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Bacon BR, Hassinger AB, Varavenkataraman G, Gould E, Sahlollbey N, Carr MM. Comparison of Epworth Sleepiness Scale and OSA-18 Scores With Polysomnography in Children. Otolaryngol Head Neck Surg 2024; 171:239-246. [PMID: 38426572 DOI: 10.1002/ohn.683] [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: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Our goal is to determine if there is a correlation between Modified Epworth Sleepiness Scale (M-ESS) scores, obstructive sleep apnea (OSA)-18 scores, and polysomnography (PSG) outcomes in children. STUDY DESIGN Retrospective chart review. SETTING Pediatric otolaryngology clinic. METHODS Charts of consecutive children presenting from July 2021 to July 2023 were reviewed. Demographics, body mass index (BMI), BMI Z score, M-ESS score, OSA-18 score, PSG results, and sleep apnea severity were included. One-way analysis of variance and Pearson/Spearman correlation coefficients were calculated. RESULTS Three hundred sixty-seven children were included, 162 (44.1%) girls and 205 (55.9%) boys. Mean patient age was 7.8 (95% confidence interval [CI]: 7.3-8.3) years. M-ESS score was 6.3 (n = 348, 95% CI: 5.8-6.8), mean OSA-18 score was 56.2 (n = 129, 95% CI: 53.0-59.4). Mean apnea-hypopnea index (AHI) was 10.1 (95% CI: 8.7-11.4) events/h, obstructive AHI 9.3 (95% CI: 8.0-12.7) events/h, respiratory distress index 14.6 (95% CI: 8.4-20.8) events/h, and oxygen saturation nadir 89.8% (95% CI: 89.1-90.4). Sixty-two children (17.2%) had mild, 192 (53.5%) moderate, and 105 (29.2%) severe sleep apnea. M-ESS score correlated weakly to AHI (r = .19, P = <.001), and OSA-18 score to oxygen saturation nadir (r = -.16, P = .002). After logistic regression adjusted for age and BMI, neither clinical scores were independently associated with AHI. CONCLUSION M-ESS and OSA-18 scores have a weak correlation with OSA severity in children. More reliable, age-appropriate screening tools are needed in pediatric sleep apnea.
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Affiliation(s)
- Beatrice R Bacon
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Amanda B Hassinger
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gaayathri Varavenkataraman
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Erin Gould
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Kang J, Lee H, Kim S, Kim HJ, Lee H, Kwon R, Son Y, Kim S, Woo HG, Kim MS, Koyanagi A, Smith L, Fond G, Boyer L, Rahmati M, López Sánchez GF, Dragioti E, Solmi M, Shin JI, Kim T, Yon DK, Cortese S. Comorbid health conditions in people with attention-deficit/hyperactivity disorders: An umbrella review of systematic reviews and meta-analyses. Asian J Psychiatr 2024; 99:104135. [PMID: 39003821 DOI: 10.1016/j.ajp.2024.104135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND We aimed to systematically review meta-analyses on the link between attention-deficit/hyperactivity disorder (ADHD) and a broad range of psychiatric, physical, and behavioral health conditions (PROSPERO; no.CRD42023448907). RESULTS We identified 22 meta-analyses that included 544 primary studies, covering 76 unique conditions in over 234 million participants across 36 countries and six continents. We found high-certainty evidence for the associations between ADHD and neuropsychiatric conditions (bipolar disorders, personality disorders, schizophrenia, and pragmatic language skills), night awakenings, obesity, decayed incipient surfaces, asthma, astigmatism, hyperopia and hypermetropia, strabismus, and suicide ideation. Moderate-certainty evidence suggested that ADHD was associated with headache, mood/affective disorders, depression, bruxism, bone fractures, atopic rhinitis, vision problems, suicide attempts, completed suicide, and all-cause mortality. Low-certainty evidence indicated associations with eating disorders, sleep efficiency, type 2 diabetes, dental trauma prevalence, atopic diseases, and atopic dermatitis. Very low-certainty evidence showed associations between ADHD and several sleep parameters. CONCLUSION We found varied levels of evidence for the associations of ADHD with multiple health conditions. Therefore, clinicians should consider a wide range of neurological, psychiatric, sleep and suicide-related, metabolic, musculoskeletal, oral, allergic, and visual conditions, as well as the increased risk of mortality when assessing individuals with ADHD.
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Affiliation(s)
- Jiseung Kang
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yejun Son
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Guillaume Fond
- Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Masoud Rahmati
- Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea; Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, South Korea.
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Regulatory Science, Kyung Hee University, Seoul, South Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA; DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
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Hansen C, Bakke M, Sonnesen L. Oro-facial function and quality of life in children and adolescents with large horizontal maxillary overjet-A case-control study. J Oral Rehabil 2024; 51:982-991. [PMID: 38414127 DOI: 10.1111/joor.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro-facial function (OF) and malocclusion have great impact on psychological well-being and quality of life (QoL). OBJECTIVES The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well-being in children and adolescents with large overjet. METHODS The study was a case-control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9-14 years old. OF was examined by use of Nordic Orofacial Test-Screening (NOT-S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well-being were examined using KIDSCREEN-10 and Strengths and Difficulties Questionnaire. RESULTS The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT-S score (p < .001) and reduced BF (p = .011), numbers of contacts (p < .001) and CE (p = .005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p = .007), hyperactivity (p = .043) and total difficulties score (p = .009) were found in the study group. CONCLUSION The study group showed higher NOT-S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well-being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group.
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Affiliation(s)
- Camilla Hansen
- Section of Orthodontics and Dental Sleep Clinic, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Bakke
- Section of Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics and Dental Sleep Clinic, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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French B, Nalbant G, Wright H, Sayal K, Daley D, Groom MJ, Cassidy S, Hall CL. The impacts associated with having ADHD: an umbrella review. Front Psychiatry 2024; 15:1343314. [PMID: 38840946 PMCID: PMC11151783 DOI: 10.3389/fpsyt.2024.1343314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD. Methods An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications. Results Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality. Discussion This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning. Registration International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).
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Affiliation(s)
- Blandine French
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Gamze Nalbant
- Lifespan and Population Health Unit, University of Nottingham, Nottingham, United Kingdom
| | - Hannah Wright
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kapil Sayal
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Daley
- Nottingham Trent University (NTU) Psychology, School of Social Science, Nottingham Trent University, Nottingham, United Kingdom
| | - Madeleine J. Groom
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte L. Hall
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Lee J, Choi A, Kim S, Kim K. Long-term effects of adenotonsillectomy in children with attention deficit hyperactivity disorder. J Clin Sleep Med 2024; 20:727-733. [PMID: 38169431 PMCID: PMC11063705 DOI: 10.5664/jcsm.10978] [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: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Adenotonsillectomy (AT) improves short-term symptoms of attention deficit hyperactivity disorder (ADHD) in children; however, its long-term effects remain unclear. We aimed to verify the therapeutic long-term effects of AT in children with ADHD. METHODS This retrospective control study included children ages < 18 years who were diagnosed with ADHD and receiving ADHD medications. Participants were divided into groups depending on whether AT was performed (AT [+] or AT [-] groups) and matched 1:1 for age, sex, and year and month of diagnosis using randomized nonreplacement selection. RESULTS Among patients with ADHD (n = 171,112), 3,615 underwent AT. In both groups, the number of drugs taken gradually increased before and decreased after the AT date (ATD). There was no difference in the number of drugs used before (P = .88) and after ATD (P = .06). Before ATD, the average number of outpatient visits (nOV) did not change in both groups (AT [+]: P = .12; AT [-]: P = .71). After ATD, the average number of outpatient visits decreased only in the AT (+) group (P = .001). However, there was no difference in the average number of outpatient visits between the two groups before (P = .47) and after ATD (P = .17). Before ATD, methylphenidate doses between the groups were not different (P = .06); however, a significant increase was noted after ATD in the AT (+) group (P < .001). CONCLUSIONS AT does not result in significant long-term therapeutic effects in terms of medication use and health care utilization in children with ADHD. CITATION Lee J, Choi A, Kim S, Kim K. Long-term effects of adenotonsillectomy in children with attention deficit hyperactivity disorder. J Clin Sleep Med. 2024;20(5):727-733.
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Affiliation(s)
- Jooyoung Lee
- Department of Pediatrics, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Arum Choi
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyunghoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Liu H, Wang X, Feng H, Zhou S, Pan J, Ouyang C, Hu X. Obstructive sleep apnea and mental disorders: a bidirectional mendelian randomization study. BMC Psychiatry 2024; 24:304. [PMID: 38654235 DOI: 10.1186/s12888-024-05754-8] [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: 11/10/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Previous studies have reported associations between obstructive sleep apnea (OSA) and several mental disorders. However, further research is required to determine whether these associations are causal. Therefore, we evaluated the bidirectional causality between the genetic liability for OSA and nine mental disorders by using Mendelian randomization (MR). METHOD We performed two-sample bidirectional MR of genetic variants for OSA and nine mental disorders. Summary statistics on OSA and the nine mental disorders were extracted from the FinnGen study and the Psychiatric Genomics Consortium. The primary analytical approach for estimating causal effects was the inverse-variance weighted (IVW), with the weighted median and MR Egger as complementary methods. The MR Egger intercept test, Cochran's Q test, Rucker's Q test, and the MR pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analyses. RESULT MR analyses showed that genetic liability for major depressive disorder (MDD) was associated with an increased risk of OSA (odds ratio [OR] per unit increase in the risk of MDD, 1.29; 95% CI, 1.11-1.49; P < 0.001). In addition, genetic liability for OSA may be associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (OR = 1.26; 95% CI, 1.02-1.56; p = 0.032). There was no evidence that OSA is associated with other mental disorders. CONCLUSION Our study indicated that genetic liability for MDD is associated with an increased risk of OSA without a bidirectional relationship. Additionally, there was suggestive evidence that genetic liability for OSA may have a causal effect on ADHD. These findings have implications for prevention and intervention strategies targeting OSA and ADHD. Further research is needed to investigate the biological mechanisms underlying our findings and the relationship between OSA and other mental disorders.
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Affiliation(s)
- Heming Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Xuemei Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Hu Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Shengze Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Jinhua Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Changping Ouyang
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China
| | - Xiaobin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, 730000, Lanzhou, Gansu Province, China.
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Alessandri-Bonetti A, Guglielmi F, Deledda G, Sangalli L, Brogna C, Gallenzi P. Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study. J Atten Disord 2024; 28:1017-1023. [PMID: 38327066 DOI: 10.1177/10870547231226139] [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] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. METHODS A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. RESULTS Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p < .00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p > .05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p < .001). CONCLUSIONS A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d.
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Affiliation(s)
| | | | - Giulia Deledda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | | | - Claudia Brogna
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | - Patrizia Gallenzi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
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Ivanov I, Miraglia B, Prodanova D, Newcorn JH. Sleep Disordered Breathing and Risk for ADHD: Review of Supportive Evidence and Proposed Underlying Mechanisms. J Atten Disord 2024; 28:686-698. [PMID: 38353411 DOI: 10.1177/10870547241232313] [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] [Indexed: 03/12/2024]
Abstract
BACKGROUND Accumulating evidence suggests that sleep disordered breathing (SDB) is under-recognized in youth and adults with ADHD. SDB may contribute to exacerbating pre-existing ADHD symptoms and may play a role in the development of cognitive deficits that may mimic ADHD symptoms. METHOD We conducted a focused review of publications on cross-prevalence, overlapping clinical and neurobiological characteristics and possible mechanisms linking SDB and ADHD. RESULTS Exiting studies suggest that co-occurrence of SDB and ADHD is as high as 50%, with frequent overlap of clinical symptoms such as distractibility and inattention. Mechanisms linking these conditions may include hypoxia during sleep, sleep fragmentation and activation of inflammation, all of which may affect brain structure and physiology to produce disturbances in attention. CONCLUSIONS The relationship between SDB and ADHD symptoms appear well-supported and suggests that more research is needed to better optimize procedures for SDB assessment in youth being evaluated and/or treated for ADHD.
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Trosman I, Ivanenko A. Classification and Epidemiology of Sleep Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:47-64. [PMID: 38302213 DOI: 10.1016/j.psc.2023.06.004] [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] [Indexed: 02/03/2024]
Abstract
Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.
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Affiliation(s)
- Irina Trosman
- Division of Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 43, Chicago, IL 60611-2991, USA
| | - Anna Ivanenko
- Division of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Berenguer C, Baixauli I, Rosa E, De Stasio S. Sleep problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder: A comparative study and effects on communication skills. Autism Res 2024; 17:355-365. [PMID: 38158389 DOI: 10.1002/aur.3077] [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: 07/16/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Sleep disturbances are highly prevalent among children with neurodevelopmental disorders, like Autism Spectrum Disorder (ASD) and Attention-Deficit/Hiperactivity Disorder (ADHD). The first objective of this study is to examine the differences in sleep problems between a group of children with ASD without intellectual disabilities, a group with ADHD and a typically developing (TD) group. A second objective is aimed at analyzing the effects of sleep problems and symptom severity on their communication skills. Participants were 122 children between 7 and 12 years old distributed in three groups: 32 TD children, 47 children with ASD and 43 children with ADHD, matched on age and intelligence. Parents completed different questionnaires that measured sleep disturbances and communication skills. Findings show significant differences between the clinical groups and the TD group in most types of sleep disorders. Moreover, the group with ADHD showed significantly more sleep breathing disorders and hyperhidrosis in comparison with ASD and TD, as well as more total sleep problems. In contrast to ASD, the predictive power of sleep problems on communication difficulties was greater in the group with ADHD. The results of the mediation analysis indicate that in both groups, sleep problems partially mediate the relationship between symptoms and communication. This investigation highlights the need of considering sleep disorders when assessing communication skills in ASD and ADHD, given its indirect influence in this domain. Understanding the sleep dysfunctions of both conditions and their repercussions is crucial to develop adjusted interventions.
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Affiliation(s)
- Carmen Berenguer
- Departamento de Psicología evolutiva y de la educación, Universitat de València, València, Spain
| | - Inmaculada Baixauli
- Departamento de Logopedia, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - Eva Rosa
- Departamento de Psicología Básica, Universitat de València, València, Spain
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Lin L, Zhao T, Ngan P, Zhuang Y, Qin D, Hua F, He H. Obstructive sleep apnea-related knowledge, attitude, experience, and behaviors among orthodontic professionals: a survey. Sleep Breath 2023; 27:2361-2369. [PMID: 37222934 DOI: 10.1007/s11325-023-02852-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To assess obstructive sleep apnea (OSA)-related experience, knowledge, attitude, and behaviors among orthodontic professionals in China and identify factors associated with their knowledge levels, attitude toward referring, and self-confidence in the management of patients with OSA. METHODS An online cross-sectional survey was conducted using a 31-item questionnaire developed with a professional online survey tool ( www.wjx.cn ) and distributed via WeChat (Tencent, Shenzhen, China). Data were collected between January 16 and 23, 2022 and analyzed using the chi-square test, Fisher's exact test, and multivariate generalized estimation equations. RESULTS A total of 1760 professionals responded to the survey, and responses to 1611 questionnaires were valid. The average score of correct answers to the 15 OSA knowledge questions was 12.1 ± 2.0. Most of the professionals agreed that it was necessary to identify patients who might have OSA in practice. The top three sources for gaining knowledge of OSA according to the survey were classrooms and textbooks (76.3%), medical lectures (75.7%), and academic conferences (73.2%). The level of knowledge was significantly correlated with self-confidence in treatment (P < 0.001) and willingness to refer patients to otolaryngologists or clinicians of related disciplines (P < 0.001). CONCLUSIONS Most orthodontic professionals agreed that there was a need to identify patients with OSA and learn further about related problems. Treatment confidence and willingness of professionals to refer patients were related to the level of OSA knowledge. These findings suggest that promotion of OSA-related education may help improve the care of patients with OSA.
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Affiliation(s)
- Lizhuo Lin
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tingting Zhao
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, USA
| | - Yimin Zhuang
- Nanshan Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Danchen Qin
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Hong He
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Sadek J. Attention Deficit Hyperactivity Disorder Misdiagnosis: Why Medical Evaluation Should Be a Part of ADHD Assessment. Brain Sci 2023; 13:1522. [PMID: 38002482 PMCID: PMC10669410 DOI: 10.3390/brainsci13111522] [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: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning and is associated with impairments in several domains. It may affect academic, educational, vocational, social, emotional, interpersonal, and health domains, and worsen risks to health outcomes. OBJECTIVE To identify and discuss medical conditions that commonly present with symptoms resembling ADHD. METHOD This review is selective and not systematic. It is conducted through a focused literature search through PubMed, Google Scholar, and EMBASE. Search term included "ADHD misdiagnosis", "medical conditions with ADHD like symptoms", "ADHD AND medical problems". EXCLUSION giftedness, high IQ, and any article that does not list medical conditions. The limits applied were the following: the work must have been published in the past 20 years, be on humans, and be in the English language. RESULTS There are several medical conditions that can be misdiagnosed as ADHD and may show a similar presentation to ADHD, particularly with inattentive symptoms. Examples include, but are not limited to, absence seizure disorder, diabetes, thyroid dysfunction, sleep deprivation, post-concussion states, inflammatory bowel disease, iron deficiency states and anemia, and disordered breathing. CONCLUSIONS Our review suggests that a thorough medical evaluation should be conducted prior to the diagnosis of ADHD. Allied health professionals and psychologists who diagnose ADHD should seek medical clearance from a physician prior to making the ADHD diagnosis in order to reduce misdiagnosis rates and improve patient outcomes. ADHD diagnosis should follow guidelines and be carried out under a systematic standardized approach. A full medical evaluation should be conducted to assess for medical conditions that may look like ADHD or be associated with ADHD.
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Affiliation(s)
- Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H4K3, Canada
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13
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Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
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May T, Birch E, Chaves K, Cranswick N, Culnane E, Delaney J, Derrick M, Eapen V, Edlington C, Efron D, Ewais T, Garner I, Gathercole M, Jagadheesan K, Jobson L, Kramer J, Mack M, Misso M, Murrup-Stewart C, Savage E, Sciberras E, Singh B, Testa R, Vale L, Weirman A, Petch E, Williams K, Bellgrove M. The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. Aust N Z J Psychiatry 2023; 57:1101-1116. [PMID: 37254562 PMCID: PMC10363932 DOI: 10.1177/00048674231166329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. METHODS Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. RESULTS The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/. CONCLUSIONS The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | | | | | - Noel Cranswick
- Clinical Pharmacology Unit, Department of Medicine and Melbourne Children’s Trials Centre, Royal Children’s Hospital, Parkville, Vic, Australia
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- University of Melbourne, Parkville, VIC, Australia
| | - Evelyn Culnane
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | - Jane Delaney
- Speech Pathology Australia, Melbourne, VIC, Australia
| | | | - Valsamma Eapen
- South Western Sydney Local Health District and Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia
| | | | - Daryl Efron
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tatjana Ewais
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Ingrid Garner
- ADHD Guideline Development Group, Melbourne, VIC, Australia
| | - Michael Gathercole
- Youth Justice, Department of Community and Justice, Grafton, NSW, Australia
| | - Karuppiah Jagadheesan
- NWAMHS–North West Area Mental Health Services, Melbourne, VIC, Australia
- Bi-National ADHD Network Committee, RANZCP - Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia
- Swinburne University, Melbourne, VIC, Australia
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - John Kramer
- ADHD, ASD and Neurodiversity Special Interest Group, Faculty of Special Interests, RACGP
- Rural Medical School, UNSW Medicine & Health, Coffs Harbour, NSW, Australia
| | - Martha Mack
- Applied Neuroscience Society of Australasia (ANSA)
| | - Marie Misso
- The Knowledge Synthesis Lab, Melbourne, VIC, Australia
| | - Cammi Murrup-Stewart
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | | | - Emma Sciberras
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Bruce Singh
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Renee Testa
- Department of Mental Health, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Psychology, Monash University, Melbourne, VIC, Australia
| | - Lisa Vale
- Occupational Therapy Australia, Splash Paediatric Therapy, Melbourne, VIC, Australia
| | - Alyssa Weirman
- ADHD Guideline Development Group, Melbourne, VIC, Australia
| | - Edward Petch
- Hakea Prison, Department of Justice, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Monash Children’s Hospital, Clayton, VIC, Australia
| | - Mark Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- AADPA Australian ADHD Professionals Association, Melbourne, VIC, Australia
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Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med 2023; 19:1027-1033. [PMID: 36727478 PMCID: PMC10235720 DOI: 10.5664/jcsm.10468] [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: 09/03/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. METHODS This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. RESULTS The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. CONCLUSIONS STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. CITATION Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Quang L. Nguyen
- Deaconess Health, Division of Pulmonary Critical Care and Sleep Medicine, University of Louisville, Louisville, Kentucky
| | | | - Yana B. Feygin
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Rajaneeshankar Palani
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Karim El-Kersh
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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16
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Kosheleff AR, Mason O, Jain R, Koch J, Rubin J. Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. J Atten Disord 2023; 27:669-697. [PMID: 36876491 PMCID: PMC10173356 DOI: 10.1177/10870547231158572] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes. METHOD Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results. RESULTS We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments. CONCLUSION This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.
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Affiliation(s)
| | - Oren Mason
- Attention MD, Grand Rapids, MI, USA and
Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Rakesh Jain
- Texas Tech University School of Medicine,
Midland, TX, USA
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17
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Migueis DP, Lopes MC, Casella E, Soares PV, Soster L, Spruyt K. Attention deficit hyperactivity disorder and restless leg syndrome across the lifespan: A systematic review and meta-analysis. Sleep Med Rev 2023; 69:101770. [PMID: 36924608 DOI: 10.1016/j.smrv.2023.101770] [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: 11/12/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
This systematic review aims to assess the association between attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for original articles that reported prevalence data on ADHD and RLS until January 24th, 2023. Two independent reviewers evaluated the quality of the articles using the National Institutes of Health assessment tool. Among the 208 articles identified between 1996 and 2022, 29 were included. In large general population studies, 2.6-15.3% of participants met the RLS criteria, of which 3.2-17.4% presented with ADHD. In the ADHD group, RLS symptoms ranged from 11 to 42.9% in children and 20-33.0% in adults. This suggests a strong co-occurrence between RLS and ADHD. A common characteristic of these conditions is sleep fragmentation, as discussed in the reviewed papers. Although large-scale studies with comparable diagnostic criteria across the lifespan are required, our findings may advocate a possible common physiological pathway, including sleep fragmentation and dopaminergic system impairment.
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Affiliation(s)
- D P Migueis
- Antonio Pedro University Hospital, Fluminense Federal University, Niterói, Brazil.
| | - M C Lopes
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil; Children Institute, HCFMUSP, Brazil.
| | - E Casella
- Children Institute, HCFMUSP, Brazil.
| | - P V Soares
- Rio de Janeiro State University, Neurology Departament, Brazil.
| | - L Soster
- Children Institute, HCFMUSP, Brazil.
| | - K Spruyt
- Université de Paris, NeuroDiderot, INSERM, 75019, Paris, France.
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18
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Sleep-disordered breathing symptoms and their association with structural and functional pulmonary changes in children born extremely preterm. Eur J Pediatr 2023; 182:155-163. [PMID: 36258056 DOI: 10.1007/s00431-022-04651-0] [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: 06/30/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
This study aimed to evaluate symptoms of sleep-disordered breathing (SDB) among children born extremely preterm, with and without a history of bronchopulmonary dysplasia (BPD), including associations between sleep and respiratory symptoms, physical activity, pulmonary function, and pulmonary magnetic resonance imaging (MRI). This multi-center cross-sectional study enrolled children aged 7-9 years born extremely preterm with and without BPD. Participants completed the Pediatric Sleep Questionnaire (PSQ), the modified Epworth sleepiness scale, a respiratory symptom questionnaire, pedometer measurements, pulmonary function testing, and pulmonary MRI. Spearman's correlations and univariate and multivariable linear regression modelling were performed. Twenty-eight of 45 children included had a history of moderate-to-severe BPD. The prevalence of sleep-related symptoms was low, with the exception of hyperactivity and inattention. There were no differences in mean (SD) scores on sleep questionnaires in children with and without BPD (PSQ: 0.21 (0.13) vs 0.16 (0.14), p = 0.3; modified Epworth: 2.4 (2.4) vs 1.8 (2.8), p = 0.4). Multiple regression analyses examining difference in sleep scores between groups, adjusting for gestational age and intraventricular hemorrhage, found no statistical difference (p > 0.05). Greater daytime sleepiness was moderately correlated with FEV1%-predicted (r = - 0.52); no other moderate-strong associations were identified. Conclusions: There was no evidence of clinically important differences in sleep symptoms between children with and without BPD, suggesting that sleep symptoms may be related to prematurity-related factors other than a BPD diagnosis, including airflow limitation. Further research is necessary to explore the relationship between sleep symptoms, airway obstruction, and neurobehavioral symptoms among premature-born children. Trial registration: NCT02921308. Date of registration: October 3, 2016. What is Known: • Presence of bronchopulmonary dysplasia (BPD) may further contribute to the development of SDB, though its impact is not well-studied. • Premature-born children have a greater risk of lung structural and functional differences, including sleep-disordered breathing (SDB). What is New: • There was no difference in sleep symptoms between children with and without BPD, suggesting that sleep symptoms are related to other prematurity-related factors, such as airflow limitation. • Greater daytime sleepiness was correlated with lower FEV1 in our population, which reflects greater airflow limitation.
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Breda V, Cerqueira RO, Ceolin G, Koning E, Fabe J, McDonald A, Gomes FA, Brietzke E. Is there a place for dietetic interventions in adult ADHD? Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110613. [PMID: 35964708 DOI: 10.1016/j.pnpbp.2022.110613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Current treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults are limited by lack of response and side effects in about one third of the individuals. Changes towards a healthier lifestyle could have a positive impact beyond the relief of specific symptoms. However, it is not clear if nutritional interventions influence mental health and cognition. The objective of this study was to summarize the available literature addressing the impact of different diets in ADHD. The most promising dietetic approaches in ADHD are diets considered to be healthy (Mediterranean-type; DASH) and the Few-Foods Diet for children. Studies should take into account the presence of multiple confounders, biases associated with difficulties in blinding participants and researchers, and search for possible mechanisms of action, so we can have better evidence to guide clinical mental care of adults with ADHD.
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Affiliation(s)
- Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Raphael O Cerqueira
- Department of Psychiatry, Federal University of São Paulo, Rua Major Maragliano 241, São Paulo, SP 04017-030, Brazil
| | - Gilciane Ceolin
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Rua Delfino Conti, Campus Trindade, Florianópolis, SC 88040-970, Brazil
| | - Elena Koning
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Jennifer Fabe
- McMasters Children's Hospital, Hamilton Health Sciences, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
| | | | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
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20
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Blumer S, Eli I, Kaminsky-Kurtz S, Shreiber-Fridman Y, Dolev E, Emodi-Perlman A. Sleep-Related Breathing Disorders in Children—Red Flags in Pediatric Care. J Clin Med 2022; 11:jcm11195570. [PMID: 36233440 PMCID: PMC9573712 DOI: 10.3390/jcm11195570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: In recent years, we have witnessed a growing interest in pediatric sleep-related breathing disorders (SRBD). Although a Pediatric Sleep Questionnaire (PSQ) exists and was found reliable in screening SRBD in children, many of the children remain underdiagnosed. The aim of the present study was to define anamnestic and clinical findings that can serve as red flags indicating the presence of SRBD in children. Methods: 227 children aged 4–12 years old were evaluated with regard to the following parameters: (i) anamnestic variables (e.g., general state of health, oral habits, bruxism, esophageal reflux, sleep continuity, snoring); (ii) clinical parameters (e.g., oral mucosa, palate, tonsils, tongue, floor of the mouth, angle classification, gingival health, caries risk) and (iii) presence of SRBD (through the PSQ). Results: Significant differences between children with and without SRBD were observed regarding continuous sleep, developmental delay, mouth breathing, and snoring. Taking medications for ADHD increased the odds of SRBD in children by over seven times, non-continuous sleep increased the odds of SRBD by six times, mouth breathing increased the odds by almost five times, and snoring increased the odds by over three times. Conclusions: Child caregivers from various fields (dentists, orthodontists, pediatric physicians, school nurses) should actively inquire about disturbed sleep, medications for ADHD, snoring, and mouth breathing among their young patients. Initial screening through a few simple questions may help raise red flags that can assist in the early detection of SRBD in children and lead to proper diagnosis and treatment.
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Affiliation(s)
- Sigalit Blumer
- Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Ilana Eli
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Shani Kaminsky-Kurtz
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Yarden Shreiber-Fridman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Eran Dolev
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
- Correspondence:
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Csábi E, Gaál V, Hallgató E, Schulcz RA, Katona G, Benedek P. Increased behavioral problems in children with sleep-disordered breathing. Ital J Pediatr 2022; 48:173. [PMID: 36109824 PMCID: PMC9479439 DOI: 10.1186/s13052-022-01364-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Healthy sleep is essential for the cognitive, behavioral and emotional development of children. Therefore, this study aimed to assess the behavioral consequences of sleep disturbances by examining children with sleep-disordered breathing compared with control participants. Methods Seventy-eight children with SDB (average age: 6.7 years (SD = 1.83); 61 had OSA and 17 had primary snoring) and 156 control subjects (average age: 6.57 years (SD = 1.46) participated in the study. We matched the groups in age (t(232) = 0.578, p = 0.564) and gender (χ2(1) = 2.192, p = 0.139). In the SDB group, the average Apnea–Hypopnea Index was 3.44 event/h (SD = 4.00), the average desaturation level was 87.37% (SD = 6.91). Parent-report rating scales were used to measure the children’s daytime behavior including Attention Deficit Hyperactivity Disorder Rating Scale, Strengths and Difficulties Questionnaire, and Child Behavior Checklist. Results Our results showed that children with SDB exhibited a higher level of inattentiveness and hyperactive behavior. Furthermore, the SDB group demonstrated more internalizing (anxiety, depression, somatic complaints, social problems) (p < 0.001) and externalizing (aggressive and rule-breaking behavior) problems compared with children without SDB, irrespective of severity. Conclusions Based on our findings we supposed that snoring and mild OSA had a risk for developing behavioral and emotional dysfunctions as much as moderate-severe OSA. Therefore, clinical research and practice need to focus more on the accurate assessment and treatment of sleep disturbances in childhood, particularly primary snoring, and mild obstructive sleep apnea.
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22
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Kang JH, Kim HJ, Song SI. Obstructive sleep apnea and anatomical structures of the nasomaxillary complex in adolescents. PLoS One 2022; 17:e0272262. [PMID: 35925992 PMCID: PMC9352039 DOI: 10.1371/journal.pone.0272262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of the present study was to reveal the associations between skeletal and soft tissue features of the nasomaxillary complex and development and severity of obstructive sleep apnea (OSA) in adolescents. A total of 100 adolescents (mean age, 14.9 ± 1.4 years; age range, 13–17 years) were enrolled. All participants underwent full-night polysomnography and had an assessment of size and position of the tongue, tonsillar size, body mass index (BMI), and circumference of the waist, neck, and hip. The skeletal features of the nasomaxillary complex, including the zygomatic arch width, nasal cavity width, nasal base width, intercanine width, intermolar width, maxillary dental arch length, palatal vault angle, palatal depth, and SNA were measured on the three-dimensional images constructed with computed tomography data. Participants with an apnea and hypopnea index (AHI) of lower than 5 (AHI ≤ 5) were classified as control and participants while those with an AHI of greater than 5 were classified as OSA group. Each variable with a significant outcome in the independent T-test and age and sex factors were integrated into the multivariate linear regression and the dependent variable was AHI. There were significant differences in the BMI and hip circumference between two groups. The width of nasal base, palatal vault angle and SNA also showed significant differences between groups. The results from multivariate linear regression demonstrated that the BMI, width of the nasal base, and SNA showed significant contributions to the severity of OSA in adolescents. The features of the nasomaxillary complex seemed to have significant influences on development and severity of OSA.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
| | - Hyun Jun Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Gyeonggi-do, Korea (ROK)
| | - Seung Il Song
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
- * E-mail:
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23
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Reiter J, Breuer O, Cohen-Cymberknoh M, Forno E, Gileles-Hillel A. Sleep in children with cystic fibrosis: More under the covers. Pediatr Pulmonol 2022; 57:1944-1951. [PMID: 33974362 PMCID: PMC8581061 DOI: 10.1002/ppul.25462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
Cystic fibrosis (CF) is a chronic multisystem disease with manifestations from birth. It involves the entire respiratory system, with increased cough, and recurrent pulmonary infections, and it also leads to intestinal malabsorption, all of which can have an impact on sleep. In this review, we summarize the available literature on the various sleep disturbances in children with CF. Sleep quality and sleep efficiency are often impaired in children with CF. They may be accompanied by symptoms associated with sleep-disordered breathing (SDB), and objective findings, such as nocturnal hypoxemia. Importantly, a strong association has been shown between SDB and the severity of lung disease, and some studies have reported a similar association for sleep quality. Further research is needed to better characterize the association of sleep disturbances with respiratory outcomes and the impact of treatment of sleep disorders on pulmonary status in children with CF.
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Affiliation(s)
- Joel Reiter
- Pediatric Pulmonology, Sleep and Cystic Fibrosis Center, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonology, Sleep and Cystic Fibrosis Center, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology, Sleep and Cystic Fibrosis Center, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Erick Forno
- Division of Pulmonary Medicine Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alex Gileles-Hillel
- Pediatric Pulmonology, Sleep and Cystic Fibrosis Center, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Wohl Center For Translational Medicine, Hadassah Medical Center, Jerusalem, Israel
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24
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Riglin L, Wootton RE, Livingston LA, Agnew-Blais J, Arseneault L, Blakey R, Agha SS, Langley K, Collishaw S, O’Donovan MC, Smith GD, Stergiakouli E, Tilling K, Thapar A. "Late-onset" ADHD symptoms in young adulthood: Is this ADHD? J Atten Disord 2022; 26:1271-1282. [PMID: 35034501 PMCID: PMC7612898 DOI: 10.1177/10870547211066486] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: We investigated whether "late-onset" ADHD that emerges in adolescence/adulthood is similar in risk factor profile to: (1) child-onset ADHD, but emerges later because of scaffolding/compensation from childhood resources; and (2) depression, because it typically onsets in adolescence/adulthood and shows symptom and genetic overlaps with ADHD. Methods: We examined associations between late-onset ADHD and ADHD risk factors, cognitive tasks, childhood resources and depression risk factors in a population-based cohort followed-up to age 25 years (N=4224-9764). Results: Parent-rated late-onset ADHD was like child-onset persistent ADHD in associations with ADHD polygenic risk scores and cognitive task performance, although self-rated late-onset ADHD was not. Late-onset ADHD was associated with higher levels of childhood resources than child-onset ADHD and did not show strong evidence of association with depression risk factors. Conclusions: Late-onset ADHD shares characteristics with child-onset ADHD when parent-rated, but differences for self-reports require investigation. Childhood resources may delay the onset of ADHD.
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Affiliation(s)
- Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Robyn E Wootton
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK,Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Lucy A Livingston
- School of Psychology, Cardiff University, Wales, UK,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jessica Agnew-Blais
- Department of Psychology, School of Biological and Chemical Sciences, Queen Mary University London, UK
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rachel Blakey
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Sharifah Shameem Agha
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,Cwm Taf Morgannwg University Health Board, Wales, UK
| | - Kate Langley
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,School of Psychology, Cardiff University, Wales, UK
| | - Stephan Collishaw
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Michael C O’Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - George Davey Smith
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Tilling
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,Corresponding author. Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ. Tel: +442920 688325.
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25
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Cooper JN, Koppera S, Bliss AJ, Lind MN. Characteristics associated with caregiver willingness to consider tonsillectomy for a child's obstructive sleep disordered breathing: Findings from a survey of families in an urban primary care network. Int J Pediatr Otorhinolaryngol 2022; 158:111143. [PMID: 35552164 DOI: 10.1016/j.ijporl.2022.111143] [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: 09/28/2021] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Tonsillectomy use is lower among Black children than White children in the U.S. despite their higher prevalence of obstructive sleep disordered breathing (oSDB). We aimed to identify factors associated with parents' willingness to consider tonsillectomy for their child's oSDB and to identify whether parents of Black children are less willing than parents of non-Black children to be willing to consider the procedure. STUDY DESIGN Prospective cohort study. SETTING Primary care network of a tertiary children's hospital. METHODS We surveyed parents/guardians of children aged 2-10 years with oSDB, to assess their knowledge about oSDB and tonsillectomy, perceived severity of their child's oSDB, perceived level of their child's sleep disturbance, perceived risks and benefits of tonsillectomy, stress, trust in their child's primary care physician and physicians in general, and health literacy. We also assessed child clinical and sociodemographic characteristics. Associations between these characteristics and parent/guardian willingness to consider tonsillectomy for their child's oSDB were assessed. RESULTS Of the 59 parents/guardians included, 90% were mothers and 71% were Black. Only 58% of caregivers of Black children but 85% of caregivers of non-Black children were willing to consider tonsillectomy (p = 0.04). Caregivers with another child who had undergone tonsillectomy and caregivers who perceived their child's sleep to be more disturbed were more often willing to consider tonsillectomy (both p = 0.02). CONCLUSIONS Parents of Black children are less willing to consider tonsillectomy for their child's oSDB, but this was not explained by any factors assessed in this study. Future studies should evaluate additional factors that may explain this difference and that might be targeted to ensure appropriate and equitable access to tonsillectomy among children with oSDB.
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Affiliation(s)
- Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra J Bliss
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Meredith N Lind
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, OH, USA
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26
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Associations of Sleep-Related Outcomes with Behavioral and Emotional Functioning in Children with Overweight/Obesity. J Pediatr 2022; 246:170-178.e2. [PMID: 35278412 DOI: 10.1016/j.jpeds.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and device-assessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/obesity. STUDY DESIGN A total of 109 children with overweight/obesity (mean age, 10.0 ± 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). RESULTS SDB was positively associated with all clinical scale variables (all β > 0.197, P ≤ .041) and with lower adaptability and leadership (all β < -0.226, P < .021). Specifically, the PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat (all β > 0.196, P ≤ .045) and lower adaptability (β = -0.246, P = .011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all β > |0.192|, P ≤ .046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. CONCLUSIONS Our study suggests that SDB symptoms, but not device-assessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability.
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27
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Pediatric obstructive sleep apnea. Int Anesthesiol Clin 2022; 60:66-73. [DOI: 10.1097/aia.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Turner EM, Koskela-Staples MSN, Evans BSC, Black LV, Heaton SC, Fedele DA. The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive Function Among Youth With Sickle Cell Disease1. Dev Neuropsychol 2022; 47:93-104. [PMID: 35157528 DOI: 10.1080/87565641.2022.2038601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine associations between sleep-disordered breathing (SDB) and executive/attentional function in pediatric sickle cell disease (SCD). METHODS Sixty youth with SCD ages 8-18 years and caregivers completed the Pediatric Sleep Questionnaire (PSQ), Delis Kaplan Executive Function System Trail Making Test (DKEFS TMT), Psychomotor Vigilance Test (PVT), and the Behavior Rating Inventory Of Executive Function, Second Edition (BRIEF-2) Parent Report. RESULTS The PSQ significantly predicted the BRIEF-2 Parent Report, F(1, 58) = 44.64, p < .001, R2 = 0.44, f2 = 0.77. CONCLUSIONS Sleep-disordered breathing symptoms may predict informant-rated executive dysfunction in pediatric SCD, but not performance-based executive function.
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Affiliation(s)
- Elise M Turner
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | | | - B S Corinne Evans
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - L Vandy Black
- Division of Pediatric Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Shelley C Heaton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
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29
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An epidemiologic study of sleep-disordered breathing in a large sample of Chinese adolescents. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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30
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Miano S, Castelnovo A, Bruni O, Manconi M. Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes. J Sleep Res 2022; 31:e13426. [PMID: 34169594 DOI: 10.1111/jsr.13426] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/16/2023]
Abstract
The analysis of sleep microstructure in attention deficit hyperactivity disorder (ADHD) revealed an under-representation of the EEG slow component during NREM sleep. Previous studies either excluded or did not characterize objectively sleep disorders, which notoriously affect sleep architecture. The present study aimed to investigate the cyclic alternating pattern in a real clinical sample of children with ADHD, in whom sleep disorders could be considered. Twenty-seven consecutively enrolled drug-naïve children (mean age, 10.53 years; nine females) and 23 controls (mean age, 10.22 years; 11 females) underwent a full sleep investigation, including attended video-polysomnography. Visual cyclic alternating pattern analysis was performed in a blinded way. Children with ADHD had one or more sleep disorders (a narcolepsy-like phenotype was found in two cases, sleep onset insomnia in three cases, arousal disorder in one case, movement disorder phenotype in six cases and obstructive sleep apnea in 11 cases, and six children had sleep-related epileptiform discharges). Children with ADHD and normal controls showed a similar microstructure with a cyclic alternating pattern rate of about 50%. Children with obstructive sleep apnea had a significantly higher cyclic alternating pattern rate during stage N3. Despite not reaching statistical differences, a lower cyclic alternating pattern rate and A1 index were found in children without epileptic abnormalities/obstructive sleep apnea. Our analysis might allow differentiation of the "primary form" of ADHD associated with a decrease of NREM instability from those forms associated with sleep apnea and epileptic activity.
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Affiliation(s)
- Silvia Miano
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Mauro Manconi
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Neurology, Inselspital, University Hospital, Bern, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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31
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Kwon SJ, Kim Y, Kwak Y. Influence of smartphone addiction and poor sleep quality on attention-deficit hyperactivity disorder symptoms in university students: a cross-sectional study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:209-215. [PMID: 32240033 DOI: 10.1080/07448481.2020.1740228] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/20/2020] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
Objective: This study examined the relationship between attention-deficit hyperactivity disorder ((ADHD)) symptoms, smartphone addiction, and poor sleep quality in university students, and identified factors affecting ADHD symptoms. Participants: Data were collected from 197 students from March to June 2017. Methods: We adopted a descriptive cross-sectional study design. Results: ADHD symptoms were positively correlated with smartphone addiction (r = .424, p < .01) and poor sleep quality (r = .313, p < .01). The regression analysis showed that academic achievement (ß =.128, p = .038), smartphone addiction (ß =.327, p < .001), sleep disturbance (ß = .197, p = .003), and daytime dysfunction (ß = .269, p < .001) were identified as factors significantly influencing ADHD symptoms, accounting for 31.1% of their variance. Conclusions: Interventions for university students with ADHD symptoms should involve the evaluation of these four factors as a multifaceted approach to reducing ADHD symptoms.
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Affiliation(s)
- Soo Jin Kwon
- Industry Academic Cooperation Foundation, Chung-Ang University, Seoul, Republic of Korea
| | - Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Yeunhee Kwak
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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32
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Prajsuchanai T, Tanphaichitr A, Hosiri T, Ungkanont K, Banhiran W, Vathanophas V, Gozal D. Prevalence of high-risk for obstructive sleep apnea in attention deficit hyperactivity disorder children referred to psychiatry clinic and impact on quality of life. Front Psychiatry 2022; 13:926153. [PMID: 35935414 PMCID: PMC9353399 DOI: 10.3389/fpsyt.2022.926153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the prevalence of high-risk obstructive sleep apnea (OSA) in attention deficit hyperactivity disorder (ADHD) children in a child and adolescent psychiatry clinic using the Thai version of the Pediatric Obstructive Sleep Apnea Screening Tool (POSAST) questionnaire. The secondary objective was to evaluate the quality of life and identify associated factors for high-risk OSA in ADHD children. STUDY DESIGN Prospective cross-sectional study. MATERIAL AND METHOD Caregivers of pediatric patients aged 5-18 years old and diagnosed with ADHD by child and adolescent psychiatrists were surveyed about their child's sleeping habits. RESULTS Two hundred and seventy-four subjects were included. The patients' mean age was 10.4 ± 2.6 years, and 82.8% were males. There were 30 children (10.9%) diagnosed with obesity, 46 (16.8%) with chronic rhinitis, and 9 (3.3%) with asthma. The median duration of ADHD symptoms was 22.1 months. The prevalence of high-risk OSA was 18.2% and was associated with significantly reduced quality of life (adjusted OR = 4.46, 95% CI: 2.26-8.81, P < 0.001). A significant association between high-risk OSA and obesity also emerged (adjusted OR = 2.84, 95% CI: 1.17-6.88, P = 0.021). CONCLUSION An elevated prevalence of high-risk OSA is present among Thai children with ADHD, and significantly impacts quality of life. A significant association between high-risk OSA and obesity is also detected in patients with ADHD. Therefore, screening for high-risk OSA in ADHD patients may likely facilitate early detection and treatment of OSA, and potentially prevent adverse consequences.
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Affiliation(s)
| | - Archwin Tanphaichitr
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tikumporn Hosiri
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitirat Ungkanont
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wish Banhiran
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vannipa Vathanophas
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, United States
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Baker-Smith CM, Isaiah A, Melendres MC, Mahgerefteh J, Lasso-Pirot A, Mayo S, Gooding H, Zachariah J. Sleep-Disordered Breathing and Cardiovascular Disease in Children and Adolescents: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2021; 10:e022427. [PMID: 34404224 PMCID: PMC8649512 DOI: 10.1161/jaha.121.022427] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep‐disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease–related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep‐disordered breathing and cardiovascular health during childhood and adolescence.
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34
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The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD). CHILDREN-BASEL 2021; 8:children8090824. [PMID: 34572256 PMCID: PMC8470037 DOI: 10.3390/children8090824] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients.
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Hasanin M, ElNaghy R, Olson D, Al-Jewair T. Three-dimensional analysis of upper airway and craniofacial morphology in orthodontic adolescents with Attention Deficit Hyperactivity Disorder (ADHD): A comparative retrospective study. Int Orthod 2021; 19:622-632. [PMID: 34507915 DOI: 10.1016/j.ortho.2021.08.005] [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: 05/24/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study is to evaluate craniofacial characteristics and upper airway morphology in adolescents with Attention Deficit Disorder with Hyperactivity (ADHD) compared to controls (CON). MATERIALS AND METHODS Records from July 2014 to May 2018 of patients who were seeking orthodontic treatment at a single institute and had full pre-treatment orthodontic records including cone-beam computed tomography (CBCT) were reviewed. Comprehensive cephalometric variables were measured to determine craniofacial morphology. Upper airway volume (UAV), minimum cross-sectional area (MCA), and linear measurements were calculated at multiple planes. RESULTS A total of 87 adolescents (ADHD, 29; CON, 58) were included in the study. Overall, UAV and MCA in ADHA group were smaller than CON. Statistical significance was evident in airway widths at planes A (P=0.002), C (P=0.042), and D (P<0.001), and airway area at plane D (lower hypopharynx) (P<0.001), with the ADHD group showing narrower widths and area compared to CON. The most common skeletal classification in the ADHD group was sequenced as Class II, Class I then Class III, with percentages of (58.6%), (31%) and (10.3%), respectively. No significant differences were found between the groups for any of the skeletal, dental, and soft tissue cephalometric variables. CONCLUSIONS ADHD affected adolescents have similar craniofacial characteristics, but narrower upper airway dimensions compared to controls. Further investigations with larger samples are warranted to further elucidate the relationship between SDB and ADHD.
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Affiliation(s)
- Majd Hasanin
- Department of Graduate Orthodontics, School of Dentistry, University of Detroit Mercy, Detroit, Michigan, USA
| | - Rahma ElNaghy
- Department of Graduate Orthodontics, School of Dentistry, University of Detroit Mercy, Detroit, Michigan, USA; Nahda University in Beni-Suef (NUB), Beni-Suef City, Egypt.
| | - Douglas Olson
- CHOC Children's Cleft and Craniofacial Center, Orange County, California, USA
| | - Thikriat Al-Jewair
- Department of Orthodontics, School of Dental Medicine, University at Buffalo, New York, USA
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Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MMJ, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BSG, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev 2021; 128:789-818. [PMID: 33549739 PMCID: PMC8328933 DOI: 10.1016/j.neubiorev.2021.01.022] [Citation(s) in RCA: 489] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, Psychiatry Research Division, SUNY Upstate Medical University, Syracuse, NY, USA; World Federation of ADHD, Switzerland; American Professional Society of ADHD and Related Disorders (APSARD), USA.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Child and Adolescent Psychiatrist's Representative, Zentrales-ADHS-Netz, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing, China; Beijing Institute for Brain Disorders, Beijing, China; Asian Federation of ADHD, China; Chinese Society of Child and Adolescent Psychiatry, China
| | - Joseph Biederman
- Clinical & Research Programs in Pediatric Psychopharmacology & Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Jeffrey H Newcorn
- American Professional Society of ADHD and Related Disorders (APSARD), USA; Departments of Psychiatry and Pediatrics, Division of ADHD and Learning Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin Gignac
- Department of Child and Adolescent Psychiatry, Montreal Children's Hospital, MUHC, Montreal, Canada; Child and Adolescent Psychiatry Division, McGill University, Montreal, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | | | - Iris Manor
- Chair, Israeli Society of ADHD (ISA), Israel; Co-chair of the neurodevelopmental section in EPA (the European Psychiatric Association), France
| | - Luis Augusto Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - Li Yang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton,UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Doron Almagor
- University of Toronto, SickKids Centre for Community Mental Health, Toronto, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | - Mark A Stein
- University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Turki H Albatti
- Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Haya F Aljoudi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Mohammed M J Alqahtani
- Clinical Psychology, King Khalid University, Abha, Saudi Arabia; Saudi ADHD Society, Saudi Arabia
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Science, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute, and Department of Internal Medicine, Medical College East Africa, the Aga Khan University, Kenya; African College of Psychopharmacology, Kenya; African Association of Psychiatrists, Kenya
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Dept. of Psychiatry, Brussel, Belgium; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK; NIHR MindTech Mental Health MedTech Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany; Zentrales-ADHS-Netz, Germany
| | | | | | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Professional Board, ADHD Europe, Belgium
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, Groningen, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; ADHD Across the Lifespan Network from European College of Neuropsychopharmacology(ECNP), the Netherlands
| | | | - Stephen P Hinshaw
- University of California, Berkeley, CA, USA; University of California, San Francisco, CA, USA
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Chris Hollis
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; NIHR MindTech MedTech Co-operative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Scott H Kollins
- Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J J Sandra Kooij
- Amsterdam University Medical Center (VUMc), Amsterdam, the Netherlands; PsyQ, The Hague, the Netherlands; European Network Adult ADHD, the Netherlands; DIVA Foundation, the Netherlands; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tingyu Li
- Growth, Development and Mental Health Center for Children and Adolescents, Children's Hospital of Chongqing Medical University, Chongqing, China; National Research Center for Clinical Medicine of Child Health and Disease, Chongqing, China; The Subspecialty Group of Developmental and Behavioral Pediatrics, the Society of Pediatrics, Chinese Medical Association, China
| | - Jing Liu
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; The Chinese Society of Child and Adolescent Psychiatry, China; The Asian Society for Child and Adolescent Psychiatry and Allied Professions, China
| | - Eugene Merzon
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel; Israeli Society of ADHD, Israel; Israeli National Diabetes Council, Israel
| | - Gregory Mattingly
- Washington University, St. Louis, MO, USA; Midwest Research Group, St Charles, MO, USA
| | - Paulo Mattos
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brazilian Attention Deficit Association (ABDA), Brazil
| | | | | | - Brooke S G Molina
- Departments of Psychiatry, Psychology, Pediatrics, Clinical & Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel T Nigg
- Center for ADHD Research, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Diane Purper-Ouakil
- University of Montpellier, CHU Montpellier Saint Eloi, MPEA, Medical and Psychological Unit for Children and Adolescents (MPEA), Montpellier, France; INSERM U 1018 CESP-Developmental Psychiatry, France
| | - Olayinka O Omigbodun
- Centre for Child & Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Child & Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yehuda Pollak
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Israel; The Israeli Society of ADHD (ISA), Israel
| | - Alison S Poulton
- Brain Mind Centre Nepean, University of Sydney, Sydney, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany; German Psychiatric Association, Germany
| | - Katya Rubia
- World Federation of ADHD, Switzerland; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany
| | - Julia Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany; Zentrales-ADHS-Netz, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France; International Collaboration on ADHD and Substance Abuse (ICASA), the Netherlands; DIVA Foundation, the Netherlands
| | - Arnt Schellekens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Renata Schoeman
- University of Stellenbosch Business School, Cape Town, South Africa; South African Special Interest Group for Adult ADHD, South Africa; The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for ADHD, South Africa; World Federation of Biological Psychiatry, Germany; American Psychiatric Association, USA; Association for NeuroPsychoEconomics, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Henal Shah
- Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Mary V Solanto
- The Zucker School of Medicine at Hofstra-Northwell, Northwell Health, Hemstead, NY, USA; Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), USA; American Professional Society of ADHD and Related Disorders (APSARD), USA; National Center for Children with Learning Disabilities (NCLD), USA
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | - César Soutullo
- American Professional Society of ADHD and Related Disorders (APSARD), USA; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany; Louis A. Faillace MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hans-Christoph Steinhausen
- University of Zurich, CH, Switzerland; University of Basel, CH, Switzerland; University of Southern Denmark, Odense, Denmark; Centre of Child and Adolescent Mental Health, Copenhagen, Denmark
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Wales, UK
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Geurt van de Glind
- Hogeschool van Utrecht/University of Applied Sciences, Utrecht, the Netherlands
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Saskia Van der Oord
- Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; European ADHD Guidelines Group, Germany
| | - Andre Venter
- University of the Free State, Bloemfontein, South Africa
| | - Benedetto Vitiello
- University of Torino, Torino, Italy; Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Yufeng Wang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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Holingue C, Volk H, Crocetti D, Gottlieb B, Spira AP, Mostofsky SH. Links between parent-reported measures of poor sleep and executive function in childhood autism and attention deficit hyperactivity disorder. Sleep Health 2021; 7:375-383. [PMID: 33461914 PMCID: PMC8205962 DOI: 10.1016/j.sleh.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess whether poor sleep is associated with aspects of executive function (EF) among children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), or typical development (TD), after adjusting for demographic variables, stimulant medications, intelligence, anxiety, inattention, and hyperactivity. DESIGN Cross-sectional. SETTING Children recruited through ongoing studies at the Kennedy Krieger Institute. PARTICIPANTS We studied 735 children (323 TD; 177 ASD; 235 ADHD) aged 8 to 12 years. MEASUREMENTS We investigated associations of parent-reported sleep measures from the Children's Sleep Habits Questionnaire (CSHQ) with parent-report measures of EF and performance-based processing speed with each clinical population. EF was measured using 8 clinical T scores that fall under 2 domains (behavioral regulation and metacognition) from the Behavior Rating Inventory of EF (BRIEF) and the processing speed index from the Wechsler Intelligence Scale for Children-IV or -V. RESULTS Higher CSHQ scores were associated with poorer EF on all BRIEF scales, across all child groups, after adjustment for demographic factors, stimulant medications, and IQ. Among children with ADHD, these associations largely remained after adjusting for anxiety. Among those ASD, anxiety partially accounted for these associations, especially for behavioral regulation EF outcomes. Co-occurring symptoms of inattention and hyperactivity/impulsivity further accounted for the associations between sleep and EF. Poor sleep was not significantly associated with processing speed. CONCLUSIONS Strong links exist between parent-reported poor sleep and executive dysfunction in children with typical development. Targeting anxiety may alleviate executive dysfunction, especially among children with ASD.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA; Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.
| | - Heather Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Bridget Gottlieb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Stickley A, Shirama A, Kitamura S, Kamio Y, Takahashi H, Saito A, Haraguchi H, Kumazaki H, Mishima K, Sumiyoshi T. Attention-deficit/hyperactivity disorder symptoms and sleep problems in preschool children: the role of autistic traits. Sleep Med 2021; 83:214-221. [PMID: 34049039 DOI: 10.1016/j.sleep.2021.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep problems are elevated in children with attention-deficit/hyperactivity disorder (ADHD). However, until now there has been comparatively little research on the role of autistic traits in this association. The current study examined the association between ADHD symptoms and sleep problems in Japanese preschool children and whether autistic traits might also be important for this relationship. METHODS Data were analyzed from 1053 children (average age 64.14 months, range 58-71; 50.3% male) that were drawn from the Tama Children's Survey (TCS). Parent-reported information was obtained on ADHD symptoms using the Strengths and Difficulties Questionnaire (SDQ) and autistic traits with the Social Responsiveness Scale Second Edition (SRS-2). Parents also provided information on three different categories of sleep problems experienced by their children - parasomnias, sleep disordered breathing and awakening/daytime problems. Ordinal logistic regression analysis was used to examine the associations. RESULTS In analyses adjusted for sociodemographic factors, the mother's mental health and child's emotional problems, compared to children with no ADHD symptoms or autistic traits, children with only ADHD symptoms had significantly increased odds for only one of 11 individual sleep problems - waking in a negative mood. In contrast, children with comorbid ADHD symptoms and autistic traits had elevated odds for five sleep problems with odds ratios ranging from 2.10 (takes time to become alert in the morning) to 3.46 (excessive body movement while sleeping). CONCLUSIONS Sleep problems may be especially elevated in children with comorbid ADHD symptoms and autistic traits.
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Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan.
| | - Aya Shirama
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Yoko Kamio
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan; Institute of Education and Human Development, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Hidetoshi Takahashi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan; Kochi Medical School Department of Child and Adolescent Psychiatry, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Aya Saito
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan; Human Science Division, Faculty of Core Research, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Hideyuki Haraguchi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Hirokazu Kumazaki
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Kazuo Mishima
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
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Isaiah A, Ernst T, Cloak CC, Clark DB, Chang L. Associations between frontal lobe structure, parent-reported obstructive sleep disordered breathing and childhood behavior in the ABCD dataset. Nat Commun 2021; 12:2205. [PMID: 33850154 PMCID: PMC8044120 DOI: 10.1038/s41467-021-22534-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023] Open
Abstract
Parents frequently report behavioral problems among children who snore. Our understanding of the relationship between symptoms of obstructive sleep disordered breathing (oSDB) and childhood behavioral problems associated with brain structural alterations is limited. Here, we examine the associations between oSDB symptoms, behavioral measures such as inattention, and brain morphometry in the Adolescent Brain Cognitive Development (ABCD) study comprising 10,140 preadolescents. We observe that parent-reported symptoms of oSDB are associated with composite and domain-specific problem behaviors measured by parent responses to the Child Behavior Checklist. Alterations of brain structure demonstrating the strongest negative associations with oSDB symptoms are within the frontal lobe. The relationships between oSDB symptoms and behavioral measures are mediated by significantly smaller volumes of multiple frontal lobe regions. These results provide population-level evidence for an association between regional structural alterations in cortical gray matter and problem behaviors reported in children with oSDB.
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Grants
- U01 DA041174 NIDA NIH HHS
- U01 DA041048 NIDA NIH HHS
- U01 DA041156 NIDA NIH HHS
- U01 DA041093 NIDA NIH HHS
- U01 DA041106 NIDA NIH HHS
- U01 DA050989 NIDA NIH HHS
- U01 DA041089 NIDA NIH HHS
- U01 DA050988 NIDA NIH HHS
- U01 DA041028 NIDA NIH HHS
- U01 DA041134 NIDA NIH HHS
- U24 DA041147 NIDA NIH HHS
- U01 DA050987 NIDA NIH HHS
- P50 DA046346 NIDA NIH HHS
- U01 DA041022 NIDA NIH HHS
- U01 DA041025 NIDA NIH HHS
- U01 DA051037 NIDA NIH HHS
- U01 DA051016 NIDA NIH HHS
- U01 DA041148 NIDA NIH HHS
- U24 DA041123 NIDA NIH HHS
- U01 DA041120 NIDA NIH HHS
- U01 DA051039 NIDA NIH HHS
- U01 DA051018 NIDA NIH HHS
- U01 DA051038 NIDA NIH HHS
- U.S. Department of Health & Human Services | National Institutes of Health (NIH)
- The ABCD Study is supported by the National Institutes of Health (NIH) and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025. A full list of supporters is available at https://abcdstudy.org/federal-partners.html. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/Consortium_Members.pdf.
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Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine C Cloak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
Sleep-disordered breathing (SDB) and attention deficit hyperactivity disorder (ADHD) are common disorders diagnosed in children. Although these diagnoses were previously considered unrelated, research now is showing that some symptoms of ADHD, specifically oppositional behavior, hyperactivity, and impulsivity, can be related to SDB in children and differs from bona fide ADHD. This article explores the connection between the two disorders and the importance of identifying and screening for SDB in children presenting with similar symptoms related to ADHD. The article also examines symptom improvement in patients with ADHD symptoms after an adenotonsillectomy, one of the first-line treatments for children diagnosed with SDB; this procedure may reduce the need for long-term stimulant use in some children with ADHD.
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Scholes M, Jensen E, Meier M, Friedman N. Effect of adenotonsillectomy in children with obstructive sleep apnea and major psychiatric disorders on obstructive apnea-hypopnea index and Epworth Sleepiness Scale scores. J Clin Sleep Med 2021; 17:685-689. [PMID: 33206042 DOI: 10.5664/jcsm.9012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study evaluates the effectiveness of adenotonsillectomy in the treatment of obstructive sleep apnea in children with major psychiatric disorders as measured by polysomnography and the Epworth Sleepiness Scale (ESS) at a tertiary children's hospital. Adults with major psychiatric disorders often have higher rates of obstructive sleep apnea and decreased response to treatment. The goal was to determine if children with serious mental illness had outcomes similar to their adult counterparts. METHODS A retrospective chart review was undertaken to identify children with obstructive sleep apnea and major psychiatric disorders who underwent adenotonsillectomy as part of their treatment for obstructive sleep apnea and had undergone preoperative and postoperative polysomnography as well as ESS. A multivariable model was run for each of the postoperative outcomes (ESS, obstructive apnea-hypopnea index, or body mass index percentile), adjusting for their respective preoperative value, age, and group. RESULTS There were 34 patients who qualified for this study and who were matched with 66 controls. There was no significant difference between the 2 groups in terms of change in ESS, obstructive apnea-hypopnea index, or body mass index percentile, both before and after adjusting for age. The only significant findings were that preoperative ESS and body mass index percentile were predictive of postoperative ESS and body mass index percentile for both groups. CONCLUSIONS Children with psychiatric disorders in our institution respond to surgical management of obstructive sleep apnea similar to pediatric controls without mental illness despite comorbidities and central-acting medications that may alter sleep.
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Affiliation(s)
- Melissa Scholes
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Emily Jensen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Maxene Meier
- Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Norman Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
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Kapoor V, Ferri R, Stein MA, Ruth C, Reed J, DelRosso LM. Restless sleep disorder in children with attention-deficit/hyperactivity disorder. J Clin Sleep Med 2021; 17:639-643. [PMID: 33155540 PMCID: PMC8020699 DOI: 10.5664/jcsm.8984] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Restless sleep is a very common parental complaint in children with attention-deficit/hyperactivity disorder (ADHD), but restless sleep has been seen in association with other comorbidities such as restless legs syndrome and obstructive sleep apnea. Restless sleep disorder (RSD) needs to be identified from other disorders when evaluating children with ADHD. In this study we aim to identify the prevalence of RSD in children with ADHD referred to our sleep center. METHODS This is a retrospective study of children with ADHD who underwent polysomnography. The following diagnostic and descriptive data were obtained for each patient: age, sex, presence/absence of RSD, other sleep disorders, psychiatric comorbidities, and medications. RSD was diagnosed per diagnostic criteria. RESULTS There were 66 children with ADHD. All of them underwent polysomnography, 17 were females, and 49 were males. Mean age was 11.6 years (± 3.6 standard deviation). The complaint of restless sleep was reported by the parents of 54 (81.1%) of the children; however, only 6 of them (9.1%) were diagnosed with RSD. Seventy-one percent had obstructive sleep apnea and 19.7% had restless legs syndrome. A significant number of patients had psychiatric comorbidities and were on various medications. CONCLUSIONS Although restless sleep is a common complaint reported in 81.1% of children with ADHD, only 9.1% had RSD. Most causes of restless sleep are secondary and associated with other sleep disorders, psychiatric comorbidities, or medication use.
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Affiliation(s)
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Mark A. Stein
- University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
| | - Chris Ruth
- Seattle Children’s Hospital, Seattle, Washington
| | | | - Lourdes M. DelRosso
- University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
- Address correspondence to: Lourdes M. DelRosso, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105; Tel: (267) 559-4515;
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Mota-Veloso I, Ramos-Jorge J, Freitas LRP, Ferreira FO, Ramos-Jorge ML, Paiva SM, Soares RV. The prevalence of malocclusion is higher in schoolchildren with signs of hyperactivity. Am J Orthod Dentofacial Orthop 2021; 159:653-659. [PMID: 33658172 DOI: 10.1016/j.ajodo.2019.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Attention deficit-hyperactivity disorder is a behavioral disorder characterized by a lack of focus, impulsive behavior, and or excessive activity. This research aimed to evaluate the association between signs of attention deficit-hyperactivity disorder and malocclusion in schoolchildren. METHODS A cross-sectional study was conducted with a representative sample of 633 children aged 7-12 years. The children were clinically examined for malocclusion using the Dental Aesthetic Index. The predominant breathing pattern was also determined. Parents answered a questionnaire addressing socioeconomic characteristics and the presence of nonnutritive sucking habits. The Swanson, Nolan, and Pelham Scale-IV was filled out by both parents and teachers to compare behavioral patterns. The children were submitted to a neuropsychological evaluation using the Raven's Colored Progressive Matrix Test. Data analysis involved the chi-square test and Poisson regression analysis. RESULTS The prevalence of malocclusion was 42% higher among children with signs of hyperactivity reported by both parents and teachers (prevalence ratio [PR], 1.42; 95% confidence interval [CI], 1.11-1.81; P = 0.004). In the final Poisson regression model, the prevalence of malocclusion was lower among schoolchildren aged 11 and 12 years (PR, 0.62; 95% CI. 0.52-0.73; P <0.001) and higher among those who used a pacifier for at least 4 years (PR, 1.25; 95% CI, 1.02-1.54; P = 0.029) as well as those classified as mouth breathers (PR, 1.28; 95% CI, 1.09-1.51; P = 0.003). CONCLUSIONS The prevalence of malocclusion was higher among children with signs of hyperactivity independently of age, pacifier use, and mouth breathing.
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Affiliation(s)
- Isabella Mota-Veloso
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Joana Ramos-Jorge
- Department of Pediatric Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Laíze Rosa Pires Freitas
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Letícia Ramos-Jorge
- Department of Pediatric Dentistry and Orthodontics, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo Villamarim Soares
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Trosman I, Ivanenko A. Classification and Epidemiology of Sleep Disorders in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:47-64. [PMID: 33223068 DOI: 10.1016/j.chc.2020.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.
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Affiliation(s)
- Irina Trosman
- Division of Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 43, Chicago, IL 60611-2991, USA
| | - Anna Ivanenko
- Division of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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46
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Shelton AR, Malow B. Neurodevelopmental Disorders Commonly Presenting with Sleep Disturbances. Neurotherapeutics 2021; 18:156-169. [PMID: 33403472 PMCID: PMC8116361 DOI: 10.1007/s13311-020-00982-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2020] [Indexed: 02/04/2023] Open
Abstract
There are multiple disorders of neurodevelopment that present with co-occurring sleep disturbances. Many of these neurodevelopmental disorders (NDD) include sleep disturbances in their diagnostic criteria. Neurobiological, genetic, and environmental factors overlap to cause different sleep disorders in individuals with NDD. Caregivers often present reporting either insomnia or hypersomnia, and based on the clinical history and findings from diagnostic tests, an appropriate diagnosis can be made. It is crucial that clinicians understand the different presentations of sleep disturbances in individuals with NDD.
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Affiliation(s)
- Althea Robinson Shelton
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave South, Medical Center North A-0118, Nashville, TN, 37232, USA.
| | - Beth Malow
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave South, Medical Center North A-0118, Nashville, TN, 37232, USA
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47
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Oswald KA, Richard A, Hodges E, Heinrich KP. Sleep and neurobehavioral functioning in survivors of pediatric cancer. Sleep Med 2020; 78:153-159. [PMID: 33444972 DOI: 10.1016/j.sleep.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Sleep problems are a common late effect in survivors of pediatric cancer. Growing literature suggests deficits in sleep functioning may be related to more impairing neurobehavioral outcomes. The purpose of the present study was to evaluate the prevalence of parent reported sleep concerns in survivors of pediatric cancer, as well as evaluate the relationship between sleep and neurobehavioral functioning utilizing both parent and teacher input. METHODS The study included parent-teacher dyads of 75 survivors of pediatric cancer between the ages of six and 17 who completed a clinical neuropsychological evaluation with embedded measures of neurobehavioral functioning and sleep, including excessive daytime sleepiness and snoring. Bivariate correlations and multiple linear regressions were conducted to evaluate the relationship between sleep and neurobehavioral functioning. RESULTS No significant difference in parent reported sleep concerns was found with regard to demographic, diagnostic, or treatment variables. Daytime sleepiness was significantly elevated for 28% of the sample; snoring was not identified as a significant concern. Daytime sleepiness was significantly associated with worse neurobehavioral outcomes as reported by parents and teachers, including inattention, hyperactivity/impulsivity, peer difficulties, anxiety, depression, somatic complaints, and aggressive behaviors. Daytime sleepiness was not significantly related to report of learning problems. CONCLUSIONS Results further support that daytime sleepiness, as reported by parents, impacts approximately one third of survivors of pediatric cancer and is associated with worse neurobehavioral outcomes across home and school environments. As a result, it is vital that sleep functioning is a target of assessment in annual survivorship care. Future longitudinal studies are needed to further delineate the directionality of the sleep-neurobehavioral relationship in survivors.
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Affiliation(s)
| | | | - Elise Hodges
- University of Michigan, Department of Psychiatry, USA
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Ferry AM, Wright AE, Ohlstein JF, Khoo K, Pine HS. Efficacy of a Pediatric Sleep Questionnaire for the Diagnosis of Obstructive Sleep Apnea in Children. Cureus 2020; 12:e12244. [PMID: 33500863 PMCID: PMC7819429 DOI: 10.7759/cureus.12244] [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: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a source of significant morbidity in children. Polysomnography (PSG), the gold standard diagnostic tool for OSA, is often unavailable due to patient financial and geographic constraints. Our objective is to analyze the relationship between a patient's subjective complaints and the results from their PSG to determine the diagnostic value of the Pediatric Sleep Questionnaire (PSQ) for detecting OSA in children. METHODS A retrospective chart review was conducted for pediatric patients with suspected OSA from March 2012 to January 2014. Preoperative PSQ scores were compared with the results from PSG in the form of Apnea-Hypopnea Index (AHI) and Respiratory Disturbance Index (RDI) values. AHI and RDI values ranging from 1 to 5 were classified as mild OSA while values ranging from 5 to 10 were classified as moderate OSA. RESULTS A total of 161 patients were recruited for this study with 63 patients (39%) both completing the PSQ and undergoing PSG. Sensitivity of the positive questionnaire was higher in patients with AHI and RDI values indicative of moderate OSA (95% and 100% respectively) versus values indicative of mild OSA (83% and 86% respectively). Conversely, the positive predictive value of the positive questionnaire (n=49) was lower in patients with AHI and RDI values indicative of moderate OSA (39% and 46% respectively) versus values indicative of mild OSA (70% and 80% respectively). CONCLUSION The PSQ has high diagnostic value for screening patients with suspected OSA. We recommend the use of the PSQ in the primary care setting for children with suspected OSA.
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Affiliation(s)
- Andrew M Ferry
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Alex E Wright
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Jason F Ohlstein
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Kim Khoo
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Harold S Pine
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
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49
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Chandrakantan A, Mehta D, Adler AC. Pediatric obstructive sleep apnea revisited: Perioperative considerations for the pediatric Anesthesiologist. Int J Pediatr Otorhinolaryngol 2020; 139:110420. [PMID: 33035805 DOI: 10.1016/j.ijporl.2020.110420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
Pediatric obstructive sleep apnea presents in up to 7% of children and represents a constellation from nasal turbulence to cessation in gas exchange. There are numerous end organ sequelae including neurocognitive morbidity associated with persistent OSA. Adenotonsillectomy (AT), the first line therapy for pediatric OSA, has not been demonstrated to reduce all end organ morbidity, specifically neurological and behavioral morbidity. Furthermore, certain at-risk populations are at higher risk from neurocognitive morbidity. Precise knowledge and perioperative planning is required to ensure optimal evidence-based practices in children with OSA. This comprehensive review covers the seminal perioperative implications of OSA, including preoperative polysomnography, pharmacotherapeutics, and postoperative risk stratification.
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Affiliation(s)
| | - Deepak Mehta
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Adam C Adler
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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50
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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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