1
|
Kitazawa T, Wada H, Onuki K, Furuya R, Miyakawa M, Zhu Q, Ueda Y, Sato S, Kameda Y, Nakano H, Gozal D, Tanigawa T. Snoring, obstructive sleep apnea, and upper respiratory tract infection in elementary school children in Japan. Sleep Breath 2024; 28:629-637. [PMID: 37837496 DOI: 10.1007/s11325-023-02932-y] [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: 09/02/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Both obstructive sleep apnea (OSA) and the common cold are disorders of the upper respiratory tract, and may be associated. However, studies on the association between OSA and upper respiratory tract infections (URTI) in children are scarce. The aim of this study was to investigate possible associations between snoring, the severity of OSA, and URTI in elementary school children. METHODS This was a cross-sectional study in a community cohort of elementary school children (first and second graders) in Japan. Information on sleep habits, history of URTI, and OSA risk was obtained from a parental questionnaire. Children underwent overnight tracheal sound recordings from which apnea-hypopnea index was estimated. Multivariable logistic analysis was employed to define the association between snoring, OSA, and URTI ≥ 3 episodes over six months. RESULTS Of the 922 potential enrollees, 653 children and their parents (71%) agreed to participate in the study. Multivariable-adjusted ORs for URTI were 1.73 (95%CI: 1.16 to 2.59) in children who snored 1 to 4 nights per week and 2.82 (95%CI: 1.26 to 6.28) in snoring ≥ 5 nights per week compared with never snoring (reference). Likewise, subjectively reported louder snoring, as well as objectively defined louder sound levels, were significantly associated with URTI. In addition, OR for URTI in children with an estimated apnea-hypopnea index ≥ 2.0 events/hour was 2.65 (95%CI: 1.32 to 5.31) compared to children with apnea-hypopnea index less than 1.0 events/hour (reference). CONCLUSIONS Snoring and severity of OSA as measured by nocturnal tracheal sound recordings were associated with increased susceptibility to URTI in elementary school children.
Collapse
Affiliation(s)
- Takayuki Kitazawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keisuke Onuki
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Ritsuko Furuya
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Mariko Miyakawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Qinye Zhu
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yuito Ueda
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Setsuko Sato
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yoshihito Kameda
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroshi Nakano
- Sleep Disorders Centre, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru Minami-Ku, Fukuoka, 811-1394, Japan
| | - David Gozal
- Dean of the Joan C. Edwards School of Medicine and Vice President of Health Affairs at Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, USA
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan.
| |
Collapse
|
2
|
Ong MBH, Davey MJ, Nixon GM, Walter LM, Horne RS. Effect of sleep disordered breathing severity in children with Down syndrome on parental wellbeing and social support. Sleep Med 2024; 116:71-80. [PMID: 38432030 DOI: 10.1016/j.sleep.2024.02.037] [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: 12/11/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Sleep disorders, particularly sleep disordered breathing (SDB), are common in children with Down syndrome (DS). We investigated the relationship between SDB severity and parental psychological wellbeing and their perception of social support. METHODS 44 children with DS (3-19 years) underwent overnight polysomnography and were categorised into three groups: primary snoring, Mild and Moderate/Severe obstructive sleep apnoea (OSA). Parents completed questionnaires about their child's behaviour (Child Behavior Checklist), sleep symptoms (Pediatric Sleep Survey Instrument) and SDB-related quality of life (OSA-18), together with the DUKE-UNC Functional Social Support (DUKE) and Psychological General Well-Being Index (PGWBI) questionnaires for themselves. 34 children completed a follow-up study after 2 years. RESULTS There were no significant differences between SDB severity groups for parental perceived social support or psychological wellbeing. Total scores on the DUKE were below average and PGWBI scores were indicative of moderate psychological distress in all three groups. Reduced perceived levels of social support were significantly correlated with externalising child behaviour and sleep disturbance. Diminished parental psychological wellbeing was also significantly correlated with increased sleep disturbances and reduced quality of life in children. At follow-up there were no significant changes in any questionnaire outcome, however parents of children with improved SDB severity had improved PGWBI vitality scores. CONCLUSION The degree of parent-reported sleep disturbance in children with DS was linked to suboptimal perceived parental social support and poor psychological wellbeing. Our results emphasise the need for enhanced awareness of the detrimental effects of sleep problems in children with DS on parental wellbeing.
Collapse
Affiliation(s)
- Miles Beng Hee Ong
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Rosemary Sc Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Mitchell RB, Cook K, Garetz S, Tapia IE, Elden LM, Kirkham EM, Shah J, Otteson T, Zopf D, Amin R, Ishman S, Baldassari CM, Chervin RD, Hassan F, Naqvi K, Wang R, Redline S. Clinical Characteristics of Primary Snoring vs Mild Obstructive Sleep Apnea in Children: Analysis of the Pediatric Adenotonsillectomy for Snoring (PATS) Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024; 150:99-106. [PMID: 38095903 PMCID: PMC10722386 DOI: 10.1001/jamaoto.2023.3816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023]
Abstract
Importance It is unknown whether children with primary snoring and children with mild obstructive sleep apnea (OSA) represent populations with substantially different clinical characteristics. Nonetheless, an obstructive apnea-hypopnea index (AHI) of 1 or greater is often used to define OSA and plan for adenotonsillectomy (AT). Objective To assess whether a combination of clinical characteristics differentiates children with primary snoring from children with mild OSA. Design, Setting, and Participants Baseline data from the Pediatric Adenotonsillectomy Trial for Snoring (PATS) study, a multicenter, single-blind, randomized clinical trial conducted at 6 academic sleep centers from June 2016 to January 2021, were analyzed. Children aged 3.0 to 12.9 years with polysomnography-diagnosed (AHI <3) mild obstructive sleep-disordered breathing who were considered candidates for AT were included. Data analysis was performed from July 2022 to October 2023. Main Outcomes and Measures Logistic regression models were fitted to identify which demographic, clinical, and caregiver reports distinguished children with primary snoring (AHI <1; 311 patients [67.8%]) from children with mild OSA (AHI 1-3; 148 patients [32.2%]). Results A total of 459 children were included. The median (IQR) age was 6.0 (4.0-7.5) years, 230 (50.1%) were female, and 88 (19.2%) had obesity. A total of 121 (26.4%) were Black, 75 (16.4%) were Hispanic, 236 (51.5%) were White, and 26 (5.7%) were other race and ethnicity. Black race (odds ratio [OR], 2.08; 95% CI, 1.32-3.30), obesity (OR, 1.80; 95% CI, 1.12-2.91), and high urinary cotinine levels (>5 µg/L) (OR, 1.88; 95% CI, 1.15-3.06) were associated with greater odds of mild OSA rather than primary snoring. Other demographic characteristics, clinical examination findings, and questionnaire reports did not distinguish between primary snoring and mild OSA. A weighted combination of the statistically significant clinical predictors had limited ability to differentiate children with mild OSA from children with primary snoring. Conclusions and Relevance In this analysis of baseline data from the PATS randomized clinical trial, primary snoring and mild OSA were difficult to distinguish without polysomnography. Mild OSA vs snoring alone did not identify a clinical group of children who may stand to benefit from AT for obstructive sleep-disordered breathing. Trial Registration ClinicalTrials.gov Identifier: NCT02562040.
Collapse
Affiliation(s)
- Ron B. Mitchell
- Children’s Medical Center of Dallas and University of Texas Southwestern Medical Center, Dallas
| | - Kaitlyn Cook
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Program in Statistical and Data Sciences, Smith College, Northampton, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Susan Garetz
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Lisa M. Elden
- Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Erin M. Kirkham
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jay Shah
- Department of Otolaryngology, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Todd Otteson
- Department of Otolaryngology, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - David Zopf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Raouf Amin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stacey Ishman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk
| | - Ronald D. Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor
| | - Fauziya Hassan
- Sleep Disorders Center and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
| | - Kamal Naqvi
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Rui Wang
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Redline
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Horne RSC, Shetty M, Davey MJ, Walter LM, Nixon GM. Follow-up of children with Down syndrome and sleep disordered breathing and the effects of treatment on actigraphically recorded sleep, quality of life, behaviour, and daytime functioning. J Sleep Res 2024; 33:e13970. [PMID: 37345340 DOI: 10.1111/jsr.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
Children with Down syndrome are at increased risk of obstructive sleep disordered breathing, which has deleterious effects on daytime functioning. We aimed to examine the effects of treatment of sleep disordered breathing on sleep quality and daytime functioning in children with Down syndrome, and hypothesised that these would be improved. Thirty-four children completed a baseline study and a follow-up 2 years later. Measures at both time points included 7 days of actigraphy and parents completed a number of questionnaires assessing sleep, behaviour, daytime functioning, and quality of life. All children had overnight polysomnography at baseline; 15 children (44%) were treated. At baseline the treated group had more severe sleep disordered breathing compared with the untreated group: obstructive apneoa-hypopnoea index 29.3 ± 38.2 events/h versus 3.3 ± 5.2 events/h (p < 0.01). Actigraphy showed no significant differences in total sleep time, sleep efficiency, sleep schedules from baseline to follow up in either group. The sleep disturbance (p < 0.01) and total problems (p < 0.05) scales on the OSA-18 and the sleep disordered breathing subscale on the Paediatric Sleep Problem Survey Instrument (p < 0.01) improved in the treated children. There were no changes in any measure in the untreated children. Treatment of sleep disordered breathing improves symptoms, sleep disturbance and quality of life in children with Down syndrome, but has no demonstrable impact on actigraphic sleep measures or daytime behaviour or function. In contrast, children who were not treated, despite having less severe disease at baseline, had increased sleep disruption and no change in quality of life.
Collapse
Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Marisha Shetty
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Zhang W, Shen Y, Ou X, Wang H, Liu S. Sleep disordered breathing and neurobehavioral deficits in children and adolescents: a systematic review and meta-analysis. BMC Pediatr 2024; 24:70. [PMID: 38245707 PMCID: PMC10799548 DOI: 10.1186/s12887-023-04511-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Sleep disordered breathing (SDB) is broadly recognized to be associated with neurobehavioral deficits, which have significant impacts on developing-aged children and adolescents. Therefore, our study aimed to quantify the proportion of neurobehavioral impairments attributed to SDB in general children and adolescents by population attributable fraction (PAF). METHODS The study was registered at PROSPERO (ID: CRD42023388143). We collected two types of literature on the prevalence of SDB and the risk of SDB-related neurobehavioral deficits from ten electronic databases and registers, respectively. The pooled effect sizes (Pe, Pc, RR) by random-effects meta-analysis were separately substituted into Levin's formula and Miettinen's formula to calculate PAFs. RESULTS Three prevalence literature and 2 risk literature, all with moderate/high quality, were included in the quantitative analysis individually. The prevalence of SDB was 11% (95%CI 2%-20%) in children and adolescents (Pe), while the SDB prevalence was 25% (95%CI 7%-42%) in neurobehavioral patients (Pc). SDB diagnosis at baseline was probably associated with about threefold subsequent incidence of neurobehavioral deficits (pooled RR 3.24, 95%CI 1.25-8.41), after multi-adjustment for key confounders. Up to 19.8% or 17.3% of neurobehavioral consequences may be attributed to SDB from Levin's formula and Miettinen's formula, respectively. CONCLUSIONS A certain number of neurobehavioral consequences may be attributable to SDB. It is essential for clinicians to identify and treat SDB timely, as well as screen for SDB in patients with neurobehavioral impairments. More longitudinal studies of SDB and neurobehavioral deficits are needed in the future to further certify the association between them.
Collapse
Affiliation(s)
- Weiyu Zhang
- Department of Respiratory Medicine and Sleep Lab, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Yubin Shen
- Department of Respiratory Medicine and Sleep Lab, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Xiwen Ou
- Department of Respiratory Medicine and Sleep Lab, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Hongwei Wang
- Department of Respiratory Medicine and Sleep Lab, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Song Liu
- Department of Respiratory Medicine and Sleep Lab, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.
| |
Collapse
|
7
|
Shetty M, Davey MJ, Nixon GM, Walter LM, Horne RSC. Sleep spindles are reduced in children with Down syndrome and sleep-disordered breathing. Pediatr Res 2023:10.1038/s41390-023-02854-1. [PMID: 37845520 DOI: 10.1038/s41390-023-02854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB). We investigated sleep spindle activity, as a marker of sleep quality, and its relationship with daytime functioning in children with DS compared to typically developing (TD) children. METHODS Children with DS and SDB (n = 44) and TD children matched for age, sex and SDB severity underwent overnight polysomnography. Fast or Slow sleep spindles were identified manually during N2/N3 sleep. Spindle activity was characterized as spindle number, density (number of spindles/h) and intensity (density × average duration) on central (C) and frontal (F) electrodes. Parents completed the Child Behavior Check List and OSA-18 questionnaires. RESULTS In children with DS, spindle activity was lower compared to TD children for F Slow and F Slow&Fast spindles combined (p < 0.001 for all). Furthermore, there were no correlations between spindle activity and CBCL subscales; however, spindle activity for C Fast and C Slow&Fast was negatively correlated with OSA-18 emotional symptoms and caregiver concerns and C Fast activity was also negatively correlated with daytime function and total problems. CONCLUSIONS Reduced spindle activity in children with DS may underpin the increased sleep disruption and negative effects of SDB on quality of life and behavior. IMPACT Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. Sleep spindles are a sensitive marker of sleep quality. We identified for the first time that children with DS had reduced sleep spindle activity compared to typically developing children matched for SDB severity. The reduced spindle activity likely underpins the more disrupted sleep and may be associated with reduced daytime functioning and quality of life and may also be an early biomarker for an increased risk of developing dementia later in life in children with DS.
Collapse
Affiliation(s)
- Marisha Shetty
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
8
|
Benbir Senel G, Aktan Suzgun M, Bibinoglu Amirov C, Karadeniz D. The Comparison of the Sleep Structure and Sleep Spindle Activity in Children With Primary Snoring and Sleep-Disordered Breathing. Clin Pediatr (Phila) 2023; 62:565-570. [PMID: 36433642 DOI: 10.1177/00099228221139985] [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: 11/27/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) in children is associated with changes in the structure of sleep. The possible effects of snoring on spindle activity have not been established. We analyzed the polysomnography recordings and sleep spindle activity in children with primary snoring and/or OSAS compared with healthy children. Fifty-one children were included; 8 had primary snoring, 16 had OSAS and snoring, 11 had OSAS without snoring, and 16 were healthy controls. The density (P = .034) and duration (P = .019) of sleep spindles were decreased in children with OSAS compared with controls. The sleep spindle activity did not show significant changes between children with primary snoring and healthy controls, or between OSAS with/without snoring. We conclude that it is not snoring per se but OSAS that affects sleep spindle activity. Obstructive sleep apnea syndrome with/without snoring deserves greater attention because it has different phenotypes of the disease with different pathophysiologies.
Collapse
Affiliation(s)
- G Benbir Senel
- Department of Neurology, Sleep and Disorders Unit, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - M Aktan Suzgun
- Department of Neurology, Sleep and Disorders Unit, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - C Bibinoglu Amirov
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D Karadeniz
- Department of Neurology, Sleep and Disorders Unit, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
9
|
Lei L, Wang Y, Zhao F, Jiang Z, Zhao Y, Yu L, Zhu P, Zou J. Behavioral and cognitive outcomes of habitual snoring in children aged 2-14 years in Chengdu, Sichuan. Am J Otolaryngol 2023; 44:103691. [PMID: 36669275 DOI: 10.1016/j.amjoto.2022.103691] [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: 08/04/2022] [Revised: 09/18/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Habitual snoring is associated with cognitive, behavioral, and other physiological problems of children. Few studies have reported specifically on the relationships between snoring and those problems in children as noticed by their parents. We aimed to identify the cognitive, behavioral, and sleep-related nocturnal problems in children with HS as noted by their parents. MATERIALS AND METHODS A cross-sectional survey was performed in Chengdu, Sichuan, China. Children aged 2-14 years from four districts were randomly chosen to participate. Questionnaires were completed voluntarily by the children's parents/guardians. RESULTS A total of 1548 questionnaires were analyzed and classified those children as 463 habitual snorers (HS group, 30.4 %), 683 occasional snorers (OS group, 44.8 %), and 402 non-snorers (NS group, 26.4 %). The percentages of children with sleep-related nocturnal symptoms were 94.6 %, 87.3 %, and 66.9 % in the HS, OS, and NS groups. Percentages of children with cognitive problems were 76.2 %, 74.6 %, and 64.9 % in the HS, OS, and NS groups, respectively (P < 0.001). The frequencies of daytime behavioral problems were 68.3 %, 61.5 %, and 46.8%in the HS, OS, and NS groups, respectively (P < 0.001).The average number of sleep-related nocturnal symptoms, cognitive symptoms and daytime behavioral problems was higher in the HS group than in the OS and NS groups. CONCLUSIONS HS is a significant contributor to sleep-related nocturnal symptoms and daytime cognitive and behavioral problems in children, as reported by their parents/guardians. HS and OS are important contributors to poor sleep quality and daytime cognitive and behavioral problems in children.
Collapse
Affiliation(s)
- Lei Lei
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Yifei Wang
- West China Medical School, Sichuan University, Sichuan, China
| | - Fanyu Zhao
- West China Medical School, Sichuan University, Sichuan, China
| | - Zijing Jiang
- West China Medical School, Sichuan University, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Lingyu Yu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Ping Zhu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Sichuan, China.
| | - Jian Zou
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China.
| |
Collapse
|
10
|
The effects of sleep disordered breathing on sleep spindle activity in children and the relationship with sleep, behavior and neurocognition. Sleep Med 2023; 101:468-477. [PMID: 36521367 DOI: 10.1016/j.sleep.2022.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep disordered breathing (SDB), has adverse neurocognitive and behavioral sequelae in children, despite conventional measures of sleep disruption being unaffected. There is growing evidence that sleep spindles may serve as a more sensitive marker of sleep quality. We investigated the relationship between sleep spindles and sleep fragmentation and neurocognition across the spectrum of SDB severity in children. METHODS Children 3-12 years old referred for clinical assessment of SDB and age matched control children from the community were recruited and underwent polysomnography. Sleep spindles were identified manually during N2 and N3 sleep. Spindle activity was characterised as spindle number, density (number of spindles/h) and intensity (spindle density x average spindle duration). Children completed a battery of tests assessing global intellectual ability, language, attention, visuospatial ability, sensorimotor skills, adaptive behaviors and skills and problem behaviors and emotional difficulties. RESULTS Children were grouped into control, Primary Snoring, Mild OSA and Moderate/severe OSA, N = 10/group. All measures of spindle activity were lower in the SDB groups compared to the Control children and this reached statistical significance for Mild OSA (p < 0.05 for all). Higher spindle indices were associated with better performance on executive function and visual ability assessments but poorer performance on auditory attention and communication skills. Higher spindle indices were associated with better behavior. CONCLUSION The reduced spindle activity observed in the children with SDB, particularly Mild OSA, indicates that sleep micro-architecture is disrupted and that this disruption may underpin the negative effects of SDB on attention, learning and memory.
Collapse
|
11
|
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.
Collapse
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:
| |
Collapse
|
12
|
Effect of allergic rhinitis on sleep in children and the risk factors of an indoor environment. Sleep Breath 2022; 26:1265-1275. [DOI: 10.1007/s11325-021-02546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
|
13
|
Betavani VMP, Davey MJ, Nixon GM, Walter LM, Horne RSC. Effects of Treatment of Sleep Disordered Breathing on Sleep Macro- and Micro-Architecture in Children with Down Syndrome. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070984. [PMID: 35883968 PMCID: PMC9317623 DOI: 10.3390/children9070984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022]
Abstract
Background: Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with intermittent hypoxia and sleep disruption affecting daytime functioning. We aimed to examine the effects of treatment of SDB on sleep quality and daytime functioning in children with DS. Methods: Children with DS and SDB (n = 24) completed a baseline and follow-up overnight polysomnographic (PSG) study 22 ± 7 months (mean ± SD) later. Sleep micro-architecture was assessed using EEG spectral analysis, and parents completed a number of questionnaires assessing sleep, behavior, daytime functioning, and quality of life (QOL). Results: A total of nine children (38%) were treated. At baseline, the treated group had more severe SDB compared to the untreated group. SDB severity was significantly improved from 40.3 ± 46.9 events/h to 17.9 ± 26.9 events/h (p < 0.01) at follow up in children who were treated. There were no significant differences in sleep macro-architecture parameters from baseline to follow up in either the treated or untreated group. Sleep micro-architecture was not different between studies in the treated group, however this tended to improve in the untreated group, particularly in REM sleep. Daytime functioning and behavior were not different between the studies in either group, however, QOL improved after treatment. Conclusions: Our study identified that treatment of SDB improves severity of the disease as defined by PSG, and this was associated with parental reports of improved QOL, despite treatment having no demonstrable impacts on sleep quality, behavior, or daytime functioning.
Collapse
Affiliation(s)
- Viecky M. P. Betavani
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
| | - Margot J. Davey
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Gillian M. Nixon
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Lisa M. Walter
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
| | - Rosemary S. C. Horne
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia; (V.M.P.B.); (M.J.D.); (G.M.N.); (L.M.W.)
- Department of Paediatrics, Level 5, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia
- Correspondence: ; Tel.: +61-385722827
| |
Collapse
|
14
|
Horne RSC. Childhood snoring cannot be ignored as it has detrimental effects on neurobehavior. Sleep 2022; 45:zsac045. [PMID: 35554578 DOI: 10.1093/sleep/zsac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
|
15
|
Yu PK, Radcliffe J, Gerry Taylor H, Amin RS, Baldassari CM, Boswick T, Chervin RD, Elden LM, Furth SL, Garetz SL, George A, Ishman SL, Kirkham EM, Liu C, Mitchell RB, Kamal Naqvi S, Rosen CL, Ross KR, Shah JR, Tapia IE, Young LR, Zopf DA, Wang R, Redline S. Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea. Sleep 2022; 45:zsac035. [PMID: 35554583 PMCID: PMC9113015 DOI: 10.1093/sleep/zsac035] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea. METHODS Children 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis. RESULTS The sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing. CONCLUSIONS Abnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention. TRIAL REGISTRATION Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.
Collapse
Affiliation(s)
- Phoebe K Yu
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA
| | - Jerilynn Radcliffe
- Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Gerry Taylor
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | - Raouf S Amin
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Cristina M Baldassari
- Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA
| | - Thomas Boswick
- Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA
| | - Ronald D Chervin
- University of Michigan, Department of Neurology, Ann Arbor, MI, USA
| | - Lisa M Elden
- Children’s Hospital of Philadelphia, Division of Otolaryngology, Philadelphia, PA, USA
| | - Susan L Furth
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - Susan L Garetz
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Alisha George
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Stacey L Ishman
- University of Cincinnati College of Medicine, Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Division of Otolaryngology – Head & Neck Surgery, Cincinnati, OH, USA
| | - Erin M Kirkham
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Christopher Liu
- University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA
| | - Ron B Mitchell
- University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA
- University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA
| | - S Kamal Naqvi
- University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA
| | - Carol L Rosen
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | - Kristie R Ross
- University Hospitals Rainbow Babies & Children’s Hospital, Department of Pediatrics, Cleveland, OH, USA
| | - Jay R Shah
- University Hospitals Rainbow Babies & Children’s Hospital, Department of Otolaryngology, Cleveland, OH, USA
| | - Ignacio E Tapia
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - Lisa R Young
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - David A Zopf
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Rui Wang
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
| | - Susan Redline
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| |
Collapse
|
16
|
Sibarani CR, Walter LM, Davey MJ, Nixon GM, Horne RSC. Sleep-disordered breathing and sleep macro- and micro-architecture in children with Down syndrome. Pediatr Res 2022; 91:1248-1256. [PMID: 34230620 DOI: 10.1038/s41390-021-01642-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with intermittent hypoxia and sleep disruption affecting daytime functioning. We aimed to compare the impact of SDB on sleep quality in children with DS compared to typically developing (TD) children with and without SDB. METHODS Children with DS and SDB (n = 44) were age- and sex-matched with TD children without SDB (TD-) and also for SDB severity with TD children with SDB (TD+). Children underwent overnight polysomnography with sleep macro- and micro-architecture assessed using electroencephalogram (EEG) spectral analysis, including slow-wave activity (SWA, an indicator of sleep propensity). RESULTS Children with DS had greater hypoxic exposure, more respiratory events during REM sleep, higher total, delta, sigma, and beta EEG power in REM than TD+ children, despite the same overall frequency of obstructive events. Compared to TD- children, they also had more wake after sleep-onset and lower sigma power in N2 and N3. The DS group had reduced SWA, indicating reduced sleep drive, compared to both TD groups. CONCLUSIONS Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children. IMPACT SDB in children with DS exacerbates disruption of sleep quality, compared to TD children. The prevalence of SDB is very high in children with DS; however, studies on the effects of SDB on sleep quality are limited in this population. Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children, and should be screened for and treated as soon as possible.
Collapse
Affiliation(s)
- Christy R Sibarani
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia
| | - Lisa M Walter
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia
| | - Margot J Davey
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Gillian M Nixon
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- Department of Paediatrics and The Ritchie Centre, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
17
|
Feng Y, Ma L, Chen X, Zhang Y, Cao Z, Yuan Y, Xie Y, Liu H, Shi Y, Ren X. Relationship between serum brain-derived neurotrophic factor and cognitive impairment in children with sleep-disordered breathing. Front Pediatr 2022; 10:1027894. [PMID: 36683819 PMCID: PMC9849753 DOI: 10.3389/fped.2022.1027894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND As an important neuroprotective factor, the brain-derived neurotrophic factor (BDNF) may have a key role in cognitive impairment in children with sleep-disordered breathing (SDB). The main aim of this study was to compare the levels of BDNF and tyrosine kinase receptor B (TrkB) in normal children and those with obstructive sleep apnea (OSA) and primary snoring (PS) and to explore a possible link between BDNF/TrkB, inflammation, and SDB with cognitive impairment in children. METHODS A total of 44 OSA children and 35 PS children who completed polysomnography between October 2017 and October 2019 were enrolled. At the same time, 40 healthy children during the same period were included as a control. Enzyme-linked immunosorbent assay was used to measure serum indices of BDNF, TrkB, interleukin-1beta (IL-1β), and tumor necrosis factor-alpha (TNF-α). Correlation and pooled analyses were performed between the cognitive scores and four serological indicators. Logistic regression was used to analyze the risk factors for cognitive impairment. RESULTS Significant differences were found in serum BDNF, TrkB, IL-1β, and TNF-α between the three groups (all P < 0.01). The serum BDNF and TrkB in the OSA and PS groups were lower than those in the control group, whereas the serum IL-1β and TNF-α were higher than those in the control group (all P < 0.05). Moreover, among these four indices, the strongest correlation was found between BDNF and the Chinese Wechsler Intelligence Scale (all P < 0.05). Logistic regression analysis revealed a correlation between OSA status, TrkB, and course of mouth breathing and cognitive status. CONCLUSION The levels of serum BDNF and TrkB were related to cognitive impairment in children with SDB. Also, BDNF and TrkB could be used as noninvasive and objective candidate markers and predictive indices of cognitive impairment in children with SDB.
Collapse
Affiliation(s)
- Yani Feng
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lina Ma
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xi Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yitong Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zine Cao
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuqi Yuan
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yushan Xie
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haiqin Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yewen Shi
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
18
|
Mlauzi R, McGuire J, Zampoli M, Takuva S, Lawrenson J, Singh Y, Peer S. Clinical correlations to distinguish severe from milder forms of obstructive sleep apnoea syndrome using overnight oximetry for prioritising adenotonsillectomy in a limited-resource setting. Int J Pediatr Otorhinolaryngol 2022; 152:110988. [PMID: 34871949 DOI: 10.1016/j.ijporl.2021.110988] [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: 02/15/2021] [Revised: 05/14/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In resource-poor settings with limited surgical services, it is essential to identify and prioritise children with severe and very severe obstructive sleep apnoea syndrome (OSAS) to expedite surgery. McGill's Oximetry Score (MOS) has been validated against polysomnography for OSAS and is affordable and easy to use. AIMS The aim of this study was to assess the correlation of tonsillar size and clinical symptoms with MOS grade 3 or 4, to identify who requires overnight oximetry and who to prioritise for adenotonsillectomy. METHODS Children with suspected OSAS were recruited from the otolaryngology clinic at the Red Cross War Memorial Children's Hospital. Demographics, symptom screening scores (SSS), patient characteristics, overnight oximetry (OO), echocardiography and MOS scores (graded 1-4) were recorded. Multivariate modified-Poisson regression models were used to examine correlations of patient characteristics 'with grade 3 or 4 MOS. RESULTS One-hundred-and-three children were analysed, 38% were female, and median (IQR) age was 3.8 (2.5-5.3) years. Increased tonsil size was associated with a 60% increased risk of grade 3 or 4 MOS, risk ratio (RR) 1.59, 95% CI 1.10-2.29 (p = 0.014). Children with witnessed apnoeic events during sleep had 1.3 times increased risk of MOS Grade 3 or 4, RR 1.31, 95% CI (p = 0.033). A significant correlation was shown with grade 3 or 4 MOS, RR 1.15, 95% CI 1.03-1.27 (p = 0.010) by combining tonsillar size with the following symptoms: apnoeic events; struggling to breathe during sleep and needing to stimulate the child to breathe. CONCLUSION Identifying children with suspected OSAS who require overnight oximetry can be performed using a simple 3-question screening tool: witnessed apnoeic events, struggling to breathe and the need to shake them awake to breathe. This is more precise with an additional clinical finding of grade 3 or 4 tonsils. These children should have surgery expedited. Any child with a MOS 3 or 4 score on OO needs to have expedited surgery.
Collapse
Affiliation(s)
- Raphael Mlauzi
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Jessica McGuire
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Department of Paediatrics and Child Health, Division of Paediatric Pulmonology, University of Cape Town, Cape Town, South Africa
| | - Simbarashe Takuva
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - John Lawrenson
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, University of Cape Town, Cape Town, South Africa
| | - Yanita Singh
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, University of Cape Town, Cape Town, South Africa
| | - Shazia Peer
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| |
Collapse
|
19
|
Horne RSC. Childhood snoring has long-term adverse effects on cardiovascular health. Respirology 2021; 26:725-726. [PMID: 34155742 DOI: 10.1111/resp.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Isaiah A, Spanier AJ, Grattan LM, Wang Y, Pereira KD. Predictors of Behavioral Changes After Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 146:900-908. [PMID: 32880655 DOI: 10.1001/jamaoto.2020.2432] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Adenotonsillectomy (AT) is associated with improved behavior in children with obstructive sleep apnea (OSA). However, it is unknown whether polysomnographic parameters are superior to the parent-reported severity of sleep-disordered breathing (SDB) in predicting behavioral changes after AT. Objective To ascertain whether polysomnographic parameters vs parent-reported severity of SDB are better predictors of treatment-related behavioral changes in children with OSA. Design, Setting, and Participants This ad hoc secondary analysis of the Childhood Adenotonsillectomy Trial (CHAT) downloaded and analyzed data from January 1 to January 31, 2020. Children aged 5 to 9 years with a polysomnographic diagnosis of OSA were enrolled in the CHAT and subsequently randomized to undergo either early AT or watchful waiting with supportive care. All outcome measures were obtained at baseline and at follow-up (7 months after randomization). Interventions Early AT vs watchful waiting with supportive care. Main Outcomes and Measures Postrandomization changes between the baseline and follow-up periods were derived from (1) T scores in 4 validated behavioral assessments (Conners Global Index parent and teacher versions, Behavior Rating Inventory of Executive Function metacognition index, and Child Behavior Checklist of total, internalizing, and externalizing behavior subscales); (2) 8 aggregated polysomnographic parameters representing the severity of obstruction, hypoxemia, sleep quality, and structure; and (3) the parent-reported severity of SDB measured by the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) scale. The treatment-related changes in each of the behavioral outcomes attributable to changes in SDB severity (represented by the subjective PSQ-SRBD score and objective polysomnographic parameters) were measured and compared using mediation analysis. Results A total of 453 children were assessed at baseline, of whom 234 were girls (52%) and the mean (SD) age was 6.6 (1.4) years. The postrandomization changes in 7 of 8 behavioral outcome measures between the baseline and follow-up periods were partially mediated by the changes in PSQ-SRBD scores (range of nonzero causally mediated effects, 2.4-3.5), without contribution from any of the polysomnographic parameters. Conclusions and Relevance This secondary analysis of a national randomized clinical trial found that most treatment-related behavioral changes in children with OSA were mediated by the changes in parent-reported SDB severity alone. These findings suggest that polysomnographic parameters provide clinicians with limited means to predict the improvement in neurobehavioral morbidity in OSA. Trial Registration ClinicalTrials.gov Identifier: NCT00560859.
Collapse
Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Adam J Spanier
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Lynn M Grattan
- Department of Neurology, University of Maryland School of Medicine, Baltimore.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| |
Collapse
|
21
|
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.
Collapse
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.
Collapse
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
| |
Collapse
|
22
|
Quality-of-life but not behavior improves 48-months post-adenotonsillectomy in children with SDB. Sleep Med 2021; 81:418-429. [PMID: 33831667 DOI: 10.1016/j.sleep.2021.02.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Long term follow-up studies (>12 mths) of changes in behavior and quality-of-life (QoL) in children with sleep disordered breathing (SDB) post-adenotonsillectomy are limited and there is a lack of consensus in the reported findings. The aim of this study was to evaluate children's sleep, QoL and behavior at baseline and 6 mths and 48 mths post-adenotonsillectomy for clinically diagnosed SDB. METHODS This prospective longitudinal study of children aged 3-12 y recruited from a Children's Hospital otolaryngology clinic compared polysomnographic parameters, behavior (Child Behavior Checklist; CBCL) and QoL (OSA-18) at baseline, 6mths and 48mths post-adenotonsillectomy and compared these parameters to healthy non-snoring controls recruited from the general community at the same time points. RESULTS Sixty-four children completed sleep, behavior and QoL assessments (SDB = 20M/9F, Controls = 18M/17F) at all three time points. Sleep and ventilatory parameters significantly improved in children with SDB with minimal residual obstruction evident at 48 mths post-adenotonsillectomy. Compared to baseline, OSA-18 scores significantly improved post-adenotonsillectomy in children with SDB and were equivalent to the scores of controls at 6 mths and 48 mths post-AT. No significant improvement was observed in behavior in children with SDB post-adenotonsillectomy over the same time period. CONCLUSION Baseline deficits in sleep and QoL in children with SDB were normalized at 6 mths post-adenotonsillectomy and gains were maintained at 48 mths post-adenotonsillectomy. Children with SDB did not show significant gains in behavior either at 6 mths or 48 mths post-adenotonsillectomy.
Collapse
|
23
|
Lushington K, Biggs S, Martin AJ, Kennedy JD. Sleep disordered breathing in children: which symptoms do parents consider a problem? Sleep Med 2021; 81:33-41. [PMID: 33636542 DOI: 10.1016/j.sleep.2021.02.014] [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: 09/21/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Parents tend to under-report symptoms suggestive of sleep disordered breathing (SDB) at medical consultation. It is thought that a contributing factor may be whether parents view SDB symptoms as a problem. The aim of the study was to examine to what extent parents view SDB symptoms as a problem in children recruited from the general community and especially in children who currently have symptoms suggestive of SDB. METHODS Parents of 1639 children aged 5-10 y attending middle school in South Australia completed a questionnaire which included demographics and assessed the frequency over the previous school week of 32 sleep habits including six SDB sleep habit items. The sample was restricted to typically developing children and excluded children with medical problems likely to impact SDB. The final sample included 1610 children without a prior diagnosis of SDB and 29 with a prior diagnosis and/or treatment of SDB. Parents were asked to rate children's sleep habits using a 4-pt scale (never, rarely, sometimes and usually) and if the sleep habit was perceived to be a problem (yes/no). Children who sometimes or usually reported a sleep habit item were labelled as symptomatic. RESULTS Parents of children with, compared to those without, a prior diagnosis of SDB, were more likely to report the presence of SDB symptoms which were more frequently viewed as a problem. In children without a prior diagnosis of SDB, parents of symptomatic children viewed most SDB symptoms as a problem ranging from 91% for apnoea, 63% snorted/gasped, 63% watched child breathing at night, 58% snored loudly, 49% snored to 32% breathing heavily at night. Additional analyses in the combined sample revealed that a prior diagnosis of SDB, gender, socioeconomic status and ethnicity were weak predictors of whether parents viewed SDB sleep symptoms as a problem. CONCLUSION In children with symptoms suggestive of SDB, most parents viewed most SDB symptoms as a problem especially apnoea. The high frequency is contrary to that expected given the under-reporting of SDB symptoms at medical consultation. This suggests that additional factors other than whether parents consider SDB symptoms as a problem might better explain the under-reporting of SDB symptoms at medical consultation. Given the important impact on child health and medical service provision, future studies examining the factors that prompt parents to discuss SDB symptoms at medical consultation are warranted.
Collapse
Affiliation(s)
| | - Sarah Biggs
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Alfred James Martin
- University of Adelaide, Adelaide, Australia; Women's and Children's Hospital Adelaide, Australia
| | - John Declan Kennedy
- University of Adelaide, Adelaide, Australia; Women's and Children's Hospital Adelaide, Australia
| |
Collapse
|
24
|
Horne RSC. Consequences of paediatric sleep disordered breathing: contributions from Australian and New Zealand investigators. Sleep Med 2020; 77:147-160. [PMID: 33373901 DOI: 10.1016/j.sleep.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
AIMS To highlight the contributions of Australian and New Zealand researchers to the identification of the consequences of paediatric sleep disordered breathing (SDB). METHODS A search was conducted in PubMed using the terms "sleep disordered breathing" "child" and "Australia or New Zealand". All abstracts were reviewed and those which focused on the consequences of SDB have been included. RESULTS Australasian research into the consequences of SDB has grown exponentially over the last 35 years. SDB has significant adverse consequences for quality of life, behaviour, neurocognition and the cardiovascular system and the Australasian research studies investigating these are summarised. CONCLUSIONS Australian and New Zealand researchers have played a significant role in understanding the consequences of paediatric SDB and the mechanisms which underpin these. The research conducted "Downunder" has led the world in this field of research and will continue to provide evidence to improve the lives of children not only in Australasia but around the world.
Collapse
Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Level 5, Monash Children's Hospital, 246 Clayton Rd, Melbourne, 3168, Victoria, Australia.
| |
Collapse
|
25
|
Journey towards a personalised medicine approach for OSA: Can a similar approach to adult OSA be applied to paediatric OSA? Paediatr Respir Rev 2020; 36:128-135. [PMID: 32217050 DOI: 10.1016/j.prrv.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 11/21/2022]
Abstract
The concept of personalised medicine is likely to revolutionise the treatment of adult obstructive sleep apnoea as a result of recent advances in the understanding of disease heterogeneity by identifying clinical phenotypes, pathophysiological endotypes, biomarkers and treatable traits. Children with the condition show a similar level of heterogeneity and paediatric obstructive sleep apnoea would also benefit from a more targeted approach to diagnosis and management. This review aims to summarise the adult literature on the phenotypes and endotypes of obstructive sleep apnoea and assess whether a similar approach may also be suitable to guide the development of new diagnostic and management approaches for paediatric obstructive sleep apnoea.
Collapse
|
26
|
Mei L, Li X, Zhou G, Ji T, Chen J, Xu Z, Peng Y, Liu Y, Li H, Zhang J, Wang S, Zhang Y, Ge W, Guo Y, Qiu Y, Jia X, Tian J, Zheng L, Liu J, Tai J, Ni X. Effects of obstructive sleep apnoea severity on neurocognitive and brain white matter alterations in children according to sex: a tract-based spatial statistics study. Sleep Med 2020; 82:134-143. [PMID: 33915429 DOI: 10.1016/j.sleep.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate alterations in neurocognitive, attention, paediatric sleep questionnaire (PSQ) scores and whole brain white matter (WM) integrity between children with mild and severe obstructive sleep apnoea (OSA) according to sex and whether these changes are associated with OSA severity. METHODS Fifty-seven children (36 males and 21 females) diagnosed with OSA were recruited for this study. Children of both sexes were divided into mild (male-MG, female-MG) and severe (male-SG, female-SG) groups according to OSA severity. Polysomnography (PSG), neurocognitive, attention and PSQ tests were compared between groups by one-way samples analysis of variance (ANOVA) F test. Diffusion tensor imaging (DTI) was scanned using a 3T GE MRI scanner and analysed by Tract-based Spatial Statistics (TBSS). Spearman correlation was calculated between DTI Eigenvalues and clinical characteristics. RESULTS Compared to mild OSA patients, severe OSA patients presented greater severity of obstructive apnoea hypopnea index (OAHI), neurocognition, PSQ and attention tests in both male and female patients. Brain WM integrity in the male-SG, compared to the male-MG, demonstrated significantly reduced fractional anisotropy (FA) values in the right middle frontal gyrus and the right frontal sub-gyral regions and increased axial diffusivity (AD) values in the right inferior frontal gyrus, left parietal angular gyrus and sub-gyral regions, while no differences were found between the female-MG and female-SG. Alterations in male-SG brain regions were observably correlated with severity in male OSA patients. CONCLUSIONS The integrity of WM, which regulates autonomic, cognitive, and attention functions, is impaired in male, but not female, children with severe OSA.
Collapse
Affiliation(s)
- Lin Mei
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Guifei Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Tingting Ji
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jun Chen
- Big Data and Engineering Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhifei Xu
- Department of Respiration, Beijing Children's Hospital, Capital Medical University,National Center for Children's Health, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yue Liu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongbin Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yamei Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Paediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Yue Qiu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xinbei Jia
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jinghong Tian
- Department of Neurorehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li Zheng
- Department of Respiration, Beijing Children's Hospital, Capital Medical University,National Center for Children's Health, Beijing, 100045, China
| | - Jiangang Liu
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, China
| | - Jun Tai
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China; Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Paediatrics, Beijing, 100020, China.
| | - Xin Ni
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| |
Collapse
|
27
|
Caregivers' absence from work before and after tonsil surgery in children with sleep-disordered breathing. Eur Arch Otorhinolaryngol 2020; 278:265-270. [PMID: 32767166 PMCID: PMC7811503 DOI: 10.1007/s00405-020-06243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/10/2020] [Indexed: 11/12/2022]
Abstract
Purpose Sleep-disordered breathing, SDB, in children is associated with morbidity that can result in caregivers having to stay at home from work. The aim of this study was to investigate whether the number of days when caregivers are reimbursed, temporary parental benefit (TPB) to stay at home from work to care for their sick child is increased among children with SDB before and after tonsil surgery.
Methods This is a retrospective, cross-sectional study of children (n = 440), aged 2–11 years, that underwent tonsil surgery for SDB in day surgery at Sahlgrenska University Hospital in 2014 and 2015. TPB, was provided by the Swedish Social Insurance Agency. The expected days of TPB in the general population of the region were calculated. The number of days with TPB was compared 2 years before and 2 years after surgery and compared with the expected days of TPB.
Results Two years before surgery, the children had no more days of TPB than expected. Two years after surgery, the children with SDB had 4.8 more days with TPB (p < 0.001) than expected, but, when the 1st month after surgery was excluded from the analysis, there was no difference in days of TPB compared with the general population. Conclusion Children with SDB who had tonsil surgery had no more days of parental benefits 2 years before and 2 years after surgery than expected. SDB is associated with increased morbidity, but it does not appear to cause caregivers to stay at home in the majority of children.
Collapse
|
28
|
Abstract
Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an indication of obstructive sleep apnoea (OSA). OSA can have health, developmental and cognitive consequences. The three common risk factors for paediatric OSA are tonsillar and/or adenoidal hypertrophy, obesity and allergic rhinitis. Primary care providers are well-placed to identify children at risk by screening for habitual snoring and associated OSA risk factors during routine consultations. Physician awareness of OSA symptoms/signs facilitates diagnosis, management and referral decisions. A trial of medical treatment may be considered for habitual snoring with mild symptoms/signs before referral. Overnight polysomnography is the gold standard investigation utilised by paediatric sleep specialists to diagnose OSA. Adenotonsillectomy is the first-line management for OSA with adenotonsillar hypertrophy, but residual/recurrent OSA may occur, so follow-up by primary care providers is important after surgery.
Collapse
Affiliation(s)
- Yi Hua Tan
- Respiratory Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Choon How How
- Care and Health Integration Division, Changi General Hospital, Singapore.,Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Yoke Hwee Chan
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.,Division of Medicine, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Respiratory Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| |
Collapse
|
29
|
Hagström K, Saarenpää-Heikkilä O, Himanen SL, Lampinlampi AM, Rantanen K. Neurobehavioral Outcomes in School-Aged Children with Primary Snoring. Arch Clin Neuropsychol 2020; 35:401-412. [PMID: 31813961 DOI: 10.1093/arclin/acz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 09/04/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We assess behavioral and attentional problems and neurocognitive functioning in school-aged children with primary snoring (PS). METHODS Seventeen children with PS and 27 non-snoring peers aged 6-10 years took part in the study. All children underwent a polysomnography (PSG) at the Sleep Laboratory. Snoring was defined by parents and with PSG. Children with obstructive sleep apnea were excluded. The parents completed the Sleep Disturbance Scale for Children. Parents and teachers assessed behavioral and attentional problems with the Child Behavior Checklist and the Conners' Rating Scale-Revised. Neuropsychological assessment included the Wechsler Intelligence Scale for Children and the Developmental Neuropsychological Assessment (NEPSY test). RESULTS The PS group had significantly more parent-reported internalizing, total, and attentional problems than the control group. Teachers did not report behavioral problems in the PS group. The PS and control groups had equal IQ scores and similar core neurocognitive functions, except for one visuospatial subtest. The PS group had significantly more inspiratory flow limitation and increased diaphragmatic electromyography compared with the controls. Parents reported significantly more daytime sleepiness in the PS group. Daytime sleepiness and snoring time were consistently associated with more behavioral and attentional problems. Flow limitation and more oxygen saturation values under 90% were associated with attentional problems, higher oxygen desaturation index, and lower mean oxygen saturation percentage with reduced language functions. CONCLUSIONS Snoring with an increase in respiratory effort without apneas and hypopneas and parent-reported daytime sleepiness may be linked to daytime symptoms. School-aged children with PS are at risk for behavioral and attentional problems, but not cognitive impairments.
Collapse
Affiliation(s)
- Kati Hagström
- Lic.A Psych, Psychology Clinic, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
| | | | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, 33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
| | - Anna-Maria Lampinlampi
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, 33521 Tampere, Finland
| | - Kati Rantanen
- Department of Pediatrics, Tampere University Hospital, 33521 Tampere, Finland.,Psychology Clinic, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
| |
Collapse
|
30
|
Chan M, Wong TCH, Weichard A, Nixon GM, Walter LM, Horne RSC. Sleep macro-architecture and micro-architecture in children born preterm with sleep disordered breathing. Pediatr Res 2020; 87:703-710. [PMID: 31195406 DOI: 10.1038/s41390-019-0453-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Both preterm birth and sleep disordered breathing (SDB) affect sleep in children. We compared the effects of SDB on sleep macro-architecture and micro-architecture in children born preterm (N = 50) and children born at term (N = 50). We hypothesized that sleep would be more disrupted in children born preterm. METHODS Polysomnographic studies matched for age (3-12 years) and SDB severity were analyzed. Sleep macro-architecture was assessed using standard criteria and micro-architecture was evaluated using spectral analysis of the electroencephalogram and slow wave activity (SWA) calculated for each sleep stage across the night. RESULTS Ex-preterm children (gestational age 29.3 ± 3.6 weeks, mean ± standard error of the mean) were not different from controls for demographic or respiratory parameters or sleep macro-architecture. Theta power in N2 tended to be higher for F4 (p < 0.05) and C4 (p < 0.07). In the second non-rapid eye movement period, SWA was significantly higher in the preterm group compared to the term group for both F4 and C4 (p < 0.05 for both). CONCLUSIONS Sleep micro-architecture in children born preterm showed increased theta power and SWA. These differences provide evidence of increased sleep debt and reduced dissipation of sleep debt across the night. Further studies are required to identify if these findings are related to impaired neurocognition and behavior.
Collapse
Affiliation(s)
- Martin Chan
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tracy C H Wong
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
31
|
Are there gender differences in the severity and consequences of sleep disordered in children? Sleep Med 2019; 67:147-155. [PMID: 31927221 DOI: 10.1016/j.sleep.2019.11.1249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In adults there is a distinct gender difference in the prevalence and severity of sleep disordered breathing (SDB), however there have been limited studies examining the effects of gender in children with SDB. We aimed to compare the effects of gender on severity of SDB, blood pressure, sleep and respiratory characteristics, quality of life, behavior and executive function. METHODS We included 533 children aged 3-18 years, who underwent standard pediatric overnight polysomnography (PSG) between 2004 and 2016. Blood pressure was recorded prior to each study. Quality of life, behavior and executive function were assessed with parental questionnaires. Children were grouped by gender and SDB severity based on their obstructive apnea hypopnea index (OAHI) into non-snoring controls, Primary Snoring (PS) (OAHI≤1 event/h), Mild obstructive sleep apnea (OSA) (OAHI>1-≤5 events/h) and moderate/severe (MS) OSA (OAHI>5 events/h) and data compared with 2-way ANOVA. RESULTS A total of 298 boys and 235 girls were studied. There were no differences in age, BMI z-score, SDB severity sleep characteristics or blood pressure between genders. Diastolic blood pressure was elevated in females with MS OSA compared to males (P < 0.05). Quality of life, behavior and executive function scores were all elevated in the SDB groups compared to controls. Females with MS OSA exhibited more internalizing behavioral problems compared to males (59.2 ± 2.4 vs. 51.4 ± 2.3, P < 0.05). CONCLUSIONS In contrast to studies in adults, we identified no gender differences in the severity or consequences of SDB in children, other than females with moderate-severe OSA exhibiting more internalizing problems and higher diastolic blood pressure.
Collapse
|
32
|
Sutherland K, Weichard AJ, Davey MJ, Horne RSC, Cistulli PA, Nixon GM. Craniofacial photography and association with sleep-disordered breathing severity in children. Sleep Breath 2019; 24:1173-1179. [DOI: 10.1007/s11325-019-01928-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 01/01/2023]
|
33
|
Zhang A, Li S, Zhang Y, Jiang F, Jin X, Ma J. Nocturnal enuresis in obese children: a nation-wide epidemiological study from China. Sci Rep 2019; 9:8414. [PMID: 31182742 PMCID: PMC6557885 DOI: 10.1038/s41598-019-44532-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/17/2019] [Indexed: 01/20/2023] Open
Abstract
Childhood obesity increases the risk of obstructive sleep apnea syndrome, type 2 diabetes mellitus, cardiovascular abnormalities, and psychological and behavioral disorders. But it is unclear whether obesity is associated with childhood nocturnal enuresis (NE). This study aimed to assess the relationship between childhood obesity and NE in a nationally representative large sample in China. Subjects were enrolled from Urumqi, Chengdu, Xi'an, Hohhot, Wuhan, Canton, Shanghai, and Harbin cities in China in November and December 2005. The survey included 20,987 children aged 5-12 years and they and their caregivers completed questionnaires. Height and weight were measured by school teachers trained in healthcare. According to the WHO child growth standards, obesity was defined as a body mass index >95th percentile of peers with the same age and gender. NE was defined as bed wetting for more than twice a week for 3 consecutive months. Demographic variables were compared among different groups. The prevalence of obesity, asthma, attention-deficit/hyperactivity disorder (ADHD), depressive moods, and snoring were different between the NE and without-NE groups (P < 0.05). The raw odds ratio (OR) for NE and obesity was 1.36 (95%CI = 1.07-1.74; P = 0.013) and the adjusted OR was 1.42 (95%CI = 1.11-1.82; P = 0.005) in the multivariable analysis. When adjusting for co-occurring conditions, the results showed that asthma did not affect the risk of NE (OR = 1.42, 95%CI = 1.11-1.82; P = 0.005), but ADHD (OR = 1.41; 95%CI = 1.10-1.81; P = 0.006) and depressive moods (OR = 1.34; 95%CI = 1.07-1.76; P = 0.012) slightly weakens the association between NE in children and obesity, while snoring weakens the association between obesity and NE and the risk became non-significant (OR = 1.21; 95%CI = 0.94-1.56; P = 0.138). In conclusion, obese children were at a higher risk of incurring NE compared to non-obese children. This association was weaker in children who either snored, had ADHD, or had depressive mood.
Collapse
Affiliation(s)
- Anyi Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghui Li
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingming Jin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
34
|
Tamanyan K, Weichard A, Biggs SN, Davey MJ, Nixon GM, Walter LM, Horne RSC. The impact of central and obstructive respiratory events on cerebral oxygenation in children with sleep disordered breathing. Sleep 2019; 42:5352806. [DOI: 10.1093/sleep/zsz044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/09/2019] [Indexed: 02/02/2023] Open
Affiliation(s)
- Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sarah N Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| |
Collapse
|
35
|
Abstract
BACKGROUND AND OBJECTIVES Early microbial colonization has a key impact on infant health through nutritional, immunological, and metabolic programming. The origin of child snoring is multifactorial and complex, and may thereby also generate long-term health problems. The link between child snoring and gut microbes remains unclear, although indirect evidence exists regarding this relationship. This study aimed to characterize the connection between gut microbiota and child snoring. METHODS In a prospective, observational CHILD-SLEEP birth cohort study, gut microbiota in a subcohort of 43 of these children at 2 years of life was profiled with 16S ribosomal RNA gene amplicon sequencing. RESULTS A higher abundance of the Proteobacteria phylum, the Enterobacteriaceae family, and Erysipelotrichaceae family, as well as a higher ratio of Firmicutes to Bacteroidetes were detected in snorers as compared to controls. Furthermore, snorers showed significantly lower microbial diversity and richness than non-snorers. CONCLUSIONS The snoring children manifest different gut microbiota as compared with healthy children. Considering that snoring and sleep disorders can be a source of long-term consequences, including cardiovascular, metabolic, immunological, neurocognitive and behavioral consequences, our results proposes early microbiota as a new treatment target.
Collapse
|
36
|
Horne RS, Wijayaratne P, Nixon GM, Walter LM. Sleep and sleep disordered breathing in children with down syndrome: Effects on behaviour, neurocognition and the cardiovascular system. Sleep Med Rev 2018; 44:1-11. [PMID: 30576943 DOI: 10.1016/j.smrv.2018.11.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/10/2018] [Accepted: 11/07/2018] [Indexed: 02/07/2023]
Abstract
Down syndrome (DS), the most common human chromosomal malformation, has an estimated annual incidence of one in 1000 live births worldwide. Sleep problems are common in children with DS, reported by parents in up to 65% of school-aged children, significantly higher rates than in typically developing (TD) children. Problems include difficulty in sleep initiation and maintenance together with obstructive sleep apnoea (OSA) which affects up to over 90%, of DS children compared with 1-5% in the general paediatric population. Any sleep problem has the potential to exert significant negative effects on daytime behaviour, learning and quality of life in TD children and there is now a growing body of evidence that children with DS are similarly affected. In addition to adverse effects on daytime functioning, OSA has adverse effects on the cardiovascular system and this is a particularly significant issue given the high rates of hypertension and premature cardiac disease in people with DS. This review discusses the effects of sleep problems and OSA on daytime functioning and cardiovascular function in children with DS and evidence of the effectiveness of treatment in improving outcomes and quality of life for these children.
Collapse
Affiliation(s)
- Rosemary Sc Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Poornima Wijayaratne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia
| |
Collapse
|
37
|
Tamanyan K, Walter LM, Weichard A, Davey MJ, Nixon GM, Biggs SN, Horne RSC. Age Effects on Cerebral Oxygenation and Behavior in Children with Sleep-disordered Breathing. Am J Respir Crit Care Med 2018; 197:1468-1477. [DOI: 10.1164/rccm.201709-1825oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Lisa M. Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Margot J. Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Gillian M. Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Sarah N. Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Rosemary S. C. Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| |
Collapse
|
38
|
Tabasi F, Raoufy MR. Eliminated respiration-coupled oscillations in the brain as a possible link between adenotonsillar hypertrophy and cognitive impairment. Med Hypotheses 2018; 112:63-64. [DOI: 10.1016/j.mehy.2018.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/22/2017] [Accepted: 01/27/2018] [Indexed: 11/29/2022]
|
39
|
Horne RSC, Roy B, Walter LM, Biggs SN, Tamanyan K, Weichard A, Nixon GM, Davey MJ, Ditchfield M, Harper RM, Kumar R. Regional brain tissue changes and associations with disease severity in children with sleep-disordered breathing. Sleep 2017; 41:4750768. [DOI: 10.1093/sleep/zsx203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/05/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Bhaswati Roy
- UCLA School of Nursing, University of California – Los Angeles, Los Angeles, CA
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sarah N Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Michael Ditchfield
- Department of Paediatrics, Monash University, Melbourne, Australia
- Department of Radiology, Monash Children’s Hospital, Melbourne, Australia
| | - Ronald M Harper
- Department of Neurobiology, University of California – Los Angeles, Los Angeles, CA
- Brain Research Institute, University of California – Los Angeles, Los Angeles, CA
| | - Rajesh Kumar
- Department of Neurobiology, University of California – Los Angeles, Los Angeles, CA
- Department of Radiological Sciences, University of California – Los Angeles, Los Angeles, CA
- Department of Anesthesiology, University of California – Los Angeles, Los Angeles, CA
| |
Collapse
|
40
|
Gudnadottir G, Ellegård E, Hellgren J. Intranasal Budesonide and Quality of Life in Pediatric Sleep-Disordered Breathing: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2017; 158:752-759. [DOI: 10.1177/0194599817742597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To study the efficacy of budesonide nasal spray on the health-related quality of life and symptoms among children with sleep-disordered breathing. Study Design Randomized, parallel, double-blind, placebo-controlled trial. Setting Tertiary referral center. Subjects and Methods Sixty children (ages, 4-10 years) who were referred because of snoring and/or apneas for >3 months were included between January 2015 and June 2016 and randomized in a double-blind design to treatment with 64 μg/mL of budesonide nasal spray (n = 30) or placebo nasal spray (n = 30) twice daily for 6 weeks. The primary outcome measurement was the change in the mean OSA-18 total score from baseline. Other variables examined were individual OSA-18 domains, a visual analog scale for quality of life, symptoms (snoring, apneas, and nasal obstruction), and adenoid and tonsil size. The trial was investigator initiated and not sponsored by the pharmaceutical industry. Results Fifty-five children completed the trial. An intention-to-treat analysis revealed a significantly greater improvement in the mean OSA-18 total score after treatment with budesonide than placebo (19.5 vs 7.5, P = .0014). Intranasal budesonide also improved 2 OSA-18 domains (sleep disturbance, caregivers’ concerns), the visual analog scale score for quality of life, as well as snoring, apneas, and nasal obstruction. No serious adverse events were reported that could be linked to the treatment. Conclusion Among children with sleep-disordered breathing, 6 weeks’ treatment with intranasal budesonide significantly improved quality of life and symptoms as compared with placebo nasal spray.
Collapse
Affiliation(s)
- Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Eva Ellegård
- Department of Otorhinolaryngology, Halland’s Hospital, Kungsbacka, Sweden
| | - Johan Hellgren
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
41
|
Overweight and obesity add to behavioral problems in children with sleep-disordered breathing. Sleep Med 2017; 39:62-69. [DOI: 10.1016/j.sleep.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022]
|
42
|
Slow wave activity and executive dysfunction in children with sleep disordered breathing. Sleep Breath 2017; 22:517-525. [DOI: 10.1007/s11325-017-1570-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/27/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
|
43
|
Martinot JB, Le-Dong NN, Denison S, Guénard HJP, Borel JC, Silkoff PE, Pepin JL, Gozal D. Persistent respiratory effort after adenotonsillectomy in children with sleep-disordered breathing. Laryngoscope 2017; 128:1230-1237. [PMID: 28833232 DOI: 10.1002/lary.26830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Adenotonsillectomy (AT) markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep-disordered breathing (SDB). Adenotonsillectomy efficacy should be evaluated by follow-up polysomnography (PSG), but this method may underestimate persistent respiratory effort (RE). Mandibular movement (MMas) monitoring is an innovative measurement that readily identifies RE during upper airway obstruction. We hypothesized that MMas indices would decrease in parallel of PSG indices and that children with persistent RE more reliably could be identified with MMas. METHODS Twenty-five children (3-12 years of age) with SDB were enrolled in this individual prospective-cohort study. Polysomnography was supplemented with a midsagittal movement magnetic sensor that measured MMas during each respiratory cycle before and > 3 months after AT. RESULTS Adenotonsillectomy significantly improved PSG indices, except for RE-related arousals (RERA). Mandibular movement index changes after AT significantly were correlated with corresponding decreases in sleep apnea-hypopnea index (AHI) and O2 desaturation index (ODI) (Spearman's rho = 0.978 and 0.922, respectively), whereas changes in MMas duration significantly were associated with both RERA duration (rho = 0.475, P = 0.017) and index (rho = 0.564, P = 0.003). Conditional multivariate analysis showed that both AHI and RERA significantly contributed to the variance of MMas index after AT (P = 0.0003 and 0.0005, respectively), whereas MMas duration consistently was related to the duration of RERA regardless of AT. CONCLUSION Adenotonsillectomy significantly reduced AHI. However, persistent RERA were apparent in a significant proportion of children, and this was reflected by the remaining abnormal MMas pattern. Follow-up of children after AT can be recommended and readily achieved by monitoring MMas to identify persistent RE. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1230-1237, 2018.
Collapse
Affiliation(s)
| | - N Nam Le-Dong
- RespiSom Private Research Medical Center, Namur, Belgium
| | | | | | | | | | - Jean-Louis Pepin
- University Grenoble Alpes, Grenoble, France.,CHU de Grenoble, Laboratoire EFCR, Pôle THORAX et VAISSEAUX, Grenoble, France
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois, U.S.A
| |
Collapse
|
44
|
Smith DL, Gozal D, Hunter SJ, Kheirandish-Gozal L. Parent-Reported Behavioral and Psychiatric Problems Mediate the Relationship between Sleep-Disordered Breathing and Cognitive Deficits in School-Aged Children. Front Neurol 2017; 8:410. [PMID: 28848496 PMCID: PMC5554505 DOI: 10.3389/fneur.2017.00410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Numerous studies over the past several decades have illustrated that children who suffer from sleep-disordered breathing (SDB) are at greater risk for cognitive, behavioral, and psychiatric problems. Although behavioral problems have been proposed as a potential mediator between SDB and cognitive functioning, these relationships have not been critically examined. METHODS This analysis is based on a community-based cohort of 1,115 children who underwent overnight polysomnography, and cognitive and behavioral phenotyping. Structural model of the relationships between SDB, behavior, and cognition, and two recently developed mediation approaches based on propensity score weighting and resampling were used to assess the mediational role of parent-reported behavior and psychiatric problems in the relationship between SDB and cognitive functioning. Multiple models utilizing two different SDB definitions further explored direct effects of SDB on cognition as well as indirect effects through behavioral pathology. All models were adjusted for age, sex, race, BMI z-score, and asthma status. RESULTS Indirect effects of SDB through behavior problems were significant in all mediation models, while direct effects of SDB on cognition were not. The findings were consistent across different mediation procedures and remained essentially unaltered when different criteria for SDB, behavior, and cognition were used. CONCLUSION Potential effects of SDB on cognitive functioning appear to occur through behavioral problems that are detectable in this pediatric population. Thus, early attentional or behavioral pathology may be implicated in the cognitive functioning deficits associated with SDB, and may present an early morbidity-related susceptibility biomarker.
Collapse
Affiliation(s)
- Dale L. Smith
- Public Health Sciences, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States
- Olivet Nazarene University, Bourbonnais, IL, United States
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States
| | - Scott J. Hunter
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States
| | - Leila Kheirandish-Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States
| |
Collapse
|
45
|
Hunter SJ, Gozal D, Smith DL, Philby MF, Kaylegian J, Kheirandish-Gozal L. Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children. Am J Respir Crit Care Med 2017; 194:739-47. [PMID: 26930303 DOI: 10.1164/rccm.201510-2099oc] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sleep-disordered breathing (SDB) in children is associated with cognitive challenges. However, potential associations between SDB severity and neurocognitive function, as well as the presence of an SDB cutoff, have not been fully explored. OBJECTIVES To determine whether SDB-associated adverse changes in neurocognitive functioning are severity dependent. METHODS A total of 1,010 snoring and nonsnoring children ages 5-7 years were prospectively recruited from public schools and underwent polysomnography and neurocognitive assessments of intellectual, attention, memory, language, and executive function development. The children were subdivided into four severity groups on the basis of apnea-hypopnea index (AHI), followed by comparisons of cognitive function, with a particular focus on standardized subtests of intellectual, language, attention, memory, and executive function. MEASUREMENT AND MAIN RESULTS Differential Ability Scales Verbal (P < 0.001) and Nonverbal (P = 0.002) performance, as well as global conceptual ability (IQ) (P < 0.001) scores, differed significantly across the groups, with individuals with higher AHI showing worse performance. Additionally, specific NEPSY (a Developmental Neuropsychological Assessment) subscores focused on attention and executive skills differed across the groups, indicating differences in levels of engagement and problem solving. Children with higher AHI (>5 per hour of total sleep time) were significantly more impaired than all three lower AHI groups, indicating a dose-response impact of SDB. CONCLUSIONS This large community-based sample of children highlights the significant deleterious impact of SDB, particularly in children with moderate to severe obstructive sleep apnea, and also that even snoring alone affects neurocognitive function. By affecting developing capabilities, as illustrated by cognitive measures in a severity-graded manner, SDB could adversely impact children's capacity to attain academic and adaptive goals, ultimately hampering their ability to reach independence. Our findings support the need for increased awareness of SDB, with particular emphasis on children with more severe obstructive sleep apnea.
Collapse
Affiliation(s)
- Scott J Hunter
- 1 Department of Pediatrics and.,2 Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, Biological Sciences Division, and
| | | | - Dale L Smith
- 4 Department of Public Health Sciences, The University of Chicago, Chicago, Illinois; and.,3 Olivet Nazarene University, Bourbonnais, Illinois
| | | | - Jaeson Kaylegian
- 2 Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, Biological Sciences Division, and
| | | |
Collapse
|
46
|
Smith DL, Gozal D, Hunter SJ, Kheirandish-Gozal L. Frequency of snoring, rather than apnea-hypopnea index, predicts both cognitive and behavioral problems in young children. Sleep Med 2017; 34:170-178. [PMID: 28522088 PMCID: PMC5532874 DOI: 10.1016/j.sleep.2017.02.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Primary snoring (PS) and obstructive sleep apnea (OSA) not only affect the quality of sleep in a large number of young children, but have also been repeatedly associated with a variety of behavioral and cognitive problems. However, little is known about the potentially differing relationships of behavioral and cognitive pathology within the sleep disordered breathing (SDB) spectrum. METHOD This study examined data from an enriched for snoring community sample of 631 children aged between 4 and 10 years. Multivariate mixed models were used to assess the relationship between both snoring and the apnea-hypopnea index (AHI). Numerous cognitive and behavioral variables were used, while adjusting for several important demographic variables. These were followed by univariate analyses of individual measures and sensitivity analyses. RESULTS Results indicated that snoring status is a significant predictor of general behavioral (p = 0.008) and cognitive (p = 0.013) domains, even after adjusting for baseline covariates and AHI severity. More frequent snoring was associated with poorer outcomes independent of AHI. However, AHI did not emerge as a significant predictor of the overall cognitive functioning domain (p = 0.377). Additionally, although AHI was a significant predictor of the general behavioral functioning domain (p = 0.008), the significance pattern and nature of its relationship with individual behavioral measures were inconsistent in post-hoc analyses. CONCLUSION The findings of this study suggest that general behavioral and cognitive function may decline with greater snoring severity. Further, snoring should not simply be assumed to represent a lower severity level of SDB, but should be examined as a potential predictor of relevant outcomes.
Collapse
Affiliation(s)
- Dale L Smith
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA; Department of Psychology, Olivet Nazarene University, Bourbonnais, IL, USA.
| | - David Gozal
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA
| | - Scott J Hunter
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA; Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | | |
Collapse
|
47
|
Tan HL, Alonso Alvarez ML, Tsaoussoglou M, Weber S, Kaditis AG. When and why to treat the child who snores? Pediatr Pulmonol 2017; 52:399-412. [PMID: 28029756 DOI: 10.1002/ppul.23658] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/25/2016] [Accepted: 11/30/2016] [Indexed: 12/31/2022]
Abstract
Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Hui-Leng Tan
- Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, Sydney St., London SW3 6NP, United Kingdom
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Silke Weber
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| |
Collapse
|
48
|
Mlynczak M, Migacz E, Migacz M, Kukwa W. Detecting Breathing and Snoring Episodes Using a Wireless Tracheal Sensor-A Feasibility Study. IEEE J Biomed Health Inform 2016; 21:1504-1510. [PMID: 27913363 DOI: 10.1109/jbhi.2016.2632976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Sleep-disordered breathing is both a clinical and a social problem. This implies the need for convenient solutions to simplify screening and diagnosis. The aim of the study was to investigate the sensitivity and specificity of a novel wireless system in detecting breathing and snoring episodes during sleep. METHODS A wireless acoustic sensor was elaborated and implemented. Segmentation (based on spectral thresholding and heuristics) and classification of all breathing episodes during recording were implemented through a mobile application. The system was evaluated on 1520 manually labeled episodes registered from 40 real-world, whole-night recordings of 16 generally healthy subjects. RESULTS The differentiation between normal breathing and snoring had 88.8% accuracy. As the system is intended for screening, high specificity of 95% is reported. CONCLUSION The system is a compromise between nonmedical phone applications and medical sleep studies. The presented approach enables the study to be repetitive, personal, and inexpensive. It has additional value in the form of well-recorded data which are reliable and comparable. SIGNIFICANCE The system opens unexplored possibilities in sleep monitoring and study enabling a multinight recording strategy involving the collection and analysis of abundant data from thousands of people.
Collapse
|
49
|
McCann M, Bayliss DM, Anderson M, Campbell C, French N, McMichael J, Reid C, Bucks RS. The relationship between sleep problems and working memory in children born very preterm. Child Neuropsychol 2016; 24:124-144. [DOI: 10.1080/09297049.2016.1235144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marie McCann
- School of Psychology, University of Western Australia, Crawley, Australia
| | - Donna M. Bayliss
- School of Psychology, University of Western Australia, Crawley, Australia
| | - Mike Anderson
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Catherine Campbell
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
| | - Noel French
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
| | - Judy McMichael
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
| | - Corinne Reid
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Romola S. Bucks
- School of Psychology, University of Western Australia, Crawley, Australia
| |
Collapse
|
50
|
Association between slow-wave activity, cognition and behaviour in children with sleep-disordered breathing. Sleep Med 2016; 25:49-55. [DOI: 10.1016/j.sleep.2016.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
|