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Riha RL, Singh A, Hill EA, Evans H, O'Regan D. Sleep-disordered breathing in children and adults with intellectual disability: mind the gap! Thorax 2024:thorax-2023-220032. [PMID: 38937106 DOI: 10.1136/thorax-2023-220032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/08/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND In adults and children with intellectual disability (ID), sleep -disordered breathing (SDB) is thought to be common. However, large epidemiological studies are lacking, and there are few studies on optimal methods of investigation and even fewer randomised, controlled intervention trials of treatment. METHOD Peer-reviewed publications from various databases were examined in line with search terms relevant to ID and SDB spanning the years 200-2024. RESULTS Findings suggest that, due to comorbid conditions, children and adults with ID may experience both an increased risk of SDB, as well as lower frequency of diagnosis. SDB can compromise the emotional, physical and mental health of individuals with ID. Appropriate treatment when tolerated leads to an improvement in health and well-being and several studies emphasized the importance of consistent follow-up of people with ID - something that is not universally occurring during childhood, in the transition to adulthood and during adulthood itself. As the most frequently occurring form of ID worldwide, we use Down syndrome as a specific example of how diagnosing and treating SDB can lead to improved outcomes. CONCLUSIONS This review highlights the importance of identifying SDB in this heterogenous population, recognising the multi-faceted, deleterious consequences of untreated SDB in people with ID, and presents some strategies that can be harnessed to improve diagnosis and management. Until further ID-specific research is available, we urge flexibility in the approach to people with ID and SDB based in guidelines and standard practice developed for the typically developing population.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ankur Singh
- Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Elizabeth A Hill
- School of Applied Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Hazel Evans
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David O'Regan
- Sleep Disorders Centre, Guy's and St Thomas' Hospital NHS Foundation Trust; Faculty of Life and Sciences Medicine, King's College London, London, UK
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Wiechers C, Sowula J, Kreutzer K, Schwarz CE, Weismann C, Krimmel M, Poets CF, Koos B. Prospective cohort study on facial profile changes in infants with Robin sequence and healthy controls. World J Pediatr 2024; 20:581-589. [PMID: 38578561 PMCID: PMC11239728 DOI: 10.1007/s12519-024-00797-z] [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] [Received: 05/23/2023] [Accepted: 01/04/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Various conservative and surgical approaches exist to treat Robin sequence (RS), but their effects on facial profile and mandibular catch-up growth are unclear. A functional treatment concept, used in our centre for 25 years, includes an individualized palatal plate with a velo-pharyngeal extension and intensive feeding training. METHODS We performed a prospective study to objectively describe facial profiles in infants with RS treated with the above concept. Infants with isolated RS were admitted to our tertiary perinatal and national referral centre for craniofacial malformations between May 2018 and Nov 2019. Infants with RS received 3D-photographs during clinically indicated visits. Healthy controls were recruited from Dec 2018 to Sep 2019 and received 3D-photographs every 3 months. The digitally measured jaw index (JI), defined as alveolar overjet (O) x maxillary arch (U)/mandibular arch (L), and the soft tissue reference points A'-point, Nasion', B'-point angle (ANB'), describing the relative position of maxilla to mandible, were evaluated. Linear mixed models were used to examine time trajectories in JI and ANB'. RESULTS A total of 207 3D images, obtained in 19 infants with RS and 32 controls, were analysed. JI and ANB' decreased over time in both groups [for JI - 0.18 (95% CI - 0.25 to - 0.10); for ANB': - 0.40° per month [(95% CI - 0.48 to - 0.32)]] but remained lower in controls [for JI - 2.5 (95% CI - 3.2 to - 1.8); for ANB'-1.7° (95% CI - 2.4 to - 1.0)]. Also, the ANB' model showed a significant effect of the interaction term diagnosis x age. CONCLUSIONS Based on longitudinal 3D images, we describe changes in objective parameters of facial profile in infants with and without RS during the first year of life. Our findings indicate catch-up growth in infants treated for RS. Video Abstract.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
- Center for Cleft Lip, Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Julian Sowula
- Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Karen Kreutzer
- Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
- Center for Cleft Lip, Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Christoph E Schwarz
- Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Christina Weismann
- Center for Cleft Lip, Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
- Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany
| | - Michael Krimmel
- Center for Cleft Lip, Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany.
- Center for Cleft Lip, Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Bernd Koos
- Center for Cleft Lip, Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
- Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany
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Combs D, Edgin J, Hsu CH, Bottrill K, Van Vorce H, Gerken B, Matloff D, La Rue S, Parthasarathy S. The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med 2023; 19:2065-2073. [PMID: 37555595 PMCID: PMC10692944 DOI: 10.5664/jcsm.10764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023]
Abstract
STUDY OBJECTIVES Children with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA). Current OSA treatments have limited effectiveness in this population. We evaluated the effectiveness of atomoxetine and oxybutynin (ato-oxy) to treat OSA in children with Down syndrome. METHODS Children ages 6-7 years old with Down syndrome and OSA participated in a double-blind crossover clinical trial evaluating two dose regimens of ato-oxy. Participants received low-dose ato-oxy (0.5 mg/kg atomoxetine and 5 mg oxybutynin) and high-dose ato-oxy (1.2 mg/kg atomoxetine and 5 mg oxybutynin) for 1 month in random order. The primary study outcome was change in obstructive apnea-hypopnea index. Health-related quality of life as measured by the OSA-18 as well as changes in sleep architecture were secondary outcomes. RESULTS Fifteen participants qualified for randomization and 11 participants had complete data at all points. Baseline obstructive apnea-hypopnea index was 7.4 ± 3.7 (mean ± standard deviation), obstructive apnea-hypopnea index with low-dose ato-oxy was 3.6 ± 3.3 (P = .001 vs baseline), and obstructive apnea-hypopnea index with high-dose ato-oxy was 3.9 ± 2.8 (P = .003 vs baseline). No significant sleep architecture differences were present with ato-oxy. No significant difference in OSA-18 score was present. OSA-18 total score was 51 ± 19 at baseline, 45 ± 17 (P = .09) at the end of 4 weeks of low-dose ato-oxy, and 45 ± 16 (P = .37) at the end of high-dose ato-oxy therapy. The most common adverse effects were irritability and fatigue, and these were generally mild. CONCLUSIONS Ato-oxy is a promising treatment for OSA in children with Down syndrome. CLINICAL TRIAL REGISTRATION Registry: Clinicaltrials.gov; Name: Medications for Obstructive Sleep Apnea In Children With Down Syndrome (MOSAIC); URL: https://clinicaltrials.gov/ct2/show/NCT04115878; Identifier: NCT04115878. CITATION Combs D, Edgin J, Hsu C-H, et al. The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med. 2023;19(12):2065-2073.
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Affiliation(s)
- Daniel Combs
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kenneth Bottrill
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Hailey Van Vorce
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Blake Gerken
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Daniel Matloff
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Sicily La Rue
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Sairam Parthasarathy
- UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson, Arizona
- Department of Medicine, University of Arizona, Tucson, Arizona
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Santos RA, Costa LH, Linhares RC, Pradella-Hallinan M, Coelho FMS, Oliveira GDP. Sleep disorders in Down syndrome: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:424-443. [PMID: 35293557 DOI: 10.1590/0004-282x-anp-2021-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep disorders are commonly observed in children with Down syndrome (DS) and can lead to significant behavioral and cognitive morbidities in these individuals. OBJECTIVE To perform a systematic review evaluating sleep disorders in individuals with DS. METHODS Search strategies were based on combinations of keywords: "Down syndrome"; "trisomy 21"; "sleep disorders"; "dyssomnias"; "sleep apnea"; "obstructive"; "sleeplessness"; "insomnia"; "parasomnias"; and "excessive daytime sleepiness". PubMed and Science Direct were used. Only original studies and retrospective reviews in English published between January 2011 and March 2021 were included. RESULTS 52 articles were included, most of them involving children and adolescents under 18 years of age. The main sleep disorder associated with DS was obstructive sleep apnea (OSA). Some studies reported the presence of cognitive dysfunction in patients with DS and sleep-disordered breathing, and few have been found about parasomnia, insomnia, and daytime sleepiness in these patients. Movement disorders and unusual postures during sleep may be related to disordered sleep breathing in DS. The main treatment options for OSA are continuous positive airway pressure therapy (CPAP), surgery, and weight control. Computational modeling associated with MRI has been used to plan surgical interventions in these patients. CONCLUSIONS Individuals with DS are at high risk of developing sleep-related breathing disorders. The main sleep disorder associated with DS was OSA. The presence of sleep-disordered breathing contributes to a worsening of cognitive function in patients with DS.
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Affiliation(s)
| | | | - Rebeca Coêlho Linhares
- Faculdade de Ciências Humanas, Exatas e de Saúde do Piauí, Instituto de Educação Superior do Vale do Parnaíba, Parnaíba PI, Brazil
| | | | - Fernando Morgadinho Santos Coelho
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Giuliano da Paz Oliveira
- Universidade Federal Delta do Parnaíba, Parnaíba PI, Brazil.,Faculdade de Ciências Humanas, Exatas e de Saúde do Piauí, Instituto de Educação Superior do Vale do Parnaíba, Parnaíba PI, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
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Wiechers C, Arand J, Koos B, Poets CF. Evidence and practical aspects of treatment with the Tübingen palatal plate. Semin Fetal Neonatal Med 2021; 26:101281. [PMID: 34602352 DOI: 10.1016/j.siny.2021.101281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Tübingen therapy concept centers on an individual orthodontic palatal plate with a spur-like velar extension (Tübingen Palatal or Epiglottic Baton Plate, TPP or PEBP) and intensive feeding training. It was primarily developed for infants with Robin sequence, but has since also be used successfully in infants with other craniofacial malformations. TPP improves not only upper airway obstruction, but also feeding problems, thriving, mandibular growth and was associated with intact neurocognitive outcome. This review provides an overview of the evidence and the clinical and practical aspects of the Tübingen therapy concept.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany; Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany.
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
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Gastelum E, Cummins M, Singh A, Montoya M, Urbano GL, Tablizo MA. Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome. CHILDREN 2021; 8:children8111074. [PMID: 34828787 PMCID: PMC8619133 DOI: 10.3390/children8111074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Abstract
Children with Down syndrome (DS) are at high risk for developing obstructive sleep apnea (OSA) compared to children without DS. The negative impact of OSA on health, behavior, and cognitive development in children with DS highlights the importance of timely and effective treatment. Due to the higher prevalence of craniofacial and airway abnormalities, obesity, and hypotonia in patients with DS, residual OSA can still occur after exhausting first-line options. While treatment commonly includes adenotonsillectomy (AT) and continuous positive airway pressure (CPAP) therapy, additional therapy such as medical management and/or adjuvant surgical procedures need to be considered in refractory OSA. Given the significant comorbidities secondary to untreated OSA in children with DS, such as cardiovascular and neurobehavioral consequences, more robust randomized trials in this patient population are needed to produce treatment guidelines separate from those for the general pediatric population of otherwise healthy children with OSA. Further studies are also needed to look at desensitization and optimization of CPAP use in patients with DS and OSA.
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Affiliation(s)
- Erica Gastelum
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA; (M.C.); (A.S.)
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
- Correspondence: ; Tel.: +1-(559)-4594300
| | - Marcus Cummins
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA; (M.C.); (A.S.)
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
| | - Amitoj Singh
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA; (M.C.); (A.S.)
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
| | - Michael Montoya
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
- School of Medicine, University of California Davis, Sacramento, Fresno, CA 95817, USA
| | - Gino Luis Urbano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig 1604, Philippines;
| | - Mary Anne Tablizo
- Department of Pulmonology, Valley Children’s Hospital, Madera, CA 93720, USA;
- Department of Pulmonology, Stanford Children’s Health, Lucille Packard Children’s Hospital, Palo Alto, CA 94304, USA
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7
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Wiechers C, Iffländer R, Gerdes R, Ciuffolotti M, Arand J, Weise C, Peters K, Grandke B, Reinert S, Koos B, Poets CF. Retrospective study on growth in infants with isolated Robin sequence treated with the Tuebingen Palate Plate. Orphanet J Rare Dis 2021; 16:338. [PMID: 34344420 PMCID: PMC8335857 DOI: 10.1186/s13023-021-01959-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Robin sequence (RS) are at risk of growth failure, mainly due to their increased work of breathing and feeding difficulties. Various conservative and surgical treatment approaches exist, but their impact on weight gain has not yet been adequately addressed. A functional treatment concept, used in our center for > 20 years, includes a pre-epiglottic baton plate (Tuebingen palatal plate) and intensive feeding training. OBJECTIVE To investigate the effect of the Tuebingen treatment protocol on growth and weight trajectories during infancy. METHODS This retrospective study analyzed longitudinal data from infants with isolated RS admitted to Tuebingen University Children's Hospital, Germany between 1998 and 2019. Through our electronic patient database, we evaluated anthropometric parameters until reaching 1-year follow-up. Results are shown as median (IQR). RESULTS In 307 infants analyzed, median Z-score for weight decreased from - 0.28 at birth to - 1.12 upon admission to our center at a median age of 22 days. Z-score then remained largely unchanged until discharge (Z-score difference, - 0.08), while the proportion of infants receiving tube feedings decreased from 55.1 to 13.7%. Z-score subsequently increased from - 1.17 at discharge to - 0.44 at the 1-year follow-up (p < 0.001). CONCLUSION Based on a comparatively large cohort, this functional treatment was associated with better weight gain and improved feeding. As RS infants often show postnatal growth failure, weight monitoring may be a valuable parameter for monitoring treatment effectiveness. Clinical Trial Registration Not necessary due to the retrospective design.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Regina Iffländer
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Rieke Gerdes
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Melissa Ciuffolotti
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Christina Weise
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Katharina Peters
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bärbel Grandke
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Siegmar Reinert
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany. .,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.
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9
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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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Bandyopadhyay A, Kaneshiro K, Camacho M. Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis. Sleep Med 2020; 75:210-217. [PMID: 32861058 DOI: 10.1016/j.sleep.2020.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To systematically review the current literature for articles describing the effect of myofunctional therapy on pediatric obstructive sleep apnea (OSA) and to perform a meta-analysis on the sleep study data. METHODS Three authors (A.B., K.K. and M.C.) independently searched from inception through April 20, 2020 in PubMed/MEDLINE, Scopus, Embase, Google Scholar and The Cochrane Library. Mean difference (MD), standard deviations and 95% confidence intervals were combined in the meta-analysis for apnea-hypopnea index (AHI), mean oxygen saturations, and lowest oxygen saturations (nadir O2). RESULTS 10 studies with 241 patients met study criteria and were further analyzed. The AHI reduced from 4.32 (5.2) to 2.48 (4.0) events/hr, a 43% reduction. Random effects modeling demonstrated a mean difference in AHI of -1.54 (95% CI -2.24,-0.85)/hr, z-score is 4.36 (p < 0.0001). Mean oxygen saturation increased by 0.37 (95% CI 0.06,0.69) percent, z-score is 2.32 (p = 0.02). There was no significant increase in nadir O2. CONCLUSIONS Despite heterogeneity in exercises, myofunctional therapy decreased AHI by 43% in children, and increased mean oxygen saturations in children with mild to moderate OSA and can serve as an adjunct OSA treatment.
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Affiliation(s)
- Anuja Bandyopadhyay
- Clinical Pediatrics Section of Pediatric Pulmonology, Allergy and Sleep Medicine Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, ROC 4270, Indianapolis, IN, 46202-5225, USA.
| | | | - Macario Camacho
- Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
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11
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Poets CF, Koos B, Reinert S, Wiechers C. The Tübingen palatal plate approach to Robin sequence: Summary of current evidence. J Craniomaxillofac Surg 2019; 47:1699-1705. [PMID: 31477439 DOI: 10.1016/j.jcms.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
Various treatments, many of them considerably invasive, are currently applied to infants with Robin sequence (RS) and accompanying upper airway obstruction (UAO). We present a narrative review of our data on the Tübingen palatal plate (TPP) which show the following: a) in a randomized trial, the TPP was superior to a sham procedure in alleviating UAO; b) children treated with the TPP in infancy showed an intellectual development within the reference range; c) prone positioning is no alternative, as it is ineffective and associated with an increased risk of sudden death; d) the TPP reduces the mixed-obstructive apnea index to near-normal values, both in isolated and most (83%) syndromic RS, e) of 443 infants (129 syndromic) treated with the TPP in our center, 23 (5%) ultimately received a tracheostomy (all with syndromic RS), f) recent data suggest that the TPP may induce mandibular catch-up growth, g) the TPP may also help to reduce respiratory complications following cleft closure in RS, and h) TPP treatment is applied by various centers around the world, although it is unclear if its effectiveness is invariably controlled by endoscopy and sleep studies, although both are necessary. Given these data from peer-reviewed studies, it may be questioned whether the "First do no harm" principle is always adhered to when subjecting RS infants to more invasive procedures such as mandibular distraction osteogenesis or tongue-lip adhesion.
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Affiliation(s)
- Christian F Poets
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Neonatology and Pediatric Sleep Lab, Tübingen University Hospital, Germany.
| | - Bernd Koos
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Orthodontics, Tübingen University Hospital, Germany
| | - Siegmar Reinert
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Craniomaxillofacial Surgery, Tübingen University Hospital, Germany
| | - Cornelia Wiechers
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Neonatology and Pediatric Sleep Lab, Tübingen University Hospital, Germany
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Bluher AE, Ishman SL, Baldassari CM. Managing the Child with Persistent Sleep Apnea. Otolaryngol Clin North Am 2019; 52:891-901. [PMID: 31301824 DOI: 10.1016/j.otc.2019.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) affects 2% to 4% of American children, and is associated with metabolic, cardiovascular, and neurocognitive sequelae. The primary treatment for pediatric OSA is adenotonsillectomy. Children with obesity, craniofacial syndromes, and severe baseline OSA are at risk for persistent disease. Evaluation of persistent OSA should focus on identifying the causes of upper airway obstruction. Interventions should be tailored to address the patient's symptomatology, sites of obstruction, and preference for surgical versus medical management. Further research is needed to identify management protocols that result in improved outcomes for children with persistent OSA.
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Affiliation(s)
- Andrew E Bluher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC# 2018, Cincinnati, OH 45229-2018, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC# 2018, Cincinnati, OH 45229-2018, USA
| | - Cristina M Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA; Departments of Pediatric Otolaryngology and Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, 601 Children's Lane, 2nd Floor, Norfolk, VA 23507, USA.
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