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Hasuneh MM, Toubasi AA, Khraisat B, Aldabbas H, Al-Iede M. Risk Factors of Obstructive Sleep Apnea (OSA) in Pediatric Patients: A Systematic Review and Meta-analysis. J Pediatr Health Care 2024; 38:717-726. [PMID: 38980242 DOI: 10.1016/j.pedhc.2024.05.008] [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: 01/28/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION This review aimed to assess the risk factors of Obstructive Sleep Apnea (OSA) in pediatric children, a common condition with serious long-term sequela. METHODS PubMed, CENTRAL, Scopus, and Google Scholar were searched using the keywords "Apnea", "Obstructive Sleep" OR "Obstructive Sleep Apnea Syndrome" AND "Child" OR "Children" OR "Pediatrics". Data from 35 studies involving 497,688 pediatric patients diagnosed with OSA using polysomnography were reviewed. Risk factors examined included sex, obesity, neck circumference, tonsillar/adenoid hypertrophy, respiratory infections, nasal stenosis, parental OSA/smoking, ethnicity, preterm birth, and breastfeeding history. Relative Risk (RR) with 95% Confidence Intervals (95% CI) were calculated, using Cochrane Q and I² statistics to estimate heterogeneity. RESULTS Tonsillar hypertrophy (RR = 3.55), adenoid hypertrophy (RR = 1.63), respiratory tract infection (RR = 2.59), obesity (RR = 1.74), and family history of OSA (RR = 3.03) were significantly associated with pediatric OSA. White ethnicity was protective (RR = 0.77). DISCUSSION Recognizing these risk factors aids in early diagnosis and treatment of pediatric OSA.
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Affiliation(s)
- Manar M Hasuneh
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Bann Khraisat
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hamdi Aldabbas
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan
| | - Montaha Al-Iede
- Manar M. Hasuneh, Ahmad A. Toubasi, Bann Khraisat, Hamdi Aldabbas, Montaha AL-Iede, School of Medicine, The University of Jordan, Amman, Jordan.; Montaha AL-Iede, Division of Respiratory and Sleep Medicine, Pediatric Department, Jordan University Hospital, Amman, Jordan..
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Teplitzky TB, Zauher AJ, Isaiah A. Alternatives to Polysomnography for the Diagnosis of Pediatric Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:diagnostics13111956. [PMID: 37296808 DOI: 10.3390/diagnostics13111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed. The goal of this review is to evaluate and discuss alternatives for evaluating pediatric SDB. To date, wearable devices, single-channel recordings, and home-based PSG have not been validated as suitable replacements for PSG. However, they may play a role in risk stratification or as screening tools for pediatric OSA. Further studies are needed to determine if the combined use of these metrics could predict OSA.
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Affiliation(s)
- Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Audrey J Zauher
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Volkov SI, Ginter OV, Covantev S, Corlateanu A. Adenoid Hypertrophy, Craniofacial Growth and Obstructive Sleep Apnea: A Crucial Triad in Children. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201202122440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Age-related (physiological) AH is an important problem in pediatric otorhinolaryngology.
Since the beginning of the 70s, there has been an increase in the proportion of children with
pharyngeal tonsil hypertrophy. Functional disorders of the oropharynx in children occupy the second
place based on their incidence (after disorders of the musculoskeletal system). In previous
years, there has been an increase in the incidence and prevalence of obstructive sleep apnea syndrome
(OSAS) among children. In most cases of pediatric OSAS, upper airway obstruction occurs
from the nasopharynx to the oropharynx, caused by upper airway stenosis. Consequences of untreated
OSAS in children can be inattention and behavioral problems, daytime sleepiness, and in
more severe cases are associated with a variety of comorbidities. The current review discusses the
links between hypertrophied adenoids, craniofacial development and OSAS in children taking into
account physiological and pathophysiological aspects as well as clinical evaluation of the problem.
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Affiliation(s)
- Stanislav I. Volkov
- Department of Endocrinology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Olga V. Ginter
- Department of Neurology, Schon Klinik, Bad Aibling, Germany
| | - Serghei Covantev
- Department of General Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State Medical and Pharmaceutical University of “N. Testimetanu”, Chisinau, Moldova, Republic of
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Su MS, Xu L, Pan WF, Li CC. Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children. World J Pediatr 2019; 15:109-116. [PMID: 30446975 DOI: 10.1007/s12519-018-0199-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children. OSA and NE are thought to be interrelated, but the exact pathophysiological mechanisms are not yet clear. This review aims to explain the possible pathogenesis of NE in children with OSA. DATE SOURCES We have retrieved all relevant original articles from Database that have been published so far, including the prevalence studies of NE and OSA in children, sleep characteristic studies that use polysomnography (PSG) to focus on children with NE, and studies on the relationship between OSA and NE. RESULTS Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers. This increased risk may be associated with sleep disorders, bladder instability, detrusor overactivity, nocturnal polyuria, endocrine and metabolic disorders, and inflammation. CONCLUSIONS Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA, but this remains to be confirmed by animal studies. Other causes such as oxidative stress and inflammatory responses need to be further researched.
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Affiliation(s)
- Miao-Shang Su
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Li Xu
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Wen-Feng Pan
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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The predictive value of polysomnography combined with quality of life for treatment decision of children with habitual snoring related to adenotonsillar hypertrophy. Eur Arch Otorhinolaryngol 2018; 275:1579-1586. [DOI: 10.1007/s00405-018-4984-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
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Zeng G, Teng Y, Zhu J, Zhu D, Yang B, Hu L, Chen M, Fu X. Clinical application of MRI-respiratory gating technology in the evaluation of children with obstructive sleep apnea hypopnea syndrome. Medicine (Baltimore) 2018; 97:e9680. [PMID: 29369187 PMCID: PMC5794371 DOI: 10.1097/md.0000000000009680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of the present study was to investigate the clinical application of magnetic resonance imaging (MRI)-respiratory gating technology for assessing illness severity in children with obstructive sleep apnea hypopnea syndrome (OSAHS).MRI-respiratory gating technology was used to scan the nasopharyngeal cavities of 51 children diagnosed with OSAHS during 6 respiratory phases. Correlations between the ratio of the area of the adenoid to the area of the nasopalatine pharyngeal cavity (Sa/Snp), with the main indexes of polysomnography (PSG), were analyzed. Receiver operator characteristic (ROC) curve and Kappa analysis were used to determine the diagnostic accuracy of Sa/Snp in pediatric OSAHS.The Sa/Snp was positively correlated with the apnea hypopnea index (AHI) (P < .001) and negatively correlated with the lowest oxygen saturation of blood during sleep (LaSO2) (P < .001). ROC analysis in the 6 respiratory phases showed that the area under the curve (AUC) of the Sa/Snp in the end-expiratory phase was the largest (0.992, P < .001), providing a threshold of 69.5% for the diagnosis of severe versus slight-moderate OSAHS in children. Consistency analysis with the AHI showed a diagnosis accordance rate of 96.0% in severe pediatric OSAHS and 96.2% in slight-moderate pediatric OSAHS (Kappa = 0.922, P < .001).Stenosis of the nasopalatine pharyngeal cavity in children with adenoidal hypertrophy was greatest at the end-expiration phase during sleep. The end-expiratory Sa/Snp obtained by a combination of MRI and respiratory gating technology has potential as an important imaging index for diagnosing and evaluating severity in pediatric OSAHS.
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Affiliation(s)
- Guohui Zeng
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Yaoshu Teng
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Jin Zhu
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Darong Zhu
- Department of Radiology, Hangzhou First People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Yang
- Department of Radiology, Hangzhou First People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Linpin Hu
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Manman Chen
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Xiao Fu
- Department of Otorhinolaryngology Head and Neck Surgery
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Çetin M, Bozan N. The effects of adenotonsillar hypertrophy corrective surgery on left ventricular functions and pulmonary artery pressure in children. Int J Pediatr Otorhinolaryngol 2017; 101:41-46. [PMID: 28964308 DOI: 10.1016/j.ijporl.2017.07.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Comparison of left ventricular functions in preoperative and postoperative periods of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction (UAO), using echocardiographic parameters. METHODS Thirty children who were diagnosed with UAO due to ATH, and who have undergone adenoidectomy/adenotonsillectomy and 30 healthy children, between 2 and 11 years of age, were included in the study. Patient group was evaluated by the pulsed wave tissue Doppler echocardiography, as well as with conventional echocardiography, before and 6 months after the operation. RESULTS Of 30 children in study group, 18 (60%) had adenotonsillectomy and 12 (40%) had adenoidectomy. The differences between groups regarding myocardial performance index (MPI) was not statistically significant (p = 0.847). There was not any statistically significant difference between groups in terms of mitral isovolemic acceleration (MIVA) (2.28 ± 0.67, 2.24 ± 0.55, 2.23 ± 0.49; p = 0.943, respectively). Interventricular septum diameter (IVSD) was significantly higher in preoperative group than postoperative and control groups (3.68 ± 0.52, 3.50 ± 0.40, 3.38 ± 0.60; p = 0.028, respectively). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control groups (107.64 ± 16.60, 119.52 ± 15.95, 120.47 ± 16.19; p = 0.004, respectively). Mean pulmonary arterial pressure (mPAP) was significantly higher in preoperative group than postoperative and control groups (30.58 ± 8.11, 25.23 ± 9.07, 25.00 ± 6.52; p = 0.002, respectively). In postoperative group mPAP was found to be similar to the control group. CONCLUSIONS Clinical or subclinical left ventricle (LV) dysfunction in children with ATH who have findings of UAO was not determined while mean pulmonary arterial pressure was significantly higher compared with the control cases. Besides early adenotonsillectomy is a beneficial treatment option for these patients.
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Affiliation(s)
- Mecnun Çetin
- Department of Pediatric Cardiology, Yuzuncu Yil University, Van, Turkey.
| | - Nazım Bozan
- Department of Otolaryngology, Yuzuncu Yil University, Van, Turkey
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Kljajić Z, Roje Ž, Bečić K, Čapkun V, Vilović K, Ivanišević P, Marušić E. Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable? Int J Pediatr Otorhinolaryngol 2017; 100:168-173. [PMID: 28802366 DOI: 10.1016/j.ijporl.2017.06.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE OF THE STUDY The aim of the study was to propose "the risk formula" for obstructive sleep apnea in children according to the general and local clinical parameters and findings relevant for obstructive sleep apnea (OSA) severity. The unmet need for this formula arises from the economic burden of polysomnography (device, staff, training, special sleep centers, etc) as the golden standard for the diagnostics. MATERIALS AND METHODS USED The study was performed from January 2013 until January 2016 in the Sleep Center, Department for Neuroscience, School of Medicine of the University of Split, Department of Pediatrics, University Hospital Split, Croatia and ENT Dept. University Hospital in Split, Croatia. Inclusion criteria were: age > two years, AHI >1 diagnosed by polysomnography. Exclusion criteria were: chronic lung disease, active tonsillitis/pharyngitis at the time of the physical exam and syndromes that affect breathing. All polysomnograms were scored by a qualified sleep technologist and interpreted by two board certified sleep physicians independently. Age, sex, BMI, Mallampati score, tonsillar size and adenoids size were recorded. All statistical calculations were performed using SPSS 20. RESULTS In total 60 children were included in the study. The median of age was 5 years (range 2-9). There were 19 (32%) girls and 41 (68%) boys. Of all evaluated predictors, there were statistically significant differences in the values of AHI among children with different modified Mallampati score (χ2 = 28.2; p < 0.001), different size of tonsils (χ2 = 25.3; p < 0.001) and different size of adenoids (z = 2.7; p = 0,006) in univariate regression analysis. Strong positive association of AHI with modified Mallampati score (standardized B = 0.51; partial correlation = 0.542, r = 0.631) was found, as well as positive correlation of AHI with tonsillar size (standardized B = 0.246; partial correlation = 0.295,R = 0.489) in the multivariate forward stepwise regression analysis. CONCLUSION Even though we are aware that PSG is the gold standard for diagnostics of SDB there is a significant financial burden for this diagnostic procedure. That is why there is a necessity for establishing good clinical standards and possible formula for OSA severity evaluation. We propose formula which includes Mallampati score and tonsillar size for OSA -risk calculation in order to perform early therapeutic intervention thereby reducing the risk of long-term negative consequences. We recommend this formula as the screening formula in circumstances where PSG is not available, in cases when the "waiting list" is too long or when a child can not cooperate to perform it. In developing countries like Croatia on time intervention with reduced procedure-associated costs is of the utmost importance.
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Affiliation(s)
- Zlatko Kljajić
- University Department of ENT, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - Željka Roje
- Private ENT Practice dr. Željka Roje, Kranjčevićeva 45, Split, Croatia
| | - Kristijan Bečić
- School of Medicine, University of Split, Šoltanska 2, Split, Croatia.
| | - Vesna Čapkun
- Department of Nuclear Medicine, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - K Vilović
- Department of Pathology, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - Petar Ivanišević
- University Department of ENT, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - Eugenija Marušić
- Department of Pediatrics, University Hospital Center Split, Spinčićeva 1, Split, Croatia
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Aubertin G, Schröder C, Sevin F, Clouteau F, Lamblin MD, Vecchierini MF. Diagnostic clinique du syndrome d’apnées obstructives du sommeil de l’enfant. Arch Pediatr 2017; 24 Suppl 1:S7-S15. [DOI: 10.1016/j.arcped.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
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Balaban O, Walia H, Tumin D, Jatana KR, Raman V, Tobias JD. Assessment of adenotonsillar size and caregiver-reported sleep symptoms among 3-6 year old children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2016; 91:43-48. [PMID: 27863640 DOI: 10.1016/j.ijporl.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Adenotonsillectomy remains the accepted first-line treatment for obstructive sleep apnea syndrome (OSAS) in children. Tonsillar size may be especially relevant in risk stratification as it may impact symptoms of sleep disordered breathing (SDB). This study assesses correlations among subjective tonsillar grading, measured tonsillar size, and degree of adenoid obstruction in patients age 3-6 years with caregiver-reported symptoms. METHODS Children 3-6 years old undergoing adenotonsillectomy for OSAS were enrolled prospectively. The subjective tonsillar grade and degree of adenoid obstruction were recorded on physical examination by the otolaryngologist, and the objective tonsillar size was obtained from pathology reports. Spearman's rho was used to assess agreement among measures of tonsillar size and adenoid obstruction; and to correlate these measures with caregiver-reported SDB symptoms obtained from a pre-operative standardized questionnaire. RESULTS The cohort included 103 boys and 97 girls of median age 4.8 (interquartile range [IQR]: 3.9, 5.9) years. Median subjective tonsillar grade was 3+ (IQR: 3+, 4+) while median tonsillar size was 2.7 cm (IQR: 2.5, 3) and median adenoid obstruction was 60% (IQR: 50%, 80%). The subjective tonsillar grade and measured tonsillar size were strongly correlated (ρ = 0.31, p < 0.001), whereas adenoid obstruction was uncorrelated with either subjective tonsillar grade (ρ = 0.01, p = 0.860) or measured size (ρ = -0.05, p = 0.497). Tonsillar grade was positively correlated with 3 common caregiver-reported SDB symptoms (loud snoring, trouble breathing at night, and daytime sleepiness). Objective tonsillar size was positively correlated only with difficulty organizing tasks or activities, and adenoid obstruction was positively correlated only with stopping breathing during sleep. CONCLUSION Subjective tonsillar grading by the otolaryngologist achieved better correlation than measured tonsillar size or degree of adenoid obstruction with caregiver-reported SDB symptoms in children 3-6 years of age undergoing adenotonsillectomy.
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Affiliation(s)
- Onur Balaban
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Hina Walia
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kris R Jatana
- Department of Otolaryngology, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Vidya Raman
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
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Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis. Int J Pediatr Otorhinolaryngol 2016; 87:18-27. [PMID: 27368437 DOI: 10.1016/j.ijporl.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/20/2016] [Accepted: 05/15/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA. METHODS The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities. RESULTS Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166). CONCLUSIONS Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
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Affiliation(s)
- Chia-Fan Lee
- Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan, ROC.
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC.
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Kang KT, Weng WC, Lee CH, Hsiao TY, Lee PL, Hsu WC. Clinical risk assessment model for pediatric obstructive sleep apnea. Laryngoscope 2016; 126:2403-9. [PMID: 26973061 DOI: 10.1002/lary.25912] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a clinical risk prediction model that identifies children with obstructive sleep apnea (OSA) in a clinical setting by examining the symptoms, physical status, and OSA-18 questionnaire results. DESIGN Single institutional, cross-sectional study. METHODS Children aged 2 to 18 years with symptoms of OSA were enrolled. Pediatric OSA was diagnosed through full-night polysomnography. Clinical data, namely demographics, symptoms, OSA-18 survey results, tonsil and adenoid sizes, and the weight of each child, were examined for constructing a simple point-based clinical model for OSA prediction. Variables for the risk model were selected using multivariable logistic regression analyses. RESULTS Of the 310 participants (mean age, 7.6 ± 3.7 years; boys, 67%), 170 (55%) experienced OSA. Modeling variables were determined using several univariate logistic regression analyses, followed by multivariable logistic regression analyses. A point-based clinical model incorporating the age, tonsil size (5 points maximum), adenoid size (5 and 20 points for age > 6 years and < 6 years, respectively), obesity (5 points for age > 6 years), and breathing pauses (5 points) was developed (area under the curve = 0.832). Moreover, the optimal cutoff points for predicting the apnea-hypopnea index of > 1 and > 5 were 10 (sensitivity, 72.9%; specificity, 65.0%) and 12 (sensitivity, 77.5%; specificity, 56.9%), respectively. Internal validation using the bootstrap method revealed no apparent overfitting problem. CONCLUSION A novel clinical prediction model was developed for determining the risk of pediatric OSA; the model can be useful in identifying high-risk patients among those with sleep disturbances. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2403-2409, 2016.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Hospital, Taipei.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei.,Department of Pediatrics, National Taiwan University Hospital, Taipei
| | - Chia-Hsuan Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Hospital, Taipei.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei. .,Sleep Center, National Taiwan University Hospital, Taipei.
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Villa MP, Sujanska A, Vitelli O, Evangelisti M, Rabasco J, Pietropaoli N, Banovcin P, Kheirandish-Gozal L, Gozal D. Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment. Sleep Breath 2015; 20:321-9. [PMID: 26564170 DOI: 10.1007/s11325-015-1287-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of our study was to evaluate the utility of the sleep clinical record (SCR) in the follow-up of children with obstructive sleep apnea (OSA) after treatment. METHODS SCR was completed and overnight polysomnography (PSG) was performed in all enrolled children (T0), with SCR considered positive for scores ≥6.5, as previously validated. Patients underwent adenotonsillectomy (T&A), rapid maxillary expansion (RME), and medical therapy according to severity of OSA and clinical features. Six months after completing therapy, the second overnight PSG and SCR (T1) were performed. RESULTS For all subjects, both Apnea-Hypopnea Index (AHI) and total SCR score decreased significantly (<0.005) from T0 to T1. For SCR items, clinical examination (item 1) and reported sleep respiratory symptoms (item 2) ameliorated significantly (<0.005). However, hyperactivity or inattention (item 3) decreased significantly (<0.005) after treatment only in T&A group, while no differences in AHI and SCR scores occurred in the medically treated group. At T1, SCR was positive in 95.6 % of children with AHI ≥1, with a concordance of 100 % in the T&A and RME groups, resulting in a positive predictive value of 100 %. A poor concordance (38.3 % in T&A group and 53.4 % in RME group) was found when SCR < 6.5. Children with SCR ≥ 6.5 at T1 showed higher AHI compared to patients with SCR < 6.5 (5.7 ± 5.9 ev/h vs 1.78 ± 1.76 ev/h; p < 0.005). CONCLUSIONS SCR emerges as a potentially useful instrument for follow-up of children with OSA after treatment.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Anna Sujanska
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Melania Evangelisti
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Peter Banovcin
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA
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Slaats MA, Van Hoorenbeeck K, Van Eyck A, Vos WG, De Backer JW, Boudewyns A, De Backer W, Verhulst SL. Upper airway imaging in pediatric obstructive sleep apnea syndrome. Sleep Med Rev 2015; 21:59-71. [DOI: 10.1016/j.smrv.2014.08.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
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Osiatuma VI, Otuyemi OD, Kolawole KA, Ogunbanjo BO, Amusa YB. Caractéristiques occlusales des enfants présentant des végétations hypertrophiées au Nigéria. Int Orthod 2015. [DOI: 10.1016/j.ortho.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Detection of pediatric obstructive sleep apnea syndrome: history or anatomical findings? Sleep Med 2015; 16:617-24. [PMID: 25921055 DOI: 10.1016/j.sleep.2014.12.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess how history and/or anatomical findings differ in diagnosing pediatric obstructive sleep apnea (OSA). METHODS Children aged 2-18 years were recruited and assessed for anatomical (ie, tonsil size, adenoid size, and obesity) and historical findings (ie, symptoms) using a standard sheet. History and anatomical findings, as well as those measures significantly correlated with OSA, were identified to establish the historical, anatomical, and the combined model. OSA was diagnosed by polysomnography. The effectiveness of those models in detecting OSA was analyzed by model fit, discrimination (C-index), calibration (Hosmer-Lemeshow test), and reclassification properties. RESULTS A total of 222 children were enrolled. The anatomical model included tonsil hypertrophy, adenoid hypertrophy, and obesity, whereas the historical model included snoring frequency, snoring duration, awakening, and breathing pause. The C-index was 0.84 for the combined model, which significantly differed from that in the anatomical (0.78, p = 0.003) and historical models (0.72, p < 0.001). The Hosmer-Lemeshow test revealed an adequate fit for all of the models. Additionally, the combined model more accurately reclassified 10.3% (p = 0.044) and 21.9% (p = 0.003) of all of the subjects than either the anatomical or historical model. Internal validation of the combined model by the bootstrapping method showed a fair model performance. CONCLUSION Overall performance of combined anatomical and historical findings offers incremental utility in detecting OSA. Results of this study suggest integrating both history and anatomical findings for a screening scheme of pediatric OSA.
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Osiatuma VI, Otuyemi OD, Kolawole KA, Ogunbanjo BO, Amusa YB. Occlusal characteristics of children with hypertrophied adenoids in Nigeria. Int Orthod 2015; 13:26-42. [PMID: 25665907 DOI: 10.1016/j.ortho.2014.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nasorespiratory function and its relation to craniofacial growth are of great interest because of the basic biological relationship between form and function, and the accumulating findings of the relationship between mode of breathing, craniofacial growth and orthodontic treatment. OBJECTIVES The aim of this study was to evaluate the effect of adenoid hypertrophy and sociodemographic variables on the occlusion of children. METHODOLOGY A total of 180 subjects aged 3-12 years were selected at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Ninety subjects had hypertrophied adenoids while 90 normal children served as the control group. Orthodontic examinations were carried out and impressions for study models taken. Occlusion was assessed in the anterior-posterior, transverse and vertical planes. RESULTS Class I relationship was the most prevalent occlusion in both adenoid and control subjects (55.6% and 72.2%, respectively). The occurrence of class II division 1 was significantly higher among adenoid than control subjects (P=0.003). Posterior crossbites occurred significantly more in adenoid subjects in the 9-12 years category. In the vertical plane, the occurrence of deep bite was significantly greater in male than female adenoid subjects. Age had a statistically significant but weak correlation with anterior open bite (r=0.37). Age and BMI also had significant though weak correlations with posterior crossbite in female adenoid subjects (r=0.39 and r=0.36, respectively). Regression analysis also showed that age had a significant effect on the occurrence of anterior open bite, while BMI had a significant effect on the occurrence of class II occlusion in adenoid subjects (P<0.05). CONCLUSION The presence of hypertrophied adenoids affects the occlusion in the three planes. Age and BMI have significant effects on the occurrence of anterior open bite and class II division 1 malocclusion respectively in adenoid subjects.
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Affiliation(s)
- Vivien Ijeoma Osiatuma
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olayinka Donald Otuyemi
- Department of Child Dental Health, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Yemisi Bola Amusa
- Otorhinolaryngology Unit, Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
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Lee CH, Kang KT, Weng WC, Lee PL, Hsu WC. Quality of life after adenotonsillectomy in children with obstructive sleep apnea: short-term and long-term results. Int J Pediatr Otorhinolaryngol 2015; 79:210-5. [PMID: 25555637 DOI: 10.1016/j.ijporl.2014.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess short-term and long-term changes in quality of life after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). MATERIALS AND METHODS Children aged 2-18 years old were enrolled. All subjects had clinical symptoms, overnight polysomnography diagnosis of OSA, and received T&A as treatment. Caregivers were asked to complete the OSA-18 survey before surgery, within 6 months after surgery (short-term), and more than 6 months after surgery (long-term). RESULTS A total of 114 children were included (mean age, 7.0±3.5 years; 75% boys). The mean OSA-18 total score was 71.5±16.0 before surgery. After surgery, the mean OSA-18 total score was significantly decreased in both the short-term (40.3±12.2, p<0.001) and the long-term (42.0±13.7, p<0.001). All five OSA-18 domains were also significantly decreased during short-term and long-term postoperative follow up (p<0.001). Short-term and long-term outcomes were compared. Mean OSA-18 total scores, sleep disturbance score, emotional distress score, daytime function score, and caregiver concerns score did not differ significantly between the short-term and long-term periods, while the physical symptom score was slightly higher in the long-term than the short-term period (9.7±3.3 vs. 8.7±3.0, p=0.02). Additionally, the physical symptoms score was higher in the long-term period in the female (p=0.01), older age (>6 years) (p=0.03), and non-obese (p=0.04) subgroups. CONCLUSION T&A improves short-term and long-term quality of life in children with OSA. Nevertheless, caregivers observed children with aggravation of physical symptoms of quality of life during long-term follow up, especially in the female, older, and non-obese subgroups.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.
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Marangu D, Jowi C, Aswani J, Wambani S, Nduati R. Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2014; 78:1381-6. [PMID: 24969347 DOI: 10.1016/j.ijporl.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya. METHODS This was a cross sectional hospital based survey conducted among children below 12 years of age with clinical and radiological adenoid hypertrophy attending the ear, nose and throat (ENT) outpatient clinic and general pediatric wards. Doppler echocardiography was used to determine pulmonary hypertension defined as a mean pulmonary arterial pressure (mPAP) of ≥ 25 mm Hg using the Chemla equation. Children with mPAP of ≥ 25 mm Hg were compared to those with lower pressures and clinical and radiological factors associated with pulmonary hypertension determined using multivariate logistic regression analysis. RESULTS Of the 123 eligible children in the study, 27 had pulmonary hypertension giving a prevalence of 21.9% (95% CI 14.64%-29.27%). Independent factors associated with pulmonary hypertension included nasal obstruction (OR=3.0 [95% CI 1.08-8.44] p=0.035) and hyperactivity on history (OR=0.2 [95% CI 0.07-0.59] p=0.003) and adenoid-nasopharyngeal ratio (ANR) >0.825 on lateral neck radiography (OR=5.0 [95% CI 1.01-24.37] p=0.048). CONCLUSION One in five children with adenoid or adenotonsillar hypertrophy had pulmonary hypertension with a 3-fold and 5-fold increased odds in those with nasal obstruction on history and ANR >0.825 on lateral neck radiography respectively and an 80% reduced odds in reportedly hyperactive children.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Christine Jowi
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joyce Aswani
- Department of ENT Surgery, University of Nairobi, Nairobi, Kenya
| | - Sidika Wambani
- Radiology Department of Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Lee CH, Kang KT, Weng WC, Lee PL, Hsu WC. Quality of life after adenotonsillectomy for children with sleep-disordered breathing: a linear mixed model analysis. Int J Pediatr Otorhinolaryngol 2014; 78:1374-80. [PMID: 24972939 DOI: 10.1016/j.ijporl.2014.05.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity. MATERIALS AND METHODS Children aged 2-18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI < 1), mild obstructive sleep apnea (OSA) (5 > AHI ≥ 1), and moderate-to-severe OSA (AHI ≥ 5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model. RESULTS In total, 144 children were enrolled (mean age, 7.0 ± 3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥ 6 years vs. < 6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P = 0.004; mild OSA vs. moderate-to-severe OSA, P = 0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring. CONCLUSIONS Children with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, China Medical University Hospital, Taipei branch, Taiwan, ROC; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, ROC
| | - Kun-Tai Kang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, ROC; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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Bhushan B, Sheldon S, Wang E, Schroeder JW. Clinical indicators that predict the presence of moderate to severe obstructive sleep apnea after adenotonsillectomy in children. Am J Otolaryngol 2014; 35:487-95. [PMID: 24746328 DOI: 10.1016/j.amjoto.2014.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine if clinical indicators can predict the presence of moderate to severe Obstructive Sleep Apnea (OSA) after Adenotonsillectomy (T&A) in children. STUDY DESIGN Retrospective study. SETTING Urban Tertiary Care Pediatric Hospital. METHODS Parents of children (<18 yrs.) with OSA completed a 55-item questionnaire based on their child's symptoms at the time of preoperative polysomnography and then again at the follow up polysomnography completed 3 to 6 months after T&A. MAIN OUTCOME MEASURES 55 item questionnaire, polysomnography variables. RESULTS 97 children were included (59 Male and 38 Female). The mean preoperative apnea hypopnea index (AHI) was 30.5±31.6/h and the mean postoperative AHI was 4.4±6.0/h. After T&A, all 97 children had reduction in AHI, and 35 (36.1%) no longer had OSA (AHI<1/h). The total symptom scores decreased from 15.8±9.4 to 11.3±8.7 after T&A (p<.0001). Fourteen symptoms highly predictive of moderate to severe OSA were identified in the univariate analysis (p<0.1). Using a cut-point of 4, this 14-item subscale illustrated an overall predictability of 72.2% (73.7% sensitivity and 70.0% specificity) for identifying children with moderate to severe OSA. CONCLUSION A cluster of 14 clinical sleep symptoms are highly predictive of moderate to severe OSA and can serve as clinical predictor for the presence of moderate to severe OSA after T&A.
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Kang KT, Weng WC, Yeh TH, Lee PL, Hsu WC. Validation of the Chinese version OSA-18 quality of life questionnaire in Taiwanese children with obstructive sleep apnea. J Formos Med Assoc 2014; 113:454-62. [DOI: 10.1016/j.jfma.2012.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/30/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022] Open
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Wootten CT, Chinnadurai S, Goudy SL. Beyond adenotonsillectomy: outcomes of sleep endoscopy-directed treatments in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2014; 78:1158-62. [PMID: 24845267 DOI: 10.1016/j.ijporl.2014.04.041] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/10/2014] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES In this study we determine the subjective and objective outcomes of pediatric patients with refractory OSA undergoing drug-induced sleep endoscopy (DISE)-directed surgical treatment. METHODS 31 consecutive children with OSA following TA underwent DISE. 26 completed DISE-directed operative management of the level(s) of ongoing upper airway obstruction. Pre- and postoperative OSA were assessed through a detailed history (of nighttime symptoms (NS) and daytime symptoms (DS)), physical examination, and polysomnography. RESULTS Age ranged 5-18 years (mean 9.7 ± 3.4). Fourteen of 26 had trisomy 21 (51%). Operations were performed in the following frequencies: lingual tonsillectomy (LT) (22), midline posterior glossectomy (MPG) (16), revision adenoidectomy (11), inferior turbinate submucosal resection (7), uvulopalatoplasty (2), and supraglottoplasty (2). Overall, 92% reported subjective improvement. NS improved from 5.8 ± 2.9 preoperatively to 2.1 ± 2.5 postoperatively (p<0.05), while DS improved from 2.1 ± 1.3 preoperatively to 0.6 ± 1.1 postoperatively (p<0.05). Seventeen patients completed preoperative polysomnography, while only 11 of them also completed postoperative polysomnography. Mean OAHI fell from 7.0 (±5.8) events/hr to 3.6 (±1.8) events/hr (t-test, p=0.09). CONCLUSIONS Individualized, multilevel, DISE-directed operative therapy was associated with substantial improvement in subjective measures of sleep.
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Affiliation(s)
- Christopher T Wootten
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Vanderbilt University, Nashville, TN, United States.
| | - Sivakumar Chinnadurai
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Vanderbilt University, Nashville, TN, United States
| | - Steven L Goudy
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Vanderbilt University, Nashville, TN, United States
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Testani E, Scarano E, Leoni C, Dittoni S, Losurdo A, Colicchio S, Gnoni V, Vollono C, Zampino G, Paludetti G, Della Marca G. Upper airway surgery of obstructive sleep apnea in pycnodysostosis: case report and literature review. Am J Med Genet A 2014; 164A:2029-35. [PMID: 24715708 DOI: 10.1002/ajmg.a.36557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 01/25/2014] [Indexed: 11/10/2022]
Abstract
Pycnodysostosis is an autosomal recessive disorder due to a mutation in the cathepsin K gene, which causes a decrease of the bone turnover; a review of the literature suggests that pycnodysostosis is frequently associated with severe respiratory obstruction, which needs surgical treatment. The aim of this paper is to describe the surgical treatment of a 3½-year-old girl affected by Pycnodysostosis complicated by a severe sleep-related respiratory disorder. The surgical treatment, consisting of adenotonsillectomy and palatoplasty, resulted in a striking amelioration of respiratory parameters and increased posterior airway space, and allowed the patient to avoid tracheotomy while awaiting for maxillo-mandibular surgery.
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Affiliation(s)
- Elisa Testani
- Department of Neurosciences, Catholic University, Rome, Italy
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Wolf RB, Kassim AA, Goodpaster RL, DeBaun MR. Nocturnal enuresis in sickle cell disease. Expert Rev Hematol 2014; 7:245-54. [DOI: 10.1586/17474086.2014.892412] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children. J Am Dent Assoc 2014; 145:165-78. [DOI: 10.14219/jada.2013.26] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jambhekar S, Carroll JL. Diagnosis of pediatric obstructive sleep disordered breathing: beyond the gold standard. Expert Rev Respir Med 2014; 2:791-809. [DOI: 10.1586/17476348.2.6.791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zou J, Guan J, Yi H, Meng L, Xiong Y, Tang X, Su K, Yin S. An effective model for screening obstructive sleep apnea: a large-scale diagnostic study. PLoS One 2013; 8:e80704. [PMID: 24312494 PMCID: PMC3846620 DOI: 10.1371/journal.pone.0080704] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/15/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) causes high morbidity and mortality and is independently associated with an increased likelihood of multiple complications. The diagnosis of OSA is presently time-consuming, labor-intensive and inaccessible. AIM This study sought to develop a simple and efficient model for identifying OSA in Chinese adult population. METHODS In this study, the efficiency of Epworth Sleepiness Scale (ESS) and a new established prediction model for screening OSA were evaluated in the test cohort (2,032 participants) and confirmed in an independent validation cohort (784 participants). RESULTS In the test cohort, a high specificity (82.77%, 95% confidence interval [CI], 77.36-87.35) and a moderate sensitivity (61.65%, 95% CI, 59.35-63.91) were obtained at the threshold of nine for the ESS alone. Notably, sex-stratified analysis revealed different optimum cut-off points: nine for males and six for females. The new generated screening model, including age, waist circumference, ESS score, and minimum oxygen saturation (SaO2) as independent variables, revealed a higher sensitivity (89.13%, 95% CI, 87.60-90.53) and specificity (90.34%, 95% CI, 85.85-93.77) at the best cut-off point. Through receiver operating characteristics curve analysis, the area under the receiver operating characteristics curve of the model was found significantly larger than that of the ESS alone (0.955 vs. 0.774, P<0.0001). All these results were confirmed in the validation cohort. CONCLUSIONS A practical screening model comprising minimum SaO2 and other parameters could efficiently identify undiagnosed OSA from the high-risk patients. Additionally, a sex-specific difference should be considered if the ESS alone is used.
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Affiliation(s)
- Jianyin Zou
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Lili Meng
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Yuanping Xiong
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Xulan Tang
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Kaiming Su
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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Fitzgerald NM, Fitzgerald DA. Managing snoring and obstructive sleep apnoea in childhood. J Paediatr Child Health 2013; 49:800-6. [PMID: 24131112 DOI: 10.1111/jpc.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 11/27/2022]
Abstract
Snoring assessment and its differentiation from obstructive sleep apnoea are difficult based upon a parent history and physical examination of the size of the tonsils. Not only is the presence of obstructive sleep apnoea important to diagnose, but confirming its severity is the key determinant in prioritising treatment in a resource-limited setting. This review provides current knowledge on the utility of common diagnostic tests, results of treatment options available and implications of treatment and unrecognised or untreated obstructive sleep apnoea.
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Affiliation(s)
- Nicholas M Fitzgerald
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Waters K, Kol-Castro C, Varghese A, Lam LT, Prelog K, Cheng A. Correlations between polysomnographic and lateral airway radiograph measurements in paediatric obstructive sleep apnoea. J Paediatr Child Health 2013; 49:445-51. [PMID: 23621401 DOI: 10.1111/jpc.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the ability of lateral airway radiography (LAR) to assess adenoidal hypertrophy in children and correlate with the severity of obstructive sleep apnoea (OSA). METHODS This cohort study was undertaken in 72 children who presented consecutively for evaluation of OSA to the outpatients of the Children's Hospital at Westmead. All children had LAR and overnight polysomnography (PSG). Five assessors, with varying experience, were blinded to the PSG results and independently analysed the LAR. Inter-rater reliability was determined for four published assessment methods; Hibbert, Johannesson, Fujioka and Cohen and Konak. We then compared the four LAR results with PSG-determined criteria for OSA. RESULTS Using intraclass correlations, inter-rater correlations were moderate to high for all four standardised evaluations of LAR with values ranging from 0.51 to 0.96. With the radiologist taken as the 'gold standard', individual assessors ranged from 0.05 to 0.91. LAR correlated best with PSG determined obstructive apnoea hypopnea index and minimum oxygen saturation for the anterior airway measurement (Hibbert) with r-values of -0.25 and 0.25 respectively (P < 0.05). CONCLUSION Amongst four methods of evaluating adenoid size, the anterior airway size correlated best with PSG variables of obstructive respiratory index and minimum oxygen saturation. However, the methods are not able to be used as a predictor for OSA.
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Affiliation(s)
- Karen Waters
- Department of Respiratory Support Service, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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Spruyt K, Gozal D. Screening of pediatric sleep-disordered breathing: a proposed unbiased discriminative set of questions using clinical severity scales. Chest 2013; 142:1508-1515. [PMID: 22677350 DOI: 10.1378/chest.11-3164] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Identification of sleep-disordered breathing (SDB) using questionnaires is critical from a clinical and research perspective. However, which questions to use and how well such questionnaires perform has thus far been fraught with substantial uncertainty. We aimed at delineating the usefulness of a set of questions for identifying pediatric SDB. METHODS Random prospective sampling of urban 5- to 9-year-old children from the community and enriched for habitual snoring underwent overnight sleep study. Subjective indicators or questions were evaluated to further characterize and discriminate SDB. RESULTS Of 1,133 subjects, 52.8% were habitual snorers. This sample was analyzed based on a clinical grouping (ie, established apnea-hypopnea index cutoffs). Several statistical steps were performed and indicated that complaints can be ranked according to a severity hierarchy: shake child to breathe, apnea during sleep, struggle breathing when asleep, and breathing concerns while asleep, followed by loudness of snoring and snoring while asleep. With a posteriori cutoff, a predictive score > 2.72 on the severity scale was found (ie, area under the curve, 0.79 ± 0.03; sensitivity, 59.03%; specificity, 82.85%; positive predictive value, 35.4; negative predictive value, 92.7), making this cutoff applicable for confirmatory purposes. CONCLUSIONS As a result, the set of six hierarchically arranged questions will aid the screening of children at high risk for SDB but cannot be used as the sole diagnostic approach.
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Affiliation(s)
- Karen Spruyt
- Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - David Gozal
- Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL.
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Combination of symptoms and oxygen desaturation index in predicting childhood obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2013; 77:365-71. [PMID: 23246417 DOI: 10.1016/j.ijporl.2012.11.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/15/2012] [Accepted: 11/17/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a screening process of obstructive sleep apnea in children based on a combination of symptoms and oxygen desaturation index (ODI). MATERIALS AND METHODS We performed a retrospective study of 141 Chinese patients who were referred to a pediatric sleep laboratory for possible obstructive sleep apnea (OSA). The parents of each patient answered a questionnaire before their child underwent polysomnography (PSG) in the laboratory. An apnea-hypopnea index (AHI) greater than five on nocturnal PSG was defined as OSA. The nocturnal PSG was interpreted by a sleep laboratory physician. The ODI and occurrence ratio of sleep problems such as snoring, observable apnea during sleep, mouth breathing, and restless sleep, among others were compared between the OSA and non-OSA groups using the chi-square test. Items that indicated statistically significant differences were tested with non-parametric Spearman correlation tests to determine the correlation between these items and AHI. ODI and the items that indicated a statistically significant difference between the OSA and non-OSA groups were analyzed using binary logistic regression. The ODI cut-off point was determined through ODI receiver operating characteristic analysis to distinguish between OSA and non-OSA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to determine the combination of OSA predictors that exhibited the best diagnostic performance. RESULTS Among the 141 patients, 78 (55%) were diagnosed with OSA by PSG. The occurrences of observable apnea during sleep, mouth breathing, and restless sleep were significantly different between the OSA and non-OSA groups (20.5% vs. 4.8%, 85.9% vs. 71.4%, 69.2% vs. 52.4%, respectively, with P<0.05). The median of ODI in the OSA group was significantly higher than that in the non-OSA group. The ODI and the occurrences of observable apnea during sleep, mouth breathing, and restless sleep were correlated with AHI and were important diagnostic factors of OSA in children, as determined through binary logistic regression. The presence of observable apnea during sleep had 95% specificity, 84% PPV, and 4.31 positive likelihood ratio (PLR). When score ≥3 (i.e., 3 or 4) was used as the cut-off point, specificity, PLR, and PPV were 0.86, 4.22, and 0.84, respectively. When score ≥2 was used as the as cut-off point, sensitivity, NLR, and NPV were 0.92, 0.2, and 0.80, respectively. CONCLUSIONS Observable apnea during sleep was an independent positive predictive factor for OSA in children. A child with observable apnea during sleep should be referred to a special sleep laboratory for PSG diagnosis. When the total score is 3 or 4 based on a combination of symptoms and ODI, OSA can be diagnosed and the child should be referred to a sleep pediatrician for appropriate intervention. When the total score is 0 or 1, the child can be considered normal but should be monitored. When the total score is 2, the result cannot be determined and the child should be referred to a special sleep laboratory for PSG diagnosis. Thus, a screening process is developed based on a combination of symptoms and ODI.
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Kotagal S, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, D'Andrea LA, Hoban TF. Non-respiratory indications for polysomnography and related procedures in children: an evidence-based review. Sleep 2012; 35:1451-66. [PMID: 23115394 DOI: 10.5665/sleep.2188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This evidence-based review provides a systematic and comprehensive review of the literature regarding the utility of polysomnography for the evaluation of non-respiratory sleep disorders in children including hypersomnias, parasomnias, sleep-related movement disorders, and sleep in other special populations. METHODS A task force of pediatric sleep medicine experts performed a systematic review of the literature regarding the use of polysomnography for non-respiratory sleep disorders in children. They identified and graded 76 papers as evidence. RESULTS The main results include (1) polysomnography combined with the multiple sleep latency test is useful for evaluating disorders of excessive somnolence to objectively quantify sleepiness. The results have to be interpreted with consideration of the pubertal stage and regularity of the sleep patterns of the child; (2) polysomnography is indicated in children with parasomnias or sleep related movement disorders who have a high likelihood of having obstructive sleep apnea (OSA); (3) polysomnography is not routinely indicated in children with enuresis unless there is a high likelihood of OSA; (4) polysomnography can be helpful in evaluating children with restless legs syndrome (RLS) and when periodic limb movement disorder (PLMD) is suspected. CONCLUSIONS These findings suggest that, in children with non-respiratory sleep disorders, polysomnography should be a part of a comprehensive sleep evaluation in selected circumstances to determine the nature of the events in more detail or when the suspicion of OSA is relatively high.
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Aurora RN, Lamm CI, Zak RS, Kristo DA, Bista SR, Rowley JA, Casey KR. Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. Sleep 2012; 35:1467-73. [PMID: 23115395 DOI: 10.5665/sleep.2190] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although a level 1 nocturnal polysomnogram (PSG) is often used to evaluate children with non-respiratory sleep disorders, there are no published evidence-based practice parameters focused on the pediatric age group. In this report, we present practice parameters for the indications of polysomnography and the multiple sleep latency test (MSLT) in the assessment of non-respiratory sleep disorders in children. These practice parameters were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine (AASM). METHODS A task force of content experts was appointed by the AASM to review the literature and grade the evidence according to the American Academy of Neurology grading system. RECOMMENDATIONS FOR PSG AND MSLT USE PSG is indicated for children suspected of having periodic limb movement disorder (PLMD) for diagnosing PLMD. (STANDARD)The MSLT, preceded by nocturnal PSG, is indicated in children as part of the evaluation for suspected narcolepsy. (STANDARD)Children with frequent NREM parasomnias, epilepsy, or nocturnal enuresis should be clinically screened for the presence of comorbid sleep disorders and polysomnography should be performed if there is a suspicion for sleep-disordered breathing or periodic limb movement disorder. (GUIDELINE)The MSLT, preceded by nocturnal PSG, is indicated in children suspected of having hypersomnia from causes other than narcolepsy to assess excessive sleepiness and to aid in differentiation from narcolepsy. (OPTION)The polysomnogram using an expanded EEG montage is indicated in children to confirm the diagnosis of an atypical or potentially injurious parasomnia or differentiate a parasomnia from sleep-related epilepsy (OPTION)Polysomnography is indicated in children suspected of having restless legs syndrome (RLS) who require supportive data for diagnosing RLS. (OPTION) RECOMMENDATIONS AGAINST PSG USE: Polysomnography is not routinely indicated for evaluation of children with sleep-related bruxism. (STANDARD) CONCLUSIONS: The nocturnal polysomnogram and MSLT are useful clinical tools for evaluating pediatric non-respiratory sleep disorders when integrated with the clinical evaluation.
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Affiliation(s)
- R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714-55. [PMID: 22926176 DOI: 10.1542/peds.2012-1672] [Citation(s) in RCA: 977] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
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Aurora RN, Zak RS, Karippot A, Lamm CI, Morgenthaler TI, Auerbach SH, Bista SR, Casey KR, Chowdhuri S, Kristo DA, Ramar K. Practice parameters for the respiratory indications for polysomnography in children. Sleep 2011; 34:379-88. [PMID: 21359087 PMCID: PMC3041715 DOI: 10.1093/sleep/34.3.379] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. METHODS A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. RECOMMENDATIONS FOR PSG USE: 1. Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) 2. Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard) 3. Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard) 4. Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard) 5. Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard) 6. Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline) 7. Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline) 8. Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome. (Guideline) 9. Follow-up PSG in children on chronic PAP support is indicated to determine whether pressure requirements have changed as a result of the child's growth and development, if symptoms recur while on PAP, or if additional or alternate treatment is instituted. (Guideline) 10. Polysomnography is indicated after treatment of children for OSAS with rapid maxillary expansion to assess for the level of residual disease and to determine whether additional treatment is necessary. (Option) 11. Children with OSAS treated with an oral appliance should have clinical follow-up and polysomnography to assess response to treatment. (Option) 12. Polysomnography is indicated for noninvasive positive pressure ventilation (NIPPV) titration in children with other sleep related breathing disorders. (Option) 13. Children treated with mechanical ventilation may benefit from periodic evaluation with polysomnography to adjust ventilator settings. (Option) 14. Children treated with tracheostomy for sleep related breathing disorders benefit from polysomnography as part of the evaluation prior to decannulation. These children should be followed clinically after decannulation to assess for recurrence of symptoms of sleep related breathing disorders. (Option) 15. Polysomnography is indicated in the following respiratory disorders only if there is a clinical suspicion for an accompanying sleep related breathing disorder: chronic asthma, cystic fibrosis, pulmonary hypertension, bronchopulmonary dysplasia, or chest wall abnormality such as kyphoscoliosis. (Option) RECOMMENDATIONS AGAINST PSG USE: 16. Nap (abbreviated) polysomnography is not recommended for the evaluation of obstructive sleep apnea syndrome in children. (Option) 17. Children considered for treatment with supplemental oxygen do not routinely require polysomnography for management of oxygen therapy. (Option) CONCLUSIONS Current evidence in the field of pediatric sleep medicine indicates that PSG has clinical utility in the diagnosis and management of sleep related breathing disorders. The accurate diagnosis of SRBD in the pediatric population is best accomplished by integration of polysomnographic findings with clinical evaluation.
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Abstract
STUDY OBJECTIVES To classify pediatric sleep disordered breathing (SDB) using unbiased approaches. In children, decisions regarding severity and treatment of SDB are conducted solely based on empirical observations. Although recognizable entities clearly exist under the SDB spectrum, neither the number of SDB categories nor their specific criteria have been critically defined. DESIGN Retrospective cohort analysis and random prospective cohort. SETTING Community and clinical sample. PATIENTS OR PARTICIPANTS Urban 5- to 9-year-old community children undergoing overnight sleep study (NPSG), and a comparable prospectively recruited clinical SDB sample. INTERVENTIONS N/a. MEASUREMENTS AND RESULTS Principal component analysis was used to identify the uniqueness of the polysomnographically derived measures that are routinely used in clinical settings: apnea-hypopnea index, apnea index, obstructive apnea index, nadir SpO2, spontaneous arousal index and respiratory arousal index. These measures were then incorporated using unbiased data mining approaches to further characterize and discriminate across categorical phenotypes. Of 1,133 subjects, 52.8% were habitual snorers. Six categorical phenotypes clustered without any a priori hypothesis. Secondly, a non-hierarchical model that incorporated 6 NPSG-derived measures enabled unbiased identification of algorithms that predicted these 6 severity-based clusters. Thirdly, a hierarchical model was developed and performed well on all severity-based clusters. Classification and predictive models were subsequently cross-validated statistically as well as clinically, using 2 additional datasets that included 259 subjects. Modeling reached approximately 93% accuracy in cluster assignment. CONCLUSIONS Data-driven analysis of conventional NPSG-derived indices identified 6 distinct clusters ranging from a cluster with normal indices toward clusters with more abnormal indices. Categorical assignment of individual cases to any of such clusters can be accurately predicted using a simple algorithm. These clusters may further enable prospective unbiased characterization of clinical outcomes and of genotype-phenotype interactions across multiple datasets.
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Affiliation(s)
- Karen Spruyt
- Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Gino Verleye
- Department of Political and Social Sciences, University of Ghent, Belgium
| | - David Gozal
- Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, University of Chicago, Chicago, IL
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Okun MN, Hadjiangelis N, Green D, Hedli LC, Lee KC, Krieger AC. Acoustic rhinometry in pediatric sleep apnea. Sleep Breath 2009; 14:43-9. [DOI: 10.1007/s11325-009-0278-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/07/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
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Barone JG, Hanson C, DaJusta DG, Gioia K, England SJ, Schneider D. Nocturnal enuresis and overweight are associated with obstructive sleep apnea. Pediatrics 2009; 124:e53-9. [PMID: 19564269 DOI: 10.1542/peds.2008-2805] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the relationship of obstructive sleep apnea (OSA), body weight (BMI percentage [BMI%]), and monosymptomatic nocturnal enuresis (MNE) in children. METHODS A case-control study design was used. All children were 5 to 15 years of age; case patients were recruited from a comprehensive sleep disorders center (n = 149), and control subjects were recruited from a general pediatric practice in the same catchment area (n = 139). Case patients were subject to overnight polysomnograms and grouped into apnea severity categories (minimal, mild, moderate, or severe) on the basis of respiratory disturbance index and minimum arterial oxygen saturation levels. Data for all children included age; gender; height; weight; and history of MNE, snoring, diabetes, nasal allergies, and/or enlarged tonsils. BMI% was used to group children into weight categories as suggested by the Centers for Disease Control and Prevention (underweight, normal weight, at risk for overweight, and overweight). Two age groupings were created (5-10 years and 11-15 years). Descriptive statistics provided the prevalence of OSA, weight category, and MNE among case patients and control subjects. Cross-tabulations examined the relationship of severity of OSA with weight categories and MNE, stratified by age and gender. A series of logistic regression models explored the interrelationship of the grouping variables. RESULTS A large majority (79.9%) of control subjects were at risk for overweight, and a large majority (80.0%) of children with MNE also had some degree of OSA. Logistic regression demonstrated that both MNE (odds ratio: 5.29) and overweight (odds ratio 4.16) were significantly associated with OSA but not with each other. CONCLUSIONS Overweight and MNE are associated with OSA but not with each other. OSA should be considered in overweight children with MNE, especially when they display other symptoms of OSA or fail to respond to standard MNE treatment programs.
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Affiliation(s)
- Joseph G Barone
- Division of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
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Reflux and sleeping disorders: a systematic review. The Journal of Laryngology & Otology 2009; 123:372-4. [PMID: 19250596 DOI: 10.1017/s0022215109004976] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Laryngopharyngeal reflux is perhaps the most extensively researched laryngology topic of the last decade. It has been suggested that some supraoesophageal symptoms, most notably asthma and laryngospasm, may be associated with night-time, or supine, reflux. The aim of this review was to assess the levels of evidence regarding a correlation between night-time reflux, snoring and apnoea. METHODS A Medline search was performed using the terms 'reflux', 'night-time', 'larynx', 'gastroesophageal', 'laryngopharyngeal', 'sleep', 'apnoea', 'snoring' and 'ear nose throat'. The retrieved literature was reviewed, focusing on randomised and non-randomised, controlled, prospective trials. Papers on both paediatric and adult populations were included. Non-English language papers were excluded. RESULTS We found no randomised, controlled trials or meta-analyses addressing the possible correlation between reflux and snoring and/or apnoea. CONCLUSIONS The role of night-time reflux in paediatric and adult snoring and apnoea is well described in the literature, but is based on poor levels of evidence from uncontrolled studies and case reports.
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Novel imaging techniques using computer methods for the evaluation of the upper airway in patients with sleep-disordered breathing: A comprehensive review. Sleep Med Rev 2008; 12:437-47. [DOI: 10.1016/j.smrv.2008.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lin CM, Davidson TM, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 2008; 12:481-96. [PMID: 18951050 DOI: 10.1016/j.smrv.2007.11.003] [Citation(s) in RCA: 248] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Obstructive sleep apnea (OSA) is a common cause of daytime sleepiness for millions of Americans. It is also a disease associated with an increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. A number of population-based studies have shown that OSA is more common in men than in women and this discrepancy is often evident in the clinical setting. There are a number of pathophysiological differences to suggest why men are more prone to the disease than women. Although the exact mechanisms are unknown, differences in obesity, upper airway anatomy, breathing control, hormones, and aging are all thought to play a role. The purpose of this review was to examine the literature on gender differences in OSA and to analyze whether or not these differences in pathogenic mechanisms affect diagnosis or treatment.
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Affiliation(s)
- Christine M Lin
- Department of Surgery, San Diego School of Medicine, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0617, USA.
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Brooks LJ. Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n8p701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The aim of this article is to review the medical literature and describe clinical and laboratory findings in children with obstructive sleep apnoea (OSA) to differentiate children with OSA from those with primary snoring or other disorders, with a particular focus on Asian children.
Methods: Medline search via Pub Med, search terms sleep apnoea and children; and sleep apnoea and children and Asian.
Results and Conclusions: Children with OSA usually present with snoring, daytime sleepiness, and/or difficulties in school or behaviour. The prevalence of OSA in Asian children is less than that of other groups, but the severity of the disorder on presentation may be greater. Overnight polysomnography remains the diagnostic “gold standard”; limited studies, or studies in the home, are not sufficient to exclude OSA in a child with suggestive symptoms, nor can they reliably assess the severity of the disorder which is important in planning treatment. Limited studies may, however, be useful in large-scale research studies.
Key words: Asian, Polysomnography, Sleep studies, Snoring
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:284-6. [PMID: 17479036 DOI: 10.1097/aco.0b013e3281e3380b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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