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Isaiah A, Teplitzky TB, Dontu P, Saini S, Som M, Pereira KD, Bortfeld H. Resting-State Cerebral Hemodynamics is Associated With Problem Behaviors in Pediatric Sleep-Disordered Breathing. Otolaryngol Head Neck Surg 2023; 169:1290-1298. [PMID: 37078337 DOI: 10.1002/ohn.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Untreated sleep-disordered breathing (SDB) is associated with problem behaviors in children. The neurological basis for this relationship is unknown. We used functional near-infrared spectroscopy (fNIRS) to assess the relationship between cerebral hemodynamics of the frontal lobe of the brain and problem behaviors in children with SDB. STUDY DESIGN Cross-sectional. SETTING Urban tertiary care academic children's hospital and affiliated sleep center. METHODS We enrolled children with SDB aged 5 to 16 years old referred for polysomnography. We measured fNIRS-derived cerebral hemodynamics within the frontal lobe during polysomnography. We assessed parent-reported problem behaviors using the Behavioral Response Inventory of Executive Function Second Edition (BRIEF-2). We compared the relationships between (i) the instability in cerebral perfusion in the frontal lobe measured fNIRS, (ii) SDB severity using apnea-hypopnea index (AHI), and (iii) BRIEF-2 clinical scales using Pearson correlation (r). A p < .05 was considered significant. RESULTS A total of 54 children were included. The average age was 7.8 (95% confidence interval, 7.0-8.7) years; 26 (48%) were boys and 25 (46%) were Black. The mean AHI was 9.9 (5.7-14.1). There is a statistically significant inverse relationship between the coefficient of variation of perfusion in the frontal lobe and BRIEF-2 clinical scales (range of r = 0.24-0.49, range of p = .076 to <.001). The correlations between AHI and BRIEF-2 scales were not statistically significant. CONCLUSION These results provide preliminary evidence for fNIRS as a child-friendly biomarker for the assessment of adverse outcomes of SDB.
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Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pragnya Dontu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sumeet Saini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maria Som
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Heather Bortfeld
- Department of Psychological Sciences, University of California, Merced, California, USA
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2
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Yee AK, Siriwardhana LS, Nixson GM, Walter LM, Wong FY, Horne RSC. Developmental consequences of short apneas and periodic breathing in preterm infants. J Perinatol 2023; 43:1420-1428. [PMID: 37558750 PMCID: PMC10615736 DOI: 10.1038/s41372-023-01748-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE We investigated the relationship between respiratory events experienced before and after hospital discharge and developmental outcomes at 6 months corrected age (CA). STUDY DESIGN Preterm infants born between 28-32 weeks gestational age (GA) were studied at 32-36 weeks postmenstrual age (PMA), 36-40 weeks PMA, 3- and 6-months CA. Percentage total sleep time (%TST) with respiratory events (isolated apneas, sequential apneas and periodic breathing (PB)) at each study was calculated. Stepwise multiple linear regressions determined significant predictors of developmental outcomes at 6 months. RESULT %TST with respiratory events at term were significant predictors of language (R2 = 0.165, β = -0.416) and motor (R2 = 0.180, β = -0.485) composite scores of the Bayley Scales of Infant Development at 6 months, independent of GA, birth weight and sex. CONCLUSIONS In clinically stable very preterm infants at term equivalent age, time spent having respiratory events, was related to a reduction in language and motor outcomes at 6 months.
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Affiliation(s)
- Alicia K Yee
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | | | - Gillian M Nixson
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Flora Y Wong
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
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3
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Torres-Lopez LV, Cadenas-Sanchez C, Migueles JH, Esteban-Cornejo I, Molina-Garcia P, H. Hillman C, Catena A, Ortega FB. Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity? Eur J Pediatr 2022; 181:2055-2065. [PMID: 35142932 PMCID: PMC9056447 DOI: 10.1007/s00431-022-04403-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED Approximately 4-11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8-12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |β|> 0.160, P > 0.076), yet it was associated with the school grade point average (β = -0.226, P = 0.007) and natural and social science grades (β = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all β < -0.188, P > 0.065) or brain volumes (all P > 0.05). CONCLUSION Our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone. WHAT IS KNOWN • Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children. • Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far. WHAT IS NEW • To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children. • SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone.
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Affiliation(s)
- Lucia V. Torres-Lopez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Cristina Cadenas-Sanchez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Institute for Innovation and Sustainable Development in the Food Chain (IS-FOOD), Public University of Navarra, Pamplona, Spain
| | - Jairo H. Migueles
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, 14183 Sweden
| | - Irene Esteban-Cornejo
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Pablo Molina-Garcia
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Charles H. Hillman
- Center for Cognitive and Brain Health, Department of Psychology, Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA USA
| | - Andres Catena
- School of Psychology, University of Granada, Granada, Spain
| | - Francisco B. Ortega
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, 14183 Sweden ,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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4
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The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD). CHILDREN-BASEL 2021; 8:children8090824. [PMID: 34572256 PMCID: PMC8470037 DOI: 10.3390/children8090824] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients.
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5
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Ren H, Jiang X, Xu K, Chen C, Yuan Y, Dai C, Chen W. A Review of Cerebral Hemodynamics During Sleep Using Near-Infrared Spectroscopy. Front Neurol 2020; 11:524009. [PMID: 33329295 PMCID: PMC7710901 DOI: 10.3389/fneur.2020.524009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Investigating cerebral hemodynamic changes during regular sleep cycles and sleep disorders is fundamental to understanding the nature of physiological and pathological mechanisms in the regulation of cerebral oxygenation during sleep. Although sleep neuroimaging methods have been studied and have been well-reviewed, they have limitations in terms of technique and experimental design. Neurologists are convinced that Near-infrared spectroscopy (NIRS) provides essential information and can be used to assist the assessment of cerebral hemodynamics, and numerous studies regarding sleep have been carried out based on NIRS. Thus, a brief historical overview of the sleep studies using NIRS will be helpful for the biomedical students, academicians, and engineers to better understand NIRS from various perspectives. In this study, the existing literature on sleep studies is reviewed, and an overview of the NIRS applications is synthesized and provided. The paper first reviews the application scenarios, as well as the patterns of fluctuation of NIRS, which includes the investigation in regular sleep and sleep-disordered breathing. Various factors such as different sleep stages, populations, and degrees of severity were considered. Furthermore, the experimental design and signal processing, as well as the regulation mechanisms involved in regular and pathological sleep, are investigated and discussed. The strengths and weaknesses of the existing NIRS applications are addressed and presented, which can direct further NIRS analysis and utilization.
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Affiliation(s)
- Haoran Ren
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xinyu Jiang
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Ke Xu
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chen Chen
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yafei Yuan
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chenyun Dai
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Wei Chen
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
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6
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Mei L, Li X, Zhou G, Ji T, Chen J, Xu Z, Peng Y, Liu Y, Li H, Zhang J, Wang S, Zhang Y, Ge W, Guo Y, Qiu Y, Jia X, Tian J, Zheng L, Liu J, Tai J, Ni X. Effects of obstructive sleep apnoea severity on neurocognitive and brain white matter alterations in children according to sex: a tract-based spatial statistics study. Sleep Med 2020; 82:134-143. [PMID: 33915429 DOI: 10.1016/j.sleep.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate alterations in neurocognitive, attention, paediatric sleep questionnaire (PSQ) scores and whole brain white matter (WM) integrity between children with mild and severe obstructive sleep apnoea (OSA) according to sex and whether these changes are associated with OSA severity. METHODS Fifty-seven children (36 males and 21 females) diagnosed with OSA were recruited for this study. Children of both sexes were divided into mild (male-MG, female-MG) and severe (male-SG, female-SG) groups according to OSA severity. Polysomnography (PSG), neurocognitive, attention and PSQ tests were compared between groups by one-way samples analysis of variance (ANOVA) F test. Diffusion tensor imaging (DTI) was scanned using a 3T GE MRI scanner and analysed by Tract-based Spatial Statistics (TBSS). Spearman correlation was calculated between DTI Eigenvalues and clinical characteristics. RESULTS Compared to mild OSA patients, severe OSA patients presented greater severity of obstructive apnoea hypopnea index (OAHI), neurocognition, PSQ and attention tests in both male and female patients. Brain WM integrity in the male-SG, compared to the male-MG, demonstrated significantly reduced fractional anisotropy (FA) values in the right middle frontal gyrus and the right frontal sub-gyral regions and increased axial diffusivity (AD) values in the right inferior frontal gyrus, left parietal angular gyrus and sub-gyral regions, while no differences were found between the female-MG and female-SG. Alterations in male-SG brain regions were observably correlated with severity in male OSA patients. CONCLUSIONS The integrity of WM, which regulates autonomic, cognitive, and attention functions, is impaired in male, but not female, children with severe OSA.
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Affiliation(s)
- Lin Mei
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Guifei Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Tingting Ji
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jun Chen
- Big Data and Engineering Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhifei Xu
- Department of Respiration, Beijing Children's Hospital, Capital Medical University,National Center for Children's Health, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yue Liu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongbin Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yamei Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Paediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Yue Qiu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xinbei Jia
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jinghong Tian
- Department of Neurorehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li Zheng
- Department of Respiration, Beijing Children's Hospital, Capital Medical University,National Center for Children's Health, Beijing, 100045, China
| | - Jiangang Liu
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, China
| | - Jun Tai
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China; Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Paediatrics, Beijing, 100020, China.
| | - Xin Ni
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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7
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Yanney MP, Prayle AP, Rowbotham NJ, Kurc M, Tilbrook S, Ali N. Observational Study of Pulse Transit Time in Children With Sleep Disordered Breathing. Front Neurol 2020; 11:316. [PMID: 32457689 PMCID: PMC7225317 DOI: 10.3389/fneur.2020.00316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Pulse transit time (PTT) is a non-invasive measure of arousals and respiratory effort for which we aim to identify threshold values that detect sleep disordered breathing (SDB) in children. We also compare the sensitivity and specificity of oximetry with the findings of a multi-channel study. Methods: We performed a cross-sectional observational study of 521 children with SDB admitted for multi-channel sleep studies (pulse oximetry, ECG, video, sound, movement, PTT) in a secondary care centre. PTT data was available in 368 children. Studies were categorised as normal; primary snoring; upper airway resistance syndrome (UARS); obstructive sleep apnoea (OSA), and "abnormal other." Receiver operator characteristic curves were constructed for different PTT (Respiratory swing; Arousal index) thresholds using a random sample of 50% of children studied (training set); calculated thresholds of interest were validated against the other 50% (test set). Study findings were compared with oximetry categories (normal, inconclusive, abnormal) using data (mean and minimum oxygen saturations; oxygen desaturations > 4%) obtained during the study. Results: Respiratory swing of 17.92 ms identified SDB (OSA/UARS) with sensitivity: 0.80 (C.I. 0.62-0.90) and specificity 0.79 (C.I. 0.49-0.87). PTT arousal index of 16.06/ hour identified SDB (OSA/UARS) with sensitivity: 0.85 (95% C.I. 0.67-0.92) and specificity 0.37 (95% C.I. 0.17-0.48). Oximetry identified SDB (OSA) with sensitivity: 0.38 (C.I. 0.31-0.46) and specificity 0.98 (C.I. 0.97-1.00). Conclusions: PTT is more sensitive but less specific than oximetry at detecting SDB in children. The additional use of video and sound enabled detection of SDB in twice as many children as oximetry alone.
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Affiliation(s)
- Michael P Yanney
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Andrew P Prayle
- Division of Child Health, Obstetrics and Gynaecology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Nicola J Rowbotham
- Division of Child Health, Obstetrics and Gynaecology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Miguel Kurc
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Sean Tilbrook
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Nabeel Ali
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
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8
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Tabone L, Khirani S, Amaddeo A, Emeriaud G, Fauroux B. Cerebral oxygenation in children with sleep-disordered breathing. Paediatr Respir Rev 2020; 34:18-23. [PMID: 31753753 DOI: 10.1016/j.prrv.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
Sleep-disordered breathing (SDB) is associated with neurocognitive and behavioral dysfunction, and structural brain abnormalities. Near infrared spectroscopy allows a continuous and non-invasive monitoring of brain tissue oxygenation, giving insight in some pathophysiological mechanisms potentially associated with SDB-related neurocognitive dysfunction. The present review summarizes the finding of studies describing brain tissue oxygenation in adults and children with SDB. Contrary to adults, mean nocturnal tissue oxygenation index (TOI) during sleep does not seem to be different in children with SDB as compared to healthy controls. During respiratory events such as apnoeas and hypopnoeas, the decrease in TOI precedes the peripheral, systemic desaturation. The decrease in TOI has been shown to be greater during apnoeas as compared to hypopnoeas, during rapid-eye movement sleep as compared to other sleep stages, in younger children as compared to their older counterparts, and in those with a high apnoea-hypopnoea index as compared with a low apnoea-hypopnoea index. Studies analyzing the association between repetitive changes in TOI and neurocognitive and behavioral dysfunction may help to decipher the pathophysiology of neurocognitive dysfunction associated with SDB in children.
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Affiliation(s)
- Laurence Tabone
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Qc, Canada; Université de Paris, VIFASOM, F-75004 Paris, France
| | - Sonia Khirani
- Université de Paris, VIFASOM, F-75004 Paris, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, F-75015 Paris, France; ASV Santé, Gennevilliers, France
| | - Alessandro Amaddeo
- Université de Paris, VIFASOM, F-75004 Paris, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Guillaume Emeriaud
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Qc, Canada
| | - Brigitte Fauroux
- Université de Paris, VIFASOM, F-75004 Paris, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, F-75015 Paris, France.
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9
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Walter LM, Shepherd KL, Yee A, Horne RS. Insights into the effects of sleep disordered breathing on the brain in infants and children: Imaging and cerebral oxygenation measurements. Sleep Med Rev 2020; 50:101251. [DOI: 10.1016/j.smrv.2019.101251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
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10
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Tabone L, Khirani S, Olmo Arroyo J, Amaddeo A, Sabil A, Fauroux B. Cerebral Oxygenation During Respiratory Events in Children with Sleep-Disordered Breathing and Associated Disorders. J Pediatr 2019; 214:134-140.e7. [PMID: 31540763 DOI: 10.1016/j.jpeds.2019.07.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/12/2019] [Accepted: 07/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders. STUDY DESIGN Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO2]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age. RESULTS There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO2 and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those <7 years old. TOI decreases correlated significantly with SpO2 decreases, duration of event, and age, regardless of the type of event. In a multivariable regression model, predictive factors of TOI decreases were the type of respiratory event, SpO2 decrease, apnea-hypopnea index, and age. CONCLUSIONS In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.
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Affiliation(s)
- Laurence Tabone
- Research Unit French Institute of Health and Medical Research U 955, team 13, Créteil, France.
| | - Sonia Khirani
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France; ASV Santé, Gennevilliers, France
| | - Jorge Olmo Arroyo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France
| | - Alessandro Amaddeo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
| | | | - Brigitte Fauroux
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
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11
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Walter LM, Tamanyan K, Weichard AJ, Davey MJ, Nixon GM, Horne RSC. Sleep disordered breathing in children disrupts the maturation of autonomic control of heart rate and its association with cerebral oxygenation. J Physiol 2018; 597:819-830. [PMID: 30471111 DOI: 10.1113/jp276933] [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: 08/01/2018] [Accepted: 11/16/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Sleep disordered breathing (SDB) affects 4-11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control. The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non-snoring control children was absent during sleep in children with SDB. Age significantly predicted increasing cerebral oxygenation during wake in non-snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation. Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep. SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non-snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. ABSTRACT The repetitive episodes of hypoxia that are features of sleep disordered breathing (SDB) in children are associated with alterations in autonomic control of heart rate in an age-dependent manner. We aimed to relate heart rate variability (HRV) parameters to age and measures of cerebral oxygenation in children (3-12 years old) with SDB and non-snoring controls. Children (SDB, n = 117; controls, n = 42; 3-12 years) underwent overnight polysomnography. Total (TP), low- (LF) and high-frequency (HF) power, tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) were analysed during wake and sleep. Pearson's correlations determined the association between age and HRV parameters, and multiple linear regressions between HRV, age and cerebral oxygenation parameters. During wake, age had a positive association with LF power, reflecting increased parasympathetic and sympathetic activity with increasing age for both control and SDB groups. This association was also evident during sleep in controls, but was absent in children with SDB. In controls, during wake TOI had a positive, and FTOE a negative association with age. During sleep, TP, LF and HF power were significant, negative determinants of TOI and positive determinants of FTOE. These associations were not seen in children with SDB during wake or sleep. SDB disrupts the normal maturation of the autonomic control of heart rate and the association between HRV and cerebral oxygenation exhibited by non-snoring control children of primary school age. These results highlight the impact SDB has on cardiovascular control and the potential impact on adverse cardiovascular outcomes.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Aidan J Weichard
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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12
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Tamanyan K, Walter LM, Weichard A, Davey MJ, Nixon GM, Biggs SN, Horne RSC. Age Effects on Cerebral Oxygenation and Behavior in Children with Sleep-disordered Breathing. Am J Respir Crit Care Med 2018; 197:1468-1477. [DOI: 10.1164/rccm.201709-1825oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Lisa M. Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Margot J. Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Gillian M. Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Sarah N. Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
| | - Rosemary S. C. Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; and
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13
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Amin R. Understanding Brain Functions in Children with Sleep-disordered Breathing. Am J Respir Crit Care Med 2018; 197:1380-1381. [DOI: 10.1164/rccm.201802-0231ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Raouf Amin
- Division of Pulmonary and Sleep MedicineCincinnati Children’s HospitalCincinnati, Ohio
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14
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Trosman I, Trosman SJ. Cognitive and Behavioral Consequences of Sleep Disordered Breathing in Children. Med Sci (Basel) 2017; 5:E30. [PMID: 29194375 PMCID: PMC5753659 DOI: 10.3390/medsci5040030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/14/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022] Open
Abstract
There is now a plethora of evidence that children with sleep disordered breathing (SDB) show deficits in neurocognitive performance, behavioral impairments, and school performance. The following review will focus on the neurobehavioral impacts of SDB, pediatric sleep investigation challenges, potential mechanisms of behavioral and cognitive deficits in children with SDB, and the impact of SDB treatment.
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Affiliation(s)
- Irina Trosman
- Sleep Medicine Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Samuel J Trosman
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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15
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Pediatric Sleep Apnea Syndrome: An Update. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:852-61. [PMID: 27372597 DOI: 10.1016/j.jaip.2016.02.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 01/04/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) may be central neurologic (<5%) or obstructive (>95%) in origin and is a relatively prevalent condition in children. It affects 1%-5% of children aged 2-8 years and is caused by a variety of different pathophysiologic abnormalities. Cardiovascular, metabolic, and neurocognitive comorbidities can occur in both children and adults when left untreated. It also can cause severe behavioral problems in children. The American Academy of Pediatrics recommends that all children be screened with an appropriate history and physical examination for symptoms and signs suggestive of OSAS. The diagnosis is primarily made clinically and confirmed by polysomnographic findings. Treatment depends on the child's age, underlying medical problems, polysomnography findings, and whether or not there is upper airway obstruction usually secondary to enlarged adenoids and/or tonsils, allergic and nonallergic rhinitis, acute and chronic sinusitis, and other upper airway pathology. If enlarged adenoid or tonsils or both conditions exist, an adenoidectomy, tonsillectomy, or adenotonsillectomy remains the treatment of choice. Pharmacotherapy of OSAS has shown some effect in children with mild symptoms. This paper reviews the prevalence, pathophysiology, clinical presentation, diagnosis, and treatment of OSAS.
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16
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Bao L, Si L, Wang Y, Wuyun G, Bo A. Effect of two GABA-ergic drugs on the cognitive functions of rapid eye movement in sleep-deprived and recovered rats. Exp Ther Med 2016; 12:1075-1084. [PMID: 27446323 DOI: 10.3892/etm.2016.3445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/16/2016] [Indexed: 01/05/2023] Open
Abstract
Rapid eye movement (REM) sleep is closely associated with nervous functions. The present study aimed to evaluate the effects of gabazine and tiagabine on the cognitive functions (CF) of REM sleep-deprived and sleep recovered rats. Rats were divided into REM sleep deprivation, blank control (CC) and environmental groups. The REM sleep deprivation group was further divided into non-operation (nonOP), sham-operated (Sham), gabazine (SR) and tiagabine groups. Each group was evaluated over five time points: Sleep deprived for 1 day (SD 1 day), SD 3 day, SD 5 day, sleep recovery 6 h (RS 6 h) and RS 12 h. A rat model of REM sleep deprivation was established by a modified multi-platform water method, with CF assessed by Morris water maze. Hypothalamic γ-aminobutyric acid (GABA) and glutamic acid contents were measured via high performance liquid chromatography. The number and morphology of hypocretin (Hcrt) neurons and Fos in the hypothalamus, and GABAARα1-induced integral optical density were detected by immunofluorescence. Compared to the CC group, the nonOP and Sham group rats CF were significantly diminished, Fos-positive and Fos-Hcrt double positive cells were significantly increased, and GABA content and GABAARα1 expression levels were significantly elevated (P<0.05). The tiagabine and CC groups exhibited similar results at three time points. The CF of rats in the SR group were diminished and the number of Fos-positive and Fos-Hcrt double positive cells were significantly increased (P<0.05) at RS 6 h and RS l2 h. GABA content and GABAARα1 expression levels were significantly increased in the SR group at all time points (P<0.05), whereas only GABAARα1 expression levels were significantly increased in the tiagabine group at SD 5 day (P<0.05). The results of the present study indicated that REM sleep deprivation diminished CF, increased the number of Hcrt neurons, GABA content and GABAARα1 expression. Furthermore, all alterations were positively correlated with deprivation time and corrected by sleep recovery, as demonstrated by single-factor multi-level variance analysis at the various time points in each group. Therefore, the Hcrt nervous system may be an eligible therapeutic target for the treatment of insomnia.
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Affiliation(s)
- Lidao Bao
- College of Traditional Mongolian Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China; Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010059, P.R. China
| | - Lengge Si
- College of Traditional Mongolian Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Yuehong Wang
- College of Traditional Mongolian Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Gerile Wuyun
- College of Traditional Mongolian Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Agula Bo
- College of Traditional Mongolian Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
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17
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Lau EYY, Choi EWM, Lai ESK, Lau KNT, Au CT, Yung WH, Li AM. Working memory impairment and its associated sleep-related respiratory parameters in children with obstructive sleep apnea. Sleep Med 2015; 16:1109-15. [PMID: 26298787 DOI: 10.1016/j.sleep.2015.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Working memory deficits in children with obstructive sleep apnea (OSA) have been reported in previous studies, but the results were inconclusive. This study tried to address this issue by delineating working memory functions into executive processes and storage/maintenance components based on Baddeley's working memory model. METHODS Working memory and basic attention tasks were administered on 23 OSA children aged 8-12 years and 22 age-, education-, and general cognitive functioning-matched controls. Data on overnight polysomnographic sleep study and working memory functions were compared between the two groups. Associations between respiratory-related parameters and cognitive performance were explored in the OSA group. RESULTS Compared with controls, children with OSA had poorer performance on both tasks of basic storage and central executive components in the verbal domain of working memory, above and beyond basic attention and processing speed impairments; such differences were not significant in the visuo-spatial domain. Moreover, correlational analyses and hierarchical regression analyses further suggested that obstructive apnea-hypopnea index (OAHI) and oxygen saturation (SpO2) nadir were associated with verbal working memory performance, highlighting the potential pathophysiological mechanisms of OSA-induced cognitive deficits. CONCLUSIONS Verbal working memory impairments associated with OSA may compromise children's learning potentials and neurocognitive development. Early identification of OSA and assessment of the associated neurocognitive deficits are of paramount importance. Reversibility of cognitive deficits after treatment would be a critical outcome indicator.
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Affiliation(s)
- Esther Yuet Ying Lau
- Sleep Laboratory, University of Hong Kong, Hong Kong; Department of Psychology, University of Hong Kong, Hong Kong; Department of Psychiatry, University of Hong Kong, Hong Kong.
| | | | | | - Kristy N T Lau
- Sleep Laboratory, University of Hong Kong, Hong Kong; Department of Psychology, University of Hong Kong, Hong Kong
| | - C T Au
- Department of Pediatrics, Prince of Wales Hospital, Hong Kong
| | - W H Yung
- School of Biomedical Sciences, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albert M Li
- Department of Pediatrics, Prince of Wales Hospital, Hong Kong
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18
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Ullman N, Anas NG, Izaguirre E, Haugen W, Ortiz H, Arguello O, Nickerson B, Mink RB. Usefulness of cerebral NIRS in detecting the effects of pediatric sleep apnea. Pediatr Pulmonol 2014; 49:1036-42. [PMID: 24339172 DOI: 10.1002/ppul.22962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/14/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with sleep apnea have increased morbidity if the sleep apnea is untreated. Polysomnography (PSG) is used to detect sleep apnea, but in children, there are technical difficulties that make the diagnosis more difficult. Cerebral near infrared spectroscopy (NIRS) has the ability to detect tissue hypoxia by measuring regional oxygen saturation (rSO2 ). We hypothesized that when used as an adjunct to PSG testing, cerebral NIRS would better detect the effects of sleep apnea in children than arterial pulse oximetry (SpO2 ). Specifically, we aimed to show that the apnea/hypopnea index (AHI) calculated with rSO2 from the NIRS would be greater than that calculated with SpO2 . METHODS Forty-seven patients under 18 years of age who underwent PSG testing for sleep apnea were evaluated. Cerebral NIRS was utilized in addition to PSG. The AHI was calculated using SpO2 and compared to the AHI calculated using the rSO2 . A pediatric pulmonologist who was unaware of the NIRS data evaluated each patient for sleep apnea. Data are median (interquartile range). RESULTS The median AHI(rSO2 ) was 2.4(1.2,5.1), significantly greater (P < 0.0001) than the AHI(SpO2 ) of 0.7(0.4,1.2). Four patients were diagnosed with sleep apnea; however, only one had an AHI(SpO2 ) ≥ 5, a typical threshold for the diagnosis of sleep apnea. All 4 subjects had an AHI(rSO2 ) ≥ 5 but 10 patients without sleep apnea had a value ≥5. The sensitivity and specificity for using the AHI(rSO2 ) to diagnose sleep apnea was 100% and 76.7%, respectively. CONCLUSION Consistent with the ability of NIRS to detect tissue hypoxia, we found that the AHI calculated with rSO2 was greater than that using SpO2 . We conclude that NIRS has potential as a valuable adjunct to PSG in evaluating patients for sleep apnea and warrants further investigation for this purpose.
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Affiliation(s)
- Nachman Ullman
- Harbor-UCLA Medical Center, Torrance, California; CHOC Children's, Orange, California
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19
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Fyfe KL, Yiallourou SR, Wong FY, Odoi A, Walker AM, Horne RSC. Cerebral oxygenation in preterm infants. Pediatrics 2014; 134:435-45. [PMID: 25157010 DOI: 10.1542/peds.2014-0773] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known about the effects of sleeping position on TOI and MAP in preterm infants. We aimed to examine TOI and MAP in preterm infants after term-equivalent age, during the period of greatest SIDS risk. METHODS Thirty-five preterm and 17 term infants underwent daytime polysomnography, including measurement of TOI (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and MAP (Finapress Medical Systems, Amsterdam, Netherlands) at 2 to 4 weeks, 2 to 3 months, and 5 to 6 months postterm age. Infants slept prone and supine in active and quiet sleep. The effects of sleep state and position were determined by using 2-way repeated measures analysis of variance and of preterm birth by using 2-way analysis of variance. RESULTS In preterm infants, TOI was significantly lower when prone compared with supine in both sleep states at all ages (P < .05). Notably, TOI was significantly lower in preterm compared with term infants at 2 to 4 weeks, in both positions (P < .05), and at 2 to 3 months when prone (P < .001), in both sleep states. MAP was also lower in preterm infants in the prone position at 2 to 3 months (P < .01). CONCLUSIONS Cerebral oxygenation is reduced in the prone position in preterm infants and is lower compared with age-matched term infants, predominantly in the prone position when MAP is also reduced. This may contribute to their increased SIDS risk.
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Affiliation(s)
- Karinna L Fyfe
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; and
| | - Stephanie R Yiallourou
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; and
| | - Flora Y Wong
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; and Monash Newborn, Monash Medical Centre, Melbourne, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia
| | - Adrian M Walker
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; and
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20
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Waist-to-height ratio distinguish obstructive sleep apnea from primary snoring in obese children. Sleep Breath 2014; 19:231-7. [DOI: 10.1007/s11325-014-1001-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 11/26/2022]
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Esteller E, Barceló M, Segarra F, Estivill E, Girabent-Farrés M. Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño. An Pediatr (Barc) 2014; 80:214-20. [DOI: 10.1016/j.anpedi.2013.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/04/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022] Open
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22
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Sleep architecture in school-aged children with primary snoring. Sleep Med 2014; 15:303-8. [DOI: 10.1016/j.sleep.2013.08.801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/05/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
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Abstract
Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment.
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Affiliation(s)
- Hui-Leng Tan
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Leila Kheirandish-Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
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Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714-55. [PMID: 22926176 DOI: 10.1542/peds.2012-1672] [Citation(s) in RCA: 948] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
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25
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Gill AI, Schaughency E, Gray A, Galland BC. Reliability of home-based physiological sleep measurements in snoring and non-snoring 3-year olds. Sleep Breath 2012; 17:147-56. [PMID: 22327554 DOI: 10.1007/s11325-012-0663-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/10/2012] [Accepted: 01/30/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To study snoring and non-snoring 3-year olds in their own homes and to establish reference values and night-to-night variability of physiological measurements taken during sleep. METHODS One hundred and sixty-six children, aged 3.2-4.0 years, identified as at high (n = 83, M/F = 1.5:1) or low (n = 83, M/F = 1.4:1) risk for persistent snoring, as rated by a parent, wore a sleep screening system (Grey Flash) for up to five consecutive nights, to measure snoring, oxygen saturation, heart rate, movement, sleep efficiency, and sleep timing. RESULTS The snoring group snored 25% of their total sleep time, while the non-snoring group snored just 7.6%. Reliability estimates were calculated, using intraclass correlations to establish the reliability of single recordings and the Spearman-Brown prophecy formula to estimate reliability over multiple recordings. Snoring (percent), turn index (number of turns per hour), and mean heart rate were adequately assessed in both groups with one recording night (all intraclass correlation coefficients (ICCs) ≥0.70). Furthermore, mean SpO(2) was measured with sufficient reliability with two recordings in non-snorers (ICC = 0.71), while five recording nights were necessary to reach reliability in snorers (ICC = 0.71). SpO(2) nadir did not reach adequate reliability in either group even after seven recording nights. CONCLUSIONS Our results showed that snoring can be measured reliably at home with just one recording night, whereas most other physiological sleep measures require two or more recordings.
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Affiliation(s)
- Amelia I Gill
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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26
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Abstract
Pediatric sleep-disordered breathing (SDB) includes an increasingly recognized, highly prevalent, yet still underdiagnosed spectrum of respiratory disorders, the most common and clinically significant of which is obstructive sleep apnea. SDB is linked with significant end-organ dysfunction across various systems, particularly with cardiovascular, neurocognitive, and metabolic consequences. This review summarizes recent advances in understanding of pediatric SDB and discusses the challenges inherent in diagnosing and treating children with SDB.
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Bronicki RA, Herrera M, Mink R, Domico M, Tucker D, Chang AC, Anas NG. Hemodynamics and cerebral oxygenation following repair of tetralogy of Fallot: the effects of converting from positive pressure ventilation to spontaneous breathing. CONGENIT HEART DIS 2011; 5:416-21. [PMID: 21087425 DOI: 10.1111/j.1747-0803.2010.00445.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Following corrective surgery for tetralogy of Fallot (TOF), approximately one-third of these patients develop low cardiac output (CO) due to right ventricular (RV) diastolic heart failure. Extubation is beneficial in these patients because the fall in intrathoracic pressure that occurs with conversion from positive pressure breathing to spontaneous breathing improves venous return, RV filling and CO. We hypothesized that if CO were to increase but remain limited following extubation, the obligatory increase in perfusion to the respiratory pump that occurs with loading of the respiratory musculature may occur at the expense of other vital organs, including the brain. MATERIALS AND METHODS We conducted a retrospective analysis of all patients undergoing repair of TOF and monitoring of cerebral oxygenation using near infrared spectroscopy. We evaluated the following parameters two hours prior to and following extubation: mean and systolic arterial blood pressure (MBP, SBP), right atrial pressure (RAP), heart rate (HR) and cerebral oxygenation. RESULTS The study included 22 patients. With extubation, MBP and SBP increased significantly from 67.3 ± 6.5 to 71.1 ± 8.4 mm Hg (P= 0.004) and from 87.2 ± 8.6 to 95.9 ± 10.9 mm Hg (P= 0.001), respectively, while the HR remained unchanged (145 vs. 146 bpm). The RAP remained unchanged following extubation (11.9 vs. 12.0 mm Hg). Following extubation, cerebral oxygen saturations increased significantly from 68.5 ± 8.4 to 74.2 ± 7.9% (P < 0.0001). Cerebral oxygen saturations increased by ≥5% in 11 of 22 patients and by ≥10% in 5 of 22 patients. CONCLUSION We conclude that converting from positive pressure ventilation to spontaneous negative pressure breathing following repair of TOF significantly improves arterial blood pressure and cerebral oxygenation.
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Affiliation(s)
- Ronald A Bronicki
- Division of Pediatric Critical Care Medicine, Children's Hospital of Orange County, Orange, California 92868, USA.
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Wise MS, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, D'Andrea LA, Hoban TF. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep 2011; 34:389-98AW. [PMID: 21359088 PMCID: PMC3041716 DOI: 10.1093/sleep/34.3.389] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This comprehensive, evidence-based review provides a systematic analysis of the literature regarding the validity, reliability, and clinical utility of polysomnography for characterizing breathing during sleep in children. Findings serve as the foundation of practice parameters regarding respiratory indications for polysomnography in children. METHODS A task force of content experts performed a systematic review of the relevant literature and graded the evidence using a standardized grading system. Two hundred forty-three evidentiary papers were reviewed, summarized, and graded. The analysis addressed the operating characteristics of polysomnography as a diagnostic procedure in children and identified strengths and limitations of polysomnography for evaluation of respiratory function during sleep. RESULTS The analysis documents strong face validity and content validity, moderately strong convergent validity when comparing respiratory findings with a variety of relevant independent measures, moderate-to-strong test-retest validity, and limited data supporting discriminant validity for characterizing breathing during sleep in children. The analysis documents moderate-to-strong test-retest reliability and interscorer reliability based on limited data. The data indicate particularly strong clinical utility in children with suspected sleep related breathing disorders and obesity, evolving metabolic syndrome, neurological, neurodevelopmental, or genetic disorders, and children with craniofacial syndromes. Specific consideration was given to clinical utility of polysomnography prior to adenotonsillectomy (AT) for confirmation of obstructive sleep apnea syndrome. The most relevant findings include: (1) recognition that clinical history and examination are often poor predictors of respiratory polygraphic findings, (2) preoperative polysomnography is helpful in predicting risk for perioperative complications, and (3) preoperative polysomnography is often helpful in predicting persistence of obstructive sleep apnea syndrome in patients after AT. No prospective studies were identified that address whether clinical outcome following AT for treatment of obstructive sleep apnea is improved in association with routine performance of polysomnography before surgery in otherwise healthy children. A small group of papers confirm the clinical utility of polysomnography for initiation and titration of positive airway pressure support. CONCLUSIONS Pediatric polysomnography shows validity, reliability, and clinical utility that is commensurate with most other routinely employed diagnostic clinical tools or procedures. Findings indicate that the "gold standard" for diagnosis of sleep related breathing disorders in children is not polysomnography alone, but rather the skillful integration of clinical and polygraphic findings by a knowledgeable sleep specialist. Future developments will provide more sophisticated methods for data collection and analysis, but integration of polysomnographic findings with the clinical evaluation will represent the fundamental diagnostic challenge for the sleep specialist.
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Affiliation(s)
- Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN, USA
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Ting H, Wong RH, Yang HJ, Lee SP, Lee SD, Wang L. Sleep-disordered breathing, behavior, and academic performance in Taiwan schoolchildren. Sleep Breath 2010; 15:91-8. [PMID: 20119852 DOI: 10.1007/s11325-010-0329-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 01/09/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The behaviors of children may be affected by sleep-disordered breathing (SDB). This study adopts a cross-sectional approach to investigate the relationship between the sleep apneas-hypopneas index during sleep and the behavioral and academic performance of schoolchildren in Taiwan. METHODS A total of 138 children (85 boys and 53 girls), ages 6-11, were recruited from two elementary schools to participate in this study. Overnight polysomnographic examinations in hospital were performed to assess sleep quality, including total sleep time, arousal index, apneas-hypopneas index, desaturation index, and lowest oxygen saturation, as well as the percentage of total sleep time spent in rapid eye movement, stage 1, stage 2, stage 3, and stage 4. The children's parents and teachers were required to complete a Chinese version of the Child Behavior Checklist and Teacher's Report Form to assess child behavior and academic achievement. RESULTS Compared with children without SDB (apneas-hypopneas index ≤1), those with severe SDB (apneas-hypopneas index >15) exhibited more irregular behavioral performance in somatic complaints (odds ratio (OR) = 9.43; 95% confidence interval (CI) = 1.04-85.71) and attention (OR = 9.95; 95% CI = 1.02-97.00). However, different severities of SDB groups did not show significant associations in academic performance. CONCLUSION Our study suggests that children with severe SDB may predispose to somatic complaints and attention problems so that sleep examination or medical intervention might be provided at an early age in these children.
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Affiliation(s)
- Hua Ting
- Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University, Taichung, Taiwan, Republic of China
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Horner RL, Bradley TD. Update in Sleep and Control of Ventilation 2008. Am J Respir Crit Care Med 2009; 179:528-32. [DOI: 10.1164/rccm.200901-0067up] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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