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Wong WET, Saniasiaya J, Salehuddin NSM, H'ng SY, Nathan AM. Modification of McGill Oximetry Score in Improving the Diagnostic Capability of Paediatric OSA. Clin Otolaryngol 2024. [PMID: 39175226 DOI: 10.1111/coa.14214] [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: 01/02/2024] [Revised: 05/27/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES This study aimed to devise a modified oximetry scoring system and calculate its diagnostic accuracy in detecting paediatric obstructive sleep apnoea syndrome (OSAS). STUDY DESIGN This prospective diagnostic accuracy study was divided into two phases. SETTING The study was conducted at a quaternary teaching hospital. METHODS Polysomnograms performed from 1 April 2014 to 31 December 2021 were included. In Phase 1, the parameters of 95 oximetry trend graphs were evaluated, and a modified scoring system was constructed. In Phase 2, the modified scoring system was employed in 272 oximetry trend graphs, and its diagnostic accuracy was determined. A logistic regression model was used to assess the ability of each scoring system to predict paediatric OSAS. RESULTS A total of 367 patients were recruited. In Phase 1, a four-tier severity classification system was constructed. In Phase 2, its diagnostic accuracy was found to be 53.3% sensitive, 97% specific, with positive predictive value of 98.5% and negative predictive value of 34.6%. The lowest detectable apnoea-hypopnoea index (AHI) was 4.5. The inter-rater reliability calculated was 80%. Logistic regression was applied to assess associations of the modified McGill score (MMS) or McGill oximetry score (MOS) with OSAS. The area under the receiver operating characteristic curve was higher for the MMS than for MOS (0.78 [95% CI 0.73-0.84] vs. 0.59 [95% CI 0.51-0.66]). CONCLUSION This study demonstrated that our modified scoring system had increased sensitivity at detecting OSAS at a much lower AHI and showed a much greater ability to predict paediatric OSAS.
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Affiliation(s)
- Wannitta E Ting Wong
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Shih Ying H'ng
- Department of Pediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Anna Marie Nathan
- Department of Pediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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2
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Ivanov I, Miraglia B, Prodanova D, Newcorn JH. Sleep Disordered Breathing and Risk for ADHD: Review of Supportive Evidence and Proposed Underlying Mechanisms. J Atten Disord 2024; 28:686-698. [PMID: 38353411 DOI: 10.1177/10870547241232313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Accumulating evidence suggests that sleep disordered breathing (SDB) is under-recognized in youth and adults with ADHD. SDB may contribute to exacerbating pre-existing ADHD symptoms and may play a role in the development of cognitive deficits that may mimic ADHD symptoms. METHOD We conducted a focused review of publications on cross-prevalence, overlapping clinical and neurobiological characteristics and possible mechanisms linking SDB and ADHD. RESULTS Exiting studies suggest that co-occurrence of SDB and ADHD is as high as 50%, with frequent overlap of clinical symptoms such as distractibility and inattention. Mechanisms linking these conditions may include hypoxia during sleep, sleep fragmentation and activation of inflammation, all of which may affect brain structure and physiology to produce disturbances in attention. CONCLUSIONS The relationship between SDB and ADHD symptoms appear well-supported and suggests that more research is needed to better optimize procedures for SDB assessment in youth being evaluated and/or treated for ADHD.
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Zaffanello M, Ferrante G, Zoccante L, Ciceri ML, Nosetti L, Tenero L, Piazza M, Piacentini G. Predictive Power of Oxygen Desaturation Index (ODI) and Apnea-Hypopnea Index (AHI) in Detecting Long-Term Neurocognitive and Psychosocial Outcomes of Sleep-Disordered Breathing in Children: A Questionnaire-Based Study. J Clin Med 2023; 12:jcm12093060. [PMID: 37176501 PMCID: PMC10179379 DOI: 10.3390/jcm12093060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Pediatric obstructive sleep apnea can negatively affect children's neurocognitive function and development, hindering academic and adaptive goals. Questionnaires are suitable for assessing neuropsychological symptoms in children with sleep-disordered breathing. The study aimed to evaluate the effectiveness of using the Oxygen Desaturation Index compared to the Obstructive Apnea-Hypopnea Index in predicting long-term consequences of sleep-disordered breathing in children. We conducted a retrospective analysis of respiratory polysomnography recordings from preschool and school-age children (mean age: 5.8 ± 2.8 years) and followed them up after an average of 3.1 ± 0.8 years from the home-based polysomnography. We administered three validated questionnaires to the parents/caregivers of the children by phone. Our results showed that children with an Oxygen Desaturation Index (ODI) greater than one event per hour exhibited symptoms in four domains (physical, school-related, Quality of Life [QoL], and attention deficit hyperactivity disorder [ADHD]) at follow-up, compared to only two symptoms (physical and school-related) found in children with an Obstructive Apnea-Hypopnea Index greater than one event per hour at the time of diagnosis. Our study also found a significant correlation between the minimum SpO2 (%) recorded at diagnosis and several outcomes, including Pediatric Sleep Questionnaire (PSQ) scores, physical, social, and school-related outcomes, and ADHD index at follow-up. These results suggest that the Oxygen Desaturation Index could serve as a valuable predictor of long-term symptoms in children with sleep-disordered breathing, which could inform treatment decisions. Additionally, measuring minimum SpO2 levels may help assess the risk of developing long-term symptoms and monitor treatment outcomes.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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Ezeugwu VE, Adamko D, van Eeden C, Dubeau A, Turvey SE, Moraes TJ, Simons E, Subbarao P, Wishart DS, Mandhane PJ. Development of a predictive algorithm to identify pre-school children at risk for behavior changes associated with sleep-related breathing disorders. Sleep Med 2022; 100:472-478. [PMID: 36252416 DOI: 10.1016/j.sleep.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES Children with late-onset (2-5 years) or persistent (3 months-5 years) sleep-related breathing disorder (SRBD) have an increased risk of behavior problems compared to children with no or early-onset SRBD. We sought to determine whether a combination of urine metabolites and sleep questionnaires could identify children at risk for SRBD-associated behavior problems. METHODS Urine and data were analyzed from the Edmonton site of the CHILD birth cohort study. We measured urine metabolites (random, mid-stream) at age three-years among a sub-cohort of participants (n = 165). Random Forest with a Boruta wrapper was used to identify important metabolites (creatinine-corrected, z-scores) for late/persistent SRBD versus no/early SRBD (reference). An algorithm was subsequently generated to predict late/persistent SRBD in children with a history of snoring using a metabolite composite score (z-scores < or ≥ 0) plus the SDBeasy score defined as [age (yrs.) of most recent positive SRBD]2 - [age (yrs.) first reported ever snoring]2. RESULTS Of the 165 children with SRBD data, 40 participants had late/persistent SRBD. Seven urinary metabolites in addition to the SDBeasy score were confirmed as important for late/persistent SRBD (AUC = 0.87). Among children with an ever-snoring history and a metabolite composite score ≥0, those with SDBeasy score ≥3 were over 13-fold more likely to have late/persistent SRBD (OR 13.7; 95%CI: 3.0, 62.1; p = 0.001). This algorithm has a Sensitivity of 69.6%, Specificity of 85.7% and a positive likelihood ratio (+LR) of 4.9. CONCLUSIONS We developed a predictive algorithm using a combination of questionnaires and urine metabolites at age three-years to identify children with late/persistent SRBD by five-years of age.
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Affiliation(s)
- Victor E Ezeugwu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Darryl Adamko
- Department of Pediatrics, University of Saskatchewan, Saskatoon SK, Canada
| | | | - Aimee Dubeau
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elinor Simons
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David S Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
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Ioan I, Weick D, Sevin F, Sanlaville D, De Fréminville B, Schweitzer C, Akkari M, Coutier L, Putois B, Plancoulaine S, Thieux M, Franco P. Neurocognitive evaluation of children with down syndrome and obstructive sleep apnea syndrome. Sleep Med 2022; 100:542-549. [PMID: 36308912 DOI: 10.1016/j.sleep.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) treatment has been shown to improve cardiac behavioral and cognitive functions in typically developing children. Early OSAS diagnosis in children with Down syndrome (DS) would be important to prevent its complications, especially cognitive ones, but remains overlooked. The main objective of our study was to assess the cognitive function of children with DS, with and without OSAS. The second objective was to determine the impact of the therapeutic intervention on the cognitive function of children with OSAS. This study included 41 children with DS who underwent polysomnography for OSAS diagnosis and a cognitive evaluation. They were aged between 3.4 and 17.3 years and 24 (59%) were boys. Their median OAHI was 2.6 (0-31)/h of sleep, 30 (73%) were diagnosed with OSAS (15 had mild OSAS, and 15 had moderate/severe OSAS). Some scores of the Raven's colored progressive matrices were negatively correlated with the respiratory arousal index, OAHI tended to be positively correlated with Reiss behavioral problems. 24 (59%) patients received a treatment. Even if we were unable to demonstrate this formally due that only 16 children (39%) accepted a follow-up visit, some displayed improvement in their neuropsychological scores, especially those with moderate/severe OSAS after treatment. Children with DS have low intellectual abilities and more risk of developing OSAS compared to the general population, which may lead to further neurocognitive impairment. Early screening and management are important in this population to prevent any further neurocognitive delay in their development.
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Affiliation(s)
- Iulia Ioan
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, DevAH, F-54000 Nancy, France
| | - Diane Weick
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - François Sevin
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Damien Sanlaville
- Département de génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte De Fréminville
- Service de Génétique, CHU de St Etienne, Centre de Référence Maladies Rares des Anomalies du Développement et des Syndromes Malformatifs de l'Inter région Centre Est (Rhône Alpes Auvergne), France
| | - Cyril Schweitzer
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, DevAH, F-54000 Nancy, France
| | - Mohamed Akkari
- Hopital Gui de Chauliac, 58 Avenue Augustin Fliche, 34295, France
| | - Laurianne Coutier
- Service de pneumologie infantile, allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Benjamin Putois
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; U1028, Lyon Neuroscience Research Center (CNRL), University Lyon 1, Lyon, France
| | | | - Marine Thieux
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; U1028, Lyon Neuroscience Research Center (CNRL), University Lyon 1, Lyon, France
| | - Patricia Franco
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; U1028, Lyon Neuroscience Research Center (CNRL), University Lyon 1, Lyon, France.
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Liu CN, Kang KT, Yao CCJ, Chen YJ, Lee PL, Weng WC, Hsu WC. Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA. JAMA Otolaryngol Head Neck Surg 2022; 148:621-629. [PMID: 35616957 DOI: 10.1001/jamaoto.2022.0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. Objective To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. Design, Setting, and Participants This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. Exposures All participants underwent CBCT and PSG before and after adenotonsillectomy. Main Outcomes and Measures Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. Results A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. Conclusions and Relevance These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.
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Affiliation(s)
- Chin-Nung Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,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, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, 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
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, 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.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Menzies B, Teng A, Burns M, Lah S. Neurocognitive outcomes of children with sleep disordered breathing: a systematic review with meta-analysis. Sleep Med Rev 2022; 63:101629. [DOI: 10.1016/j.smrv.2022.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
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Wu D, Au VH, Yang B, Horne SJ, Weedon J, Bernstein MJ, Goldstein NA. Impact of Adenotonsillectomy on Homework Performance in Children With Obstructive Sleep-Disordered Breathing. Ann Otol Rhinol Laryngol 2021; 131:1231-1240. [PMID: 34872386 DOI: 10.1177/00034894211062543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE As a first line treatment for pediatric obstructive sleep-disordered breathing (SDB), adenotonsillectomy (AT) has been shown to confer physiologic and neurocognitive benefits to a child. However, there is a scarcity of data on how homework performance is affected postoperatively. Our objective was to evaluate the impact of AT on homework performance in children with SDB. METHODS Children in grades 1 to 8 undergoing AT for SDB based on clinical criteria with or without preoperative polysomnography along with a control group of children undergoing surgery unrelated to the treatment of SDB were recruited. The primary outcome of interest was the differential change in homework performance between the study group and control at follow-up as measured by the validated Homework Performance Questionnaire (HPQ-P). Adjustments were made for demographics and Pediatric Sleep Questionnaire (PSQ) scores. RESULTS 116 AT and 47 control subjects were recruited, and follow-up data was obtained in 99 AT and 35 control subjects. There were no significant differences between the general (total) HPQ-P scores and subscale scores between the AT and control subjects at entry and there were no significant differences in the change scores (follow-up minus initial scores) between the groups. Regression modeling also demonstrated that there were no group (AT vs control) by time interactions that predicted differential improvements in the HPQ-P (P > .10 for each model) although initial PSQ score was a significant predictor of lower HPQ-P scores for all models. CONCLUSIONS Children with SDB experienced improvement in HPQ-P scores postoperatively, but the degree of change was not significant when compared to controls. Further studies incorporating additional educational metrics are encouraged to assess the true scholastic impact of AT in children with SDB.
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Affiliation(s)
- Derek Wu
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Vivienne H Au
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Billy Yang
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sylvia J Horne
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jeremy Weedon
- Medical Research Library, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michelle J Bernstein
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nira A Goldstein
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Shi Y, Feng Y, Zhang Y, Liu H, Luo H, Shang L, Xing L, Hou J, Yan J, Liu X, Zhang Q, Si C, Ren X. Assessment of event-related evoked potentials and China-Wechsler intelligence scale for cognitive dysfunction in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2021; 150:110901. [PMID: 34450546 DOI: 10.1016/j.ijporl.2021.110901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/06/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the relationship between obstructive sleep apnea (OSA) and cognitive impairment by combining event-related evoked potentials (ERPs) and China-Wechsler Younger Children Scale (C-WISC) in children with sleep-disordered breathing (SDB) with vs. without OSA. METHODS This was a retrospective case-control study of all consecutive children (n = 148) with adenoid tonsil hypertrophy between July 2017 and March 2019 at the Hospital. RESULTS The children were divided into the OSA (n = 102) and non-OSA (n = 46) groups. The apnea-hypopnea index (AHI), obstructive apnea index (OAI), and obstructive apnea-hypopnea index (OAHI) in the OSA group were elevated compared with those of the non-OSA group (all P < 0.001). The mean oxygen saturation (SaO2) and SaO2 nadir were lower in the OSA group compared with the non-OSA group (both P < 0.001). The respiratory arousal index (RAI) values in the OSA group were larger than those of the non-OSA group (P < 0.001). The P300 and N100 latencies in the OSA group were longer than those of the non-OSA group (both P < 0.001). Pearson's correlation analysis revealed correlations of the P300 peak latency with full-scale intelligence quotient (FIQ) (P < 0.001 and r = -0.527), verbal intelligence quotient (VIQ) (P < 0.001 and r = -0.448), and performance intelligence quotient (PIQ) (P < 0.001 and r = -0.515). There was a correlation between the N100 peak latency and PIQ (P = 0.026 and r = -0.183). CONCLUSION ERPs, as an objective measurement, might help assess cognitive impairment in children with OSA.
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Affiliation(s)
- Yewen Shi
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yani Feng
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yitong Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haiqin Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huanan Luo
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lei Shang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Liang Xing
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Tongchuan, Tongchuan, Shaanxi, China
| | - Jin Hou
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Yan
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaohong Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qingqing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Si
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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10
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Horger MN, DeMasi A, Allia AM, Scher A, Berger SE. Newly walking infants' night sleep impacts next day learning and problem solving. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:57-83. [PMID: 33641800 DOI: 10.1016/bs.acdb.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sleep is part of the process that prepares children and adults for next day cognitive activity. Insufficient or fragmented sleep has a detrimental impact on subsequent encoding (Rouleau et al., 2002) and cognitive functioning (Joo et al., 2012). However, fragmented sleep early in life is a developmental norm, limiting the extent to which conclusions derived from older populations can be generalized. To directly test the continuity of this relationship, newly-walking infants' (N=58) sleep was monitored overnight using actigraphy. The next morning they were taught a motor problem-solving task. The task required infants to navigate through a tunnel to reach a goal at the other end. We coded infants' exploratory behaviors and the extent of training required to solve the task. Using a cluster analysis that accounted for exploratory behaviors and number of training prompts, infants were sorted into three profiles: those who found the task Easy to solve, those who found it Difficult, and those who Never solved it. Wake episodes and sleep efficiency were entered as predictors of cluster membership in a multinomial logistic regression. Of the infants who ultimately solved the task, those with more wake episodes and lower sleep efficiency had more difficulty. Specifically, fragmentation appeared to negatively impact preparedness to learn. Contrary to our expectations, infants who Never solved the task had the least fragmented sleep, indicating that an optimal level of fragmentation is needed for efficient problem-solving. For infants, some level of sleep fragmentation is needed the night before learning in order to solve a task efficiently. These findings highlight the interaction between developmental domains, from sleep quality to motor experience, and their impact on infant learning in real time.
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Affiliation(s)
- Melissa N Horger
- The Graduate Center, City University of New York (CUNY), New York, NY, United States.
| | - Aaron DeMasi
- The Graduate Center, City University of New York (CUNY), New York, NY, United States
| | - Angelina M Allia
- The College of Staten Island, CUNY, Staten Island, NY, United States
| | - Anat Scher
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Sarah E Berger
- Department of Psychology, The College of Staten Island and the Graduate Center of the City University of New York, NY, United States
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11
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Nilsen FM, Ruiz JD, Tulve NS. A Meta-Analysis of Stressors from the Total Environment Associated with Children's General Cognitive Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155451. [PMID: 32751096 PMCID: PMC7432904 DOI: 10.3390/ijerph17155451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
General cognitive ability, often referred to as ‘general intelligence’, comprises a variety of correlated abilities. Childhood general cognitive ability is a well-studied area of research and can be used to predict social outcomes and perceived success. Early life stage (e.g., prenatal, postnatal, toddler) exposures to stressors (i.e., chemical and non-chemical stressors from the total (built, natural, social) environment) can impact the development of childhood cognitive ability. Building from our systematic scoping review (Ruiz et al., 2016), we conducted a meta-analysis to evaluate more than 100 stressors related to cognitive development. Our meta-analysis identified 23 stressors with a significant increase in their likelihood to influence childhood cognitive ability by 10% or more, and 80 stressors were observed to have a statistically significant effect on cognitive ability. Stressors most impactful to cognition during the prenatal period were related to maternal health and the mother’s ability to access information relevant to a healthy pregnancy (e.g., diet, lifestyle). Stressors most impactful to cognition during the early childhood period were dietary nutrients (infancy), quality of social interaction (toddler), and exposure to toxic substances (throughout early childhood). In conducting this analysis, we examined the relative impact of real-world exposures on cognitive development to attempt to understand the inter-relationships between exposures to both chemical and non-chemical stressors and early developmental life stages. Our findings suggest that the stressors observed to be the most influential to childhood cognitive ability are not permanent and can be broadly categorized as activities/behaviors which can be modified to improve childhood cognition. This meta-analysis supports the idea that there are complex relationships between a child’s total environment and early cognitive development.
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Affiliation(s)
- Frances M. Nilsen
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Correspondence: ; Tel.: +1-919-541-2574
| | - Jazmin D.C. Ruiz
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Honeywell International, Buffalo, NY 14210, USA
| | - Nicolle S. Tulve
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
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12
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Combs D, Edgin JO, Klewer S, Barber BJ, Morgan WJ, Hsu CH, Abraham I, Parthasarathy S. OSA and Neurocognitive Impairment in Children With Congenital Heart Disease. Chest 2020; 158:1208-1217. [PMID: 32222588 DOI: 10.1016/j.chest.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD. RESEARCH QUESTION Is OSA is associated with neurocognitive impairment in children with CHD? STUDY DESIGN AND METHODS Children aged 6 to 17 years with corrected moderate to complex CHD without syndromes that may affect neurocognition were recruited from the pediatric cardiology clinic. Participants underwent home sleep testing and neurocognitive testing, including a validated Intellectual Quotient (IQ) test as well as validated tests of memory (Paired Associates Learning test), executive function (Intra-Extra Dimensional set shift test), and attention (Simple Reaction Test) from the CANTAB neurocognitive testing battery. RESULTS Complete results were available for 30 children. Seventeen children (57%) were found to have OSA. Total IQ was markedly lower in children with CHD and comorbid OSA compared with children with CHD without comorbid OSA (mean, 86 ± 12 vs 98 ± 11; P = .01). Children with CHD and OSA did significantly worse on the Paired Associates Learning test, with a median of eight total errors (interquartile range [IQR], 2.25-15) compared with children with CHD without OSA (median total errors, 2, IQR, 1-8; P = .02). INTERPRETATION Children with CHD and comorbid OSA have impaired neurocognition compared with children with CHD without comorbid OSA. OSA may be a reversible cause of neurocognitive impairment in children with CHD. Further research is needed to evaluate the effects of OSA treatment on neurocognitive impairment in children with CHD.
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Affiliation(s)
- Daniel Combs
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, AZ; Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ; University of Arizona Health Sciences Center for Sleep & Circadian Science, University of Arizona, Tucson, AZ.
| | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Scott Klewer
- Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, AZ
| | - Brent J Barber
- Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, AZ
| | - Wayne J Morgan
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ
| | - Sairam Parthasarathy
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ; University of Arizona Health Sciences Center for Sleep & Circadian Science, University of Arizona, Tucson, AZ
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13
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Kurnik NM, Weidler EM, Lien KM, Cordero KN, Williams JL, Temkit M, Beals SP, Singh DJ, Sitzman TJ. The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2020; 57:860-871. [PMID: 32070129 DOI: 10.1177/1055665620902883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness. METHODS PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale. RESULTS Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI]: 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI: 12%-33%). The incidence of OSA was 28% (95% CI: 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes (P = .6572). CONCLUSIONS Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.
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Affiliation(s)
- Nicole M Kurnik
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Erica M Weidler
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kari M Lien
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Kelly N Cordero
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Jessica L Williams
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - M'hamed Temkit
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Stephen P Beals
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Davinder J Singh
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA.,Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA.,Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
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14
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Bergeron M, Duggins AL, Cohen AP, Leader BA, Ishman SL. The impact of persistent pediatric obstructive sleep apnea on the Quality of Life of Patients' families. Int J Pediatr Otorhinolaryngol 2020; 129:109723. [PMID: 31678898 DOI: 10.1016/j.ijporl.2019.109723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To (1) quantify the quality of life (QOL) for families of children affected by persistent obstructive sleep apnea (OSA), and (2) assess factors contributing to the negative impact of OSA on families. METHODS Prospective case series in a multidisciplinary upper airway center at a tertiary pediatric institution. Our study included patients with persistent OSA referred to our clinic from 2014 to 2016. Both patients and their families completed validated questionnaires assessing QOL and OSA symptoms, including the Family Impact Questionnaire (FIQ), Pediatric Sleep Questionnaire, the Pediatric Quality of Life Inventory, the OSA-18, and the Epworth Sleepiness Scale. RESULTS Families of 67 patients were included. The mean patient age was 12.5 (95%CI 11.9-13.1); 23 (34.3%) were female, and the mean BMI percentile was 80.2 (95%CI 73.6-86.8). The single most common comorbidity was Down syndrome (45.6%). The mean obstructive apnea-hypopnea index was 9.7 ± 10.3 events/hour. A significant association exists between OSA severity and 18 FIQ negative subscore (P < 0.001). Financial impact was the primary negative concern for parents of patients with OSA compared to those without OSA (P = 0.03). There were no other significant differences between those with and without OSA. CONCLUSIONS There was a significant correlation between persistent OSA severity and the FIQ negative impact of disease score on patients' families. Concern regarding financial burden was more common for families of children with OSA than for those without OSA. This suggests that targeted interventions, particularly regarding the financial burden of persistent OSA diagnosis and management, may provide some relief to families.
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Affiliation(s)
- Mathieu Bergeron
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA; Ste-Justine Hospital, Department of Pediatric Otolaryngology- Head and Neck Surgery, Montreal, Quebec, Canada
| | - Angela L Duggins
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, OH, USA
| | - Aliza P Cohen
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA
| | - Brittany A Leader
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA.
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15
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Tamkin J. Impact of airway dysfunction on dental health. Bioinformation 2020; 16:26-29. [PMID: 32025158 PMCID: PMC6986941 DOI: 10.6026/97320630016026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
The airway encompasses the mouth, jaw, nasal passages, tongue, and throat. Dentists in collaboration with other health professionals can recognize the early signs of the disorder,
perform proper assessment of facial and dental structures, and provide treatment to help prevent and manage the dysfunction. Therefore, it is of interest to discuss the impact of
airway development and dysfunction on dental health.
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16
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Bergeron M, Cohen AP, Maby A, Babiker HE, Pan BS, Ishman SL. The Effect of Cleft Palate Repair on Polysomnography Results. J Clin Sleep Med 2019; 15:1581-1586. [PMID: 31739847 PMCID: PMC6853397 DOI: 10.5664/jcsm.8016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES In view of the risk that surgical repair of cleft palate may induce or worsen obstructive sleep apnea (OSA), the goal of this study was to assess presurgical and postsurgical polysomnography (PSG) results for children who underwent primary palatoplasty. METHODS Retrospective case-control series for children with cleft palate repair performed between January 2008 and December 2016 at a tertiary pediatric center. Children underwent PSG before and after surgery. RESULTS Sixty-four children (53.1% female) with a mean age of 2.0 ± 2.8 years (range 0.6-16.4) were included in the study. Pierre-Robin sequence was the most common comorbidity (67%). Before palatal repair, the mean obstructive apnea-hypopnea index (oAHI) was 3.4 ± 3.9 (range 0-17.9) events/h; this did not significantly change, with 5.9 ± 14.5 (range 0-105.7) events/h after surgery (P = 0.30). However, 34.4% of patients had a worsening of more than 1 obstructive event/h and 18.9% had a worsening of 5 or more obstructive events/h. The presence of a concomitant syndrome (eg, Treacher Collins) was a risk factor for postoperative OSA (odds ratio 4.2, 95% confidence interval 1.1-15.8, P = .03). CONCLUSIONS OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty. These findings suggest that palatoplasty does not worsen or cause OSA in most patients, and that nonsyndromic children are at low risk for the development or worsening of OSA.
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Affiliation(s)
- Mathieu Bergeron
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
- Sainte-Justine Hospital, Department of Pediatric Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Aliza P Cohen
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Alexandra Maby
- Laval University, Department of Otolaryngology-Head and Neck Surgery, Quebec City, Quebec, Canada
| | - Haithem E Babiker
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Plastic Surgery, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Division of Plastic, Reconstructive, Hand, and Burn Surgery, Cincinnati, Ohio
| | - Brian S Pan
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Plastic Surgery, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Division of Plastic, Reconstructive, Hand, and Burn Surgery, Cincinnati, Ohio
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
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17
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Combs D, Goodwin JL, Quan SF, Morgan WJ, Hsu CH, Edgin JO, Parthasarathy S. Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. J Clin Sleep Med 2019; 15:111-117. [PMID: 30621839 PMCID: PMC6329554 DOI: 10.5664/jcsm.7582] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Parent report or child report is commonly used to obtain information on sleep in children. Data are lacking comparing the validity of parent-reported versus child-reported sleep parameters. METHODS A total of 285 children (age 9 to 17 years) from the Tucson Children's Assessment of Sleep Apnea community cohort study were assessed. Parent report and child report of total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) for a single night were compared to polysomnography (PSG). Intraclass correlations (ICCs) were used to evaluate agreement between child report, parent report, and PSG findings. RESULTS When compared to PSG, children overestimated TST by a median of 32 minutes (interquartile range [IQR] 6 to 68), whereas parents overestimated TST by 36 minutes (IQR 13-70) (P = .006). Children overestimated SL by 4 minutes (IQR -8 to 20), whereas parents overestimated SL by 2 minutes (IQR -10 to 13) (P = .001). Children overestimated SE by 5% (IQR 0% to 11%), whereas parents overestimated SE by 6% (IQR 2% to 11%, P = .04). Both child-reported TST (ICC 0.722, P < .001) and parent-reported TST (ICC 0.776, P < .001) agreed substantially with PSG. Child-reported SL (ICC 0.467, P < .001) and parent-reported SL (r = .419, P < .001) moderately agreed with PSG. Least agreement with PSG was seen between child-reported SE (ICC 0.404, P < .001) and parent-reported SE (ICC 0.473, P < .001), but significant agreement was still present. CONCLUSIONS When compared to PSG, children overestimate TST to a smaller degree than their parents and overestimate SL to a larger degree than their parents, but these differences appear small. Child and parent reports appear to be equally valid for TST, SL, and SE.
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Affiliation(s)
- Daniel Combs
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, Arizona
- Department of Medicine, University of Arizona, Tucson, Arizona
- University of Arizona Health Sciences Center for Sleep & Circadian Sciences and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona
| | - James L. Goodwin
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Stuart F. Quan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Wayne J. Morgan
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, Arizona
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Jamie O. Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tucson, Arizona
- University of Arizona Health Sciences Center for Sleep & Circadian Sciences and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona
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18
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Zhao J, Han S, Zhang J, Wang G, Wang H, Xu Z, Tai J, Peng X, Guo Y, Liu H, Tian J, Jin X, Zheng L, Zhang J, Ni X. Association between mild or moderate obstructive sleep apnea-hypopnea syndrome and cognitive dysfunction in children. Sleep Med 2018; 50:132-136. [DOI: 10.1016/j.sleep.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
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19
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Bergeron M, Duggins AL, Cohen AP, Ishman SL. Comparison of Patient- and Parent-Reported Quality of Life for Patients Treated for Persistent Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2018; 159:789-795. [DOI: 10.1177/0194599818782415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mathieu Bergeron
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Angela L. Duggins
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aliza P. Cohen
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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20
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Smithson L, Baird T, Tamana SK, Lau A, Mariasine J, Chikuma J, Lefebvre DL, Subbarao P, Becker AB, Turvey SE, Sears MR, Beal DS, Pei J, Mandhane PJ. Shorter sleep duration is associated with reduced cognitive development at two years of age. Sleep Med 2018; 48:131-139. [DOI: 10.1016/j.sleep.2018.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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21
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Franklin AM, Giacheti CM, Silva NCD, Campos LMG, Pinato L. Correlation between sleep profile and behavior in individuals with specific learning disorder. Codas 2018; 30:e20170104. [PMID: 29972444 DOI: 10.1590/2317-1782/20182017104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/04/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study aimed to correlate sleep profile and behavior in individuals with Specific Learning Disorder (SLD). METHODS The Sleep General Habits Questionnaire, Sleep Diary, and Sleep Disturbance Scale for Children (SDSC) were used in analysis of sleep, whereas the Child Behavior Checklist (CBCL) inventory was used in analysis of behavior. RESULTS 65.5% of the individuals with SLD presented symptoms of sleep disorders, most frequently wakefulness-sleep transition and sleep disturbance total score, which showed values higher than acceptable. In addition, individuals with SLD presented higher sleep latency than those with typical development. Concerning behavior, 72.4% of the individuals with SLD presented clinical condition of behavior problems. In the control group, none of the participants showed symptoms of sleep or behavior problems. In the SLD group, correlation was observed between behavioral problems and sleep disturbance. CONCLUSION Individuals with SLD showed high rates of sleep disturbance and behavioral problems. The worse the sleep disturbance, the worse the behavioral aspects in these individuals.
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Affiliation(s)
- Amanda Maião Franklin
- Faculdade de Filosofia e Ciências, Universidade Estadual Paulista - UNESP - Marília (SP), Brasil
| | - Célia Maria Giacheti
- Faculdade de Filosofia e Ciências, Universidade Estadual Paulista - UNESP - Marília (SP), Brasil
| | | | | | - Luciana Pinato
- Faculdade de Filosofia e Ciências, Universidade Estadual Paulista - UNESP - Marília (SP), Brasil
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Kostkova M, Durdik P, Ciljakova M, Vojtkova J, Sujanska A, Pozorciakova K, Snahnicanova Z, Jancinova M, Banovcin P. Short-term metabolic control and sleep in children and adolescents with type 1 diabetes mellitus. J Diabetes Complications 2018; 32:580-585. [PMID: 29709336 DOI: 10.1016/j.jdiacomp.2018.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/14/2017] [Accepted: 03/17/2018] [Indexed: 12/15/2022]
Abstract
AIMS The aim of this study was to examine sleep in T1D children and in healthy controls by polysomnographic (PSG) examination and to determine the influence of short-term metabolic compensation on sleep quality and sleep disordered breathing (SDB). METHODS The prospective cross-sectional study included 44 T1D subjects and 60 healthy controls, aged 10-19 years. Subjects underwent anthropometric measurements, laboratory testing and standard overnight in-laboratory video polysomnography with continuous glucose monitoring (CGM). RESULTS No significant differences were found in total sleep time, sleep efficiency, percentage of sleep stages and respiratory parameters between T1D and healthy group. T1D children with more optimal short-term metabolic control (AvgSG < 10 mmol/l, n = 18) had a significantly lower apnea-hypopnea index (AHI) (0.3(0-0.5) vs. 0.6 (0.2-0.9) events/h, p < 0.05)and respiratory arousal index (0(0-0,1) vs. 0.2(0-0.3)), p < 0.01) compared to children with suboptimal short-term control(n = 26), no significant differences were found in parameters of sleep architecture. Obstructive sleep apnea (OSA) was diagnosed in only one T1D patient, nine T1D children had mild central apnea. CONCLUSIONS There may be an association between short-term metabolic compensation and SDB in T1D children without chronic complications, obesity or overweight and hypoglycemia. Further research is needed to confirm this result.
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Affiliation(s)
- Martina Kostkova
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Peter Durdik
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia.
| | - Miriam Ciljakova
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia; National Endocrinological and Diabetes Institute in Lubochna, Slovakia
| | - Jarmila Vojtkova
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Anna Sujanska
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Katarina Pozorciakova
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Zuzana Snahnicanova
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia; Division of Oncology, Biomedical Center Martin JFM CU, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 036 01 Martin, Slovakia
| | - Maria Jancinova
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Peter Banovcin
- Department of Pediatrics, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia.
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Trosman I, Trosman SJ. Cognitive and Behavioral Consequences of Sleep Disordered Breathing in Children. Med Sci (Basel) 2017; 5:E30. [PMID: 29194375 PMCID: PMC5753659 DOI: 10.3390/medsci5040030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/14/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022] Open
Abstract
There is now a plethora of evidence that children with sleep disordered breathing (SDB) show deficits in neurocognitive performance, behavioral impairments, and school performance. The following review will focus on the neurobehavioral impacts of SDB, pediatric sleep investigation challenges, potential mechanisms of behavioral and cognitive deficits in children with SDB, and the impact of SDB treatment.
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Affiliation(s)
- Irina Trosman
- Sleep Medicine Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Samuel J Trosman
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Lau A, Ewing C, Gnanapragasam J, Majaesic C, MacLean J, Mandhane PJ. Changes to a pediatric sleep disordered breathing clinic improve wait-times and clinic efficiency. Pediatr Pulmonol 2016; 51:1234-1241. [PMID: 27133382 DOI: 10.1002/ppul.23440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recognition of the impact of sleep disordered breathing (SDB) on health has increased referrals in pediatric respiratory medicine with a concomitant increase in wait-times. METHODS To reduce wait-time (primary outcome), we developed a rapid SDB clinic (RSC) to identify, diagnose, and treat patients with few to no comorbidities (uncomplicated) and presumed SDB based on the referral letter. The RSC uses 1) parent-report questionnaires to capture the patients' medical history and 2) sleep testing (e.g., overnight oximetry) completed prior to the initial consultation. RESULTS The combination of pre-clinic electronic-questionnaires and testing increased patient consult capacity by 100%. Of the 256 patients referred to the RSC over 28 months, 130 patients were seen through the RSC, 17 patients were re-triaged to a standard sleep clinic (SSC) after questionnaire review, 51 patients were completing the RSC process, and 75 patients had their referral cancelled. An electronic-questionnaire RSC (n = 45) reduced wait-times by 34% to 142.8 (SD 57) days compared to a paper-questionnaire RSC (P < 0.001). The electronic RSC was also associated with 77.4 (SD 74.1) days reduction in wait-time (P = 0.04) for SSC patients seen during the same timeframe. RSC patients were 75% less likely to require a follow-up visit (P < 0.001) compared to SSC patients seen during the same timeframe. CONCLUSION A targeted, streamlined clinic using electronic-questionnaires for uncomplicated patients can improve wait-times for children being referred to pediatric respiratory medicine for evaluation of sleep disordered breathing. Pediatr Pulmonol. 2016;51:1234-1241. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amanda Lau
- University of Alberta, Edmonton, Alberta, Canada
| | - Chris Ewing
- University of Alberta, Edmonton, Alberta, Canada.,Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Carina Majaesic
- University of Alberta, Edmonton, Alberta, Canada.,Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Joanna MacLean
- University of Alberta, Edmonton, Alberta, Canada.,Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Piush J Mandhane
- University of Alberta, Edmonton, Alberta, Canada. .,Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Cognitive Event-Related Potentials in Patients With Adenoid Hypertrophy: A Case-Control Pilot Study. J Clin Neurophysiol 2016; 33:443-449. [PMID: 26808619 DOI: 10.1097/wnp.0000000000000258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Children with adenoid hypertrophy commonly have sleep-disordered breathing. Sleep-disordered breathing is associated with various neurocognitive problems. The aim of this study was to assess the cognitive function in those patients using cognitive event-related potentials. METHODS Twenty-three patients with moderate to severe adenoid hypertrophy were compared with 20 healthy controls. The intelligence quotient was performed for all study participants. The latencies of the N200, P300 peaks and the amplitudes of the N200/P300 components of event-related potentials were recorded. The above variables were measured at baseline for both patients and control groups and 2 months after adenoidectomy for the patient group. RESULTS There was no significant difference between patients and controls regarding full intelligence quotient scales. P300 latency was significantly prolonged in patient group compared with the healthy controls. Moreover, postoperative P300 latency was significantly reduced compared with the preoperative P300 latency. Postoperative P300 latency was not statistically different from healthy controls' data. CONCLUSIONS P300 latency delay may reflect some sort of cognitive impairment in patients with adenoid hypertrophy. This delay was reversible after adenoidectomy. Event-related potentials may help for assessment of cognitive functions in patients with adenoid hypertrophy.
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Taylor HG, Bowen SR, Beebe DW, Hodges E, Amin R, Arens R, Chervin RD, Garetz SL, Katz ES, Moore RH, Morales KH, Muzumdar H, Paruthi S, Rosen CL, Sadhwani A, Thomas NH, Ware J, Marcus CL, Ellenberg SS, Redline S, Giordani B. Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea. Pediatrics 2016; 138:peds.2015-4458. [PMID: 27464674 PMCID: PMC4960728 DOI: 10.1542/peds.2015-4458] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial. METHODS Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures. RESULTS Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d, 0.20-0.24). As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures. CONCLUSIONS Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest.
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Affiliation(s)
- H. Gerry Taylor
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Susan R. Bowen
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Dean W. Beebe
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Raouf Amin
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Raanan Arens
- Department of Pediatrics, Children’s Hospital at Montefiore and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ronald D. Chervin
- Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Susan L. Garetz
- Department of Otolaryngology–Head and Neck Surgery and Sleep Disorders Center, University of Michigan Health Center, Ann Arbor, Michigan
| | - Eliot S. Katz
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Reneé H. Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Knashawn H. Morales
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hiren Muzumdar
- Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shalini Paruthi
- Department of Pediatrics, Cardinal Glennon Children’s Medical Center, Saint Louis University, St Louis, Missouri
| | - Carol L. Rosen
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anjali Sadhwani
- Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Nina Hattiangadi Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Neuropsychology and Assessment Group, and
| | - Janice Ware
- Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Carole L. Marcus
- Department of Pediatrics, Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susan S. Ellenberg
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Ruiz JDC, Quackenboss JJ, Tulve NS. Contributions of a Child's Built, Natural, and Social Environments to Their General Cognitive Ability: A Systematic Scoping Review. PLoS One 2016; 11:e0147741. [PMID: 26840411 PMCID: PMC4739499 DOI: 10.1371/journal.pone.0147741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/09/2015] [Indexed: 12/24/2022] Open
Abstract
The etiology of a child’s cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children’s cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003–2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child’s total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child’s ability to learn.
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Affiliation(s)
- Jazmin Del Carmen Ruiz
- Oak Ridge Institute for Science and Education, Research Participation Program, Oak Ridge, TN, United States of America
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, Durham, NC, United States of America
- * E-mail: ;
| | - James J. Quackenboss
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Las Vegas, NV, United States of America
| | - Nicolle S. Tulve
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, Durham, NC, United States of America
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Csábi E, Benedek P, Janacsek K, Zavecz Z, Katona G, Nemeth D. Declarative and Non-declarative Memory Consolidation in Children with Sleep Disorder. Front Hum Neurosci 2016; 9:709. [PMID: 26793090 PMCID: PMC4707283 DOI: 10.3389/fnhum.2015.00709] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022] Open
Abstract
Healthy sleep is essential in children’s cognitive, behavioral, and emotional development. However, remarkably little is known about the influence of sleep disorders on different memory processes in childhood. Such data could give us a deeper insight into the effect of sleep on the developing brain and memory functions and how the relationship between sleep and memory changes from childhood to adulthood. In the present study we examined the effect of sleep disorder on declarative and non-declarative memory consolidation by testing children with sleep-disordered breathing (SDB) which is characterized by disrupted sleep structure. We used a story recall task to measure declarative memory and Alternating Serial Reaction time (ASRT) task to assess non-declarative memory. This task enables us to measure two aspects of non-declarative memory, namely general motor skill learning and sequence-specific learning. There were two sessions: a learning phase and a testing phase, separated by a 12 h offline period with sleep. Our data showed that children with SDB exhibited a generally lower declarative memory performance both in the learning and testing phase; however, both the SDB and control groups exhibited retention of the previously recalled items after the offline period. Here we showed intact non-declarative consolidation in SDB group in both sequence-specific and general motor skill. These findings suggest that sleep disorders in childhood have a differential effect on different memory processes (online vs. offline) and give us insight into how sleep disturbances affects developing brain.
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Affiliation(s)
- Eszter Csábi
- Institute of Psychology, University of Szeged Szeged, Hungary
| | | | - Karolina Janacsek
- MTA-ELTE NAP B Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of SciencesBudapest, Hungary; Institute of Psychology, Eotvos Lorand UniversityBudapest, Hungary
| | - Zsófia Zavecz
- Institute of Psychology, Eotvos Lorand University Budapest, Hungary
| | | | - Dezso Nemeth
- MTA-ELTE NAP B Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of SciencesBudapest, Hungary; Institute of Psychology, Eotvos Lorand UniversityBudapest, Hungary
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Modified STOP-Bang Tool for Stratifying Obstructive Sleep Apnea Risk in Adolescent Children. PLoS One 2015; 10:e0142242. [PMID: 26581088 PMCID: PMC4651349 DOI: 10.1371/journal.pone.0142242] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/18/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is prevalent in children and diagnostic polysomnography is costly and not readily available in all areas. We developed a pediatric modification of a commonly used adult clinical prediction tool for stratifying the risk of OSA and the need for polysomnography. METHODS A total of 312 children (age 9-17 years) from phase 2 of the Tucson Children's Assessment of Sleep Apnea cohort study, with complete anthropomorphic data, parent questionnaires, and home polysomnograms were included. An adolescent modification of STOP-Bang (teen STOP-Bang) was developed and included snoring, tired, observed apnea, blood pressure ≥ 95th percentile, BMI > 95th percentile, academic problems, neck circumference >95th percentile for age, and male gender. An apnea-hypopnea index ≥ 1.5 events/hour was considered diagnostic of OSA. RESULTS Receiver Operator Characteristic (ROC) curves for parent-reported STOP-Bang scores were generated for teenage and pre-teen children. A STOP-Bang score of < 3 in teenagers was associated with a negative predictive value of 0.96. ROC curves were also generated based upon child-reported sexual maturity rating (SMR; n = 291). The ability of teen STOP-Bang to discriminate the presence or absence of OSA as measured by the AUC for children with SMR ≥ 4 (0.83; 95%CI 0.71-0.95) was better than children with SMR < 4 (0.63; 95%CI 0.46-0.81; p = 0.048). CONCLUSIONS In community dwelling adolescents, teen STOP-Bang may be useful in stratifying the risk of OSA.
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Galland B, Spruyt K, Dawes P, McDowall PS, Elder D, Schaughency E. Sleep Disordered Breathing and Academic Performance: A Meta-analysis. Pediatrics 2015; 136:e934-46. [PMID: 26347434 DOI: 10.1542/peds.2015-1677] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance. METHODS Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I(2)) were conducted. RESULTS Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES -0.31; P < .001; I(2) = 74%), math (ES -0.33; P < .001; I(2) = 55%), and science (ES -0.29; P = .001; I(2) = 0%), and with unsatisfactory progress/learning problems (ES -0.23; P < .001; I(2) = 0%) but not general school performance. CONCLUSIONS Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.
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Affiliation(s)
| | - Karen Spruyt
- Department of Developmental and Behavioral Pediatrics, Jiao Tong University School of Medicine, Shanghai, China; Faculty of Psychology, Vrije Universiteit Brussel and School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Patrick Dawes
- Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Philippa S McDowall
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and
| | - Dawn Elder
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and
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Abstract
Sleep-disordered breathing (SDB) refers to a group of disorders characterized by abnormalities of respiration or ventilation during sleep. It encompasses obstructive sleep apnea (OSA), central sleep apnea (CSA) syndromes, sleep-related hypoventilation and sleep-related hypoxemia disorders. This review will concentrate on the disorder most prevalent in pediatrics, i.e., OSA, highlighting the most recent developments in our understanding of the etiology, pathophysiology and treatment options of this condition. OSA morbidities primarily involve the neurocognitive, cardiovascular and metabolic systems. However, there can be significant phenotypic variation in terms of end organ morbidity for the same OSA severity. This is likely due to the interplay between genetic and environmental factors; recent developments in the fields of genomics and proteomics have the potential to shed light on these complex pathological cascades. As we enter the era of personalized medicine, phenotyping patients to enable clinicians to tailor bespoke clinical management plans will be of crucial importance.
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Lau EYY, Choi EWM, Lai ESK, Lau KNT, Au CT, Yung WH, Li AM. Working memory impairment and its associated sleep-related respiratory parameters in children with obstructive sleep apnea. Sleep Med 2015; 16:1109-15. [PMID: 26298787 DOI: 10.1016/j.sleep.2015.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Working memory deficits in children with obstructive sleep apnea (OSA) have been reported in previous studies, but the results were inconclusive. This study tried to address this issue by delineating working memory functions into executive processes and storage/maintenance components based on Baddeley's working memory model. METHODS Working memory and basic attention tasks were administered on 23 OSA children aged 8-12 years and 22 age-, education-, and general cognitive functioning-matched controls. Data on overnight polysomnographic sleep study and working memory functions were compared between the two groups. Associations between respiratory-related parameters and cognitive performance were explored in the OSA group. RESULTS Compared with controls, children with OSA had poorer performance on both tasks of basic storage and central executive components in the verbal domain of working memory, above and beyond basic attention and processing speed impairments; such differences were not significant in the visuo-spatial domain. Moreover, correlational analyses and hierarchical regression analyses further suggested that obstructive apnea-hypopnea index (OAHI) and oxygen saturation (SpO2) nadir were associated with verbal working memory performance, highlighting the potential pathophysiological mechanisms of OSA-induced cognitive deficits. CONCLUSIONS Verbal working memory impairments associated with OSA may compromise children's learning potentials and neurocognitive development. Early identification of OSA and assessment of the associated neurocognitive deficits are of paramount importance. Reversibility of cognitive deficits after treatment would be a critical outcome indicator.
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Affiliation(s)
- Esther Yuet Ying Lau
- Sleep Laboratory, University of Hong Kong, Hong Kong; Department of Psychology, University of Hong Kong, Hong Kong; Department of Psychiatry, University of Hong Kong, Hong Kong.
| | | | | | - Kristy N T Lau
- Sleep Laboratory, University of Hong Kong, Hong Kong; Department of Psychology, University of Hong Kong, Hong Kong
| | - C T Au
- Department of Pediatrics, Prince of Wales Hospital, Hong Kong
| | - W H Yung
- School of Biomedical Sciences, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albert M Li
- Department of Pediatrics, Prince of Wales Hospital, Hong Kong
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O’Brien LM. Sleep-Related Breathing Disorder, Cognitive Functioning, and Behavioral-Psychiatric Syndromes in Children. Sleep Med Clin 2015; 10:169-79. [DOI: 10.1016/j.jsmc.2015.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Brockmann PE, Schlaud M, Poets CF, Urschitz MS. Predicting poor school performance in children suspected for sleep-disordered breathing. Sleep Med 2015; 16:1077-83. [PMID: 26298782 DOI: 10.1016/j.sleep.2015.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Habitually snoring children are at a greater risk of poor school performance (PSP). We investigated the ability of conventional sleep-disordered breathing (SDB) measures for predicting PSP in habitually snoring children. METHODS The dataset of Hannover Study on Sleep Apnea in Childhood (HASSAC), a large community-based study in primary school children, was retrospectively analyzed. All habitual snorers were included. Based on their grades, children were grouped into good and poor school performers. SDB measures obtained by a parental questionnaire, a home pulse oximetry, and a home polysomnography were evaluated for their accuracy in predicting poor school performance by calculating receiver operating characteristic curves and area under this curve (AUC). The most predictive single factors were identified and entered into a prediction model. RESULTS Of 114 habitual snorers (mean age 9.6 years, 51 boys), 59 had PSP. All investigated SDB measures showed low accuracy (ie, AUC <0.8). The highest AUC observed was 0.686 for a questionnaire score, 0.565 for an oximetry factor, and 0.624 for a polysomnography factor. Of 20 single significant predictors for PSP, five were selected for inclusion into a prediction model. The model reached an unadjusted AUC of 0.826 and an adjusted AUC of 0.851. CONCLUSIONS Conventional SDB measures obtained with questionnaire, oximetry, or polysomnography may not be sufficiently predictive of PSP in children suspected for SDB. However, combining factors in a clinical prediction model may improve prediction. Results of such a model may be used to assess the risk of developing neurocognitive impairment and to decide whether a child suspected for SDB might benefit from treatment.
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Affiliation(s)
- Pablo E Brockmann
- Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany; Department of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany
| | - Michael S Urschitz
- Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany; Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Naraghi M, Adil S, Bastaninejad S, Dabiran S. Evaluation of pediatric voice handicap index and pediatric voice related quality of life before and after adenotonsillectomy in pediatric population. Int J Pediatr Otorhinolaryngol 2015; 79:388-91. [PMID: 25599861 DOI: 10.1016/j.ijporl.2014.12.034] [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: 10/03/2014] [Revised: 12/25/2014] [Accepted: 12/26/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up. METHODS Quasi-experimental (before and after study). Eighty-six children aged 3-13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it. RESULTS Reliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001). CONCLUSION Adenotonsillectomy improved PVHI and PVRQOL scores in children with adenotonsillar problems, regardless of obstructive or infectious surgical indications.
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Affiliation(s)
- Mohsen Naraghi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Rhinology Research Society, Iran
| | - Susan Adil
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheila Dabiran
- Department of community medicine, Tehran University of Medical Sciences, Iran
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Garetz SL, Mitchell RB, Parker PD, Moore RH, Rosen CL, Giordani B, Muzumdar H, Paruthi S, Elden L, Willging P, Beebe DW, Marcus CL, Chervin RD, Redline S. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics 2015; 135:e477-86. [PMID: 25601979 PMCID: PMC4306791 DOI: 10.1542/peds.2014-0620] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Data from a randomized, controlled study of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) were used to test the hypothesis that children undergoing surgery had greater quality of life (QoL) and symptom improvement than control subjects. The objectives were to compare changes in validated QoL and symptom measurements among children randomized to undergo adenotonsillectomy or watchful waiting; to determine whether race, weight, or baseline OSAS severity influenced changes in QoL and symptoms; and to evaluate associations between changes in QoL or symptoms and OSAS severity. METHODS Children aged 5 to 9.9 years with OSAS (N = 453) were randomly assigned to undergo adenotonsillectomy or watchful waiting with supportive care. Polysomnography, the Pediatric Quality of Life inventory, the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire, the 18-item Obstructive Sleep Apnea QoL instrument, and the modified Epworth Sleepiness Scale were completed at baseline and 7 months. Changes in the QoL and symptom surveys were compared between arms. Effect modification according to race and obesity and associations between changes in polysomnographic measures and QoL or symptoms were examined. RESULTS Greater improvements in most QoL and symptom severity measurements were observed in children randomized to undergo adenotonsillectomy, including the parent-completed Pediatric Quality of Life inventory (effect size [ES]: 0.37), the 18-item Obstructive Sleep Apnea QoL instrument (ES: -0.93), the modified Epworth Sleepiness Scale score (ES: -0.42), and the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire (ES: -1.35). Effect modification was not observed by obesity or baseline severity but was noted for race in some symptom measures. Improvements in OSAS severity explained only a small portion of the observed changes. CONCLUSIONS Adenotonsillectomy compared with watchful waiting resulted in significantly more improvements in parent-rated generic and OSAS-specific QoL measures and OSAS symptoms.
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Affiliation(s)
- Susan L. Garetz
- Department of Otolaryngology–Head and Neck Surgery and Sleep Disorders Center
| | - Ron B. Mitchell
- Departments of Otolaryngology and Pediatrics, Utah Southwestern and Children’s Medical Center, Dallas, Texas
| | | | - Reneé H. Moore
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Carol L. Rosen
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bruno Giordani
- Departments of Psychiatry and Psychology and Sleep Disorders Center, and
| | - Hiren Muzumdar
- Division of Pulmonary Medicine, Allergy, & Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shalini Paruthi
- Department of Pediatrics, Cardinal Glennon Children’s Medical Center, Saint Louis University, St Louis, Missouri
| | | | - Paul Willging
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and
| | - Dean W. Beebe
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Carole L. Marcus
- Pediatrics, Sleep Center, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ronald D. Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan Health Center, Ann Arbor, Michigan
| | - Susan Redline
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Ullman N, Anas NG, Izaguirre E, Haugen W, Ortiz H, Arguello O, Nickerson B, Mink RB. Usefulness of cerebral NIRS in detecting the effects of pediatric sleep apnea. Pediatr Pulmonol 2014; 49:1036-42. [PMID: 24339172 DOI: 10.1002/ppul.22962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/14/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with sleep apnea have increased morbidity if the sleep apnea is untreated. Polysomnography (PSG) is used to detect sleep apnea, but in children, there are technical difficulties that make the diagnosis more difficult. Cerebral near infrared spectroscopy (NIRS) has the ability to detect tissue hypoxia by measuring regional oxygen saturation (rSO2 ). We hypothesized that when used as an adjunct to PSG testing, cerebral NIRS would better detect the effects of sleep apnea in children than arterial pulse oximetry (SpO2 ). Specifically, we aimed to show that the apnea/hypopnea index (AHI) calculated with rSO2 from the NIRS would be greater than that calculated with SpO2 . METHODS Forty-seven patients under 18 years of age who underwent PSG testing for sleep apnea were evaluated. Cerebral NIRS was utilized in addition to PSG. The AHI was calculated using SpO2 and compared to the AHI calculated using the rSO2 . A pediatric pulmonologist who was unaware of the NIRS data evaluated each patient for sleep apnea. Data are median (interquartile range). RESULTS The median AHI(rSO2 ) was 2.4(1.2,5.1), significantly greater (P < 0.0001) than the AHI(SpO2 ) of 0.7(0.4,1.2). Four patients were diagnosed with sleep apnea; however, only one had an AHI(SpO2 ) ≥ 5, a typical threshold for the diagnosis of sleep apnea. All 4 subjects had an AHI(rSO2 ) ≥ 5 but 10 patients without sleep apnea had a value ≥5. The sensitivity and specificity for using the AHI(rSO2 ) to diagnose sleep apnea was 100% and 76.7%, respectively. CONCLUSION Consistent with the ability of NIRS to detect tissue hypoxia, we found that the AHI calculated with rSO2 was greater than that using SpO2 . We conclude that NIRS has potential as a valuable adjunct to PSG in evaluating patients for sleep apnea and warrants further investigation for this purpose.
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Affiliation(s)
- Nachman Ullman
- Harbor-UCLA Medical Center, Torrance, California; CHOC Children's, Orange, California
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Sedky K, Bennett DS, Carvalho KS. Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: A meta-analysis. Sleep Med Rev 2014; 18:349-56. [DOI: 10.1016/j.smrv.2013.12.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 11/25/2013] [Accepted: 12/15/2013] [Indexed: 12/25/2022]
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Sleep architecture in school-aged children with primary snoring. Sleep Med 2014; 15:303-8. [DOI: 10.1016/j.sleep.2013.08.801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/05/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
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Mohsen N, Susan A, Shahin B, Soheila D. Sleep related quality of life before and after adenotonsillar surgery in pediatric population. Int J Pediatr Otorhinolaryngol 2014; 78:330-3. [PMID: 24377491 DOI: 10.1016/j.ijporl.2013.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 12/01/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the quality of life in children with adenotonsillar problems before and after adenotonsillectomy in short term follow-up. METHODS Quasi-experimental study (before and after study) of children with adenotonsillar problems at Tehran University of Medical Sciences, Amir'Alam hospital. Eighty six pediatric patients aged 3 through 13 years (58 boys and 28 girls) who underwent adenotonsillectomy, for treatment of sleep disordered breathing or recurrent throat infection, were recruited. Parents completed OSA-18 quality of life survey and Brouillette score questionnaire before and one month after surgery. RESULTS Reliability of the Brouillette score and OSA-18 survey was established by evaluating the Cronbach α value. Cronbach α for Brouillette score was 0.70 and for OSA-18 survey it was 0.88. Preoperative values for the OSA-18 total and domain scores were high in children: mean±SD; 61.65±20.78. Preoperative values for the Brouillette score were: mean±SD; 0.41±2.34. The total OSA-18 survey score and the scores for all domains showed significant improvement after surgery: mean±SD; 28.01±9.09 (P<0.001). Post-operative Brouillette score had a significant improvement: mean±SD; -3.57±0.91 (P<0.001). CONCLUSION Considering the OSA-18 survey and Brouillete score results, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life in both obstructive and infective adenotonsillar disease.
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Affiliation(s)
- Naraghi Mohsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Rhinology Research Society, Iran
| | - Adil Susan
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bastaninejad Shahin
- Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Dabiran Soheila
- Department of Community Medicine, Tehran University of Medical Sciences, Iran
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Perfect MM, Levine-Donnerstein D, Archbold K, Goodwin JL, Quan SF. THE CONTRIBUTION OF SLEEP PROBLEMS TO ACADEMIC AND PSYCHOSOCIAL FUNCTIONING. PSYCHOLOGY IN THE SCHOOLS 2014. [DOI: 10.1002/pits.21746] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Borgström A, Nerfeldt P, Friberg D. Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2013; 77:1864-8. [PMID: 24055180 DOI: 10.1016/j.ijporl.2013.08.030] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/23/2013] [Accepted: 08/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of the quality-of-life instrument OSA-18 by comparing it with objective data from polysomnography in children with sleep-disordered breathing. STUDY DESIGN Cross-sectional. PATIENTS AND METHODS Full-night polysomnographic data were obtained from 225 subjects, 139 boys and 86 girls, median age 4.5 years (1-12) in our sleep laboratory. Their caregivers answered the OSA-18 quality-of-life instrument (range 18-126). The polysomnographic parameter, the apnea-hypopnea index (AHI) was compared with the total symptom score (TSS) and with the subscale of sleep disturbance (SD) from the OSA-18 questionnaire. Receiver operating characteristic (ROC) curves were created to test the predictive value of OSA-18. RESULTS With the TSS of the OSA-18 at ≥60, compared with AHI levels of >1 and ≥5, the sensitivity was 55.2% and 59.3% respectively, and the specificity 40.9% and 48.4%, respectively. With the TSS>80 and AHI levels of ≥5 and ≥10, the sensitivity was 24.6% and 32.1%, respectively. For the subscale of SD, the majority of the subjects showed poor correlation with the AHI values. The ROC area under the curve for different levels of the AHI (>1, ≥5, and ≥10) was 0.49, 0.57, and 0.56, respectively. CONCLUSIONS The OSA-18 questionnaire showed poor validity in detecting and predicting pediatric OSA. The majority of the children with severe OSA would not be correctly diagnosed if the OSA-18 were used as a dominant diagnostic tool.
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Affiliation(s)
- Anna Borgström
- Department of Otorhinolaryngology, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden.
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Brockmann PE, Schaefer C, Poets A, Poets CF, Urschitz MS. Diagnosis of obstructive sleep apnea in children: A systematic review. Sleep Med Rev 2013; 17:331-40. [DOI: 10.1016/j.smrv.2012.08.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/19/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
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Soylu E, Soylu N, Yıldırım YS, Sakallıoğlu Ö, Polat C, Orhan I. Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2013; 77:1775-81. [PMID: 24011939 DOI: 10.1016/j.ijporl.2013.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/14/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy. MATERIALS AND METHODS The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms. RESULTS Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six. CONCLUSION Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.
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Affiliation(s)
- Erkan Soylu
- Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, İstanbul, Turkey.
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Abstract
Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment.
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Affiliation(s)
- Hui-Leng Tan
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Leila Kheirandish-Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
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Csábi E, Benedek P, Janacsek K, Katona G, Nemeth D. Sleep disorder in childhood impairs declarative but not nondeclarative forms of learning. J Clin Exp Neuropsychol 2013; 35:677-85. [PMID: 23848557 DOI: 10.1080/13803395.2013.815693] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A large amount of studies have investigated the association between sleep and memory systems. However, remarkably little is known of the effect of sleep disorders on declarative and nondeclarative memory for children. In the present study we examined the effects of sleep disorders on different aspects of memory functions by testing children with sleep-disordered breathing (SDB), which is characterized by disrupted sleep patterns. We used "The War of the Ghosts" test to measure declarative memory and the Alternating Serial Reaction Time (ASRT) task. This enabled us to measure two aspects of nondeclarative memory--general skill learning and sequence-specific learning--separately. Ten children with SDB and 10 healthy controls participated in this study. Our data showed dissociation between declarative and nondeclarative memory in children with SDB. They showed impaired declarative memory, while the sequence-specific and general skill learning was similar to that of healthy controls, in spite of sleep disruption. Our findings suggest that sleep-disordered breathing affects declarative and nondeclarative memory differently in children. Moreover, these findings imply that the disrupted sleep pattern influences the more attention-demanding and cortical structure-guided explicit processes, while the less attention-demanding implicit processes mediated by subcortical structures are preserved.
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Affiliation(s)
- Eszter Csábi
- a Institute of Psychology, University of Szeged , Szeged , Hungary
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Soylu E, Soylu N, Yıldırım YS, Polat C, Sakallıoğlu O. The prevelance of psichiatric symptoms in preschool children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2013; 77:1094-8. [PMID: 23643332 DOI: 10.1016/j.ijporl.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of psychiatric disorders and symptoms in preschool-age children who are indicated for operation due to adenotonsillar hypertrophy. MATERIALS AND METHODS Forty-eight patients between the ages of three and five years with indication for adenotonsillectomy were included in the study, as well as 40 control patients. Cases underwent routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry. The Early Childhood Inventory-4 (ECI-4) parent form and Strengths and Difficulties Questionnaire (SDQ) parent form were completed by the parent caring for the child. The SPSS for Windows 16.0 program was used for statistical analysis. RESULTS Groups were compared according to they received at least one psychiatric diagnosis measured by ECI-4, the group of adenotonsillar hypertrophy was diagnosed more than the control group. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and sleep disorders were detected at a higher rate in patients with adenotonsillar hypertrophy. It also was established that in the comparison of the severity of psychiatric symptoms determined by ECI-4, symptom severity of ADHD, ODD, anxiety disorders, and sleep disorders was higher in the adenotonsillar hypertrophy group than in the control group. In the evaluation of the SDQ parent form, it was determined that attention deficit, hyperactivity, behavioral, and peer relations problems occurred more frequently in the adenotonsillar hypertrophy group. CONCLUSIONS In addition to oral respiration, snoring, and disordered breathing during sleep, adenotonsillar hypertrophy may also associated with psychiatric disorders and symptoms.
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Affiliation(s)
- Erkan Soylu
- Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, İstanbul, Turkey.
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Effect of adenotonsillectomy on nocturnal enuresis in children with OSA. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Quan SF, Archbold K, Gevins AS, Goodwin JL. Long-Term Neurophysiologic Impact of Childhood Sleep Disordered Breathing on Neurocognitive Performance. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2013; 7:165-175. [PMID: 24511452 PMCID: PMC3915536 DOI: 10.13175/swjpcc110-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY OBJECTIVE To determine the impact of sleep disordered breathing (SDB) in children on neurocognitive function 5 years later. DESIGN SETTING AND PARTICIPANTS A subgroup of 43 children from the Tucson Children's Assessment of Sleep Apnea Study (TuCASA) who had SDB (RDI ≥ 6 events/hour) at their initial exam (ages 6-11 years) were matched on the basis of age (within 1 year), gender and ethnicity (Anglo/Hispanic) to 43 children without SDB (Control, RDI ≤ 4 events/hour). The Sustained Working Memory Task (SWMT) which combines tests of working memory (1-Back Task), reaction time (Simple Reaction Time) and attention (Multiplexing Task) with concurrent electroencephalographic monitoring was administered approximately 5 years later. RESULTS There were no differences in performance on the working memory, reaction time and attention tests between the SDB and Control groups. However, the SDB group exhibited lower P300 evoked potential amplitudes during the Simple Reaction Time and Multiplexing Tasks. Additionally, peak alpha power during the Multiplexing Task was lower in the SDB Group with a similar trend in the Simple Reaction Time Task (p=0.08). CONCLUSIONS SDB in children may cause subtle long-term changes in executive function that are not detectable with conventional neurocognitive testing and are only evident during neuroelectrophysiologic monitoring.
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Affiliation(s)
- Stuart F. Quan
- Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Kristen Archbold
- Practice Division, University of Arizona College of Nursing, Tucson, AZ
| | - Alan S. Gevins
- SAM Technology & San Francisco Brain Research Institute, San Francisco, CA
| | - James L. Goodwin
- Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
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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: 968] [Impact Index Per Article: 80.7] [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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