [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: 04/19/2016] [Revised: 06/25/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a widespread disorder, characterized by recurrent upper airway obstruction during sleep, mostly as a result of complete or partial pharyngeal obstruction. Due to the occurrence of frequent and regular hypoxic events, patients with OSAS are at increased risk of cardiovascular disease, stroke, metabolic disorders, occupational errors, motor vehicle accidents and even death. Thus, OSAS has severe consequences and represents a significant economic burden. However, some of the consequences, as well as their costs can be reduced with appropriate detection and treatment. In this context, the recent advances that were made in stem cell biology knowledge and stem cell - based technologies hold a great promise for various medical conditions, including respiratory diseases. However, the investigation of the role of stem cells in OSAS is still recent and rather limited, requiring further studies, both in animal models and humans. The goal of this review is to summarize the current state of knowledge regarding both lung resident as well as circulating stem/progenitor cells and discuss existing controversies in the field in order to identify future research directions for clinical applications in OSAS. Also, the paper highlights the requisite for inter-institutional, multi-disciplinary research collaborations in order to achieve breakthrough results in the field.
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Kheirandish-Gozal L, Gozal D. Pediatric OSA Syndrome Morbidity Biomarkers: The Hunt Is Finally On! Chest 2016; 151:500-506. [PMID: 27720883 DOI: 10.1016/j.chest.2016.09.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/12/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022] Open
Abstract
Since initial reports 40 years ago on pediatric OSA syndrome (OSAS) as a distinct and prevalent clinical entity, substantial advances have occurred in the delineation of diagnostic and treatment approaches. However, despite emerging and compelling evidence that OSAS increases the risk for cognitive, cardiovascular, and metabolic end-organ morbidities, routine assessment of such morbidities is seldom conducted in clinical practice. One of the major reasons for such discrepancies resides in the relatively labor-intensive and onerous steps that would be required to detect the presence of any of such morbidities, further adding to the already elevated cost of diagnosing the disorder. To circumvent these obstacles, the search for biomarker signatures of pediatric OSA and its cognitive and cardiometabolic consequences was launched, and considerable progress has occurred since then. Here, we review the current evidence for the presence of morbidity-related biomarkers among children with OSAS, and explore future opportunities in this promising arena.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL.
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL
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Frimer Z, Goldberg S, Joseph L, Mimouni FB, Picard E. Is obstructive sleep apnea syndrome in children season dependent? Sleep Breath 2016; 20:1313-1318. [PMID: 27230012 DOI: 10.1007/s11325-016-1361-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/07/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The most common cause of obstructive sleep apnea (OSA) in children is an enlargement of tonsils and/or adenoids. Previous studies have shown that the size of adenoids and tonsils is influenced by upper respiratory tract infections and exposure to allergens. The rate of exposure to bacteria, viruses, and allergens fluctuates from season to season. Therefore, we hypothesized that the rate of polysomnograms positive for OSA may vary according to season. OBJECTIVE The objective of this study is to determine whether the prevalence of OSA in children, as determined by polysomnography, is affected by the season during which the study was performed. METHODS We retrospectively reviewed polysomnography tests of 296 children, ages 0-12 years, referred for suspected OSA. We compared the Obstructive Apnea Hypopnea Index (OAHI) between the seasons and the rates of abnormal tests in each season according to the degree of severity. RESULTS The mean OAHI did not significantly differ among the seasons (winter, 3.0 ± 5.0; spring, 3.0 ± 4.9; summer, 4.0 ± 6.3; fall, 3.4 ± 5.7, p = 0.183). When dividing the OAHI by levels of severity, no seasonality was found in moderate (winter, 13.8 %; spring, 6.7 %; summer, 11.7 %; fall, 14.1 %, p = NS) and severe OSA (winter, 8.8 %; spring, 11.2 %; summer, 10 %; fall, 7.8 %, p = NS). There was a small increase in the frequency of mild OSA diagnoses in the summer compared to the other seasons. CONCLUSION In this study, season does not appear to affect the rate of diagnosis of significant OSA in children. Re-evaluation during a different season is unlikely to provide different results and may postpone surgery unnecessarily.
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Affiliation(s)
- Zev Frimer
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, School of Medicine, affiliated with The Hebrew University school of medicine, Jerusalem, Israel
| | - Shmuel Goldberg
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, School of Medicine, affiliated with The Hebrew University school of medicine, Jerusalem, Israel
| | - Leon Joseph
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, School of Medicine, affiliated with The Hebrew University school of medicine, Jerusalem, Israel
| | - Francis B Mimouni
- Neonatal Department, Shaare Zedek Medical Center, affiliated with The Hebrew University school of medicine, POB 3235, Jerusalem, 91031, Israel
| | - Elie Picard
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, School of Medicine, affiliated with The Hebrew University school of medicine, Jerusalem, Israel.
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Vlastos I, Athanasopoulos I. Cutting-edge technologies for diagnosis and monitoring of snoring in children. World J Clin Pediatr 2016; 5:63-66. [PMID: 26862503 PMCID: PMC4737694 DOI: 10.5409/wjcp.v5.i1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/17/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Snoring is a very common problem in children and may be an indication of obstructive sleep apnea (OSA). Appropriate diagnosis is of importance due to detrimental effects of OSA. Polysomnography is considered the gold standard for the diagnosis of OSA. However, it is impractical for several reasons and this is why other tests have been developed as alternatives to formal polysomnography (PSG) for the assessment of children with snoring. In this mini-review basic features of PSG as well as alternative tests are presented and future perspectives are provided in addition to current guideline for the diagnosis and monitoring of childhood snoring. The aim of this review is to highlight briefly currently developed technologies that seem promising for the evaluation of snoring.
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Abstract
Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel.
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Affiliation(s)
- Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, England
| | - Leila Kheirandish-Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.
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