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Xian ZX, Wang X, Chen YC, Teng YS. Preliminary assessment of portable sleep monitoring for diagnosis of obstructive sleep apnea in children. Sleep Breath 2024; 28:419-425. [PMID: 37718356 PMCID: PMC10955026 DOI: 10.1007/s11325-023-02919-9] [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: 06/19/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE By observing the differences in sleep parameters between portable sleep monitoring (PM) and polysomnography (PSG) in children, we aimed to investigate the diagnostic value and feasibility of PM in children with suspected obstructive sleep apnea (OSA). STUDY DESIGN This prospective study enrolled consecutive children (aged 3-14 years) with suspected OSA in Shenzhen Children's Hospital. They had PSG and PM in the sleep laboratory. Clinical parameters of the two sleep monitoring methods were compared. RESULTS A total of 58 children participated. They were classified into two groups according to age: 28 children aged 3 to 5 years and 30 children aged 6 to 14 years. No significant differences were observed in apnea-hypopnea index (AHI), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) between PM and PSG, but the sleep efficiency with PM was significantly higher (3-5 years age: 92.2 ± 11.3% vs 85.2 ± 14.3%, 6-14 years age: 93.2 ± 14.5% vs 84.8 ± 16.3%, both P < 0.05) than the sleep efficiency with PSG. Pearson correlation analysis indicated a strong correlation between AHI, LSaO2, MSaO2, and sleep efficiency measured by PSG and PM. Receiver operating characteristic curve (ROC) analysis showed that PM was a reliable diagnostic tool for OSA. PM has high sensitivity (3-5 years age: 95.8%, 6-14 years age: 96.3%) and low specificity (3-5 years age: 25.0%, 6-14 years age: 33.3%) for OSA in children. Thus, there is a low rate of missed diagnoses, but there is some inaccuracy in excluding children who do not have OSA. CONCLUSION The results showed that PM has a good correlation with the various parameters of PSG. PM may be a reliable tool for diagnosing moderate and severe OSA in children, especially those who cannot cooperate with PSG or who have limited access to PSG.
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Affiliation(s)
- Zhi-Xiong Xian
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
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Baddam SKR, Canapari CA, Van de Grift J, McGirr C, Nasser AY, Crowley MJ. Screening and Evaluation of Sleep Disturbances and Sleep Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:65-86. [PMID: 38302214 DOI: 10.1016/j.psc.2023.06.005] [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] [Indexed: 02/03/2024]
Abstract
Sleep disturbances and sleep disorders are prevalent in children/adolescents and have a bidirectional relationship with pediatric medical and mental health disorders. Screening tools and mechanisms for the evaluation and treatment of sleep disturbances and sleep disorders in the pediatric mental health clinic are less well-known; hence, sleep disturbances and disorders are under-recognized in the pediatric clinics. We present specific, validated screening and evaluation tools to identify sleep disturbances and sleep disorders in children/adolescents. We offer guidance related to the use of consumer wearables for sleep assessments and use of sleep telemedicine in pediatric mental health and primary care clinics.
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Affiliation(s)
- Suman K R Baddam
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA.
| | - Craig A Canapari
- Pediatric Pulmonology, Allergy, Immunology & Sleep Medicine, PO Box 208064, New Haven, CT, 06520-8064, USA
| | - Jenna Van de Grift
- Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Christopher McGirr
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | | | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
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Aragón-Villalba G, Munoz-Quintana G, Rubin de Celis GN, Torres-Hortelano JM, Espinosa de Santillana IA. Efficacy of Roncolab mobile application for diagnosing the primary sign of sleep-disordered breathing (snoring) in children. ACTA ODONTOLOGICA LATINOAMERICANA : AOL 2023; 36:150-155. [PMID: 38345276 PMCID: PMC10867856 DOI: 10.54589/aol.36/3/150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/01/2023] [Indexed: 02/15/2024]
Abstract
Sleep-disordered breathing (SDB) is a group of disorders associated with breathing anomalies during sleep. Easily detectable by sound, snoring is one of the most common manifestations and the main sign of SDB. Snoring is characteristic of breathing sound during sleep, without apnea, hypoventilation, or interrupted sleep. It may reduce the percentage of sleep and increase microarousals due to breathing effort or gas exchange. A range of questionnaires have been validated and adapted to the pediatric population to screen for patients who require laboratory testing. The Pediatric Sleep Questionnaire (PSQ) screens for SDB and identifies primary signs such as snoring. RoncoLab is a mobile application that records and measures snoring intensity and frequency. Aim To compare the RoncoLab app and the PSQ regarding how efficiently they diagnose snoring. Materials and Method This was an observational, analytical study of 31 children aged 7 to 11 years who visited the pediatric dental clinic at Benemérita Universidad Autónoma de Puebla, Mexico (BUAP). The PSQ was applied to diagnose SDB. Guardians were then instructed on how to download and use the mobile application to record data while the child was sleeping at home. Agreement between RoncoLab and the PSQ was analyzed statistically by Cohen's Kappa index at 95% confidence level. Results The Kappa index for identification of primary snoring was 0.743 (p<0.05). App sensitivity was 0.92, and specificity 0.82. Conclusion There is good agreement between PSQ and RoncoLab for diagnosing primary snoring, with acceptable sensitivity and specificity.
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Affiliation(s)
- Gerardo Aragón-Villalba
- Benemérita Universidad Autónoma de Puebla, Estomatología, Terminal Pediatría Maestría en Estomatología, Puebla México
| | - Gabriel Munoz-Quintana
- Benemérita Universidad Autónoma de Puebla, Estomatología, Terminal Pediatría Maestría en Estomatología, Puebla México
| | - Gisela N Rubin de Celis
- Benemérita Universidad Autónoma de Puebla, Estomatología, Terminal Pediatría Maestría en Estomatología, Puebla México
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Tuohuti A, Lin Z, Cai J, Chen X. Can portable sleep monitors replace polysomnography for diagnosis of pediatric OSA: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4351-4359. [PMID: 37405453 DOI: 10.1007/s00405-023-08095-6] [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: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an increasing health problem in children. The "gold standard" for OSA diagnosis at the moment is overnight polysomnography (PSG). Some researchers think portable monitors (PMs) are promising methods for diagnosing OSA, which make children more comfortable and lower costs. Compared with PSG, our comprehensively evaluated the diagnostic accuracy of PMs for diagnosing OSA in pediatrics. RESEARCH QUESTION This study aims to determine whether PMs can replace PSG in pediatric OSA diagnosis. STUDY DESIGN AND METHODS The PubMed, Embase, Medline databases Scopus, Web of Science, and Cochrane Library databases were searched systematically for studies published up to December 2022, evaluating the ability of PMs to diagnose OSA in children. For estimating the pooled sensitivity and specificity of the PMs in the included studies, we used a random-effects bivariate model. Studies included in this meta-analysis were evaluated systematically according to QUADAS-2 guidelines for assessing diagnostic accuracy studies. Two independent investigators conducted each stage of the review independently. RESULTS A total of 396 abstracts and 31 full-text articles were screened, and 41 full-text articles were chosen for final review. There were 707 pediatric patients enrolled in these twelve studies, and 9 PMs were evaluated. There was a wide range of diagnostic sensitivity and specificity among PM systems as compared to AHI measured by PSG. The pooled sensitivity and specificity in diagnosing pediatric OSA were, respectively, 0.91 [0.86, 0.94] and 0.76 [0.58, 0.88] for PMs. According to the summary receiver operating characteristic (SROC) curve, the AUC of PMs in diagnosing OSA in pediatric population was 0.93 [0.90, 0.95]. INTERPRETATION PMs were more sensitive but slightly less specific for pediatric OSA. The combination of PMs and questionnaires appeared to be a reliable tool for the diagnosis of pediatric OSA. This test may be used for screening subjects or populations at high risk of OSA when there is a high demand for PSG, but the quantity is limited. No clinical trial was involved in the current study.
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Affiliation(s)
- Aikebaier Tuohuti
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Zehua Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Jie Cai
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Cielo CM, Kelly A, Xanthopoulos M, Pipan M, Arputhan A, Walega R, Ward M, Falvo J, Roman Y, Xiao R, Tapia IE. Feasibility and performance of home sleep apnea testing in youth with Down syndrome. J Clin Sleep Med 2023; 19:1605-1613. [PMID: 37185265 PMCID: PMC10476042 DOI: 10.5664/jcsm.10610] [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: 12/01/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
STUDY OBJECTIVES In-laboratory polysomnography is recommended for the evaluation of obstructive sleep apnea (OSA) in youth with Down syndrome. However, insufficient sleep laboratories are available, particularly for youth with neurocognitive disabilities such as Down syndrome. We hypothesized that level II home sleep apnea testing (HSAT) would be feasible, acceptable, and accurate in detecting polysomnography-defined moderate-severe OSA in youth with Down syndrome. METHODS Youth 6 to 25 years old with Down syndrome were recruited to undergo in-home level II HSAT with electroencephalogram and in-lab polysomnography. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored blinded to polysomnography result, were compared to reference polysomnography. RESULTS Forty-three youth (23 female) aged [median (range)] 15.5 (6.1, 25.1) years participated in the study. Forty-one participants were able to complete HSAT and 41 completed polysomnography, with 40 who underwent both tests. HSAT was preferred to polysomnography by 73.7% of parents. Total sleep time for HSAT was 437 ± 123 minutes vs 366 ± 90 minutes for polysomnography (P = .003). Obstructive apnea-hypopnea index by polysomnography was 12.7 events/h (0.2, 113.8), and 32 youth (80%) who completed all testing had OSA. Compared to polysomnography, sensitivity of HSAT was: 0.81, specificity was 0.75, accuracy was 0.8 including 2 youth whose HSAT demonstrated OSA when polysomnography did not. CONCLUSIONS In youth with Down syndrome, level II HSAT was well-tolerated, preferred compared to in-lab polysomnography, and had good accuracy for detecting moderate-severe OSA. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with Down syndrome. CITATION Cielo CM, Kelly A, Xanthopoulos M, et al. Feasibility and performance of home sleep apnea testing in youth with Down syndrome J Clin Sleep Med. 2023;19(9):1605-1613.
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Affiliation(s)
- Christopher M. Cielo
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Xanthopoulos
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Pipan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Trisomy 21 Program, Division of Developmental Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ahtish Arputhan
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Walega
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Ward
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Falvo
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yaelis Roman
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ignacio E. Tapia
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sleep-Disordered Breathing among Saudi Primary School Children: Incidence and Risk Factors. Healthcare (Basel) 2023; 11:healthcare11050747. [PMID: 36900753 PMCID: PMC10000777 DOI: 10.3390/healthcare11050747] [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: 01/11/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
This study aimed to identify the incidence and risk factors of sleep-disordered breathing (SDB) using an Arabic version of the pediatric sleep questionnaire (PSQ). A total of 2000 PSQs were circulated to children aged 6-12 years who were randomly selected from 20 schools in Al-Kharj city, Saudi Arabia. The questionnaires were filled out by the parents of participating children. The participants were further divided into two groups (younger group: 6-9 years and older group: 10-12 years). Out of 2000 questionnaires, 1866 were completed and analyzed (93.3% response rate), of which 44.2% were from the younger group and 55.8% were from the older group. Among all the participants, a total of 1027 participants were female (55%) and 839 were male (45%) with a mean age of 9.67 ± 1.78 years. It showed that 13% of children were suffering from a high risk of SDB. Chi-square test and logistic regression analyses within this study cohort showed a significant association between SDB symptoms (habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting) and risk of developing SDB. In conclusion: habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting strongly contribute the to development of SDB.
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Masoud AI, Mosli RH. Arabic translation and validation of a pediatric sleep questionnaire to assess the prevalence of sleep-disordered breathing among Saudi pre-school children. BMC Pediatr 2023; 23:50. [PMID: 36721123 PMCID: PMC9890847 DOI: 10.1186/s12887-022-03820-2] [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: 09/24/2022] [Accepted: 12/26/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES (1) To translate to Arabic a validated pediatric sleep questionnaire, (2) To assess the validity and reliability of the translated questionnaire, and (3) To assess the prevalence of sleep-disordered breathing (SDB) among a group of pre-school children in Jeddah, Saudi Arabia. METHODS Using forward and back-translation, a set of 6 hierarchically arranged questions that comprise the Gozal sleep questionnaire was translated into Arabic. Validity was assessed using face validity and content validity for consistency and clarity, using both item-level and scale-level content validity indices (I-CVI, S-CVI). Consent forms were sent to 1783 mothers recruited from 8 different pre-schools in Jeddah between October 2017 and April 2018, and 209 signed and returned the consent forms. Out of this sample, 34 mothers were contacted to assess internal consistency using Cronbach's alpha, and test-retest reliability using Interclass correlation coefficient (ICC). Finally, all 209 mothers were contacted to answer the questionnaire to obtain the prevalence of SDB. RESULTS Using face validity and content validity, the translated questionnaire proved to be valid with perfect I-CVI and S-CVI. Internal consistency (Cronbach's Alpha 0.64-0.89) and test-retest reliability (ICC=0.87, p<0.001) showed the translated questionnaire to have good to favorable reliability. Depending on the severity of SDB, the prevalence of SDB was 7.7%, 5.7%, and 3.8% for mild, moderate and severe cut-off values respectively. CONCLUSION A validated pediatric sleep questionnaire to assess SDB was translated into Arabic and the translation proved to be valid and reliable. The prevalence of SDB was found to be very comparable to other areas in the world.
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Affiliation(s)
- Ahmed I Masoud
- grid.412125.10000 0001 0619 1117Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, PO Box 80209, Jeddah, 21589 Saudi Arabia
| | - Rana H Mosli
- grid.412125.10000 0001 0619 1117Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, PO Box 80209, Jeddah, 21589 Saudi Arabia
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Lee YH. Relationship Analogy between Sleep Bruxism and Temporomandibular Disorders in Children: A Narrative Review. CHILDREN 2022; 9:children9101466. [PMID: 36291402 PMCID: PMC9600472 DOI: 10.3390/children9101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022]
Abstract
Sleep bruxism (SB) is a condition characterized by repetitive clenching or grinding teeth and/or by bracing or thrusting of the mandible during sleep. Although SB is not considered a disorder in children, SB can be a potential physical and psychological hazard or consequence, and this study examines whether SB is a risk factor for TMD as it is in adults. A narrative review on the topic of inferring the relationship between sleep bruxism and TMD in children was performed based on a search in the PubMed and Google Scholar databases for articles published between 1999 and 2022. A total of 76 articles were included in this review. SB is very common in children, may be related to psychological distress or sleep breathing disorder, with a prevalence of up to 49%, and mainly occurs in the non-rapid eye movement stage in the sleep structure. SB may be one cause of TMD. The prevalence of TMD in children is 16–33%. Compared to the female-dominant TMD prevalence in adults, the sex-differences in TMD prevalence in children are less pronounced. However, TMD-related pain is more prevalent in girls than in boys. Given the complex etiology of each of SB and TMD in children, it can be inferred that the explanation of the relationship between the two conditions is very challenging. Ultimately, their relationship should be understood in the individual biopsychosocial model in the process of special physical growth and mental development of children. Moreover, appropriate clinical guidelines for a definitive diagnosis of SB and TMD in children and more research with a high scientific evidence level, which is comprehensive, considering physical, psychological, genetic, and social cultural factors, are required.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University School of Dentistry, Kyung Hee University Medical Center, #613 Hoegi-Dong, Dongdaemun-gu, Seoul 02447, Korea
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Masoud AI, Adavadkar PA, Park C, Gowharji LF, Alwadei AH, Carley DW. Comparing two pediatric sleep questionnaires: The Pediatric Sleep Questionnaire (PSQ) and a set of 6 hierarchically arranged questions (6Q). Cranio 2022; 40:303-312. [DOI: 10.1080/08869634.2020.1792221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ahmed I. Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pranshu A. Adavadkar
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, IL, USA
| | - Chang Park
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL, USA
| | - Lena F. Gowharji
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdurahman H. Alwadei
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - David W. Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL, USA
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Lin CH, Chen CH, Hong SY, Chou IC, Liang SJ, Hang LW. Polysomnography Is an Important Method for Diagnosing Pediatric Sleep Problems: Experience of One Children’s Hospital. CHILDREN 2021; 8:children8110991. [PMID: 34828704 PMCID: PMC8622789 DOI: 10.3390/children8110991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
In this study, we collected and analyzed polysomnography (PSG) data to investigate the value of PSG in diagnosing sleep problems in children. The results of PSG studies of children (<18 years old) with sleep problems conducted from April 2015 to May 2017 at a children’s hospital in Taiwan were collected and analyzed retrospectively. Data for 310 patients (209 males and 101 females) who underwent PSG were collected. The final diagnoses were as follows: obstructive sleep apnea in 159 (51.3%), snoring in 81 (26.4%), limb movement sleep disorder in 25 (8.1%), hypersomnias in 12 (3.9%), central apnea in 8 (2.9%), enuresis in 7 (2.3%), bruxism in 5 (1.6%), sleep terrors in 5 (1.6%), narcolepsy in 3 (1.0%), sleep seizures in 3 (1.0%), sleep walking in 1 (0.3%), and insomnia in 1 (0.3%). PSG may help detect significant sleep-related problems in children and is useful for making therapeutic decisions regarding children. Obstructive sleep apnea syndrome (OSAS) was the primary sleep problem for most of the children (51.3%); however, only 7.4% of them underwent surgery for OSAS. We therefore suggest that children with sleep problems should undergo PSG.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatric Pulmonology, China Medical University Children’s Hospital, Taichung 404327, Taiwan; (C.-H.L.); (C.-H.C.)
- College of Medicine, China Medical University, Taichung 404328, Taiwan;
| | - Chieh-Ho Chen
- Division of Pediatric Pulmonology, China Medical University Children’s Hospital, Taichung 404327, Taiwan; (C.-H.L.); (C.-H.C.)
| | - Syuan-Yu Hong
- College of Medicine, China Medical University, Taichung 404328, Taiwan;
- Division of Pediatric Neurology, China Medical University Children’s Hospital, Taichung 404327, Taiwan;
| | - I-Ching Chou
- Division of Pediatric Neurology, China Medical University Children’s Hospital, Taichung 404327, Taiwan;
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 404328, Taiwan
| | - Shinn-Jye Liang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404327, Taiwan;
| | - Liang-Wen Hang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404327, Taiwan;
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung 404328, Taiwan
- Correspondence:
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Bhattacharjee R, Benjafield A, Blase A, Dever G, Celso J, Nation J, Good R, Malhotra A. The accuracy of a portable sleep monitor to diagnose obstructive sleep apnea in adolescent patients. J Clin Sleep Med 2021; 17:1379-1387. [PMID: 33666166 DOI: 10.5664/jcsm.9202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The efficacy of portable-monitor (PM) sleep testing in children is not well understood. While most studies have evaluated PM in a lab setting, the utility of PM in the home environment is relatively unknown. We sought to determine whether home PM accurately diagnoses obstructive sleep apnea in adolescents and to assess patient satisfaction with home PM sleep testing. METHODS We evaluated adolescents (age 12-18 years) with suspected obstructive sleep apnea using a PM device. In addition to in-laboratory polysomnography (PSG), all participants had PM testing performed twice, once in their home and once concurrent to in-laboratory PSG. PM was compared to PSG using 2 primary outcomes: the apnea-hypopnea index and oxygen desaturation index. All participants were approached for interview to evaluate their experience with PM sleep testing. RESULTS Twenty adolescents participated. Bland-Altman analysis comparing the apnea-hypopnea index and oxygen desaturation index determined by home or in-laboratory PM to in-laboratory PSG revealed mostly agreement; however, some deviations were observed when either parameter was markedly increased. While PM testing tended to underestimate the apnea-hypopnea index, the diagnostic agreement between home PM and PSG was 80% (by the White-Westbrook method). Most preferred PM to PSG and found PM easy to very easy to set up. CONCLUSIONS In a small cohort of adolescents, our study supports the application of home PM in the diagnosis of suspected obstructive sleep apnea. Until studies implementing PM using larger cohorts become readily available, the findings from this preliminary study could contribute to adolescents receiving sleep apnea therapy more promptly. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Identifier: NCT03748771. At the time of issue publication, this registration is not publicly available because the trial includes a device that is not approved or cleared for use in pediatric populations. Once the device is FDA cleared, the registration will become public.
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Affiliation(s)
- Rakesh Bhattacharjee
- University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | | | - Amy Blase
- ResMed Science Center, San Diego, California
| | | | | | - Javan Nation
- University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | - Raquel Good
- Rady Children's Hospital, San Diego, California
| | - Atul Malhotra
- University of California San Diego, La Jolla, California
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13
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Westenberg JN, Petrof BJ, Noel F, Zielinski D, Constantin E, Oskoui M, Kaminska M. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med 2021; 17:1579-1590. [PMID: 33739260 PMCID: PMC8656910 DOI: 10.5664/jcsm.9254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD. METHODS Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference. RESULTS Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants. CONCLUSIONS HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD. CITATION Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med. 2021;17(8):1579-1590.
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Affiliation(s)
- Jean N. Westenberg
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
| | - Basil J. Petrof
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
- Meakins Christie Laboratories, Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Francine Noel
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zielinski
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
| | - Maryam Oskoui
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Marta Kaminska
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
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14
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Masoud AI, Alwadei FH. Two-dimensional upper airway normative values in children aged 7 to 17 years. Cranio 2021; 40:536-543. [PMID: 34176452 DOI: 10.1080/08869634.2021.1943137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To develop two-dimensional (2D) upper airway normative values in pediatric patients and correlate upper airway measurements with age.Methods: Cone beam computed tomography scans of 3738 patients were examined, and a sample of 61 patients, divided into two age groups (7-11 and 12-17 years), w used to reconstruct lateral cephalograms.Results: The mean adenoid-nasopharynx (A/N) ratio was 0.45 and 0.44 for age groups 1 and 2, respectively. The mean PNS-ad1 and PNS-ad2 were 24 and 18.7 mm, respectively, for age group 1, and 26.7 and 21.2 mm, respectively, for age group 2. Additional normative values for the hyoid bone, airway space, uvula, and tongue are presented. The highest correlation with age was the upper airway length (r = 0.557, p < 0.001).Conclusion: Although cephalometric radiographs remain 2D reconstructions of three-dimensional structures, they have significant value and can aid clinicians in the screening process for pediatric sleep apnea.
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Affiliation(s)
- Ahmed I Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia and University of Illinois at Chicago, Chicago, IL, USA
| | - Farhan H Alwadei
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
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15
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Baddam SKR, Canapari CA, Van de Grift J, McGirr C, Nasser AY, Crowley MJ. Screening and Evaluation of Sleep Disturbances and Sleep Disorders in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:65-84. [PMID: 33223069 DOI: 10.1016/j.chc.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sleep disturbances and sleep disorders are prevalent in children/adolescents and have a bidirectional relationship with pediatric medical and mental health disorders. Screening tools and mechanisms for the evaluation and treatment of sleep disturbances and sleep disorders in the pediatric mental health clinic are less well-known; hence, sleep disturbances and disorders are under-recognized in the pediatric clinics. We present specific, validated screening and evaluation tools to identify sleep disturbances and sleep disorders in children/adolescents. We offer guidance related to the use of consumer wearables for sleep assessments and use of sleep telemedicine in pediatric mental health and primary care clinics.
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Affiliation(s)
- Suman K R Baddam
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA.
| | - Craig A Canapari
- Pediatric Pulmonology, Allergy, Immunology & Sleep Medicine, PO Box 208064, New Haven, CT, 06520-8064, USA
| | - Jenna Van de Grift
- Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Christopher McGirr
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | | | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
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16
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Masoud AI, Alwadei AH, Gowharji LF, Park CG, Carley DW. Relating three-dimensional airway measurements to the apnea-hypopnea index in pediatric sleep apnea patients. Orthod Craniofac Res 2020; 24:137-146. [PMID: 32757439 DOI: 10.1111/ocr.12417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/28/2020] [Accepted: 07/20/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES (a) To evaluate three-dimensional radiographic airway analysis as it relates to the pre-test probability for sleep apnea in pediatric patients, and (b) to develop cut-off values for measurements showing promising results. SETTING AND SAMPLE POPULATION A consecutive series of pediatric patients between the ages of 7 and 17 years, referred for a sleep study were recruited. Cone beam computed tomography (CBCT) scans were acquired for 103 subjects within one month following the sleep study. METHODS Three-dimensional airway analysis was performed including volumetric, area and linear measurements. Correlations with the apnea-hypopnea index (AHI) and receiver operating characteristic (ROC) curves were constructed. Sensitivity and specificity were calculated for prediction of AHI ≥ 5 and AHI ≥ 10. RESULTS 99 CBCT scans were included (median age = 11 years). The nasopharyngeal volume (NPV) significantly correlated with AHI (rho≈-0.4, P < .05). In subjects aged 7-11 years, proposed cut-off values for NPV are 2400mm3 and 1600mm3 for AHI ≥ 5 and AHI ≥ 10, respectively. In subjects aged 12-17 years, proposed cut-off values for NPV are 3500mm3 and 2700mm3 for AHI ≥ 5 and AHI ≥ 10, respectively. Oropharyngeal cross-sectional area (OCSA) demonstrated significant predictive value in ROC curve analysis, and cut-off values for this airway measure are also proposed. CONCLUSIONS Contrary to findings in adults, the NPV shows promise when screening for sleep apnea in children when CBCT scans are available. The OCSA might also be of value when screening for sleep apnea especially in older children.
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Affiliation(s)
- Ahmed I Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abdurahman H Alwadei
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Lena F Gowharji
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chang G Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David W Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois, USA
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17
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Combs D, Edgin JO, Klewer S, Barber BJ, Morgan WJ, Hsu CH, Abraham I, Parthasarathy S. OSA and Neurocognitive Impairment in Children With Congenital Heart Disease. Chest 2020; 158:1208-1217. [PMID: 32222588 DOI: 10.1016/j.chest.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD. RESEARCH QUESTION Is OSA is associated with neurocognitive impairment in children with CHD? STUDY DESIGN AND METHODS Children aged 6 to 17 years with corrected moderate to complex CHD without syndromes that may affect neurocognition were recruited from the pediatric cardiology clinic. Participants underwent home sleep testing and neurocognitive testing, including a validated Intellectual Quotient (IQ) test as well as validated tests of memory (Paired Associates Learning test), executive function (Intra-Extra Dimensional set shift test), and attention (Simple Reaction Test) from the CANTAB neurocognitive testing battery. RESULTS Complete results were available for 30 children. Seventeen children (57%) were found to have OSA. Total IQ was markedly lower in children with CHD and comorbid OSA compared with children with CHD without comorbid OSA (mean, 86 ± 12 vs 98 ± 11; P = .01). Children with CHD and OSA did significantly worse on the Paired Associates Learning test, with a median of eight total errors (interquartile range [IQR], 2.25-15) compared with children with CHD without OSA (median total errors, 2, IQR, 1-8; P = .02). INTERPRETATION Children with CHD and comorbid OSA have impaired neurocognition compared with children with CHD without comorbid OSA. OSA may be a reversible cause of neurocognitive impairment in children with CHD. Further research is needed to evaluate the effects of OSA treatment on neurocognitive impairment in children with CHD.
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Affiliation(s)
- Daniel Combs
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, AZ; Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ; University of Arizona Health Sciences Center for Sleep & Circadian Science, University of Arizona, Tucson, AZ.
| | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Scott Klewer
- Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, AZ
| | - Brent J Barber
- Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, AZ
| | - Wayne J Morgan
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ
| | - Sairam Parthasarathy
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ; University of Arizona Health Sciences Center for Sleep & Circadian Science, University of Arizona, Tucson, AZ
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18
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Ikizoglu NB, Kiyan E, Polat B, Ay P, Karadag B, Ersu R. Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome? Pediatr Pulmonol 2019; 54:1541-1546. [PMID: 31290291 DOI: 10.1002/ppul.24440] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 06/06/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND AIM Obstructive sleep apnea syndrome (OSAS) is frequent in children with Down syndrome (DS) and polysomnography (PSG) is recommended for all children with DS. However PSG is not always available and alternative diagnostic methods are needed. The aim of the study was to evaluate the feasibility and validity of home polygraphy (HPG) in children with DS. METHODS A national DS association was contacted and children aged 6 to 18 years who accepted to participate were recruited. Otorhinolaryngologic evaluation, in-lab PSG and HPG were performed. OSAS was diagnosed by PSG with an apnea-hypopnea index (AHI) more than or equal to 1. OSAS severity was classified as moderate-to-severe if AHI was more than or equal to 5. Receiver operating characteristic curves were calculated for HPG using PSG as the gold standard. RESULTS Nineteen children (12 girls) completed the study. Median age was 11.3 years. Demographic and clinical characteristics were similar in children with and without OSAS. Eighty-nine percent of HPG studies were technically acceptable at the initial night and the success rate was 100% when two failed studies were repeated. PSG revealed OSAS in six (32%) children, two had mild and four had moderate-to-severe OSAS. All four patients with moderate-to-severe OSAS diagnosed with PSG have been diagnosed with the same severity on HPG. HPG had 100% sensitivity and 83% specificity when AHI ≥ 3 was set as diagnostic criteria. CONCLUSION HPG is a feasible and reliable test of OSAS in children with DS and may be useful in diagnosis and treatment of patients with moderate-to-severe OSAS in this patient group.
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Affiliation(s)
- Nilay Bas Ikizoglu
- Department of Pediatric Pulmonology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Esen Kiyan
- Department of Pulmonology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Beldan Polat
- Department of Otorhinolaryngology, Head and Neck Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Marmara University Medical Faculty, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Refika Ersu
- Department of Pediatric Pulmonology, Marmara University Medical Faculty, Istanbul, Turkey
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19
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Bhattacharjee R. Ready for Primetime? Home Sleep Apnea Tests for Children. J Clin Sleep Med 2019; 15:685-686. [PMID: 31053225 DOI: 10.5664/jcsm.7748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/09/2023]
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20
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Masoud AI, Patwari PP, Adavadkar PA, Arantes H, Park C, Carley DW. Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients. J Clin Sleep Med 2019; 15:733-742. [PMID: 31053204 DOI: 10.5664/jcsm.7764] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) is considered the gold standard in the diagnosis of sleep apnea. In pediatric patients, because of limited availability and access to laboratory-based PSG, there can be significant delays in the diagnosis and management of sleep apnea that can result in progressive associated comorbidities. The main objective of the current study was to test the diagnostic value of a portable sleep monitor (PM), the MediByte, in comparison with laboratory PSG in pediatric patients wearing both setups simultaneously. METHODS A consecutive series of pediatric patients referred to the University of Illinois Sleep Science Center wore the MediByte during simultaneous PSG. The apnea-hypopnea index (AHI) was calculated for PSG and both manual and autoscoring functions of the PM. Pearson correlation and Bland-Altman plots were assessed. RESULTS A total of 70 patients successfully completed simultaneous PSG and PM studies (median age 10.8 years). The AHI obtained both manually and automatically scored PM studies strongly correlated with the AHI obtained from the PSG (r ≥ .932, P < .001). The oxygen saturation obtained by the PM showed significant correlation with that obtained by PSG among children aged 12 to 17 years (P < .001), but not among children aged 7 to 11 years (P ≥ .24). The sensitivity and specificity for detection of severe sleep apnea diagnosed by PSG (AHI ≥ 10 events/h) using both PM scoring methods was very high (> 93% for both). CONCLUSIONS Although PSG is still recommended for the diagnosis of sleep apnea, PMs can play a valuable role in diagnosing moderate and severe sleep apnea, especially in older pediatric patients. COMMENTARY A commentary on this article appears in this issue on page 685.
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Affiliation(s)
- Ahmed I Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Pallavi P Patwari
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois.,Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois
| | - Pranshu A Adavadkar
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois
| | - Henry Arantes
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois.,Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois
| | - Chang Park
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois
| | - David W Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois
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21
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Developing pediatric three-dimensional upper airway normative values using fixed and interactive thresholds. Oral Radiol 2019; 36:89-99. [PMID: 30963481 DOI: 10.1007/s11282-019-00384-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop and compare pediatric upper airway three-dimensional normative values using the two most commonly used cone beam computed tomography (CBCT) software: Invivo5 (fixed threshold) and Dolphin 3D (interactive threshold). STUDY DESIGN Out of 3738 CBCT scans, scans of 81 pediatric patients were utilized after applying strict exclusion criteria. The sample was grouped into two age groups (7-11 and 12-17 years). Intra-class correlation coefficient was used to test intra-rater and inter-rater reliability and showed coefficients greater than 0.9 indicating good reliability of the methods used. RESULTS Paired t tests showed that volumetric and area measurements obtained using Dolphin 3D were significantly larger than those obtained using Invivo5 (p < 0.05). The mean minimal cross-sectional areas (MCSA) for Dolphin 3D were 151 mm2 and 177 mm2 for age groups 1 and 2, respectively. The mean MCSA values for Invivo5 for age groups 1 and 2 were 120 mm2 and 145 mm2, respectively. CONCLUSION Pediatric upper airway volumetric, area, and linear measurements were reported after applying strict exclusion criteria including a validated sleep questionnaire. Our goal is that clinicians utilize the proposed-here normative values for screening and assist in the timely diagnosis and management of pediatric sleep apnea.
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22
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MacLean JE. Assessment and treatment of pediatric obstructive sleep apnea in Canada: history and current state of affairs. Sleep Med 2019; 56:23-28. [PMID: 30745075 DOI: 10.1016/j.sleep.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 02/07/2023]
Abstract
AIM To highlight Canada's contributions to the assessment and treatment of pediatric obstructive sleep apnea as well as outline the current state of pediatric obstructive sleep apnea in Canada. METHODS A search was conducted in MEDLINE (Ovid) using Medical Subject Headings (MeSH) and free-text terms for 'child' and 'obstructive sleep apnea' with subsequent 'human' limit. The results were reviewed to identify publications where any author's listed a Canadian institution. RESULTS Canadian contributions to the field of pediatric obstructive sleep apnea have grown over the last 30 years with an increase in number of contributors and centres. Much of the early work stemmed from McGill University with important contributions in examining alternatives to polysomnography and post-adenotonsillectomy respiratory compromise. Today, contributors from centres across the country are engaged in the field and come from a greater diversity of disciplines. With continued challenges and opportunities, Canada will continue to help advance the field of pediatric OSA. CONCLUSION Canada has a strong community of people invested in continuing to work to improve the lives of Canadian children with pediatric OSA.
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Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
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23
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Fishman H, Massicotte C, Li R, Zabih W, McAdam LC, Al-Saleh S, Amin R. The Accuracy of an Ambulatory Level III Sleep Study Compared to a Level I Sleep Study for the Diagnosis of Sleep-Disordered Breathing in Children With Neuromuscular Disease. J Clin Sleep Med 2018; 14:2013-2020. [PMID: 30518444 DOI: 10.5664/jcsm.7526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) surveillance recommendations are not being met for children with neuromuscular disease (NMD) because of limited diagnostic facilities. We evaluated the diagnostic accuracy of an ambulatory level III device as compared to a level I PSG. METHODS A cross-sectional study was conducted at a tertiary pediatric institution. Eligibility criteria included: (1) children with NMD; (2) age 6 to 18 years; (3) booked for a clinically indicated overnight level I PSG. Participants were randomized to an overnight level I PSG followed by an ambulatory level III study with end tidal carbon dioxide (etCO2) or vice versa. Sensitivity and specificity of the ambulatory level III device to diagnose sleep-disordered breathing (SDB) at an apnea-hypopnea index (AHI) cutoff of > 1.0 events/h was the primary outcome. RESULTS Moderate to severe SDB was found in 46% of participants (13/28). The device's sensitivity and specificity to detect SDB was 61.5% and 86.7%, respectively. The positive predictive value of the level III study was 80.0% and the negative predictive value was 72.0%. Fifty percent of the cohort were either missing or had incomplete or falsely low ambulatory etCO2 data. CONCLUSIONS A level III device with etCO2 is not yet able to be implemented in clinical practice as a diagnostic tool for SDB in pediatric patients with NMD. COMMENTARY A commentary on this article appears in this issue on page 1973.
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Affiliation(s)
- Haley Fishman
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rhonda Li
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Weeda Zabih
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Laura C McAdam
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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24
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Araújo I, Marques F, André S, Araújo M, Marques S, Ferreira R, Moniz P, Proença M, Borrego P, Fonseca C. Diagnosis of sleep apnea in patients with stable chronic heart failure using a portable sleep test diagnostic device. Sleep Breath 2018; 22:749-755. [PMID: 29344749 DOI: 10.1007/s11325-017-1607-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed comorbidity in heart failure patients. A prospective cross-sectional study in patients with chronic heart failure was carried out to assess the sensitivity and specificity of apnea-hypopnea index (AHI) measurements using ApneaLink against the standard polysomnography test. METHODS Adult patients with a prior hospitalization in an acute heart failure hospital unit were recruited for the study. All participants were tested for sleep apnea using ApneaLink and polysomnography simultaneously during an overnight stay at a sleep laboratory. Global sleep apnea was evaluated according to the AHI, which was analyzed and compared. Subpopulation comparison based on ejection fraction was not realized due to population size. RESULTS Thirty-five patients with stable chronic heart failure completed the study (mean age 70.9 ± 10.5 years and body mass index 30.0 ± 4.7 kg/m2). Two patients were excluded due to insufficient study duration. ApneaLink had a sensitivity greater than 80% for all AHI measurements, and a specificity greater than 80% for all AHI measurements, except for AHI ≥ 5 events/h (61.5%). The results showed higher sensitivities and specificities at AHI values of ≥ 10 events/h (sensitivity 81.3% and specificity 84.2%) and ≥ 15 events/h (sensitivity 83.3% and specificity 91.3%). Correlation analysis showed that AHI measurements using ApneaLink and polysomnography had a strong and significant correlation (r = 0.794; P < 0.001). CONCLUSIONS Our results suggest that ApneaLink could be used in clinical practice to identify heart failure patients with high (AHI ≥ 15 events/h) and low (AHI < 5 events/h) probability of having sleep apnea, sparing the need for a diagnostic polysomnography and thus potentially impacting prognosis by providing a more cost-effective and timely diagnosis of this non-cardiac comorbidity.
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Affiliation(s)
- Inês Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal. .,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Filipa Marques
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Sandra André
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Manuel Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Sara Marques
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Rita Ferreira
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Patrícia Moniz
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Margarida Proença
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Pedro Borrego
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.,Centre for Public Administration and Public Policies (CAPP), Instituto Superior de Ciências Sociais e Políticas (ISCSP), Universidade de Lisboa, Rua Almerindo Lessa, 1300-663, Lisbon, Portugal
| | - Cândida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
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Mancini J, Dubus JC, Jouve E, Roux JC, Franco P, Lagrue E, Castelnau P, Cances C, Chaix Y, Rougeot-Jung C, Cornu C, Desportes V, Vallée L, Bahi-Buisson N, Truillet R, Attolini L, Villard L, Blin O, Micallef J. Effect of desipramine on patients with breathing disorders in RETT syndrome. Ann Clin Transl Neurol 2017; 5:118-127. [PMID: 29468173 PMCID: PMC5817841 DOI: 10.1002/acn3.468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022] Open
Abstract
Objective Rett Syndrome (RTT) is a severe neurodevelopmental condition with breathing disorders, affecting around one in 10,000 female births. Desipramine, a noradrenaline reuptake inhibitor, reduced the number of apneas in Mecp2-deficient mice, a model of RTT. We planned a phase 2 trial to test its efficacy and its safety on breathing patterns in 36 girls with RTT. Methods The trial was a 6-month, multicenter, randomized, double-blind, placebo-controlled study registered with ClinicalTrials.gov, number NCT00990691. Girls diagnosed according to clinical examination and confirmed by genotyping were randomly assigned in a 1:1:1 ratio to receive 2-3 mg/kg Desipramine per day (high Desipramine), 1-2 mg/kg Desipramine per day (low Desipramine), or a placebo. The primary outcome was the change of apnea hypopnea index (AHI), defined by the number of apnea and hypopnea events per hour, assessed at 6 months from baseline. Intention-to-treat analysis was applied. Results The median change in AHI from baseline to 6 months was -31 (IQR: -37 to -11) for the high Desipramine, -17.5 (IQR: -31 to 13) for the low Desipramine, and -13 (IQR:-31 to 0) for the placebo group. We did not find any significant difference in these changes between the groups (P = 0.781). A significant inverse correlation between Desipramine plasma concentration and AHI (r = -0.44; P = 0.0002) was underlined. Interpretation This first clinical trial of desipramine did not show clinical efficacy. Although required further studies, the significant correlation between Desipramine concentrations and improvement of AHI provided additional and relevant reasons to test the noradrenergic pathway in RTT.
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Affiliation(s)
- Josette Mancini
- Neuropediatric Unit Aix Marseille University Children Hospital APHM, Timone, Neurosciences Institute Marseille France
| | - Jean-Christophe Dubus
- Pneumology Pediatric Unit Aix Marseille University Children Hospital CNRS URMITE 6236A PHM Marseille France
| | - Elisabeth Jouve
- Department of Pharmacology F-CRIN Orphan DEV Timone Neurosciences Institute Aix Marseille University CNRS INTAPHM, CIC CPCET CHU Timone Marseille France
| | | | - Patricia Franco
- Neuropediatric Ward Hypnology Unit Lyon University Civil Hospices of Lyon INSERM U628 Lyon France
| | - Emmanuelle Lagrue
- Neuropediatrics and Handicap Department Tours University INSERM, UMR U930 Imaging and Brain, CHRU Tours Tours France
| | - Pierre Castelnau
- Neuropediatrics and Handicap Department Tours University INSERM, UMR U930 Imaging and Brain, CHRU Tours Tours France
| | - Claude Cances
- Neuropediatric Unit Neuro Imaging Center Toulouse University Children Hospital CHU PURPANUMR 1214 Toulouse France
| | - Yves Chaix
- Neuropediatric Unit Neuro Imaging Center Toulouse University Children Hospital CHU PURPANUMR 1214 Toulouse France
| | - Christelle Rougeot-Jung
- Lyon University National Reference Center for Rare Diseases with Intellectual Disability HFME Hospices Civils de Lyon Lyon France.,CNRS UMR 5304 ISC Lyon France
| | - Catherine Cornu
- Department of Pharmacotoxicology Clinical Investigation Center Hospices Civils de Lyon INSERM 1407 Lyon France.,Lyon University CNRS UMR 5558 Lyon France
| | - Vincent Desportes
- Lyon University National Reference Center for Rare Diseases with Intellectual Disability HFME Hospices Civils de Lyon Lyon France.,CNRS UMR 5304 ISC Lyon France
| | - Louis Vallée
- Department of Neuropediatrics Lille North 2 University CHRU Hôpital Roger Salengro Lille France
| | - Nadia Bahi-Buisson
- Imagine Institute and INSERM UMR-1163 Embryology and Genetics of Congenital Malformations Pediatric Neurology Paris Descartes - Sorbonne Paris Cité University Necker Enfants Malades University Hospital AP-HP Paris France
| | - Romain Truillet
- Department of Pharmacology F-CRIN Orphan DEV Timone Neurosciences Institute Aix Marseille University CNRS INTAPHM, CIC CPCET CHU Timone Marseille France
| | - Laurence Attolini
- Department of Pharmacology F-CRIN Orphan DEV Timone Neurosciences Institute Aix Marseille University CNRS INTAPHM, CIC CPCET CHU Timone Marseille France
| | - Laurent Villard
- Aix Marseille University INSERM, GMGF UMR_S 910 Marseille France
| | - Olivier Blin
- Department of Pharmacology F-CRIN Orphan DEV Timone Neurosciences Institute Aix Marseille University CNRS INTAPHM, CIC CPCET CHU Timone Marseille France
| | - Joëlle Micallef
- Department of Pharmacology F-CRIN Orphan DEV Timone Neurosciences Institute Aix Marseille University CNRS INTAPHM, CIC CPCET CHU Timone Marseille France
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Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2017; 100:44-51. [PMID: 28802385 DOI: 10.1016/j.ijporl.2017.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) affects 1-5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA. METHODS A prospective study was conducted in children, ages 2-17. Subjects completed in-lab polysomnography simultaneously with ambulatory monitoring. Caregivers attempted home studies on two subsequent nights to compare the home monitor and the laboratory polysomnogram (PSG). RESULTS Thirty-three subjects completed simultaneous laboratory polysomnogram with portable monitoring. Twenty patients completed home studies, with 16 completing 2 nights of monitoring. The measurement of AHI by the portable monitor was different than that obtained by the PSG with statistical significance for the comparisons of PSG vs. In-Lab (p = 0.0026), PSG vs. Home 1 (p = 0.033), and PSG vs. Home 2 (p = 0.033). The sensitivity of the portable monitor for diagnosing OSA was best for the In-lab use at 81%, but only 69% and 70% for the uses at home on the 2 nights respectively. Interestingly, the comparison of AHI and lowest oxygen saturation measurements from the home sleep test in children age 6 and older did not differ significantly from the PSG. CONCLUSIONS This pilot study demonstrated differences between home sleep testing and in-lab polysomnography for the diagnosis of pediatric sleep apnea. These differences were predominantly found to exist in younger children. Larger prospective studies are needed prior to widespread use, but home studies may alleviate issues of access to care and higher costs of laboratory polysomnography.
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Bauer EE, Lee R, Campbell YN. Preoperative Screening for Sleep-Disordered Breathing in Children: A Systematic Literature Review. AORN J 2016; 104:541-553. [DOI: 10.1016/j.aorn.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/19/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION Dentists can be the first professionals to recognize a patient's potential sleep problem since they typically have more frequent contact with their patients than do physicians. It is important that dentists have a reasonable understanding of sleep disorders and how to assess their patients if they suspect such a problem so that a timely referral can be made or treatment can be provided as appropriate. OBJECTIVE To review the key literature relevant to sleep-disordered breathing (SDB) characteristics and diagnosis, including history, examination, and investigation with an emphasis on radiographic airway analyses. CONCLUSION The authors present a concise explanation of SDB conditions and an outline for thorough patient examination and evaluation, including radiographic airway analyses. Limited two-dimensional and three-dimensional norms exist for adult patients with no SDB and even less so for children. Much more research is needed, particularly in the pediatric population.
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Affiliation(s)
- Ahmed I Masoud
- a Department of Orthodontics, Faculty of Dentistry , King Abdulaziz University , Jeddah , Saudi Arabia.,b Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA.,c Graduate Program in Neuroscience , University of Illinois , Chicago , IL , USA
| | - Gregory W Jackson
- b Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA
| | - David W Carley
- d Departments of Biobehavioral Health Science, Medicine and Bioengineering , University of Illinois , Chicago , IL , USA
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29
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Jackson GW. Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient. Case Rep Dent 2016; 2016:5473580. [PMID: 27668098 PMCID: PMC5030400 DOI: 10.1155/2016/5473580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022] Open
Abstract
A case report is presented which demonstrates the effectiveness of comprehensive orthodontic treatment combined with orthognathic surgery in the correction of malocclusion and reduction in the sequelae of Obstructive Sleep Apnea (OSA). The patient's severe OSA was improved to very mild as evaluated by full overnight polysomnogram. The orthodontic treatment included the expansion of both dental arches and mandibular advancement surgery. There was significant improvement in the patient's sleep continuity and architecture with the elimination of obstructive apneas.
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Affiliation(s)
- Gregory W. Jackson
- Department of Orthodontics (M/C 841), College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Chicago, IL 60612, USA
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30
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High prevalence of poststroke sleep-disordered breathing in Mexican Americans. Sleep Med 2016; 33:97-102. [PMID: 28449915 DOI: 10.1016/j.sleep.2016.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/28/2015] [Accepted: 01/26/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study is to compare sleep-disordered breathing (SDB) prevalence and severity after stroke between Mexican Americans (MAs) and non-Hispanic whites (NHWs). PATIENTS/METHODS Ischemic stroke (IS) patients within ∼30 days of onset were identified from the population-based BASIC Project (2010-2014) and offered screening with an overnight cardiopulmonary monitoring device, ApneaLink Plus™. The number of apneas and hypopneas per hour, as reflected by the apnea/hypopnea index (AHI), was used to measure SDB severity; SDB was defined as AHI ≥10. Ethnicity, demographics, and risk factors were collected from interviews and medical records. Log and negative-binomial regression models were used to determine prevalence ratios (PRs) and apnea/hypopnea event rate ratios (RRs) comparing MAs with NHWs after adjustment for demographics, risk factors, and stroke severity. RESULTS A total of 549 IS cases had AHI data. The median age was 65 years (interquartile range (IQR): 57-76), 55% were men, and 65% were MA. The MAs had a higher prevalence of SDB (68.5%) than NHWs (49.5%) in unadjusted (PR = 1.38; 95% confidence interval (CI): 1.14-1.67) and adjusted analyses (PR = 1.21; 95% CI: 1.01-1.46). The median AHI was 16 (IQR: 7-31) in MAs and nine (IQR: 5-24) in NHWs. The severity of SDB (rate of apneas/hypopneas) was higher in MAs than NHWs in unadjusted (RR = 1.31; 95% CI: 1.09-1.58) but not adjusted analysis (RR = 1.14; 95% CI: 0.95-1.38). There was no ethnic difference in severity among subjects with SDB. CONCLUSION More than two-thirds of MA stroke patients had SDB, which was almost 40% more common among MAs than NHWs. Physicians treating MA patients after stroke should have a high index of suspicion for SDB, a treatable condition that could otherwise have adverse impact.
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Effects of rapid maxillary expansion and mandibular advancement on upper airways in Marfan’s syndrome children: a home sleep study and cephalometric evaluation. Sleep Breath 2015; 19:1213-20. [DOI: 10.1007/s11325-015-1141-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/02/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022]
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Good as 'gold'? Portable sleep study devices for sleep-disordered breathing in children. Can Respir J 2014; 21:29-30. [PMID: 24511570 DOI: 10.1155/2014/306486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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