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Kim CY, Reinertsen E, Dang C, Nkutshweu D, Sathekge R, Choi YJ, Cha JY, Alturki G, Jamel A, Suzuki A, Arai K, Amm E, Motro M, Parsi G. Association among craniofacial morphology, ethnicity, and risk of pediatric sleep-related breathing disorders: A multicenter study. Am J Orthod Dentofacial Orthop 2024; 165:414-422. [PMID: 38149956 DOI: 10.1016/j.ajodo.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Craniofacial morphology and ethnicity may be risk factors for sleep-related breathing disorder (SRBD) in children but have not yet been assessed in an international multicenter study. The objectives of this study were to assess the association among craniofacial features, self-reported ethnicity, and risk of SRBD in children undergoing orthodontic treatment. METHODS Children aged 5-18 years who presented for orthodontic evaluation were enrolled in the United States, South Africa, South Korea, Saudi Arabia, and Japan. The risk of SRBD was defined as answering ≥0.33 positive responses to the Pediatric Sleep Questionnaire. Craniofacial features included measurements in sagittal and vertical dimensions to evaluate the cranial base, maxillomandibular and dental relationships, and nasopharyngeal airway dimensions. Logistic regression was performed to assess the association among craniofacial features, ethnicity, age, body mass index, and risk of SRBD. RESULTS Data were obtained from 602 patients from 5 sites. A total of 76 patients (12.6%) had a risk of SRBD. The mean age was 12.5 years. Male gender (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.0-3.4; P = 0.041), Middle Eastern ethnicity (OR, 10.2; 95% CI, 4.1-25.4; P = 0.001), body mass index (OR, 1.1; 95% CI, 1.04-1.10; P = 0.001), gonial angle (OR, 0.91; 95% CI, 0.85-0.98; P = 0.011), and inferiorly positioned hyoid (OR, 1.1; 95% CI, 1.0-1.2; P = 0.002) were significantly associated with the risk of SRBD. CONCLUSIONS In an ambidirectional cohort study across 5 sites, male gender, Middle Eastern ethnicity, body mass index, gonial angle, and inferiorly positioned hyoid were associated with the risk of SRBD in children undergoing orthodontic treatment.
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Affiliation(s)
- Chai Yoon Kim
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Erik Reinertsen
- Research Laboratory of Electronics, MIT, Massachusetts Institute of Technology, Cambridge, Mass
| | - Calvin Dang
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Dineo Nkutshweu
- Department of Orthodontics, 1 Military Hospital, Pretoria, South Africa
| | - Rachel Sathekge
- Department of Orthodontics, 1 Military Hospital, Pretoria, South Africa
| | - Yoon Jeong Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ghassan Alturki
- Department of Orthodontics, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Ahmad Jamel
- Department of Orthodontics, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Akihiro Suzuki
- Department of Orthodontics, School of Life Dentistry, The Nippon Dental University, Tokyo, Japan
| | - Kazuhito Arai
- Department of Orthodontics, School of Life Dentistry, The Nippon Dental University, Tokyo, Japan
| | - Elie Amm
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Melih Motro
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Goli Parsi
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass.
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El Hamid AAA, Askoura AM, Abdel Hamed DM, Taha MS, Allam MF. Surgical versus Non-Surgical Management of Obstructive Sleep-disordered Breathing in Children: A Meta-analysis. Open Respir Med J 2020; 14:47-52. [PMID: 33299493 PMCID: PMC7705953 DOI: 10.2174/1874306402014010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/09/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Obstructive sleep-disordered breathing (OSDB) is a term for several chronic conditions in which partial or complete cessation of breathing occurs many times throughout the night, resulting in fatigue or daytime sleepiness that interferes with a person’s functions and reduces the quality of life. Objective: Comparing the effectiveness of surgical versus non-surgical treatment of OSDB in children in clinical trials through a meta-analysis study. Patients and Methods: A number of available studies and abstracts concerning the surgical versus non-surgical treatment of OSDB in children were identified through a comprehensive search of electronic databases. Data were abstracted from every study in the form of a risk estimate and its 95% confidence interval. Results: The current study revealed that there was a statistically significant improvement in the surgically treated patients rather than non-surgically treated patients regarding the quality of life. Conclusion: The current meta-analysis reports a significant clinical improvement in the surgical (adenotonsillectomy) group as compared to the non-surgical group, in terms of disease specific quality of life, and healthcare utilization in spite of the availability of only one study.
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Affiliation(s)
| | - Anas Mohamed Askoura
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Shehata Taha
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Farouk Allam
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Predicting the outcome after adenoidectomy-alone for adenoid hypertrophy causing sleep disordered breathing. Am J Otolaryngol 2020; 41:102646. [PMID: 32688182 DOI: 10.1016/j.amjoto.2020.102646] [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: 01/07/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE By using preoperative parameters age, body mass index, nasopharyngeal obstruction as assessed using flexible videonasopharyngoscopy, and quality of life scores in patients undergoing adenoidectomy-alone because of adenoid hypertrophy causing sleep disordered breathing, we aimed to examine the relationship between the change in quality of life scores, and preoperative parameters and to develop a tool to predict the change. MATERIALS AND METHODS Patients who were scheduled for adenoidectomy-alone in a 12-month period were included. Flexible videnonasopharyngoscopy of the nasopharynx was performed. Nasopharyngeal obstruction was measured by using Image J software. Preoperative quality of life was evaluated using OSA-18 quality of life survey. OSA-18 survey has 5 subcategories consisting of sleep disturbance (O1), physical suffering (O2), emotional distress (O3), daytime problems (O4), caregiver concerns (O5). A question about the overall quality of life(O6) was added. Postoperative OSA-18 domain scores were obtained at the 3-month-follow-up. Preoperative OSA-18 subscores were compared to postoperative subscores. Linear regression analysis to predict the proportional change in OSA-18 subscores was performed. RESULTS Our study group consisted of 94 cases. Mean postoperative O1, O2,O3, O4 and O5 scores were significantly lower compared to the preoperative scores. Mean postoperative O6 score was significantly higher. Linear regression analysis was carried out for predicting change in O1(r2 = 0.686; p = 0.006), O5(r2 = 0.711; p = 0.003) and O6(r2 = 0.757; p = 0.001). CONCLUSION Change in quality of life scores for sleep disturbance, physical suffering and general quality of life may be predicted by using preoperative parameters.
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Liao YF, Noordhoff MS, Huang CS, Chen PKT, Chen NH, Yun C, Chuang ML. Comparison of Obstructive Sleep Apnea Syndrome in Children with Cleft Palate following Furlow Palatoplasty or Pharyngeal Flap for Velopharyngeal Insufficiency. Cleft Palate Craniofac J 2017; 41:152-6. [PMID: 14989690 DOI: 10.1597/02-162] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). Patients A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. Interventions An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. Main Outcome Measures Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. Results In the P group, the mean percentage of stage 2 sleep was lower than the F group (p < .05). The mean RDI and DI were larger in the P group, compared with the F group (p < .001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p < .001 and p = 0.05, respectively). Conclusions A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.
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Affiliation(s)
- Yu-Fang Liao
- Division of Orthodontics, the Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
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Othman MN, Bee See G, Abdul Latif H. Impact of adenotonsillectomy on the quality of life in children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2016; 91:105-107. [PMID: 27863621 DOI: 10.1016/j.ijporl.2016.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mohd Nazir Othman
- ORL-HNS Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Goh Bee See
- ORL-HNS Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hasniah Abdul Latif
- Paediatric Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Nava-Guerra L, Tran WH, Chalacheva P, Loloyan S, Joshi B, Keens TG, Nayak KS, Davidson Ward SL, Khoo MCK. Model-based stability assessment of ventilatory control in overweight adolescents with obstructive sleep apnea during NREM sleep. J Appl Physiol (1985) 2016; 121:185-97. [PMID: 27174926 DOI: 10.1152/japplphysiol.01081.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/05/2016] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) involves the interplay of several different factors such as an unfavorable upper airway anatomy, deficiencies in pharyngeal muscle responsiveness, a low arousal threshold, and ventilatory control instability. Although the stability of ventilatory control has been extensively studied in adults, little is known about its characteristics in the pediatric population. In this study, we developed a novel experimental setup that allowed us to perturb the respiratory system during natural non-rapid eye movement (NREM) sleep conditions by manipulating the inspiratory pressure, provided by a bilevel pressure ventilator, to induce sighs after upper airway stabilization. Furthermore, we present a modeling framework that utilizes the noninvasively measured ventilatory responses to the induced sighs and spontaneous breathing data to obtain representations of the processes involved in the chemical regulation of respiration and extract their stability characteristics. After validation with simulated data, the modeling technique was applied to data collected experimentally from 11 OSA and 15 non-OSA overweight adolescents. Statistical analysis of the model-derived stability parameters revealed a significantly higher plant gain and lower controller gain in the OSA group (P = 0.046 and P = 0.007, respectively); however, no differences were found in loop gain (LG) and circulatory time delay between the groups. OSA severity and LG, within the 0.03-0.04-Hz frequency band, were significantly negatively associated (r = -0.434, P = 0.026). Contrary to what has been found in adults, our results suggest that in overweight adolescents, OSA is unlikely to be initiated through ventilatory instability resulting from elevated chemical loop gain.
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Affiliation(s)
- L Nava-Guerra
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California;
| | - W H Tran
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - P Chalacheva
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - S Loloyan
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - B Joshi
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - T G Keens
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - K S Nayak
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California; Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California
| | - S L Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - M C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
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Leite JMRS, Ferreira VR, do Prado LF, do Prado GF, de Morais JF, de Carvalho LBC. TuCASA questionnaire for assessment of children with obstructive sleep apnea: validation. Sleep Med 2015; 16:265-9. [PMID: 25576135 DOI: 10.1016/j.sleep.2014.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/08/2014] [Accepted: 09/15/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of the present study was to validate The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) questionnaire for use in the Brazilian population. METHODS Of the total 62 children who participated in the present study (27 girls), aged 4 to 11 years, 45 (72.6%) had sleep-disordered breathing (SDB) diagnosed by polysomnography, while 17 (27.4%) had no sleep disorders. Translation, back-translation, and pretesting were previously performed. The final Portuguese-language version of TuCASA was administered to the participants from May 2012 to August 2013. The interviewer was blinded to presence or absence of SDB. Cronbach's alpha for the overall scale (with 95% CI) and the effect of excluding any items were evaluated. RESULTS There was no difference among TuCASA items/score and the presence of SDB with either age or gender. The TuCASA had a Cronbach's alpha coefficient of 0.726 (95% CI 0.614 to 0.817), which denotes satisfactory internal consistency - a finding reinforced by evaluation of the effect of item exclusion on the questionnaire. Convergent validity was also satisfactory, in as much as most correlations were positive and significant. CONCLUSION The translated version of the TuCASA questionnaire was validated for Brazilian populations and proved to be a reliable, validated instrument that can be used in clinical practice for evaluation of children with symptoms of SDB.
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Affiliation(s)
| | | | | | | | | | - Luciane Bizari Coin de Carvalho
- Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Mbam TT, Adeosun AA, Akinyemi OA, Nwaorgu OGB. Comparing Oxygen Saturation of Normal Children with that of Children with Adenotonsillar Hypertrophy. Indian J Otolaryngol Head Neck Surg 2014; 66:173-7. [PMID: 24822157 DOI: 10.1007/s12070-014-0701-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/18/2014] [Indexed: 10/25/2022] Open
Abstract
To compare the nocturnal oxygen saturation profiles of children with adenotonsillar enlargement with that of normal children. A 1 year comparative study. The study was carried out at the Otorhinolaryngology Ward of the University College Hospital Ibadan. These comprise of 60 children (1-9 years) with clinically confirmed adenotonsillar enlargement admitted for adenotonsillectomy and 60 normal children matched for age and sex. The biodata and common clinical presentations of the study group were acquired with a structured proforma. The severity of nasopharyngeal obstruction was determined by the adenoidal-nasopharyngeal ratio while the degree of tonsillar enlargement was graded by the Brodsky's classification. The nocturnal oxygen saturation of all the participants were recorded with a wrist worn pulse oximeter. Recording was for at least for 4 h. Oxygen saturation <92 % was regarded as desaturation. The oximetric values of the study and control group were compared. The mean nocturnal SPO2 (peripheral saturation of oxygen) profiles of children with adenotonsillar enlargement were as follows: basal = 96.86 %, minimum = 84.99 %; maximum = 99 % and average SPO2 <92 % = 87.74 % while the saturation profiles of the control group were as follows; basal = 97.88 %, minimum = 89.71 %; maximum = 99 %, average SPO2 <92 % = 90.82 %. Normal children have better nocturnal saturation profiles than children with adenotonsillar enlargement.
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Affiliation(s)
- T T Mbam
- Department of ENT, University College Hospital, Ibadan, Nigeria
| | - A A Adeosun
- Department of ENT, University College Hospital, Ibadan, Nigeria
| | - O A Akinyemi
- Department of Anaesthesia, University College Hospital, Ibadan, Nigeria
| | - O G B Nwaorgu
- Department of ENT, University College Hospital, Ibadan, Nigeria
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Alasil SM, Omar R, Ismail S, Yusof MY, Dhabaan GN, Abdulla MA. Evidence of Bacterial Biofilms among Infected and Hypertrophied Tonsils in Correlation with the Microbiology, Histopathology, and Clinical Symptoms of Tonsillar Diseases. Int J Otolaryngol 2013; 2013:408238. [PMID: 24454384 PMCID: PMC3886491 DOI: 10.1155/2013/408238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022] Open
Abstract
Diseases of the tonsils are becoming more resistant to antibiotics due to the persistence of bacteria through the formation of biofilms. Therefore, understanding the microbiology and pathophysiology of such diseases represent an important step in the management of biofilm-related infections. We have isolated the microorganisms, evaluated their antimicrobial susceptibility, and detected the presence of bacterial biofilms in tonsillar specimens in correlation with the clinical manifestations of tonsillar diseases. Therefore, a total of 140 palatine tonsils were collected from 70 patients undergoing tonsillectomy at University Malaya Medical Centre. The most recovered isolate was Staphylococcus aureus (39.65%) followed by Haemophilus influenzae (18.53%). There was high susceptibility against all selected antibiotics except for cotrimoxazole. Bacterial biofilms were detected in 60% of patients and a significant percentage of patients demonstrated infection manifestation rather than obstruction. In addition, an association between clinical symptoms like snore, apnea, nasal obstruction, and tonsillar hypertrophy was found to be related to the microbiology of tonsils particularly to the presence of biofilms. In conclusion, evidence of biofilms in tonsils in correlation with the demonstrated clinical symptoms explains the recalcitrant nature of tonsillar diseases and highlights the importance of biofilm's early detection and prevention towards better therapeutic management of biofilm-related infections.
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Affiliation(s)
- Saad Musbah Alasil
- Department of Microbiology, Faculty of Medicine, MAHSA University, 59100 Kuala Lumpur, Malaysia
| | - Rahmat Omar
- Pantai Hospital Cheras, 56100 Kuala Lumpur, Malaysia
| | - Salmah Ismail
- Institute of Biological Science, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohd Yasim Yusof
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ghulam N. Dhabaan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mahmood Ameen Abdulla
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Madrid JRP, Ortega VG, Echeverri P, Velasquez NL. Prevalence of Obstructive Sleep Apnea After Orticochea Pharyngoplasty for Velopharyngeal Insufficiency Management. Cleft Palate Craniofac J 2013; 52:682-7. [PMID: 23952561 DOI: 10.1597/12-049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with velopharyngeal insufficiency after at least 1 year of the surgical procedure. DESIGN Case series prospective descriptive study. MAIN OUTCOME MEASURES At FISULAB, a rehabilitation center for patients with cleft palate, we studied 37 patients who were treated elsewhere with Orticochea pharyngoplasty for velopharyngeal insufficiency; these patients may or may not have had clinical symptoms related to OSA. All participants underwent a polysomnography sleep study, which was also done in different institutions. We applied the Epworth Sleepiness Scales during the clinical investigation because it is an effective instrument used to measure average daytime sleepiness. Another questionnaire to identify cases of OSA was used. Among other variables studied, the apnea/hypopnea index was the main outcome, while age and type of cleft were secondary variables. RESULTS From 37 patients who were studied (100%), we obtained the following results: normal apnea/hypopnea index: seven patients (18.9%); mild apnea/hypopnea index: 14 patients (37.8%); moderate apnea/hypopnea index: eight patients (21.6%); and severe apnea/hypopnea index: eight patients (21.6%). CONCLUSIONS In this study, we found that more than three quarters (81%) of the patients who were treated for velopharyngeal insufficiency with Orticochea pharyngoplasty presented obstructive sleep apnea when analyzing the apnea/hypopnea index in the polysomnography sleep study.
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Obstructive sleep apnea syndrome (OSAS) in children with Class III malocclusion: involvement of the PHOX2B gene. Sleep Breath 2013; 17:1275-80. [PMID: 23536260 DOI: 10.1007/s11325-013-0833-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this study is to provide new molecular approaches to the children with obstructive sleep apnea syndrome by evaluating the possible involvement of the PHOX2B gene, notoriously associated to congenital central hypoventilation syndrome (CCHS), in Class III malocclusion. METHODS Fifty subjects with Class III malocclusion, aged from 8 to 14 years, and with history of sleep apneic episodes, and 20 age-matched controls were submitted to genomic DNA examination from oral cells to specifically analyze the PHOX2B genotype. RESULTS Point "silent" mutations affecting different nucleotides of the PHOX2B gene were observed in 32 % of patients with Class III malocclusion and never in controls (0 %). CONCLUSION The genetic data obtained in this study in children with Class III malocclusion and sleep-related breathing disorders provide new information useful to the genetic characterization of this pathology. The PHOX2B gene silent mutations can lead to structural and functional modification of their product providing to a group of children with Class III malocclusion similar features to those of CCHS (sleep apnea episodes and craniofacial malformations).
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Kamdar BB, Nandkumar P, Krishnan V, Gamaldo CE, Collop NA. Self-reported sleep and breathing disturbances in Joubert syndrome. Pediatr Neurol 2011; 45:395-9. [PMID: 22115003 DOI: 10.1016/j.pediatrneurol.2011.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/12/2011] [Indexed: 10/15/2022]
Abstract
Joubert syndrome is a rare autosomal recessive disease characterized by malformations of the cerebellar vermis, hypotonia, developmental delay, and respiratory variability. Because little is known about sleep and ventilatory dysregulation in this patient population, a questionnaire was distributed at the Joubert Syndrome and Related Disorders Foundation Conference. This questionnaire addressed respiratory and sleep abnormalities, and included the Pediatric Sleep Questionnaire. Parents or proxies completed questionnaires for patients unable to do so themselves because of young age or neurologic problems. Twenty surveys were collected. The median age was 8.3 years, and 45% were female. Seven patients (35%) reported existing episodic tachypnea, four (20%) reported apnea, and three (15%) reported both. Snoring was reported by 10 patients (50%), of whom four snored nightly and five had coexisting daytime tachypnea. Six of 14 (43%) Pediatric Sleep Questionnaire responders had scores suggestive of sleep-related breathing disorder. These results suggest that episodic tachypnea, apnea, snoring, and Pediatric Sleep Questionnaire scores suggestive of sleep-related breathing disorder are common in Joubert syndrome. Early detection and improved understanding of sleep and breathing abnormalities may contribute to improved outcomes for patients with Joubert syndrome.
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Affiliation(s)
- Biren B Kamdar
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Prades Morera E, Moré EE. Clínica de los trastornos respiratorios del sueño en los niños. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61 Suppl 1:22-5. [DOI: 10.1016/s0001-6519(10)71241-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
HYPOTHESIS Adenotonsillectomy improves general and disease-specific quality of life for properly selected patients suffering for upper airway obstruction secondary to adenotonsillar hypertrophy (UAO) and obstructive sleep apnea (OSA). STUDY DESIGN Prospective, nonrandomized questionnaire. SPECIFIC AIMS To evaluate quality of life in patients with UAO and OSA using general quality of life instruments as well as disease-specific instruments. The results will be compared both pre- and postoperatively. METHODS Fifty-five patients aged 2 to 16 with the clinical diagnosis of UAO or OSA were recruited. The caregivers completed Children's Health Questionnaire Parent Form-28 (CHQPF-28) and OSA-18 quality of life measures both pre- and postoperatively in the long and short term. Statistical analysis was performed using the unpaired Student t test, P value less than.05, and Spearman Rank coefficient. RESULTS CHQ-PF28 scores were improved in the Physical Summary parameter in long-term follow-up. Psychosocial scores did not improve significantly. OSA-18 scores showed improvement in both the short-and long-term scores. Physical findings and symptoms did not impact scores in any domain. CONCLUSIONS Quality of life in children with OSA does improve after adenotonsillectomy. Disease-specific clinometric instruments show improvement in domains affected by the disease process. However, instruments used to assess general quality of life may show physical improvement but not psychosocial.
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Affiliation(s)
- Valerie A Flanary
- Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Lundeborg I, McAllister A, Samuelsson C, Ericsson E, Hultcrantz E. Phonological development in children with obstructive sleep-disordered breathing. CLINICAL LINGUISTICS & PHONETICS 2009; 23:751-761. [PMID: 19883185 DOI: 10.3109/02699200903144770] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.
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Affiliation(s)
- Inger Lundeborg
- Division of Speech and Language Pathology, Linköping University, Sweden
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Long term results in the life quality of children with obstructive sleep disorders. Braz J Otorhinolaryngol 2008; 74:718-724. [PMID: 19082354 PMCID: PMC9445978 DOI: 10.1016/s1808-8694(15)31382-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 08/25/2007] [Indexed: 11/23/2022] Open
Abstract
Obstructive Sleep Disorders (OSD) affect mostly the pediatric population. Within this group, its main etiology is adenotonsillar hyperplasia, being adenoidectomy or adenotonsillectomy the best treatment option for quality of life improvement. Aim To asses quality of life of children with OSD after adenoidectomy/adenotonsillectomy. Method A prospective study was carried out with 48 children, between 2 and 11 years, with clinical manifestations of OSD and obstructive adenotonsillar hyperplasia. The OSA18 questionnaire was answered by the parents to evaluate their children’s quality of life before surgery; at about thirty days and at least eleven months after the procedure. A higher score meant a worse quality of life. Results Before surgery, the average OSA18 score was 82.83(SD=12.57), with an average global score for quality of life of 6.04(SD=1.66). Within thirty days after surgery, the average OSA18 score was 34.3 (SD=9.95) with an average global score of 9.6(SD=0.81), both showing significant reduction (p< 0.001). Thirty-four children (70.83%) were re-evaluated between 11 and 30 months (average=16.85; SD=5.16). The average OSA18 score was 35.44 (SD=19.95) with an average global score of 9.28 (SD=1.78). The postoperative evaluations weren’t significantly different. Conclusion surgery improves the quality of life of children with OSD, and such improvement maintains for the long run.
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Silva VCD, Leite AJM. Quality of life in children with sleep-disordered breathing: evaluation by OSA-18. Braz J Otorhinolaryngol 2007; 72:747-56. [PMID: 17308827 DOI: 10.1016/s1808-8694(15)31041-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 05/10/2006] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Sleep-disordered breathing (SDB) is prevalent. There is evidence of their effect on quality of life. AIM To assess the quality of life in children with SDB before and after adenoidectomy or adenotonsillectomy. METHODS A prospective before and after interventional study, with a component for assessment. A consecutive sample of children referred to adenoidectomy or adenotonsillectomy was recruited from the otolaryngology clinic; guardians answered a specific survey for the evaluation of quality of life in children with SDB, the OSA-18, before and at least 30 days after surgery. Nasofibroscopic and otolaryngological exams and a semi-structured survey on the childs social and clinical profile were done on both appointments. RESULTS 48 children with a mean age of 5.93 years (SD=2.43) were evaluated. The mean number of schooling years for guardians was 8.29 years (SD=3.14). The most frequent symptoms were: agitated sleep, apnea and snoring. The total mean score of the initial OSA-18 was 82.83 (major impact); following surgery, the total mean score was 34.15. The differences in the total scores and in the domains between the initial OSA-18 and post-surgery scores were all significant (p<0.00). CONCLUSION SDB has a relevant impact on quality of life, and patients show dramatic improvements after surgical treatment.
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Silva VCD, Leite AJM. Qualidade de vida em crianças com distúrbios obstrutivos do sono: avaliação pelo OSA-18. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s0034-72992006000600005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Distúrbios obstrutivos do sono (DOS) são prevalentes e existem evidências de afetarem a qualidade de vida das crianças. OBJETIVO: Avaliar a qualidade de vida de crianças com DOS antes e após adenoidectomia ou adenotonsilectomia. MATERIAL E MÉTODOS: Estudo prospectivo de intervenção, tipo antes e após, com componente avaliativo. Foi recrutada uma amostra consecutiva de crianças com indicação de adenoidectomia ou adenotonsilectomia em um ambulatório de otorrinolaringologia e aplicado aos cuidadores um questionário específico para a avaliação da qualidade de vida, o OSA-18, antes da cirurgia e com pelo menos 30 dias após. Foi realizado exame nasofibroscópico, otorrinolaringológico e questionário semi-estruturado sobre o perfil clínico e social da criança, em ambas as consultas. RESULTADOS: Foram avaliadas 48 crianças com média de idade de 5,93 anos (DP=2,43). A média de escolaridade do cuidador foi de 8,29 anos (DP=3,14). Os sintomas mais freqüentes foram: sono agitado, apnéia e ronco. A média de escore total do OSA-18 basal foi de 82,83 (grande impacto) e no pós-operatório, de 34,15. As diferenças nos escores total e dos domínios entre o OSA-18 basal e pós-operatório foram todas significantes (p<0,00). CONCLUSÃO: DOS apresentam impacto relevante na qualidade de vida e melhoram consideravelmente após o tratamento cirúrgico.
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Alonso Álvarez ML, Terán Santos J, Cordero Guevara JA, Navazo Egüia AI. Síndrome de apneas e hipopneas durante el sueño en niños. Arch Bronconeumol 2006. [DOI: 10.1157/13097281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Despite increasing recognition of childhood obstructive sleep apnea syndrome (OSAS) as a significant public health problem, treatment of the condition remains inconsistent. Some children are screened using polysomnography and treated only when objective respiratory disturbances are identified. Many others receive adenotonsillectomy based only on signs and symptoms of upper airway obstruction without ever having a formal sleep study. Outcome-based data regarding the effectiveness of adenotonsillectomy, continuous positive airway pressure, and other treatments for childhood OSAS remain extremely limited. In this article, the major therapeutic options for treatment of childhood OSAS are reviewed. Adenotonsillectomy remains the most frequently used treatment for uncomplicated OSAS in children, but residual airway obstruction persists in a notable minority of patients. Nasal continuous positive airway pressure is used for children who are not good surgical candidates or who have failed previous surgical treatment, but is sometimes not tolerated by young children or their parents. Various alternative treatments are used on an individualized basis for children who cannot use the two first-line therapies for sleep apnea.
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Affiliation(s)
- Timothy F Hoban
- Department of Pediatrics, L3227, Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Rieder AA, Flanary V. The effect of polysomnography on pediatric adenotonsillectomy postoperative management. Otolaryngol Head Neck Surg 2005; 132:263-7. [PMID: 15692539 DOI: 10.1016/j.otohns.2004.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We retrospectively investigated the effect and predictability of preoperative polysomnography (PSG) on the postoperative course of younger pediatric patients undergoing adenotonsillectomy. STUDY DESIGN AND SETTING A retrospective chart review was performed for patients 3 years of age and younger who had undergone adenotonsillectomy between July 1997 and July 2002 at the Children's Hospital of Wisconsin. RESULTS Two hundred eighty-two patients were identified. Forty-three patients had preoperative PSG. No correlation between the severity of PSG results and postoperative course was identified. CONCLUSIONS The role of PSG in upper airway obstruction and OSA remains controversial. This study suggests that although the complication rate may be higher in this younger population, these complications do not appear to have a large impact on their length of stay. SIGNIFICANCE This study suggests that the 3-years-and-younger group, in the absence of other comorbidities, can safely undergo adenotonsillectomy without undergoing preoperative PSG. EBM raing: C.
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Affiliation(s)
- Anthony A Rieder
- Division of Pediatric Otolaryngology and Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, USA
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Abstract
Good airway management technique is an essential skill for physicians in most specialties. This article begins with a review of basic airway anatomy and the physiology of the uninstrumented airway. This subject is of particular importance given the increasing use of procedural sedation and the increased recognition of sleep-disordered breathing in infants and children. A discussion of the various artificial airways and their advantages and disadvantages follows. The difficult airway is an important contributor to both patient morbidity and mortality. It is important to have a planned management approach available for the anticipated and, more importantly, the unanticipated difficult airway. The recommendations of the American Society of Anesthesiologists Taskforce on the Management of the Difficult Airway have good application for this important problem. The fetus with the prenatal diagnosis of a lesion that predicts a difficult airway presents a particular challenge. The utilization of an ex-utero intrapartum treatment method is presented as an important approach for the delivery and airway management of these infants. This section closes with a discussion of the prehospital airway management of the pediatric patient.
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Affiliation(s)
- William L McNiece
- Department of Anesthesia, Section of Pediatric Anesthesia, James Whitcomb Riley Hospital for Sick Children, Indiana University, Indianapolis 46202-5128, USA
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Goodwin JL, Kaemingk KL, Fregosi RF, Rosen GM, Morgan WJ, Smith T, Quan SF. Parasomnias and sleep disordered breathing in Caucasian and Hispanic children - the Tucson children's assessment of sleep apnea study. BMC Med 2004; 2:14. [PMID: 15115546 PMCID: PMC419382 DOI: 10.1186/1741-7015-2-14] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 04/28/2004] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent studies in children have demonstrated that frequent occurrence of parasomnias is related to increased sleep disruption, mental disorders, physical harm, sleep disordered breathing, and parental duress. Although there have been several cross-sectional and clinical studies of parasomnias in children, there have been no large, population-based studies using full polysomnography to examine the association between parasomnias and sleep disordered breathing. The Tucson Children's Assessment of Sleep Apnea study is a community-based cohort study designed to investigate the prevalence and correlates of objectively measured sleep disordered breathing (SDB) in pre-adolescent children six to 11 years of age. This paper characterizes the relationships between parasomnias and SDB with its associated symptoms in these children. METHODS Parents completed questionnaires pertaining to their child's sleep habits. Children had various physiological measurements completed and then were connected to the Compumedics PS-2 sleep recording system for full, unattended polysomnography in the home. A total of 480 unattended home polysomnograms were completed on a sample that was 50% female, 42.3% Hispanic, and 52.9% between the ages of six and eight years. RESULTS Children with a Respiratory Disturbance Index of one or greater were more likely to have sleep walking (7.0% versus 2.5%, p < 0.02), sleep talking (18.3% versus 9.0%, p < 0.006), and enuresis (11.3% versus 6.3%, p < 0.08) than children with an Respiratory Disturbance Index of less than one. A higher prevalence of other sleep disturbances as well as learning problems was observed in children with parasomnia. Those with parasomnias associated with arousal were observed to have increased number of stage shifts. Small alterations in sleep architecture were found in those with enuresis. CONCLUSIONS In this population-based cohort study, pre-adolescent school-aged children with SDB experienced more parasomnias than those without SDB. Parasomnias were associated with a higher prevalence of other sleep disturbances and learning problems. Clinical evaluation of children with parasomnias should include consideration of SDB.
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Affiliation(s)
- James L Goodwin
- Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Kris L Kaemingk
- Children's Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- General Clinical Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Ralph F Fregosi
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Department of Physiology, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Gerald M Rosen
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN 55415, USA
- Sleep Disorders Center, Hennepin County Medical Center, Minneapolis, MN 55415, USA
| | - Wayne J Morgan
- Children's Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- General Clinical Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Terry Smith
- General Clinical Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Stuart F Quan
- Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Sleep Disorders Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA
- General Clinical Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
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Abstract
Snoring and obstructive sleep apnea are a frequent problem not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. The epidemiology, etiology, diagnosis, and management of obstructive sleep apnea syndrome (OSAS) in adults have been adequately established on the basis of evidential data. As a result of this, both physicians and the public are increasingly aware of OSAS in adults. Although there are numerous parallels between pediatric and adult OSAS, the situation in children differs that in adults. There is a greater variety of symptoms in children with OSAS, diagnosis is often more difficult with serious consequences for growth and development of children. Treatment of OSAS in children is also different from that of the adult patient. There are many possible causes for the development of obstructive sleep apnea in children. These include hypertrophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. OSAS can, however, also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy. Epidemiological data presented in the literature concerning the incidence of OSAS in children is extremely varied. This wide range is probably due to the fact that snoring may be misdiagnosed as OSAS. The diagnosis of OSAS in children may only be made by considering clinical history (such as rate of growth, tendency to fall asleep during the day, sleep disturbances, susceptibility to infection, etc.), polysomnography (if possible during several nights) and accompanying instrumental diagnosis including cephalometry or laryngoscopy. One of the problems of polysomnography in childhood is that performance and interpretation of the results have not yet been standardized or evaluated for different age groups. Treatment depends on the cause of OSAS and require multidisciplinary management involving the pediatrician, pediatric or adolescent psychiatrist, ear, nose, and throat specialist, maxillofacial surgeons, and neurosurgeons. Adenotonsillectomy (ATE) is the therapy generally chosen if the child has adenoidal vegetations and/or tonsillar hypertrophy. Corrective surgery is possible for rare malformation syndromes. Nocturnal masks for continuous positive airway nasal pressure or procedures for mask respiration are effective in children, but are only used in exceptional cases, such as when ATE is contraindicated or when symptoms of OSAS remain after surgery. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials.
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Affiliation(s)
- Thomas Erler
- Department of Pediatrics, Carl-Thiem-Klinikum, Cottbus, Germany.
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Kaemingk KL, Pasvogel AE, Goodwin JL, Mulvaney SA, Martinez F, Enright PL, Rosen GM, Morgan WJ, Fregosi RF, Quan SF. Learning in children and sleep disordered breathing: findings of the Tucson Children's Assessment of Sleep Apnea (tuCASA) prospective cohort study. J Int Neuropsychol Soc 2003; 9:1016-26. [PMID: 14738283 DOI: 10.1017/s1355617703970056] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/22/2003] [Indexed: 11/07/2022]
Abstract
We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6-12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills.
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Affiliation(s)
- Kris L Kaemingk
- Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona 85724, USA.
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Liao YF, Yun C, Huang CS, Chen PKT, Chen NH, Hung KF, Chuang ML. Longitudinal Follow-Up of Obstructive Sleep Apnea Following Furlow Palatoplasty in Children With Cleft Palate: A Preliminary Report. Cleft Palate Craniofac J 2003. [DOI: 10.1597/1545-1569(2003)040<0269:lfoosa>2.0.co;2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Liao YF, Yun C, Huang CS, Chen PKT, Chen NH, Hung KF, Chuang ML. Longitudinal follow-up of obstructive sleep apnea following Furlow palatoplasty in children with cleft palate: a preliminary report. Cleft Palate Craniofac J 2003; 40:269-73. [PMID: 12733955 DOI: 10.1597/1545-1569_2003_040_0269_lfoosa_2.0.co_2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To longitudinally investigate the incidence and severity of obstructive sleep apnea (OSA) following Furlow palatoplasty for velopharyngeal insufficiency (VPI) in children with cleft palate. SUBJECTS Ten children, six boys and four girls, mean age 5.1 years, at Furlow palatoplasty. DESIGN Prospective analysis. MAIN OUTCOME MEASURES Overnight polysomnographic studies were used to determine the incidence and severity of sleep apneas 1 day prior to Furlow palatoplasty, 1 week postoperatively, and approximately 3 and 6 months postoperatively. RESULTS None of the patients suffered OSA prior to Furlow palatoplasty. A high incidence of mild OSA (100%) occurred during the early postoperative period (p <.001) but resolved within 3 months in all but two patients (20%). Only one OSA (10%) persisted 6 months postoperatively. CONCLUSIONS Furlow palatoplasty for VPI in children with cleft palate might induce temporary and mild OSA.
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Affiliation(s)
- Yu-Fang Liao
- Department of Dentistry, Craniofacial Center, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei 105, Taiwan
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Compliment JM, Abdelmalek M, Post JC. Identifying the etiology of sleep problems in children. Nurse Pract 2002; 27:43-6. [PMID: 12493949 DOI: 10.1097/00006205-200212000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- James M Compliment
- Pediatric Otolaryngology, Allegheny General Hospital, Pittsburgh, Pa., USA
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Liao YF, Chuang ML, K.T. Chen P, Chen NH, Yun C, Huang CS. Incidence and Severity of Obstructive Sleep Apnea Following Pharyngeal Flap Surgery in Patients With Cleft Palate. Cleft Palate Craniofac J 2002. [DOI: 10.1597/1545-1569(2002)039<0312:iasoos>2.0.co;2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Liao YF, Chuang ML, Chen PKT, Chen NH, Yun C, Huang CS. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate. Cleft Palate Craniofac J 2002; 39:312-6. [PMID: 12019007 DOI: 10.1597/1545-1569_2002_039_0312_iasoos_2.0.co_2] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the incidence and severity of obstructive sleep apnea (OSA) associated with pharyngeal flap surgery in patients with cleft palate at least 6 months postoperatively and to determine whether age or the flap width had an effect on them. The hypothesis tested in this study was that the severity of OSA associated with pharyngeal flap surgery is greater in children than in adults. SUBJECTS Ten adults, six men and four women, with a mean age of 28.0 years at pharyngeal flap (adult group). Twenty-eight children, 13 boys and 15 girls, with a mean age of 6.3 years at pharyngeal flap (child group). DESIGN A prospective analysis. MAIN OUTCOME MEASURES An overnight polysomnographic study was used to determine the incidence and severity of OSA 6 months after pharyngeal flap. RESULTS The incidence of OSA following pharyngeal flap was high but not significantly different between these two groups (90% in adults and 93% in children, p = 1.000). When OSA was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups (p =.022). In the adult group, eight patients (89%) had mild OSA and 1 patient (11%) had moderate to severe OSA. In the child group, 11 patients (42%) were found to have mild OSA, and 15 patients (58%) had moderate to severe OSA. No relation was found between the flap width and the incidence (p =.435 in adults and.640 in children) or the severity (p =.325 in adults and.310 in children) of OSA in each group. CONCLUSIONS Six months following pharyngeal flap surgery, more than 90% of the patients with cleft palate still had OSA. The severity of OSA associated with pharyngeal flap surgery tended to be greater in children than in adults. The flap width was unrelated to the incidence and severity of OSA, no matter in adults or in children.
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Affiliation(s)
- Yu-Fang Liao
- Department of Orthodontics, Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
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