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Selby A, Buchan E, Davies M, Hill CM, Kingshott RN, Langley RJ, McGovern J, Presslie C, Senior E, Shinde SS, Yuen HM, Samuels M, Evans HJ. Role of overnight oximetry in assessing the severity of obstructive sleep apnoea in typically developing children: a multicentre study. Arch Dis Child 2024; 109:308-313. [PMID: 38253431 DOI: 10.1136/archdischild-2023-326191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Cardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is, however, cheaper and more accessible. This study evaluated the ability of NPO indices to predict OSA in typically developing (TD) children. METHODS Indices from simultaneous NPO and CRP recordings were compared in TD children (aged 1-16 years) referred to evaluate OSA in three tertiary centres. OSA was defined as an obstructive apnoea-hypopnoea index (OAHI) ≥1 event/hour. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices including ODI3 (3% Oxygen Desaturation Index, ODI4 (4% Oxygen Desaturation Index), delta 12 s index and minimum oxygen saturation. Two-by-two tables were generated to determine the sensitivities and specificities of whole number cut-off values for predicting OAHIs ≥1, 5 and 10 events/hour. RESULTS Recordings from 322 TD children, 197 male (61.2%), median age 4.9 years (range 1.1-15.6), were reviewed. OAHI was ≥1/hour in 144 (44.7%), ≥5/hour in 61 (18.9%) and ≥10/hour in 28 (8.7%) cases. ODI3 and ODI4 had the best diagnostic accuracy. ODI3 ≥7/hour and ODI4 ≥4/hour predicted OSA in TD children with sensitivities/specificities of 57.6%/85.4% and 46.2%/91.6%, respectively. ODI3 ≥8/hour was the best predictor of OAHI ≥5/hour (sensitivity 82.0%, specificity 84.3%). CONCLUSION Raised ODI3 and ODI4 predict OSA in TD children with high specificity but variable sensitivity. NPO may be an alternative to diagnose moderate-severe OSA if access to CRP is limited. Low sensitivities to detect mild OSA mean that confirmatory CRP is needed if NPO is normal.
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Affiliation(s)
- Anna Selby
- Faculty of Medicine, University of Southampton, Southampton, UK
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elise Buchan
- Respiratory and Sleep Physiology, Royal Hospital for Children, Glasgow, UK
| | - Matthew Davies
- Respiratory Sleep Unit, Great Ormond Street Hospital for Children, London, UK
| | - Catherine M Hill
- Faculty of Medicine, University of Southampton, Southampton, UK
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ruth N Kingshott
- Department of Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ross J Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Julia McGovern
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Callum Presslie
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Emily Senior
- Paediatric Sleep and Respiratory Medicine Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Ho Ming Yuen
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin Samuels
- Paediatric Respiratory and Sleep Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Hazel J Evans
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Chocron Y, Cote A, Alabdulkarim A, Barone N, Gilardino MS. The Montreal Children's Hospital Experience Managing Robin Sequence: An Analysis of Outcomes and Algorithm for Surgical Technique Selection. Plast Reconstr Surg 2024; 153:597e-604e. [PMID: 37104466 DOI: 10.1097/prs.0000000000010587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The development of mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA) has led to significant improvements in respiratory outcomes for the Robin sequence (RS) population. Despite such advances, there continues to be debate regarding management strategies. The authors present their experience managing the RS population with insights on technique selection. METHODS A retrospective review of RS patients treated at the senior author's institution from 2003 to 2021 was conducted. Baseline patient demographics and clinical parameters including feeding and respiratory status were recorded. Outcomes included the need for tracheostomy or tracheostomy, decannulation rates, and feeding status. Patients were evaluated through overnight oximetry and drug-induced sleep endoscopy (DISE). Outcomes were stratified according to management technique (MDO, TLA, versus conservative) and compared through statistical analysis. RESULTS Fifty-nine RS patients were included. Twenty-eight were managed conservatively, 19 underwent MDO, 10 underwent TLA, one underwent both TLA and MDO, and one underwent tracheostomy primarily. Overall, 1.7% of the cohort required a tracheostomy and 86% achieved oral feeding after the procedure. The MDO cohort had lower Apgar scores and mean birth weight compared with the conservative and TLA cohorts ( P < 0.05). There were no statistical differences in respiratory and feeding outcomes across all three cohorts. CONCLUSIONS A therapeutic algorithm was developed with insight into the use of DISE and risk stratification with overnight oximetry to guide procedural selection. Using this approach, safe and satisfactory respiratory outcomes were achieved with a low tracheostomy rate. Risk stratification is possible without polysomnography, and DISE is a promising tool (that requires further validation) for procedural selection in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Yehuda Chocron
- From the Divisions of Plastic and Reconstructive Surgery
| | - Aurore Cote
- Pediatric Respirology, McGill University Health Centre, Montreal Children's Hospital
| | - Abdulaziz Alabdulkarim
- Plastic Surgery, Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University
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Shinde SS, Wen Yi Ong J, Evans HJ. To define reference ranges for the 3% and 4% mean desaturation nadir in healthy children under 12 years: observational study using oximetry motion-resistant technology. Arch Dis Child 2023; 109:74-75. [PMID: 37940362 DOI: 10.1136/archdischild-2022-325046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Supriya Suresh Shinde
- Paediatric Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jonathan Wen Yi Ong
- Paediatric Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hazel J Evans
- Paediatric Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Everitt L, Roberts P, Evans HJ. Use of pulse oximetry as an investigative test for paediatric respiratory sleep disorders. Arch Dis Child Educ Pract Ed 2023; 108:429-438. [PMID: 37280089 DOI: 10.1136/archdischild-2022-324846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
The article covers the following elements: practical and technological considerations for optimising data collection and output; reference ranges for oximetry parameters across the ages; things to consider when interpreting a pulse oximetry study (eg, sleep/wake times); the ability of pulse oximetry to predict obstructive sleep apnoea; using oximetry as a screening tool for sleep disordered breathing in children with Down syndrome; things to consider when setting up a home oximetry service; and a case of an infant being weaned from oxygen using pulse oximetry studies.
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Affiliation(s)
- Lucy Everitt
- Department of Respiratory Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Phoebe Roberts
- Department of Respiratory Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hazel J Evans
- Department of Respiratory Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Evans HJ, Gibson NA, Bennett J, Chan SY, Gavlak J, Harman K, Ismail-Koch H, Kingshott RN, Langley R, Morley A, Opstad KS, Russo K, Samuels MP, Tan HL, Tweedie D, Yanney M, Whitney A. British Thoracic Society Guideline for diagnosing and monitoring paediatric sleep-disordered breathing. Thorax 2023; 78:1043-1054. [PMID: 37553155 DOI: 10.1136/thorax-2022-219582] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Hazel J Evans
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Samantha Ys Chan
- St George's Hospital, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - Johanna Gavlak
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Ruth N Kingshott
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Kylie Russo
- Bond University, Robina, Queensland, Australia
| | - Martin P Samuels
- Great Ormond Street Hospital for Children, London, UK
- Staffordshire Children's Hospital, Stoke-on-Trent, UK
| | | | - Daniel Tweedie
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Andrea Whitney
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Garde AJ, Gibson NA, Samuels MP, Evans HJ. Recent advances in paediatric sleep disordered breathing. Breathe (Sheff) 2022; 18:220151. [PMID: 36340818 PMCID: PMC9584598 DOI: 10.1183/20734735.0151-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
This article reviews the latest evidence pertaining to childhood sleep disordered breathing (SDB), which is associated with negative neurobehavioural, cardiovascular and growth outcomes. Polysomnography is the accepted gold standard for diagnosing SDB but is expensive and limited to specialist centres. Simpler tests such as cardiorespiratory polygraphy and pulse oximetry are probably sufficient for diagnosing obstructive sleep apnoea (OSA) in typically developing children, and new data-processing techniques may improve their accuracy. Adenotonsillectomy is the first-line treatment for OSA, with recent evidence showing that intracapsular tonsillectomy results in lower rates of adverse events than traditional techniques. Anti-inflammatory medication and positive airway pressure respiratory support are not always suitable or successful, although weight loss and hypoglossal nerve stimulation may help in select comorbid conditions. Educational aims To understand the clinical impact of childhood sleep disordered breathing (SDB).To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.
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Affiliation(s)
- Alison J.B. Garde
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Martin P. Samuels
- Staffordshire Children's Hospital, Royal Stoke University Hospital, Stoke-on-Trent, UK,Great Ormond Street Hospital, London, UK
| | - Hazel J. Evans
- University Hospital Southampton NHS Foundation Trust, Southampton, UK,Corresponding author: Hazel J. Evans ()
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Everitt LH, Awoseyila A, Bhatt JM, Johnson MJ, Vollmer B, Evans HJ. Weaning oxygen in infants with bronchopulmonary dysplasia. Paediatr Respir Rev 2021; 39:82-89. [PMID: 33309219 DOI: 10.1016/j.prrv.2020.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease commonly seen in preterm infants as the sequelae following respiratory distress syndrome. The management of evolving BPD aims to minimise lung injury and prevent the impact of hypoxia and hyperoxia. Proposed morbidities include respiratory instability, pulmonary hypertension, suboptimal growth, altered cerebral oxygenation and long-term neurodevelopmental impairment. The ongoing management and associated morbidity present a significant burden for carers and healthcare systems. Long-term oxygen therapy may be required for variable duration, though there is a lack of consensus and wide variation in practise when weaning supplemental oxygen. Furthermore, a shift in care towards earlier discharge and community care underlines the importance of a structured discharge and weaning process that eliminates the potential risks associated with hypoxia and hyperoxia. This review article describes recent evidence outlining oxygen saturation reference ranges in young infants, on which structured guidance can be based.
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Affiliation(s)
- Lucy H Everitt
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Adejumoke Awoseyila
- Department of Paediatrics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Jayesh M Bhatt
- Department of Respiratory Paediatrics, Nottingham Children's Hospital, Nottingham, UK
| | - Mark J Johnson
- Department of Neonatal Medicine, Southampton Children's Hospital, Southampton, UK; NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Neonatal and Paediatric Neurology, Southampton Children's Hospital, Southampton, UK
| | - Hazel J Evans
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK.
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