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Senthilvel E, Jawad K, Gearhart AM, Naidugari JR, El-Kersh K. Adenotonsillectomy outcomes in children with down syndrome and obstructive sleep apnea: a single center study. Sleep Breath 2024:10.1007/s11325-024-03085-2. [PMID: 38896208 DOI: 10.1007/s11325-024-03085-2] [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: 12/20/2023] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE This study aimed to evaluate polysomnographic (PSG) outcomes of tonsillectomy and adenoidectomy (T&A) in children with Down Syndrome (DS) and OSA, and the difference in PSG outcomes of T&A between children with DS and age- and gender-matched normally developing (non-DS) children. METHODS This was a single center retrospective study that included children with DS and OSA who underwent T&A and had pre-operative and post-operative PSG. The baseline and the differences of pre- and post-operative PSG variables were compared with those of an age- and gender-matched group of non-DS children. RESULTS Forty-eight children with DS were included in the study; the median age was 5 years (IQR 5.5), 58% were males, and the median BMI was 18.2 (IQR 3.3). There was statistically significant improvement noted between pre-operative and post-operative OAHI 17.9 ± 26.7 vs. 9.1 ± 13.6 (p = 0.022) and non-REM AHI 13.9 ± 19.7 vs. 6.9 ± 14.2 (p = 0.027). However, there were no significant changes in sleep architecture, oxygen desaturation nadir, or CO2 levels. 54.2% of the DS children continued to have moderate to severe OSA after T&A. Univariate logistic regression showed that for every 1% increase in oxygen desaturation nadir, the odds of having residual moderate or severe OSA decreased by 28% (p = 0.002) compared to the cured and mild OSA groups. There was no significant pre- and post-operative differences in PSG variables noted in 16 children with DS compared to age- and gender-matched non-DS children. CONCLUSION Despite the overall significant reduction of OAHI in children with DS and OSA who underwent T&A, there was a residual moderate to severe OSA in about half of the included children. Oxygen desaturation nadir was a predicting factor for persistent moderate to severe OSA. There were no significant pre- and post-operative PSG differences in between DS children compared to non-DS children.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, KY40241, USA.
| | - Kahir Jawad
- Department of Pediatrics, Norton Children's Research Institute, Affiliated with University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Alessandra M Gearhart
- Department of Pulmonary, Critical Care and Sleep Medicine, Oklahoma State University, Tulsa, OK, USA
| | - Janki R Naidugari
- University of Louisville School of Medicine, Louisville, Kentucky,, USA
| | - Karim El-Kersh
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Silva de Sousa A, Pereira da Rocha A, Brandão Tavares DR, Frazão Okazaki JÉ, de Andrade Santana MV, Fernandes Moça Trevisani V, Pereira Nunes Pinto AC. Respiratory muscle training for obstructive sleep apnea: Systematic review and meta-analysis. J Sleep Res 2024; 33:e13941. [PMID: 37258418 DOI: 10.1111/jsr.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
Obstructive sleep apnea is the most common sleep disorder. This review aims to evaluate the effectiveness and safety of respiratory muscle training in the treatment of patients with obstructive sleep apnea. The study protocol was registered in Prospero Platform (CRD42018096980). We performed searches in the main databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed; Excerpta Medica dataBASE (Embase) via Elsevier; Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library; Latin American and Caribbean Literature on Health Sciences (LILACS) through the Portal of the Virtual Health Library and Physiotherapy Evidence Database (PEDro) for all randomised-controlled trials published before July 2022. The randomised-controlled trials were assessed for risk of bias and certainty of evidence. Thirteen randomised-controlled trials were included. All studies had an overall high risk of bias. Inspiratory muscle training probably improves systolic blood pressure and sleepiness when compared with sham. However, inspiratory muscle training probably does not improve diastolic blood pressure and maximum expiratory pressure, and may not be superior to sham for apnea-hypopnea index, forced expiratory volume in 1 s, forced vital capacity, sleep quality and quality of life. In addition, it is uncertain whether there is any effect of inspiratory muscle training on maximum inspiratory pressure and physical capacity. Inspiratory muscle training may also improve maximum inspiratory pressure and maximum expiratory pressure compared with oropharyngeal exercises. However, it may not be superior for apnea-hypopnea index, sleep quality, sleepiness, quality of life and functional capacity. When associated with physical exercise, inspiratory muscle training may not be superior to physical exercise alone for maximum inspiratory pressure, maximum expiratory pressure, systolic and diastolic blood pressure, and functional capacity. At the same time, when associated with cardiac rehabilitation exercises, inspiratory muscle training may reduce apnea-hypopnea index, improve inspiratory muscle strength, sleepiness and sleep quality compared with cardiac rehabilitation alone. However, it may not be superior for improving quality of life. Regarding expiratory muscle training, it may improve expiratory muscle strength and sleep quality, but not sleepiness when compared with sham. The evidence on the effects of expiratory muscle training in apnea-hypopnea index is very uncertain.
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Affiliation(s)
- André Silva de Sousa
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | - Aline Pereira da Rocha
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Jane Érika Frazão Okazaki
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Virgínia Fernandes Moça Trevisani
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
- Universidade de Santo Amaro, São Paulo, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
- Universidade Federal do Amapá, Macapá, Brazil
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Lai WY, Wei CC, Lin CH, Hang LW, Shih YH, Huang FW, Yen HR. Integrative traditional Chinese medicine treatment for children with obstructive sleep apnea. J Tradit Complement Med 2024; 14:109-120. [PMID: 38223810 PMCID: PMC10785241 DOI: 10.1016/j.jtcme.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is a chronic disease that affects 1%-6% of children. Our study aims to explore the effectiveness and clinical characteristics of integrative Traditional Chinese Medicine (ITCM) for pediatric OSA. Materials and methods In this retrospective cohort study, we assessed differences of polysomnography (PSG) parameters and clinical characteristics between 2009 and 2020. Children <12 years old diagnosed with OSA (n = 508) were included and were categorized into ITCM cohort, western medicine (WM) cohort ,and surgery cohort. Outcomes were apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and body mass index (BMI). Results There were 56 (11%), 324 (63.8%), and 128 (25.2%) patients in the ITCM, WM, and surgery cohorts. Among 17, 26, and 33 patients in the ITCM, WM, and surgery cohorts underwent follow-up PSG studies, respectively. In the ITCM follow-up cohort, AHI were significantly reduced (9.59 to 5.71, p < 0.05). BMI significantly increased in the WM follow-up cohort (19.46 to 20.50, p < 0.05) and the surgery follow-up cohort (18.04 to 18.85, p < 0.01). Comparing ITCM to WM cohort, a significant difference was found between the changes in RDI (ITCM: -6.78, WM: 0.51, p < 0.05) after treatment. Among ITCM follow-up cohort, the most prescribed TCM formula was Forsythia and Laminaria Combination. The most prescribed TCM herb was Ephedrae Herba. Conclusions ITCM therapy can significantly reduce RDI and control BMI. We identified potential TCM treatments for pediatric OSA. Further study of the pharmacological mechanisms and clinical efficacy is warranted.
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Affiliation(s)
- Wan-Yu Lai
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chang-Ching Wei
- Department of Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Heng Lin
- Department of Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Liang- Wen Hang
- Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fen-Wei Huang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
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Michaud L, Sharedalal P, Seplowe M, Rosenzveig A, Frishman WH, Aronow WS. Hyperlipidemia in Children and Adolescents. Cardiol Rev 2023; 31:330-335. [PMID: 35700367 DOI: 10.1097/crd.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While coronary artery disease (CAD) is thought to be a disease of adulthood, atherosclerosis can originate in childhood and adolescence. There is a paucity of randomized controlled treatment trials regarding dyslipidemia among the younger population. However, it is apparent that childhood dyslipidemia is associated with an earlier onset of CAD. Most recent guidelines by the American College of Cardiology (ACC) and American Heart Association (AHA) focus on lifestyle modification and lifetime risk of atherosclerotic disease, as well as adequate screening measures. Genetic factors, environmental contributors such as pollution, obesity linked to poor nutrition, and sedentary lifestyles are shown to be associated with increased lipid levels and early CAD among children and adolescents. Familial hyperlipidemia is one of the most prevalent genetic diseases and can affect 1 in 250 individuals. A multimodal treatment plan is most effective for children and adolescents with dyslipidemia including lifestyle changes (a modified diet and moderate physical activity) and pharmacologic intervention. The mainstay of pharmacologic treatment for childhood dyslipidemia is similar to that of adults. Statins are the most widely used medications. Newer medications have proven integral in treatment for genetic dyslipidemias including evolocumab and evinacumab.
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Affiliation(s)
- Liana Michaud
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Parija Sharedalal
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Matthew Seplowe
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | - William H Frishman
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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Jiang W, Li W, Cheng J, Li W, Cheng F. Efficacy and safety of liraglutide in patients with type 2 diabetes mellitus and severe obstructive sleep apnea. Sleep Breath 2023; 27:1687-1694. [PMID: 36542275 PMCID: PMC10539428 DOI: 10.1007/s11325-022-02768-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To observe the efficacy and side effects of liraglutide in the treatment of type 2 diabetes mellitus (T2DM) patients with severe obstructive sleep apnea (OSA). METHODS The study conducted in an outpatient setting was a two-center, prospective randomized controlled study. T2DM patients with severe OSA were randomized to the control group (continuous positive airway pressure [CPAP] and drug treatment without liraglutide) or the liraglutide group (CPAP and drug treatment including liraglutide). Demographic and clinical characteristics, sleep-disordered breathing indices, cardiac function indices, and side effects were evaluated and compared between the two groups before and after 3 months. RESULTS Of 90 patients, 45 were randomized to the intervention arm (with liraglutide) and 45 to the control arm (without liraglutide). One patient in the liraglutide group dropped out of the study on day 8 after enrollment due to obvious gastrointestinal symptoms. No significant differences were found between the two groups in baseline demographics, clinical characteristics, cardiac function indicators, or sleep disorder respiratory indices (P > 0.05). After 3 months, the body mass index (BMI), apnea hypopnea index (AHI), and mean systolic blood pressure in the liraglutide treatment group were significantly lower than those in the control group (P < 0.05). The minimum oxygen saturation was significantly higher in the liraglutide group compared with that in the control group after 3 months of follow-up (P < 0.05). No difference was found between the two groups in the summary of side effects (P > 0.05). CONCLUSIONS Liraglutide combined with CPAP can effectively reduce BMI, lower mean systolic blood pressure, and improve AHI scores and hypoxia in T2DM patients with severe OSA. Liraglutide did not increase side effects.
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Affiliation(s)
- Wenlong Jiang
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China
| | - Weiguo Li
- Department of Cardiovascular, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian, China
| | - Jing Cheng
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China
| | - Wen Li
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China
| | - Fangzhou Cheng
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China.
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Chuang HH, Lin RH, Hsu JF, Chuang LP, Li HY, Fang TJ, Huang YS, Yang AC, Lee GS, Kuo TBJ, Yang CCH, Lee LA. Dietary profile of pediatric obstructive sleep apnea patients, effects of routine educational counseling, and predictors for outcomes. Front Public Health 2023; 11:1160647. [PMID: 37377550 PMCID: PMC10291126 DOI: 10.3389/fpubh.2023.1160647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Background Dietary behavior is a main contributing yet modifiable factor to the body weight status of children and may be involved in the pathophysiology of childhood obstructive sleep apnea (OSA). This study aimed to investigate the dietary profile of pediatric OSA patients, effects of educational counseling after adenotonsillectomy, and predictor for disease resolution. Methods This observational study included 50 pediatric OSA patients undergoing adenotonsillectomy with routine educational counseling (Group 1), 50 pediatric OSA patients undergoing adenotonsillectomy without formal educational counseling (Group 2), and 303 healthy children without OSA (Control). The three groups were matched by age. The consumption frequency of 25 food items/groups was assessed by the Short Food Frequency Questionnaire. Quality of life was evaluated by the OSA-18 questionnaire. Sleep architecture and OSA severity were measured by standard polysomnography. Between- and within-group comparisons were analyzed by non-parametric approaches and generalized estimating equations. Prediction of disease recovery was performed by multivariable logistic regression models. Results Group 1 children consumed fruit drinks with sugar, vegetables, sweets, chocolate, rice, and noodles more frequently than Control Group children. At baseline, the distributions of sex, weight status, OSA-18 scores, and polysomnographic variables were comparable between Group 1 and Group 2. After a 12-month follow-up, Group 1 had better improvements in physical suffering, caregiver concerns, sleep architecture, and mean peripheral oxygen saturation compared to Group 2. Furthermore, Group 1 no longer had excessive consumption of fruit drinks with sugar, chocolate, and noodles; however, food consumption frequencies did not change significantly. Notably, younger age and reduced intake of butter/margarine on bread and noodles were independent predictors of cured OSA in Group 1. Conclusion The present study preliminarily characterized an unhealthy dietary profile among pediatric OSA patients and suggested that routine educational counseling in addition to adenotonsillectomy yielded some clinical benefits. Certain items/groups of food frequencies may be associated with disease recovery and further investigations are warranted.
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Affiliation(s)
- Hai-Hua Chuang
- Department of Family Medicine, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Industrial Engineering and Manage-ment, National Taipei University of Technology, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Rong-Ho Lin
- Department of Industrial Engineering and Manage-ment, National Taipei University of Technology, Taipei, Taiwan
| | - Jen-Fu Hsu
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pulmonary and Critical Care Medicine, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Child Psychiatry, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Albert C. Yang
- Department of Psychiatry, Taipei Veter-ans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Guo-She Lee
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Otolaryngology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Tsaotun Psychiatric Center, Ministry of Health and Wel-fare, Nantou, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ang Lee
- Metabolism and Obesity Institute, Taipei and Linkou Main Branches, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Sleep Center, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med 2023; 19:1027-1033. [PMID: 36727478 PMCID: PMC10235720 DOI: 10.5664/jcsm.10468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. METHODS This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. RESULTS The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. CONCLUSIONS STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. CITATION Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Quang L. Nguyen
- Deaconess Health, Division of Pulmonary Critical Care and Sleep Medicine, University of Louisville, Louisville, Kentucky
| | | | - Yana B. Feygin
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Rajaneeshankar Palani
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Karim El-Kersh
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Cuda SE, Kharofa R, Williams DR, O'Hara V, Conroy R, Karjoo S, Paisley J, Censani M, Browne NT. Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100031. [PMID: 37990723 PMCID: PMC10662000 DOI: 10.1016/j.obpill.2022.100031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age. Conclusions This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
- Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Valerie O'Hara
- WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, Pediatric Gastroenterology, 501 6th Ave S St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street, Lawrenceburg, IN, 47025-2048, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
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Maghsoudipour M, Allison MA, Patel SR, Talavera GA, Daviglus M, Zee PC, Reid KJ, Makarem N, Malhotra A. Associations of chronotype and sleep patterns with metabolic syndrome in the Hispanic community health study/study of Latinos. Chronobiol Int 2022; 39:1087-1099. [PMID: 35509113 PMCID: PMC9177706 DOI: 10.1080/07420528.2022.2069030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sleep duration, sleep efficiency, and sleep timing have been shown to have potential effects on metabolic functions relevant to circadian rhythms. It is not clear if the impact of sleep patterns on metabolic risk factors is through sociocultural and environmental factors or circadian misalignment. We investigated the associations of sleep patterns, chronotype, and social jet lag with metabolic syndrome among non-shift worker Hispanic/Latino adults. We used cross-sectional data from the Sueño Ancillary Study of The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data from a subsample of 2189 participants aged 18-64 years were used in the analysis. Mean nightly sleep duration, mean sleep onset time, mean sleep offset time, mean sleep midpoint time, sleep efficiency, sleep variability (standard deviation (SD) of sleep duration, and SD of sleep midpoint), and time spent above light exposure threshold (1000 lux) in a day were assessed by wrist actigraphy (Acti-watch Spectrum). Chronotype was determined by the reduced Morningness-Eveningness Questionnaire. Medical conditions including dyslipidemia, hypertension, and diabetes mellitus were determined from a fasting blood specimen and physical exam at the baseline visit. To determine whether sleep patterns, light levels, chronotype, and social jetlag are associated with metabolic syndrome, multivariable logistic regression models were fitted, including variables with P < .15 in the univariate analysis. The results of the multivariable analysis demonstrated that in participants older than 40 years, intermediate chronotype (vs early) was significantly associated with a higher risk of metabolic syndrome (Odds ratio (95%CI): 1.33 (1.04,1.7)), while later chronotype (vs. early) in participants younger than 40 years was significantly associated with a lower risk of metabolic syndrome (Odds ratio (95%CI): 0.37 (0.14, 0.96)). Also, higher sleep efficiency was significantly associated with decreased odds of metabolic syndrome (Odds ratio (95%CI): 0.98 (0.96, 0.99)). Nightly sleep duration was not significantly different between two groups of participants with and without metabolic syndrome in multivariable analyses. There was no significant association between social jet lag and metabolic syndrome in multivariable analysis (p = .286). Moreover, there was no significant association between chronotype and social jet lag in multivariable analysis. The association between metabolic syndrome and chronotype is age-dependent. While early chronotype is associated with metabolic syndrome in younger individuals, it tended to be associated with lower odds for metabolic syndrome in older individuals.
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Affiliation(s)
- Maryam Maghsoudipour
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Matthew A. Allison
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
| | - Sanjay R. Patel
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gregory A. Talavera
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kathryn J. Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nour Makarem
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA
| | - Atul Malhotra
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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10
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Afolabi-Brown O, Moore ME, Tapia IE. Sleep Deficiency in Adolescents: The School Start Time Debate. Clin Chest Med 2022; 43:239-247. [PMID: 35659022 DOI: 10.1016/j.ccm.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Adolescence is commonly accepted as a challenging time for sleep, with multiple factors contributing to sleep deficiency in adolescents. These include physiologic changes with shifts in their circadian rhythm; medical sleep disorders; and social, cultural, and environmental factors. Early school start times negatively affect sleep in adolescents as well, with poorer outcomes in their overall health, wellbeing, and performance. This article highlights the different contributing factors for sleep deficiency in adolescents and the consequences of sleep deficiency. In addition, the authors discuss the impact of delayed school start times in improving adolescents' sleep and overall function.
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Affiliation(s)
- Olufunke Afolabi-Brown
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Melisa E Moore
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Children and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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11
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Abstract
Pediatric obstructive sleep apnea (OSA) is a common entity that can cause both daytime and nighttime issues. Children with symptoms should be screened for OSA. If possible, polysomnography should be performed to evaluate symptomatic children. Depending on the severity, first-line options for treatment of pediatric OSA may include observation, weight loss, medication, or surgery. Even after adenotonsillectomy, about 20% of children will have persistent OSA. Sleep endoscopy and cine MRI are tools that may be used to identify sites of obstruction, which in turn can help in the selection of site-specific treatment.
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Affiliation(s)
- Pakkay Ngai
- Division of Pediatric Pulmonology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN 3rd Floor, Hackensack, NJ 07601, USA
| | - Michael Chee
- Division of Pediatric Otolaryngology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN PC-311, Hackensack, NJ 07601, USA.
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12
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Narang I, Kendzerska T, Heffernan A, Malik U, Carvalho CG, Ryan CM. Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care. Nat Sci Sleep 2022; 14:153-163. [PMID: 35140537 PMCID: PMC8818969 DOI: 10.2147/nss.s345143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. RESEARCH QUESTION Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? STUDY DESIGN AND METHODS Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. RESULTS Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01. INTERPRETATION Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.
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Affiliation(s)
- Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Canada.,Sleep Research laboratory, KITE-UHN
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13
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Rueda-Etxebarria M, Mugueta-Aguinaga I, Rueda JR, Lascurain-Aguirrebena I. Respiratory muscle training for obstructive sleep apnoea. Hippokratia 2021. [DOI: 10.1002/14651858.cd015039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology; Biocruces Health Research Institute, Cruces University Hospital; Barakaldo Spain
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health; University of the Basque Country; Leioa Spain
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14
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Kang EK, Jang MJ, Kim KD, Ahn YM. The association of obstructive sleep apnea with dyslipidemia in Korean children and adolescents: a single-center, cross-sectional study. J Clin Sleep Med 2021; 17:1599-1605. [PMID: 33739258 DOI: 10.5664/jcsm.9258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES To evaluate whether obstructive sleep apnea (OSA) and its severity are related to dyslipidemia and alanine transaminase elevation as a marker of nonalcoholic fatty liver disease in children. METHODS The data collected from polysomnography, laboratory measurements (lipid profile and liver enzyme), and body mass index in children aged 0-18 years who visited the pediatric department between 2012 and 2018 were retrospectively analyzed. RESULTS There were a total of 273 participants in the study (ages 0-6 years, 7-12 years, and 13-18 years: 61.9%, 26.4%, and 11.7%, respectively). In the ages 7-12 and 13-18 years groups, obesity was strongly associated with OSA severity (Cramer's V = 0.498, P < .001). High-density lipoprotein cholesterol levels were significantly lower in the OSA group than in the non-OSA group, irrespective of the presence of obesity. In addition, high-density lipoprotein cholesterol levels were significantly different between the OSA severity groups after adjusting for body mass index (P = .000). In participants who were obese, moderate and severe OSA were associated with alanine transaminase elevation (P = .023 and P = .045, respectively). CONCLUSIONS This study suggests that OSA may be an independent risk factor for dyslipidemia and that OSA and obesity have a synergistic effect on alanine transaminase elevation. Early diagnosis and treatment of OSA from childhood, especially in obese children, will reduce metabolic complications. CITATION Kang EK, Jang MJ, Kim KD, Ahn YM. The association of obstructive sleep apnea with dyslipidemia in Korean children and adolescents: a single-center, cross-sectional study. J Clin Sleep Med. 2021;17(8):1599-1605.
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Affiliation(s)
- Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Min Jeong Jang
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ki Duk Kim
- School of Medicine, Eulji University, Daejeon, Korea
| | - Young Min Ahn
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.,School of Medicine, Eulji University, Daejeon, Korea
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15
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Mochol J, Gawrys J, Gajecki D, Szahidewicz-Krupska E, Martynowicz H, Doroszko A. Cardiovascular Disorders Triggered by Obstructive Sleep Apnea-A Focus on Endothelium and Blood Components. Int J Mol Sci 2021; 22:5139. [PMID: 34066288 PMCID: PMC8152030 DOI: 10.3390/ijms22105139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. Among arousal from sleep, increased thoracic pressure and enhanced sympathetic activation, intermittent hypoxia is now considered as one of the most important pathophysiological mechanisms contributing to the development of endothelial dysfunction. Nevertheless, not much is known about blood components, which justifies the current review. This review focuses on molecular mechanisms triggered by sleep apnea. The recurrent periods of hypoxemia followed by reoxygenation promote reactive oxygen species (ROS) overproduction and increase inflammatory response. In this review paper we also intend to summarize the effect of treatment with continuous positive airway pressure (CPAP) on changes in the profile of the endothelial function and its subsequent potential clinical advantage in lowering cardiovascular risk in other comorbidities such as diabetes, atherosclerosis, hypertension, atrial fibrillation. Moreover, this paper is aimed at explaining how the presence of OSA may affect platelet function and exert effects on rheological activity of erythrocytes, which could also be the key to explaining an increased risk of stroke.
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Affiliation(s)
| | | | | | | | | | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.); (J.G.); (D.G.); (E.S.-K.); (H.M.)
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16
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Filipek N, Kirkham E, Chen M, Ma CC, Horn DL, Johnson KE, Parikh SR. Drug-induced sleep endoscopy directed surgery improves polysomnography measures in overweight and obese children with obstructive sleep apnea. Acta Otolaryngol 2021; 141:397-402. [PMID: 33372808 DOI: 10.1080/00016489.2020.1863465] [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: 10/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea affects approximately 1-4% of all children, with increased prevalence amongst overweight and obese children. OBJECTIVE To assess the effects of drug-induced sleep endoscopy (DISE)-directed surgery on polysomnography parameters in obese and overweight children. MATERIAL/METHODS A retrospective case-series was performed on obese and overweight pediatric patients who underwent clinically indicated DISE-directed surgery. Forty children met the inclusion criteria, including: body mass index ≥85%, DISE-study, and pre- and post-DISE polysomnography. Patients were divided into surgically naïve (n = 23) and prior adenotonsillectomy (n = 17) groups. Demographic and clinical characteristics were examined with chi-square and Wilcoxon rank-sum test. Polysomnography parameters were compared with Wilcoxon signed rank test. RESULTS Of 40 children with mean BMI 94% and mean age 8 ± 6 years old, 17 (43%) underwent a previous adenotonsillectomy. Overall, significant improvements were observed in the apnea-hypopnea index (AHI; 25.0 to 9.9 events/hour, p < .01) and oxygen nadir (82.7% to 88.5%, p < .01). A similar pattern was observed among the surgically naïve (AHI: 35.9 to 12.7 events/hour, p = .04; oxygen nadir: 79.7% to 86.4%, p = .2) and post-adenotonsillectomy groups (AHI: 10.4 to 6.2 events/hour, p = .02; oxygen nadir: 86.7% to 91.2%, p < .01). CONCLUSIONS/SIGNIFICANCE Polysomnography parameters significantly improved following DISE-directed interventions in obese and overweight children with obstructive sleep apnea.
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Affiliation(s)
- Natalia Filipek
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Erin Kirkham
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Maida Chen
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - Cheng Cheng Ma
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - David L. Horn
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Kaalan E. Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Sanjay R. Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
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17
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Kaar JL, Morelli N, Russell SP, Talker I, Moore JM, Inge TH, Nadeau KJ, Hawkins SMM, Aloia MS, Simon SL. Obstructive sleep apnea and early weight loss among adolescents undergoing bariatric surgery. Surg Obes Relat Dis 2020; 17:711-717. [PMID: 33478907 DOI: 10.1016/j.soard.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known regarding obstructive sleep apnea's (OSA's) prevalence or the factors related to OSA remission post-metabolic bariatric surgery (MBS) in adolescents. OBJECTIVES To identify the baseline OSA prevalence in adolescents with severe obesity and examine factors associated with post-MBS OSA remission. SETTING Tertiary-care children's hospital. METHODS We conducted a retrospective chart review of 81 patients pre-MBS with OSA assessments done between June 2017 to September 2020 to collect demographic characteristics; co-morbidities; polysomnography (PSG) results, if indicated; and weight data. Chi-square or Mann-Whitney tests compared baseline characteristics and surgical outcomes by pre-MBS OSA status. McNemar's test or t tests assessed differences in baseline characteristics, stratified by remission versus no remission of OSA. RESULTS The patients were 71% female, had an average age of 16.9 ± 2.0 years, and had a mean body mass index (BMI) of 47.9 ± 7.3 kg/m2. Half (50%) of the patients were Hispanic and 20% had type 2 diabetes. The OSA prevalence, defined as an Obstructive Apnea Hypopnea Index (OAHI) score ≥5, was 54% pre-MBS (n = 44), with 43% having severe OSA (OAHI > 30). Those with OSA were older (17.3 versus 16.4 yr, respectively; P = .05), more likely to be male (79% versus 42%, respectively; P = .022), and had higher baseline weights (142.0 versus 126.4 kg, respectively; P = .001) than those without OSA. Of the 23 patients with a post-MBS PSG result (average 5 mo post MBS), 15 (66%) had remission of OSA. Patients with OSA remission had a lower average pre-MBS BMI (46.0 versus 57.7 kg/m2, respectively; P < .001) and weight (132.9 versus 172.6 kg, respectively; P = .002) but no significant differences in percentage weight loss through 12 months post MBS versus those with continued OSA. CONCLUSION The OSA prevalence in an adolescent MBS population was higher than that in the general adolescent population with severe obesity. Remission of OSA was correlated with lower pre-MBS BMI and weight, but not weight loss within the first year post-MBS.
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Affiliation(s)
- Jill L Kaar
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Nazeen Morelli
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samuel P Russell
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ishaah Talker
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime M Moore
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Thomas H Inge
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen M M Hawkins
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Stacey L Simon
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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18
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Chandrakantan A, Mehta D, Adler AC. Pediatric obstructive sleep apnea revisited: Perioperative considerations for the pediatric Anesthesiologist. Int J Pediatr Otorhinolaryngol 2020; 139:110420. [PMID: 33035805 DOI: 10.1016/j.ijporl.2020.110420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
Pediatric obstructive sleep apnea presents in up to 7% of children and represents a constellation from nasal turbulence to cessation in gas exchange. There are numerous end organ sequelae including neurocognitive morbidity associated with persistent OSA. Adenotonsillectomy (AT), the first line therapy for pediatric OSA, has not been demonstrated to reduce all end organ morbidity, specifically neurological and behavioral morbidity. Furthermore, certain at-risk populations are at higher risk from neurocognitive morbidity. Precise knowledge and perioperative planning is required to ensure optimal evidence-based practices in children with OSA. This comprehensive review covers the seminal perioperative implications of OSA, including preoperative polysomnography, pharmacotherapeutics, and postoperative risk stratification.
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Affiliation(s)
| | - Deepak Mehta
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Adam C Adler
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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19
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 11:CD013449. [PMID: 33141943 PMCID: PMC8094400 DOI: 10.1002/14651858.cd013449.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. OBJECTIVES To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. SELECTION CRITERIA We included RCTs that recruited adults and children with a diagnosis of OSA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. MAIN RESULTS We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.
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Affiliation(s)
- José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Jordi Vilaró
- Department of Health Sciences, Ramon Lull University, Barcelona, Spain
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Abstract
Pediatric obstructive sleep apnea affects a large number of children and has multiple end-organ sequelae. Although many of these have been demonstrated to be reversible, the effects on some of the organ systems, including the brain, have not shown easy reversibility. Progress in this area has been hampered by lack of a preclinical model to study the disease. Therefore, perioperative and sleep physicians are tasked with making a number of difficult decisions, including optimal surgical timing to prevent disease evolution, but also to keep the perioperative morbidity in a safe range for these patients.
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Affiliation(s)
- Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, A330, Houston, TX 77030, USA.
| | - Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, A330, Houston, TX 77030, USA
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A multidisciplinary weight loss intervention in obese adolescents with and without sleep-disordered breathing improves cardiometabolic health, whether SDB was normalized or not. Sleep Med 2020; 75:225-235. [PMID: 32861060 DOI: 10.1016/j.sleep.2020.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pediatric obesity and sleep-disordered breathing (SDB) are strongly associated, and both promote metabolic impairments. However, the effects of a lifestyle intervention on the overall metabolic syndrome (MetS) are unknown. The objectives were i) to evaluate the effects of a lifestyle intervention on cardiometabolic risk (CMR), assessed with a dichotomous (MetS) and a continuous (MetScoreFM) instrument, in obese adolescents with and without SDB and ii) to compare the post-intervention cardiometabolic responses between adolescents with persistent (apnea-hypopnea index; AHI≥2) or normalized-SDB (AHI<2). METHODS Seventy-six adolescents with obesity recruited from two specialized institutions underwent a 9-12month diet and exercise intervention. Sleep and SDB (AHI≥2) were studied by polysomnography. Anthropometric parameters, fat mass (FM), glucose, insulin, lipid and leptin profiles, blood pressure (BP), MetScoreFM and MetS were assessed pre- and post-intervention. We performed comparisons between Non-SDB and SDB groups and between Normalized-SDB and Persistent-SDB subgroups. RESULTS Fifty participants completed the study. Pre-intervention, twenty youth had SDB (40%) with higher insulin concentrations and systolic BP than Non-SDB participants (p < 0.01), for a similar degree of obesity. Post-intervention, MetScoreFM (p < 0.001) and MetS prevalence (p < 0.05) were decreased in both groups. Eleven participants (55%) normalized SDB along with a decrease in insulin concentrations and BP (p < 0.05). Triglycerides, total cholesterol and LDL-cholesterol concentrations (p < 0.01) improved equally in the Normalized and Persistent-SDB subgroups. CONCLUSION SDB was associated with lower insulin sensitivity and higher BP but did not affect the lipid profile. A diet and exercise lifestyle intervention is effective in decreasing the CMR whether or not SDB was normalized in obese adolescents.
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Rodriguez-Lopez S, Palkowski S, Gerdung C, Keto-Lambert D, Sebastianski M, Castro-Codesal ML. Does obstructive sleep apnoea contribute to obesity, hypertension and kidney dysfunction in children? A systematic review protocol. BMJ Open 2020; 10:e039342. [PMID: 32868367 PMCID: PMC7462153 DOI: 10.1136/bmjopen-2020-039342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Childhood obstructive sleep apnoea (OSA) is a highly prevalent disorder that may directly contribute to the development of obesity, hypertension and renal injury. Although those associations seem to be clearer in adults, studies in children have revealed conflicting results and updated synthesis of the evidence is lacking. The aim of this systematic review is to summarise the available evidence on the effect of OSA on obesity, systemic blood pressure and kidney function, to help to elucidate whether respiratory interventions to correct OSA would have the potential to improve those outcomes. METHODS AND ANALYSIS A systematic literature review search was created by a medical librarian and peer-reviewed by a second librarian prior to running. Ovid Medline, Ovid Embase, CINAHL via EbscoHOST, Wiley Cochrane Library and ProQuest Dissertations and Theses Global were searched on 25 February 2020. Titles and abstracts will be screened by two independent reviewers for inclusion, followed by full-text screening of relevant articles. Studies in children will be included if they report data on OSA and weight, systemic blood pressure or kidney parameters. The extracted data will be combined for analysis and the information subcategorised in groups based on outcome. Risk of bias will be determined using tools specific to study methodology and certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. ETHICS AND DISSEMINATION This study will provide essential information for healthcare professionals to better understand the relationship between childhood OSA and changes in body mass index, systemic blood pressure and kidney function indicators. Our findings will be disseminated through conferences and publications. The results of this review may guide the initiation of new strategies and the development of future research studies. This research did not involve human subjects and therefore did not undergo research ethical review. PROSPERO REGISTRATION NUMBER CRD42020171186.
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Affiliation(s)
- Sara Rodriguez-Lopez
- Nephrology, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Respiratory Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Luisa Castro-Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Respiratory Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
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Gerdung C, Rodriguez-Lopez S, Palkowski S, Keto-Lambert D, Sebastianski M, Castro Codesal ML. Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol. BMJ Open 2020; 10:e039655. [PMID: 32830118 PMCID: PMC7445331 DOI: 10.1136/bmjopen-2020-039655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA. METHODS AND ANALYSIS A systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed. ETHICS AND DISSEMINATION There are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.
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Affiliation(s)
- Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sara Rodriguez-Lopez
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Maria Luisa Castro Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
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24
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Abstract
Obstructive sleep apnea (OSA) syndrome is a destructive and insidious entity mostly underdiagnosed and undertreated. It affects not only individuals but the society as a whole. The costs to the populations can be measured not only in morbidity and mortality but also in the financial wellbeing of a society. Financial burden of this disease is staggering. The social fabric of society is also greatly impacted. Physiologic effects of OSA are far reaching. It has been shown that early intervention with treatment of OSA can often prevent and/or reverse many of the negative outcomes associated with this condition.
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25
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Roche J, Corgosinho FC, Dâmaso AR, Isacco L, Miguet M, Fillon A, Guyon A, Moreira GA, Pradella-Hallinan M, Tufik S, Túlio de Mello M, Gillet V, Pereira B, Duclos M, Boirie Y, Masurier J, Franco P, Thivel D, Mougin F. Sleep-disordered breathing in adolescents with obesity: When does it start to affect cardiometabolic health? Nutr Metab Cardiovasc Dis 2020; 30:683-693. [PMID: 32008915 DOI: 10.1016/j.numecd.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Pediatric obesity and sleep-disordered breathing (SDB) are associated with cardiometabolic risk (CMR), but the degree of severity at which SDB affects cardiometabolic health is unknown. We assessed the relationship between the CMR and the apnea-hypopnea index (AHI), to identify a threshold of AHI from which an increase in the CMR is observed, in adolescents with obesity. We also compared the clinical, cardiometabolic and sleep characteristics between adolescents presenting a high (CMR+) and low CMR (CMR-), according to the threshold of AHI. METHODS AND RESULTS 114 adolescents with obesity were recruited from three institutions specialized in obesity management. Sleep and SDB as assessed by polysomnography, anthropometric parameters, fat mass (FM), glucose and lipid profiles, and blood pressure (BP) were measured at admission. Continuous (MetScoreFM) and dichotomous (metabolic syndrome, MetS) CMR were determined. Associations between MetScoreFM and AHI adjusted for BMI, sex and age were assessed by multivariable analyses. Data of 82 adolescents were analyzed. Multivariable analyses enabled us to identify a threshold of AHI = 2 above which we observed a strong and significant association between CMR and AHI (Cohen's d effect-size = 0.57 [0.11; 1.02] p = 0.02). Adolescents with CMR+ exhibited higher MetScoreFM (p < 0.05), insulin resistance (p < 0.05), systolic BP (p < 0.001), sleep fragmentation (p < 0.01) and intermittent hypoxia than CMR- group (p < 0.0001). MetS was found in 90.9% of adolescents with CMR+, versus 69.4% in the CMR- group (p < 0.05). CONCLUSIONS The identification of a threshold of AHI ≥ 2 corresponding to the cardiometabolic alterations highlights the need for the early management of SDB and obesity in adolescents, to prevent cardiometabolic diseases. CLINICAL TRIALS NCT03466359, NCT02588469 and NCT01358773.
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Affiliation(s)
- Johanna Roche
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France; Sleep and Health Medicine Center Ellipse, Franois, France; Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Flavia C Corgosinho
- Universidade Federal de Goiás - Faculdade de Nutrição - Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil
| | - Ana R Dâmaso
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil
| | - Laurie Isacco
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France
| | - Maud Miguet
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France
| | - Alicia Fillon
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France
| | - Aurore Guyon
- Sleep Pediatric Unit, Woman Mother Child Hospital, Hospices Civils de Lyon, Lyon1 University, F-69500, France; Physiology of Brain Arousal System Research Laboratory, CRNL, INSERM-U1028, CNRS UMR5292, Lyon1 University, Lyon, France
| | - Gustavo A Moreira
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Marcia Pradella-Hallinan
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Marco Túlio de Mello
- Universidade Federal de Minas Gerais - Programa de Pós-Graduação em Educação Física - Minas Gerais, Brazil
| | - Valérie Gillet
- Sleep and Health Medicine Center Ellipse, Franois, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
| | - Martine Duclos
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR, 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France
| | - Yves Boirie
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR, 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Human Nutrition, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France
| | - Julie Masurier
- UGECAM Nutrition Obesity Ambulatory Hospital, Clermont-Ferrand, France
| | - Patricia Franco
- Sleep Pediatric Unit, Woman Mother Child Hospital, Hospices Civils de Lyon, Lyon1 University, F-69500, France; Physiology of Brain Arousal System Research Laboratory, CRNL, INSERM-U1028, CNRS UMR5292, Lyon1 University, Lyon, France
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France
| | - Fabienne Mougin
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France
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Simon S, Rahat H, Carreau AM, Garcia-Reyes Y, Halbower A, Pyle L, Nadeau KJ, Cree-Green M. Poor Sleep Is Related to Metabolic Syndrome Severity in Adolescents With PCOS and Obesity. J Clin Endocrinol Metab 2020; 105:dgz285. [PMID: 31901092 PMCID: PMC7059992 DOI: 10.1210/clinem/dgz285] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/20/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a common endocrine disorder and is associated with metabolic syndrome (MS). Development of MS in PCOS is likely multifactorial and may relate to poor sleep. OBJECTIVE The objective of this research is to investigate differences in objective markers of sleep in adolescents with obesity and PCOS with and without MS. We also aimed to examine the relationships between markers of sleep with MS markers. DESIGN A cross-sectional study was conducted. PARTICIPANTS Participants included adolescents with PCOS and obesity with MS (N = 30) or without MS (N = 36). OUTCOME MEASURES Hormone and metabolic measurements, abdominal magnetic resonance imaging for hepatic fat fraction, actigraphy to estimate sleep, and overnight polysomnography (PSG). RESULTS Adolescents with obesity and PCOS who also had MS had significantly worse sleep-disordered breathing including higher apnea-hypopnea index (AHI, P = .02) and arousal index (P = .01) compared to those without MS. Actigraphy showed no differences in habitual patterns of sleep behaviors including duration, timing, or efficiency between groups. However, a greater number of poor sleep health behaviors was associated with greater number of MS components (P = .04). Higher AHI correlated with higher triglycerides (TG) (r = 0.49, P = .02), and poorer sleep efficiency correlated with higher percentage of liver fat (r = -0.40, P = .01), waist circumference (r = -0.46, P < .01) and higher TG (r = -0.34, P = .04). CONCLUSIONS Among girls with PCOS and obesity, sleep-disordered breathing was more prevalent in those with MS, and poor sleep behaviors were associated with metabolic dysfunction and more MS symptoms. Sleep health should be included in the assessment of adolescents with PCOS and obesity.
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Affiliation(s)
- Stacey Simon
- Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
- Center for Women’s Health Research, Aurora, Colorado
| | - Haseeb Rahat
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
| | - Anne-Marie Carreau
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
| | - Yesenia Garcia-Reyes
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
| | - Ann Halbower
- Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
| | - Kristen J Nadeau
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
- Center for Women’s Health Research, Aurora, Colorado
| | - Melanie Cree-Green
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, Colorado
- Center for Women’s Health Research, Aurora, Colorado
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Mehra R, Kashyap SR, Shah V. Is Better Sleep Beneficial for Metabolic Outcomes in Obese Female Adolescents with Polycystic Ovarian Syndrome? J Clin Endocrinol Metab 2020; 105:5713452. [PMID: 31965168 PMCID: PMC7059987 DOI: 10.1210/clinem/dgaa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/20/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Reena Mehra
- Sleep Disorders Center, Neurologic Institute, Respiratory Institute, Heart and Vascular Institute and Molecular Cardiology Department of the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Correspondence and Reprint Requests: Reena Mehra, MD, MS, FCCP, FAASM, Sleep Disorders Center, Neurologic Institute, Respiratory Institute, Heart and Vascular Institute and Lerner Research Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, Ohio 44195. E-mail:
| | - Sangeeta R Kashyap
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Vaishal Shah
- Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio
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The application of meta-analytic (multi-level) models with multiple random effects: A systematic review. Behav Res Methods 2020; 52:2031-2052. [DOI: 10.3758/s13428-020-01373-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Talib A, Roebroek YGM, van Waardenburg DA, van der Grinten CPM, Winkens B, Bouvy ND, van Heurn ELWE. Obstructive sleep apnea in obese adolescents referred for bariatric surgery: association with metabolic and cardiovascular variables. Sleep Med 2020; 75:246-250. [PMID: 32862012 DOI: 10.1016/j.sleep.2020.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND obstructive sleep apnea syndrome (OSA) is a well-described disease entity in adults, with a higher prevalence in severely obese individuals, while at the same time associated with several comorbidities independently of BMI. Literature regarding OSA in severely obese adolescents is qualitatively and quantitatively limited, possibly resulting in suboptimal diagnosis and treatment. METHODS polysomnographic, demographic, anthropometric, and comorbidity-related data were prospectively collected in 56 adolescents with morbid obesity refractory to conservative treatment who presented for surgical therapy. Differences between adolescents with no/mild (apnea-hypopnea index (AHI) 0-4.9) and moderate/severe OSA (AHI ≥ 5.0) were evaluated using independent-samples t, chi-square or Fisher's exact tests. Multivariable linear regression analysis was performed to evaluate the association of several variables with AHI, corrected for BMI z-score. RESULTS of the 53 included subjects, 48 (90.6%) showed some degree of sleep disordered breathing and 20 (37.7%) had moderate/severe OSA. Patients with moderate/severe OSA had on average a higher neck circumference (42.4 versus 40.1 cm, p = 0.008), higher BMI z-score (3.7 versus 3.4, p = 0.003), higher plasma triglyceride level (2.2 versus 1.5 mmol/L, p = 0.012), and lower IGF (29.6 versus 40.2 mmol/L, p = 0.010) than those with no/mild OSA. BMI z-score and plasma triglyceride levels were independently related to AHI. CONCLUSIONS OSA is highly prevalent amongst morbidly obese adolescents and is strongly associated with BMI z-score. Elevated plasma triglyceride levels are associated with AHI, independent of BMI z-score.
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Affiliation(s)
- Ali Talib
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Yvonne G M Roebroek
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of General Surgery, Maxima Medical Center, Veldhoven, The Netherlands.
| | - Dick A van Waardenburg
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Chris P M van der Grinten
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Ernst L W E van Heurn
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Pediatric Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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30
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Kuvat N, Tanriverdi H, Armutcu F. The relationship between obstructive sleep apnea syndrome and obesity: A new perspective on the pathogenesis in terms of organ crosstalk. CLINICAL RESPIRATORY JOURNAL 2020; 14:595-604. [PMID: 32112481 DOI: 10.1111/crj.13175] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 02/13/2020] [Accepted: 02/23/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a common disorder that has a major impact on public health. The connection between OSAS and obesity is very complex and likely represents an interaction between biological and lifestyle factors. Oxidative stress, inflammation and metabolic dysregulation are both actors involved in the pathogenesis of OSAS and obesity. Also, the current evidence suggests that gut microbiota plays a significant role in the emergence and progression of some metabolic disorders. When the relationship between OSAS and obesity is evaluated extensively, it is understood that they show mutual causality with each other, and that metabolic challenges such as impaired microbiota affect this bidirectional organ interaction, and by ensuing organ injury. OBJECTIVES The aim of this study is to investigate the association between OSAS and obesity, and the effect of "organ crosstalk" on the pathogenesis of the relationship and to contribute to the diagnosis and treatment options in the light of current data. DATA SOURCE We performed an electronic database search including PubMed, EMBASE and Web of Science. We used the following search terms: OSAS, obesity, inflammation, metabolic dysregulation and gut microbiota. CONCLUSION Obesity and OSAS adversely affect many organs and systems. Besides the factors affecting the diagnosis of the OSAS-obesity relationship, mutual organ interactions among the respiratory system, adipose tissue and intestines should not be ignored for prevention and treatment of OSAS and obesity. Comprehensive clinical trials addressing the efficacy and efficiency of current or potential treatments on therapeutic applications in the OSAS-obesity relationship are needed.
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Affiliation(s)
- Nuray Kuvat
- Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Hakan Tanriverdi
- Department of Chest Diseases, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ferah Armutcu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Are obstructive sleep apnea and sleep improved in response to multidisciplinary weight loss interventions in youth with obesity? A systematic review and meta-analysis. Int J Obes (Lond) 2020; 44:753-770. [PMID: 31911659 DOI: 10.1038/s41366-019-0497-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pediatric obesity is closely associated with obstructive sleep apnea (OSA) and short sleep duration. While multidisciplinary weight loss interventions are recommended for pediatric obesity management, the evidence for their effects on OSA severity and overall sleep in youth have not been systematically examined. OBJECTIVES To conduct a systematic review and meta-analysis investigating the effects of multidisciplinary weight loss interventions on OSA severity and prevalence, and on overall sleep health in youth with obesity. METHODS A systematic search of interventional studies (participants age range: 10-19 yrs) was performed using PubMed, CENTRAL and Embase, from inception to May 2019. The quality of the evidence was assessed using the Cochrane risk of bias tool. RESULTS Ten studies were included by the end of the screening process. Ninety percent of the included studies reported a decrease in OSA prevalence post-intervention, and OSA was normalized for 46.2-79.7% of the youth. The meta-analysis comprising seven longitudinal studies revealed significant reductions in apnea-hypopnea index (effect size: -0.51, 95%CI -0.94 to -0.08, p = 0.019), and oxygen desaturation index (effect size: -0.28, 95%CI = -0.50 to -0.05, p = 0.016). Seventy-five percent of the studies reported improved sleep duration in youth with OSA. CONCLUSIONS Evidence suggests that multidisciplinary weight loss interventions result in improvements in OSA severity and sleep duration in youth with obesity. Future randomized controlled trials are warranted to better assess and understand the independent implications of weight loss, fat mass decrease and chronic exercise on OSA and sleep health in this population.
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Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr 2020; 8:581461. [PMID: 33511092 PMCID: PMC7835259 DOI: 10.3389/fped.2020.581461] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Obesity is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors; it is a significant public health problem. The most common cause of obesity throughout childhood and adolescence is an inequity in energy balance; that is, excess caloric intake without appropriate caloric expenditure. Adiposity rebound (AR) in early childhood is a risk factor for obesity in adolescence and adulthood. The increasing prevalence of childhood and adolescent obesity is associated with a rise in comorbidities previously identified in the adult population, such as Type 2 Diabetes Mellitus, Hypertension, Non-alcoholic Fatty Liver disease (NAFLD), Obstructive Sleep Apnea (OSA), and Dyslipidemia. Due to the lack of a single treatment option to address obesity, clinicians have generally relied on counseling dietary changes and exercise. Due to psychosocial issues that may accompany adolescence regarding body habitus, this approach can have negative results. Teens can develop unhealthy eating habits that result in Bulimia Nervosa (BN), Binge- Eating Disorder (BED), or Night eating syndrome (NES). Others can develop Anorexia Nervosa (AN) as they attempt to restrict their diet and overshoot their goal of "being healthy." To date, lifestyle interventions have shown only modest effects on weight loss. Emerging findings from basic science as well as interventional drug trials utilizing GLP-1 agonists have demonstrated success in effective weight loss in obese adults, adolescents, and pediatric patients. However, there is limited data on the efficacy and safety of other weight-loss medications in children and adolescents. Nearly 6% of adolescents in the United States are severely obese and bariatric surgery as a treatment consideration will be discussed. In summary, this paper will overview the pathophysiology, clinical, and psychological implications, and treatment options available for obese pediatric and adolescent patients.
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Affiliation(s)
- Alvina R Kansra
- Division of Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sinduja Lakkunarajah
- Division of Adolescent Medicine, Department of Pediatrics, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, United States
| | - M Susan Jay
- Division of Adolescent Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
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Heffernan A, Malik U, Cheng R, Yo S, Narang I, Ryan CM. Transition to Adult Care for Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8122120. [PMID: 31810317 PMCID: PMC6947540 DOI: 10.3390/jcm8122120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Abstract
Obstructive sleep apnea may occur throughout the lifespan, with peak occurrences in early childhood and during middle and older age. Onset in childhood is overwhelmingly due to adeno-tonsillar hypertrophy, while in adulthood, contributors include risk factors, such as obesity, male sex, and aging. More recently, there has been a precipitous increase in the prevalence of obstructive sleep apnea in youth. Drivers of this phenomenon include both increasing obesity and the survival of children with complex medical conditions into adulthood. Appropriate treatment and long-term management of obstructive sleep apnea is critical to ensure that these youth maintain well-being unfettered by secondary comorbidities. To this end, patient engagement and seamless transition of care from pediatric to adult health care systems is of paramount importance. To date, this is an unacknowledged and unmet need in most sleep programs. This article highlights the need for guideline-driven sleep disorder transition processes and illustrates the authors’ experience with the development of a program for sleep apnea.
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Affiliation(s)
- Austin Heffernan
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Uzair Malik
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Russell Cheng
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Shaun Yo
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Indra Narang
- Department of Pediatrics, Division of Respirology, University of Toronto, Toronto, ON M5G1X8, Canada;
- Sleep Laboratory, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Clodagh M. Ryan
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
- Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON M5G2N2, Canada
- Correspondence:
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Amat P. [Obstructive sleep disordered breathing and orthodontics: primum non nocere]. Orthod Fr 2019; 90:247-262. [PMID: 34643513 DOI: 10.1051/orthodfr/2019039] [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: 06/13/2023]
Abstract
Obstructive sleep apnoea syndrome is a widespread and under-diagnosed condition, making it a major public health and safety issue. The objective of this article was to clarify some of the evidence-based elements of therapeutic decision-making and the information provided to the patient and family on the benefit-cost-security ratio of several of his therapeutic options. Published data on the effectiveness of oral appliances and functional orthopaedic appliances for obstructive sleep apnea (OSA) in children, the durability of their effects, the therapeutic possibilities of maxillary or bimaxillary expansion, and the interrelationships between permanent teeth extractions and obstructive sleep disordered breathing, were researched and analyzed. Based on available evidence, in growing patients with Class II malocclusion, treatment with functional orthopedic devices can increase the volume of the pharyngeal airway and thus hopefully reduce the risk of developing OSA. An improvement in the apnea-hypopnea index and lower oxygen saturation was observed in children treated with rapid maxillary expansion. Permanent teeth extractions prescribed for the treatment of teeth crowding in an orthodontic age patient do not result in any significant change in the upper airway. The role of the orthodontist in the multidisciplinary team in the screening and management of Obstructive Sleep Disordered Breathing (OSDB) is essential. By combining clinical experience with published data on various therapeutic approaches, the orthodontist helps the patient to benefit from better adapted care and a more sustainable outcome, while taking into account his or her preferences.
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Affiliation(s)
- Philippe Amat
- 19, Place des Comtes du Maine, 72000 Le Mans, France
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35
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Amat P, Tran Lu Y É. [The contribution of orofacial myofunctional reeducation to the treatment of obstructive sleep apnoea syndrome (OSA): a systematic review of the literature]. Orthod Fr 2019; 90:343-370. [PMID: 34643521 DOI: 10.1051/orthodfr/2019035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obstructive sleep apnoea syndrome (OSA) is a widespread and under-diagnosed condition, making it a major public health and safety problem. Orofacial myofunctional reeducation (OMR) has been shown to be effective in the multidisciplinary treatment of OSA in children, adolescents and adults and is prescribed at several stages of OSA management. The main objective of this systematic literature review was to evaluate the effectiveness of active or passive orofacial myofunctional reeducation (OMR) in the treatment of obstructive sleep apnoea syndrome in children, adolescents and adults. The systematic literature review was undertaken from the three electronic databases: Medline (via PubMed), Cochrane Library, Web of Science Core Collection, and supplemented by a limited grey literature search (Google Scholar) in order to identify the studies evaluating the effectiveness of the OMR on OSA. The primary outcome of interest was a decrease in the Apnea-Hypopnea Index (AHI) of at least five episodes per hour compared to the baseline state. Secondary outcomes were an improvement in subjective sleep quality, sleep quality measured by night polysomnography and subjectively measured quality of life. Only ten studies met all the inclusion criteria. Eight were randomized controlled clinical trials, one was a prospective cohort study and another was a retrospective cohort study. Six studies were devoted to adult OSA and four to pediatric OSA. All included studies were assessed as "low risk of bias" based on the 12 bias risk criteria of the Cochrane Back Review Group. Based on the available evidence, RMO allows a significant reduction in AHI, up to 90.6% in children and up to 92.06% in adults. It significantly reduces the intensity and frequency of snoring, helps reduce daytime sleepiness, limits the recurrence of OSA symptoms after adenoamygdalectomy in children and improves adherence to PPC therapy. Passive RMO, with the assistance provided to the patient by wearing a custom orthosis, increases adherence to reeducation, significantly improves snoring intensity, AHI and significantly increases the upper airway. Published data show that orofacial myofunctional rééducation is effective in the multidisciplinary treatment of OSA in children, adolescents and adults and should be widely prescribed at several stages of OSA management. Passive RMO, with the pearl mandibular advancement orthosis designed by Michèle Hervy-Auboiron, helps to compensate for the frequent non-compliance observed during active RMO treatments.
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Orr M, Isaacs J, Godbout R, Witmans M, Corkum P. A usability study of an internet-delivered behavioural intervention tailored for children with residual insomnia symptoms after obstructive sleep apnea treatment. Internet Interv 2019; 18:100265. [PMID: 31890618 PMCID: PMC6926281 DOI: 10.1016/j.invent.2019.100265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022] Open
Abstract
Better Nights, Better Days (BNBD) is a 5-session online intervention designed to treat insomnia in 1-10-year-old children (Corkum et al. 2016). Obstructive sleep apnea (OSA) and insomnia commonly occur in children and, after surgical treatment for OSA, it is estimated that up to 50% of children may continue to suffer from insomnia symptoms. Access to insomnia interventions following OSA treatment is limited as there are few programs available, few trained practitioners to deliver these programs, and limited recognition that these problems exist. The current study involved the usability testing of an internet-based parent-directed session of BNBD tailored towards the needs of children (ages 4-10 years) who experience residual insomnia symptoms after treatment of OSA. This new session was added to the BNBD program. Participants (n = 43) included 6 parents, 17 sleep experts, and 20 front-line healthcare providers who completed and provided feedback on the new session. Participants completed a feedback questionnaire, with both quantitative and qualitative questions, after reviewing the session. Quantitative responses analyzed via descriptive statistics suggested that the session was primarily viewed as helpful by most participants, and open-ended qualitative questions analyzed by content analyses generated a mix of positive and constructive feedback. The results provide insights on how to optimally tailor the BNBD program to meet the needs of the target population and suggest that testing the session on a larger scale would be beneficial.
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Affiliation(s)
- Matthew Orr
- Department of Psychology and Neuroscience, Dalhousie University, Canada
| | - Jason Isaacs
- Department of Psychology and Neuroscience, Dalhousie University, Canada
| | - Roger Godbout
- Department of Psychiatry, Université de Montréal, Canada
| | | | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Canada
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Hippokratia 2019. [DOI: 10.1002/14651858.cd013449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- José-Ramón Rueda
- University of the Basque Country; Department of Preventive Medicine and Public Health; Barrio Sarriena S.N. Leioa Bizkaia Spain E-48080
| | - Iranzu Mugueta-Aguinaga
- Biocruces Health Research Institute, Cruces University Hospital; Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology; Barakaldo Spain
| | - Jordi Vilaró
- Ramon Lull University; Department of Health Sciences; Padilla, 326-332 Barcelona Spain 08025
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Park KM, Kim SY, Sung D, Kim H, Kim BN, Park S, Jung KI, Park MH. The relationship between risk of obstructive sleep apnea and other sleep problems, depression, and anxiety in adolescents from a community sample. Psychiatry Res 2019; 280:112504. [PMID: 31401289 DOI: 10.1016/j.psychres.2019.112504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
Obstructive sleep apnea (OSA) is highly related to mental health problems, such as depression and anxiety. However, previous studies on OSA and depression and anxiety have mostly been conducted in the adult population. We aimed to (1) screen for risk of OSA in a sample of adolescents from the general population using self-report questionnaires and (2) examine whether there are differences between the high- and low-risk groups for OSA in depressive and anxiety symptoms, self-esteem, and sleep-related variables. The data of 793 students (age range: 12-17 years old) were analyzed. The participants were assigned to the high-risk (n = 202, 25.5%) or the low-risk group (n = 591, 74.5%) of OSA. The participants in the high-risk group had more severe anxiety symptoms, lower self-esteem, insomnia, excessive daytime sleepiness, and higher BMI compared those in the low-risk group. This study shows that it is possible to efficiently screen for risks of various problems associated with OSA in adolescents using an easy and simple screening tool.
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Affiliation(s)
- Kyu-Myoung Park
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shin-Young Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dajung Sung
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyemin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Subin Park
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - Kyu-In Jung
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Parmar A, Baker A, Narang I. Positive airway pressure in pediatric obstructive sleep apnea. Paediatr Respir Rev 2019; 31:43-51. [PMID: 31130426 DOI: 10.1016/j.prrv.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by snoring, recurrent obstruction (apneas) of the upper airway which disrupts normal ventilation during sleep. In the last decade, there has been a increase in children diagnosed with persistent, severe OSA attributed to (1) the obesity epidemic as 25-60% of obese children will have obesity related OSA (2) advances in medical technology that have increased life expectancy of medically complex children (3) improved diagnostics and (4) increased awareness. Positive airway pressure (PAP) is commonly used to treat persistent, severe OSA. PAP devices deliver pressurized air via nasal or oronasal interfaces to distend the upper airway and ameliorate OSA. Although effective in treating OSA, PAP adherence is suboptimal. This review article provides an overview of (1) PAP use in pediatric OSA (2) PAP devices (3) PAP adherence, (4) strategies and interventions to improve adherence and (5) Optimizing PAP delivery during pediatric to adult transition.
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Affiliation(s)
- Arpita Parmar
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Adele Baker
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci 2019; 20:ijms20030459. [PMID: 30678164 PMCID: PMC6387387 DOI: 10.3390/ijms20030459] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates. In adult patients, excessive daytime sleepiness (EDS) is the most frequent symptom leading to clinical referral for evaluation and treatment, but classic EDS features are less likely to be reported in children, particularly among those with normal body-mass index. The cumulative evidence collected over the last two decades supports a conceptual framework, whereby sleep-disordered breathing in general and more particularly OSAS should be viewed as low-grade chronic inflammatory diseases. Accordingly, it is assumed that a proportion of the morbid phenotypic signature in OSAS is causally explained by underlying inflammatory processes inducing end-organ dysfunction. Here, the published links between OSAS and systemic inflammation will be critically reviewed, with special focus on the pro-inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), since these constitute classical prototypes of the large spectrum of inflammatory molecules that have been explored in OSAS patients.
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Ding H, Huang JF, Xie HS, Wang BY, Lin T, Zhao JM, Lin QC. The association between glycometabolism and nonalcoholic fatty liver disease in patients with obstructive sleep apnea. Sleep Breath 2018; 23:373-378. [PMID: 30349997 PMCID: PMC6418049 DOI: 10.1007/s11325-018-1744-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/07/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022]
Abstract
Purpose Growing evidence has revealed that nonalcoholic fatty liver disease (NAFLD) is associated with type 2 diabetes. This study aimed to assess the association between glycometabolism and NAFLD in patients with obstructive sleep apnea (OSA). Methods Patients with suspected OSA were enrolled consecutively and then underwent polysomnography, liver ultrasound, and biochemical measurements. Logistic regressions were used to identify factors associated with NAFLD. Results In total, 415 patients were included. The prevalence of NAFLD in the non-OSA, mild OSA, moderate OSA, and severe OSA groups was 37.21%, 69.09%, 68.34%, and 78.08%, respectively. Stepwise logistic regression suggested that percentage of total sleep time spent with oxygen saturation of < 90% (TS90), lowest oxygen saturation (LaSO2), and homeostatic model assessment of insulin resistance (HOMA-IR) were independently associated with NAFLD in all subjects, after adjusting for confounders (odds ratio [OR] = 1.037, p = 0.014; OR = 1.056, p = 0.004; OR = 0.732, p = 0.009; respectively). TS90, LaSO2, and HOMA-IR were also independent predictors for NAFLD in patients with mild and moderate OSA, whereas TS90, LaSO2, and ODI were independent predictors for NAFLD in patients with severe OSA. Conclusions There is a relationship between OSA and NAFLD, and the combination of disordered glycometabolism and intermittent hypoxia may act as a “two hit” mechanism to promote the development of NAFLD. Furthermore, intermittent hypoxia alone was an independent predictor for NAFLD in severe OSA patients.
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Affiliation(s)
- Haibo Ding
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China.,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Jie-Feng Huang
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China.,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Han-Sheng Xie
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China.,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Bi-Ying Wang
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China.,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Ting Lin
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China.,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Jian-Ming Zhao
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China.,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Qi-Chang Lin
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, People's Republic of China. .,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, People's Republic of China. .,Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong road, Taijiang district, Fuzhou, Fujian Province, 350005, People's Republic of China.
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Muscogiuri G, Barrea L, Annunziata G, Di Somma C, Laudisio D, Colao A, Savastano S. Obesity and sleep disturbance: the chicken or the egg? Crit Rev Food Sci Nutr 2018; 59:2158-2165. [PMID: 30335476 DOI: 10.1080/10408398.2018.1506979] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Epidemiological studies suggested an association between obesity and sleep disturbances. Obstructive sleep apnea is the most prevalent type of obesity-related sleep disorder that lead to an increased risk for numerous chronic health conditions. In addition the increased visceral adipose tissue might be responsible for the secretion of inflammatory cytokines that could contribute to alter the sleep-wake rhythm. Unhealthy food characterized by high consumption of fat and carbohydrate seems to negatively influence the quality of sleep while diet rich of fiber is associated to more restorative and deeper sleep. Although obesity could cause through several pathogenetic mechanisms an alteration of sleep, it has been reported that subjects suffering from sleep disorders are more prone to develop obesity. Experimental laboratory studies have demonstrated that decreasing either the amount or quality of sleep increase the risk of developing obesity. Experimental sleep restriction also causes physiological, hormonal and food behavioral changes that promote a positive energy balance and a compensatory disproportionate increase in food intake, decrease in physical activity, and weight gain. Thus, the aim of this review is to provide observational evidence on the association of obesity with sleep disturbances and viceversa with emphasis on possible pathophysiological mechanisms (hormonal and metabolic) that link these two pathological conditions.
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Affiliation(s)
- Giovanna Muscogiuri
- a Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology , Federico II University Medical School of Naples , Naples , Italy
| | - Luigi Barrea
- a Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology , Federico II University Medical School of Naples , Naples , Italy
| | - Giuseppe Annunziata
- a Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology , Federico II University Medical School of Naples , Naples , Italy
| | | | - Daniela Laudisio
- a Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology , Federico II University Medical School of Naples , Naples , Italy
| | - Annamaria Colao
- a Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology , Federico II University Medical School of Naples , Naples , Italy
| | - Silvia Savastano
- a Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology , Federico II University Medical School of Naples , Naples , Italy
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Effects of 12 weeks of regular aerobic exercises on autonomic nervous system in obstructive sleep apnea syndrome patients. Sleep Breath 2018; 22:1189-1195. [DOI: 10.1007/s11325-018-1736-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
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44
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Zhang F, Wu Y, Feng G, Ni X, Xu Z, Gozal D. Polysomnographic correlates of endothelial function in children with obstructive sleep apnea. Sleep Med 2018; 52:45-50. [PMID: 30269047 DOI: 10.1016/j.sleep.2018.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate endothelial function in a large cohort of children clinically referred for suspected obstructive sleep apnea syndrome (OSAS), and to identify risk factors contributing to the presence of endothelial dysfunction (ED). METHODS Habitually snoring children (age range, 3-11 years) were recruited. All participants underwent overnight polysomnography (PSG). Endothelial function test used peripheral arterial tonometry (PAT) to derive the reactive hyperemia index (RHI). Subjects were then divided into mild OSA, moderate-severe OSA and primary snorers (PS), according to their obstructive apnea-hypopnea index (OAHI). RESULTS A total of 355 subjects were recruited. There were no differences in age, gender, or BMI z score among the three groups. Both mild and moderate-severe OSA groups had lower RHI than PS (P < 0.001, P = 0.001, respectively). Linear regression analysis revealed that RHI was positively correlated with age (r = 0.17, P = 0.002), BMI z score (r = 0.14, P = 0.008) and oxygen saturation nadir (r = 0.15, P = 0.006), but negatively correlated with oxygen desaturation index (ODI3%; r = -0.19, P = 0.001) and respiratory-related arousal index (ArI-resp) (r = -0.24, P < 0.001). In stepwise regression analysis, age, BMI z score, and ArI-resp were independently associated with endothelial function (r = 0.34, P < 0.001). CONCLUSION Children with OSA are at increased risk for abnormal endothelial function than habitually snoring children. Furthermore, in addition to age and BMI, which are well-established factors affecting endothelial function, both intermittent hypoxia and sleep fragmentation during sleep also emerge as candidate risk factors contributing to endothelial dysfunction in snoring children. CLINICAL TRIAL Follow up of PS and OSAHS in Chinese children, https://clinicaltrials.gov/, Clinical number: NCT02447614.
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Affiliation(s)
| | - Yunxiao Wu
- Beijing Key Laboratory of Pediatric Otolaryngology, Head & Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guoshuang Feng
- Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Otolaryngology, Head and Neck Surgery Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhifei Xu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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Carneiro G, Zanella MT. Obesity metabolic and hormonal disorders associated with obstructive sleep apnea and their impact on the risk of cardiovascular events. Metabolism 2018. [PMID: 29534971 DOI: 10.1016/j.metabol.2018.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze metabolic and hormonal disorders resulting from the association between obesity and obstructive sleep apnea (OSA) syndrome that predispose to cardiovascular diseases and investigate the clinical benefits obtained from treatment approaches for both conditions. METHODS A literature review between 1997 and 2017 was conducted in the PubMed search database. RESULTS Obesity is the most important risk factor for OSA, and the progressive increase in its prevalence also affects OSA incidence. In addition, OSA may aggravate weight gain and obesity comorbidities. Both conditions lead to an increase in the risk of cardiovascular events and mortality. The gold standard treatment for moderate to severe OSA is CPAP, but significant reduction in major cardiovascular events was not observed in clinical trials. Body weight reduction appears effective to improve OSA, as long as it is maintained. Lifestyle modifications and drug therapy seem to be the preferred approach to treat obesity, but in severe obesity and moderate to severe OSA, bariatric surgery is probably the most adequate treatment. CONCLUSIONS Weight control is essential to decrease the risk of cardiovascular events and mortality potentially linked to both obesity and OSA. CPAP seems to treat only OSA without decreasing these risks. Other treatment strategies are lifestyle modifications and drug therapy, which need further investigation as well as bariatric surgery for severe cases.
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Affiliation(s)
- Glaucia Carneiro
- Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | - Maria T Zanella
- Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Impairment of vascular strain in patients with obstructive sleep apnea. PLoS One 2018; 13:e0193397. [PMID: 29489881 PMCID: PMC5831412 DOI: 10.1371/journal.pone.0193397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular diseases. Aim of this present study was to evaluate and extend recent research on the influence of obstructive sleep apnea on vascular strain. Methods A total number of 98 patients were integrated in the study. Patients were grouped according to the Apnea-Hypopnea-Index (AHI) in patients with mild-to-moderate OSA (5/h ≤ AHI < 30/h), severe OSA (AHI ≥ 30/h) and controls (AHI < 5/h). Groups were matched in age, body-mass-index and cardiovascular risks. Vascular strain of common carotid arteries was assessed by ultrasound speckle-tracking. A minor group of 30 patients and controls further underwent assessment of vascular strain of brachial and femoral arteries. Additionally, all patients underwent blood testing to reveal potential influences of inflammatory markers on arterial stiffness. In additional analysis we examined the effect of statin therapy on vascular strain. Results Patients with OSA showed significantly reduced values of vascular strain of common carotid arteries. Radial and circumferential strains were significantly lower in both patients with mild-to-moderate (p = .05) and patients with severe OSA (p = .001) compared to control. Vascular strain parameters of brachial and femoral arteries showed no consistent results. There were no significant correlations of inflammatory markers with vascular strain parameters. No significant differences in vascular strain were detected between statin and non-statin groups. Conclusion Patients with OSA show significantly reduced vascular strain assessed by ultrasound-based speckle-tracking. Vascular stiffness increases with the severity of the disease. Target vessels to assess vascular strain in patients with OSA are common carotid arteries, whereas other sites of the arterial tree are not reliable. No significant impact of current statin therapy on vascular strain was found. Further studies are needed to evaluate potential benefit of statins in secondary prevention of atherosclerosis in OSA.
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Jin S, Jiang S, Hu A. Association between obstructive sleep apnea and non-alcoholic fatty liver disease: a systematic review and meta-analysis. Sleep Breath 2018; 22:841-851. [PMID: 29335916 DOI: 10.1007/s11325-018-1625-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 12/23/2022]
Abstract
The relationship between obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) has been an issue of great concern. The primary purpose of this study was to determine the influence of OSA on the levels of liver enzymes including alanine transaminase (ALT) and aspartate transaminase (AST). The secondary purpose was to estimate the effect of OSA on the histological lesions of NAFLD, such as steatosis, lobular inflammation, ballooning degeneration, fibrosis, as well as NAFLD activity score (NAS). A systematic literature review using PubMed, Cochrane Library, Embase, and Ovid technologies from January 2007 to April 2017 was performed, and 9 studies (2272 participants) that met the selection criteria were evaluated. The present study demonstrated that OSA was related to ALT levels, but no significant correlation was found with AST levels. The subgroup analysis showed that the severity of OSA was associated with ALT levels, not with AST levels. The meta-regression analysis showed that age, sex, homeostasis model assessment, diabetes mellitus, body mass index, and waist circumference did not have a significant effect on the levels of ALT and AST. OSA was also found to be significantly correlated with steatosis, lobular inflammation, ballooning degeneration, and fibrosis, but was not correlated with NAS. OSA was independently related to the development and progression of NAFLD in terms of liver enzyme level and histological alterations. Future studies should investigate the possible relevant mechanisms, thereby guiding the exploration of potential therapeutic implications to prevent the progression of disease.
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Affiliation(s)
- Shanshan Jin
- Ningbo University School of Medicine, Ningbo City, Zhejiang Province, China
| | - Suwen Jiang
- Institute of Liver Diseases, Ningbo No. 2 Hospital, 41 Xibei Street, Haishu District, Ningbo City, Zhejiang Province, 315010, China
| | - Airong Hu
- Ningbo University School of Medicine, Ningbo City, Zhejiang Province, China. .,Institute of Liver Diseases, Ningbo No. 2 Hospital, 41 Xibei Street, Haishu District, Ningbo City, Zhejiang Province, 315010, China.
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Gohil A, Hannon TS. Poor Sleep and Obesity: Concurrent Epidemics in Adolescent Youth. Front Endocrinol (Lausanne) 2018; 9:364. [PMID: 30042730 PMCID: PMC6048236 DOI: 10.3389/fendo.2018.00364] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/18/2018] [Indexed: 12/11/2022] Open
Abstract
Poor sleep and obesity are both extraordinarily common in the US adolescent population and often occur simultaneously. This review explores the links between obesity and sleep, outlining what is known about the relationships between sleep characteristics, obesity, and cardiometabolic risk factors in youth. Sleep duration is less than optimal in teens, and decreases as age increases. This is detrimental to overall well-being and is associated with obesity in children, adolescents, and young adults. Accordingly, inadequate sleep duration is associated with poor diet quality, decreased insulin sensitivity, hyperglycemia, and prevalent cardiometabolic risk factors. Evidence suggests that poor sleep quality and altered circadian timing characterized by a preferred later sleep onset, known as "adolescent chronotype," contributes to shortened sleep duration. Obstructive sleep apnea (OSA) occurs more frequently among youth with obesity, and is associated with autonomic nervous system activity promoting higher blood pressure, increased markers of cardiovascular disease risk, and insulin resistance. While there is a clear association between OSA and type 2 diabetes in adults, whether or not this association is prevalent in youth is unclear at this time. Interventions to improve both sleep duration and quality, and obesity in adolescents are scarce and more evidence is needed to determine if such interventions can improve obesity-related health outcomes.
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Affiliation(s)
- Anisha Gohil
- Pediatric Endocrinology Fellow, Section of Pediatric Endocrinology/Diabetology, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Anisha Gohil
| | - Tamara S. Hannon
- Section of Pediatric Endocrinology/Diabetology, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, United States
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