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Vennard H, Buchan E, Davies P, Gibson N, Lowe D, Langley R. Paediatric sleep diagnostics in the 21st century: the era of "sleep-omics"? Eur Respir Rev 2024; 33:240041. [PMID: 38925792 PMCID: PMC11216690 DOI: 10.1183/16000617.0041-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
Paediatric sleep diagnostics is performed using complex multichannel tests in specialised centres, limiting access and availability and resulting in delayed diagnosis and management. Such investigations are often challenging due to patient size (prematurity), tolerability, and compliance with "gold standard" equipment. Children with sensory/behavioural issues, at increased risk of sleep disordered breathing (SDB), often find standard diagnostic equipment difficult.SDB can have implications for a child both in terms of physical health and neurocognitive development. Potential sequelae of untreated SDB includes failure to thrive, cardiopulmonary disease, impaired learning and behavioural issues. Prompt and accurate diagnosis of SDB is important to facilitate early intervention and improve outcomes.The current gold-standard diagnostic test for SDB is polysomnography (PSG), which is expensive, requiring the interpretation of a highly specialised physiologist. PSG is not feasible in low-income countries or outwith specialist sleep centres. During the coronavirus disease 2019 pandemic, efforts were made to improve remote monitoring and diagnostics in paediatric sleep medicine, resulting in a paradigm shift in SDB technology with a focus on automated diagnosis harnessing artificial intelligence (AI). AI enables interrogation of large datasets, setting the scene for an era of "sleep-omics", characterising the endotypic and phenotypic bedrock of SDB by drawing on genetic, lifestyle and demographic information. The National Institute for Health and Care Excellence recently announced a programme for the development of automated home-testing devices for SDB. Scorer-independent scalable diagnostic approaches for paediatric SDB have potential to improve diagnostic accuracy, accessibility and patient tolerability; reduce health inequalities; and yield downstream economic and environmental benefits.
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Affiliation(s)
- Hannah Vennard
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Elise Buchan
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Philip Davies
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Neil Gibson
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - David Lowe
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ross Langley
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
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Nakajima S, Kaneko Y, Fujii N, Kizuki J, Saitoh K, Nagao K, Kawamura A, Yoshiike T, Kadotani H, Yamada N, Uchiyama M, Kuriyama K, Suzuki M. Transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders. Front Psychiatry 2023; 14:1114945. [PMID: 37168089 PMCID: PMC10165079 DOI: 10.3389/fpsyt.2023.1114945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
In psychiatric disorders, comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. Previous studies have found a close relationship between insomnia and depressive symptoms in major depressive disorder (MDD), and that actively improving insomnia heightens the improvement of depressive symptoms. This study aimed to investigate whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders besides MDD. The subjects were 144 patients with MDD (n = 71), schizophrenia (n = 25), bipolar disorder (n = 22), or anxiety disorders (n = 26). Sleep status was assessed subjectively and objectively using the Athens Insomnia Scale (AIS) and sleep electroencephalography (EEG), respectively. Sleep EEG was performed using a portable EEG device. Depressive symptoms were assessed using the Beck Depression Inventory. Subjective insomnia, as defined by the AIS, was associated with depressive symptoms in all disorders. Moreover, in schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Our findings suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders. Further studies are needed to clarify whether therapeutic interventions for comorbid insomnia can improve depressive symptoms in major psychiatric disorders, similar to MDD.
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Affiliation(s)
- Suguru Nakajima
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Nobukuni Fujii
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Kizuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Kaori Saitoh
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Aoi Kawamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | | | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
- Tokyo Adachi Hospital, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
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Abstract
This article describes the changes in normal sleep regulation, structure, and organization and sleep-related changes in respiration from infancy to adolescence. The first 2 years of age are striking, with more time asleep than awake. With development, the electroencephalogram architecture has a marked reduction in rapid eye movement sleep and the acquisition of K-complexes, sleep spindles, and slow-wave sleep. During adolescence there is a reduction in slow-wave sleep and a delay in the circadian phase. Infants have a more collapsible upper airway and lower lung volumes than older children, which predisposes them to obstructive sleep apnea and sleep-related hypoxemia.
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Morris AC, Telesia L, Wickersham A, Epstein S, Matcham F, Sonuga-Barke E, Downs J. Examining the acceptability of actigraphic devices in children using qualitative and quantitative approaches: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e070597. [PMID: 36858478 PMCID: PMC9980313 DOI: 10.1136/bmjopen-2022-070597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Actigraphy is commonly used to record free living physical activity in both typically and atypically developing children. While the accuracy and reliability of actigraphy have been explored extensively, research regarding young people's opinion towards these devices is scarce. This review aims to identify and synthesise evidence relating to the acceptability of actigraphic devices in 5-11 year olds. METHODS AND ANALYSIS Database searches will be applied to Embase, MEDLINE, PsychInfo and Social Policy and Practice through the OVID interface; and Education Resources Information Center (ERIC), British Education Index and CINAHL through the EBSCO interface from January 2018 until February 2023. Supplementary forward and backward citation and grey literature database searches, including Healthcare Management Information Consortium (HMIC) and PsycEXTRA will be conducted. Qualitative and quantitative studies, excluding review articles and meta-analyses, will be eligible, without date restrictions. Article screening and data extraction will be undertaken by two review authors and disagreements will be deferred to a third reviewer. The primary outcome, actigraphic acceptability, will derive from the narrative synthesis of the main themes identified from included qualitative literature and pooled descriptive statistics relating to acceptability identified from quantitative literature. Subgroup analyses will determine if acceptability changes as a function of the key participant and actigraphic device factors. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review as it uses data from previously published literature. The results will be presented in a manuscript and published in a peer review journal and will be considered alongside a separate stream of codesign research to inform the development of a novel child-worn actigraphic device. PROSPERO REGISTRATION NUMBER CRD42021232466.
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Affiliation(s)
- Anna Charlotte Morris
- CAMHS Digital Lab, Dept of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK, London, UK
| | - Laurence Telesia
- CAMHS Digital Lab, Dept of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK, London, UK
| | - Alice Wickersham
- CAMHS Digital Lab, Dept of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK, London, UK
| | - Sophie Epstein
- CAMHS Digital Lab, Dept of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Brighton, Brighton and Hove, UK
| | - Edmund Sonuga-Barke
- Dept of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- CAMHS Digital Lab, Dept of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK, London, UK
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Night-to-night variability in respiratory sleep parameters to diagnose obstructive sleep apnea in children: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2022; 162:111285. [PMID: 36067710 DOI: 10.1016/j.ijporl.2022.111285] [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: 02/15/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This systematic review aims to assess the night-to-night variability (NtNV) in respiratory sleep parameters in children and the accuracy of diagnosing obstructive sleep apnea (OSA) in children based on a single-night sleep study. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched until March 8, 2021. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021239838). RESULTS Our study included 395 patients from 5 articles. The mean (SD) age of all included patients was 11.78 (4.05) years. AHI was reported for 325 participants in 4 studies, and the mean change between two consecutive nights was -0.13 [95% CI: -0.40, 0.14] events per hour. The mean change in OAI was -0.07 [95% CI: -0.27, 0.12] events per hour in 187 participants across 3 studies. Based on the diagnostic criteria used, three studies reported that the diagnostic rates of OSA patients in a single-night sleep study were 83%, 84.6%, and 91%. The NtNV in AHI in children with severe and moderate OSA was greater than that in children with mild OSA (3.35 [95% CI: 0.07, 6.62] events per hour vs -0.15 [95% CI: -0.42, 0.12] events per hour), and these children with more severe OSA may have shown a higher AHI on the first night. CONCLUSIONS The NtNV in AHI was not statistically significant in the group sample of children. However, there were significant differences in NtNV in AHI between children with mild and moderate-to-severe OSA. Individual NtNV in respiratory sleep parameters may cause children to be misdiagnosed by single-night diagnostic sleep studies.
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Giurgiu M, Kolb S, Nigg C, Burchartz A, Timm I, Becker M, Rulf E, Doster AK, Koch E, Bussmann JBJ, Nigg C, Ebner-Priemer UW, Woll A. Assessment of 24-hour physical behaviour in children and adolescents via wearables: a systematic review of free-living validation studies. BMJ Open Sport Exerc Med 2022; 8:e001267. [PMID: 35646389 PMCID: PMC9109110 DOI: 10.1136/bmjsem-2021-001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Studies that assess all three dimensions of the integrative 24-hour physical behaviour (PB) construct, namely, intensity, posture/activity type and biological state, are on the rise. However, reviews on validation studies that cover intensity, posture/activity type and biological state assessed via wearables are missing. Design Systematic review. The risk of bias was evaluated by using the QUADAS-2 tool with nine signalling questions separated into four domains (ie, patient selection/study design, index measure, criterion measure, flow and time). Data sources Peer-reviewed validation studies from electronic databases as well as backward and forward citation searches (1970–July 2021). Eligibility criteria for selecting studies Wearable validation studies with children and adolescents (age <18 years). Required indicators: (1) study protocol must include real-life conditions; (2) validated device outcome must belong to one dimension of the 24-hour PB construct; (3) the study protocol must include a criterion measure; (4) study results must be published in peer-reviewed English language journals. Results Out of 13 285 unique search results, 76 articles with 51 different wearables were included and reviewed. Most studies (68.4%) validated an intensity measure outcome such as energy expenditure, but only 15.9% of studies validated biological state outcomes, while 15.8% of studies validated posture/activity type outcomes. We identified six wearables that had been used to validate outcomes from two different dimensions and only two wearables (ie, ActiGraph GT1M and ActiGraph GT3X+) that validated outcomes from all three dimensions. The percentage of studies meeting a given quality criterion ranged from 44.7% to 92.1%. Only 18 studies were classified as ‘low risk’ or ‘some concerns’. Summary Validation studies on biological state and posture/activity outcomes are rare in children and adolescents. Most studies did not meet published quality principles. Standardised protocols embedded in a validation framework are needed. PROSPERO registration number CRD42021230894.
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Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Simon Kolb
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Carina Nigg
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Sport Pedagogy, University of Bern, Bern, Switzerland
| | - Alexander Burchartz
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marlissa Becker
- Department of Orthopedics, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen Rulf
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ann-Kathrin Doster
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Elena Koch
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claudio Nigg
- Department of Health Science, University of Bern, Bern, Switzerland
| | - Ulrich W Ebner-Priemer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Department of Sports and Sports Science, Institute of Sports and Sports Science, Karlsruhe, Germany
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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7
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Examining First Night Effect on Sleep Parameters with hd-EEG in Healthy Individuals. Brain Sci 2022; 12:brainsci12020233. [PMID: 35203996 PMCID: PMC8870064 DOI: 10.3390/brainsci12020233] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/04/2022] Open
Abstract
Difficulty sleeping in a novel environment is a common phenomenon that is often described as the first night effect (FNE). Previous works have found FNE on sleep architecture and sleep power spectra parameters, especially during non-rapid eye movement (NREM) sleep. However, the impact of FNE on sleep parameters, including local differences in electroencephalographic (EEG) activity across nights, has not been systematically assessed. Here, we performed high-density EEG sleep recordings on 27 healthy individuals on two nights and examined differences in sleep architecture, NREM (stages 2 and 3) EEG power spectra, and NREM power topography across nights. We found higher wakefulness after sleep onset (WASO), reduced sleep efficiency, and less deep NREM sleep (stage 3), along with increased high-frequency NREM EEG power during the first night of sleep, corresponding to small to medium effect sizes (Cohen’s d ≤ 0.5). Furthermore, study individuals showed significantly lower slow-wave activity in right frontal/prefrontal regions as well as higher sigma and beta activities in medial and left frontal/prefrontal areas, yielding medium to large effect sizes (Cohen’s d ≥ 0.5). Altogether, these findings suggest the FNE is characterized by less efficient, more fragmented, shallower sleep that tends to affect especially certain brain regions. The magnitude and specificity of these effects should be considered when designing sleep studies aiming to compare across night effects.
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8
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Huang YC, Huang SH, Chung RJ, Wang BL, Chung CH, Chien WC, Sun CA, Yu PC, Lu CH. Obese Patients Experience More Severe CSA than Non-Obese Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031289. [PMID: 35162313 PMCID: PMC8835470 DOI: 10.3390/ijerph19031289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Objective: To investigate whether central sleep apnea (CSA) is associated with an increased risk of obesity. Materials and methods: From 1 January 2000 to 31 December 2015, we screened 24,363 obese patients from the 2005 longitudinal health insurance database, which is part of the Taiwan National Health Insurance Research Database. From the same database, 97,452 non-obese patients were also screened out. Age, gender, and index dates were matched. Multiple logistic regression was used to analyze the previous exposure risk of obese and CSA patients. A p-value of <0.05 was considered significant. Results: Obese patients were more likely to be exposed to CSA than non-obese patients would (AOR = 2.234, 95% CI = 1.483–4.380, p < 0.001). In addition, the closeness of the exposure time to the index time is positively correlated with the severity of obesity and has a dose–response effect (CSA exposure < 1 year, AOR = 2.386; CSA exposure ≥ 1 year and <5 years, AOR = 1.725; CSA exposure time ≥ 5 years, AOR = 1.422). The CSA exposure time of obese patients was 1.693 times that of non-obese patients. Longer exposure time is associated with more severe obesity and has a dose-response effect (CSA exposure < 1 year, AOR = 1.420; CSA exposure ≥ 1 year and <5 years, AOR = 2.240; CSA ≥ 5 years, AOR = 2.863). Conclusions: In this case-control study, patients with CSA had a significantly increased risk of obesity. Long-term exposure to CSA and obesity is more likely and has a dose-response effect.
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Affiliation(s)
- Yao-Ching Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.-C.H.); (S.-H.H.); (R.-J.C.)
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (C.-H.L.)
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Big Data Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Pi-Ching Yu
- Graduate Institute of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
- Cardiovascular Intersive Care Unit, Department of Critical Care Medicine, Far-Eastern Memorial Hospital, New Taipei City 10602, Taiwan
| | - Chieh-Hua Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (C.-H.L.)
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Sinha S, Dhooria S, Sasi A, Tomer A, Thejeswar N, Kumar S, Gupta G, Pandey RM, Behera D, Mohan A, Sharma S. A study on the effect of mobile phone use on sleep. Indian J Med Res 2022; 155:380-386. [DOI: 10.4103/ijmr.ijmr_2221_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Sleep plays a critical role in the development of healthy children. Detecting sleep and sleep disorders and the effectiveness of interventions for improving sleep in children require valid sleep measures. Assessment of sleep in children, in particular infants and young children, can be a quite challenging task. Many subjective and objective methods are available to evaluate various aspects of sleep in childhood, each with their strengths and limitations. None can, however, replace the importance of thorough clinical interview with detailed history and clinical examination by a sleep specialist.
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Affiliation(s)
- Barbara Gnidovec Stražišar
- Pediatric Department, Centre for Pediatric Sleep Disorders, General Hospital Celje, Oblakova ulica 5, Celje 3000, Slovenia; College of Nursing in Celje, Celje, Slovenia; Medical Faculty, University of Maribor, Maribor, Slovenia.
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11
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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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12
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Shiraishi Y, Tachibana M, Shirota A, Mohri I, Taniike M, Yamashiro T, Kato T. Relationships between cortical, cardiac, and arousal-motor activities in the genesis of rhythmic masticatory muscle activity across sleep cycles in primary sleep bruxism children. Sleep 2021; 44:6310842. [PMID: 34181734 DOI: 10.1093/sleep/zsab156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES The present study aimed to clarify the physiological relationships between rhythmic masticatory muscle activity (RMMA) and cyclic changes in cortical, autonomic, and arousal-motor activities during sleep in sleep bruxism (SB) children. METHODS Polysomnographic recordings were performed on fifteen SB children (9 boys, 6 girls, 10.3 ± 2.5 years) and eighteen control children (5 boys, 13 girls, 10.7 ± 3.1 years) free from sleep and developmental disorders. Sleep and RMMA were scored by the standard rules. Sleep cycle was divided into NREM and REM sleep segments and the frequency of RMMA, transient arousal and movement, and cortical and cardiac activities were then quantitatively analyzed in relation to sleep cycles. RESULTS Neither sleep architecture nor sleep stage distribution of RMMA significantly differed between two groups. In sleep cycles, SB children showed more frequent RMMA in all segments than controls, while cyclic changes in cortical and autonomic activities did not significantly differ between two groups. In SB children, RMMA was the most frequent in the last NREM segment before REM sleep and was associated with increases in cortical beta activity and arousal; more than 70% of RMMA time-dependently occurred with cortical and motor arousals. CONCLUSIONS This is the first study to suggest that the potentiation of RMMA occurrence was associated with transient arousal under cyclic sleep processes in primary SB children.
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Affiliation(s)
- Yuki Shiraishi
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.,Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Masaya Tachibana
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
| | - Ai Shirota
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Ikuko Mohri
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
| | - Masako Taniike
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
| | - Takashi Yamashiro
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.,United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan.,Osaka University Hospital, Sleep Medicine Center, Suita, Osaka, Japan
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13
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Villalobos-Aguirre MC, Restrepo-Gualteros SM, Peña-Valenzuela A, Sossa-Briceño MP, Rodriguez-Martinez CE. Validation of a Spanish version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in children living in a high-altitude city. Pediatr Pulmonol 2021; 56:1077-1084. [PMID: 33373497 DOI: 10.1002/ppul.25231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to validate a Spanish version of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (SRBD-PSQ) in children living in a high-altitude Colombian city. METHODS In a prospective cohort validation study, patients aged between 2 and 17 years who attended the Ear, Nose, and Throat pediatric department of our institution for symptoms related to sleep-related breathing disorders had a baseline visit at enrollment, a second visit the day scheduled for the surgical intervention, and a follow-up visit at least 3 months after the surgical intervention. In these three visits, we gathered the necessary data for assessing the criterion validity, construct validity, test-retest reliability, internal consistency, and sensitivity to change of the Spanish version of the SRBD-PSQ. RESULTS In total, 121 patients were included in the analyses. The exploratory factor analysis (generalized least squares method, varimax rotation) yielded a four-factor structure, explaining 65.93% of the cumulative variance. The intraclass correlation coefficient (ICC) of the measurements was 0.887 (95% CI: 0.809-0.934), and the Lin concordance correlation coefficient was 0.882 (95% CI, 0.821-0.943). SRBD-PSQ scores at baseline were significantly higher than those obtained after adenotonsillectomy surgery (median [IQR] 11.0 [9.0- 14.0] vs. 4.00 [1.50-7.0]; p < 0.0001). Cronbach's α was 0.7055 for the questionnaire as a whole. CONCLUSIONS The Spanish version of the SRBD-PSQ has acceptable construct validity, excellent test-retest reliability and sensitivity to change, and adequate internal consistency-reliability when used in pediatric patients living at high altitude with symptoms related to sleep-related breathing disorders.
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Affiliation(s)
| | - Sonia M Restrepo-Gualteros
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology, Fundacion Hospital de La Misericordia, Bogota, Colombia
| | - Alberto Peña-Valenzuela
- Ear, Nose and Throat Department, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
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Galway NC, Maxwell B, Shields M, O'Donoghue D. Use of oximetry to screen for paediatric obstructive sleep apnoea: is one night enough and is 6 hours too much? Arch Dis Child 2021; 106:58-61. [PMID: 32788202 DOI: 10.1136/archdischild-2019-318559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/14/2020] [Accepted: 06/17/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Nocturnal pulse oximetry can be used to screen for obstructive sleep apnoea (OSA) using the McGill Oximetry Score (MOS). The MOS has a time threshold for a technically adequate study of 6 hours. It has been suggested that one night of oximetry is sufficient to screen for OSA using the MOS. AIMS (1) To evaluate night-to-night variation of the MOS. (2) To determine the impact of recording three nights of oximetry on the screening yield for OSA. (3) To explore whether useful MOS data are discarded when a threshold of 6 hours of oximetry recording is used. METHODS A retrospective study of nocturnal pulse oximetry done at home over three consecutive nights in paediatric patients with suspected OSA. Studies were scored (MOS) using thresholds of ≥6 and ≥4 hours of recording. RESULTS A total of 329 patients were studied. MOS scores over three nights showed only fair to moderate agreement. On the first night 126 patients (38%) screened positive for OSA. When three nights of oximetry were done 195 patients (59%) screened positive on at least one of the nights. There were 48 patients with studies of between 4 and 6 hours duration on one or more nights. If these studies are scored 20 patients (42%) would screen positive for OSA on at least one night based on scoring these studies alone. CONCLUSION One night of oximetry screening may not be sufficient to screen for OSA. Lowering the time threshold to ≥4 hours may increase the screening capability of nocturnal oximetry.
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Affiliation(s)
- Niamh Catherine Galway
- Paediatric Respiratory Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Barbara Maxwell
- Paediatric Respiratory Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Michael Shields
- Paediatric Respiratory Department, Royal Belfast Hospital for Sick Children, Belfast, UK.,Queen's University Belfast Centre for Infection and Immunity, Belfast, UK
| | - Dara O'Donoghue
- Paediatric Respiratory Department, Royal Belfast Hospital for Sick Children, Belfast, UK .,Centre for Medical Education, Queen's University Belfast, Belfast, UK
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16
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Night-to-night variability in respiratory parameters in children and adolescents examined for obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 137:110206. [PMID: 32896337 DOI: 10.1016/j.ijporl.2020.110206] [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: 04/06/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The diagnosis of obstructive sleep apnea (OSA) is routinely based on just a single night's sleep examination. The night-to-night variability in children and adolescents has previously been investigated using type 4 sleep monitors or PSG. However, there is a lack of studies investigating the night-to-night variability when using type 3 sleep monitors. Therefore, the main purpose was to investigate the night-to-night variability in respiratory parameters in children and adolescents using a portable type 3 monitor. Furthermore, the purpose was to investigate the clinical relevance of night-to-night variability. METHODS The study population was recruited from an ongoing research project concerning the effect of weight loss in children and adolescents with OSA and overweight/obesity. The inclusion criterion was the successful recording of two consecutive nights of sleep. Sleep examinations were recorded at home using the Nox T3 device and then blindly scored by the same registered polysomnographic technologist. To compare the respiratory parameters measured each night, a paired t-test or a Wilcoxon signed-rank test was used. The apnea-hypopnea index (AHI) was further described graphically with a scatter plot and a Bland-Altman plot. The presence and severity of OSA were described in tables. RESULTS A total of 30 children and adolescents with a median age of 14.8 years were included. When comparing respiratory parameters between nights, all p-values derived from paired t-tests and Wilcoxon signed-rank tests were >0.05. When considering the graphical depictions of AHI, it was evident that for some participants AHI measurements varied widely from night to night. Regarding the presence of OSA, 27% of participants changed diagnostic category between nights and 40% of those with a normal AHI on the first night had OSA on the second night. Regarding OSA severity, 50% of participants changed severity category between nights. CONCLUSIONS AHI measurements varied widely between nights in some children and adolescents leading to frequent changes in both diagnosis and severity of OSA from night to night. We therefore suggest the presence of a clinically relevant night-to-night variability which should be taken into account when diagnosing pediatric OSA.
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Yuksel D, Baker FC, Goldstone A, Claudatos SA, Forouzanfar M, Prouty DE, Colrain IM, de Zambotti M. Stress, sleep, and autonomic function in healthy adolescent girls and boys: Findings from the NCANDA study. Sleep Health 2020; 7:72-78. [PMID: 32732156 DOI: 10.1016/j.sleh.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Starting in adolescence, female sex is a strong risk factor for the development of insomnia. Reasons for this are unclear but could involve altered stress reactivity and/or autonomic nervous system (ANS) dysregulation, which are strongly associated with the pathophysiology of insomnia. We investigated sex differences in the effect of stress on sleep and ANS activity in adolescents, using the first night in the laboratory as an experimental sleep-related stressor. DESIGN Repeated measures (first night vs. a subsequent night) with age (older/younger) and sex (males/females) as between factors. SETTING Recordings were performed at the human sleep laboratory at SRI International. PARTICIPANTS One hundred six healthy adolescents (Age, mean ± SD: 15.2 ± 2.0 years; 57 boys). MEASURES Polysomnographic sleep, nocturnal heart rate (HR), and frequency-domain spectral ANS HR variability (HRV) indices. RESULTS Boys and girls showed a first-night effect, characterized by lower sleep efficiency, lower %N1 and %N2 sleep, more wake after sleep onset and %N3 sleep, altered sleep microstructure (increased high-frequency sigma and Beta1 electroencephalographic activity), and reduced vagal activity (P < .05) on the first laboratory night compared to a subsequent night. The first night ANS stress effect (increases in HR and suppression in vagal HRV during rapid eye movement sleep) was greater in girls than boys (P < .05). CONCLUSIONS Sleep and ANS activity were altered during the first laboratory night in adolescents, with girls exhibiting greater ANS alterations than boys. Findings suggest that girls may be more vulnerable than boys to sleep-specific stressors, which could contribute to their increased risk for developing stress-related sleep disturbances.
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Affiliation(s)
- Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, California, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Aimee Goldstone
- Center for Health Sciences, SRI International, Menlo Park, California, USA
| | | | | | - Devin E Prouty
- Center for Health Sciences, SRI International, Menlo Park, California, USA
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, California, USA; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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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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Mazza S, Bastuji H, Rey AE. Objective and Subjective Assessments of Sleep in Children: Comparison of Actigraphy, Sleep Diary Completed by Children and Parents' Estimation. Front Psychiatry 2020; 11:495. [PMID: 32587532 PMCID: PMC7297917 DOI: 10.3389/fpsyt.2020.00495] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Abstract
In research and clinical contexts, parents' report and sleep diary filled in by parents are often used to characterize sleep-wake rhythms in children. The current study aimed to investigate children self-perception of their sleep, by comparing sleep diaries filled in by themselves, actigraphic sleep recordings, and parental subjective estimation. Eighty children aged 8-9 years wore actigraph wristwatches and completed sleep diaries for 7 days, while their parents completed a sleep-schedule questionnaire about their child' sleep. The level of agreement and correlation between sleep parameters derived from these three methods were measured. Sleep parameters were considered for the whole week and school days and weekends separately and a comparison between children with high and low sleep efficiency was carried out. Compared to actigraphy, children overestimated their sleep duration by 92 min and demonstrated significant difficulty to assess the amount of time they spent awake during the night. The estimations were better in children with high sleep efficiency compared to those with low sleep efficiency. Parents estimated that their children went to bed 36 min earlier and obtained 36.5 min more sleep than objective estimations with actigraphy. Children and parents' accuracy to estimate sleep parameters was different during school days and weekends, supporting the importance of analyzing separately school days and weekends when measuring sleep in children. Actigraphy and sleep diaries showed good agreement for bedtime and wake-up time, but not for SOL and WASO. A satisfactory agreement for TST was observed during school days only, but not during weekends. Even if parents provided more accurate sleep estimation than children, parents' report, and actigraphic data were weakly correlated and levels of agreement were insufficient. These results suggested that sleep diary completed by children provides interesting measures of self-perception, while actigraphy may provide additional information about nocturnal wake times. Sleep diary associated with actigraphy could be an interesting tool to evaluate parameters that could contribute to adjust subjective perception to objective sleep values.
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Affiliation(s)
- Stéphanie Mazza
- HESPER Laboratory, Université Lyon 1, Université de Lyon, Lyon, France
| | - Hélène Bastuji
- Central Integration of Pain, Lyon Neuroscience Research Center, Inserm U1028, Université Lyon 1, Université de Lyon, Lyon, France
- Unité d’Hypnologie, Service de Neurologie Fonctionnelle et d’Épileptologie, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Amandine E. Rey
- Central Integration of Pain, Lyon Neuroscience Research Center, Inserm U1028, Université Lyon 1, Université de Lyon, Lyon, France
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Metin M, Avcu M. An evaluation of the effects of video modelling on the first-night effect in polysomonography examination of patients with obstructive sleep apnea. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00272-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Graef DM, Byars KC. Utility of the Sleep Disorders Inventory for Students in Clinically Referred Youth With Insomnia: Risk Identification and Relationship With Polysomnographic Measures. Behav Sleep Med 2020; 18:249-261. [PMID: 30793972 DOI: 10.1080/15402002.2019.1578770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective/Background: This study evaluated the overall performance of the Sleep Disorders Inventory for Students (SDIS) in identifying sleep disorders risk and the sensitivity and specificity of specific SDIS subscales in a clinically referred sample of youth with insomnia. Participants: Youth (N = 1,329, M = 2.5-18.99 years) with insomnia, of whom 392 underwent clinically indicated diagnostic PSG within ± 6 months of SDIS screening. Methods: Risk identification for sleep disturbance warranting sleep specialist evaluation was determined based on elevation on any SDIS scale for the entire sample. Patients with obstructive sleep apnea (OSA) and periodic limb movement disorder (PMLD) based on PSG were evaluated in relation to SDIS-OSA and SDIS-PLMD subscales (T-scores ≥ 60), with sensitivity, specificity, and receiver operator characteristic curves computed. Results: Clinical elevation correctly identified 74.0% to 83.6% referred to a sleep specialist. Nearly 30% of the subsample undergoing PSG met criteria for OSA and 20.2% had PLMs. The SDIS-OSA subscale demonstrated low to fair sensitivity and specificity. The SDIS-PLMD subscale displayed low sensitivity and low (children) to fair (adolescents) specificity, with the area under the curve suggesting good classification accuracy for adolescents. Conclusions: The SDIS performed well in identifying overall sleep disturbance risk in a large pediatric insomnia sample, suggesting careful examination of all subscales and total score to increase confidence in referral to a sleep specialist. Sensitivity and specificity indices highlight challenges in identifying primary sleep disorder risk and raise potential research questions regarding measurement of parent perceptions in children with insomnia. Additional research in nationally representative samples is warranted.
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Affiliation(s)
- Danielle M Graef
- Division of Behavioral Medicine and Clinical Psychology/Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kelly C Byars
- Division of Behavioral Medicine and Clinical Psychology/Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Kang S, Lee Y, Lim YH, Park HK, Cho SH, Cho SH. Validation of noncontact cardiorespiratory monitoring using impulse-radio ultra-wideband radar against nocturnal polysomnography. Sleep Breath 2019; 24:841-848. [DOI: 10.1007/s11325-019-01908-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
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The association between sleep and dual-task performance in preterm and full-term children: an exploratory study. Sleep Med 2019; 55:100-108. [PMID: 30772694 DOI: 10.1016/j.sleep.2018.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The present study explored associations between sleep and children's dual-task performance using cognitive-motor dual tasks (eg, walking and talking). Previous research with older adults indicated correlations between higher gait variability and unfavorable sleep continuity variables. Based on this research, as a first objective, we investigated similar correlations in a sample of children. Second, we explored correlations between dual-task performance and dimensions of sleep architecture. Third, we tested moderating effects of prematurity on these associations. METHODS In this study, 7-to 12-year-old children were tested in dual-task situations; of those, 39 were formerly preterm, and 59 were full-term born children. They were asked to walk and simultaneously perform different cognitive tasks. Gait was measured using an electronic walkway system. Sleep was measured using in-home sleep-electroencephalography. RESULTS After accounting for age and cognition, regression analyses revealed correlations between a higher number of awakenings after sleep onset and lower dual-task performance; concerning sleep architecture, analyses revealed correlations between a higher amount of rapid-eye-movement (REM) sleep and lower gait variability. Furthermore, associations between a higher amount of slow wave sleep (SWS) and children's higher cognitive performance were found. Moderation analyses indicated no effects of prematurity. CONCLUSIONS Our exploratory study suggests that a more disrupted sleep was related to children's poorer dual-task performance. Our findings support claims that REM sleep seems more related to performance in procedural tasks whereas SWS seems more related to performance in declarative tasks, suggesting that different sleep stages may support the processing of different performance types.
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Dafna E, Tarasiuk A, Zigel Y. Sleep staging using nocturnal sound analysis. Sci Rep 2018; 8:13474. [PMID: 30194402 PMCID: PMC6128888 DOI: 10.1038/s41598-018-31748-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/22/2018] [Indexed: 01/19/2023] Open
Abstract
Sleep staging is essential for evaluating sleep and its disorders. Most sleep studies today incorporate contact sensors that may interfere with natural sleep and may bias results. Moreover, the availability of sleep studies is limited, and many people with sleep disorders remain undiagnosed. Here, we present a pioneering approach for rapid eye movement (REM), non-REM, and wake staging (macro-sleep stages, MSS) estimation based on sleep sounds analysis. Our working hypothesis is that the properties of sleep sounds, such as breathing and movement, within each MSS are different. We recorded audio signals, using non-contact microphones, of 250 patients referred to a polysomnography (PSG) study in a sleep laboratory. We trained an ensemble of one-layer, feedforward neural network classifiers fed by time-series of sleep sounds to produce real-time and offline analyses. The audio-based system was validated and produced an epoch-by-epoch (standard 30-sec segments) agreement with PSG of 87% with Cohen's kappa of 0.7. This study shows the potential of audio signal analysis as a simple, convenient, and reliable MSS estimation without contact sensors.
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Affiliation(s)
- Eliran Dafna
- Department of Biomedical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ariel Tarasiuk
- Sleep-Wake Disorders Unit, Soroka University Medical Center, and Department of Physiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Zigel
- Department of Biomedical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Heart rate variability feature selection in the presence of sleep apnea: An expert system for the characterization and detection of the disorder. Comput Biol Med 2017; 91:47-58. [DOI: 10.1016/j.compbiomed.2017.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022]
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Pamula Y, Nixon GM, Edwards E, Teng A, Verginis N, Davey MJ, Waters K, Suresh S, Twiss J, Tai A. Australasian Sleep Association clinical practice guidelines for performing sleep studies in children. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Yagihara F, Lorenzi-Filho G, Santos-Silva R. Nasal Dilator Strip is an Effective Placebo Intervention for Severe Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:215-221. [PMID: 27707442 DOI: 10.5664/jcsm.6450] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate the effects of nasal dilator strip (NDS) as a placebo intervention compared with continuous positive airway pressure (CPAP) treatment in patients with severe obstructive sleep apnea (OSA). METHODS Patients were treated with both NDS and nasal CPAP. The sequence was randomized and interposed by 15 days of washout. Polysomnography was performed at baseline and on the first night of intervention with NDS and CPAP (titration). The Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and Beck Depression Inventory (BDI) were completed at baseline and at the end of both interventions. A questionnaire on the comfort and satisfaction (0 = no to 10 = total) was completed at the end of each intervention. RESULTS Twenty-six patients with OSA were evaluated (19 male; age 46.3 ± 9.3 y; body mass index 33.2 ± 5.1 kg/m2; ESS 15.8 ± 4.1; apnea-hypopnea index 60.7 ± 25.2). Adherence was high in both NDS (98%) and CPAP interventions (94%; 5.8 ± 1.7 h/night). In contrast to the baseline values, NDS intervention had no significant effect on all polysomnographic parameters, but NDS improved somnolence (ESS 13.0 ± 5.4, p = 0.001) and depressive symptoms (BDI 7.7 ± 6.9, p = 0.005). Reported satisfaction was significantly higher for CPAP than for NDS (sleep quality 9.2 ± 0.8 vs. 6.1 ± 2.1; wake up at morning: 8.6 ± 1.2 vs. 6.0 ± 2.2; daily activities: 8.9 ± 1.4 vs. 5.8 ± 1.5; quality of life: 8.3 ± 2.1 vs. 3.8 ± 3.5, p < 0.001), but similar low levels of difficulty for both interventions were observed (1.3 ± 2.2 vs. 0.3 ± 1.3, p = 0.098). CONCLUSIONS Our data indicate that NDS is an attractive placebo intervention for randomized controlled trials evaluating the effects of CPAP in sleepy patients with OSA.
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Affiliation(s)
- Fabiana Yagihara
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo, Brazil.,Núcleo Interdisciplinar da Ciência do Sono (NICS), São Paulo, Brazil
| | - Rogerio Santos-Silva
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo, Brazil.,Núcleo Interdisciplinar da Ciência do Sono (NICS), São Paulo, Brazil
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Diagnostic du syndrome d’apnée obstructive du sommeil chez l’enfant (2–18 ans) : place de la polysomnographie et de la polygraphie ventilatoire. Arch Pediatr 2017; 24 Suppl 1:S16-S27. [DOI: 10.1016/j.arcped.2016.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/27/2016] [Indexed: 11/21/2022]
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Wang G, Xu Z, Tai J, Li X, Wu Y, Zhang Y, Zhang J, Zheng L, Peng X, Ni X. Normative values of polysomnographic parameters in Chinese children and adolescents: a cross-sectional study. Sleep Med 2016; 27-28:49-53. [DOI: 10.1016/j.sleep.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
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Abstract
OBJECTIVES Evidence of a 'first night effect' has been documented for polysomnography. The possibility of this has not been previously assessed in wrist actigraphy, yet may have important implications for the study design of future sleep research. We sought to examine potential evidence of a 'first night effect' for wrist actigraphy in adolescents across weekdays and weekend nights for multiple sleep outcomes. DESIGN 3-year prospective cohort study (Midlands Adolescent Schools Sleep Education Study). SETTING 8 secondary schools in the Midlands region of the UK. PARTICIPANTS Adolescents (aged 11-13 years at baseline) were recruited to the study and were requested to wear a wrist actigraph for 7 consecutive days/nights at baseline and then annually for 2 years during the second term of the academic year. PRIMARY OUTCOME MEASURES We compared multiple sleep outcomes (total sleep time, wake after sleep onset, sleep efficiency, sleep onset latency, number of awakenings, length of awakenings, sleep onset time) when the device was worn on a weekday and weekend and compared these to other nights to identify possible evidence of a 'first night effect' for wrist actigraphy. RESULTS No significant differences were found between any sleep outcomes when the first night of wrist actigraphy was on a weekday compared with other weekdays. When the first night was measured on a weekend (Friday), average total sleep time was significantly greater (486±5 min) compared with the second night (Saturday; 469±6 min), p=0.01. CONCLUSIONS We found no evidence to support a 'first night effect' for wrist actigraphy in our adolescent sample. The first night of actigraphy data should not be disregarded in future studies that deploy this technique to measure sleep over prolonged time periods.
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Affiliation(s)
- Teresa Arora
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine in New York USA, Doha, Qatar
| | - Omar M Omar
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine in New York USA, Doha, Qatar
| | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine in New York USA, Doha, Qatar
- Department of Medicine, King's College London, London, UK
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Jacola LM, Conklin HM, Scoggins MA, Ashford JM, Merchant TE, Mandrell BN, Ogg RJ, Curtis E, Wise MS, Indelicato DJ, Crabtree VM. Investigating the Role of Hypothalamic Tumor Involvement in Sleep and Cognitive Outcomes Among Children Treated for Craniopharyngioma. J Pediatr Psychol 2016; 41:610-22. [PMID: 27189690 PMCID: PMC4913761 DOI: 10.1093/jpepsy/jsw026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Despite excellent survival prognosis, children treated for craniopharyngioma experience significant morbidity. We examined the role of hypothalamic involvement (HI) in excessive daytime sleepiness (EDS) and attention regulation in children enrolled on a Phase II trial of limited surgery and proton therapy. METHODS Participants completed a sleep evaluation (N = 62) and a continuous performance test (CPT) during functional magnetic resonance imaging (fMRI; n = 29) prior to proton therapy. RESULTS EDS was identified in 76% of the patients and was significantly related to increased HI extent (p = .04). There was no relationship between CPT performance during fMRI and HI or EDS. Visual examination of group composite fMRI images revealed greater spatial extent of activation in frontal cortical regions in patients with EDS, consistent with a compensatory activation hypothesis. CONCLUSION Routine screening for sleep problems during therapy is indicated for children with craniopharyngioma, to optimize the timing of interventions and reduce long-term morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | - Elizabeth Curtis
- Indiana University School of Medicine, Indiana University-Purdue University
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Mjid M, Ouahchi Y, Toujani S, Snen H, Ben Salah N, Ben Hmida A, Louzir B, Mhiri N, Cherif J, Beji M. [Night-to-night variability of the obstructive sleep apnoea-hypopnoea syndrome]. Rev Mal Respir 2016; 33:775-780. [PMID: 27179365 DOI: 10.1016/j.rmr.2016.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/25/2016] [Indexed: 11/19/2022]
Abstract
The apnoea-hypopnoea index (AHI) is the primary measurement used to characterize the obstructive sleep apnoea-hypopnoea syndrome (OSAHS). Despite its popularity, there are limiting factors to its application such as night-to-night variability. AIM To evaluate the variability of AHI in the OSAHS. PATIENTS AND METHODS A prospective study was designed in our university hospital's sleep unit. Adults with clinical suspicion of OSAHS underwent 2 consecutive nights of polysomnographic recording. The population was divided in two groups according to an AHI>or<10. Patients with psychiatric disorders or professions that might result in sleep deprivation or an altered sleep/wake cycle were excluded. RESULTS Twenty patients were enrolled. The mean age was 50.6±9.3 years. OSAHS was mild in 4 cases, moderate in 6 cases and severe in 8 cases. AHI was less than 5 in two cases. AHI values were not significantly altered throughout both recording nights (33.2 vs. 31.8 events/h). A significant positive correlation was found between AHI measured on the first and the second night. However, a significant individual variability was noted. Comparison between both patient's groups showed a correlation between AHI and the body mass index. CONCLUSION This study demonstrates that the AHI in OSAHS patients is well correlated between two consecutive nights. However, a significant individual variability should be taken into consideration, especially when AHI is used in the classification of OSAHS or as a criterion of therapeutic success.
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Affiliation(s)
- M Mjid
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie.
| | - Y Ouahchi
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie
| | - S Toujani
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie
| | - H Snen
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie
| | - N Ben Salah
- Service de pneumologie, hôpital Mongi Slim, faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - A Ben Hmida
- Service de médecine préventive, faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - B Louzir
- Service de pneumologie, hôpital Mongi Slim, faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - N Mhiri
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie
| | - J Cherif
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie
| | - M Beji
- Unité de recherche 12SP06, service de pneumologie, hôpital La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie
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Silva AM, Descalço A, Salgueiro M, Pereira L, Barreto C, Bandeira T, Ferreira R. Respiratory sleep disturbance in children and adolescents with cystic fibrosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:202-8. [PMID: 27052354 DOI: 10.1016/j.rppnen.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/22/2015] [Accepted: 02/06/2016] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED Sleep disturbance has been described in cystic fibrosis (CF) patients as relevant to clinical and lung function predictive factors helping to improve the diagnosis and early intervention. Related paediatric studies are scarce. OBJECTIVE To describe respiratory sleep disturbance (RSD) and its association with spirometric indices in a population of CF children. A second aim was to determine if spirometric indices and wake-time SpO2 are predictors of sleep disturbance. METHODS A cross-sectional study involving 33CF paediatric patients. All participants underwent in-lab polysomnography (PSG), pulse oximetry and spirometry. A standardized sleep questionnaire was completed for each patient. Two subgroups were considered: I - Normal (FEV1>-1.64 z-score); II - Obstructed (FEV1≤-1.64 z-score). RESULTS Participant's median age was 12 (6-18) years, 16 (48.5%) were male. Twenty-nine patients (87.9%) presented sleep complaints. Sleep efficiency was reduced; sleep latency and waking after sleep onset (WASO) increased. N1 increased, N2, N3, REM and awakenings were normal. The apnoea-hypopnoea index was 0.6/h (sd 0.9); respiratory disturbance index (RDI) was 6.6/h (sd 5.2). Mean awaking (97% (sd 1.1)) and sleep SpO2 (95% (sd 2.7)) were normal; mean nocturnal oximetry desaturation index was 2.36/h; minimal nocturnal SpO2 was 89% (sd 4.1). We found associations between mean nocturnal SPO2 and mean values of FEV1 (r=0.528; p=0.002) and FEF25-75 (r=0.426; p=0.013). There were significant differences in nocturnal SpO2 between normal and obstructed patients (p<0.000). PSG data correlated with the questionnaire answers for night awakenings and WASO (p=0.985) and difficult breathing during sleep and RDI (p=0.722). This study points to most CF children having sleep complaints, and highlights the correlation between subjective assessment of sleep and PSG and spirometric results. Awake-time SpO2 and spirometric values are possible risk predictors for nocturnal desaturation.
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Affiliation(s)
- A M Silva
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - A Descalço
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - M Salgueiro
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - L Pereira
- Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - C Barreto
- Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - T Bandeira
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal; Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
| | - R Ferreira
- Pediatric Lung Function and Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal; Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Center, Portugal.
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Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea. BIOMED RESEARCH INTERNATIONAL 2015; 2015:915185. [PMID: 26636102 PMCID: PMC4618120 DOI: 10.1155/2015/915185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/06/2015] [Accepted: 08/09/2015] [Indexed: 11/18/2022]
Abstract
Rationale. The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. Objectives. To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. Methods. Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. Measurements and Main Results. The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81–1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82–0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76–0.92) for severe OSA (AHI ≥ 30). Conclusions. The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.
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Yamakita M, Sato M, Ando D, Suzuki K, Yamagata Z. Availability of a simple self-report sleep questionnaire for 9- to 12-year-old children. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mitsuya Yamakita
- Faculty of Nursing; Yamanashi Prefectural University; Kofu Yamanashi Japan
- Department of Health Sciences; University of Yamanashi; Chuo Yamanashi Japan
| | - Miri Sato
- Center for Birth Cohort Studies; Interdisciplinary Graduate School of Medicine and Engineering; University of Yamanashi; Chuo Yamanashi Japan
| | - Daisuke Ando
- Department of Physical Education; National Defense Academy; Yokosuka Kanagawa Japan
| | - Kohta Suzuki
- Department of Health Sciences; University of Yamanashi; Chuo Yamanashi Japan
| | - Zentaro Yamagata
- Department of Health Sciences; University of Yamanashi; Chuo Yamanashi Japan
- Center for Birth Cohort Studies; Interdisciplinary Graduate School of Medicine and Engineering; University of Yamanashi; Chuo Yamanashi Japan
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Nevéus T, Leissner L, Rudblad S, Bazargani F. Respiration during sleep in children with therapy-resistant enuresis. Acta Paediatr 2014; 103:300-4. [PMID: 24236639 DOI: 10.1111/apa.12515] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Abstract
AIM Although there is a known association between enuresis and snoring or sleep apnoeas, respiration during sleep has not been thoroughly studied in enuretic children. This study was performed with the aim of filling this gap in our knowledge. METHODS Thirty-four children with therapy-resistant enuresis, but no history of heavy snoring or sleep apnoeas, underwent sleep registrations, including standard electroencephalography (EEG) and electrooculography (EOG) as well as registration of oxygen saturation, respiratory effort and nasal air flow. To assess nasal airway patency, rhinomanometry and acoustic rhinometry were performed before and after nasal decongestion. RESULTS The children were found to have a higher than expected apnoea hypopnoea index (AHI), due to a high frequency of hypopnoeas. They were also noted to have a tendency for respiratory arousals. Standard polysomnographic variables were normal. CONCLUSION We provide baseline data of nocturnal respiration in enuretic children. The children were found to have subclinical signs of disordered respiration. This may be one of the explanations for their high arousal thresholds.
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Affiliation(s)
- Tryggve Nevéus
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Lena Leissner
- Department of Neurology; University Hospital Örebro; Örebro Sweden
| | - Stig Rudblad
- Department of Otorhinolaryngology; University Hospital Örebro; Örebro Sweden
| | - Farhan Bazargani
- Department of Orthodontics; Postgraduate Dental Education Center; Örebro Sweden
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Abstract
Sleep problems are common in attention-deficit/hyperactivity disorder (ADHD) to the extent that they mimic or exacerbate daytime symptoms expression. In this review, we advocate the need for a better understanding of sleep alterations in youths with ADHD and their impact on neurobehavioral functions including learning, memory and emotional regulation. An in-depth exploration of existing data showed that although extensively studied, the actual nature of sleep problems in ADHD and their effects on daytime behavior are still less well understood. Important issues, among which developmental changes in sleep architecture and role of subtle sleep electroencephalogram signatures, are generally neglected. Future research of sleep effects on behavior in ADHD would benefit from considering developmental aspects and links between brain activation patterns during sleep and wake.
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Affiliation(s)
- Roumen Kirov
- Institute of Neurobiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. 23, 1113 Sofua, Bulgaria
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Jobert M, Wilson FJ, Roth T, Ruigt GSF, Anderer P, Drinkenburg WHIM, Bes FW, Brunovsky M, Danker-Hopfe H, Freeman J, van Gerven JMA, Gruber G, Kemp B, Klösch G, Ma J, Penzel T, Peterson BT, Schulz H, Staner L, Saletu B, Svetnik V. Guidelines for the recording and evaluation of pharmaco-sleep studies in man: the International Pharmaco-EEG Society (IPEG). Neuropsychobiology 2014; 67:127-67. [PMID: 23548759 DOI: 10.1159/000343449] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/26/2012] [Indexed: 01/19/2023]
Abstract
The International Pharmaco-EEG Society (IPEG) presents guidelines summarising the requirements for the recording and computerised evaluation of pharmaco-sleep data in man. Over the past years, technical and data-processing methods have advanced steadily, thus enhancing data quality and expanding the palette of sleep assessment tools that can be used to investigate the activity of drugs on the central nervous system (CNS), determine the time course of effects and pharmacodynamic properties of novel therapeutics, hence enabling the study of the pharmacokinetic/pharmacodynamic relationship, and evaluate the CNS penetration or toxicity of compounds. However, despite the presence of robust guidelines on the scoring of polysomnography -recordings, a review of the literature reveals inconsistent -aspects in the operating procedures from one study to another. While this fact does not invalidate results, the lack of standardisation constitutes a regrettable shortcoming, especially in the context of drug development programmes. The present guidelines are intended to assist investigators, who are using pharmaco-sleep measures in clinical research, in an effort to provide clear and concise recommendations and thereby to standardise methodology and facilitate comparability of data across laboratories.
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Affiliation(s)
- Marc Jobert
- International Pharmaco-EEG Society, Berlin, Germany.
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Jambhekar S, Carroll JL. Diagnosis of pediatric obstructive sleep disordered breathing: beyond the gold standard. Expert Rev Respir Med 2014; 2:791-809. [DOI: 10.1586/17476348.2.6.791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Pavone M, Cutrera R, Verrillo E, Salerno T, Soldini S, Brouillette RT. Night-to-night consistency of at-home nocturnal pulse oximetry testing for obstructive sleep apnea in children. Pediatr Pulmonol 2013; 48:754-60. [PMID: 23533148 DOI: 10.1002/ppul.22685] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 01/18/2023]
Abstract
RATIONALE At-home nocturnal pulse oximetry has a high positive predictive value (PPV) for polysomnographically-diagnosed obstructive sleep apnea (OSA) but no studies have been published testing the night-to-night consistency of at-home nocturnal pulse oximetry for the evaluation of suspected OSA in children. We therefore determined the night-to-night consistency of nocturnal pulse oximetry as a diagnostic test for OSA in children. METHODS We prospectively studied 148 children (96 male) aged 4.9 ± 2.4 (1.2-11.8) years, referred for suspected OSA. To evaluate night-to-night consistency, we compared an oximetry analysis method, the McGill Oximetry Score (MOS), from two consecutive at-home nocturnal pulse oximetry recordings. RESULTS Pulse oximetry metrics were similar on the two nights. The MOS on the two nights showed excellent night-to-night consistency when analyzed as positive for OSA versus inconclusive, 143/148 (Spearman's correlation coefficient = 0.90). A more detailed analysis using four categories (MOS 1, 2, 3, and 4) of OSA severity showed very good night-to-night agreement, 133/148 (Spearman's correlation coefficient = 0.91). Variability was increased in children younger than 4 years of age compared to older children. CONCLUSIONS Night-to-night consistency of nocturnal pulse oximetry as a diagnostic test for OSA showed excellent agreement. Night-to-night consistency of pulse oximetry, as analyzed by the MOS, for diagnosis and severity evaluation further validates this abbreviated testing method for pediatric OSA. Polysomnography (PSG) is required to rule in or rule out OSA in children if a single night oximetry testing is inconclusive.
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Affiliation(s)
- Martino Pavone
- Respiratory Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Piazza S. Onofrio, 00165 Rome, Italy.
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Punjabi NM, Aurora RN, Patil SP. Home sleep testing for obstructive sleep apnea: one night is enough! Chest 2013; 143:291-294. [PMID: 23381307 PMCID: PMC3566993 DOI: 10.1378/chest.12-2699] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Naresh M Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
| | - R Nisha Aurora
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Susheel P Patil
- Department of Medicine, Johns Hopkins University, Baltimore, MD
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Buckley A, Wingert K, Swedo S, Thurm A, Sato S, Appel S, Rodriguez AJ. First night effect analysis in a cohort of young children with autism spectrum disorder. J Clin Sleep Med 2013; 9:67-70. [PMID: 23319907 DOI: 10.5664/jcsm.2344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate for the first night effect (FNE) in a group of young children with autism. DESIGN Analysis of polysomnographic data from a 2-night sleep laboratory study. SETTING Clinical Center of the National Institutes of Health. PATIENTS OR PARTICIPANTS 15 children (aged 2-10 years) with a diagnosis of an ASD. INTERVENTIONS None. MEASUREMENTS AND RESULTS Polysomnographic analysis showed the presence of a FNE for wake after sleep onset minutes, stage 2, and sleep efficiency, but not for REM sleep parameters or TST. CONCLUSIONS In this 2-night polysomnographic analysis of sleep stages in young children with autism, we did not find the expected second night increase in total sleep time or REM sleep percentage or a decrease in REM sleep latency. This lack of an FNE for TST and REM parameters suggests that a single-night polysomnogram may be sufficient to evaluate children with an ASD for TST or REM parameters.
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Affiliation(s)
- Ashura Buckley
- National Institute of Mental Health, Pediatrics and Developmental Neuroscience Branch, Bethesda, MD 20982, USA.
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Attention-deficit/hyperactivity disorder (ADHD) and adaptation night as determinants of sleep patterns in children. Eur Child Adolesc Psychiatry 2012; 21:681-90. [PMID: 22810917 DOI: 10.1007/s00787-012-0308-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
Sleep problems are a prominent feature in children with attention-deficit/hyperactivity disorder (ADHD) but their relationships to sleep structure are not consistent across studies. We aimed at further examining the sleep architecture in children with ADHD, while considering the role of the first-night effect (FNE) as a possible confounder. Twenty unmedicated children with ADHD combined type (8-15 years old; mean 11.24, SD 2.31) and 19 healthy controls, matched for age and gender, underwent polysomnography during an adaptation and a consecutive second night. ADHD and controls displayed a typical FNE without group differences. Independently of testing night, children with ADHD spent more time in sleep and had shortened rapid eye movement (REM) sleep latency and a greater amount of REM sleep relative to controls. However, the increased REM sleep amount in ADHD children was more expressed in the second night when it was also significantly related to scores of inattention and hyperactivity. Our results (1) document similar sleep adaptation processes in children with ADHD and typically developing children, (2) reveal that REM sleep changes in association with ADHD-specific psychopathology may characterize sleep in ADHD children, which is evident only when the FNE is accounted for, (3) indicate that ADHD psychopathology and adaptation night may exert opposite effects on REM sleep in children. These results may prompt the awareness of clinicians about the importance of actual sleep alterations and their precise evaluation in children with ADHD, which could significantly contribute to better diagnostic, treatment and early prevention strategies.
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Mullin JE, Cooper BP, Kirkham FJ, Rosen CL, Strunk RC, DeBaun MR, Redline S, Kemp JS. Stability of polysomnography for one year and longer in children with sickle cell disease. J Clin Sleep Med 2012; 8:535-9. [PMID: 23066365 DOI: 10.5664/jcsm.2150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Serious morbidity may be linked to sleep disordered breathing (SDB) among children with sickle cell disease (SCD). We investigated the stability of polysomnography (PSG) results among children not having acute complications of SCD. METHODS Two PSGs were performed on a subsample of 63 children 4 to 18 years of age from the Sleep and Asthma Cohort Study. All had Hb SS or HbSβ(0) disease. Two PSGs were compared for 45 subjects. Excluded from comparison were 18 children who had begun transfusions or hydroxyurea, had an adenotonsillectomy between the PSGs, or had a pain crisis or the acute chest syndrome within 3 months of the second PSG. Sleep disordered breathing was identified using 2 thresholds for the apnea hypopnea index (AHI): ≥ 2 or ≥ 5 respiratory events per hour. RESULTS Ages were 12.3 yrs ± 4.0, BMI, 18.2 ± 3.2. Interval between PSGs was 581 ± 119 days (19.1 ± 3.9 months). Ten of 45 changed from ≥ 2 events per hour to < 2; 3 of 45 from < 2 to ≥ 2; 7 of 45 had ≥ 2 on both nights. Six of 45 changed from ≥ 5 to < 5, 2 of 45 from < 5 to ≥ 5, and 1 had ≥ 5 on both nights (McNemar χ(2), p = 0.09, and p = 0.29). CONCLUSIONS In the absence of acute SCD complications, overnight PSG usually remains stable or improves over a 12- to 30-month period. Only 6.7% subjects, or fewer, had AHI on a subsequent PSG that would re-classify the child as having SDB not identified in the earlier PSG.
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Affiliation(s)
- Jonathan E Mullin
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Yazdi Z, Sadeghniiat-Haghighi K, Zohal MA, Elmizadeh K. Validity and reliability of the Iranian version of the insomnia severity index. Malays J Med Sci 2012; 19:31-36. [PMID: 23613647 PMCID: PMC3629678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 07/11/2012] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The Insomnia Severity Index (ISI) is a short subjective questionnaire which helps physicians in making decisions about patients suffering from insomnia. The present study was an attempt to test the reliability and validity of the Iranian version of the ISI and to measure the correlation between ISI items and polysomnography results in chronic insomnia patients. METHODS Two groups responded to the Persian translation of four questionnaires; ISI, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and General Health Questionnaire (GHQ). The first group consisted of 135 patients diagnosed with chronic insomnia, and the second group was comprised of 55 normal people. After completing the questionnaires, the insomniac patients underwent standard overnight polysomnography. RESULTS The internal consistency demonstrated by Cronbach's alpha coefficient was above 0.8 for both groups. The Intra-class correlation coefficient was above 0.7 after two weeks for both groups. The correlations between ISI, PSQI, ESS, and GHQ were high. In addition, close correlations were found between scores obtained from the ISI questionnaire items in insomniac patients with corresponding polysomnographic variables. CONCLUSION The Iranian version of the ISI is a reliable and valid instrument. It is a valuable short and first-line questionnaire for insomnia research and clinical work.
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Affiliation(s)
- Zohreh Yazdi
- Qazvin University of Medical Sciences, Qazvin, Iran
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Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714-55. [PMID: 22926176 DOI: 10.1542/peds.2012-1672] [Citation(s) in RCA: 957] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
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Sleep architecture impairment in epileptic children and putative role of anti epileptic drugs. Neurol Sci 2012; 34:57-62. [DOI: 10.1007/s10072-012-0971-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 01/31/2012] [Indexed: 11/24/2022]
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Cheliout-Heraut F, Senny F, Djouadi F, Ouayoun M, Bour F. Obstructive sleep apnoea syndrome: comparison between polysomnography and portable sleep monitoring based on jaw recordings. Neurophysiol Clin 2011; 41:191-8. [PMID: 22078731 DOI: 10.1016/j.neucli.2011.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 09/14/2011] [Accepted: 09/14/2011] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea syndrome (OSAS) constitutes a new major public health problem because of its several pathophysiologic consequences such as cognitive disorders, excessive daytime sleepiness with risks of traffic accidents, cardiovascular implications, and decrease of quality of life. The necessity of a gold-standard polysomnography to ensure an accurate diagnosis implies an expensive, technical and time-consuming examination. Thus, it seems logical to develop new systems so as to diagnose SAS and to make it possible to detect apnoeas/hypopnoeas easily during sleep even at home. AIM OF THE STUDY To assess a novel type-3 portable monitoring (PM) device, the Somnolter, and dedicated automatic analysis of several signals, one of which is the mandibular movement signal. METHOD We studied patients suffering from OSAS. For all the patients, a nocturnal diagnosis polysomnography (PSG) was recorded in hospital settings, based on six EEG channels, two EOG channels, chin EMG channel, EKG, and respiratory parameters. At the same time, the Somnolter PM device recorded the physiological parameters from its own nasal prongs, thoracic belt, pulse oxymeter, body position, and jaw movement sensors. A visual analysis of PSG recordings was made leading to the detection of apnoea/hypopnoea index (AHI-PSG) and an automatic analysis of the Somnolter traces was performed to get automatic apnoea/hypopnoea index (AHI-A). The added value of the mandible movement signals was the particular jaw movements related to arousals, to respiratory efforts and to sleep/wake state. A comparison was made between the automatic and gold AHIs standard and the correlation was calculated between them. RESULTS Ninety patients, aged between 47 and 70 years (mean age: 55.4±8.7) took part in the study. The linear regression and the correlation coefficient between AHI-PSG and AHI-A showed the good reliability of the automatic method. The Bland Altman analysis shows a correlation of 0.95 with a sensitivity of 83.6 and specificity of 81.8. CONCLUSION The dedicated automatic analysis based on mandibular movements presents a good potential for the diagnosis of OSAS. The AHI computed by the automatic method is correlated with the AHI-PSG and the Somnolter could easily be used both in hospital, and in ambulatory settings.
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Affiliation(s)
- F Cheliout-Heraut
- Physiology department, Versailles-Saint-Quentin University, Garches hospital, Garches, France.
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Silva GE, Goodwin JL, Parthasarathy S, Sherrill DL, Vana KD, Drescher AA, Quan SF. Longitudinal association between short sleep, body weight, and emotional and learning problems in Hispanic and Caucasian children. Sleep 2011; 34:1197-205. [PMID: 21886357 PMCID: PMC3157661 DOI: 10.5665/sleep.1238] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To determine the impact of lower amounts of childhood sleep assessed by polysomnogram on development of obesity, being anxious or depressed, or having learning problems 5 years later. DESIGN Prospective cohort. PARTICIPANTS Subjects were 304 community participants from the Tucson Children's Assessment of Sleep Apnea study, aged 6-12 years old at baseline. MEASUREMENTS AND RESULTS Children were classified according to baseline sleep as those who slept ≥ 9 h/night, those who slept > 7.5 to < 9 h/night, and those who slept ≤ 7.5 h/night. Odds of overweight/obese (≥ 85(th) BMI percentile), obese (≥ 95(th) BMI percentile), anxious or depressed, and learning problems at follow-up were assessed according to baseline sleep categories. Children who slept ≤ 7.5 h/night had higher odds of being obese (OR = 3.3, P < 0.05) at follow-up than children who slept ≥ 9 h/night. Borderline significance for overweight/obese (OR = 2.2, P < 0.1), anxious or depressed (OR = 3.3, P < 0.1), and having learning problems (OR = 11.1, P < 0.1) were seen for children who slept ≤ 7.5 h/night as compared to those who slept ≥ 9 h/night. A mean increase in BMI of 1.7 kg/m(2) (P = 0.01) over the 5 years of follow-up was seen for children who slept ≤ 7.5 h/night compared to those who slept ≥ 9 h/night. These relationships did not differ between Hispanic and Caucasian children. CONCLUSIONS Children with reduced amounts of sleep (≤ 7.5 h/night) had an increased risk for higher body weight in early adolescence. Similarly, children who slept ≤ 7.5 h/night had higher risk of being anxious or depressed or having learning problems in early adolescence.
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Affiliation(s)
- Graciela E Silva
- College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ 85004-0698, USA.
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