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Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [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: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Carabelli G, Binotto I, Armano C, Bertù L, Luini C, Nosetti L, Agosti M, Salvatore S. Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED). CHILDREN (BASEL, SWITZERLAND) 2024; 11:450. [PMID: 38671666 PMCID: PMC11048841 DOI: 10.3390/children11040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying. METHODS We enrolled all infants (0-12 months) referred for suspected GER disease who underwent esophageal impedance-pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis. RESULTS We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH. CONCLUSIONS Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors.
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Affiliation(s)
- Greta Carabelli
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Ivan Binotto
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Chiara Armano
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Lorenza Bertù
- Research Center Tromboembolic Diseases, University of Insubria, 21100 Varese, Italy;
| | - Chiara Luini
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Luana Nosetti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Massimo Agosti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Silvia Salvatore
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
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Fitzgerald DA, MacLean J, Fauroux B. Assessment of obstructive sleep apnoea in children: What are the challenges we face? Paediatr Respir Rev 2024:S1526-0542(24)00027-7. [PMID: 38616458 DOI: 10.1016/j.prrv.2024.04.002] [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: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
There is an increasing demand for the assessment of sleep-disordered breathing in children of all ages to prevent the deleterious neurocognitive and behaviour consequences of the under-diagnosis and under-treatment of obstructive sleep apnoea [OSA]. OSA can be considered in three broad categories based on predominating contributory features: OSA type 1 [enlarged tonsils and adenoids], type II [Obesity] and type III [craniofacial abnormalities, syndromal, storage diseases and neuromuscular conditions]. The reality is that sleep questionnaires or calculations of body mass index in isolation are poorly predictive of OSA in individuals. Globally, the access to testing in tertiary referral centres is comprehensively overwhelmed by the demand and financial cost. This has prompted the need for better awareness and focussed history taking, matched with simpler tools with acceptable accuracy used in the setting of likely OSA. Consequently, we present key indications for polysomnography and present scalable, existing alternatives for assessment of OSA in the hospital or home setting, using polygraphy, oximetry or contactless sleep monitoring.
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Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia.
| | - Joanna MacLean
- Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Brigitte Fauroux
- Pediatric Non-invasive Ventilation and Sleep Unit AP-HP, Necker Enfants Malades University Hospital, 149 rue de Sèvres, 75015 Paris, France; Paris Cité University, EA 7330 VIFASOM, Paris, France
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Aubertin G, Akkari M, Andrieux A, Colas des Francs C, Fauroux B, Franco P, Gagnadoux F, de Santerre OG, Grollemund B, Hartley S, Jaffuel D, Lafond L, Schröder CM, Schweitzer C, Charley-Monaca C. Management of obstructive sleep apnea syndrome type 1 in children and adolescents - A French consensus. Arch Pediatr 2023; 30:510-516. [PMID: 37537084 DOI: 10.1016/j.arcped.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/23/2023] [Accepted: 06/04/2023] [Indexed: 08/05/2023]
Abstract
This document is the outcome of a group of experts brought together at the request of the French Society of Sleep Research and Medicine to provide recommendations for the management of obstructive sleep apnea syndrome type 1 (OSA1) in children. The recommendations are based on shared experience and published literature. OSA1 is suspected when several nighttime respiratory symptoms related to upper airway obstruction are identified on clinical history taking. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. A sleep study for OSA1 is not mandatory when at least two nighttime symptoms (including snoring) are noted. Therapeutic management must be individualized according to the location of the obstruction. Ear, nose, and throat (ENT) surgery is often required, as hypertrophy of the lymphoid tissues is the main cause of OSA1 in children. According to clinical findings, orthodontic treatment generally associated with specialized orofacial-myofunctional therapy might also be indicated. Whatever treatment is chosen, follow-up must be continuous and multidisciplinary, in a network of trained specialists.
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Affiliation(s)
- G Aubertin
- Pediatric Pulmonology, Armand Trousseau Hospital, AP-HP Hospital, Sorbonne University, Paris, 75012, France; Centre de recherche Saint Antoine (CRSA), INSERM UMR-S 938, Paris, 75012, France; Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Boulogne-Billancourt, 92100, France.
| | - M Akkari
- Ear, Nose and Throat & Head and Neck Surgery, University Hospital Gui de Chauliac, University of Montpellier, Montpellier, 34000, France
| | - A Andrieux
- Cabinet de pneumo-pédiatrie et somnologie pédiatrique, Mérignac, 33700, France; Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel Air, Bordeaux, 33200, France; Pediatric Pulmonology Unit, University Hospital Pellegrin - Enfants, University of Bordeaux, Bordeaux, 33000, France
| | - C Colas des Francs
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Réseau Morphée, Garches, 92380, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, 75015, France; VIFASOM, University of Paris Cité, Paris, 75004, France
| | - P Franco
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292 University of Lyon 1, Bron, 69675, France
| | - F Gagnadoux
- Department of Pulmonary and Sleep Medicine, University Hospital of Angers, Angers, 49000, France; INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, 49000, France
| | | | - B Grollemund
- Department of Dental-Facial Orthopedics, Pole of Bucco Dentaries' Medicine and Surgery, Cleft Competence Center, Strasbourg University Hospital, Strasbourg, 67000, France
| | - S Hartley
- Réseau Morphée, Garches, 92380, France; Sleep Unit, Department of Physiology, Raymond Poincaré Hospital, AP-HP, Garches, 92380, France
| | - D Jaffuel
- Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, 34000, France; PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, 34000, France
| | - L Lafond
- Oro-myofunctional Therapy Office, Bordeaux, 33000, France
| | - C M Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University and Strasbourg University Hospitals, Strasbourg, 67000, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, 67000, France; Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), Strasbourg University Hospitals, Strasbourg, 67000, France
| | - C Schweitzer
- Children's Medicine, Department of Pediatric Lung Function Testing, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, 54501, France; EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Vandoeuvre les Nancy, 54505, France
| | - C Charley-Monaca
- Department of Clinical Neurophysiology-Sleep Disorders Unit, University of Lille, University Hospital of Lille, and U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, 59000, France
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Affiliation(s)
- Tamara S Hannon
- From the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis (T.S.H.); and the Center for Pediatric Research in Obesity and Metabolism and the Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.)
| | - Silva A Arslanian
- From the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis (T.S.H.); and the Center for Pediatric Research in Obesity and Metabolism and the Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.)
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Roy R, Banger S, Singh SK, Swami H, Gupta DK, Goyal S, Chugh R, Yadav S, Patel B, Mahesh R. Post Surgical Outcomes in Paediatric Adenotonsillar Hypertrophy with Obstructive Sleep Apnea: Subjective and Objective Evaluation. Indian J Otolaryngol Head Neck Surg 2023; 75:822-827. [PMID: 37206789 PMCID: PMC10188855 DOI: 10.1007/s12070-022-03453-y] [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: 04/12/2022] [Accepted: 12/20/2022] [Indexed: 01/02/2023] Open
Abstract
The aim of the study was to determine the post surgical outcomes in pediatric adenotonsillar hypertrophy with OSA using portable polysomnography (PSG), OSA 18 Questionnaire and Quality of life (QoL) scores. Secondly to correlate the subjective outcomes with objective scores of polysomonography. A prospective, single-arm, nonrandomized, single center study was performed at a tertiary care centre on children aged 3-12 years (n = 30) with adenoid hypertrophy/ tonsillar hypertrophy/adenotonsillar hypertrophy and symptoms suggestive of OSA. All subjects underwent appropriate surgical intervention. A portable PSG and OSA 18 questionnaire evaluation was performed pre surgery and 06 weeks post surgery to assess objective and clinical assessment for OSA. The mean age of children enrolled in the study was 8.68 ± 3 years. The mean pre treatment AHI was 12.56 ± 13.16 which improved to 1.72 ± 1.53 post surgery and was statistically significant (p < 0.05, Wilcoxon signed rank test). There was a statistically significant improvement in other PSG indices such as RDI and ODI post surgery also. The mean total symptom score (TSS) and QoL score also showed a statistically significant improvement post treatment (p < 0.05). However there was no correlation between the PSG and OSA 18 questionnaire scores pre and post surgery. Children with OSA like symptoms can undergo a portable polysomnography pre and post surgery to demonstrate severity of OSA and objectively monitor improvement in OSA post treatment. In the absence of availability of PSG, OSA 18 questionnaire is a suitable alternative to monitor disease severity and outcomes. Further studies may plan to include impact of paediatric OSA on other function such as the cardiac, dentition & malocclusion and neurocognitive function.
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Affiliation(s)
- Ravi Roy
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sween Banger
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - S. K. Singh
- Department of ENT HNS, Military Hospital, Jhansi, India
| | - Himanshu Swami
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - D. K. Gupta
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sunil Goyal
- Department of ENT HNS, Command Hospital (Eastern Command), Alipore Road, Kolkata, 700027 India
| | - Rajeev Chugh
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sneha Yadav
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Bhaumik Patel
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - R. Mahesh
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
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Translation and validation of the Arabic version of the sleep-related breathing disorder scale of the pediatric sleep questionnaire (PSQ-SRBD). Am J Otolaryngol 2023; 44:103805. [PMID: 36871419 DOI: 10.1016/j.amjoto.2023.103805] [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: 09/30/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND/OBJECTIVES The incidence of sleep-related breathing disorders is underestimated because polysomnography is required to confirm its diagnosis. The pediatric sleep questionnaire-sleep-related breathing disorder (PSQ-SRBD) scale is a self-reported questionnaire completed by a patient's guardian. There is no validated Arabic version of the PSQ-SRBD that can be used in the Arabic-speaking population. Therefore, we aimed to translate, validate, and culturally adapt the PSQ-SRBD scale. We also aimed to evaluate its psychometric properties for the diagnosis of obstructive sleep apnea (OSA). METHODS The cross-cultural adaptation method consisted of the following steps: forward-backward translation, appraisal of a sample of 72 children (aged between 2 and 16 years) by an expert group, and performing Cronbach's alpha coefficient testing, Spearman's rank correlation coefficient testing, Wilcoxon signed-rank testing, and sign testing. The reliability of the Arabic version of the PSQ-SRBD scale was assessed using a test-retest comparison, and a factor analysis of the items was used to verify construct validity. For statistical purposes, p-values <0.05 were considered to indicate significance. RESULTS All subscales had adequate internal consistency: 0.799 for snoring and breathing, 0.69 for sleepiness, 0.711 for behavioral problems, and 0.805 for the entire questionnaire. Comparing questionnaire responses administered 2 weeks apart revealed no statistically significant difference in total scores between the two groups (p-values >0.05 by Spearman's rank correlation coefficient test for all domains) and also no statistical difference among 20 out of 22 questions independently (p-value >0.05 by sign test). A factor analysis conducted to assess the structure of the Arabic-SRBD scale revealed good correlational patterns. The mean score before surgery was 0.464 ± 0.166, and this changed to 0.185 ± 0.142 after surgery with a reduction of 0.278 ± 0.184 which was statistically significant (p < 0.001). CONCLUSION The Arabic version of the PSQ-SRBD scale is a valid tool for the assessment of pediatric OSA patients and can be used to follow-up patients after surgery. Future research will determine this translated questionnaire's applicability.
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Ishman SL, Maturo S, Schwartz S, McKenna M, Baldassari CM, Bergeron M, Chernobilsky B, Ehsan Z, Gagnon L, Liu YCC, Smith DF, Stanley J, Zalzal H, Dhepyasuwan N. Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy. Otolaryngol Head Neck Surg 2023; 168:115-130. [PMID: 36757810 PMCID: PMC10105630 DOI: 10.1002/ohn.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/03/2022] [Accepted: 08/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. METHODS An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. RESULTS After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug-induced sleep endoscopy, surgical management, and postoperative care. CONCLUSION The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.
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Affiliation(s)
- Stacey L. Ishman
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephen Maturo
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Seth Schwartz
- Virginia Mason Medical Center, Seattle, Washington, USA
| | - Margo McKenna
- University of Rochester Medical Center/Golisano Children’s Hospital, Rochester, New York, USA
| | - Cristina M. Baldassari
- Eastern Virginia Medical School/Children’s Hospital of the King’s Daughter, Norfolk, Virginia, USA
| | - Mathieu Bergeron
- Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | | | - Zarmina Ehsan
- University of Missouri—Kansas City, Kansas City, Missouri, USA
| | - Lisa Gagnon
- Yale University/Connecticut Pediatric Otolaryngology, New Haven, Connecticut, USA
| | - Yi-Chun Carol Liu
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - David F. Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey Stanley
- University of Michigan Health/Michigan Medicine, Ann Arbor, Michigan, USA
| | - Habib Zalzal
- Children’s National Health System, Washington, District of Columbia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Arzilli C, Annunziata M, Ernst CM, Peruzzi M, Macucci C, Pochesci S, Nassi N. Inter-hospital cardiorespiratory telemonitoring of newborns and infants: a wellworking example of a hub and spoke network. Ital J Pediatr 2023; 49:5. [PMID: 36635722 PMCID: PMC9837930 DOI: 10.1186/s13052-022-01407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Patients who experience cardiorespiratory events usually have to be moved to specialized centers to perform cardiorespiratory studies. To avoid the transfer of these patients to specialized centers, a network has been created based on an interchange system, where the recordings were uploaded in unspecialized centers (spokes) and downloaded by the Sleep Disorders Breathing (SDB) Center (hub) to be analyzed. METHODS The inter-hospital network was established in November 2008. Initially only 3 non-tertiary hospitals in the Tuscany Region joined the network. Currently, 12 Tuscany hospitals are included. RESULTS From November 2008 to December 2020, 625 recordings were collected belonging to 422 infants. No recurrent life-threatening episode or infant death occurred in the study population and none of the infants needed to be readmitted or be moved to a tertiary center, except infants who underwent home monitoring. The discharge diagnoses belong to the following categories: apnoea, respiratory problem of the newborn, syncope, gastroesophageal reflux, altered consciousness, transient loss of consciousness and cyanosis. CONCLUSIONS This study shows that the inter-hospital network is an efficient system that allows accurate and safe management of infants at risk for apnoea, bradycardia, and hypoxemia to remain in unspecialized centers, avoiding unnecessary transfers of patients and over - hospitalizations.
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Affiliation(s)
- Cinzia Arzilli
- grid.413181.e0000 0004 1757 8562Meyer Children’s Hospital IRCCS, Sleep Disorder Breathing and SIDS Center, Viale Pieraccini, 24, Florence, 50139 Italy
| | - Monica Annunziata
- grid.413181.e0000 0004 1757 8562Meyer Children’s Hospital IRCCS, Sleep Disorder Breathing and SIDS Center, Viale Pieraccini, 24, Florence, 50139 Italy
| | - Carola-Maria Ernst
- grid.413181.e0000 0004 1757 8562Meyer Children’s Hospital IRCCS, Sleep Disorder Breathing and SIDS Center, Viale Pieraccini, 24, Florence, 50139 Italy
| | - Marta Peruzzi
- grid.413181.e0000 0004 1757 8562Meyer Children’s Hospital IRCCS, Sleep Disorder Breathing and SIDS Center, Viale Pieraccini, 24, Florence, 50139 Italy
| | - Chiara Macucci
- grid.8404.80000 0004 1757 2304Department of Paediatrics, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Saverio Pochesci
- grid.8404.80000 0004 1757 2304Department of Paediatrics, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Niccolò Nassi
- grid.413181.e0000 0004 1757 8562Meyer Children’s Hospital IRCCS, Sleep Disorder Breathing and SIDS Center, Viale Pieraccini, 24, Florence, 50139 Italy
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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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Okorie CUA, Afolabi-Brown O, Tapia IE. Pediatric pulmonary year in review 2021: Sleep medicine. Pediatr Pulmonol 2022; 57:2298-2305. [PMID: 35779240 DOI: 10.1002/ppul.26047] [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: 04/18/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Pediatric pulmonology publishes original research, review articles, and case reports on a wide variety of pediatric respiratory disorders. In this article, we summarized the past year's publications in sleep medicine and reviewed selected literature from other journals in this field. We focused on original research articles exploring aspects of sleep-disordered breathing in patients with underlying conditions such as cystic fibrosis, asthma, and sickle cell disease. We also explored sleep-disordered breathing risk factors, monitoring, diagnosis, and treatment; and included recent recommendations for drug-induced sleep endoscopy and ways to monitor and improve PAP adherence remotely.
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Affiliation(s)
- Caroline U A Okorie
- Division of Pediatric Pulmonology, Asthma and Sleep Medicine, Stanford Children's Health, Stanford, California, USA
| | - Olufunke Afolabi-Brown
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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12
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Panagiotou P, Kanaka-Gantenbein C, Kaditis AG. Changes in Ventilatory Support Requirements of Spinal Muscular Atrophy (SMA) Patients Post Gene-Based Therapies. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081207. [PMID: 36010097 PMCID: PMC9406975 DOI: 10.3390/children9081207] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/10/2023]
Abstract
Spinal muscular atrophy (SMA) is a genetic neuromuscular disease resulting in global muscular weakness and, frequently, in respiratory failure and premature death. Gene-based therapies like Nusinersen are now available for patients with SMA. The aim of this review was to assess in "real world" studies, whether novel treatments would have a positive impact on the mechanical ventilatory support requirements of SMA patients, already initiated on ventilatory support prior to treatment administration. A literature search was performed in Pubmed using multiple combinations of MESH terms and the snowball procedure. A total of 14 publications were discussed in this review. Considering all patients included in the published studies who were on ventilatory support and were treated with Nusinersen, 13/172 (7.5%) had reduced needs for ventilatory support, 1/172 (0.6%) did not need ventilation post-treatment, and 122/172 (70.9%) were maintained on the same ventilator settings. Moreover, 2/41 (4.9%) children who were offered gene therapy had no need for further ventilatory support and 12/41 (29.2%) had reduced requirements. In conclusion, available evidence suggests that among children with SMA, who are on mechanical respiratory support either noninvasively or via tracheostomy at the time of gene-based treatment, only a few will be weaned off the ventilator or have reduced ventilator needs per 24 h. Children will usually require the same level of support as before treatment.
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Affiliation(s)
- Panagiota Panagiotou
- Department on Pediatric Respiratory Medicine, Evelina London Children’s Hospital, London SE1 7EH, UK
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, Agia Sofia Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, Agia Sofia Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanasios G. Kaditis
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, Agia Sofia Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Paul GR, Hayes D, Tumin D, Gulati I, Jadcherla S, Splaingard ML. What Are the Factors Affecting Total Sleep Time During Video Polysomnography in Infants? Am J Perinatol 2022; 39:853-860. [PMID: 33111280 DOI: 10.1055/s-0040-1718948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study is to investigate factors affecting total sleep time (TST) during infant polysomnography (PSG) and assess if <4 hours of TST is sufficient for accurate interpretation. STUDY DESIGN Overall, 242 PSGs performed in 194 infants <6 months of chronological age between March 2013 and December 2015 were reviewed to identify factors that affect TST, including age of infant, location and timing of study, presence of medical complexity, and presence of nasal tubes. A continuum of apnea-hypopnea index (AHI) in relation to TST was reviewed. Data were examined in infants who had TST <4 hours and low AHI. RESULTS Greater TST (p < 0.001) was noted among infants during nocturnal PSGs, at older chronological and post-menstrual ages, and without medical complexity. The presence of nasogastric/impedance probes reduced TST (p = 0.002). Elevated AHIs were identified even in PSGs with TST <4 hours. Short TST may have affected interpretation and delayed initial management in one infant without any inadvertent complications. CONCLUSION Clinical factors such as PMA and medical complexity, and potentially modifiable factors such as time of day and location of study appeared to affect TST during infant PSGs. TST < 4 hours can be sufficient to identify high AHI allowing physician interpretation. KEY POINTS · Less than 4 hours of TST is enough for interpretation of infant polysomnography.. · Shorter TST appears related to infant age, medical complexity, and higher apnea-hypopnea index.. · Modifiable factors seen with higher TST were time of day, environment, and presence of nasal tubes..
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Affiliation(s)
- Grace R Paul
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Don Hayes
- Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Ish Gulati
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Mark L Splaingard
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Initiation of acid suppression therapy for laryngomalacia. Am J Otolaryngol 2022; 43:103434. [PMID: 35483169 DOI: 10.1016/j.amjoto.2022.103434] [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: 02/14/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Evidence supporting the use of acid suppression therapy (AST) for laryngomalacia (LM) is limited. The objective of this study was to determine if outpatient-initiated AST for LM was associated with symptom improvement, weight gain, and/or avoidance of surgery. METHODS A retrospective cohort was reviewed at a tertiary-care children's hospital. Patients were included if they were diagnosed with LM at ≤6 months of age, seen in an outpatient otolaryngology clinic between 2012 and 2018, and started on AST. Primary outcomes were improvement of airway and dysphagia symptoms, weight gain, and need for surgery. Severity was assessed by symptom severity. RESULTS Of 2693 patients reviewed, 199 met inclusion criteria. Median age of diagnosis was 4 weeks (range: 0-29 weeks). LM was classified as mild/moderate (71.4%) and severe (28.6%) based on symptom severity. Severity on flexible fiberoptic laryngoscopy (FFL) was not associated with clinical severity. Weight percentile, airway symptoms, and dysphagia symptoms improved within the cohort. In total, 26.1% underwent supraglottoplasty (SGP). In multivariate analysis, only severe LM on FFL was predictive of SGP (OR: 7.28, 95%CI: 1.91-27.67, p = .004). CONCLUSION Clinical symptom severity did not predict response to AST raising the question of utility of AST in LM. Severity of LM based on FFL, not clinical severity, was associated with decision to pursue SGP. Prospective randomized trials are needed to better understand the role of AST in LM. LEVEL OF EVIDENCE Level 3.
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Kang M, Mo F, Witmans M, Santiago V, Tablizo MA. Trends in Diagnosing Obstructive Sleep Apnea in Pediatrics. CHILDREN 2022; 9:children9030306. [PMID: 35327678 PMCID: PMC8947481 DOI: 10.3390/children9030306] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/05/2022]
Abstract
Obstructive sleep apnea in children has been linked with behavioral and neurocognitive problems, impaired growth, cardiovascular morbidity, and metabolic consequences. Diagnosing children at a young age can potentially prevent significant morbidity associated with OSA. Despite the importance of taking a comprehensive sleep history and performing thorough physical examination to screen for signs and symptoms of OSA, these findings alone are inadequate for definitively diagnosing OSA. In-laboratory polysomnography (PSG) remains the gold standard of diagnosing pediatric OSA. However, there are limitations related to the attended in-lab polysomnography, such as limited access to a sleep center, the specialized training involved in studying children, the laborious nature of the test and social/economic barriers, which can delay diagnosis and treatment. There has been increasing research about utilizing alternative methods of diagnosis of OSA in children including home sleep testing, especially with the emergence of wearable technology. In this article, we aim to look at the presentation, physical exam, screening questionnaires and current different modalities used to aid in the diagnosis of OSA in children.
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Affiliation(s)
- Mandip Kang
- Department of Medicine, University of California San Francisco-Fresno, Fresno, CA 93701, USA; (F.M.); (M.A.T.)
- Correspondence:
| | - Fan Mo
- Department of Medicine, University of California San Francisco-Fresno, Fresno, CA 93701, USA; (F.M.); (M.A.T.)
| | - Manisha Witmans
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | | | - Mary Anne Tablizo
- Department of Medicine, University of California San Francisco-Fresno, Fresno, CA 93701, USA; (F.M.); (M.A.T.)
- Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA
- Department of Pediatrics, Valley Children’s Hospital, Madera, CA 93720, USA
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Normal Neonatal Sleep Defined: Refining Patient Selection and Interpreting Sleep Outcomes for Mandibular Distraction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4031. [PMID: 35070593 PMCID: PMC8769137 DOI: 10.1097/gox.0000000000004031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
Background: Although polysomnography is paramount when evaluating neonatal airway obstruction, “normal” published references do not exist. We present normative polysomnography data for newborns age 0–1 month. We compare this reference to pre and postoperative sleep data from infants undergoing mandibular distraction osteogenesis (MDO) at this same age. Methods: Following IRB approval, normative subjects were recruited from our neonatal intensive care unit to undergo nap polysomnography. One blinded sleep physician read all studies. From 2016 to 2019, we prospectively collected sleep data for newborns undergoing MDO. Results: In total, 22 neonates without airway obstruction provided normative sleep data. Median total apnea-hypopnea index (AHI), obstructive apnea-hypopnea index (OAHI), and central apnea index (CAI) were 7.3, 4.9, and 0.7 events/hour. Median O2 nadir was 91%. Polysomnography for 13 neonates before MDO and during consolidation showed median preoperative AHI was 38.3, OAHI was 37.0, CAI was 1.9, and median O2 nadir was 83%. Following MDO, median AHI was 6.1, OAHI was 4.0, CAI was 1.3, and median O2 nadir was 92.5%. Paired t-tests confirmed significant improvements in all indices; when comparing the postoperative group with the normative group, there was no difference in oxygenation nor any respiratory index. Conclusions: “Normal” neonates have more obstructive events and lower oxygenation nadirs than previously appreciated. We provide normative nap polysomnography values for this age group and encourage centers with multidisciplinary MDO teams to utilize this data to calibrate patient selection algorithms, inform treatment discussions, and better understand surgical outcomes. Limitations include a small sample size and single institution study.
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Bozzini MF, Di Francesco RC, Soster LA. Clinical and anatomical characteristics associated with obstructive sleep apnea severity in children. Clinics (Sao Paulo) 2022; 77:100131. [PMID: 36334493 PMCID: PMC9636441 DOI: 10.1016/j.clinsp.2022.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/13/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the clinical and anatomical characteristics associated with obstructive sleep apnea severity in children with adenotonsillar hypertrophy. METHODS The authors conducted a cross-sectional multidisciplinary survey and selected 58 Brazilian children (4‒9 years old) with adenotonsillar hypertrophy, parental complaints of snoring, mouth-breathing, and witnessed apnea episodes. The authors excluded children with known genetic, craniofacial, neurological, or psychiatric conditions. Children with a parafunctional habit or early dental loss and those receiving orthodontic treatment were not selected. All children underwent polysomnography, and three were excluded because they showed an apnea-hypopnea index lower than one or minimal oxygen saturation higher than 92%. The sample consisted of 55 children classified into mild (33 children) and moderate/severe (22 children) obstructive sleep apnea groups. Detailed clinical and anatomical evaluations were performed, and anthropometric, otorhinolaryngological, and orthodontic variables were analyzed. Sleep disorder symptoms were assessed using the Sleep Disturbance Scale for Children questionnaire. All children also underwent teleradiography exams and Rickett's and Jarabak's cephalometric analyses. RESULTS The mild and moderate/severe obstructive sleep apnea groups showed no significant differences in clinical criteria. Facial depth angle, based on Ricketts cephalometric analysis, was significantly different between the groups (p = 0.010), but this measurement by itself does not express the child's growth pattern, as it is established by the arithmetic mean of the differences between the obtained angles and the normal values of five cephalometric measurements. CONCLUSIONS The clinical criteria and craniofacial characteristics evaluated did not influence the disease severity.
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Affiliation(s)
| | | | - Letícia A Soster
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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18
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Rosen CL. Sleep-Disordered Breathing (SDB) in Pediatric Populations. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Hansen C, Markström A, Sonnesen L. Sleep-disordered breathing and malocclusion in children and adolescents-a systematic review. J Oral Rehabil 2021; 49:353-361. [PMID: 34779522 DOI: 10.1111/joor.13282] [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] [Received: 03/24/2021] [Revised: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB. OBJECTIVES The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls. METHODS Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence. RESULTS The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low. CONCLUSION No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.
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Affiliation(s)
- Camilla Hansen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agneta Markström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Davidovich E, Hevroni A, Gadassi LT, Spierer-Weil A, Yitschaky O, Polak D. Dental, oral pH, orthodontic and salivary values in children with obstructive sleep apnea. Clin Oral Investig 2021; 26:2503-2511. [PMID: 34677695 DOI: 10.1007/s00784-021-04218-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Mouth breathing is a key feature of obstructive sleep apnea (OSA). The current study evaluated dental, salivary and orthodontic characteristics of children with OSA, and compared them to those of children without OSA. MATERIALS AND METHODS Twenty-two children (mean age 5.3 years, 13 males) with OSA and 21 children without OSA who served as a control group (mean age 6.8 years, 11 males) underwent dental examinations. The OSA group was classified according to the apnea-hypopnea Index. Clinical examination included plaque index, gingival index, caries status, pH at 7 oral sites, salivary carries bacterial counts and inflammatory cytokine levels. Orthodontics measurements were calculated as the percentage of children with values in the normal range, in each group. RESULTS The mean values of the decayed, missing and filled teeth (DMFT)/dmft index, the gingival index and the plaque index were higher in the OSA than the control group. Salivary Mutans streptococci and lactobacilli counts were significantly higher in the OSA than the control group; as were pH values in the hard and soft palate, and in the posterior and middle tongue. Significantly lower values were observed in the OSA than the control group for most of the orthodontic variables examined. Similarly, stratification of AHI according to severity shows the lowest values among those with mild OSA, and the highest among those with severe AHI. CONCLUSIONS Compared to a control group, mouth breathing children with obstructive sleep apnea had differences in oral microbiota, greater acidity and poorer dental status. CLINICAL RELEVANCE Clinicians should be aware of the various oral disturbances that may accompany OSA, and implement preventive measures.
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Affiliation(s)
- E Davidovich
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
| | - A Hevroni
- Department of Pulmonology, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - L Tzur Gadassi
- Department of Orthodontics, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - A Spierer-Weil
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - O Yitschaky
- Department of Orthodontics, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - D Polak
- Department of Periodontology, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel
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[Diagnostic criteria for obstructive sleep apnea syndrome in adolescent]. Rev Mal Respir 2021; 38:829-839. [PMID: 34565640 DOI: 10.1016/j.rmr.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/13/2021] [Indexed: 11/20/2022]
Abstract
The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.
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Martín-Montero A, Gutiérrez-Tobal GC, Kheirandish-Gozal L, Vaquerizo-Villar F, Álvarez D, Del Campo F, Gozal D, Hornero R. Heart Rate Variability as a Potential Biomarker of Pediatric Obstructive Sleep Apnea Resolution. Sleep 2021; 45:6366352. [PMID: 34498074 DOI: 10.1093/sleep/zsab214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/26/2021] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Pediatric obstructive sleep apnea (OSA) affects cardiac autonomic regulation, altering heart rate variability (HRV). Although changes in classical HRV parameters occur after OSA treatment, they have not been evaluated as reporters of OSA resolution. Specific frequency bands (named BW1, BW2 and BWRes) have been recently identified in OSA. We hypothesized that changes with treatment in these spectral bands can reliably identify changes in OSA severity and reflect OSA resolution. METHODS 404 OSA children (5-9.9 years) from the prospective Childhood Adenotonsillectomy Trial (CHAT) were included; 206 underwent early adenotonsillectomy (eAT), while 198 underwent watchful waiting with supportive care (WWSC). HRV changes from baseline to follow-up were computed for classical and OSA-related frequency bands. Causal mediation analysis was conducted to evaluate how treatment influences HRV through mediators such as OSA resolution and changes in disease severity. Disease resolution was initially assessed by considering only obstructive events, and was followed by adding central apneas to the analyses. RESULTS Treatment, regardless of eAT or WWSC, affects HRV activity, mainly in the specific frequency band BW2 (0.028-0.074 Hz). Furthermore, only changes in BW2 were specifically attributable to all OSA resolution mediators. HRV activity in BW2 also showed statistically significant differences between resolved and non-resolved OSA. CONCLUSIONS OSA treatment affects HRV activity in terms of change in severity and disease resolution, especially in OSA-related BW2 frequency band. This band allowed to differentiate HRV activity between children with and without resolution, so we propose BW2 as potential biomarker of pediatric OSA resolution.
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Affiliation(s)
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health and The Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
- Sleep-Ventilation Unit, Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Félix Del Campo
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
- Sleep-Ventilation Unit, Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - David Gozal
- Department of Child Health and The Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
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Martín-Montero A, Gutiérrez-Tobal GC, Kheirandish-Gozal L, Jiménez-García J, Álvarez D, del Campo F, Gozal D, Hornero R. Heart rate variability spectrum characteristics in children with sleep apnea. Pediatr Res 2021; 89:1771-1779. [PMID: 32927472 PMCID: PMC7956022 DOI: 10.1038/s41390-020-01138-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Classic spectral analysis of heart rate variability (HRV) in pediatric sleep apnea-hypopnea syndrome (SAHS) traditionally evaluates the very low frequency (VLF: 0-0.04 Hz), low frequency (LF: 0.04-0.15 Hz), and high frequency (HF: 0.15-0.40 Hz) bands. However, specific SAHS-related frequency bands have not been explored. METHODS One thousand seven hundred and thirty-eight HRV overnight recordings from two pediatric databases (0-13 years) were evaluated. The first one (981 children) served as training set to define new HRV pediatric SAHS-related frequency bands. The associated relative power (RP) were computed in the test set, the Childhood Adenotonsillectomy Trial database (CHAT, 757 children). Their relationships with polysomnographic variables and diagnostic ability were assessed. RESULTS Two new specific spectral bands of pediatric SAHS within 0-0.15 Hz were related to duration of apneic events, number of awakenings, and wakefulness after sleep onset (WASO), while an adaptive individual-specific new band from HF was related to oxyhemoglobin desaturations, arousals, and WASO. Furthermore, these new spectral bands showed improved diagnostic ability than classic HRV. CONCLUSIONS Novel spectral bands provide improved characterization of pediatric SAHS. These findings may pioneer a better understanding of the effects of SAHS on cardiac function and potentially serve as detection biomarkers. IMPACT New specific heart rate variability (HRV) spectral bands are identified and characterized as potential biomarkers in pediatric sleep apnea. Spectral band BW1 (0.001-0.005 Hz) is related to macro sleep disruptions. Spectral band BW2 (0.028-0.074 Hz) is related to the duration of apneic events. An adaptive spectral band within the respiratory range, termed ABW3, is related to oxygen desaturations. The individual and collective diagnostic ability of these novel spectral bands outperforms classic HRV bands.
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Affiliation(s)
| | - Gonzalo C. Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health and The Child Health Research Institute, The University of Missouri School of Medicine, Columbia, Missouri
| | | | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain.,Sleep-Ventilation Unit, Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Félix del Campo
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain.,Sleep-Ventilation Unit, Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - David Gozal
- Department of Child Health and The Child Health Research Institute, The University of Missouri School of Medicine, Columbia, Missouri
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
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Home respiratory polygraphy in obstructive sleep apnea syndrome in children: Comparison with a screening questionnaire. Int J Pediatr Otorhinolaryngol 2021; 143:110635. [PMID: 33535090 DOI: 10.1016/j.ijporl.2021.110635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The prevalence of obstructive sleep apnea syndrome (OSAS) in children referred for sleep-disordered breathing reaches up to 59%. We aimed to test the adequacy of a questionnaire compared to home respiratory polygraphy (HRP), in 45 subjects (5-16 years-old), without maxillofacial malformations nor other comorbidities, presenting with symptoms compatible with OSAS. METHODS All children passed a 12-items questionnaire (Obstructive Airway Child test: OACT) and the HRP. OSAS was classified in severity according to the apnea-hypopnea index (AHI). RESULTS With HRP, 60% and 15% children were detected to have at least mild (AHI ≥1) and moderate (AHI >5) OSAS, respectively. The sensitivity of the questionnaire to detect mild and moderate OSAS was good (93% and 71%, respectively) but the specificity was very low (11% and 34%). However, an OACT score under 61 showed a very good negative predictive value for moderate and severe OSAS (87%). With the questionnaire, we could have avoided a complementary PSG or HRP in 25/45 (56%) of our subjects as in children with mild OSAS and without comorbidities only clinical observation is usually advised. CONCLUSIONS The OACT questionnaire has shown to be a good and quick instrument to exclude moderate and severe OSAS in our population of children without maxillofacial malformations. Indeed children scoring under 61 could avoid a constraining and expensive sleep exam. However, if the score is above this cut-off, the performance to recognize OSAS is low and the child's evaluation must be completed by a HRP or PSG.
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Comparison of Frequency and Severity of Sleep-Related Breathing Disorders in Children with Simple Obesity and Paediatric Patients with Prader-Willi Syndrome. J Pers Med 2021; 11:jpm11020141. [PMID: 33670584 PMCID: PMC7923084 DOI: 10.3390/jpm11020141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/02/2022] Open
Abstract
Sleep-related breathing disorders (SRBDs) can be present in children with simple obesity and with Prader–Willi syndrome (PWS) and influence an individual diagnostic and treatment approach. We compared frequency and severity of SRBDs in children with simple obesity and with PWS, both without and on recombinant human growth hormone (rhGH) treatment, and correlation of SRBDs with insulin resistance tests. A screening polysomnography-polygraphy (PSG), the oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR) were analysed in three groups of patients—with simple obesity (group 1, n = 30, mean age 14.2 years), patients with PWS without the rhGH therapy (group 2, n = 8, mean age 13.0 years) and during the rhGH treatment (group 3, n = 17, mean age 8.9 years). The oxygen desaturation index (ODI) was significantly higher in groups 2 and 3, compared to group 1 (p = 0.00), and hypopnea index (HI) was higher in group 1 (p = 0.03). Apnea–hypopnea index (AHI) and apnea index (AI) results positively correlated with the insulin resistance parameters in groups 1 and 3. The PSG values worsened along with the increasing insulin resistance in children with simple obesity and patients with PWS treated with rhGH that may lead to a change in the patients’ care.
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Sader N, Hader W, Hockley A, Kirk V, Adeleye A, Riva-Cambrin J. The relationship between Chiari 1.5 malformation and sleep-related breathing disorders on polysomnography. J Neurosurg Pediatr 2021; 27:452-458. [PMID: 33513576 DOI: 10.3171/2020.8.peds20462] [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: 05/30/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chiari 1.5 malformation is a subgroup of the Chiari malformation in which tonsillar descent into the foramen magnum is accompanied by brainstem descent. No data exist on whether operative decompression in patients with Chiari 1.5 improves sleep-related breathing disorders (SRBDs) and whether there are radiological parameters predicting improvement. METHODS The authors performed a retrospective cohort study of consecutive pediatric patients with Chiari 1.5 malformation and SRBDs at the Alberta Children's Hospital. An SRBD was characterized using nocturnal polysomnography (PSG), specifically with the apnea-hypopnea index (AHI), the obstructive apnea index, and the central apnea index. Preoperative values for each of these indices were compared to those following surgical decompression. The authors also compared preoperative radiographic factors as predictors to both preoperative AHI and the change in AHI with surgery. Radiological factors included tonsillar and obex descent beneath the basion-opisthion line, the presence of syringomyelia, the frontooccipital horn ratio, the pB-C2 line, and the clivoaxial angle. RESULTS Seven patients (5 males, 2 females) met inclusion criteria. One patient had two surgical decompressions, each with pre- and postoperative PSG studies (n = 8). The median age was 9 years. Before surgical decompression, 75% underwent tonsillectomy/adenoidectomy. The majority (87.5%) experienced snoring/witnessed apnea preoperatively. The median tonsillar and obex descent values were 21.3 mm and 11.2 mm, respectively. The median values for the pB-C2 line and clivoaxial angle were 5.4 mm (interquartile range [IQR] 4.5 mm, 6.8 mm) and 144° (IQR 139°, 167°), respectively. There was a statistically significant change from preoperative to postoperative AHI (19.7 vs 5.1, p = 0.015) and obstructive apnea index (4.5 vs 1.0, p = 0.01). There was no significant change in the central apnea index with surgery (0.9 vs 0.3, p = 0.12). No radiological factors were statistically significant in predicting preoperative AHI and change in AHI. CONCLUSIONS This is the first series of pediatric patients with Chiari 1.5 with SRBDs who demonstrated a marked improvement in their PSG results postdecompression. Sleep apnea has a significant impact on learning and development in children, highlighting the urgency to recognize Chiari 1.5 as a more severe form of the Chiari I malformation.
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Affiliation(s)
- Nicholas Sader
- 1Department of Clinical Neurosciences, Alberta Children's Hospital, University of Calgary
| | - Walter Hader
- 1Department of Clinical Neurosciences, Alberta Children's Hospital, University of Calgary
| | - Aaron Hockley
- 2Department of Neurosurgery, University of Alberta Hospital, University of Alberta, Edmonton; and
| | - Valerie Kirk
- 3Department of Pediatric Respiratory Medicine, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Adetayo Adeleye
- 3Department of Pediatric Respiratory Medicine, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Jay Riva-Cambrin
- 1Department of Clinical Neurosciences, Alberta Children's Hospital, University of Calgary
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Calderón JM, Álvarez-Pitti J, Cuenca I, Ponce F, Redon P. Development of a Minimally Invasive Screening Tool to Identify Obese Pediatric Population at Risk of Obstructive Sleep Apnea/Hypopnea Syndrome. Bioengineering (Basel) 2020; 7:E131. [PMID: 33086521 PMCID: PMC7712243 DOI: 10.3390/bioengineering7040131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 01/20/2023] Open
Abstract
Obstructive sleep apnea syndrome is a reduction of the airflow during sleep which not only produces a reduction in sleep quality but also has major health consequences. The prevalence in the obese pediatric population can surpass 50%, and polysomnography is the current gold standard method for its diagnosis. Unfortunately, it is expensive, disturbing and time-consuming for experienced professionals. The objective is to develop a patient-friendly screening tool for the obese pediatric population to identify those children at higher risk of suffering from this syndrome. Three supervised learning classifier algorithms (i.e., logistic regression, support vector machine and AdaBoost) common in the field of machine learning were trained and tested on two very different datasets where oxygen saturation raw signal was recorded. The first dataset was the Childhood Adenotonsillectomy Trial (CHAT) consisting of 453 individuals, with ages between 5 and 9 years old and one-third of the patients being obese. Cross-validation was performed on the second dataset from an obesity assessment consult at the Pediatric Department of the Hospital General Universitario of Valencia. A total of 27 patients were recruited between 5 and 17 years old; 42% were girls and 63% were obese. The performance of each algorithm was evaluated based on key performance indicators (e.g., area under the curve, accuracy, recall, specificity and positive predicted value). The logistic regression algorithm outperformed (accuracy = 0.79, specificity = 0.96, area under the curve = 0.9, recall = 0.62 and positive predictive value = 0.94) the support vector machine and the AdaBoost algorithm when trained with the CHAT datasets. Cross-validation tests, using the Hospital General de Valencia (HG) dataset, confirmed the higher performance of the logistic regression algorithm in comparison with the others. In addition, only a minor loss of performance (accuracy = 0.75, specificity = 0.88, area under the curve = 0.85, recall = 0.62 and positive predictive value = 0.83) was observed despite the differences between the datasets. The proposed minimally invasive screening tool has shown promising performance when it comes to identifying children at risk of suffering obstructive sleep apnea syndrome. Moreover, it is ideal to be implemented in an outpatient consult in primary and secondary care.
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Affiliation(s)
- José Miguel Calderón
- Fundación Investigación Hospital Clínico (INCLIVA), Avda. Menedez Pelayo 4, 46010 Valencia, Spain; (J.M.C.); (I.C.)
| | - Julio Álvarez-Pitti
- Pediatric Department, Consorcio Hospital General Universitario de Valencia, Avda. Tres Cruces s/n, 46014 Valencia, Spain; (J.Á.-P.); (F.P.)
| | - Irene Cuenca
- Fundación Investigación Hospital Clínico (INCLIVA), Avda. Menedez Pelayo 4, 46010 Valencia, Spain; (J.M.C.); (I.C.)
| | - Francisco Ponce
- Pediatric Department, Consorcio Hospital General Universitario de Valencia, Avda. Tres Cruces s/n, 46014 Valencia, Spain; (J.Á.-P.); (F.P.)
- CIBEROBN, Health Institute Carlos III, Av. Monforte de Lemos, 3-5. Pavilion 11, 28029 Madrid, Spain
| | - Pau Redon
- Pediatric Department, Consorcio Hospital General Universitario de Valencia, Avda. Tres Cruces s/n, 46014 Valencia, Spain; (J.Á.-P.); (F.P.)
- CIBEROBN, Health Institute Carlos III, Av. Monforte de Lemos, 3-5. Pavilion 11, 28029 Madrid, Spain
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Maroda AJ, Spence MN, Larson SR, Estepp JH, Gillespie MB, Harris AJ, Mamidala MP, Sheyn AM. Screening for Obstructive Sleep Apnea in Children With Sickle Cell Disease: A Pilot Study. Laryngoscope 2020; 131:E1022-E1028. [PMID: 32818314 DOI: 10.1002/lary.29036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Obstructive sleep apnea (OSA) and sickle cell disease (SCD) represent two complex disease processes. Current guidelines recommend that children with SCD receive polysomnography (PSG) after presenting with signs or symptoms of sleep-disordered breathing (SDB). Recent studies suggest a disproportionately elevated prevalence of SDB in the population of children with SCD, and traditional risk factors may not be evident within these patients. Further objective testing might be needed to screen all pediatric patients with SCD, even in the absence of overt signs or symptoms of OSA to prevent complications of both conditions. STUDY DESIGN Prospective cohort study. METHODS Institutional review board approval was obtained. An eight-question OSA risk assessment screening questionnaire was presented prospectively to 100 consecutive patients with SCD in the pediatric hematology clinic regardless of complaints of SDB. RESULTS Out of 100 patients, 51 were female. The average age, body mass index (BMI), BMI percentile, and I'M SLEEPY score of the entire cohort were 3.97 years, 15.97%, 55.4%, and 1.63%, respectively. Nineteen patients had a positive sleep apnea screening score and were referred for PSG. The average age BMI, BMI percentile, and I'M SLEEPY score for those 19 patients were 3.77%, 16.67%, 65%, and 3.95%, respectively. Ten patients completed PSG, with seven diagnosed with OSA. CONCLUSIONS This pilot study demonstrates a higher incidence of SDB and OSA in children with SCD relative to the general pediatric population. Although more PSG reports and further testing is needed to determine whether the results hold, preliminary data indicate that children with SCD should at least undergo OSA screening in the office regardless of overt symptoms. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E1022-E1028, 2021.
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Affiliation(s)
- Andrew J Maroda
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Matthew N Spence
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Stephen R Larson
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Jeremie H Estepp
- Department of Pediatric Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Atia J Harris
- Division of Pulmonology and Sleep Medicine, Le Bonheur Children's Hospital, Memphis, Tennessee, U.S.A
| | - Madhu P Mamidala
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Anthony M Sheyn
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.,Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, Memphis, Tennessee, U.S.A.,Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, Memphis, Tennessee, U.S.A
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29
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Kaditis AG, Polytarchou A, Moudaki A, Panaghiotopoulou-Gartagani P, Kanaka-Gantenbein C. Measures of nocturnal oxyhemoglobin desaturation in children with neuromuscular disease or Prader-Willi syndrome. Pediatr Pulmonol 2020; 55:2089-2096. [PMID: 32525614 DOI: 10.1002/ppul.24899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/10/2020] [Accepted: 06/06/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Evidence for nocturnal oximetry interpretation in patients with abnormal neuromuscular function is limited. We aimed to compare children with neuromuscular disease (NMD) or Prader-Willi syndrome (PWS) to otherwise healthy subjects with obstructive sleep-disordered breathing (SDB) or without respiratory disorder (controls) regarding nocturnal oximetry parameters. METHODS We analyzed recordings from children with: (a) NMD; (b) PWS; (c) snoring and adenotonsillar hypertrophy and/or obesity (SDB); and (d) controls. Outcomes included: (a) basal SpO2 ; (b) proportions of subjects with McGill oximetry score (MOS) >1 (clusters of desaturations); and (c) desaturation index (SpO2 drops ≥3%/h-ODI3). RESULTS Data of 12 subjects with NMD (median age, 5.2 years; IQR, 2.7, 8.2), 14 children with PWS (5 years; 2.3, 6.9), 21 children with SDB (5.8 years; 4.6, 9.6), and 20 controls (6.2 years; 5.4, 11.2) were analyzed. Children with NMD, PWS, and SDB had lower basal SpO2 than controls (95.6% [94.5%, 96.9%], 96.2% [95.1%, 97.4%], 96.1% [95.8%, 97.5%] vs 97.8% [97.2%, 97.9%], respectively; (P < .01). NMD and PWS showed the greatest negative effect on basal SpO2 (P < .05). Children with SDB or PWS had a higher risk of MOS >1 than patients with NMD (OR, 25.9 [95% CI, 3.4-200.4] and 9.5 [1.5-62.6]). NMD, PWS, and SDB were similar regarding ODI3, which was elevated compared to ODI3 in controls (P < .05). Frequent desaturations predominated in NMD, while periods of sustained desaturation were noted in NMD and PWS. CONCLUSION PWS and NMD have a negative effect on basal SpO2 , while clusters of desaturations are prevalent in patients with PWS or obstructive SDB.
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Affiliation(s)
- Athanasios G Kaditis
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Anastasia Polytarchou
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Aggeliki Moudaki
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Polytimi Panaghiotopoulou-Gartagani
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Ioan I, Weick D, Schweitzer C, Guyon A, Coutier L, Franco P. Feasibility of parent-attended ambulatory polysomnography in children with suspected obstructive sleep apnea. J Clin Sleep Med 2020; 16:1013-1019. [PMID: 32056538 PMCID: PMC7954050 DOI: 10.5664/jcsm.8372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Due to a limited number of pediatric sleep centers, the aim was to test the feasibility of ambulatory polysomnography (PSG-home) in a group of French children suspected of OSA. METHODS Children undergoing one-night PSG-home, with the device installed at the pediatric sleep physician's office, were prospectively included. General failure was considered when PSG-home recording captured < 5 h of artifact-free sleep or when ≥ 1 channel (nasal flow, thoraco-abdominal belts, oximetry) presented artifacts > 75% of the recording time. No-OSA was defined as an obstructive apnea-hypopnia index (OAHI) < 1 event/h and respiratory-related arousals index (RAI) < 1 event/h. OSA was defined as upper airways resistance syndrome (UARS) with OAHI < 1 event/h with RAI ≥ 1 event/h, or mild OSA (OAHI ≥ 1 event/h-5 events/h), moderate OSA (OAHI ≥ 5 events/h-10 events/h), or severe OSA (OAHI ≥ 10 events/h). Parents completed a severity hierarchy score questionnaire, Conners Parent Rating Scale, and an adapted Epworth Sleepiness Scale. RESULTS Fifty-seven children aged 3 through 16 years were included. PSG-home was technically acceptable in 46 (81%). Failure due to nasal cannula was observed in 11% (n = 6), oximetry in 7% (n = 4), and both in 2% (n = 1) of cases. No difference in feasibility was found according to age, sex, OSA severity, or comorbidities. There were 14 (25%) children categorized as no-OSA, 43 (75%) as OSA, 4 (7%) as UARS, 26 (46%) as mild, 6 (10%) as moderate, and 7 (12%) as severe OSA. Neither questionnaires nor clinical and physical examination predicted OSA diagnosis. CONCLUSIONS When equipment is installed at the professional's office and a parent monitors the child, PSG-home is feasible and technically acceptable in children aged 3 through 16 years old. The short delay and feasibility provided by PSG-home could improve the management of children suspected of OSA.
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Affiliation(s)
- Iulia Ioan
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
- Faculté de Médecine, Université de Lorraine, Nancy, France
- Contributed equally
| | - Diane Weick
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Contributed equally
| | - Cyril Schweitzer
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
- Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Aurore Guyon
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Laurianne Coutier
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Service de pneumologie infantile, allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, CNRL, Université de Lyon 1, France
| | - Patricia Franco
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, CNRL, Université de Lyon 1, France
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Testa D, Carotenuto M, Precenzano F, Russo A, Donadio A, Marcuccio G, Motta G. Evaluation of neurocognitive abilities in children affected by obstructive sleep apnea syndrome before and after adenotonsillectomy. ACTA ACUST UNITED AC 2020; 40:122-132. [PMID: 32469006 PMCID: PMC7256902 DOI: 10.14639/0392-100x-n0267] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/28/2019] [Indexed: 11/23/2022]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is the most severe form of sleep-related disordered breathing (SRDB) and is characterised by snoring, apnoeas, and/or hypopnoeas associated to hypoxia, hypercarbia, or repeated arousals from sleep. OSAS has three major categories of morbidities: neurobehavioural, cardiovascular and somatic growth failure. The gold standard for objective diagnosis of obstructive-SRDB severity is polysomnography (PSG). The indication for surgical treatment in children is moderate-severe OSAS (AHI, apnoea hypopnoea index > 5/h) and in mild OSAS (AHI 2-5/h) with complications or morbidity. The entire spectrum of PSG-defined SRDB (ranging from Primary Snoring to severe OSAS) may correlate with behavioural, attentional and executive function deficits relating to hypoxia and sleep disruption: in some cases, these alterations may mimic attention deficit hyperactivity disorder (ADHD). The aim of this research was to evaluate visuoperceptual and constructional abilities, paediatric sleep questionnaire and polysomnographic scores before and 6 months after adenotonsillectomy with objective and subjective information. We included 59 children who underwent neuropsychiatric and otolaryngologist clinical evaluation and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI); children parents were asked to fill in the Paediatric Sleep Questionnaire (PSQ); each child underwent PSG. At 6 months after adenotonsillectomy, all patients were evaluated again. There is a significant difference in PSQ parameters, VMI standard, visual tests scores and PSG parameters before and after adenotonsillectomy in children affected by OSAS. These results showed the achievement of therapeutic benefits with improvement of the quality of life for both children and their parents.
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Affiliation(s)
- Domenico Testa
- Otolaryngology, Head and Neck Surgery, Department of General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Italy
| | - Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Italy
| | - Alessia Russo
- Otolaryngology, Head and Neck Surgery, Department of General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Italy
| | - Anna Donadio
- Otolaryngology, Head and Neck Surgery, Department of General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Italy
| | - Giuseppina Marcuccio
- Otolaryngology, Head and Neck Surgery, Department of General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Italy
| | - Gaetano Motta
- Otolaryngology, Head and Neck Surgery, Department of General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Italy
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Stowe RC, Afolabi-Brown O. Pediatric polysomnography-A review of indications, technical aspects, and interpretation. Paediatr Respir Rev 2020; 34:9-17. [PMID: 31761560 DOI: 10.1016/j.prrv.2019.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Polysomnography is an elaborate diagnostic test composed of numerous data-collecting sensors working concomitantly to aid in the evaluation of varied sleep disorders in all age groups. Polysomnography is the study of choice for the assessment of pediatric sleep-disordered breathing, including obstructive sleep apnea syndrome, central apnea, and hypoventilation disorders, and is used to help determine treatment efficacy. Beyond the purview of snoring and breathing pauses, polysomnography can elucidate the etiology of hypersomnolence, when associated with a multiple sleep latency test, and abnormal movements or events, whether nocturnal seizure or complex parasomnia, when a thorough patient history cannot provide clear answers. This review will highlight the multitudinous indications for pediatric polysomnography and detail its technical aspects by describing the multiple neurophysiologic and respiratory parametric sources. Knowledge of these technical aspects will provide the practitioner with a thoughtful means to understand the limitations and interpretation of polysomnography.
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Affiliation(s)
- Robert C Stowe
- Division of Neurology, Children's Hospital of Philadelphia, United States; Children's Hospital of Philadelphia Sleep Center, United States.
| | - Olufunke Afolabi-Brown
- Children's Hospital of Philadelphia Sleep Center, United States; Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, United States.
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Coutier L, Franco P. [Sleep-related breathing disorders in children and teenagers: diagnosis, consequences and comorbidities]. Orthod Fr 2019; 90:273-287. [PMID: 34643515 DOI: 10.1051/orthodfr/2019034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a frequent sleep-related breathing disorder in children with a prevalence of approximately 3% between the ages of 3 and 8. Its origin is multifactorial (hypertrophy of pharyngeal soft tissues, narrowing of the bone airways, damage to the neuromuscular tone). The symptoms and clinical signs to look for during the day and at night are directly related to upper airway (UA) obstruction or poor sleep quality. After a complete anamnestic and clinical evaluation, including nasofibroscopy, the ENT specialist will refer to an adeno-amygdalectomy or night recording by polysomnography or polygraph to confirm the diagnosis in the child. Among adolescents, the prevalence of OSAS is reported to be between 0.5 and 6%. The main risk factors are obesity, male sex and a history of tonsillectomy. In addition to the classic symptoms of childhood OSAS, this syndrome may, in adolescents, manifest itself as a misleading semiology of dyssomnia, excessive daytime sleepiness and/or mood disorders. Differential diagnoses with risk behaviours, phase delay or narcolepsy should be systematically discussed. It is essential to record breathing during sleep. Even if the obstructive apnea/hypopnea index is low, it must be considered. In both children and adolescents, multidisciplinary management (ENT, orthodontist, maxillofacial physiotherapist, pulmonologist) should be early in order to avoid neurocognitive, behavioural, cardiovascular and metabolic complications. Maxillofacial surgery can be discussed from the age of 15. It is important not to forget to pay attention to the rules of healthy living and sleep as well as the management of obesity.
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Affiliation(s)
- Laurianne Coutier
- Service de pneumologie, allergologie et mucoviscidose pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 59 boulevard Pinel, 69500 Lyon, France, Unité de sommeil pédiatrique, ESEFNP, HFME, Hospices Civils de Lyon & U1028, CRNL, Université Lyon 1, 59 boulevard Pinel, 69500 Lyon, France, U1028, CNRL, Université de Lyon 1, 59 boulevard Pinel, 69500 Lyon, France
| | - Patricia Franco
- Unité de sommeil pédiatrique, ESEFNP, HFME, Hospices Civils de Lyon & U1028, CRNL, Université Lyon 1, 59 boulevard Pinel, 69500 Lyon, France, U1028, CNRL, Université de Lyon 1, 59 boulevard Pinel, 69500 Lyon, France
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Translation and cross-cultural validation of the French version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire. Sleep Med 2019; 58:123-129. [DOI: 10.1016/j.sleep.2019.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 11/23/2022]
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35
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Katsouli G, Polytarchou A, Tsaoussoglou M, Loukou I, Chrousos G, Kaditis AG. Nocturnal oximetry in children with obstructive lung disease or sleep-disordered breathing. Pediatr Pulmonol 2019; 54:551-556. [PMID: 30672145 DOI: 10.1002/ppul.24259] [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: 09/29/2018] [Accepted: 12/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Although progress has been made in the standardized interpretation of nocturnal oximetry in children with obstructive sleep-disordered breathing (SDB), no evidence exists on oximetry abnormalities in other respiratory disorders. We aimed to compare obstructive lung disease (OLD) and SDB regarding nocturnal oximetry parameters. METHODS We analyzed oximetry recordings from children with (i) OLD (obliterative bronchiolitis; cystic fibrosis); (ii) snoring and adenotonsillar hypertrophy (SDB); and (iii) no respiratory disorder (controls). The three groups were compared regarding: (i) oxygen desaturation of hemoglobin index (SpO2 drops ≥3%/h-ODI3) and (ii) basal SpO2 (average SpO2 between SpO2 drops). The associations of oximetry parameters (natural logarithm) with study group were tested using linear regression including age as covariate. RESULTS Data of 16 subjects with OLD (median age: 7.3 years; Q25, Q75: 5.4, 12), 22 children with SDB (6.3 years; 4, 9) and 22 controls (6.8 years; 5.6, 10.3) were analyzed. Children with OLD or SDB had significantly lower basal SpO2 than controls (91.9% [90.8, 93.4] vs 96.3% [96, 97.4] vs 97.6% [97.1, 97.9]; P < 0.01). No subjects in the SDB or control groups had basal SpO2 < 95%. Children with SDB had significantly higher ODI3 than children with OLD or controls [8.4 episodes/h (6.2, 16.6) vs 4.4 episodes/h (3.6, 6.6) vs 2 episodes/h (1.3, 2.7); P < 0.01]. OLD had the greatest negative effect on basal SpO2 (R2 = 0.62; P < 0.001) and SDB the greatest positive effect on ODI3 (R2 = 0.34; P < 0.001). CONCLUSION OLD is associated mostly with reduced basal SpO2 , whereas SDB is characterized by elevated ODI3.
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Affiliation(s)
- Georgia Katsouli
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Anastasia Polytarchou
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Marina Tsaoussoglou
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioanna Loukou
- Cystic Fibrosis Center, Aghia Sophia Children's Hospital, Athens, Greece
| | - George Chrousos
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Athanasios G Kaditis
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Stowe RC, Glaze DG. Electroencephalographic Patterns During Routine Polysomnography in Childhood and Association With Future Epilepsy Diagnosis. J Clin Sleep Med 2019; 15:553-562. [PMID: 30952213 DOI: 10.5664/jcsm.7712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/04/2019] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Evaluate the frequency of abnormal electroencephalograph (EEG) records during pediatric polysomnography (PSG) at a tertiary referral center and determine frequency with which these records may predict future seizures and a diagnosis of epilepsy. METHODS Retrospective review of all pediatric PSG reports from 2013 was performed. Demographics, medical history, indications, diagnoses, and EEG reports were collected. Patients were evaluated for follow-up of future diagnosis of seizure or epilepsy over a 30-month period. RESULTS A total of 1,969 studies (56.9% males, median age 7 years) were analyzed. Abnormal EEG results were detected in 314 studies (15.9%); abnormalities included slowing in 75 (3.8%) and interictal epileptiform discharges (IEDs) in 239 (12.1%). Incidental abnormal EEG recordings were found in 186 patients (9.4%) without a prior diagnosis of seizure or epilepsy. Incidental IEDs were recorded in 126 (6.4%) and were most commonly focal (66.7%). Ten patients received follow-up EEG without clinical follow-up, 68 received clinical follow-up without follow-up EEG, and 29 received both within a 30-month period. Follow-up EEG was normal in only 30.8% of cases. Thirteen patients in the 30-month window received a new diagnosis of epilepsy. Each new diagnosis occurred in patients with preexisting neurodevelopmental disorders at high risk for seizures. CONCLUSIONS Abnormal EEG during pediatric PSG without additional history of seizure is a poor prognosticator for a future diagnosis of epilepsy. Abnormalities detected on PSG did not always portend abnormal diagnostic EEG and thus its utility to corroborate findings does not appear to be supported without additional clinical context concerning for seizure.
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Affiliation(s)
- Robert C Stowe
- Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Daniel G Glaze
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Department of Neurology, Baylor College of Medicine, Houston, Texas
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Abstract
Neuromuscular and chest wall diseases include a diverse group of conditions that share common risk factors for sleep-disordered breathing, including respiratory muscle weakness and/or thoracic restriction. Sleep-disordered breathing results from both the effects of normal sleep on ventilation and the additional challenges imposed by the underlying disorders. Patterns of sleep- disordered breathing vary with the specific diagnosis and stage of disease. Sleep hypoventilation precedes diurnal respiratory failure and may be difficult to recognize clinically because symptoms are nonspecific. Polysomnography has a role in both the diagnosis of sleep-disordered breathing and in the titration of effective noninvasive positive-pressure ventilation.
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Affiliation(s)
- Janet Hilbert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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38
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Pires PJ, Mattiello R, Lumertz MS, Morsch TP, Fagondes SC, Nunes ML, Gozal D, Stein RT. Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire. J Pediatr (Rio J) 2019; 95:231-237. [PMID: 29501352 DOI: 10.1016/j.jped.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To validate the Pediatric Obstructive Sleep Apnea Screening tool for use in Brazil. MATERIALS AND METHODS The Brazilian version of this questionnaire, originally validated and tested in the United States, was developed as follows: (a) translation; (b) back-translation; (c) completion of the final version; (d) pre-testing. The questionnaire was applied prior to polysomnography to children aged 3-9 years from October 2015 to October 2016, and its psychometric properties (i.e., validity and reliability) were evaluated. The accuracy was assessed from comparisons between polysomnographic results and corresponding questionnaire scores. RESULTS Sixty patients were enrolled, and based on polysomnographic findings, 48% patients had normal apnea-hypopnea index, while the remaining 52% met the criteria for obstructive sleep apnea. Minimum O2 saturation level was significantly lower among obstructive sleep apnea children (p=0.021). Satisfactory concordance was found between individual apnea-hypopnea index and questionnaire scores. Bland-Altman plot-derived bias was 0.1 for the difference between measures, with 5.34 (95% CI: 4.14-6.55) and -5.19 (95%CI: -6.39 to -3.98) for the upper and lower agreement range. Internal consistency derived from Cronbach's alpha was 0.84 (95%CI: 0.78-0.90). CONCLUSION The questionnaire was translated to and validated into Brazilian-Portuguese version, and showed good reliability and concordance with apnea-hypopnea index. This questionnaire offers a reliable screening option for sleep-disordered breathing in children.
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40
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Jacob SB, Smith GM, Rebholz WN, Cash ED, Kalathoor SR, Goldman JL, Chandran SK. Relationship between obstructive sleep apnea and difficulty of anesthesia induction in children undergoing tonsillectomy. Int J Pediatr Otorhinolaryngol 2019; 118:42-46. [PMID: 30578995 DOI: 10.1016/j.ijporl.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine whether anesthesiologists need to rely on polysomnography (PSG) when predicting need for airway intervention during induction in patients with sleep-disordered breathing (SDB). METHODS Prospective case-control observational study at a tertiary care pediatric hospital. Children between the ages of 2-17 undergoing tonsillectomy were divided into three groups: those presenting with OSA observed by history and/or physical examination alone (SDB; n = 33), those with OSA determined by preoperative PSG (OSA; n = 32), and a control group (n = 35) undergoing tonsillectomy for recurrent tonsillitis. An anesthesiologist ranked each case on the level of intervention required to maintain ventilation. RESULTS Age, height and BMI were associated with greater induction difficulty (r's > .225, p's < .025). Compared to controls, induction difficulty was significantly greater for the SDB group (mean difference = -0.751, 95% confidence interval [CI] = -1.241, -0.261, p = .003), but not for the OSA group (p = .061). No significant difference in induction difficulty was observed between SDB and OSA groups. In a subgroup analysis of the OSA group, an apnea-hypopnea index (AHI) > 10 correlated with increased level of intervention during induction (r = .228, p = .022). Race was also associated with AHI >10 (odds ratio = 3.859, 95% CI = 1.485, 10.03, p = .006). CONCLUSION Children with OSA undergoing tonsillectomy require more airway intervention during induction than children with recurrent tonsillitis. Age and BMI were correlated with greater induction difficulty, suggesting that PSG data should be considered in light of these clinical characteristics to ensure an optimal postoperative course for children undergoing tonsillectomy.
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Affiliation(s)
- Sarah B Jacob
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Guerin M Smith
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Whitney N Rebholz
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Elizabeth D Cash
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA; Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA; James Graham Brown Cancer Center, Louisville, KY, USA
| | - Sasi R Kalathoor
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, USA; Norton Children's Hospital, Louisville, KY, USA
| | - Julie L Goldman
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Swapna K Chandran
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA.
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Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, Kang KS, Hong J, Shim JO, Lee Y, Kang B, Lee YJ, Kim MJ, Moon JS, Koh H, You J, Kwak YS, Lim H, Yang HR. Clinical Practice Guideline for the Diagnosis and Treatment of Pediatric Obesity: Recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. Pediatr Gastroenterol Hepatol Nutr 2019; 22:1-27. [PMID: 30671370 PMCID: PMC6333581 DOI: 10.5223/pghn.2019.22.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University, College of Medicine, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Chungju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea.,Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - JeongAe You
- Department of Physical Education, College of Education, Chung-Ang University, Seoul, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Objectives To describe the frequency of sleep-disordered breathing (SDB) in pediatric cystic fibrosis (CF) and to study associations between polysomnographic respiratory parameters and available clinical information. Methods This was a retrospective, cross-sectional study. The sample data were obtained from information recorded on patient charts in 2015 and 2016. The study included all individuals with CF aged from 2 to 20 years for whom records were available for polysomnography performed within the previous two years. Results Sixteen individuals with CF (mean age 11 ± 5.6 years old) were included. Polysomnographic respiratory parameter abnormalities were defined as an apnea-hypopnea index (AHI) exceeding one event per hour of sleep or an oxyhemoglobin saturation (SpO2) nadir below 90%; observed in 10 subjects (62.5%). Forced expiratory volume in first second (FEV1) was correlated (r=0.602, p=0.023) with mean sleep SpO2. FEV1 was also negatively correlated with sleep peak end-tidal carbon dioxide (EtpCO2) (r=-0.645, p=0.024). Additionally, chronic airway colonization by Pseudomonas aeruginosa was associated with mean EtpCO2 in non-REM sleep (p=0.024). Discussion SDB was frequently observed in this sample of children with CF. There was an association between CF respiratory disease progression markers and sleep breathing parameters in children. Sleep studies appear to be an important tool for assessment of the respiratory status of these individuals with CF, although further studies are needed, especially with carbon dioxide sleep analysis.
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43
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Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, Kang KS, Hong J, Shim JO, Lee Y, Kang B, Lee YJ, Kim MJ, Moon JS, Koh H, You J, Kwak YS, Lim H, Yang HR. Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. KOREAN JOURNAL OF PEDIATRICS 2018; 62:3-21. [PMID: 30589999 PMCID: PMC6351800 DOI: 10.3345/kjp.2018.07360] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022]
Abstract
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Chungju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Eulji University School of Medicine, Nowon Eulji Medical Hospital, Seoul, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea
| | - JeongAe You
- Department of Physical Education, College of Education, Chung-Ang University, Seoul, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Fishman H, Massicotte C, Li R, Zabih W, McAdam LC, Al-Saleh S, Amin R. The Accuracy of an Ambulatory Level III Sleep Study Compared to a Level I Sleep Study for the Diagnosis of Sleep-Disordered Breathing in Children With Neuromuscular Disease. J Clin Sleep Med 2018; 14:2013-2020. [PMID: 30518444 DOI: 10.5664/jcsm.7526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) surveillance recommendations are not being met for children with neuromuscular disease (NMD) because of limited diagnostic facilities. We evaluated the diagnostic accuracy of an ambulatory level III device as compared to a level I PSG. METHODS A cross-sectional study was conducted at a tertiary pediatric institution. Eligibility criteria included: (1) children with NMD; (2) age 6 to 18 years; (3) booked for a clinically indicated overnight level I PSG. Participants were randomized to an overnight level I PSG followed by an ambulatory level III study with end tidal carbon dioxide (etCO2) or vice versa. Sensitivity and specificity of the ambulatory level III device to diagnose sleep-disordered breathing (SDB) at an apnea-hypopnea index (AHI) cutoff of > 1.0 events/h was the primary outcome. RESULTS Moderate to severe SDB was found in 46% of participants (13/28). The device's sensitivity and specificity to detect SDB was 61.5% and 86.7%, respectively. The positive predictive value of the level III study was 80.0% and the negative predictive value was 72.0%. Fifty percent of the cohort were either missing or had incomplete or falsely low ambulatory etCO2 data. CONCLUSIONS A level III device with etCO2 is not yet able to be implemented in clinical practice as a diagnostic tool for SDB in pediatric patients with NMD. COMMENTARY A commentary on this article appears in this issue on page 1973.
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Affiliation(s)
- Haley Fishman
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rhonda Li
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Weeda Zabih
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Laura C McAdam
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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45
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Zaffanello M, Antoniazzi F, Tenero L, Nosetti L, Piazza M, Piacentini G. Sleep-disordered breathing in paediatric setting: existing and upcoming of the genetic disorders. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:343. [PMID: 30306082 PMCID: PMC6174189 DOI: 10.21037/atm.2018.07.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Childhood obstructive sleep apnea syndrome (OSAS) is characterized by anatomical and functional upper airway abnormalities as pathophysiological determinants, and clinical symptoms are frequently clear. OSAS is widely described in rare genetic disorders, such as achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, and mucopolysaccharidosis. Craniofacial and upper airway involvement is frequently morbid conditions. In children with genetic diseases, the clinical symptoms of OSAS are often slight or absent, and related morbidities are usually more severe and can be observed at any age. The present review is aimed to updating the discoveries regarding OSAS on Achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, Sickle cell disease, or encountered in our clinical practice (Ehlers-Danlos syndrome, Ellis-van Creveld syndrome, Noonan syndrome). Two additional groups of genetic disorders will be focused (mucopolysaccharidoses and osteogenesis imperfecta). The flowing items are covered for each disease: (I) what is the pathophysiology of OSAS? (II) What is the incidence/prevalence of OSAS? (III) What result from the management and prognosis? (IV) What are the recommendations? Considering the worries of OSAS, such as inattention and behavioural problems, daytime sleepiness, failure to thrive, cardiological and metabolic complications, the benefit of a widespread screening and the treatment in children with genetic diseases is undoubtful. The goals of the further efforts can be the inclusion of various genetic diseases into guidelines for the screening of OSAS, updating the shreds of evidence based on the research progression.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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46
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Sleep and Challenging Behaviors in the Context of Intensive Behavioral Intervention for Children with Autism. J Autism Dev Disord 2018; 48:3871-3884. [DOI: 10.1007/s10803-018-3648-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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47
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Ss M. A Pediatric Patient with Idiopathic Short Stature Who Developed Obstructive Sleep Apnea after Starting Growth Hormone Replacement Therapy. J Mol Genet Med 2018; 11. [PMID: 29399036 DOI: 10.4172/1747-0862.1000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Growth hormone (GH) therapy has long been suspected to induce obstructive sleep apnea (OSA) in children and adults. Moreover, reports about GH-associated sudden death in children with Prader-Willi syndrome (PWS) have prompted concerns about GH worsening sleep apnea. Previous studies have supported routine polysomnography for children with PWS prior to starting GH treatments, regardless of clinical history. However, there are no established guidelines recommending routine polysomnography (PSG) prior to the commencement of GH therapy in other pediatric patients. Case description We report a case of a 15-year-old young man with intractable headaches, referred to the sleep clinic to rule out any sleep-related variables. After an initial non-significant (mild snoring) sleep study, the patient returned with worsening snoring about one year after starting GH therapy for concerns of short stature. Results A second polysomnogram revealed that his obstructive apnea-hypopnea index had risen dramatically from baseline. His symptoms resolved after tonsillectomy and adenoidectomy. Conclusion This interesting case highlights the need for caution with any patient eligible for GH therapy. We recommend additional research to look in the development of definitive guidelines regarding the indications for polysomnography for patients with idiopathic short stature and non-significant initial sleep history-particularly before and during the administration of GH therapy.
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Affiliation(s)
- Morkous Ss
- Department of Pediatrics, Pediatric Neurology Division, Lehigh Valley Children's Hospital, Allentown, PA, USA.,Pediatrics Core Academic Rank, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Clinical Sciences, DeSales University, Center Valley, PA, USA
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48
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Abel F, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Tan HL, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50:50/6/1700985. [PMID: 29217599 DOI: 10.1183/13993003.00985-2017] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Abstract
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
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Affiliation(s)
- Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Francois Abel
- Dept of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Paediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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49
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Holmes EM, Singh HHK, Kirk VG, Brindle M, Luntley J, Weber BA, Yunker WK. Incidence of children at risk for obstructive sleep apnea undergoing common day surgery procedures. J Pediatr Surg 2017; 52:1791-1794. [PMID: 28587728 DOI: 10.1016/j.jpedsurg.2017.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/02/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prevalence of sleep-related breathing disorders (SRBD) in children undergoing elective day surgery procedures. METHODS A validated Pediatric Sleep Questionnaire (PSQ) was distributed to the parents of children aged 2months to 18 years who met inclusion criteria and were undergoing urologic, otolaryngologic, and general surgical day surgery procedures a 3-month period of time. The prevalence of children at risk for pediatric SRBD was determined from PSQ results. RESULTS From a total of 288 PSQ Questionnaires, 9.1% of urology, 11.1% of general surgery, and 51.9% of otolaryngology patients admitted to day surgery were found to be at risk for sleep disordered breathing. The median PSQ score for the children at risk was 9.2 for urological surgeries, 10.9 for general surgery, and 11.3 for otolaryngological procedures. CONCLUSIONS There is an increased prevalence of children at risk of SRBD awaiting common day surgery procedures than previously expected based on existing literature. Patients undergoing otolaryngological procedures were at greater risk of sleep-related breathing disorders when compared with patients undergoing urological or general surgical procedures. There may be a role for screening of pediatric patients with a PSQ prior to day-surgery. LEVEL OF EVIDENCE Type of study: prognosis study, level IV.
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Affiliation(s)
- Emma M Holmes
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heena H K Singh
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie G Kirk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary Brindle
- Department of Surgery, Division of Pediatric Surgery, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jeremy Luntley
- Department of Anesthesia, Division of Pediatric Anesthesia, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Bryce A Weber
- Department of Surgery, Divisions of Urology and Pediatric Surgery, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Warren K Yunker
- Department of Surgery, Divisions of Otolaryngology and Pediatric Surgery, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
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50
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Joosten K, de Goederen R, Pijpers A, Allegaert K. Sleep related breathing disorders and indications for polysomnography in preterm infants. Early Hum Dev 2017; 113:114-119. [PMID: 28711234 DOI: 10.1016/j.earlhumdev.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a range of breathing problems which occur and may persist in preterm infants, such as central apneas, obstructive apneas and periodic breathing. Preterm infants may also suffer from respiratory distress syndrome and chronic lung disease necessitating prolonged use of oxygen therapy after discharge from the hospital. Due to these persistent breathing pattern abnormalities in preterm infants, there is a higher risk of altered sleep and apparent life threatening events. Polysomnography can be a helpful tool to identify those infants who have abnormalities in their breathing pattern, to identify those infants who have an increased risk to get a sleep related breathing event at home and to decide about the discontinuation of oxygen therapy.
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Affiliation(s)
- Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Pediatric Intensive Care, Rotterdam, The Netherlands.
| | - Robbin de Goederen
- Dutch Craniofacial Center, Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Pijpers
- Kempenhaeghe Academic Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands
| | - Karel Allegaert
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia, Rotterdam, The Netherlands; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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