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Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [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: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Kang E, Hong YH, Kim J, Chung S, Kim KK, Haam JH, Kim BT, Kim EM, Park JH, Rhee SY, Kang JH, Rhie YJ. Obesity in Children and Adolescents: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2024; 33:11-19. [PMID: 38193204 PMCID: PMC11000513 DOI: 10.7570/jomes23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
The prevalence of obesity in children and adolescents has been gradually increasing in recent years and has become a major health problem. Childhood obesity can readily progress to adult obesity. It is associated with obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension, obstructive sleep apnea, non-alcoholic fatty liver disease, and the risk factor for cardiovascular disease. It is important to make an accurate assessment of overweight and obesity in children and adolescents with consideration of growth and development. Childhood obesity can then be prevented and treated using an appropriate treatment goal and safe and effective treatment strategies. This article summarizes the clinical practice guidelines for obesity in children and adolescents that are included in the 8th edition of the Clinical Practice Guidelines for Obesity of the Korean Society for the Study of Obesity.
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Affiliation(s)
- Eungu Kang
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Ji-Hee Haam
- Deptartment of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bom Taeck Kim
- Department of Family Practice & Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Xiao L, Voutsas G, Ryan CM, Katz SL, Narang I. The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity. J Clin Sleep Med 2023; 19:1877-1883. [PMID: 37409497 PMCID: PMC10620665 DOI: 10.5664/jcsm.10706] [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] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and poor sleep quality are highly prevalent in children with obesity, but their individual associations with health-related quality of life (HRQOL) are unknown in this population. The primary objective was to describe the independent association of OSA and sleep quality with HRQOL in children with obesity. METHODS This was a cross-sectional study of children with obesity at 2 tertiary care centers. Sleep quality and HRQOL were measured with the Pittsburgh Sleep Quality Index and Pediatric Quality of Life Inventory questionnaires, respectively. Multivariable regression models were created to evaluate associations between OSA and sleep quality with HRQOL. RESULTS There were 98 children (median age 15.0 years, median body mass index z-score 3.8, 44% females). Among the study population, 49/98 (50%) children reported poor sleep quality, 41/98 (42%) children had OSA, and 52/98 (53%) children reported impaired HRQOL. Self-reported poor sleep quality was independently associated with reduced HRQOL, whereas the presence of OSA was not. Children with poor sleep quality had a reduced Pediatric Quality of Life Inventory score by 8.8 compared to children with good sleep quality (95% confidence interval, 2.6-14.9; P = .006), when adjusting for age, sex, body mass index z-score, attention-deficit/hyperactivity disorder, mood/anxiety disorder, and study site. CONCLUSIONS In the current study of children with obesity, we found that HRQOL was more strongly associated with the self-reported experience of sleep than the presence of OSA. Clinicians should assess and optimize sleep quality as part of the evaluation for OSA in children with obesity. CITATION Xiao L, Voutsas G, Ryan CM, Katz SL, Narang I. The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity. J Clin Sleep Med. 2023;19(11):1877-1883.
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Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Giorge Voutsas
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh M. Ryan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Respirology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sherri Lynne Katz
- Division of Respiratory Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Cui J, Li G, Zhang M, Xu J, Qi H, Ji W, Wu F, Zhang Y, Jiang F, Hu Y, Zhang W, Wei X, Manza P, Volkow ND, Gao X, Wang GJ, Zhang Y. Associations between body mass index, sleep-disordered breathing, brain structure, and behavior in healthy children. Cereb Cortex 2023; 33:10087-10097. [PMID: 37522299 PMCID: PMC10656948 DOI: 10.1093/cercor/bhad267] [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: 03/21/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 08/01/2023] Open
Abstract
Pediatric overweight/obesity can lead to sleep-disordered breathing (SDB), abnormal neurological and cognitive development, and psychiatric problems, but the associations and interactions between these factors have not been fully explored. Therefore, we investigated the associations between body mass index (BMI), SDB, psychiatric and cognitive measures, and brain morphometry in 8484 children 9-11 years old using the Adolescent Brain Cognitive Development dataset. BMI was positively associated with SDB, and both were negatively correlated with cortical thickness in lingual gyrus and lateral orbitofrontal cortex, and cortical volumes in postcentral gyrus, precentral gyrus, precuneus, superior parietal lobule, and insula. Mediation analysis showed that SDB partially mediated the effect of overweight/obesity on these brain regions. Dimensional psychopathology (including aggressive behavior and externalizing problem) and cognitive function were correlated with BMI and SDB. SDB and cortical volumes in precentral gyrus and insula mediated the correlations between BMI and externalizing problem and matrix reasoning ability. Comparisons by sex showed that obesity and SDB had a greater impact on brain measures, cognitive function, and mental health in girls than in boys. These findings suggest that preventing childhood obesity will help decrease SDB symptom burden, abnormal neurological and cognitive development, and psychiatric problems.
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Affiliation(s)
- Jianqi Cui
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Guanya Li
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Minmin Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Jiayu Xu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Haowen Qi
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Weibin Ji
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Feifei Wu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Yaqi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Fukun Jiang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Yang Hu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Wenchao Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Xiaorong Wei
- Kindergarten, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Peter Manza
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Nora D Volkow
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Xinbo Gao
- Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing 400065, China
- Chongqing Institute for Brain, Guangyang Bay Laboratory, Chongqing 400064, China
| | - Gene-Jack Wang
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Yi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
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Gueye-Ndiaye S, Williamson AA, Redline S. Disparities in Sleep-Disordered Breathing: Upstream Risk Factors, Mechanisms, and Implications. Clin Chest Med 2023; 44:585-603. [PMID: 37517837 PMCID: PMC10513750 DOI: 10.1016/j.ccm.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Sleep-disordered breathing (SDB) refers to a spectrum of disorders ranging from habitual snoring without frank episodes of obstructed breathing or desaturation during sleep to obstructive sleep apnea, where apneas and hypopneas repetitively occur with resultant intermittent hypoxia, arousal, and sleep disruption. Disparities in SDB reflect its overall high prevalence in children and adults from racially and ethnically minoritized or low socioeconomic status backgrounds coupled with high rates of underdiagnosis and suboptimal treatment.
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, 2716 South Street Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Redline
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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Borrelli M, Corcione A, Cimbalo C, Annunziata A, Basilicata S, Fiorentino G, Santamaria F. Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1331. [PMID: 37628330 PMCID: PMC10452996 DOI: 10.3390/children10081331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.
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Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Chiara Cimbalo
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Anna Annunziata
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Simona Basilicata
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Giuseppe Fiorentino
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
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Ergenekon AP, Gokdemir Y, Ersu R. Medical Treatment of Obstructive Sleep Apnea in Children. J Clin Med 2023; 12:5022. [PMID: 37568423 PMCID: PMC10419369 DOI: 10.3390/jcm12155022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent complete or partial obstruction of the upper airway. The prevalence is 1-4% in children aged between 2 and 8 years and rising due to the increase in obesity rates in children. Although persistent OSA following adenotonsillectomy is usually associated with obesity and underlying complex disorders, it can also affect otherwise healthy children. Medical treatment strategies are frequently required when adenotonsillectomy is not indicated in children with OSA or if OSA is persistent following adenotonsillectomy. Positive airway pressure treatment is a very effective modality for persistent OSA in childhood; however, adherence rates are low. The aim of this review article is to summarize medical treatment options for OSA in children.
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Affiliation(s)
- Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey; (A.P.E.); (Y.G.)
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey; (A.P.E.); (Y.G.)
| | - Refika Ersu
- Division of Respirology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Zaffanello M, Pietrobelli A, Zoccante L, Ferrante G, Tenero L, Piazza M, Ciceri ML, Nosetti L, Piacentini G. Mental Health and Cognitive Development in Symptomatic Children and Adolescents Scoring High on Habitual Snoring: Role of Obesity and Allergy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1183. [PMID: 37508681 PMCID: PMC10377772 DOI: 10.3390/children10071183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Obstructive sleep apnea can have a negative impact on children's and adolescents' neurocognitive abilities and hinder their academic and adaptive progress in academic, social, and/or behavioral dimensions. In this retrospective cross-sectional study, we investigated the influence of body weight conditions and allergy status on long-term mental health, cognitive development, and quality of life in children and adolescents who snored. METHODS The study sample included 47 subjects (age range 4.1 to 15.3 years) who exhibited high levels of snoring and underwent home-based polysomnography between 2015 and 2019. Follow-up assessments (3 years on average between baseline and follow-up) entailed phone interviews with the subject's parents/caregivers who completed three validated questionnaires investigating sleep, quality of life, and parental ratings. RESULTS We found a correlation between age at diagnosis and being retrospectively overweight and high levels of snoring. In addition to a higher risk of developing emotional symptoms (8.2% increase in retrospective overweight status for each unit increase in the emotional score at follow-up) and oppositional behavior (9% increase in retrospective overweight status for each unit of oppositional T points at follow-up), we also noted reduced long-term social symptoms (11% decrease in retrospective overweight status for each unit increase in the social score at follow-up) and cognitive symptoms (10.6% decrease in retrospective overweight status for each unit increase in the cognitive score at follow-up), as well as a 6.1% increase in retrospective allergy status for each unit increase in academic performance at follow-up. CONCLUSIONS Snoring can have negative impacts on mental health and cognitive development in the long term. Early detection and intervention for neuropsychological disorders is important in children and adolescents who score high on snoring. In the long term, the effects of snoring on neuropsychological disorders may vary based on previous body weight and allergy status.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Laura Tenero
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, Filippo Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
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Chuang HH, Lin RH, Hsu JF, Chuang LP, Li HY, Fang TJ, Huang YS, Yang AC, Lee GS, Kuo TBJ, Yang CCH, Lee LA. Dietary profile of pediatric obstructive sleep apnea patients, effects of routine educational counseling, and predictors for outcomes. Front Public Health 2023; 11:1160647. [PMID: 37377550 PMCID: PMC10291126 DOI: 10.3389/fpubh.2023.1160647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Background Dietary behavior is a main contributing yet modifiable factor to the body weight status of children and may be involved in the pathophysiology of childhood obstructive sleep apnea (OSA). This study aimed to investigate the dietary profile of pediatric OSA patients, effects of educational counseling after adenotonsillectomy, and predictor for disease resolution. Methods This observational study included 50 pediatric OSA patients undergoing adenotonsillectomy with routine educational counseling (Group 1), 50 pediatric OSA patients undergoing adenotonsillectomy without formal educational counseling (Group 2), and 303 healthy children without OSA (Control). The three groups were matched by age. The consumption frequency of 25 food items/groups was assessed by the Short Food Frequency Questionnaire. Quality of life was evaluated by the OSA-18 questionnaire. Sleep architecture and OSA severity were measured by standard polysomnography. Between- and within-group comparisons were analyzed by non-parametric approaches and generalized estimating equations. Prediction of disease recovery was performed by multivariable logistic regression models. Results Group 1 children consumed fruit drinks with sugar, vegetables, sweets, chocolate, rice, and noodles more frequently than Control Group children. At baseline, the distributions of sex, weight status, OSA-18 scores, and polysomnographic variables were comparable between Group 1 and Group 2. After a 12-month follow-up, Group 1 had better improvements in physical suffering, caregiver concerns, sleep architecture, and mean peripheral oxygen saturation compared to Group 2. Furthermore, Group 1 no longer had excessive consumption of fruit drinks with sugar, chocolate, and noodles; however, food consumption frequencies did not change significantly. Notably, younger age and reduced intake of butter/margarine on bread and noodles were independent predictors of cured OSA in Group 1. Conclusion The present study preliminarily characterized an unhealthy dietary profile among pediatric OSA patients and suggested that routine educational counseling in addition to adenotonsillectomy yielded some clinical benefits. Certain items/groups of food frequencies may be associated with disease recovery and further investigations are warranted.
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Affiliation(s)
- Hai-Hua Chuang
- Department of Family Medicine, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Industrial Engineering and Manage-ment, National Taipei University of Technology, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Rong-Ho Lin
- Department of Industrial Engineering and Manage-ment, National Taipei University of Technology, Taipei, Taiwan
| | - Jen-Fu Hsu
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pulmonary and Critical Care Medicine, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Child Psychiatry, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Albert C. Yang
- Department of Psychiatry, Taipei Veter-ans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Guo-She Lee
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Otolaryngology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Tsaotun Psychiatric Center, Ministry of Health and Wel-fare, Nantou, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ang Lee
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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10
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Teplitzky TB, Zauher AJ, Isaiah A. Alternatives to Polysomnography for the Diagnosis of Pediatric Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:diagnostics13111956. [PMID: 37296808 DOI: 10.3390/diagnostics13111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed. The goal of this review is to evaluate and discuss alternatives for evaluating pediatric SDB. To date, wearable devices, single-channel recordings, and home-based PSG have not been validated as suitable replacements for PSG. However, they may play a role in risk stratification or as screening tools for pediatric OSA. Further studies are needed to determine if the combined use of these metrics could predict OSA.
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Affiliation(s)
- Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Audrey J Zauher
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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11
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Bhattacharjee EB, Sun X, Malhotra A, Tantisira KG, Landeo‐Gutierrez JS, Jain S, Bhattacharjee R. Association of body anthropometry and obstructive sleep apnea in children: Variations observed in Hispanic children. Obes Sci Pract 2023; 9:210-217. [PMID: 37287517 PMCID: PMC10242256 DOI: 10.1002/osp4.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 06/09/2023] Open
Abstract
Objectives Obesity is a risk factor for obstructive sleep apnea (OSA) in children. Childhood obesity rates vary amongst different ethnic groups. Here the interaction of Hispanic ethnicity and obesity on OSA risk was evaluated. Methods Retrospective cross-sectional analysis of consecutive children undergoing polysomnography and anthropometry using bioelectrical impedance from 2017 to 2020. Demographics obtained from the medical chart. Children who had also undergone cardiometabolic testing were identified and the relationship of cardiometabolic markers with OSA and anthropometry was assessed. Results Data from 1217 children revealed Hispanic children were more likely to have moderate-severe OSA (36.0%) compared to Non-Hispanic children (26.5%), p < 0.001. Hispanic children had greater Body mass index (BMI), BMI percentile and percent body fat, p < 0.0001. In children that underwent cardiometabolic testing, Hispanic children had significantly greater serum alanine aminotransferase levels (ALT) levels. Following adjustment of age and sex, Hispanic ethnicity was not found to moderate the association of anthropometry with OSA, anthropometry with cardiometabolic markers, and OSA with cardiometabolic markers. Conclusions OSA was more likely in Hispanic children; this relationship was likely driven by obesity status rather than ethnicity. Among children undergoing cardiometabolic testing, Hispanic children were observed to have greater ALT concentrations however ethnicity did not impact the association of anthropometry and ALT or other cardiometabolic markers.
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Affiliation(s)
| | - Xiaoying Sun
- Biostatistics Research CenterHerbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep MedicineDepartment of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Kelan G. Tantisira
- Division of Respiratory MedicineDepartment of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Jeremy S. Landeo‐Gutierrez
- Division of Respiratory MedicineDepartment of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Sonia Jain
- Biostatistics Research CenterHerbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Rakesh Bhattacharjee
- Division of Respiratory MedicineDepartment of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
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12
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Piotto M, Gambadauro A, Rocchi A, Lelii M, Madini B, Cerrato L, Chironi F, Belhaj Y, Patria MF. Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors. CHILDREN (BASEL, SWITZERLAND) 2023; 10:955. [PMID: 37371187 DOI: 10.3390/children10060955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase "sleep-disordered breathing (SDB)" indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy ("classic phenotype") is the main cause of OSA in preschool age (3-5 years), obesity ("adult phenotype") is the most common cause in adolescence. There is also a "congenital-structural" phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.
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Affiliation(s)
- Marta Piotto
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Antonella Gambadauro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mara Lelii
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Barbara Madini
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lucia Cerrato
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Federica Chironi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Youssra Belhaj
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maria Francesca Patria
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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13
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Gustin MP, Putois B, Guyon A, Lecendreux M, Challamel MJ, Plancoulaine S, Bioulac-Rogier S, Schroder C, Royant-Parola S, Huguelet S, Franco P. French Sleepiness Scale for Adolescents-8 items: A discriminant and diagnostic validation. L'ENCEPHALE 2023; 49:109-116. [PMID: 36253180 DOI: 10.1016/j.encep.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022]
Abstract
The objective of the present study was to validate the Short Version of French Sleepiness Scale for Adolescents (FSSA) with eight items (FSSA8). METHODS A total of 384 adolescents, aged between 12 and 18 years, completed the FSSA8. These included 269 nonclinical adolescents and 115 adolescents admitted for overnight polysomnography and Multiple Sleep Latency Test (MSLT) because of suspected hypersomnia (85 patients with narcolepsy and 30 with other sleep disorders). Item response theory (IRT) assumptions were tested and psychometric properties were analysed. Matching on sex ratio and age was conducted to estimate concurrent criterion, diagnostic validity and cut-offs. RESULTS IRT assumptions were validated confirming the one-dimensionality of the FSSA8. The latent continuum sleepiness for which the scale and its items are reliable encompassed most of the clinical subjects. FSSA8 is weakly correlated with MSLT. Distribution of scores for the nonclinical group and the clinical group differed significantly; the FSSA8 had very good screening validity in sleep disorders. The cut-off was seven points. CONCLUSION The FSSA8 appeared to be more reliable for patients than for nonclinical participants and to be a good tool for screening excessive daytime sleepiness in sleep disorders.
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Affiliation(s)
- M-P Gustin
- Emerging Pathogens Laboratory-Fondation Mérieux, International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France; Institute of Pharmaceutic and Biological Sciences, Public Health department, Biostatistics, University Claude-Bernard Lyon 1, Villeurbanne, France
| | - B Putois
- Faculty of Psychology, Swiss Distance Learning University, Brig 3900, Switzerland
| | - A Guyon
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Lyon Neuroscience Research Centre, CNRS UMR 5292-INSERM U1028-Lyon 1 University, Bron 69005, France
| | - M Lecendreux
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Centre pédiatrique des pathologies du sommeil, Hôpital Robert Debré, Paris, France
| | - M-J Challamel
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France
| | - S Plancoulaine
- Université de Paris Cité, Inserm, INRAE, CRESS, 75004 Paris, France
| | - S Bioulac-Rogier
- Service de Psychiatrie de l'enfant et l'adolescent, Hôpital Couple enfant, CHU Grenoble Alpes CHU CS 10217, 38046 Grenoble, France
| | - C Schroder
- University of Strasbourg; CNRS UPR 3212, Institute of Cellular and Integrative Neurosciences
| | | | - S Huguelet
- Faculty of Psychology, Swiss Distance Learning University, Brig 3900, Switzerland
| | - P Franco
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Lyon Neuroscience Research Centre, CNRS UMR 5292-INSERM U1028-Lyon 1 University, Bron 69005, France.
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14
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Carrello J, Hayes A, Baur LA, Lung T. Potential cost-effectiveness of e-health interventions for treating overweight and obesity in Australian adolescents. Pediatr Obes 2023; 18:e13003. [PMID: 36649693 PMCID: PMC10909552 DOI: 10.1111/ijpo.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/04/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND E-health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost-effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking. OBJECTIVES Assess the potential cost-effectiveness of a hypothetical e-health intervention for adolescents with overweight and obesity. METHODS The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro-simulation model with a lifetime time horizon, we conducted a modelled cost-utility analysis of the intervention compared to a 'do-nothing' approach. To explore uncertainty, we conducted bootstrapping on individual-level costs and quality-adjusted life years (QALYs) and performed multiple one-way sensitivity analyses. RESULTS The incremental cost-effectiveness ratio (ICER) for the e-health intervention was dominant (cheaper and more effective), with a 96% probability of being cost-effective at a willingness-to-pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost-effectiveness at a WTP of $50 000/QALY to 51%. CONCLUSION E-health interventions for treatment of adolescent overweight and obesity demonstrate very good cost-effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment.
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Affiliation(s)
- Joseph Carrello
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Louise A. Baur
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Weight Management Services, The Children's Hospital at WestmeadWestmeadAustralia
| | - Thomas Lung
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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15
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Home Respiratory Polygraphy and Spirometry in Normal Weight and Children with Obesity Suspected for Obstructive Sleep Apnea Syndrome: Are There Any Associations? Pulm Med 2023; 2023:1532443. [PMID: 36760693 PMCID: PMC9906030 DOI: 10.1155/2023/1532443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Aim It is known that children and adolescents with obesity are more prone to obstructive sleep apnea syndrome (OSAS) and that their lung function may show some disturbance. Literature is scarce about potential associations; therefore, we aimed to study the relationship between OSAS, lung function, and adiposity in a population of children suspected of OSAS. Material and Methods. We performed home respiratory polygraphy and spirometry in all subjects. The relationships between body mass index z-score (zBMI), polygraphy, and spirometry data were analyzed. Results We recruited 81 subjects aged between 5 and 16 years, 63% being obese. 43.2% of subjects were diagnosed with OSAS (32.1% mild, 4.9% moderate, and 6.2% severe). We found no correlation between respiratory polygraphy and the zBMI. The mean spirometric value FEV1, FVC, and FEV1/FVC ratio z's were normal in all subjects, whereas FVC z's and FEV1/FVC ratio z's were significantly positively related for obesity and negatively for normal weight (p < 0.05). FEV1 z's was inversely correlated to the percentage of analyzed time passed below 90% of SpO2 (r = -0.224, p = 0.044). All subjects with FEV1 (n = 8) and/or FVC (n = 9) z's below the lower limit for normal (LLN) had an AHI ≥ 1 (FEV1: p = 0.001; FVC: p < 0.001), especially subjects with normal weight (FEV1: p = 0.003; FVC: p = 0.010). Conclusion When comparing normal-weight children and adolescents with obesity, the prevalence of OSAS but not spirometric values was strongly related to BMI z-score, probably because obesity engenders advanced puberty and an accelerated growth spurt. FEV1 was more frequently <LLN in normal-weight children, while obese subjects presented low FEV1/FVC ratio z's and FEF25-75% z's. Moreover, all subjects with abnormal spirometric values were suffering from at least mild OSAS, again more frequently in normal-weight subjects.
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16
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Mazur A, Zachurzok A, Baran J, Dereń K, Łuszczki E, Weres A, Wyszyńska J, Dylczyk J, Szczudlik E, Drożdż D, Metelska P, Brzeziński M, Kozioł-Kozakowska A, Matusik P, Socha P, Olszanecka-Gilianowicz M, Jackowska T, Walczak M, Peregud-Pogorzelski J, Tomiak E, Wójcik M. Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity. Nutrients 2022; 14:nu14183806. [PMID: 36145182 PMCID: PMC9505061 DOI: 10.3390/nu14183806] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.
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Affiliation(s)
- Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Agnieszka Zachurzok
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Zabrze, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Joanna Baran
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Aneta Weres
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Dylczyk
- Children’s University Hospital, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Ewa Szczudlik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paulina Metelska
- Department of Public Health and Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Michał Brzeziński
- Chair and Department of Paediatrics, Gastroenterology, Allergology and Child Nutrition, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Chair of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Socha
- The Children’s Memorial Health Institute, 04-736 Warsaw, Poland
| | - Magdalena Olszanecka-Gilianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of the Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Elżbieta Tomiak
- The College of Family Physicians in Poland, 00-209 Warszawa, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
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17
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Bhattacharjee R. Early onset hypertension? Implications of childhood obstructive sleep apnea. Sleep Med Rev 2022; 65:101694. [PMID: 36152500 DOI: 10.1016/j.smrv.2022.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, University of California, San Diego, 9500, California, United States.
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Cuda SE, Pratt JS, Santos M, Browne A. Obesity Pillars roundtable: Metabolic and bariatric surgery in children and adolescents. OBESITY PILLARS (ONLINE) 2022; 3:100023. [PMID: 37990731 PMCID: PMC10661994 DOI: 10.1016/j.obpill.2022.100023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2023]
Abstract
Background Obesity is a chronic disease which frequently begins in childhood and requires a life-long multidisciplinary approach. Metabolic-bariatric surgery (MBS) is a key component of the treatment of severe obesity in children, adolescents and adults. Children and adolescents who have class II obesity and a complication of obesity or have class III obesity should be considered for MBS, regardless of age, race, sex, or gender. Children and adolescents with cognitive disabilities, a history of mental illness, a treated eating disorder, immature bone growth, or low Tanner Stage should not be denied treatment. Early intervention can reduce the risk of persistent obesity, end organ damage, and sequelae from long-standing complications of obesity. Methods This roundtable discussion includes three pediatric obesity specialists with experience in the medical and surgical management of children and adolescents with obesity. Included are citations regarding metabolic-bariatric surgery in children and adolescents. Results MBS in pediatric patients is increasingly recognized as an essential part of managing the disease of obesity in combination with medication, nutrition, behavioral training, and physical activity. Vertical sleeve gastrectomy or Roux-en-Y gastric bypass in patients meeting criteria for severe obesity should be considered, especially when children have complications such as poor quality of life, orthopedic disease, idiopathic intracranial hypertension, type 2 diabetes mellitus, obstructive sleep apnea, or cardiovascular risk. Children and adolescents with autism, developmental delay, or syndromic obesity should be considered for MBS on a case-by-case basis. Early intervention may result in improved long-term outcomes, and referral for MBS should not be conditional based on stage of pubertal development (Tanner Staging), bone age, or prior weight loss attempts. Conclusions Children and adolescents who suffer from severe obesity need the entire spectrum of treatment modalities available to achieve a healthy weight and control obesity-related complications. This treatment spectrum should include MBS. These children and adolescents should be cared for by a pediatric weight management team prepared to care for them until they transition to adult care.
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Affiliation(s)
- Suzanne E. Cuda
- American Board of Obesity Medicine, Alamo City Healthy Kids & Families, 1919 Oakwell Farms Parkway, Suite 145, San Antonio, TX, 78218, USA
| | - Janey S.A. Pratt
- American Society of Metabolic and Bariatric Surgery Committee on Pediatrics, Adolescent Bariatric Surgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Center for Academic Medicine, 4th Floor Division of Pediatric Surgery, 453 Quarry Rd, Palo Alto, CA, 94304, USA
| | - Melissa Santos
- Pediatrics Obesity Center at Connecticut Children's, 282 Washington St, Hartford, CT, 06106, USA
| | - Allen Browne
- American Board of Obesity Medicine, LLC, 25 Andrews Ave, Falmouth, Maine, 04105, USA
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19
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Monzon AD, Patton SR, Koren D. Childhood diabetes and sleep. Pediatr Pulmonol 2022; 57:1835-1850. [PMID: 34506691 DOI: 10.1002/ppul.25651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.
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Affiliation(s)
- Alexandra D Monzon
- Department of Psychology and Applied Behavioral Science, Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Susana R Patton
- Department of Biomedical Research, Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dorit Koren
- Department of Pediatrics, Pediatric Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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20
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Nosetti L, Zaffanello M, Katz ES, Vitali M, Agosti M, Ferrante G, Cilluffo G, Piacentini G, Grutta SL. Twenty-year follow-up of children with obstructive sleep apnea. J Clin Sleep Med 2022; 18:1573-1581. [PMID: 35164899 DOI: 10.5664/jcsm.9922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in children is associated with acute metabolic, cardiovascular, and neuro-cognitive abnormalities. The long-term outcomes of childhood OSA into adulthood has not been established. We performed a 20-year follow-up of patients with polysomnographically documented OSA in childhood compared to a healthy control group to evaluate the long-term anthropometric, sleep, cognitive, and cardiovascular outcomes. METHODS Children diagnosed to have severe OSA between the ages of 1 - 17 years (4.87 ± 2.77) were prospectively contacted by telephone as young adults after approximately 20 years. Data collected included reported anthropometric, educational level, health history, and the Berlin questionnaire. RESULTS Young adults with confirmed severe OSA in childhood had significantly higher adulthood BMI (p=0.038), lower academic degrees (p<0.001), and more snoring (p=0.045) compared to controls. The AHI during childhood trended towards predicting cardiovascular outcomes and the Berlin questionnaire in adulthood. CONCLUSIONS Adults with history of severe childhood OSA have a high risk of having snoring, elevated BMI, and lower academic achievement in adulthood. Thus, children with severe OSA may be at increased risk of chronic diseases later in life. The intervening COVID-19 pandemic has introduced considerable additional neurobehavioral morbidity complicating the identification of the full long-term consequences of childhood OSA.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | | | - Eliot S Katz
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston MA.,Harvard Medical School, Boston, MA
| | - Maddalena Vitali
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Massimo Agosti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | | | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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21
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Danielsen YS, Skjåkødegård HF, Bjorvatn B, Juliusson PB, Pallesen S. Polysomnographic comparison of sleep in children with obesity and normal weight without suspected sleep-related breathing disorder. Clin Obes 2022; 12:e12493. [PMID: 34781415 DOI: 10.1111/cob.12493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Short sleep and obstructive apneas/hypopneas have been shown to be associated with childhood obesity. Still, few studies have compared sleep in children with obesity, without suspected sleep disordered breathing and normal weight peers by objective sleep measures and compared results with subjective parent assessment of sleep. Children with obesity aged 7-13 years (N = 44) and a matched group of normal weight children (N = 42) completed clinical polysomnography (Embla A10 Recording System). Parents scored their children's sleep on the Children's Sleep Habits Questionnaire (CSHQ). Mann-Whitney U tests were used to compare groups. There was a higher obstructive apnea/hypopnea index (AHI) (median obesity = 1.20 vs. median normal = 0.66; z = -1.33, U = 560.50, p = 0.002) and number of oxygen desaturation events per hour (median obesity = 0.7 vs. median normal = 0.2; z = -3.45, U = 402.50, p = 0.001) in the children with obesity compared to children with normal weight. The children with obesity had a significantly longer sleep duration (median obesity 8:50 h = vs. median normal = 8:32 h; z = -2.05, U = 687.00, p = 0.041), longer stage N2 sleep (median obesity = 87 min vs. median normal = 52 min; z = -2.87, U = 576.50, p = 0. 004) and shorter REM sleep (median obesity = 94 min vs. median normal = 121 min; z = 5.05, U = 1477.00, p ≤ .001). No differences were observed for time in sleep stage N1 and N3, wake time after sleep onset or the total arousal index . Further, no group differences were found on the CSHQ sleep-disordered breathing sub-scale (p = 0.399). The children with obesity demonstrated significantly more mild to moderate sleep disordered breathing than children with normal weight, although this was not corroborated by parent report.
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Affiliation(s)
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Petur Benedikt Juliusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Health Registry Research and Development, National Institute of Public Health, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Optentia Research Unit, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
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22
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Narang I, Kendzerska T, Heffernan A, Malik U, Carvalho CG, Ryan CM. Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care. Nat Sci Sleep 2022; 14:153-163. [PMID: 35140537 PMCID: PMC8818969 DOI: 10.2147/nss.s345143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. RESEARCH QUESTION Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? STUDY DESIGN AND METHODS Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. RESULTS Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01. INTERPRETATION Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.
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Affiliation(s)
- Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Canada.,Sleep Research laboratory, KITE-UHN
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23
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Torres-Lopez LV, Cadenas-Sanchez C, Migueles JH, Esteban-Cornejo I, Molina-Garcia P, H. Hillman C, Catena A, Ortega FB. Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity? Eur J Pediatr 2022; 181:2055-2065. [PMID: 35142932 PMCID: PMC9056447 DOI: 10.1007/s00431-022-04403-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED Approximately 4-11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8-12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |β|> 0.160, P > 0.076), yet it was associated with the school grade point average (β = -0.226, P = 0.007) and natural and social science grades (β = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all β < -0.188, P > 0.065) or brain volumes (all P > 0.05). CONCLUSION Our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone. WHAT IS KNOWN • Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children. • Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far. WHAT IS NEW • To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children. • SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone.
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Affiliation(s)
- Lucia V. Torres-Lopez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Cristina Cadenas-Sanchez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Institute for Innovation and Sustainable Development in the Food Chain (IS-FOOD), Public University of Navarra, Pamplona, Spain
| | - Jairo H. Migueles
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, 14183 Sweden
| | - Irene Esteban-Cornejo
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Pablo Molina-Garcia
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Charles H. Hillman
- Center for Cognitive and Brain Health, Department of Psychology, Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA USA
| | - Andres Catena
- School of Psychology, University of Granada, Granada, Spain
| | - Francisco B. Ortega
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, 14183 Sweden ,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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24
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Carrello J, Lung T, Killedar A, Baur LA, Hayes A. Relationship between obesity and school absenteeism in Australian children: Implications for carer productivity. Obes Res Clin Pract 2021; 15:587-592. [PMID: 34625400 DOI: 10.1016/j.orcp.2021.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Economic evaluations of childhood obesity interventions are often used to assist decision making when presented with alternative course of action. Including indirect costs related to productivity losses is recommended; in children this would include school absenteeism. Our aim was to determine the association between school absenteeism and weight status among Australian children and estimate the indirect costs of this. METHODS We used data from a nationally representative sample of 8551 Australian children in the Longitudinal study of Australian Children (LSAC) with follow-up between 2006 and 2018. A mixed-effects negative binomial regression model was used to investigate the relationship between school absenteeism and weight status, controlling for age, sex, socio-economic position, indigenous status, rural/remote status and long-term medical conditions. We used average daily wages for the year 2018 to value the indirect costs of school absenteeism (through caregiver lost productivity). RESULTS Australian children with obesity aged 6-13 years missed on average an extra day of school annually compared to children of a healthy weight (p = 0.004), while adolescents with obesity aged 14-17 years missed on average an extra 0.69 days of school annually (p = 0.006). The estimated national cost for children with obesity aged 6-13 years was approximately $64 million AUD ($43 million USD) or $338 AUD ($230 USD) per child through caregiver lost productivity in 2018. CONCLUSIONS There is a small but significant association between school absenteeism and childhood obesity in Australia which is estimated to generate a considerable national cost through caregiver productivity losses. Our results will assist health economists evaluating childhood obesity interventions capture the full extent of the associated costs with this condition.
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Affiliation(s)
- Joseph Carrello
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Thomas Lung
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia; The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia
| | - Anagha Killedar
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia; Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Alison Hayes
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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25
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Mills TG, Bhattacharjee R, Nation J, Ewing E, Lesser DJ. Management and outcome of extreme pediatric obstructive sleep apnea. Sleep Med 2021; 87:138-142. [PMID: 34607111 DOI: 10.1016/j.sleep.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Classify post-adenotonsillectomy (AT) respiratory support, identify variables that predict these interventions, and evaluate outcomes in children with extreme obstructive sleep apnea (OSA). METHODS Retrospective chart analysis was performed on patients found to have apnea/hypopnea index (AHI) > 100 events/h. Patients with chronic diseases other than obesity were excluded. RESULTS Forty-one subjects were studied, average age of 11.4 ± 4.3 years, majority (73.1%) were Hispanic, with a mean total AHI (TAHI) of 128.1 ± 22.9/h. Twenty-eight (68.3%) patients underwent AT. Lower age (P < 0.001), lower BMI Z-score (P < 0.01), higher OAHI (P < 0.05) were associated with having surgery. Eleven out of 28 (39.3%) surgical patients required respiratory support (oxygen or positive airway pressure) postoperatively. Longer % total sleep time SpO2 <90% during PSG (P < 0.05) and lower SpO2 nadir (P < 0.05) were associated with requiring airway support. No patients experienced mortality, reintubation, or hospital readmission following AT, with majority (71.4%) discharged 1 day post-operatively. Eleven (57.9%) of the 19 patients who had a postoperative PSG had residual OSA, defined as AHI >5 events/h, but there was a significant improvement in TAHI (P < 0.01). CONCLUSION Our findings confirm the need for postoperative observation in a controlled setting for patients with extreme OSA undergoing AT. Although at higher risk of needing respiratory support, those patients undergoing AT for extreme OSA did not require re-intubation post-operatively or suffer serious harm. Barring contraindications to AT, surgery may still be a first-line therapy for some children with extreme OSA.
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Affiliation(s)
- Tatyana G Mills
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA, 92123, USA.
| | - Rakesh Bhattacharjee
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA, 92123, USA
| | - Javan Nation
- Division of Pediatric Otolaryngology, Department of Surgery, University of California San Diego, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA, 92123, USA
| | - Emily Ewing
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA, 92123, USA
| | - Daniel J Lesser
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA, 92123, USA
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26
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Epigenetic Alterations in Pediatric Sleep Apnea. Int J Mol Sci 2021; 22:ijms22179523. [PMID: 34502428 PMCID: PMC8430725 DOI: 10.3390/ijms22179523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
Pediatric obstructive sleep apnea has significant negative effects on health and behavior in childhood including depression, failure to thrive, neurocognitive impairment, and behavioral issues. It is strongly associated with an increased risk for chronic adult disease such as obesity and diabetes, accelerated atherosclerosis, and endothelial dysfunction. Accumulating evidence suggests that adult-onset non-communicable diseases may originate from early life through a process by which an insult applied at a critical developmental window causes long-term effects on the structure or function of an organism. In recent years, there has been increased interest in the role of epigenetic mechanisms in the pathogenesis of adult disease susceptibility. Epigenetic mechanisms that influence adaptive variability include histone modifications, non-coding RNAs, and DNA methylation. This review will highlight what is currently known about the phenotypic associations of epigenetic modifications in pediatric obstructive sleep apnea and will emphasize the importance of epigenetic changes as both modulators of chronic disease and potential therapeutic targets.
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27
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Jacobs S, Mylemans E, Ysebaert M, Vermeiren E, De Guchtenaere A, Heuten H, Bruyndonckx L, De Winter BY, Van Hoorenbeeck K, Verhulst SL, Van Eyck A. The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population. Sleep Med 2021; 86:48-55. [PMID: 34461597 DOI: 10.1016/j.sleep.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/05/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood obesity is an increasing problem with substantial comorbidities such as obstructive sleep apnea (OSA) and increased cardiovascular morbidity. Endothelial dysfunction is an underlying mechanism related to both obesity and OSA. RESEARCH QUESTION To investigate the effect of weight loss on endothelial function and OSA in obese children and to determine whether a change in endothelial function can be linked to an improvement in OSA. METHODS Obese children between 8 and 18 years of age were recruited while entering a 12-month inpatient weight loss program. Patients were followed at 3 study visits: baseline, after 10 months of weight loss, and 6 months after ending the program (18 months). Anthropometry and endothelial function (EndoPAT) were determined at all study visits. At baseline, sleep screening with a portable device (ApneaLink) was performed. This was repeated after 10 months if OSA was diagnosed at baseline. RESULTS At baseline, 130 children were included, of which 87 had OSA (67%). Seventy-two patients attended the follow-up visit at 10 months, and 28 patients attended the follow-up visit at 18 months. The BMI z-score decreased after 10 months (from 2.7 (1.4-3.4) to 1.7 (0.5-2.7); p < 0.001) and remained stable at 18 months. Endothelial function improved significantly after weight loss, evidenced by a shorter time to peak response (TPR) and higher reactive hyperemia index (p = 0.02 and p < 0.001), and remained improved after 18 months (p < 0.001 and p = 0.007). After 10 months of weight loss, 10 patients had residual OSA. These patients had a higher TPR at 10 months (225 (75-285)s) than those without OSA (135 (45-225)s) and patients with a normalized sleep study (105 (45-285)s; p = 0.02). Linear mixed models showed that more severe OSA was associated with a worse TPR at baseline and less improvement after weight loss. CONCLUSION Weight loss improves endothelial function in an obese pediatric population. However, even after weight loss, endothelial function improved less in the presence of OSA.
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Affiliation(s)
- Sofie Jacobs
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Emilie Mylemans
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Marijke Ysebaert
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | | | - Hilde Heuten
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | - Stijn L Verhulst
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
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Bhattacharjee R, Benjafield A, Blase A, Dever G, Celso J, Nation J, Good R, Malhotra A. The accuracy of a portable sleep monitor to diagnose obstructive sleep apnea in adolescent patients. J Clin Sleep Med 2021; 17:1379-1387. [PMID: 33666166 DOI: 10.5664/jcsm.9202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The efficacy of portable-monitor (PM) sleep testing in children is not well understood. While most studies have evaluated PM in a lab setting, the utility of PM in the home environment is relatively unknown. We sought to determine whether home PM accurately diagnoses obstructive sleep apnea in adolescents and to assess patient satisfaction with home PM sleep testing. METHODS We evaluated adolescents (age 12-18 years) with suspected obstructive sleep apnea using a PM device. In addition to in-laboratory polysomnography (PSG), all participants had PM testing performed twice, once in their home and once concurrent to in-laboratory PSG. PM was compared to PSG using 2 primary outcomes: the apnea-hypopnea index and oxygen desaturation index. All participants were approached for interview to evaluate their experience with PM sleep testing. RESULTS Twenty adolescents participated. Bland-Altman analysis comparing the apnea-hypopnea index and oxygen desaturation index determined by home or in-laboratory PM to in-laboratory PSG revealed mostly agreement; however, some deviations were observed when either parameter was markedly increased. While PM testing tended to underestimate the apnea-hypopnea index, the diagnostic agreement between home PM and PSG was 80% (by the White-Westbrook method). Most preferred PM to PSG and found PM easy to very easy to set up. CONCLUSIONS In a small cohort of adolescents, our study supports the application of home PM in the diagnosis of suspected obstructive sleep apnea. Until studies implementing PM using larger cohorts become readily available, the findings from this preliminary study could contribute to adolescents receiving sleep apnea therapy more promptly. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Identifier: NCT03748771. At the time of issue publication, this registration is not publicly available because the trial includes a device that is not approved or cleared for use in pediatric populations. Once the device is FDA cleared, the registration will become public.
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Affiliation(s)
- Rakesh Bhattacharjee
- University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | | | - Amy Blase
- ResMed Science Center, San Diego, California
| | | | | | - Javan Nation
- University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | - Raquel Good
- Rady Children's Hospital, San Diego, California
| | - Atul Malhotra
- University of California San Diego, La Jolla, California
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29
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Gonzalez DO, Michalsky MP. Update on pediatric metabolic and bariatric surgery. Pediatr Obes 2021; 16:e12794. [PMID: 34041862 DOI: 10.1111/ijpo.12794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
The prevalence of childhood obesity has risen sharply over the last several decades and poses a significant threat to the health and well-being of today's youth. Childhood-onset obesity is associated with a number of cardiometabolic consequences, which contribute to diminished quality of life. Metabolic and bariatric surgery offers a powerful treatment paradigm with positive long-term health effects. A growing body of literature supports the notion that earlier intervention in younger patients results in long-term health benefits. The development of a multidisciplinary care model and best practice guidelines are central to providing optimal care for this vulnerable patient population. Although the outcomes of metabolic and bariatric surgery in pediatric patients are reassuring and support the ongoing utilization of this important treatment paradigm, a number of significant challenges remain regarding access to care. As the literature continues to support earlier intervention for youth with severe obesity, future efforts should address these challenges to ensure that eligible patients are referred in timely fashion.
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Affiliation(s)
- Dani O Gonzalez
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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30
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Subramanyam R, Willging P, Ding L, Yang G, Varughese A. Factors Associated With Postadenotonsillectomy Unexpected Admissions in Children. Anesth Analg 2021; 132:1700-1709. [PMID: 32833717 DOI: 10.1213/ane.0000000000005123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postadenotonsillectomy unexpected admission remains an important challenge. Unexpected admissions can be quite frightening, increase health care burden, and cause unnecessary suffering in children and families. Identifying factors associated with postadenotonsillectomy unexpected admissions using a pragmatic approach could lead to a shift in the assessment and management of children presenting for adenotonsillectomy. METHODS Institutional review board (IRB) approval, consent, and assent were obtained for this single-center, prospective, observational study done in children aged 0-17 years undergoing tonsillectomy. Data were collected from direct observation, electronic medical record, and phone calls using Research Electronic Data Capture (REDCap) database. Incidence, causes, and factors associated with 3-week and 3-day postadenotonsillectomy unexpected admissions were analyzed. RESULTS The study included 2375 children. Clinical intraoperative adverse events were reported in 6.2%. Three-week and 3-day unexpected admissions occurred in 7.9% and 5.9%, respectively, with bleeding being the commonest reason for both. On multivariable analysis, for 3-week unexpected admissions, the odds ratio was 2.3 (95% confidence interval, 1.45-1.69) with using preoperative medications, 1.4 (1.02-1.97) with home medications for comorbidities, 0.56 (0.34-0.90) with using intraoperative acetaminophen, and 0.60 (0.36-0.94) with otolaryngologic preoperative comorbidity versus otherwise. For 3-day unexpected admissions, the odds ratio was 1.10 (1.05-1.16) with 1 U increase in total comorbidities, 1.70 (1.03-2.81) with the presence of recent upper respiratory infection, and 1.83 (1.16-2.90) with intravenous versus inhalational anesthesia induction. CONCLUSIONS Overall, our study shows the factors that contribute to unexpected admissions postadenotonsillectomy. Identification of both modifiable and nonmodifiable factors associated with unexpected admissions after adenotonsillectomy will enable appropriate risk mitigation.
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Affiliation(s)
| | | | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gang Yang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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31
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Kirk VG, Edgell H, Joshi H, Constantin E, Katz SL, MacLean JE. Cardiovascular changes in children with obstructive sleep apnea and obesity after treatment with noninvasive ventilation. J Clin Sleep Med 2021; 16:2063-2071. [PMID: 32808921 DOI: 10.5664/jcsm.8760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES Adults with obesity and obstructive sleep apnea (OSA) are at risk for cardiometabolic disease, and this risk likely extends to children with both conditions. Noninvasive ventilation (NIV; including continuous and bilevel positive airway pressure) is often used to treat OSA in children with obesity. The aim of this study was to examine the impact of NIV treatment on heart rate variability (HRV), as a marker of cardiovascular risk, in children with obesity and newly diagnosed OSA. METHODS A prospective multicenter cohort study was conducted in children with obesity prescribed NIV therapy for newly diagnosed moderate-severe OSA. Measurements of HRV were derived from polysomnography recordings at baseline and after 12 months of treatment. HRV parameters were examined by sleep stage, before and after arousal and oxygen desaturation events. HRV parameters were compared between time points using pair t tests as well as mixed model analysis. RESULTS Twelve children had appropriate data for analysis at baseline and 12 months. Heart rate decreased by 4.5 beats/min after NIV treatment, with no change in HRV parameters. HRV parameters differed by sleep stage and showed an increase in arousal-related sympathetic-parasympathetic balance after 12 months of NIV treatment. HRV parameters did not differ before and after oxygen desaturation events. CONCLUSIONS NIV for the treatment in children with obesity and OSA resulted in a small decrease in heart rate and an increase in arousal-related sympathetic-parasympathetic balance. These findings suggest small, potentially positive impacts of NIV on cardiovascular risk in children with concurrent obesity and OSA.
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Affiliation(s)
- Valerie G Kirk
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Evelyn Constantin
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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32
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Gilbertson M, Richardson C, Eastwood P, Wilson A, Jacoby P, Leonard H, Downs J. Determinants of sleep problems in children with intellectual disability. J Sleep Res 2021; 30:e13361. [PMID: 34032327 DOI: 10.1111/jsr.13361] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Children with intellectual disabilities are more likely to experience sleep disorders of insomnia, excessive daytime sleepiness and sleep breathing disorders than typically developing children. The present study examined risk factors for these sleep disorders in 447 children (aged 5-18 years), diagnosed with an intellectual disability and comorbid autism spectrum disorder, cerebral palsy, Down syndrome or Rett syndrome. Primary caregivers reported on their child's sleep using the Sleep Disturbance Scale for Children (SDSC), as well as medical comorbidities and functional abilities. Multivariate linear and logistic regressions were used to examine the effects of these factors on SDSC t scores and a binary indicator, respectively for the relevant subscales. Receiving operating characteristic curves were generated for each logistic regression model to determine their ability to discriminate between poor and good sleep. Comorbidities rather than functional abilities were associated with poorer sleep. In particular, recurrent pain, frequent seizures, frequent coughing, constipation and prescription of sleep medications were associated with abnormal sleep across the entire sample, but predictors differed between diagnostic groups. The present study suggests that comorbidities are more strongly associated with quality of sleep than functional impairments. The present study provides new information on potential associations between frequent coughing, prescription sleep medications and sleep quality that should be further investigated.
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Affiliation(s)
- Melissa Gilbertson
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Cele Richardson
- Centre of Sleep Science, School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| | - Peter Eastwood
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Andrew Wilson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Discipline of Paediatrics, School of Medicine, The University of Western Australia, Perth, WA, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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Start J. Portable pediatric sleep diagnostics: 2 measures closer to reliable home sleep apnea tests for all ages. J Clin Sleep Med 2021; 17:617-618. [PMID: 33551022 DOI: 10.5664/jcsm.9126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jefrey Start
- Sleep Medicine Department, Great Plains Health Center, North Platte, Nebraska
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Abstract
Childhood obesity can lead to comorbidities that cause significant decrease in health-related quality of life and early mortality. Recognition of obesity as a disease of polygenic etiology can help deter implicit bias. Current guidelines for treating severe obesity in children recommend referral to a multidisciplinary treatment center that offers metabolic and bariatric surgery at any age when a child develops a body mass index that is greater than 120% of the 95th percentile. Obesity medications and lifestyle counseling about diet and exercise are not adequate treatment for severe childhood obesity. Early referral can significantly improve quality and quantity of life.
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Affiliation(s)
- Adi Steinhart
- Department of Pediatrics, Stanford University School of Medicine, 1017 Paradise Way, Palo Alto, CA 94306, USA
| | - Deborah Tsao
- Stanford University School of Medicine, 227 Ayrshire Farm Ln (Apt 203), Stanford, CA 94305, USA
| | - Janey S A Pratt
- Division of Pediatric Surgery, Stanford University School of Medicine, Lucille Packard Children's Hospital, M166 Alway Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Leung TN, Cheng JW, Chan AK. Paediatrics: how to manage obstructive sleep apnoea syndrome. Drugs Context 2021; 10:dic-2020-12-5. [PMID: 33828609 PMCID: PMC8007210 DOI: 10.7573/dic.2020-12-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/19/2021] [Indexed: 02/02/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.
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Affiliation(s)
- Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - James Wch Cheng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong SAR, China
| | - Anthony Kc Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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36
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Shen T, Wang J, Yang W, Li L, Qiao Y, Yan X, Chen M, Tang X, Zou J, Zhao Y. Hematological Parameters Characteristics in Children with Obstructive Sleep Apnea with Obesity. Risk Manag Healthc Policy 2021; 14:1015-1023. [PMID: 33737842 PMCID: PMC7961133 DOI: 10.2147/rmhp.s297341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/24/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the possible correlation between obesity and hematological parameters in children with obstructive sleep apnea (OSA). Methods A total of 460 children was initially included in our study, which were divided into children with OSA and children without OSA. Multiple analysis was performed for obesity by adjusting confounding factors such as age and gender in 460 children. Further, to minimize the influence of confounding factors and selective bias, propensity score matching (PSM) was performed in children with OSA. Hematological parameters such as inflammatory and coagulable parameters were compared between the normal weight children with OSA and the obese children with OSA following PSM. Results OSA (OR = 3.061; P<0.001; 95% CI, 1.772–5.288) represented an independent risk factor for obesity. Besides, the obese children with OSA had higher levels of white blood cell (WBC) (P<0.001), neutrophil (NEUT) (P<0.001), neutrophil-lymphocyte ratio (NLR) (P=0.006), fibrinogen (FIB) (P=0.033), while had a lower level of activated partial thromboplastin time (APTT) (P=0.048). No significant differences were observed in other hematological parameters. In linear regression, the results indicated that the levels of WBC (R2 = 0.123, Beta = 0.289, P<0.001), NEUT (R2 = 0.124, Beta = 0.282, P<0.001), NLR (R2 = 0.105, Beta = 0.184, P=0.026) and FIB (R2 = 0.086, Beta = 0.246, P=0.003) were positively correlated with BMI, while the level of APTT (R2 = 0.057, Beta = −0.171, P=0.044) was significantly negatively correlated with BMI. Conclusion OSA was an independent risk factor contributing to obesity. WBC, NEUT, NLR, FIB and APTT are correlated with obesity in children with OSA (aged from 2 to 14 years). These indicators could be used to estimate the status of inflammation and hypercoagulation in the obese children with OSA.
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Affiliation(s)
- Tian Shen
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wen Yang
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Linke Li
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yixin Qiao
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiaohong Yan
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Chengdu Shangjin Nanfu Hospital, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jian Zou
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Childhood Obesity and Respiratory Diseases: Which Link? CHILDREN-BASEL 2021; 8:children8030177. [PMID: 33669035 PMCID: PMC7996509 DOI: 10.3390/children8030177] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022]
Abstract
Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. Several evidences showed that obesity is a major preventable risk factor and disease modifier of some respiratory conditions such as asthma and Obstructive Sleep Apnea Syndrome (OSAS). Co-occurrence of asthma and obesity may be due to common pathogenetic factors including exposure to air pollutants and tobacco smoking, Western diet, and low Vitamin D levels. Lung growth and dysanapsis phenomenon in asthmatic obese children play a role in impaired respiratory function which appears to be different than in adults. Genes involved in both asthma and obesity have been identified, though a gene-by-environment interaction has not been properly investigated yet. The identification of modifiable environmental factors influencing gene expression through epigenetic mechanisms may change the natural history of both diseases. Another important pediatric respiratory condition associated with obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS). OSAS and obesity are linked by a bidirectional causality, where the effects of one affect the other. The factors most involved in the association between OSAS and obesity are oxidative stress, systemic inflammation, and gut microbiota. In OSAS pathogenesis, obesity's role appears to be mainly due to mechanical factors leading to an increase of respiratory work at night-time. However, a causal link between obesity-related inflammatory state and OSAS pathogenesis still needs to be properly confirmed. To prevent obesity and its complications, family education and precocious lifestyle changes are critical. A healthy diet may lead to an improved quality of life in obese children suffering from respiratory diseases. The present review aimed to investigate the links between obesity, asthma and OSAS, focusing on the available evidence and looking for future research fields.
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Vaishali K, Gatty A, Srivastav P, Amin RR. Coping strategies for obese individuals with obstructive sleep apnea during COVID-19 pandemic: A narrative review. ACTA ACUST UNITED AC 2021; 22:100324. [PMID: 33589881 PMCID: PMC7874942 DOI: 10.1016/j.obmed.2021.100324] [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: 12/22/2020] [Revised: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
Background Patients infected with SARS-CoV-2- having pre-existing non-communicable diseases (NCDs)- are at a higher risk of complications. Obesity is one of the proven risk factors causing NCDs and can influence outcomes of COVID-19 patients. It is closely related to obstructive sleep apnea (OSA). The increased risk of COVID-19 and reduced access to treatment of non-COVID conditions during the pandemic may increase the stress in obese patients with OSA. This situation makes it necessary for them to cope with their condition by themselves. This review aimed at the effect of this pandemic on these patients and coping strategies for them. Methods Databases like PubMed and Scopus were searched using a combination of key words. Full-text articles meeting the inclusion criteria were selected. Results The search yielded eight studies, discussing about the potential interactions between the COVID-19, obesity and OSA, the impact of COVID-19 on them, and management of these patients. Conclusions Increased prevalence of COVID-19 was found among obese patients with OSA. The fear of COVID-19 and shift of health care workers to manage COVID-19 patients has affected their regular visits to the hospital. However, there is lack of coping strategies for them, which should soon be established for these patients.
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Affiliation(s)
- K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Aishwarya Gatty
- College of Physiotherapy, Srinivas University, Mangalore, India
| | - Prateek Srivastav
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Revati Ravi Amin
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
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Katz SL, Blinder H, Naik T, Barrowman N, Narang I. Does neck circumference predict obstructive sleep apnea in children with obesity? Sleep Med 2021; 78:88-93. [PMID: 33418431 DOI: 10.1016/j.sleep.2020.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) affects 10-50% of children with obesity, but its identification is challenging and wait times for testing are long. Previous studies suggest that neck circumference (NC) and neck-to-height ratio (NHR) may predict OSA. Our objectives were to 1) evaluate associations of NC and NHR with OSA; 2) model NHR as a predictor of OSA, adjusting for age, sex, and Tanner stage; and 3) identify thresholds of NHR associated with OSA, in children with obesity. METHODS Participants were aged 8-17 years, with obesity (BMI >95%ile), undergoing polysomnography. Associations between NC and NHR with OSA were evaluated. NHR, age, sex and self-reported Tanner stage (early/late) were included in a negative binomial multiple regression model to predict obstructive apnea hypopnea index (OAHI). RESULTS 71 children participated, with median age 14.8 years (IQR 12.6, 16.0), 54% male, median BMI z-score 2.5 (IQR 2.3, 2.7), and 77% late Tanner stage. OSA was severe in 18 children (25.4%), moderate in 12 (16.9%), and mild in 18 (25.4%). In the model, each 0.01 increase in NHR was associated with a 55% increase in OAHI (95% CI: 36%, 80%); boys had a 119% higher OAHI than girls (95% CI: 10%, 337%). Threshold NHR associated with moderate-severe OSA was 0.25 in females and 0.23 in males. CONCLUSIONS NHR and male sex independently predict OSA severity in children with obesity, adjusting for age and Tanner stage. Children with obesity and NHR above identified thresholds are more likely to have moderate-severe OSA, and may benefit from earlier polysomnography.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada.
| | - Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada
| | - Tanvi Naik
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
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Effect of body weight on upper airway findings and treatment outcome in children with obstructive sleep apnea. Sleep Med 2020; 79:19-28. [PMID: 33465738 DOI: 10.1016/j.sleep.2020.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE/BACKGROUND Surgical interventions for obstructive sleep apnea (OSA) are less effective in obese than in normal-weight children. However, the mechanisms that underpin this relationship are not fully understood. Therefore, this study aimed to explore how body weight influences upper airway collapse and treatment outcome in children with OSA. METHODS We conducted a retrospective analysis of prospectively collected data on polysomnography, drug-induced sleep endoscopy (DISE), and treatment outcome in otherwise healthy children with OSA. Associations between body mass index (BMI) z-score and upper airway collapse during DISE were assessed using logistic regression modelling. Treatment success was defined as obstructive apnea-hypopnea index (oAHI) < 5 events/hour and cure as oAHI < 2 events/hour with obstructive apnea index < 1 event/hour. RESULTS A total of 139 children were included [median (Q1─Q3); age 4.5 (3.1─8.4) years; BMI z-score 0.3 (-0.8 to 1.4); oAHI 10.8 (6.8─18.0) events/hour]. Twenty-five of them were overweight and 21 were obese. After adjusting for age and history of upper airway surgery, BMI z-score was significantly correlated with circumferential upper airway collapse during DISE (odds ratio 1.67; 95% confidence interval 1.12─2.65; P = 0.011). Outcome of DISE-directed treatment was similar in normal-weight (success: 91.4%; cure: 78.5%), overweight (success: 88.0%; cure: 80.0%), and obese (success: 90.5%; cure: 76.5%) children. Children with circumferential collapse responded better to continuous positive airway pressure than to (adeno)tonsillectomy. CONCLUSION Increasing body weight is associated with circumferential upper airway collapse during DISE and, accordingly, may require treatment strategies other than (adeno)tonsillectomy.
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Kim KM, Kim JH, Kim D, Lim MH, Joo H, Yoo SJ, Kim E, Ha M, Paik KC, Kwon HJ. Associations among High Risk for Sleep-disordered Breathing, Related Risk Factors, and Attention Deficit/Hyperactivity Symptoms in Elementary School Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2020; 18:553-561. [PMID: 33124587 PMCID: PMC7609213 DOI: 10.9758/cpn.2020.18.4.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
Objective : Habitual snoring is a common problem in children. We evaluated the association between a high risk for sleep-disordered breathing and attention deficit/hyperactivity symptoms. Methods Parents of 13,560 children aged 6 to 12 years responded to questionnaires including items on habitual snoring and the Korean attention deficit/hyperactivity disorder rating scale. The snoring score comprised the number of "yes" responses to habitual-snoring items, and a high risk for sleep-disordered breathing was defined as a snoring score ≥ 2. Results The odds ratio (OR) of a high risk for sleep-disordered breathing was significantly higher in boys (OR = 1.47; p < 0.001), overweight children (OR = 2.20; p < 0.001), and children with current secondhand-smoking exposure (OR = 1.38; p < 0.001). The Korean attention deficit/hyperactivity disorder rating scale score increased significantly with the snoring score (0 vs. 1, B = 1.56, p < 0.001; 0 vs. 2, B = 2.44, p < 0.001; 0 vs. 3, B = 2.48, p < 0.001; 0 vs. 4, B = 3.95; p < 0.001). Conclusion Our study confirms several risk factors of sleep-disordered breathing, namely male sex, overweight, and exposure to tobacco smoking, and found a positive association between habitual snoring and attention deficit/hyperactivity symptoms.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea
| | - Jee Hyun Kim
- Department of Neurology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dohyun Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Public Human Resources, Dankook University, Cheonan, Korea
| | - Hyunjoo Joo
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seung-Jin Yoo
- Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Eunjung Kim
- Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ki Chung Paik
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea.,Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.,Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
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Selvadurai S, Voutsas G, Propst EJ, Wolter NE, Narang I. Obstructive sleep apnea in children aged 3 years and younger: Rate and risk factors. Paediatr Child Health 2020; 25:432-438. [PMID: 33173554 PMCID: PMC7606157 DOI: 10.1093/pch/pxz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/25/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Undiagnosed and untreated obstructive sleep apnea (OSA) can predispose children to neurobehavioural consequences. However, there is a lack of data identifying rate of, and risk factors for, OSA in very young healthy children. The objective of this study was to determine the rate of OSA and identify risk factors associated with the presence and severity of OSA in children aged 3 years and younger. METHODS This was a retrospective chart review of healthy children between 1 and 3 years old who had a baseline polysomnogram (PSG) between January 2012 and June 2017. Patient demographics, referral history, and PSG data were recorded. RESULTS One hundred and thirteen children were referred for a PSG, of which 66 (58%) were diagnosed with OSA and 47 (42%) did not have OSA. In the OSA group, 13 (20%) were mild and 53 (80%) were moderate-severe. Nasal congestion (P=0.001), adenoid hypertrophy (P=<0.001), and tonsillar hypertrophy (P=0.04) reported at the time of referral were more common in the OSA group compared to the no-OSA group. Binary logistic regression analysis showed that referral from an otolaryngologist (odds ratio=2.6, 95% confidence interval=1.1 to 6.0) were associated with moderate-severe OSA. CONCLUSION A high rate of OSA was found among children aged 3 years and younger. Children referred by an otolaryngologist are more likely to be diagnosed with moderate-severe OSA. Children aged 3 years and younger with symptoms of OSA should be considered high-risk for OSA and be prioritized for early PSG and management.
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Affiliation(s)
- Sarah Selvadurai
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Giorge Voutsas
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - Evan J Propst
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Nikolaus E Wolter
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 138:110320. [PMID: 32889438 DOI: 10.1016/j.ijporl.2020.110320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. METHODS This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. RESULTS A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). CONCLUSION We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.
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Kim SJ, Ahn HW, Kim SW. Advanced interdisciplinary treatment protocol for pediatric obstructive sleep apnea including medical, surgical, and orthodontic care: a narrative review. Cranio 2020; 41:274-286. [PMID: 33092497 DOI: 10.1080/08869634.2020.1839722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To suggest an updated interdisciplinary treatment protocol for pediatric obstructive sleep apnea (POSA) based on the integration of craniofacial growth modification into medical and surgical sleep practice. METHODS PubMed, Scopus, and Cochrane library were searched up to February 2020 using keywords. Among 184 articles, 80 studies were finally included. An integrated treatment protocol for POSA encompassing craniofacial skeletal management as well as medical and surgical care was attempted. RESULTS A differential diagnostic workflow for identifying the phenotype of POSA was suggested, and a phenotype-based treatment protocol for POSA was proposed. Despite the lack of high level of evidence, timely skeletal growth modification in three dimensions using craniofacial growth potential could be valuable treatment for upper airway development in POSA patients with craniofacial phenotypic cause. CONCLUSION A novel precision treatment protocol will advance clinicians to determine the primary option or to apply the combined strategy for POSA patients.
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Affiliation(s)
- Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Hyo-Won Ahn
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Sung-Wan Kim
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Abstract
Sleep-disordered breathing (SDB) includes disorders of breathing that affect airway patency, which impair children's sleep and lead to negative consequences. Obstructive sleep apnea, hypoventilation and upper airway resistance syndrome are common causes of morbidity and mortality in childhood. These clinical practice guidelines, intended for use by pediatricians and primary care clinicians, provide a clear recommendation for the diagnosis and management of sleep-disordered breathing, focusing on the most serious disorder, obstructive sleep apnea syndrome (OSAS). These clinical guidelines formulate clear recommendations to identify patients with suspected OSAS. Further, the manuscript will highlight the potential consequences of SBD in children, and how to overcome such difficulties, what could be the therapeutic options, a 12 recommendations and what are the future direction for pediatric sleep medicine.
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Affiliation(s)
- Abdullah Al-Shamrani
- Pediatric Respiratory and Sleep Medicine, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Siriwat R, Wang L, Shah V, Mehra R, Ibrahim S. Obstructive sleep apnea and insulin resistance in children with obesity. J Clin Sleep Med 2020; 16:1081-1090. [PMID: 32118578 DOI: 10.5664/jcsm.8414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVES Because existing data investigating obstructive sleep apnea (OSA) and insulin resistance (IR) are inconsistent, we examine OSA and IR in a pediatric obesity clinic. METHODS Children (2-18 years) in the obesity clinic (2013-2017) undergoing polysomnography (PSG), anthropometric measurements, and fasting laboratory tests were included. Linear regression assessed OSA defined by the obstructive apnea-hypopnea index (oAHI) with the homeostatic model assessment of insulin resistance (HOMA-IR). Secondary aims assessed oxygen desaturation index (ODI) and age interactions with HOMA-IR. Logistic regression models and receiver operating characteristic analysis were performed to investigate optimal oAHI and ODI cutoffs relative to HOMA-IR ≥ 3. RESULTS Eighty children were included (mean age, 11.4 ± 4.0 years; 56% female; 46% Caucasian; median body mass index [BMI], 34.6 kg/m² [interquartile ratio, 29.9-40.1], median BMI z-score, 2.5 [interquartile ratio, 2.3-2.8); 46% with oAHI ≥ 5 events/h. HOMA-IR was higher in the OSA group (oAHI ≥ 5 events/h): 5 vs 3.8 (P = .034). After adjustment for sex, race, and BMI z-score, oAHI ≥ 5 events/h retained significance with HOMA-IR (P = .041). HOMA-IR increased in older children (age ≥ 12 years) when adjusting for waist circumference z-score and waist-height ratio (statistical interaction, P = .020 and .034, respectively). Receiver operating characteristic showed optimal cut points of oAHI and ODI for predicting significant IR 4.9 (area under the curve, 0.70; 95% confidence interval, 0.57-0.83; sensitivity, 0.76; specificity, 0.66) and 4.6 (area under the curve, 0.68; 95% confidence interval, 0.55-0.80; sensitivity, 0.70; specificity, 0.67), respectively. CONCLUSIONS In a clinic-based pediatric cohort with obesity, OSA is associated with increased IR even after adjusting for confounders including obesity defined by the BMI z-score. Age ≥ 12 years was associated with AHI relative to IR after adjustment for waist circumference z-score and waist-height ratio. Significant IR could be discriminated by oAHI ≥ 4.9 with moderate sensitivity/specificity. Future studies are needed to verify these findings.
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Affiliation(s)
| | - Lu Wang
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Vaishal Shah
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Sally Ibrahim
- Division of Pulmonary, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital of University Hospitals, Cleveland, Ohio
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Torres-Lopez LV, Cadenas-Sanchez C, Migueles JH, Adelantado-Renau M, Plaza-Florido A, Solis-Urra P, Molina-Garcia P, Ortega FB. Associations of Sedentary Behaviour, Physical Activity, Cardiorespiratory Fitness and Body Composition with Risk of Sleep-Related Breathing Disorders in Children with Overweight/Obesity: A Cross-Sectional Study. J Clin Med 2020; 9:jcm9051544. [PMID: 32443799 PMCID: PMC7291123 DOI: 10.3390/jcm9051544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to examine the associations of sedentary behaviour, physical activity, cardiorespiratory fitness (CRF), and body composition parameters with risk of sleep-related breathing disorders (SRBD) in children with overweight/obesity. One-hundred and nine children (10.0 ± 1.1 years old, 45 girls) with overweight (n = 27) and obesity (n = 82) were included. Television viewing time was self-reported by using the Spanish adaptation of the "Youth Activity Profile" (YAP) questionnaire. Sedentary time and physical activity were measured with accelerometry. CRF was assessed with the 20-m shuttle-run test and body composition parameters with Dual-energy X-ray absorptiometry. SRBD were evaluated by using the Spanish version of the Pediatric Sleep Questionnaire. Television viewing time was positively associated with risk of SRBD (r = 0.222, p = 0.021). CRF was negatively correlated with risk of SRBD (r = -0.210, p = 0.030). Body composition parameters were positively associated with risk of SRBD (all p < 0.05), except fat mass index. Stepwise regression analyses showed that body mass index (BMI) explained the largest proportion of the variance in SRBD (r2 = 0.063, p = 0.01) and television viewing time was the only one added after BMI (r2 change = 0.048, p = 0.022). This study supports the notion that higher body weight status negatively influences risk of SRBD and adds that unhealthy behaviours could contribute to worsen SRBD, related to an increased risk of cardiovascular diseases. All the significant association observed in this manuscript were of small magnitude, indicating than other factors in addition to the one hereby studied contribute to explain the variance in SRBD.
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Affiliation(s)
- Lucia V. Torres-Lopez
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
- Correspondence:
| | - Cristina Cadenas-Sanchez
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
- MOVE-IT research group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11519 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cádiz, Spain
| | - Jairo H. Migueles
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
| | | | - Abel Plaza-Florido
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
| | - Patricio Solis-Urra
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
- IRyS Research Group, School of Physical Education, Pontificia Universidad Católica de Valparaíso, Valparaíso 2374631, Chile
| | - Pablo Molina-Garcia
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, 3000 Leuven, Belgium
| | - Francisco B. Ortega
- PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (C.C.-S.); (J.H.M.); (A.P.-F.); (P.S.-U.); (P.M.-G.); (F.B.O.)
- Department of Biosciences and Nutrition, Karolinska Institutet, 14183 Huddinge, Sweden
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Dong Z, Xu X, Wang C, Cartledge S, Maddison R, Shariful Islam SM. Association of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.obmed.2020.100185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Pratt JS, Roque SS, Valera R, Czepiel KS, Tsao DD, Stanford FC. Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery. Semin Pediatr Surg 2020; 29:150890. [PMID: 32238283 PMCID: PMC7238975 DOI: 10.1016/j.sempedsurg.2020.150890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
To ensure successful outcomes in pediatric patients with severe obesity who undergo metabolic and bariatric surgery (MBS), a number of pre-operative patient management options should be considered. This manuscript will review the indications and contraindications of MBS and special considerations for youth who might benefit from MBS. The treatment team conducts a thorough pre-operative evaluation, assessing risks and benefits of surgical intervention, and prepares patients and families to be successful with MBS by providing education about the surgical intervention and lifestyle changes that will be necessary. This article reviews the pre-operative considerations for adolescents with severe obesity who are being considered for MBS, based upon recent clinical practice guidelines.
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Affiliation(s)
- Janey S.A. Pratt
- Stanford University School of Medicine, Palo Alto, CA, USA,Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Corresponding author at: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Always Building, M116, Stanford, CA 94305, USA, (J.S.A. Pratt)
| | | | - Ruben Valera
- Tufts University School of Medicine, Boston, MA, USA
| | - Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA,Internal Medicine- Neuroendocrine Division and Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
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Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2020; 1:CD007074. [PMID: 31978261 PMCID: PMC6984442 DOI: 10.1002/14651858.cd007074.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is characterised by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy being the most common underlying risk factor. Surgical removal of enlarged adenoids or tonsils is the currently recommended first-line treatment for OSA due to adenotonsillar hypertrophy. Given the perioperative risk and an estimated recurrence rate of up to 20% following surgery, there has recently been an increased interest in less invasive alternatives to adenotonsillectomy. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory drugs have been proposed as a potential non-surgical treatment option in children with OSA. OBJECTIVES To assess the efficacy and safety of anti-inflammatory drugs for the treatment of OSA in children. SEARCH METHODS We identified trials from searches of the Cochrane Airways Group Specialised Register, CENTRAL and MEDLINE (1950 to 2019). For identification of ongoing clinical trials, we searched ClinicalTrials.gov and the World Health Organization (WHO) trials portal. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing anti-inflammatory drugs against placebo in children between one and 16 years with objectively diagnosed OSA (apnoea/hypopnoea index (AHI) ≥ 1 per hour). DATA COLLECTION AND ANALYSIS Two authors independently performed screening, data extraction, and quality assessment. We separately pooled results for the comparisons 'intranasal steroids' and 'montelukast' against placebo using random-effects models. The primary outcomes for this review were AHI and serious adverse events. Secondary outcomes included the respiratory disturbance index, desaturation index, respiratory arousal index, nadir arterial oxygen saturation, mean arterial oxygen saturation, avoidance of surgical treatment for OSA, clinical symptom score, tonsillar size, and adverse events. MAIN RESULTS We included five trials with a total of 240 children aged one to 18 years with mild to moderate OSA (AHI 1 to 30 per hour). All trials were performed in specialised sleep medicine clinics at tertiary care centres. Follow-up time ranged from six weeks to four months. Three RCTs (n = 137) compared intranasal steroids against placebo; two RCTs compared oral montelukast against placebo (n = 103). We excluded one trial from the meta-analysis since the patients were not analysed as randomised. We also had concerns about selective reporting in another trial. We are uncertain about the difference in AHI (MD -3.18, 95% CI -8.70 to 2.35) between children receiving intranasal corticosteroids compared to placebo (2 studies, 75 participants; low-certainty evidence). In contrast, children receiving oral montelukast had a lower AHI (MD -3.41, 95% CI -5.36 to -1.45) compared to those in the placebo group (2 studies, 103 participants; moderate-certainty evidence). We are uncertain whether the secondary outcomes are different between children receiving intranasal corticosteroids compared to placebo: desaturation index (MD -2.12, 95% CI -4.27 to 0.04; 2 studies, 75 participants; moderate-certainty evidence), respiratory arousal index (MD -0.71, 95% CI -6.25 to 4.83; 2 studies, 75 participants; low-certainty evidence), and nadir oxygen saturation (MD 0.59%, 95% CI -1.09 to 2.27; 2 studies, 75 participants; moderate-certainty evidence). Children receiving oral montelukast had a lower respiratory arousal index (MD -2.89, 95% CI -4.68 to -1.10; 2 studies, 103 participants; moderate-certainty evidence) and nadir of oxygen saturation (MD 4.07, 95% CI 2.27 to 5.88; 2 studies, 103 participants; high-certainty evidence) compared to those in the placebo group. We are uncertain, however, about the difference in desaturation index (MD -2.50, 95% CI -5.53 to 0.54; 2 studies, 103 participants; low-certainty evidence) between the montelukast and placebo group. Adverse events were assessed and reported in all trials and were rare, of minor nature (e.g. nasal bleeding), and evenly distributed between study groups. No study examined the avoidance of surgical treatment for OSA as an outcome. AUTHORS' CONCLUSIONS There is insufficient evidence for the efficacy of intranasal corticosteroids for the treatment of OSA in children; they may have short-term beneficial effects on the desaturation index and oxygen saturation in children with mild to moderate OSA but the certainty of the benefit on the primary outcome AHI, as well as the respiratory arousal index, was low due to imprecision of the estimates and heterogeneity between studies. Montelukast has short-term beneficial treatment effects for OSA in otherwise healthy, non-obese, surgically untreated children (moderate certainty for primary outcome and moderate and high certainty, respectively, for two secondary outcomes) by significantly reducing the number of apnoeas, hypopnoeas, and respiratory arousals during sleep. In addition, montelukast was well tolerated in the children studied. The clinical relevance of the observed treatment effects remains unclear, however, because minimal clinically important differences are not yet established for polysomnography-based outcomes in children. Long-term efficacy and safety data on the use of anti-inflammatory medications for the treatment of OSA in childhood are still not available. In addition, patient-centred outcomes like concentration ability, vigilance, or school performance have not been investigated yet. There are currently no RCTs on the use of other kinds of anti-inflammatory medications for the treatment of OSA in children. Future RCTs should investigate sustainability of treatment effects, avoidance of surgical treatment for OSA, and long-term safety of anti-inflammatory medications for the treatment of OSA in children and include patient-centred outcomes.
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Affiliation(s)
- Stefan Kuhle
- Dalhousie UniversityDepartments of Pediatrics and Obstetrics & GynaecologyHalifaxNSCanada
| | - Dorle U Hoffmann
- University Medical Centre of the Johannes Gutenberg UniversityDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Langenbeckstrausse 1MainzRhineland‐PalatinateGermany55131
| | - Souvik Mitra
- Dalhousie University & IWK Health CentreDepartments of Pediatrics, Community Health & EpidemiologyG‐2214, 5850/5980 University AvenueHalifaxNova ScotiaCanadaB3K 6R8
| | - Michael S Urschitz
- University Medical Centre of the Johannes Gutenberg UniversityDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Langenbeckstrausse 1MainzRhineland‐PalatinateGermany55131
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