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Wie K, Zaccor N, Zou J, Vandjelovic N, Faria J. Early Adverse Respiratory Outcomes in Obese Pediatric Tonsillectomy Patients. Otolaryngol Head Neck Surg 2024. [PMID: 38822768 DOI: 10.1002/ohn.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE To determine if body mass index (BMI) is predictive of adverse respiratory events (ARE) in the obese pediatric population undergoing tonsillectomy. STUDY DESIGN Case series with chart review. SETTING Single institution academic otolaryngology practice. METHODS All patients 3 to 12 years old with BMI ≥95th percentile that underwent tonsillectomy March 1, 2011 to July 15, 2020 were included. The study excluded patients with comorbidities that warranted admission independent of BMI, including Trisomy 21, gross developmental delay, neuromuscular disorders, and congenital heart disease. Perioperative AREs following tonsillectomy were recorded. AREs were defined as postoperative desaturation (SpO2 < 90%), intubation, continuous positive airway pressure (CPAP), or new O2 requirement for >2 hours. RESULTS Eighteen patients (8%) had at least 1 ARE. There were no children age 5 and older with a BMI 95th percentile to 98.9th percentile who had an early adverse respiratory outcome. Preoperative polysomnogram (PSG) metrics, obstructive apnea-hypopnea index (oAHI), and oxygen saturations (SpO2) nadir was significantly different between patients with and without AREs (mean oAHI 54.3 vs 17.4, P = .02; mean SpO2 nadir 73.1% vs 84.5%, P = .05). There was no significant difference in the BMI z score (2.88 vs 2.45, P = .09) between groups. CONCLUSION AREs requiring inpatient management are uncommon in obese children after tonsillectomy. BMI is a poor independent indication for admission except at BMI extremes. We found significantly higher oAHI and lower SpO2 nadir on PSG indicate a higher risk for AREs and can guide admission postoperatively. There may be a subset of obese tonsillectomy patients who can be safely discharged home on the day of surgery.
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Affiliation(s)
- Kathryn Wie
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Nicholas Zaccor
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Jonathan Zou
- Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Nathan Vandjelovic
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
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Fagundes NCF, Young R, Flores-Mir C, Heo G, Perez A. Parental experiences in navigating health services for paediatric residual obstructive sleep apnoea: An exploratory qualitative descriptive study. Orthod Craniofac Res 2024. [PMID: 38590218 DOI: 10.1111/ocr.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES To explore parents' experiences and perceptions regarding engagement in health services for managing residual paediatric obstructive sleep apnoea (OSA) across levels of care. METHODS Qualitative description guided study design. Data were collected through semi-structured interviews with parents of children diagnosed with residual OSA at a university-based sleep clinic. The relevant literature informed the interview guide and was piloted before data collection. Inductive, manifest content analysis was used to describe parents' perceptions and experiences using data-driven categories and sub-categories. Several strategies were employed to ensure rigour in this study. RESULTS Eight interviews were conducted. Parents' views were organized into five categories: awareness of the sleep issue, interaction with non-sleep specialists, interaction with sleep specialists, interaction with dental professionals, and further actions and support. Parents reported several engagement issues due to their interactions with different care providers. These issues included having to personally identify and raise the sleep problem, feeling that care providers did not take this problem seriously, waiting for an extended period to be referred for sleep services, and receiving conflicting or insufficient treatment recommendations. Overall, parents perceived that their actions and the services received across levels of care were not effective enough to address paediatric OSA. CONCLUSION Based on this exploratory qualitative descriptive research, along with developing evidence-based clinical guidelines for paediatric OSA screening and management tailored to different levels of care, strategies intended to improve the engagement of patients and care providers in addressing paediatric OSA should be developed and empirically tested.
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Affiliation(s)
- Nathalia Carolina Fernandes Fagundes
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthodontics, Faculty of Dentistry, Federal University of Para, Belém, Brazil
| | - Rochelle Young
- Division of Pulmonary and Sleep Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Chiang J, Xiao L, Nigro E, St-Laurent A, Weinstock L, Law E, Janevski J, Kuyntjes S, Cithiravel N, Tran T, Wolter NE, Gonorazky H, Amin R. Sleep disordered breathing in infants identified through newborn screening with spinal muscular atrophy. Sleep Med 2023; 111:161-169. [PMID: 37778092 DOI: 10.1016/j.sleep.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a genetic disorder that may result in neuromuscular weakness and respiratory insufficiency. Gene replacement therapy has changed the trajectory of this condition, but long-term outcomes related to sleep disordered breathing are not known. METHODS This was a retrospective review of infants with SMA identified via newborn screening who subsequently received onasemnogene abeparvovec at the Hospital for Sick Children (Ontario, Canada). Polysomnograms were conducted at the time of confirmed diagnosis as well as regularly thereafter. RESULTS Eleven children (4 female) were identified via newborn screen (7 with 2 copies of the SMN2 gene and 4 with 3 copies of the SMN2 gene) and received onasemnogene abeparvovec at a median age of 3.6 weeks. All eleven infants met criteria for sleep disordered breathing based on their first completed polysomnograms but improved over time. Three infants required respiratory technology, including a premature infant who was prescribed nocturnal supplemental oxygen therapy for central sleep apnea and two symptomatic infants with neuromuscular weakness who required nocturnal noninvasive ventilation. We did not find a correlation between motor scores and polysomnogram parameters. CONCLUSION Children treated with onasemnogene abeparvovec have reduced sleep disordered breathing over time. Polysomnograms revealed abnormal parameters in all children, but the clinical significance of these findings was unclear for children who were asymptomatic for sleep disordered breathing or neuromuscular weakness. These results highlight the need to evaluate both motor scores and respiratory symptoms to ensure a holistic evaluation of clinical status.
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Affiliation(s)
- Jackie Chiang
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Lena Xiao
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Elisa Nigro
- Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Division of Neurology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Aaron St-Laurent
- Western University, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, 1151 Richmond St, London, Ontario, N6A 3K7, Canada; Western University, Division of Pediatric Respirology, Children's Hospital, London Health Sciences Centre, 1151 Richmond St, London, Ontario, N6A 3K7, Canada
| | - Lauren Weinstock
- Department of Rehabilitation Services, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Eugenia Law
- Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Division of Neurology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Joanna Janevski
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Sarah Kuyntjes
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Nisha Cithiravel
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Tuyen Tran
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Nikolaus E Wolter
- University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada; Department of Otolaryngology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Hernan Gonorazky
- Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada; Division of Neurology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada.
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Wijayaratne PR, Williams K, Davey MJ, Horne RSC, Nixon GM. Prediction of obstructive sleep apnoea in children and adolescents with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:880-892. [PMID: 37382027 DOI: 10.1111/jir.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is common in children and adolescents with Down syndrome (DS). Clinical guidelines recommend that all children with DS have polysomnography (PSG) for assessment of OSA by the age of 4 years, but access is limited and testing may be burdensome for children and families. METHODS The purpose of this prospective cross-sectional cohort study was to identify a model to predict OSA in this group that could be tested in an external population to triage children and adolescents with DS for PSG. These models were based on a comprehensive set of potential predictive demographic, anthropometric, quality of life and sleep-related variables. RESULTS The results of this study show the predictive power of a model based on the sleep disordered breathing subscale of the Pediatric Sleep Survey Instrument and sleep fragmentation quantified using actigraphy in determining moderate-severe OSA in children and adolescents with DS. This model exhibits high sensitivity (82%), specificity (80%), positive predictive value (75%) and negative predictive value (86%). CONCLUSIONS We demonstrate the utility of a tool containing the sleep disordered breathing subscale of the Pediatric Sleep Survey Instrument and sleep fragmentation quantified using actigraphy in identifying children and adolescents with DS who have moderate/severe OSA.
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Affiliation(s)
- P R Wijayaratne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - K Williams
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Developmental Paediatrics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - M J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - R S C Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - G M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
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Fishman H, Al-Shamli N, Sunkonkit K, Maguire B, Selvadurai S, Baker A, Amin R, Propst EJ, Wolter NE, Eckert DJ, Cohen E, Narang I. Heated humidified high flow nasal cannula therapy in children with obstructive sleep apnea: A randomized cross-over trial. Sleep Med 2023; 107:81-88. [PMID: 37148831 DOI: 10.1016/j.sleep.2023.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE/BACKGROUND Moderate-to-severe obstructive sleep apnea (OSA) is highly prevalent in children with obesity and/or underlying medical complexity. The first line of therapy, adenotonsillectomy (AT), does not cure OSA in more than 50% of these children. Consequently, continuous positive airway pressure (CPAP) is the main therapeutic option but adherence is often poor. A potential alternative which may be associated with greater adherence is heated high-flow nasal cannula (HFNC) therapy; however, its efficacy in children with OSA has not been systematically investigated. The study aimed to compare the efficacy of HFNC with CPAP to treat moderate-to-severe OSA with the primary outcome measuring the change from baseline in the mean obstructive apnea/hypopnea index (OAHI). PARTICIPANTS/METHODS This was a single-blinded randomized, two period crossover trial conducted from March 2019 to December 2021 at a Canadian pediatric quaternary care hospital. Children aged 2-18 years with obesity and medical complexity diagnosed with moderate-to-severe OSA via overnight polysomnography and recommended CPAP therapy were included in the study. Following diagnostic polysomnography, each participant completed two further sleep studies; a HFNC titration study and a CPAP titration study (9 received HFNC first, and 9 received CPAP first) in a random 1:1 allocation order. RESULTS Eighteen participants with a mean ± SD age of 11.9 ± 3.8 years and OAHI 23.1 ± 21.7 events/hour completed the study. The mean [95% CI] reductions in OAHI (-19.8[-29.2, -10.5] vs. -18.8 [-28.2, -9.4] events/hour, p = 0.9), nadir oxygen saturation (7.1[2.2, 11.9] vs. 8.4[3.5, 13.2], p = 0.8), oxygen desaturation index (-11.6[-21.0, -2.3] vs. -16.0[-25.3, -6.6], p = 0.5) and sleep efficiency (3.5[-4.8, 11.8] vs. 9.2[0.9, 15.5], p = 0.2) with HFNC and CPAP therapy were comparable between conditions. CONCLUSION HFNC and CPAP therapy yield similar reductions in polysomnography quantified measures of OSA severity among children with obesity and medical complexities. TRIAL REGISTRATION NCT05354401 ClinicalTrials.gov.
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Affiliation(s)
- Haley Fishman
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nawal Al-Shamli
- Division of Respiratory Medicine, Department of Pediatrics, Sultan Qaboos University, Muscat 123, Oman
| | - Kanokkarn Sunkonkit
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bryan Maguire
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Sarah Selvadurai
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Adele Baker
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Kids, Toronto, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Kids, Toronto, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Danny J Eckert
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Eyal Cohen
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Indra Narang
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Ontario, Canada.
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Temporal and Regional Trends in Obstructive Sleep Apnea Using Administrative Health Data in Alberta, Canada. Ann Am Thorac Soc 2023; 20:433-439. [PMID: 36516070 DOI: 10.1513/annalsats.202209-789oc] [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: 12/15/2022] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is a common treatable condition with important health and societal consequences. Objectives: We aimed to assess the annual incidence and prevalence of clinically recognized and geographic clustering of OSA in Alberta, Canada, using administrative health data case definitions. Methods: We used two administrative health databases in Alberta to identify ICD-9 and ICD-10 (International Classification of Diseases, Ninth and 10th Revisions, respectively) diagnostic codes for adults and children at least 2 years old diagnosed with OSA between 2003 and 2020. We defined OSA using an algorithm developed and validated in Alberta: at least three claims or one hospitalization within 2 years. We mapped residential postal codes to 70 subregional health authorities (SRHAs). Crude, age group- and sex-specific incidence and prevalence, and age group- and sex-standardized rates were calculated for Alberta and SRHAs. Spatial scan statistics identified clusters of SRHAs in which OSA cases were higher (hot spots) or lower (cold spots) than expected. Results: Between 2003 and 2020, OSA prevalence increased from 0.14% to 4.59%. The annual incidence of OSA increased after 2013. Incidence and prevalence were higher in older adults and children aged 2-11 years compared with 12-17 years. Cluster analysis revealed regional variation in OSA incidence and prevalence over time with no consistent pattern except for cold spots in one large metropolitan center (Calgary). Conclusions: From 2003 to 2020, the incidence and prevalence of clinically recognized OSA increased but varied by geography. Administrative health data can be used to guide interventions aimed at improving health service delivery and the quality of OSA care.
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Ambulatory transcutaneous carbon dioxide monitoring for children with neuromuscular disease. Sleep Med 2023; 101:221-227. [PMID: 36435158 DOI: 10.1016/j.sleep.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early screening and diagnosis of nocturnal hypoventilation can slow progression to diurnal hypercapnia and mortality in children with neuromuscular disease (NMD). However, gold standard, laboratory-based polysomnography (PSG) testing is a limited resource. Therefore, we evaluated the diagnostic accuracy of ambulatory transcutaneous carbon dioxide (tcCO2) monitoring used in the home compared to PSG in children with NMD. METHODS Prospective, cross-sectional study in children 0-18 years old with a confirmed diagnosis of NMD and a clinically indicated need for PSG. Ambulatory tcCO2 was assessed by a respiratory therapist in participant's homes. Demographics, and PSG (including tcCO2). RESULTS We enrolled 39 children with NMD; 3 had unusable ambulatory tcCO2 data because of failure of drift correction on the machine (n = 2) or an air bubble (n = 1). The remaining 36 patients aged 11 months to 16 years (median (IQR) 12.5 years (6.0-15.8)) had ambulatory tcCO2 and outpatient level 1 PSG data. Ambulatory tcCO2 monitoring had a sensitivity of 20.0% (95% confidence interval [CI] 0.5-71.6%) and a specificity of 93.5% (95% CI 78.6-99.2%). Almost all children and/or parents (34/36, 94%) preferred ambulatory monitoring over in-hospital PSG. CONCLUSIONS Ambulatory transcutaneous carbon dioxide monitoring was not sufficiently accurate as a clinical tool for the diagnosis of nocturnal hypoventilation our cohort of children with neuromuscular disease despite being preferred over PSG by both children and parents.
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Wu J, Lu Y, Cai X, Chen Y, Shen Z, Lyv Q. Gut microbiota dysbiosis in 4- to 6-year-old children with obstructive sleep apnea-hypopnea syndrome. Pediatr Pulmonol 2022; 57:2012-2022. [PMID: 35580999 DOI: 10.1002/ppul.25967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/16/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Several experiments on animals have reported the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and gut microbiota. We investigated the gut microbiota composition of children aged 4-6 years with OSAHS to complement the pathogenesis and clinical screening methods of OSAHS. METHODS We collected feces from 43 children with OSAHS and 45 controls aged 4-6 years. We extracted total bacterial DNA from feces and analyzed the composition of gut microbiota through 16S ribosomal RNA sequencing. RESULTS There were significant differences in bacteria producing short-chain fatty acids (SCFAs) between OSAHS children and controls, including Faecalibacterium, Roseburia, and a member of Ruminococcaceae. A gut microbiota model for pediatric OSAHS screening showed that the receiver operating characteristic-area under the curve (ROC-AUC) was 0.794 with 79.1% and 80.0% sensitivity and specificity, respectively. Functional analysis of the gut microbiota revealed several alterations in metabolism. CONCLUSION The composition of gut microbiota in OSAHS children is partially changed. The altered intestinal flora may provide a new screening method for the diagnosis of children with OSAHS. The prediction of gut microbiota function suggests that intestinal metabolic function may be altered in OSAHS children.
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Affiliation(s)
- Junhua Wu
- Medical School of Ningbo University, Ningbo, Zhejiang, China.,Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Yanbo Lu
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Xiaohong Cai
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Yuanyuan Chen
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Zhisen Shen
- Department of Otorhinolaryngology, Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qin Lyv
- Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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Chaput JP, Gariépy G, Pendharkar SR, Ayas NT, Samuels C, Vallières A, Davidson JR, Morin CM, Simonelli G, Bourguinat C, Gruber R, Petit D, Narang I, Viau V, Carrier J. National strategy on the integration of sleep and circadian rhythms into public health research and policies: Report from the Canadian Sleep and Circadian Network. Sleep Health 2022; 8:551-563. [PMID: 35963823 DOI: 10.1016/j.sleh.2022.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 10/15/2022]
Abstract
Scientists in sleep and circadian rhythms, public health experts, healthcare providers, partners, and stakeholders convened in 2020 for a 2-day meeting organized by the Canadian Sleep and Circadian Network to develop a national strategy for the integration of sleep and circadian rhythms into public health and policies in Canada. The objective of this paper is to present the national strategy that emerged from this meeting of 60 participants from across Canada. The meeting focused on 4 key target priorities: (1) atypical working schedules, (2) sleep and circadian rhythms of children and adolescents, (3) insomnia, and (4) impact of sleep apnea on health. Following constructive discussions over 2 days, it was decided that the following 4 strategic objectives should be prioritized to accelerate the integration of sleep and circadian rhythms into public health policies in Canada: (1) Increase public health sleep and circadian rhythm research, (2) Increase public health education and knowledge mobilization on sleep, (3) Inform and support public health sleep interventions and policies, and (4) Promote sleep health training. The participants recommended that research and public health efforts should address the needs along the continuum of sleep health. The committee noted that strategies and interventions could differ across contexts, settings, sectors, and jurisdictions. The national strategy also identified high-priority research questions in public health and recommended mechanisms to build research capacity, providing a path forward for the integration of sleep and circadian rhythms into public health research and policies.
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Affiliation(s)
- Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Gariépy
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada; Institut universitaire de santé mentale de Montréal, Montreal, Québec, Canada
| | - Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Najib T Ayas
- Department of Medicine, Respiratory and Critical Care Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles Samuels
- Centre for Sleep and Human Performance, Calgary, Alberta, Canada
| | - Annie Vallières
- École de Psychologie, Université Laval, Quebec City, Québec, Canada
| | - Judith R Davidson
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Charles M Morin
- École de Psychologie, Université Laval, Quebec City, Québec, Canada
| | - Guido Simonelli
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada
| | | | - Reut Gruber
- Attention, Behavior and Sleep Laboratory, Douglas Hospital Research Centre, Montreal, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Dominique Petit
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada
| | - Indra Narang
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Julie Carrier
- Département de psychologie, Université de Montréal, Montreal, Québec, Canada; Centre d'étude avancée en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada.
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Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2022; 18:1865-1875. [PMID: 35074045 PMCID: PMC9243277 DOI: 10.5664/jcsm.9904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA). METHODS Seven databases were searched to fulfill our research objectives. Clinical studies that included participants younger than 18 years with fully diagnosed OSA or without OSA and that evaluated skeletal, soft craniofacial features, or dental arch morphology were considered for this review. The risk of bias and certainty of evidence were assessed. A meta-analysis was performed when low methodological and clinical heterogeneity were detected. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA-2020) guidelines. RESULTS Nine studies were identified at the end of the selection process, from which 5 did not report differences. Four studies reported differences between craniofacial features when OSA was compared to an asymptomatic control group. Mandibular retrognathia, reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids), longer facial profile, and a narrower intercanine width were described among children with OSA. A meta-analysis was performed considering the studies with a similar methodological approach, and no differences were observed in all the considered cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN). All the included studies were considered at low risk of bias even though some limitations were noted. CONCLUSIONS Due to the very low to moderate level of certainty, neither an association nor a lack thereof between craniofacial morphology and pediatric OSA can be supported by these data. CITATION Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(7):1865-1875.
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Affiliation(s)
| | - Silvia Gianoni-Capenakas
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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11
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Fagundes NCF, Perez-Garcia A, Graf D, Flores-Mir C, Heo G. Orthodontic interventions as a management option for children with residual obstructive sleep apnea: a cohort study protocol. BMJ Open 2022; 12:e061651. [PMID: 35705345 PMCID: PMC9204397 DOI: 10.1136/bmjopen-2022-061651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is a sleep-breathing disorder that seems likely to have long-term negative social and health consequences in children and adolescents. There are no established standard management approaches when the first line of therapy, the tonsillectomy and adenoidectomy (T&A), is not indicated or fails to address paediatric OSA (residual paediatric OSA). This protocol describes a prospective cohort study that aims to assess the effectiveness of orthodontic interventions for managing residual paediatric OSA in patients with concomitant craniofacial issues. METHODS AND ANALYSIS Children aged 6-16 years who with an OSA diagnosis and did not benefit from previous T&A or qualified for T&A will be recruited. Orthodontic intervention(s), when adequately indicated (maxillary expansion, mandibular advancement or maxillary complex advancement with skeletal anchored headgear), and a control (orthodontic intervention declined) cohorts will be involved. A sample size of 70 participants (n=35 per cohort) is planned. Effectiveness data will be assessed through nocturnal polysomnography, a craniofacial index, sleep questionnaires and medical records. Additionally, the association of residual OSA and two comorbidities, obesity and asthma, will be investigated through assessing blood, urine and saliva metabolites. The changes on body mass index will also be investigated as a secondary outcome. Other additional outcomes, including association between residual paediatric OSA and periodic limbs movement, restless leg syndrome, insomnia, and the use of abiometric shirt to sleep monitoring purposes will also be considered. All participants will be followed up for 12 months after treatment allocation. The effectiveness of the intervention will be analysed by the assessment of sleep parameters, medical history (from medical chart reviews), questionnaire responses, craniofacial characteristics and metabolomic markers using an algorithm to be developed. ETHICS AND DISSEMINATION This study was approved by the Health Research Ethics Board-Health Panel, University of Alberta, Edmonton, Canada (Pro00084763). The findings will be shared with scientific and patient content-specific social network communities to maximise their impact on clinical practice and future research in the study topic. TRIAL REGISTRATION NUMBER NCT03821831; Pre-results.
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Affiliation(s)
| | | | - Daniel Graf
- Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Giseon Heo
- Dentistry, University of Alberta, Edmonton, Alberta, Canada
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12
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Xiao L, Barrowman N, Momoli F, Murto K, Bromwich M, Katz SL. Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a retrospective cohort study. Eur J Pediatr 2022; 181:2399-2408. [PMID: 35278117 DOI: 10.1007/s00431-022-04438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy (AT). However, these children are at increased risk for perioperative respiratory adverse events (PRAEs). The objective of this study was to examine risk factors for major PRAEs requiring intervention in children with Down syndrome undergoing AT and to describe their postoperative monitoring environment. This retrospective study included all children with Down syndrome aged 0-18 years who underwent a preoperative polysomnogram followed by AT at a tertiary pediatric institution. Descriptive statistics were used to summarize baseline demographic and clinical characteristics. A multivariable model for prediction of PRAEs was constructed. A priori, it was decided that minimum oxygen saturation, apnea-hypopnea index, and average oxygen saturation asleep would be included, along with medical comorbidities associated with PRAEs at p < 0.2 in univariable analyses. Fifty-eight children were included in this study; twelve had a PRAE. Cardiac disease was associated with PRAEs on univariable analysis (p = 0.03). In multivariable analysis, average oxygen saturation asleep was associated with PRAEs (OR 1.50; 95% confidence interval 1.00, 2.41; p = 0.05). For all of the remaining variables, p > 0.15. Fifty-six children were admitted for monitoring overnight; four were admitted to the intensive care unit and fifty-two were admitted to the ward. CONCLUSIONS A multivariable model found evidence that lower average oxygen saturation while asleep was associated with PRAEs requiring intervention in children with Down syndrome. This study highlights the difficulty in predicting complications in this population. WHAT IS KNOWN • Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy. • However, children with Down syndrome are at increased risk for perioperative respiratory adverse events (PRAEs) following adenoidectomy and/or tonsillectomy. WHAT IS NEW • We found that a lower average oxygen saturation asleep is associated with increased odds of PRAEs, adjusting for age, total apnea-hypopnea index, cardiac comorbidity, and minimum oxygen saturation. • This study highlights the difficulty in predicting complications in this population.
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Affiliation(s)
- Lena Xiao
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.,University of Ottawa, Ottawa, Canada
| | - Nicholas Barrowman
- University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Franco Momoli
- University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kimmo Murto
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.,University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Matthew Bromwich
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.,University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada. .,University of Ottawa, Ottawa, Canada. .,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
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13
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Bseikri M, Zhang J, Kirley J, Lee C, Castillo A, Feliciano EMC. Predicting obstructive sleep apnea severity in children referred for polysomnography: use of the Pediatric Sleep Questionnaire and Subscales. Sleep Breath 2022; 27:545-552. [DOI: 10.1007/s11325-022-02647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
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14
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Feasibility of split night polysomnography in children to diagnose and treat sleep related breathing disorders. Sleep Med 2022; 96:107-112. [DOI: 10.1016/j.sleep.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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15
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Xiao L, Kaspy K, Zielinski D, Amin R. Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO-CON debate. Pediatr Pulmonol 2022; 57:609-615. [PMID: 34825785 DOI: 10.1002/ppul.25773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
Determining the timing for decannulation in children with a tracheostomy is a complex process, as the appropriate timing varies based on the initial indication for the tracheostomy tube as well as individual patient characteristics. The original condition for which a tracheostomy was created may improve over time with decannulation being a very important long-term goal for many families and multidisciplinary teams. However, decannulation is an inherently risky procedure associated with morbidity and mortality. Therefore, careful planning is required to ensure the safety of the procedure. Although routine airway endoscopy is an important component of decannulation protocols, guidelines are less prescriptive regarding the definition of a complete endoscopic airway evaluation and the routine use of polysomnography. This review will summarize the important PRO and CON arguments of integrating polysomnography into pediatric decannulation protocols.
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Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Kimberley Kaspy
- Division of Respiratory Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - David Zielinski
- Division of Respiratory Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Radhakrishnan D, Knight B, Gozdyra P, Katz SL, Maclusky IB, Murto K, To TM. Geographic disparities in performance of pediatric polysomnography to diagnose obstructive sleep apnea in a universal access health care system. Int J Pediatr Otorhinolaryngol 2021; 147:110803. [PMID: 34198156 DOI: 10.1016/j.ijporl.2021.110803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/14/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diagnostic polysomnography (PSG) is recommended prior to adenotonsillectomy (AT) for children with obstructive sleep apnea (OSA) and certain high-risk characteristics, but resource limitations often prevent this practice. OBJECTIVE We performed a population-based assessment of children across Ontario, Canada to describe and quantify disparities in PSG. METHODS AND MATERIALS This retrospective cohort study was performed using provincial health administrative data held at ICES. We identified children 0-10 years old who underwent PSG and AT between 2009 and 2018, and those with a PSG within 18 months prior to and/or 12 months following AT. We calculated the odds of PSG prior to/following AT after adjustment for demographics, medical comorbidities, geographic and socioeconomic characteristics. Our main predictor was driving time/distance to the nearest pediatric sleep centre ascertained using spatial analysis and geographic information systems. RESULTS We identified 27,837 children <10 years old who underwent AT for OSA in Ontario. Only 12.8% had a PSG within 18 months prior and 5.7% had a PSG within 12 months following AT. Shorter driving time/distance, older age, male sex and certain comorbidities were associated with increased odds of PSG. CONCLUSION Only a small proportion of children in our cohort underwent PSG prior to or following AT surgery despite universal access to healthcare. This study suggests a need to increase overall PSG access, particularly for those living distant from existing pediatric sleep centres. Future studies could determine if increased PSG testing in 'underserviced areas' would reduce overall surgery rates and/or improve health outcomes.
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Affiliation(s)
- D Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute, ON, Canada; Department of Pediatrics, University of Ottawa, ON, Canada; ICES, Ontario, Canada.
| | | | | | - S L Katz
- Children's Hospital of Eastern Ontario Research Institute, ON, Canada; Department of Pediatrics, University of Ottawa, ON, Canada
| | - I B Maclusky
- Children's Hospital of Eastern Ontario Research Institute, ON, Canada; Department of Pediatrics, University of Ottawa, ON, Canada
| | - K Murto
- Children's Hospital of Eastern Ontario Research Institute, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - T M To
- ICES, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, ON, Canada; Child Health Evaluative Sciences, Hospital for Sick Children, ON, Canada
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17
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Westenberg JN, Petrof BJ, Noel F, Zielinski D, Constantin E, Oskoui M, Kaminska M. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med 2021; 17:1579-1590. [PMID: 33739260 PMCID: PMC8656910 DOI: 10.5664/jcsm.9254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD. METHODS Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference. RESULTS Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants. CONCLUSIONS HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD. CITATION Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med. 2021;17(8):1579-1590.
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Affiliation(s)
- Jean N. Westenberg
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
| | - Basil J. Petrof
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
- Meakins Christie Laboratories, Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Francine Noel
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zielinski
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
| | - Maryam Oskoui
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Marta Kaminska
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
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18
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Heath DS, El-Hakim H, Al-Rahji Y, Eksteen E, Uwiera TC, Isaac A, Castro-Codesal M, Gerdung C, Maclean J, Mandhane PJ. Development of a pediatric obstructive sleep apnea triage algorithm. J Otolaryngol Head Neck Surg 2021; 50:48. [PMID: 34266488 PMCID: PMC8281470 DOI: 10.1186/s40463-021-00528-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diagnosis and treatment of obstructive sleep apnea (OSA) in children is often delayed due to the high prevalence and limited physician and sleep testing resources. As a result, children may be referred to multiple specialties, such as pediatric sleep medicine and pediatric otolaryngology, resulting in long waitlists. METHOD We used data from our pediatric OSA clinic to identify predictors of tonsillectomy and/or adenoidectomy (AT). Before being seen in the clinic, parents completed the Pediatric Sleep Questionnaire (PSQ) and screening questionnaires for restless leg syndrome (RLS), nasal rhinitis, and gastroesophageal reflux disease (GERD). Tonsil size data were obtained from patient charts and graded using the Brodsky-five grade scale. Children completed an overnight oximetry study before being seen in the clinic, and a McGill oximetry score (MOS) was assigned based on the number and depth of oxygen desaturations. Logistic regression, controlling for otolaryngology physician, was used to identify significant predictors of AT. Three triage algorithms were subsequently generated based on the univariate and multivariate results to predict AT. RESULTS From the OSA cohort, there were 469 eligible children (47% female, mean age = 8.19 years, SD = 3.59), with 89% of children reported snoring. Significant predictors of AT in univariate analysis included tonsil size and four PSQ questions, (1) struggles to breathe at night, (2) apneas, (3) daytime mouth breathing, and (4) AM dry mouth. The first triage algorithm, only using the four PSQ questions, had an odds ratio (OR) of 4.02 for predicting AT (sensitivity = 0.28, specificity = 0.91). Using only tonsil size, the second algorithm had an OR to predict AT of 9.11 (sensitivity = 0.72, specificity = 0.78). The third algorithm, where MOS was used to stratify risk for AT among those children with 2+ tonsils, had the same OR, sensitivity, and specificity as the tonsil-only algorithm. CONCLUSION Tonsil size was the strongest predictor of AT, while oximetry helped stratify individual risk for AT. We recommend that referral letters for snoring children include graded tonsil size to aid in the triage based on our findings. Children with 2+ tonsil sizes should be triaged to otolaryngology, while the remainder should be referred to a pediatric sleep specialist.
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Affiliation(s)
- D S Heath
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - H El-Hakim
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Y Al-Rahji
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - E Eksteen
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - T C Uwiera
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - A Isaac
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - M Castro-Codesal
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - C Gerdung
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - J Maclean
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - P J Mandhane
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Leader BA, Koritala BSC, Moore CA, Dean EG, Kottyan LC, Smith DF. Epigenetics of obstructive sleep apnea syndrome: a systematic review. J Clin Sleep Med 2021; 17:2533-2541. [PMID: 34176557 DOI: 10.5664/jcsm.9514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a chronic and widely prevalent disease, associated with multiple health disorders. Current diagnostic strategies for OSA are limited due to cost, time, and access. Epigenetic signatures offer insight into the relationships between disease and environment and could play a significant role in developing both diagnostic and therapeutic tools for OSA. In the current study, a systematic literature search was conducted to investigate the existing evidence of OSA-associated epigenetic modifications. METHODS A systematic literature search was performed using electronic academic databases including PubMed, CINAHL, Scopus, Embase, EBM Reviews, and Web of Science. However, the current study focused on screening for original, English language articles pertaining to OSA and associated epigenetic mechanisms. To produce unbiased results, screening was performed independently by authors. RESULTS We identified 2,944 publications in our systematic search. Among them, 65 research articles were related to OSA-associated differential gene expression, genetic variation, and epigenetic modifications. Although these 65 articles were considered for full manuscript review, only twelve articles met the criteria of OSA-associated epigenetic modifications in humans and animal models. Human subjects with OSA had unique epigenetic changes compared to healthy controls, and, interestingly, epigenetic signatures were commonly identified in genes associated with metabolic and inflammatory pathways. CONCLUSIONS Although the available studies are limited, this research provides novel insights for development of epigenetic markers for the diagnosis and treatment of OSA. Thorough genome wide investigations will be required to develop cost-effective, robust biomarkers for the identification of OSA among children and adults. Here, we offer a study design for such efforts.
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Affiliation(s)
- Brittany A Leader
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.,Contributed equally and are co-first authors
| | - Bala S C Koritala
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Contributed equally and are co-first authors
| | - Charles A Moore
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elaine G Dean
- Pratt Research Library, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Leah C Kottyan
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David F Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,The Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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20
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Xiao L, Barrowman N, Momoli F, Murto K, Bromwich M, Proulx F, Katz SL. Polysomnography parameters as predictors of respiratory adverse events following adenotonsillectomy in children. J Clin Sleep Med 2021; 17:2215-2223. [PMID: 34019475 DOI: 10.5664/jcsm.9420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The first line treatment of obstructive sleep apnea syndrome in children is adenotonsillectomy but this may result in perioperative respiratory adverse events (PRAEs). The primary aim of this study is to examine whether the McGill oximetry score (MOS) and other polysomnography parameters can predict major PRAEs following adenotonsillectomy. We secondarily evaluated the MOS inter-rater reliability and correlation with other polysomnography parameters. METHODS This retrospective study included all children aged 0-18 years who underwent preoperative polysomnography between June 2010 and January 2016 prior to adenotonsillectomy at a tertiary pediatric institution. Oximetries from polysomnograms were assigned a MOS. Univariable and multivariable models for prediction of major PRAEs were constructed. MOS was correlated with polysomnography parameters and inter-rater reliability was evaluated. RESULTS This study included 106 children; 15 had a major PRAE. A multivariable prediction model that combined MOS and age showed evidence for the ability to predict major PRAEs with an area under the receiver operating characteristic curve of 0.68 (95% confidence interval 0.52, 0.84), whereby increased MOS and younger age were associated with PRAEs, but apnea-hypopnea index was not. MOS had excellent inter-rater reliability (Kappa=0.95) and was highly correlated with oxygen saturation nadir and cumulative time percentage with oxygen saturation less than 90%. CONCLUSIONS A prediction model including MOS and age may predict PRAEs following adenotonsillectomy. This suggests that nocturnal oximetry provides the most essential information of polysomnography measures to direct postoperative monitoring following adenotonsillectomy.
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Affiliation(s)
- Lena Xiao
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Nicholas Barrowman
- University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Franco Momoli
- University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kimmo Murto
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Matthew Bromwich
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Frédéric Proulx
- Centre Hospitalier de l'Université Laval, Québec City, Canada.,Université Laval, Québec City, Canada
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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21
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Logjes RJH, MacLean JE, de Cort NW, Poets CF, Abadie V, Joosten KFM, Resnick CM, Trindade-Suedam IK, Zdanski CJ, Forrest CR, Kruisinga FH, Flores RL, Evans KN, Breugem CC. Objective measurements for upper airway obstruction in infants with Robin sequence: what are we measuring? A systematic review. J Clin Sleep Med 2021; 17:1717-1729. [PMID: 33960296 DOI: 10.5664/jcsm.9394] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES Identifying optimal treatment for infants with Robin sequence (RS) is challenging due to substantial variability in the presentation of upper airway obstruction (UAO) in this population. Objective assessments of UAO and treatments are not standardized. A systematic review of objective measures of UAO was conducted as step towards evidence based clinical decision making for RS. METHODS A literature search was performed in Pubmed and Embase databases (1990-2020) following PRISMA-guidelines. Articles reporting on RS and UAO-treatment were included if the following objective measures were studied: oximetry, polysomnography and blood gas. Quality was appraised by methodological index for non-randomized studies (MINORS, range:0-24). RESULTS A total of 91 articles met inclusion criteria. Mean MINORS-score was 7.1 (range:3-14). Polysomnography was most frequently used (76%) followed by oximetry (20%) and blood gas (11%). Sleep position of the infant was reported in 35% of studies, with supine position most frequently, and monitoring time in 42%, including overnight recordings in more than half. Of 71 studies that evaluated UAO-interventions, the majority used polysomnography (90%), of which 61% did not specify the polysomnography technique. Reported polysomnography metrics included oxygen saturation (61%), apnea-hypopnea index (52%), carbon dioxide levels (31%), obstructive-apnea-hypopnea index (27%), and oxygen-desaturation-index (16%). Only 42 studies reported indications for UAO-intervention, with oximetry and polysomnography thresholds used equally (both 40%). In total, 34 distinct indications for treatment were identified. CONCLUSIONS This systematic review demonstrates a lack of standardization, interpretation and reporting of assessment and treatment indications for UAO in RS. An international, multidisciplinary consensus protocol is needed to guide clinicians on optimal UAO assessment in RS.
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Affiliation(s)
- Robrecht J H Logjes
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centre, location AMC & VU, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Alberta, Canada
| | - Noor W de Cort
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
| | - Véronique Abadie
- Department of General Pediatrics, Necker University Hospital, Paris, France
| | - Koen F M Joosten
- Department Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Harvard Medical School Boston, Boston Children's Hospital, USA
| | - Ivy K Trindade-Suedam
- Sleep Unit, Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, USA
| | - Christopher R Forrest
- Division Plastic and Reconstructive Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Frea H Kruisinga
- Department of Pediatrics, Amsterdam University Medical Centre, location AMC, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - Kelly N Evans
- Department of Pediatrics, University of Washington, Seattle Children's Craniofacial Center, Seattle, USA
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centre, location AMC & VU, Emma Children's Hospital, Amsterdam, The Netherlands
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22
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van Eeden C, Tamana SK, Narang I, Hammam N, Chikuma J, Lefebvre DL, Azad MB, Moraes TJ, Subbarao P, Becker AB, Turvey SE, Sears MR, Rasmussen C, Pei J, Mandhane PJ. Development and Validation of SDBeasy Score as a Predictor of Behavioral Outcomes in Childhood. Am J Respir Crit Care Med 2021; 203:718-725. [PMID: 32898424 DOI: 10.1164/rccm.202002-0363oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale: There are limited tools to identify which children are at greatest risk for developing sleep-disordered breathing (SDB)-associated behavioral morbidity.Objectives: To examine associations between age of onset and duration of parent-reported symptoms of SDB and behavioral problems at the age of 5 years.Methods: Data were collected and analyses were completed for participants in the CHILD (Canadian Healthy Infant Longitudinal Development) cohort at the Edmonton and Toronto sites. We generated an SDBeasy score on the basis of the age of onset and duration of SDB symptoms as reported by parents completing the Pediatric Sleep Questionnaire. Using CHILD-Edmonton data, we completed multivariate linear regression to determine whether the SDBeasy score was associated with behavioral problems at the age 5 years of age as assessed by using the Child Behavior Checklist (CBCL). We then validated the SDBeasy score using CHILD-Toronto data.Measurements and Main Results: At the 5-year visit, 581 of 716 (81%) CHILD-Edmonton participants still enrolled had CBCL data. Of the 581 children with data, 77% (446 of 581) had an SDBeasy score of 0 (never had SDB symptoms), whereas 20 of 581 children (3.4%) had persistent SDB symptoms from infancy through 5 years of age (SDBeasy score of 24). Children had a 0.35-point-higher CBCL total behavioral score at 5 years for each 1-point increase in their SDBeasy score (95% confidence interval, 0.24-0. 5; P < 0.01). We found consistent results among CHILD-Toronto participants; children had a 0.26-point-higher CBCL total behavioral score at 5 years for each 1-point increase in their SDBeasy score (95% confidence interval, 0.08-0.44; P = 0.005).Conclusions: The SDBeasy score, based on the Pediatric Sleep Questionnaire, enables identification of children with higher behavioral-problem scores.
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Affiliation(s)
| | | | - Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Theo J Moraes
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Jacqueline Pei
- Department of Education Psychology, University of Alberta, Edmonton, Alberta, Canada
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23
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Jewitt N, Orkin J, Cohen E, Narang I, Al-Saleh S, Amin R. The impact of polysomnograms and family-centred decision making in children with medical complexity. Paediatr Child Health 2021; 26:114-119. [DOI: 10.1093/pch/pxaa021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/03/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To determine whether a change in clinical management (e.g., new tracheostomy or adenotonsillectomy) occurred following a polysomnogram (PSG) in children with medical complexity (CMC) and to explore whether families’ goals of care (regarding results and treatment implications) were discussed prior to the completion of a PSG.
Methods
All CMC enrolled in a complex care program at the Hospital for Sick Children, Canada, who underwent a baseline PSG from 2009 to 2015 were identified. Exclusion criteria included (1) PSGs for ventilation titration and (2) PSGs outside the study time frame. Health records were retrospectively reviewed to determine demographics, medical histories, families’ wishes, PSG results, and their impact on clinical care. Descriptive statistics were used to summarize results.
Results
Of 145 patients identified, 96 patients met inclusion criteria. Fifty (52%) were male. Median age was 3 years. Forty-eight (50%) were diagnosed with clinically significant (i.e., moderate to severe obstructive sleep apnea, central sleep apnea, and/or hypoventilation) sleep-related breathing disorders. Of those diagnosed, 9 (19%) had surgery, 25 (52%) underwent respiratory technology initiation, and 3 (6%) underwent both. In the remaining 11 (23%) patients, treatment was either considered too risky or did not align with the families’ wishes. Only 3 of 96 patients had clear documentation of their families’ wishes prior to PSG completion.
Conclusion
Recognizing the burden of medical tests for both the child and the health care system, a process of shared-decision making that includes clarifying a family’s wishes may be prudent prior to conducting a PSG.
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Affiliation(s)
- Natalie Jewitt
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Julia Orkin
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario
| | - Eyal Cohen
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario
| | - Indra Narang
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Respiratory and Sleep Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Suhail Al-Saleh
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Respiratory and Sleep Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Reshma Amin
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario
- Division of Respiratory and Sleep Medicine, Hospital for Sick Children, Toronto, Ontario
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24
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Schiza S, Simonds A, Randerath W, Fanfulla F, Testelmans D, Grote L, Montserrat JM, Pepin JL, Verbraecken J, Ersu R, Bonsignore MR. Sleep laboratories reopening and COVID-19: a European perspective. Eur Respir J 2021; 57:13993003.02722-2020. [PMID: 33214202 PMCID: PMC7683791 DOI: 10.1183/13993003.02722-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023]
Abstract
Clinical activities regarding sleep disordered breathing (SDB) have been sharply interrupted during the initial phase of the coronavirus disease 2019 (COVID-19) epidemic throughout Europe. In the past months, activities have gradually restarted, according to epidemiological phase of COVID-19 and national recommendations. The recent increase in cases throughout Europe demands a reconsideration of management strategies of SDB accordingly. Diagnosis of SDB and initiation of treatment pose some specific problems to be addressed to preserve the safety of patients and health personnel. This perspective document by a group of European sleep experts aims to summarise some different approaches followed in Europe and United States, which reflect national recommendations according to the epidemiological phase of the COVID-19 infection. Respiratory sleep medicine is likely to change in the near future, and use of telemedicine will grow to avoid unnecessary risks and continue to provide optimal care to patients. In addition, the document covers paediatric sleep studies and indications for titration of noninvasive ventilation, as well as precautions to be followed by patients who are already on positive airway pressure treatment. A single consensus document developed by the European Respiratory Society and national societies would be desirable to harmonise SDB management throughout Europe. Specific precautions should be applied for starting activities in respiratory sleep centres during the COVID-19 epidemichttps://bit.ly/3keRjii
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Anita Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, IstitutiCliniciScientifici Maugeri IRCCS, Pavia, Italy
| | - Dries Testelmans
- Clinical Dept of Respiratory Diseases, UZ Leuven - BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Ludger Grote
- Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital and Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Joseph M Montserrat
- Sleep Laboratory, Hospital Clinic, Universitat de Barcelona, Barcelona, and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Jean-Louis Pepin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Verbraecken
- Dept of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Refika Ersu
- Division of Pediatric Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Maria R Bonsignore
- Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Dept, University of Palermo, and IRIB, National Research Council (CNR), Palermo, Italy
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25
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Katz SL, Blinder H, Naik T, Barrowman N, Narang I. Does neck circumference predict obstructive sleep apnea in children with obesity? Sleep Med 2021; 78:88-93. [PMID: 33418431 DOI: 10.1016/j.sleep.2020.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) affects 10-50% of children with obesity, but its identification is challenging and wait times for testing are long. Previous studies suggest that neck circumference (NC) and neck-to-height ratio (NHR) may predict OSA. Our objectives were to 1) evaluate associations of NC and NHR with OSA; 2) model NHR as a predictor of OSA, adjusting for age, sex, and Tanner stage; and 3) identify thresholds of NHR associated with OSA, in children with obesity. METHODS Participants were aged 8-17 years, with obesity (BMI >95%ile), undergoing polysomnography. Associations between NC and NHR with OSA were evaluated. NHR, age, sex and self-reported Tanner stage (early/late) were included in a negative binomial multiple regression model to predict obstructive apnea hypopnea index (OAHI). RESULTS 71 children participated, with median age 14.8 years (IQR 12.6, 16.0), 54% male, median BMI z-score 2.5 (IQR 2.3, 2.7), and 77% late Tanner stage. OSA was severe in 18 children (25.4%), moderate in 12 (16.9%), and mild in 18 (25.4%). In the model, each 0.01 increase in NHR was associated with a 55% increase in OAHI (95% CI: 36%, 80%); boys had a 119% higher OAHI than girls (95% CI: 10%, 337%). Threshold NHR associated with moderate-severe OSA was 0.25 in females and 0.23 in males. CONCLUSIONS NHR and male sex independently predict OSA severity in children with obesity, adjusting for age and Tanner stage. Children with obesity and NHR above identified thresholds are more likely to have moderate-severe OSA, and may benefit from earlier polysomnography.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada.
| | - Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada
| | - Tanvi Naik
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
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26
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Selvadurai S, Voutsas G, Propst EJ, Wolter NE, Narang I. Obstructive sleep apnea in children aged 3 years and younger: Rate and risk factors. Paediatr Child Health 2020; 25:432-438. [PMID: 33173554 PMCID: PMC7606157 DOI: 10.1093/pch/pxz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/25/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Undiagnosed and untreated obstructive sleep apnea (OSA) can predispose children to neurobehavioural consequences. However, there is a lack of data identifying rate of, and risk factors for, OSA in very young healthy children. The objective of this study was to determine the rate of OSA and identify risk factors associated with the presence and severity of OSA in children aged 3 years and younger. METHODS This was a retrospective chart review of healthy children between 1 and 3 years old who had a baseline polysomnogram (PSG) between January 2012 and June 2017. Patient demographics, referral history, and PSG data were recorded. RESULTS One hundred and thirteen children were referred for a PSG, of which 66 (58%) were diagnosed with OSA and 47 (42%) did not have OSA. In the OSA group, 13 (20%) were mild and 53 (80%) were moderate-severe. Nasal congestion (P=0.001), adenoid hypertrophy (P=<0.001), and tonsillar hypertrophy (P=0.04) reported at the time of referral were more common in the OSA group compared to the no-OSA group. Binary logistic regression analysis showed that referral from an otolaryngologist (odds ratio=2.6, 95% confidence interval=1.1 to 6.0) were associated with moderate-severe OSA. CONCLUSION A high rate of OSA was found among children aged 3 years and younger. Children referred by an otolaryngologist are more likely to be diagnosed with moderate-severe OSA. Children aged 3 years and younger with symptoms of OSA should be considered high-risk for OSA and be prioritized for early PSG and management.
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Affiliation(s)
- Sarah Selvadurai
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Giorge Voutsas
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - Evan J Propst
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Nikolaus E Wolter
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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27
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Abstract
"Home noninvasive ventilation (NIV) is indicated for numerous conditions including neuromuscular disease, thoracic cage disorders, chronic obstructive pulmonary disease, and hypoventilation syndromes. Effective management of patients on home NIV requires clinicians to interpret data downloads from NIV devices. Clinicians must first look at adherence and factors that may impact this including mask comfort and fit. Next, leak assessment is undertaken. Once these are addressed, such information as apnea-hypopnea index, exhaled tidal volume, and percent triggered breaths help clinicians troubleshoot setting changes. Finally, overnight oximetry and transcutaneous CO2 monitoring are useful adjuncts to the data download to optimize NIV settings."
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Affiliation(s)
- Philip Choi
- University of Michigan, 3916 Taubman Center/1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109, USA
| | - Veronique Adam
- Programme National d'assistance Ventilatoire à Domicile, McGill University Health Center, Building V - Division of Clinical Epidemiology, 1025 Pine Ave W, Montreal, Quebec H3A 1A1, Canada
| | - David Zielinski
- Montreal Children's Hospital, Research Institute of McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
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28
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Cardiorespiratory Monitoring Data during Sleep in Healthy Canadian Infants. Ann Am Thorac Soc 2020; 17:1238-1246. [DOI: 10.1513/annalsats.201909-703oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Diskin C, McVeigh TP, Cox DW. Sleep disordered breathing in children with Down syndrome in the Republic of Ireland. Am J Med Genet A 2020; 182:2847-2856. [PMID: 32902194 DOI: 10.1002/ajmg.a.61855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022]
Abstract
Down syndrome (DS) is associated with a complex respiratory phenotype, including obstructive sleep apnea syndrome (OSAS). The study explored parent-reported prevalence and presentation of OSAS symptoms in children and adolescents with DS in Ireland. It also investigated treatment and compliance in those who have OSAS. A cross-sectional survey was distributed to parents registered with Down Syndrome Ireland (DSI) (n = 1,343). Data was collated and analyzed using SPSS v23. The response rate was 393 (29%). Twenty-one percent of parents (n = 84) reported a diagnosis of OSAS in their child. The parents of children reported as compliant with continuous positive airway pressure (CPAP) were more likely to report a perceived benefit of treatment (p = .018). Ninety-two percent (n = 212) of children without a formal diagnosis of OSAS had at least one symptom (median 4 symptoms) of the condition. This, the largest survey of parental reporting of OSAS or its symptoms, demonstrates a high reported prevalence of symptoms in children and adolescents with DS in Ireland without a formal diagnosis of OSAS, indicating under-recognition. In treated patients, perception of the benefit of CPAP correlated with reported compliance, suggesting a need for tailored education.
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Affiliation(s)
- Catherine Diskin
- Department of Respiratory Medicine, Children's Hospital Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Des W Cox
- Department of Respiratory Medicine, Children's Hospital Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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30
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Kong DK, Kong AM, Wasserman I, Villavisanis DF, Hackett AM. Ambulatory tonsillectomy for children with severe obstructive sleep apnea without risk factors. Am J Otolaryngol 2020; 41:102467. [PMID: 32234256 DOI: 10.1016/j.amjoto.2020.102467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/24/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recommendations for polysomnography (PSG) in pediatric sleep disordered breathing (SDB) vary between the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the American Academy of Pediatrics (AAP). We determined the rates of preoperative PSG in children without risk factors outlined in the AAO-HNS Clinical Practice Guidelines and described the postoperative course of those patients following T&A. METHODS Patients aged 3-17 undergoing T&A for SDB or OSA who did not have an indication for preoperative PSG were included. We conducted retrospective review to describe the rate, type, and timing of respiratory complications for patients with and without PSG following T&A, and discuss cases where disposition was changed due to PSG results. RESULTS 1135 patients without risk factors underwent T&A for SDB or OSA. 196 (17%) had a preoperative PSG, of whom 85 (43.3%) had AHI >10 and 38 (24.8%) had an O2 nadir <80%. 69 (85%) patients with PSG-diagnosed severe OSA were admitted overnight. Of the entire cohort, 5 patients (0.44%) had hypoxemia requiring blow-by oxygen or repositioning. 4 (0.43%) patients without PSG experienced respiratory events and were converted to overnight stay. The timing of respiratory events for all children ranged from immediately following extubation in the operating room to 3 h postoperatively. CONCLUSION PSG in children without risk factors results in admission of otherwise healthy patients following T&A who would have otherwise undergone ambulatory surgery. PSG alone in pediatric patients with no AAO-HNS risk factors should not influence postoperative disposition. These patients should be monitored for 3 h post-T&A and discharged in the absence of complications. EVIDENCE LEVEL 2b.
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Affiliation(s)
- Derek K Kong
- Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | | | - Alyssa M Hackett
- Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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31
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Wong MD, Chung H, Chawla J. Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease. J Paediatr Child Health 2020; 56:309-316. [PMID: 31464352 DOI: 10.1111/jpc.14606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
AIM The aims of this study are: (i) to survey the knowledge of paediatric clinicians using overnight continuous pulse oximetry data to guide management of infants with chronic neonatal lung disease (CNLD); (ii) to assess the ability of paediatric clinicians to interpret overnight continuous pulse oximetry data; and (iii) to describe the overnight oximetry interpretation practices of paediatric respiratory specialists. METHODS Paediatric clinicians from three tertiary teaching hospitals completed an anonymous survey regarding overnight continuous pulse oximetry in chronic neonatal lung disease. Using a modified Delphi technique, paediatric respiratory specialists participated in a concordance exercise and discussions to establish consensus interpretations for 25 oximetry studies. Paediatric clinicians were invited to complete the same exercise as a comparison. RESULTS Self-rated knowledge from 74 surveyed clinicians was proportional to clinical experience. Twenty paediatric clinicians and nine paediatric respiratory specialists completed the oximetry exercise with scores of 64% (κ = 0.25) and 80% (κ = 0.45), respectively. Individual parameters like a mean peripheral arterial haemoglobin saturation (SpO2 ) below 93% and percentage time spent below SpO2 93% correlated poorly with the consensus interpretations. Paediatric respiratory specialists instead relied on visual analysis of SpO2 waveforms, utilising the frequency and depth of desaturations to guide management. CONCLUSION Interpretation of overnight oximetry data is variable amongst both paediatric clinicians and respiratory specialists. This likely reflects inadequate evidence defining clinically significant intermittent hypoxaemia, whether in terms of desaturation duration, frequency or nadir.
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Affiliation(s)
- Matthew D Wong
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Hinfan Chung
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jasneek Chawla
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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32
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Blinder H, Momoli F, Bokhaut J, Bacal V, Goldberg R, Radhakrishnan D, Katz SL. Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis. Sleep Med 2020; 69:19-33. [PMID: 32045851 DOI: 10.1016/j.sleep.2019.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND While positive airway pressure (PAP) is effective for treating sleep-disordered breathing (SDB) in children, adherence is poor. Studies evaluating predictors of PAP adherence have inconsistent findings, and no rigorous reviews have been conducted. This systematic review aims to summarize the literature on predictors of PAP therapy adherence in children. METHODS Studies evaluating baseline predictors of PAP therapy adherence in children (≤20 years) with SDB were included. We searched MEDLINE, Embase, CENTRAL, CINAHL, Clinicaltrials.gov, and the last four years of conference abstracts. Results were described narratively, with random-effects meta-analyses performed where feasible. Risk of bias and confidence in the evidence were assessed. RESULTS We identified 50 factors evaluated across 28 studies (21 full text articles, seven abstracts). The highest rates of PAP therapy adherence were most consistently found with female sex, younger age, Caucasian race, higher maternal education, greater baseline apnea-hypopnea index (AHI), and presence of developmental delay. Pooled estimates included odds ratios of 1.48 (95%CI: 0.75-2.93) favoring female sex, 1.26 (95%CI: 0.68-2.36) favoring Caucasian race, and a mean difference in AHI of 4.32 (95%CI: -0.61-9.26) events/hour between adherent and non-adherent groups. There was low quality evidence to suggest that psychosocial factors like health cognitions and family environment may predict adherence. CONCLUSION In this novel systematic review, we identified several factors associated with increased odds of PAP therapy adherence in children. These findings may help guide clinicians to identify and support children less likely to adhere to PAP therapy and should be considered when developing interventions to improve adherence.
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Affiliation(s)
- Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Julia Bokhaut
- Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Vanessa Bacal
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; Department of Obstetrics and Gynecology, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Reuben Goldberg
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Department of Family Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; ICES uOttawa, Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
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Liu CC, Chaput KH, Kirk V, Yunker W. Overnight oximetry in children undergoing adenotonsillectomy: a single center experience. J Otolaryngol Head Neck Surg 2019; 48:69. [PMID: 31796111 PMCID: PMC6888940 DOI: 10.1186/s40463-019-0391-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is the most common indication for adenotonsillectomy in children. Home-based sleep oximetry continues to be used in the diagnosis of pediatric OSA despite a lack of correlation with lab-based polysomnography. This study investigates whether factors influence surgeons in selecting patients for home-based sleep oximetry, how the study findings are used in patient management, and whether abnormal oximetry findings are associated with post-operative complications. Methods A retrospective review was performed on children with suspected OSA who had undergone a tonsillectomy and/or an adenoidectomy over a three-year period. Demographic features, comorbidities, pre-operative oximetry results, and post-operative complications were recorded. Data analysis consisting primarily of logistic regression was performed using Stata 12.0 (College Station, Texas). Results Data was collected from 389 children. Two hundred and seventy-one children underwent pre-operative oximetry (69.7%). There was no significant association between age or the presence of comorbidities and the likelihood of undergoing pre-operative sleep oximetry. The post-operative complication rate was 0.8%. There was no significant association between abnormal sleep oximetry parameters and post-operative complications. Children with one or more abnormal sleep oximetry parameters were more likely to be observed in hospital for at least one night (OR 2.4, p < 0.0001). Conclusions Our study suggests that surgeons are using home-based sleep oximetry findings to inform the post-operative care of children with suspected OSA, as those with abnormal home-based sleep oximetry findings were more likely to be observed in hospital. These hospital admissions may be unnecessary given the poor correlation of home-based oximetry and PSG as well as the low rate of serious post-operative complications.
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Affiliation(s)
- C Carrie Liu
- Sections of Otolaryngology - Head and Neck Surgery and Pediatric Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen H Chaput
- Department of Obstetrics and Gynecology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie Kirk
- Division of Pediatric Respirology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Warren Yunker
- Sections of Otolaryngology - Head and Neck Surgery and Pediatric Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Tsampalieros A, Blinder H, Hoey L, Momoli F, Barrowman N, Feber J, Spitale N, Katz SL. Obstructive sleep apnea and hypertension in pediatric chronic kidney disease. Pediatr Nephrol 2019; 34:2361-2370. [PMID: 31254112 DOI: 10.1007/s00467-019-04295-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) are at risk for obstructive sleep apnea (OSA) and hypertension. The objectives of this study were to explore associations between OSA severity using the apnea-hypopnea-index(AHI) and obstructive apnea-hypopnea-index(OAHI) on polysomnography (PSG), OSA symptoms, and measures of hypertension in children with CKD. METHODS One-night in-laboratory PSGs and 24-h ambulatory blood pressure monitoring (ABPM) were performed on children with CKD stages 2-5 (non-dialysis dependent). Sleep questionnaires, including the modified Epworth Sleepiness Scale (ESS) and the Pediatric Sleep Questionnaire (PSQ), were administered during the sleep study. RESULTS Nineteen children and adolescents completed a PSG and questionnaires and thirteen completed ABPMs. Mean (standard deviation) age at the time of the sleep study was 14.1 (3.2) years. Eleven (58%) participants had CKD stage two, and eight (42%) had stage 3-4. None of the participants were found to have OSA on PSG. One participant had a positive ESS score (≥ 11) and five participants had positive PSQ scores (≥ eight). Night systolic and diastolic pressures were strongly correlated with the OAHI (r = 0.67 and r = 0.69, respectively, p < 0.05), while the AHI was not correlated with any blood pressure measures. CONCLUSIONS Our study did not find OSA on PSG in children with predominantly mild to moderate CKD. The OAHI was found to be strongly correlated with nighttime blood pressures. Future prospective studies with a larger sample size are needed to monitor for potential progression of symptoms and findings on PSG in pediatric patients as they evolve across the spectrum of CKD.
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Affiliation(s)
- Anne Tsampalieros
- Department of Pediatrics, Division of Nephrology, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 5B2, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Lynda Hoey
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 5B2, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Nicholas Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Department of Pediatrics, Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Janusz Feber
- Department of Pediatrics, Division of Nephrology, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Naomi Spitale
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 5B2, Canada. .,Department of Pediatrics, Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
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Nehme J, LaBerge R, Pothos M, Barrowman N, Hoey L, Kukko M, Monsour A, Katz SL. Treatment and persistence/recurrence of sleep-disordered breathing in children with Down syndrome. Pediatr Pulmonol 2019; 54:1291-1296. [PMID: 31172656 DOI: 10.1002/ppul.24380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is common in children with Down syndrome, but the trajectory and long-term outcomes are not well-described. In a retrospective longitudinal cohort of children with Down syndrome, study objectives were to (1) characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB and (2) explore predictors of SDB persistence/recurrence. METHODS A retrospective cohort study was conducted of children who underwent PSGs between 2004 and 2014. SDB was defined as obstructive sleep apnea (OSA)-mixed (apnea-hypopnea index [AHI] >5 events/hour), central sleep apnea or hypoventilation. PSGs, interventions, and trajectory of SDB were described. Age, body mass index (BMI) Z-score and AHI at first SDB diagnosis were evaluated as predictors of persistent/recurrent SDB. RESULTS Of 506 children, 120 had ≥1 PSG; 54 had subsequent PSGs. Children with ≥2 PSGs were more likely to have higher total AHI (P = .02) and obstructive-mixed AHI (P = .01). Thirty-five of fifty-four (65%) were initially diagnosed with OSA-mixed SDB. After first PSG, 67 of 120 had OSA-mixed SDB, of whom 25 (37.3%) underwent adenotonsillectomy (T&A), 13 (19.4%) received positive airway pressure (PAP). Those who underwent T&A after PSG were significantly younger than those who received PAP (median age 6.2 vs 12.5 years; P = .005). OSA-mixed SDB persisted/recurred in 33 of 54 (73.3%) with ≥2 PSGs. Persistence/recurrence was not associated with age, AHI or BMI Z-score at first SDB. CONCLUSION Children with Down syndrome undergoing T&A for SDB were significantly younger than those treated with PAP. SDB persisted/recurred in three of four and was not predicted by age, SDB severity or BMI Z-score. Longitudinal PSG assessment for persistence/recurrence of SDB is required in this population.
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Affiliation(s)
- Joy Nehme
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Robert LaBerge
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Mary Pothos
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Nicholas Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lynda Hoey
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Madelaine Kukko
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Sherri L Katz
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.,Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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MacLean JE. Understanding the Spectrum of Treatment Options for Infants With Pierre Robin Sequence and Airway Obstruction. J Clin Sleep Med 2019; 15:373-374. [PMID: 30853057 DOI: 10.5664/jcsm.7654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics and Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
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MacLean JE. Assessment and treatment of pediatric obstructive sleep apnea in Canada: history and current state of affairs. Sleep Med 2019; 56:23-28. [PMID: 30745075 DOI: 10.1016/j.sleep.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 02/07/2023]
Abstract
AIM To highlight Canada's contributions to the assessment and treatment of pediatric obstructive sleep apnea as well as outline the current state of pediatric obstructive sleep apnea in Canada. METHODS A search was conducted in MEDLINE (Ovid) using Medical Subject Headings (MeSH) and free-text terms for 'child' and 'obstructive sleep apnea' with subsequent 'human' limit. The results were reviewed to identify publications where any author's listed a Canadian institution. RESULTS Canadian contributions to the field of pediatric obstructive sleep apnea have grown over the last 30 years with an increase in number of contributors and centres. Much of the early work stemmed from McGill University with important contributions in examining alternatives to polysomnography and post-adenotonsillectomy respiratory compromise. Today, contributors from centres across the country are engaged in the field and come from a greater diversity of disciplines. With continued challenges and opportunities, Canada will continue to help advance the field of pediatric OSA. CONCLUSION Canada has a strong community of people invested in continuing to work to improve the lives of Canadian children with pediatric OSA.
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Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Ernst H, Dzioba A, Glicksman J, Paradis J, Rotenberg B, Strychowsky J. Evaluating the impact of adenotonsillectomy for pediatric sleep‐disordered breathing on parental sleep. Laryngoscope 2019; 130:232-237. [DOI: 10.1002/lary.27806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/30/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Hannah Ernst
- Department of Otolaryngology–Head and Neck SurgerySchulich School of Medicine and Dentistry, Western University London Ontario Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck SurgerySchulich School of Medicine and Dentistry, Western University London Ontario Canada
| | - Jordan Glicksman
- Department of OtolaryngologyHarvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Josee Paradis
- Department of Otolaryngology–Head and Neck SurgerySchulich School of Medicine and Dentistry, Western University London Ontario Canada
| | - Brian Rotenberg
- Department of Otolaryngology–Head and Neck SurgerySchulich School of Medicine and Dentistry, Western University London Ontario Canada
| | - Julie Strychowsky
- Department of Otolaryngology–Head and Neck SurgerySchulich School of Medicine and Dentistry, Western University London Ontario Canada
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Katz SL, Weiss SK, Fleetham JA. Pediatric sleep disorder medicine training in Canada: past, present and future. Sleep Med 2018; 56:38-40. [PMID: 30458976 DOI: 10.1016/j.sleep.2018.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Abstract
Pediatric sleep medicine is rapidly evolving in Canada. As pediatric sleep disorders are increasingly recognized, there is a growing need for clinicians educated in the evaluation and treatment of pediatric sleep disorders. Current pediatric sleep resources in Canada are inadequate to meet the needs of the population. Until this year, there was no formal pathway or specific requirements for pediatric sleep disorder medicine training in Canada and exposure to this field of medicine in post-graduate training was limited. In 2018, the Royal College of Physicians of Canada approved an Area of Focused Competence program for certification and maintenance of competence in Sleep Disordered Medicine. It was designed to ensure adequate breadth and depth of training experiences in this diverse field. The goals of the program are to ensure competence in the assessment and management of adults and children with a range of sleep-wake disorders and sleep-disordered breathing, to interpret sleep investigations, to administratively manage a sleep laboratory and to advance the discipline of Sleep Disorder Medicine through research. The program follows a competency-based model in which, within the year of training, trainees accumulate a dossier of experiences which are evaluated by a Royal College of Physicians and Surgeons committee. This new program will ensure that a critical mass of trained sleep medicine physicians is developed to meet the needs of the Canadian pediatric population and to contribute to advancement of the field of pediatric sleep medicine.
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Affiliation(s)
- Sherri L Katz
- Division of Pediatric Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
| | - Shelly K Weiss
- Division of Neurology, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - John A Fleetham
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, 2275 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
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40
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Rose L, McKim D, Leasa D, Nonoyama M, Tandon A, Bai YQ, Goldstein R, Amin R, Katz S, Gershon A. Respiratory health service utilization of children with neuromuscular disease. Pediatr Pulmonol 2018; 53:1378-1386. [PMID: 30129703 DOI: 10.1002/ppul.24145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/29/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To quantify health service utilization including assessment, monitoring, and treatment of respiratory complications of children with neuromuscular disease (NMD), identifying practice variation and adherence to guideline recommendations at a population level. METHODS North American population-based cohort study (2003-2015) of children with NMD using hospital diagnostic and physician billing codes within health administrative databases. RESULTS We identified 18 163 children with NMD. Mean (SD) age was 7.8 (5.6) years with 40% ≤5; 45% were female. Most common diagnoses were cerebral palsy (50%) and spina bifida (16%); 8% had muscular dystrophy. From fiscal years 2003-2014, 15 600 (86%) children went to an emergency department on average 3.5 times every 3 years; 6575 (36%) for respiratory reasons. 8788 (48%) were admitted to hospital with 2190 (12%) for respiratory reasons and 2451 (13%) required intensive care. Respiratory specialist outpatient visits occurred for 2226 (12%) children on average 6.5 visits every 3 years; 723 (4%) had in-hospital respiratory specialist consultation. Pulmonary function testing was conducted in 3194 (18%) children on average 2.4 times every 3 years; sleep studies in 1389 (8%). CONCLUSION In this population-based study of children with NMD, healthcare utilization for respiratory complications was considerable. Frequency of respiratory specialist consultation, monitoring of respiratory function and sleep disordered breathing was variable but on average reflected professional society recommendations. Children with NMD are frequent ED users suggesting a need to improve community and social supports. We did not detect reduced access to respiratory monitoring or specialist consultation in adolescents transitioning to adult services.
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Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Kings College London, Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, University of Toronto, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Douglas McKim
- The Ottawa Hospital Respiratory Rehabilitation and The Ottawa Hospital Sleep Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - David Leasa
- Department of Medicine, Divisions of Critical Care and Respirology London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mika Nonoyama
- University of Ontario Institute of Technology, Child Health Evaluative Sciences & Respiratory Therapy, SickKids, Rehabilitation Sciences & Physical Therapy, University of Toronto, Oshawa, Ontario, Canada
| | - Anu Tandon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Roger Goldstein
- West Park Healthcare Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, SickKids, SickKids Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sherri Katz
- Division of Respirology, Children's Hospital of Eastern Ontario, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Gershon
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute and the Institute of Clinical Evaluative Sciences, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Garde A, Hoppenbrouwer X, Dehkordi P, Zhou G, Rollinson AU, Wensley D, Dumont GA, Ansermino JM. Pediatric pulse oximetry-based OSA screening at different thresholds of the apnea-hypopnea index with an expression of uncertainty for inconclusive classifications. Sleep Med 2018; 60:45-52. [PMID: 31288931 DOI: 10.1016/j.sleep.2018.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessments of pediatric obstructive sleep apnea (OSA) are underutilized across Canada due to a lack of resources. Polysomnography (PSG) measures OSA severity through the average number of apnea/hypopnea events per hour (AHI), but is resource intensive and requires a specialized sleep laboratory, which results in long waitlists and delays in OSA detection. Prompt diagnosis and treatment of OSA are crucial for children, as untreated OSA is linked to behavioral deficits, growth failure, and negative cardiovascular consequences. We aim to assess the performance of a portable pediatric OSA screening tool at different AHI cut-offs using overnight smartphone-based pulse oximetry. MATERIAL AND METHODS Following ethics approval and informed consent, children referred to British Columbia Children's Hospital for overnight PSG were recruited for two studies including 160 and 75 children, respectively. An additional smartphone-based pulse oximeter sensor was used in both studies to record overnight pulse oximetry [SpO2 and photoplethysmogram (PPG)] alongside the PSG. Features characterizing SpO2 dynamics and heart rate variability from pulse peak intervals of the PPG signal were derived from pulse oximetry recordings. Three multivariate logistic regression screening models, targeted at three different levels of OSA severity (AHI ≥ 1, 5, and 10), were developed using stepwise-selection of features using the Bayesian information criterion (BIC). The "Gray Zone" approach was also implemented for different tolerance values to allow for more precise detection of children with inconclusive classification results. RESULTS The optimal diagnostic tolerance values defining the "Gray Zone" borders (15, 10, and 5, respectively) were selected to develop the final models to screen for children at AHI cut-offs of 1, 5, and 10. The final models evaluated through cross-validation showed good accuracy (75%, 82% and 89%), sensitivity (80%, 85% and 82%) and specificity (65%, 79% and 91%) values for detecting children with AHI ≥ 1, AHI ≥ 5 and AHI ≥ 10. The percentage of children classified as inconclusive was 28%, 38% and 16% for models detecting AHI ≥ 1, AHI ≥ 5, and AHI ≥ 10, respectively. CONCLUSIONS The proposed pulse oximetry-based OSA screening tool at different AHI cut-offs may assist clinicians in identifying children at different OSA severity levels. Using this tool at home prior to PSG can help with optimizing the limited resources for PSG screening. Further validation with larger and more heterogeneous datasets is required before introducing in clinical practice.
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Affiliation(s)
- Ainara Garde
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands; The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Xenia Hoppenbrouwer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands
| | - Parastoo Dehkordi
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- Center for Outcomes Research & Evaluation, School of Medicine, Yale University, New Haven, United States
| | - Aryannah Umedaly Rollinson
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wensley
- Division of Critical Care, The University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Guy A Dumont
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Respiratory Diagnostic Tools in Neuromuscular Disease. CHILDREN-BASEL 2018; 5:children5060078. [PMID: 29914128 PMCID: PMC6025604 DOI: 10.3390/children5060078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 01/05/2023]
Abstract
Children with neuromuscular disease (NMD) are at risk of acquiring respiratory complications. Both clinical assessments and respiratory diagnostic tests are important to optimize the respiratory health and care of such children. The following respiratory diagnostic tools and their utility for evaluating children with NMD are discussed in this article: lung function testing (spirometry and lung volumes), peak cough flow (PCF), respiratory muscle strength testing, oximetry, capnography, and polysomnography.
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The scope of sleep problems in Canadian children and adolescents with obesity. Sleep Med 2018; 47:44-50. [PMID: 29880147 DOI: 10.1016/j.sleep.2018.03.006] [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: 07/12/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the scope of sleep concerns, clinical features, and polysomnography (PSG) results and to identify factors that predict obstructive sleep apnea (OSA) in a cohort of children with obesity. METHODS The study was a multicenter retrospective chart review. Data were collected from three pediatric sleep laboratories over a two year period for all children of age 8-16 years with a body mass index [BMI] ≥95th centile who were undergoing PSG. Data sources included clinical charts and PSG results. Clinical and PSG factors were examined as predictors of OSA. RESULTS A total of 210 children met inclusion criteria, and 205 had sufficient data for analysis. The mean age was 12.5 ± 2.7 years; and 65% were male. Multiple sleep concerns and comorbidities were reported in most children (90% and 91%, respectively). OSA was identified by PSG in 44% of children; and 28% of children demonstrated moderate/severe OSA. Mouth breathing/nasal congestion (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.18-0.61), syndrome/multiple anomalies (OR = 2.4, 95% CI = 1.22-4.93), and family history of OSA (OR = 2.7, 95% CI = 1.2-5.8) or sleep problems (OR = 12.4, 95% CI = 1.5, 99.6) were the only factors predictive of OSA. Oxygen desaturation index <6 events/h measured by PSG showed an OR of 4.96 (95% CI = 2.27-10.86) for the absence of OSA. CONCLUSIONS Children with obesity who undergo PSG are medically complex with multiple sleep concerns including a high burden of daytime symptoms; slightly less than half of children demonstrate polysomnographic features of OSA. Earlier identification of OSA, recognition of non-OSA sleep concerns, and treatment strategies to improve sleep may contribute to overall health outcomes for children with obesity.
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Narang I, Al-Saleh S, Amin R, Propst EJ, Bin-Hasan S, Campisi P, Ryan C, Kendzerska T. Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth. Otolaryngol Head Neck Surg 2017; 158:745-751. [DOI: 10.1177/0194599817740349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To determine whether neck:height ratio combined with adenoid and tonsillar size is a good predictive tool for obstructive sleep apnea in obese youth. Study Design Cross-sectional study. Setting Sleep clinics at the Hospital for Sick Children, Toronto, Canada. Subjects and Methods Consented obese individuals aged 8 to 18 years were recruited between 2013 and 2015. Anthropometric measures were obtained by a trained research coordinator in a standardized manner. Otolaryngologists evaluated adenoid and tonsil sizes. Obstructive sleep apnea was diagnosed with an overnight polysomnogram as an obstructive apnea-hypopnea index ≥2. Multivariable logistic regressions investigated the relationship between potential predictors and obstructive sleep apnea. The C-statistic measured the predictive ability. Results Of the 53 subjects (median age, 13 years; 55% males), 28 (53%) were diagnosed with obstructive sleep apnea, with a median index of 10.6 per hour. In a logistic regression controlling for adenoid size, enlarged tonsils were significantly associated with the presence of obstructive sleep apnea ( P < .01). Adding neck:height ratio into the model improved the model predictive ability (C-index increased from 0.73 to 0.84). Controlling for tonsil and adenoid sizes, an increase in neck:height ratio was significantly associated with the presence of obstructive sleep apnea ( P = .01). Conclusion Our study suggests that neck:height ratio combined with tonsillar hypertrophy may have a strong predictive ability for obstructive sleep apnea and may be useful in an ambulatory setting to screen obese youth at high risk. These findings should be confirmed in a larger study.
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Affiliation(s)
- Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Evan J. Propst
- University of Toronto, Toronto, Canada
- Department of Otolaryngology–Head and Neck Surgery, Hospital for Sick Children, Toronto, Canada
| | - Saadoun Bin-Hasan
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Paolo Campisi
- University of Toronto, Toronto, Canada
- Department of Otolaryngology–Head and Neck Surgery, Hospital for Sick Children, Toronto, Canada
| | - Clodagh Ryan
- University of Toronto, Toronto, Canada
- Division of Respirology, Toronto General Hospital University Health Network, Toronto, Canada
| | - Tetyana Kendzerska
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Prevalence of obstructive sleep apnea among obese toddlers and preschool children. Sleep Breath 2017; 22:511-515. [DOI: 10.1007/s11325-017-1576-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/18/2017] [Accepted: 10/06/2017] [Indexed: 11/26/2022]
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Nehme J, LaBerge R, Pothos M, Barrowman N, Hoey L, Monsour A, Kukko M, Katz SL. Predicting the presence of sleep-disordered breathing in children with Down syndrome. Sleep Med 2017; 36:104-108. [PMID: 28735906 DOI: 10.1016/j.sleep.2017.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is highly prevalent in children with Down syndrome. Given the scarcity of resources and the presence of risk factors for SDB in this population, the objective of this study is to identify the clinical predictors of SDB, which would assist prioritization of children with Down syndrome for SDB evaluation. METHODS A retrospective cohort study was conducted on children enrolled in the Down syndrome clinic at CHEO who underwent polysomnography in 2004-2014. Total apnea-hypopnea index (AHI) or obstructive AHI (OAHI) > 5 events/hour was considered clinically significant. Associations between SDB and concurrent diagnoses, referral reasons, and sleep symptoms assessed by questionnaire were examined using Pearson's chi-square test or Fisher's exact test as appropriate. Univariate and multivariate logistic regression analyses were used to examine the predictors of SDB. RESULTS SDB was present in 42.9% of 119 children, with its highest prevalence at age 8 years. Symptoms were not significantly associated with AHI > 5 events/hour or OAHI > 5 events/hour. Gastroesophageal reflux was associated with lower odds of OAHI > 5 events/hour on univariate testing (odds ratio 0.16, 95% CI 0.04-0.72; p = 0.02) and multivariate analysis (odds ratio 0.05, 95% CI 0.0006-0.50; p = 0.002). CONCLUSIONS SDB is highly prevalent at all ages in children with Down syndrome. Symptoms did not predict SDB in this population, although gastroesophageal reflux may mimic SDB, which indicates that clinicians should continue to perform ongoing surveillance for SDB throughout the lifespan of children with Down syndrome.
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Affiliation(s)
- Joy Nehme
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert LaBerge
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Pothos
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Andrea Monsour
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Madelaine Kukko
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
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Glicksman A, Hadjiyannakis S, Barrowman N, Walker S, Hoey L, Katz SL. Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity. J Clin Sleep Med 2017; 13:545-550. [PMID: 28095969 DOI: 10.5664/jcsm.6538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/19/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obesity and regional fat distribution, measured by neck fat mass percentage using dual-energy X-ray absorptiometry (DXA), correlate with obstructive sleep apnea (OSA) severity in adults. In obese children, neck-to-waist-circumference ratio predicts OSA. This study examined associations between body fat percentage and distribution and sleep-disordered breathing (SDB) severity in obese youth, measured with DXA. METHODS Cross-sectional retrospective study conducted at a tertiary children's hospital. Participants were aged 6 to 18 years with obesity (body mass index [BMI] > 99th percentile [BMI z-score 2.35] or > 95th percentile with comorbidity). They underwent polysomnography and DXA to quantify body fat percentage and distribution ratios (neck-to-abdominal fat percentage [NAF % ratio]). SDB was defined as apnea-hypopnea index (AHI) > 5 and OSA as obstructive AHI (OAHI) > 1 event/h. Relationships of BMI z-score and NAF % ratio to log AHI and log OAHI were evaluated. RESULTS Thirty individuals participated; 18 male; median age 14.1 years. Twenty-four individuals had BMI z-scores > 2.35. Ten had AHI > 5 events/h. NAF % ratio was significantly associated with log AHI in males and with log OAHI in all, whereas total fat mass percent was not. The association between log OAHI and NAF % ratio was significant in males, but not females. NAF % ratio was significantly associated with log OAHI in those with BMI z-score above 2.35. CONCLUSIONS NAF % ratio was associated with OSA severity in males and youth with BMI > 99th percentile; however, total fat mass percentage was not, suggesting that body fat distribution is associated with OSA risk in youth.
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Affiliation(s)
- Amy Glicksman
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Barrowman
- University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Scott Walker
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
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Al-Saleh S, Sayal P, Stephens D, Florence J, Sayal A, Baker A, Syed F, Narang I, Amin R. Factors Associated with Changes in Invasive and Noninvasive Positive Airway Pressure Therapy Settings during Pediatric Polysomnograms. J Clin Sleep Med 2017; 13:183-188. [PMID: 27707439 DOI: 10.5664/jcsm.6442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/21/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Our aim was to identify clinical predictors associated with changes in settings for pediatric invasive and noninvasive positive airway pressure therapy, which could help inform the allocation of limited polysomnogram (PSG) resources. METHODS A retrospective review was conducted in children who underwent one or more PSGs for technology titration. Children were included if they were using continuous positive airway pressure (CPAP) therapy, bilevel positive airway pressure (BPAP) therapy, or invasive positive pressure ventilation (IPPV) the night of the PSG. The primary outcome measure for the study were predictors of change in settings during IPPV, CPAP, and BPAP titration studies. RESULTS During the study period, 274 children using CPAP, BPAP, or IPPV underwent one or more titration PSGs. The mean (standard deviation [SD]) age of the children at the time of the first titration PSG was 10.52 (5.11) y. Fifty percent (n = 136) of the study participants were male. Most patients underwent BPAP titration studies (n = 166), followed by CPAP (n = 83) and then IPPV (n = 25). A total of 623 technology titration PSGs were completed. Reason for respiratory technology, type of respiratory technology, and time between ventilation initiation and the PSG were significant predictors of a change in settings in the multivariable regression model. CONCLUSIONS Children were more likely to have a change in their technology settings during a PSG if there was a shorter period of time from the original technology initiation, if they were using BPAP (as compared to CPAP or IPPV) and/or if they had a primary central nervous system or musculoskeletal diagnosis.
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Affiliation(s)
- Suhail Al-Saleh
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | - Derek Stephens
- Biostatistics, Hospital for Sick Children, Toronto, Canada
| | - Joshua Florence
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Aman Sayal
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Adele Baker
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Faiza Syed
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
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Smith DF, Dalesio NM, Benke JR, Petrone JA, Vigilar V, Cohen AP, Ishman SL. Anthropometric and Dental Measurements in Children with Obstructive Sleep Apnea. J Clin Sleep Med 2016; 12:1279-84. [PMID: 27448427 DOI: 10.5664/jcsm.6132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/23/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES A number of authors have shown that children with OSA are more likely to have certain physical characteristics than healthy controls. With this in mind, our objectives were to collect normative baseline data and determine if there was a significant difference in anthropometric and dental measurements between children with OSA and age-matched nonsnoring controls. METHODS Children 2 to 12 y of age, in whom OSA was diagnosed by overnight polysomnography, were recruited to our experimental group. Age-matched nonsnoring controls were screened for signs of sleep-disordered breathing. Anthropometric measurements, including waist, neck, and hip circumferences, and waist-hip and neck-waist ratios, were obtained on all study participants preoperatively. Dental casts were acquired to determine intertooth distances and palatal height. RESULTS Sixty-one children (42 with OSA [69%] and 19 controls [31%]) with a mean age of 4.7 y participated in the study. Waist and hip circumferences were significantly larger in children with OSA (p = 0.001 and 0.001, respectively). However, there was no difference in neck circumference and waist-hip ratios between the two groups. Neck-waist ratio in children with OSA was significantly smaller than in controls (p = 0.001). Intertooth distance for the first (p < 0.0001) and second deciduous (p = 0.0002) and first permanent molars (p = 0.022) were significantly narrowed in children with OSA; however, no difference was seen in palatal height between groups. Body mass index was similar between groups (p = 0.76). CONCLUSIONS Anthropometric and dental measurements were significantly different in children with OSA compared to nonsnorers. Future studies with a large sample size may allow us to determine if these measurements can be used by clinicians to identify children at risk for OSA. COMMENTARY A commentary on this article appears in this issue on page 1213.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nicholas M Dalesio
- Department of Anesthesiology, Division of Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine
| | - James R Benke
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine
| | - John A Petrone
- Department of Otolaryngology, Head and Neck Surgery, Division of Dentistry and Oral Maxillofacial Surgery, Johns Hopkins School of Medicine
| | | | - Aliza P Cohen
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine
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Determining an optimal management strategy for upper airway obstruction in Pierre Robin sequence. Can Respir J 2015; 22:132. [PMID: 26057370 DOI: 10.1155/2015/959686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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