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de Araujo Dantas AB, Gonçalves FM, Martins AA, Alves GÂ, Stechman-Neto J, Corrêa CDC, Santos RS, Nascimento WV, de Araujo CM, Taveira KVM. Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression. Sleep Breath 2023; 27:2083-2109. [PMID: 36971971 DOI: 10.1007/s11325-023-02810-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE This study aimed to identify the prevalence of obstructive sleep apnea (OSA) and associated risk factors globally. METHODS Six databases and registrations and three grey databases were explored for observational field research. Independently and impartially paired reviewers selected research, gathered data, and evaluated the methodological quality. Heterogeneity was investigated using subgroup analysis and meta-regression following the moderating variable in a meta-analysis of proportions with a random-effects model. The critical appraisal instrument developed by the Joanna Briggs Institute was used to evaluate the listed studies' methodology. The certainty of the evidence was evaluated using the GRADE tool. RESULTS A total of 8236 articles were collected during the database search, resulting in 99 articles included for qualitative synthesis, and 98 articles were included for the meta-analysis. The estimated combined prevalence of OSA was 54% [CI 95% = 46-62%; I2 = 100%]. Mean age, percentage of moderate-severe cases, and the sample's body mass index (BMI) did not affect the heterogeneity that was already present when meta-regressed (p > 0.05). Ninety-one studies were deemed to have a low risk of bias, while eight were deemed to have a moderate risk. For OSA prevalence outcomes, the GRADE criteria were considered very low. CONCLUSION Approximately half of the people worldwide have OSA. High BMI, increasing age, and male gender are described as risk factors in the literature, but these covariates do not affect pre-existing heterogeneity.
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Affiliation(s)
- Anna Beatriz de Araujo Dantas
- Department of Morphology - Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), BR 101- Lagoa Nova, Natal, RN - 59072-970, Brazil
| | - Flávio Magno Gonçalves
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Agnes Andrade Martins
- Department of Morphology - Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), BR 101- Lagoa Nova, Natal, RN - 59072-970, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | | | - José Stechman-Neto
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Camila de Castro Corrêa
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
- Planalto University Center of the Federal District (UNIPLAN), Brasília, Brazil
| | - Rosane Sampaio Santos
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Weslania Viviane Nascimento
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
- Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Cristiano Miranda de Araujo
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Karinna Veríssimo Meira Taveira
- Department of Morphology - Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), BR 101- Lagoa Nova, Natal, RN - 59072-970, Brazil.
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil.
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Jurado MJ, Sampol G, Quintana M, Romero O, Cambrodí R, Ferré A, Sampol J. Nasal cannula use during polysomnography in children aged under three with suspected sleep apnea. Sleep Med 2022; 99:41-48. [PMID: 35947888 DOI: 10.1016/j.sleep.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Early diagnosis of obstructive sleep apnea (OSA) in children is important. The use of a nasal cannula as an airflow sensor during polysomnography has not been evaluated in younger children. The study aims to evaluate the use of nasal cannula in detecting respiratory events in children under three with suspected OSA during daytime nap studies. METHODS A total of 185 patients were prospectively included. Respiratory events were scored using nasal cannula alone, thermistor alone, and both methods simultaneously as the airflow sensor. Agreement and diagnostic accuracy were assessed. RESULTS One hundred and seventy-two children were finally analyzed and 110 (64.0%) presented OSA. Total sleep time with an uninterpretable signal was longer with the nasal cannula than with the thermistor (17.8% vs 1.9%; p < 0.001), and was associated with poor sensor tolerance and adenotonsillar hypertrophy. In the estimation of the apnea-hypopnea index, the nasal cannula showed lower agreement than the thermistor with the joint use of the two sensors (intraclass correlation coefficient: 0.79 vs 0.996 with thermistor). Compared with the thermistor, the nasal cannula presented lower sensitivity for detecting OSA (82.7% vs 95.5%) and a lower negative predictive value (76.5% vs 92.4%). Overall, fewer children were diagnosed with severe OSA with the nasal cannula (19.8% vs 30.8% with the thermistor, and 32.6% with both). CONCLUSIONS In children under the age of three, the ability of the nasal cannula to detect obstructive events was relatively low. Therefore, other non-invasive measurements for identifying respiratory events during sleep may be of additional value.
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Affiliation(s)
- María José Jurado
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Gabriel Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Odile Romero
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Roser Cambrodí
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Alex Ferré
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Júlia Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
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Ducloyer M, Wargny M, Medo C, Gourraud PA, Clement R, Levieux K, Gras-Le Guen C, Corre P, Rambaud C. The Ogival Palate: A New Risk Marker of Sudden Unexpected Death in Infancy? Front Pediatr 2022; 10:809725. [PMID: 35509830 PMCID: PMC9058094 DOI: 10.3389/fped.2022.809725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ogival palate (i.e., a narrow and high-arched palate) is usually described in obstructive breath disorder but has been found in infants unexpectedly deceased. We studied the association between ogival palate and sudden unexpected death in infancy (SUDI) on the basis of a computed tomography (CT) evaluation. METHODS We conducted a monocentric case-control study of children under 2 years of age who died of SUDI, for which a head CT scan and an autopsy were performed between 2011 and 2018. Each case was matched by sex and age (± 30 days) to two controls selected among living children in the same center who benefited from a cranio-encephalic CT scan. Four parameters of the hard palate were measured by CT: height, width, length, and sagittal angle; the height/width ratio was calculated. The presence of an ogival palate was also subjectively evaluated by the radiologists, independently from the measurements. Standardized odds ratios (OR) were calculated using conditional logistic regression models, all expressed for +1 standard deviation (SD). RESULTS Thirty-two deceased children were matched to 64 living control children. Mean ages were 5.0 and 5.3 months, respectively. Twenty-eight cases were considered to have died as a result of SIDS. The mean heights of the hard palate were significantly higher in the deceased children [4.1 (± 0.7) millimeters (mm)] than in the living children [3.2 (± 0.6) mm], with OR (+1SD) = 4.30 (95% confidence interval [CI], 2.04-9.06, P = 0.0001). The mean widths of the hard palate were 21.0 (± 1.9) mm and 23.2 (± 2.1) mm, respectively, with OR = 0.15 (95% CI, 0.06-0.40, P = 0.0001). The mean sagittal angles were significantly more acute in deceased children [134.5° (± 9.3)] than in living children [142.9° (± 8.1)], with OR = 0.28 (95% CI, 0.14-0.56, P = 0.0003). The mean height/width ratios were 19.8 (± 3.7) and 14.1 (± 3.3), respectively, with OR = 6.10 (95% CI, 2.50-14.9, P = 0.0001). The hard palate was subjectively considered as ogival in 59.4% (19/32) of the cases versus 12.5% (8/64) of the controls. CONCLUSION Radiological features of the ogival palate were strongly associated with SUDI. This observation still needs to be confirmed and the corresponding clinical features must be identified.
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Affiliation(s)
- Mathilde Ducloyer
- Department of Forensic Medicine, University Hospital, Nantes, France.,Department of Radiology, University Hospital, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Charlotte Medo
- Department of Radiology, University Hospital, Nantes, France
| | - Pierre-Antoine Gourraud
- CHU de Nantes, INSERM CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Renaud Clement
- Department of Forensic Medicine, University Hospital, Nantes, France
| | - Karine Levieux
- Department of Pediatrics, University Hospital, Nantes, France
| | | | - Pierre Corre
- Department of Oral and Maxillo-Facial Surgery, University Hospital, Nantes, France
| | - Caroline Rambaud
- Department of Pathology and Forensic Medicine, AP-HP University Hospital Raymond Poincaré, University of Paris-Saclay, Garches, France
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Kajiyama T, Komori M, Hiyama M, Kobayashi T, Hyodo M. Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea. Auris Nasus Larynx 2021; 49:625-633. [PMID: 34840035 DOI: 10.1016/j.anl.2021.11.001] [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] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly. METHODS Our prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments. RESULTS The respective proportions of patients who improved to obstructive AHI (O-AHI) < 1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaO2 improved significantly between before and after medical treatment in both O-AHI < 1/h and O-AHI ≥ 1/h patients (respectively p < 0.0001, p = 0.0009). The lowest nadir SaO2 before medical treatment was 74% in patients in whom O-AHI was normalized after medical treatments. CONCLUSION Medical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO2 of less than 74% by medical treatment.
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Affiliation(s)
- Taihei Kajiyama
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan.
| | - Mariko Hiyama
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Taisuke Kobayashi
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
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