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Kim J, Nwaogu C, Mitchell RB, Johnson RF. Influence of Economic Connectedness on Pediatric Obstructive Sleep Apnea Severity and Adenotonsillectomy Outcomes. Otolaryngol Head Neck Surg 2024. [PMID: 38881394 DOI: 10.1002/ohn.860] [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: 10/28/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine the influence of economic connectedness (EC), a measure of social capital, on obstructive sleep apnea (OSA) severity and adenotonsillectomy outcomes in children. STUDY DESIGN Retrospective study. SETTING Single tertiary medical center. METHODS The study population included 286 children who were referred for full-night polysomnography for OSA and underwent adenotonsillectomy. The primary outcome was the relationship between EC and the presence of severe OSA, and secondary outcomes included postoperative emergency room visits and residual OSA after adenotonsillectomy. Linear regression, Kruskal-Wallis test, Pearson's χ2 test, and multiple logistic regression were used for categorical and continuous data as appropriate. RESULTS In this population, the median age was 9.0 (interquartile range [IQR] = 6.9-11.7) and 144 (50.3%) were male. The majority were white (176, 62.0%), black (60, 21.1%), and/or of Hispanic ethnicity (173, 60.9%). The median EC of this population was 0.64 (IQR = 0.53-0.86). Higher EC was associated with decreased odds of having severe OSA (odds ratio: 0.17, 95% confidence interval = 0.05-0.61). However, EC was not associated with either postoperative emergency room visits or residual OSA. CONCLUSION EC was significantly associated with severe OSA (ie, apnea-hypopnea index ≥ 10) but not with postoperative emergency room visits or residual OSA after adenotonsillectomy. Further research is needed to understand the effects of various social capital measures on pediatric OSA and adenotonsillectomy outcomes.
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Affiliation(s)
- Jenny Kim
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cullins Nwaogu
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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Solano-Pérez E, Coso C, Romero-Peralta S, Castillo-García M, López-Monzoni S, Ortigado A, Mediano O. New Approaches to the Management of Cardiovascular Risk Associated with Sleep Respiratory Disorders in Pediatric Patients. Biomedicines 2024; 12:411. [PMID: 38398013 PMCID: PMC10887096 DOI: 10.3390/biomedicines12020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Exposure to risk factors in youth can exacerbate the development of future cardiovascular disease (CVD). Obstructive sleep apnea (OSA), characterized by repetitive episodes of airway obstructions, could trigger said CVD acting as a modifiable risk factor. Measurements from echocardiography have shown impairments in the anatomy and function of the heart related to the severity of OSA. Therefore, the aim of this review was to propose a new clinical approach to the management of cardiovascular risk (CVR) in children based on treating OSA. The review includes studies assessing echocardiographic parameters for cardiac function and structure in pediatric OSA diagnosed using the apnea-hypopnea index (AHI) ≥ 1/h using polysomnography (PSG) and conducted within a year. Based on the reviewed evidence, in addition to PSG, echocardiography should be considered in OSA children in order to indicate the need for treatment and to reduce their future CVR. A follow-up echocardiography after treatment could be performed if impairments in the anatomy and function were found. Prioritizing parameters intimately connected to comorbidity could propel more effective patient-centered care. In conclusion, a reevaluation of pediatric OSA strategies should be considered, emphasizing comorbidity-related parameters in the cardiovascular field. Further studies are needed to assess this approach, potentially leading to enhanced protocols for more effective pediatric OSA treatment and CVR prevention.
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Affiliation(s)
- Esther Solano-Pérez
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Carlota Coso
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Sofía Romero-Peralta
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - María Castillo-García
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Sleep Research Institute, 28036 Madrid, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
| | - Sonia López-Monzoni
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Alfonso Ortigado
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
- Paediatric Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Olga Mediano
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
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Iannella G, Magliulo G, Greco A, De Virgilio A, Maniaci A, Lechien JR, Calvo-Henriquez C, Bahgat AY, Casale M, Lugo R, Baptista P, Salamanca F, D’Ecclesia A, Perrone T, Leone F, Cannavicci A, Cammaroto G, Vicini C, Pace A. Clinical Application of Pediatric Sleep Endoscopy: An International Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:94. [PMID: 38255407 PMCID: PMC10814917 DOI: 10.3390/children11010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE. METHODS A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations. RESULTS A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral. CONCLUSION Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.
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Affiliation(s)
- Giannicola Iannella
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
| | - Giuseppe Magliulo
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
| | - Antonio Greco
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Antonino Maniaci
- Department of Otolaryngology, Kore University, 94100 Enna, Italy;
| | - Jerome R. Lechien
- Department of Otolaryngology, Elsan Polyclinic of Poitiers, 86000 Poitiers, France;
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Rhinology Unit, Hospital Complex of Santiago de Compostela Travesía de Choupana, 15706 Santiago de Compostela, Spain;
| | - Ahmed Yassin Bahgat
- Department of Otorhinolaryngology-Head & Neck Surgery, Alexandria University, Alexandria 5424041, Egypt;
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy;
| | - Rodolfo Lugo
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey 64660, Mexico;
| | - Peter Baptista
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Fabrizio Salamanca
- Otorhinolaryngology Unit, San Pio X Hospital, 20159 Milan, Italy; (F.S.); (F.L.)
| | - Aurelio D’Ecclesia
- IRCCS ‘Casa Sollievo della Sofferenza’, 71013 San Giovanni Rotondo, Italy;
| | - Tiziano Perrone
- Otorhinolaryngology Unit, Civil Hospital of Alghero, 07041 Alghero, Italy;
| | - Federico Leone
- Otorhinolaryngology Unit, San Pio X Hospital, 20159 Milan, Italy; (F.S.); (F.L.)
| | - Angelo Cannavicci
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy; (A.C.); (G.C.)
| | - Giovanni Cammaroto
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy; (A.C.); (G.C.)
| | - Claudio Vicini
- Department ENT & Audiology, University of Ferrara, 44121 Ferrara, Italy;
| | - Annalisa Pace
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
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