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Liao Z, Chen Y, Wu L, Huang Y, Li S, Liu J, Zong X, Tai J, Chen F. Associations of Obstructive Sleep Apnea Risk with Obesity, Body Composition and Metabolic Abnormalities in School-Aged Children and Adolescents. Nutrients 2024; 16:2419. [PMID: 39125300 PMCID: PMC11313962 DOI: 10.3390/nu16152419] [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: 06/28/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
The objective of this study is to explore the associations between obesity, body composition, and the self-reported risk of obstructive sleep apnea (OSA) and to examine whether the risk of OSA is related to metabolic abnormalities in children and adolescents aged 6-17 years. Utilizing data from the 2022 to 2023 Beijing Children and Adolescents Health Cohort baseline survey, 5000 school-aged participants were analyzed. OSA risk was assessed via the Pediatric Sleep Questionnaire, with anthropometric and body composition measurements taken. Metabolic markers included blood pressure, lipid levels, blood glucose, and uric acid. Associations were analyzed using logistic regression and generalized linear models. Results showed that 88.6% were low-risk and 11.4% were high-risk for OSA. Overweight (aOR 1.53, 95% CI 1.22-1.92), obesity (aOR 1.94, 95% CI 1.57-2.40), and abdominal obesity (aOR 1.59, 95% CI 1.31-1.93) significantly increased OSA risk. High fat mass was a critical factor, while muscle mass was not, especially in those who were overweight and obese. Associations of OSA risk with metabolic abnormalities were non-significant after adjusting for BMI. Our research highlights the significant associations of obesity and body composition with OSA risk, with child BMI influencing the relationship between OSA and metabolic abnormalities. Future research should explore causative relationships and the enduring impacts of OSA on metabolic health in children.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Tai
- Capital Institute of Pediatrics, Beijing 100020, China; (Z.L.); (Y.C.); (L.W.); (Y.H.); (S.L.); (J.L.); (X.Z.)
| | - Fangfang Chen
- Capital Institute of Pediatrics, Beijing 100020, China; (Z.L.); (Y.C.); (L.W.); (Y.H.); (S.L.); (J.L.); (X.Z.)
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Gan Q, Liu Q, Wu Y, Zhu X, Wang J, Su X, Zhao D, Zhang N, Wu K. The Causal Association Between Obstructive Sleep Apnea and Child-Onset Asthma Come to Light: A Mendelian Randomization Study. Nat Sci Sleep 2024; 16:979-987. [PMID: 39050365 PMCID: PMC11268851 DOI: 10.2147/nss.s472014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Obstructive sleep apnea (OSA) had been associated with asthma in observational studies, but the effect of OSA on the onset of asthma in childhood or adulthood remains unclear, and the causal inferences have not been confirmed. This study aims to investigate the potential causal association between OSA with asthma, including different age-of-onset subtypes, providing reliable basis for the clinical treatment of OSA and asthma. Patients and Methods Causality between OSA and asthma was assessed using a two-sample bi-directional Mendelian randomization (MR) analysis. OSA data were obtained from the FinnGen consortium R9, while asthma and its subtypes (adult-onset asthma, child-onset asthma, and moderate-to-severe asthma) were sourced from the IEU OpenGWAS project. The inverse-variance weighted (IVW) method was chosen as the primary analysis and was complemented by various sensitivity analyses. The MR-PRESSO outlier test was employed to systematically identify and remove outlier variants, mitigating heterogeneity and potential effects of horizontal pleiotropy. Results The MR analyses provided evidence of genetically predicted OSA having a promoting effect on child-onset asthma (OR,1.49; 95% CI, 1.05-2.11; P=0.025) and moderate-to-severe asthma (OR,1.03; 95% CI, 1.00-1.06; P=0.046). However, no causal association between OSA with asthma and adult-onset asthma was observed. Conclusion Our study revealed a causal association between OSA and child asthma, but not in adults. Moderate-to-severe asthma may have a potential promoting effect on OSA. These findings underscore the importance of age-specific considerations in managing asthma and suggests the need for personalized approaches in clinical practice.
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Affiliation(s)
- Qiming Gan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
| | - Quanzhen Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, 511436, People’s Republic of China
| | - Yanjuan Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
| | - Xiaofeng Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, 511436, People’s Republic of China
| | - Jingcun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
| | - Xiaofen Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
| | - Kang Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China
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Alkhateeb AA, Alrusayyis DF, Alrashedi EA, Alkhunaizi LT, Alali SM, Alghamdi AA. The diagnostic accuracy of the Arabic version of the Pediatric Sleep Questionnaire for screening for pediatric sleep-related breathing disorders in Saudi children. J Family Community Med 2024; 31:244-250. [PMID: 39176016 PMCID: PMC11338391 DOI: 10.4103/jfcm.jfcm_49_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Pediatric Sleep Questionnaire (PSQ) is a valid, reliable tool for screening for sleep-related breathing disorders (SRBDs) translated into several languages since 2000. The diagnostic accuracy of an Arabic version of the PSQ has never been tested. Our aim was to translate the original version of PSQ into Arabic (Arabic-PSQ), validate it as a reliable screening tool, and compare it to the gold standard diagnostic method for SRBDs. MATERIALS AND METHODS This was a prospective longitudinal study of 54 children (2-14 years) who were to undergo polysomnography (PSG). SRBD was assessed by administering the Arabic version of PSQ to the parents of these children. The validity and reliability of the Arabic-PSQ were assessed. Data were analyzed using Stata 16. Correlation between with polysomnographic indices and PSQ scores, as well as measurement of the diagnostic accuracy were determined. Receiver operating characteristic analysis between the mean PSQ scores and binary PSG results was done and the area under curve (AUC) value was calculated. RESULTS Thirty-four (63%) children were diagnosed with obstructive sleep apnea by PSG (Apnea-Hypopnea Index [AHI] ≥1), 26 of whom were accurately identified with the Arabic-PSQ (76.5%). Arabic-PSQ showed comparable validity and reliability. Using a cutoff of 0.33, the score showed a significant correlation with AHI: Rs: 0.30 (P = 0.029). The sensitivity was 76.5%, the specificity was 50%, the positive predictive was 72.2%, the negative predictive value was 55.6%, the positive likelihood ratio was 1.63, and the negative likelihood ratio was 0.37. CONCLUSIONS The Arabic-PSQ is a valid tool for the screening of Arabic-speaking populations for SRBD. It is valuable for directing the diagnostic approach in a timely and cost-effective manner.
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Affiliation(s)
- Ahmed A. Alkhateeb
- Department of Otolaryngology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Dammam, Saudi Arabia
- Department of College of Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Danah F. Alrusayyis
- Department of Otolaryngology, First Health Cluster in the Eastern Province, Dammam, Saudi Arabia
| | - Essa A. Alrashedi
- Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lama T. Alkhunaizi
- Department of College of Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shahad M. Alali
- Department of College of Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal A. Alghamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Voltan C, Concer F, Pecoraro L, Pietrobelli A, Piacentini G, Zaffanello M. Exploring the Complex Interplay of Obesity, Allergic Diseases, and Sleep-Disordered Breathing in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:595. [PMID: 38790590 PMCID: PMC11120164 DOI: 10.3390/children11050595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
This narrative review study investigates the correlations between obesity, allergies, and sleep-disordered breathing in pediatric populations. Searches for pertinent articles were conducted on the Medline PubMed Advanced Search Builder, Scopus, and Web of Science databases from unlimited to April 2024. Sleep-disordered breathing causes repeated upper airway obstructions, leading to apneas and restless sleep. Childhood obesity, which affects around 20% of children, is often associated with sleep-disordered breathing and allergies such as asthma and allergic rhinitis. It is distinguished between diet-induced obesity (resulting from excess of diet and physical inactivity) and genetic obesity (such as is seen in Down syndrome and Prader-Willi syndrome). In children with diet-induced obesity, chronic inflammation linked to weight can worsen allergies and increase the risk and severity of asthma and rhinitis. Furthermore, the nasal congestion typical of rhinitis can contribute to upper respiratory tract obstruction and obstructive sleep apnea. A vicious circle is created between asthma and sleep-disordered breathing: uncontrolled asthma and sleep-disordered breathing can worsen each other. In children with genetic obesity, despite alterations in the immune system, fewer allergies are observed compared to the broader population. The causes of this reduced allergenicity are unclear but probably involve genetic, immunological, and environmental factors. Additional research is necessary to elucidate the underlying mechanisms. The present narrative review study emphasizes the importance of jointly evaluating and managing allergies, obesity, and obstructive sleep apnea in children considering their close interconnection.
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Affiliation(s)
| | | | | | | | | | - Marco Zaffanello
- Pediatric Clinic, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy (A.P.)
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Kaneko M, Hirata M, Kimura A, Inada H, Shikano K, Ito S, Okano T, Yatsuya H, Nakata S. Relationship between size of pharyngeal and palatine tonsils and apnea-hypopnea index in pediatric obstructive sleep apnea. FUJITA MEDICAL JOURNAL 2024; 10:60-63. [PMID: 38708074 PMCID: PMC11063576 DOI: 10.20407/fmj.2023-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/19/2023] [Indexed: 05/07/2024]
Abstract
Objective To determine whether the combination of the pharyngeal tonsil grade and palatine tonsil grade results in differences in the apnea-hypopnea index (AHI) and to determine whether each parameter separately (pharyngeal tonsil grade and palatine tonsil grade) results in differences in severe obstructive sleep apnea (OSA). Methods This cross-sectional study involved 107 children (mean age, 7.2 years; range, 4-12 years) suspected of having OSA because of snoring or sleep-related complaints. The patients underwent polysomnography, and their palatine and pharyngeal tonsils were graded. Results In examining whether the palatine tonsils and pharyngeal tonsils could be risk factors for severe OSA, the adjusted odds ratios were 4.42 for palatine tonsil grade 4 versus 1-3 and 10.40 for pharyngeal tonsil grade 4 versus 1-3; both were highly statistically significant. We also found that the AHI when both the pharyngeal and palatine tonsils were grade 4 was higher than the AHI expected for the pharyngeal and palatine tonsils alone. Conclusions The combination of grade 4 pharyngeal tonsils and grade 4 palatine tonsils resulted in an AHI much higher than the AHI of other combinations (pharyngeal tonsils grades 1-3 and 4, palatine tonsils grades 1-3 and 4). We believe that grade 4 pharyngeal tonsils and grade 4 palatine tonsils have a great influence on severe OSA and that grade 4 pharyngeal tonsils increase the AHI.
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Affiliation(s)
- Masamichi Kaneko
- Department of Otolaryngology and Sleep Medicine, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Masatoshi Hirata
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Ayami Kimura
- Department of Otolaryngology and Sleep Medicine, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Hiroya Inada
- Department of Otolaryngology and Sleep Medicine, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Kazuki Shikano
- Department of Otolaryngology and Sleep Medicine, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Ito
- Department of Otolaryngology and Sleep Medicine, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Takayuki Okano
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Seiichi Nakata
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
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Dékány L, Molnár V, Molnár A, Bikov A, Lázár Z, Bárdos-Csenteri O, Benedek P. Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome. Eur Arch Otorhinolaryngol 2023; 280:5607-5614. [PMID: 37758856 PMCID: PMC10620301 DOI: 10.1007/s00405-023-08237-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA. METHODS This retrospective study included 921 children aged 2-18 years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman's correlation, Receiver Operating Characteristics (ROC) analyses were performed and area under the curve (AUC) was determined. RESULTS We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the BMI percentile (0.59 AUC [0.54-0.65]) and age (0.58 AUC [0.52-0.63]) predicted severe OSA, according to the sensitivity and specificity values of the ROC curve, the association presents a slight clinical relevance. CONCLUSIONS OSA severity is determined by the BMI percentile and age in children; however, these factors are unsuitable for predicting severe OSA in clinical practice. Based on our results, obesity is also a significant risk factor for OSA in younger children. Our study highlights that older, overweight, and obese children have a higher risk for severe OSA.
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Affiliation(s)
- Lea Dékány
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Viktória Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
| | - András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - András Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zsófia Lázár
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Pálma Benedek
- Sleep Laboratory and Sleep Surgery Unit, Heim Pál National Paediatric Institute, Budapest, Hungary
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Taherifard E, Taherifard E, Hosseini-Bensenjan M, Sayadi M, Haghpanah S. The Prevalence of Obstructive Sleep Apnea and Associated Symptoms among Patients with Sickle Cell Disease: A Systematic Review and Meta-analysis. Hemoglobin 2023; 47:215-226. [PMID: 38102839 DOI: 10.1080/03630269.2023.2290507] [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: 08/01/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
Previous studies have shown that patients with sickle cell disease (SCD) are at high risk for obstructive sleep apnea (OSA). In the current study, we aimed to systematically review the literature to address the prevalence of OSA and associated symptoms among patients with SCD. Electronic databases, including Web of Science, Scopus, PubMed, Google Scholar, and Embase were systematically searched to identify the relevant original articles on patients with SCD. Newcastle Ottawa scale was used for quality assessment. Data were pooled by using random effects models. Subgroup analyses were performed by age groups. Thirty-nine studies containing details of 299,358 patients with SCD were included. The pooled results showed that more than half of these patients had OSA with different severities. The prevalence rates of OSA among children with apnea hypopnea index (AHI) cutoffs of above 1, 1.5, and 5 were 51% (95% confidence interval (CI) 36-67%), 29% (95% CI 19-40%), and 18% (95% CI 14-23%), respectively. The prevalence of OSA among adults with AHI cutoff of 5 was 43% (95% CI 21-64%). The pooled rates of snoring, nocturnal enuresis, nocturnal desaturation, and daytime sleepiness were 55% (95% CI 42-69%), 37% (95% CI 33-41%), 49% (95% CI 26-72%), and 21% (95% CI 12-30%), respectively. Given the high prevalence of OSA in patients with SCD, probable greater burden of SCD complications, and irreversible consequences of OSA, screening for OSA symptoms and signs seems useful in these patients. By screening and identifying this heterogeneous disorder earlier, available treatment modalities can be individualized for each patient.
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Affiliation(s)
- Ehsan Taherifard
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Taherifard
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zaffanello M, Piacentini G, Nosetti L, Zoccante L. Sleep Disordered Breathing in Children with Autism Spectrum Disorder: An In-Depth Review of Correlations and Complexities. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1609. [PMID: 37892271 PMCID: PMC10605434 DOI: 10.3390/children10101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Sleep-disordered breathing is a significant problem affecting the pediatric population. These conditions can affect sleep quality and children's overall health and well-being. Difficulties in social interaction, communication, and repetitive behavioral patterns characterize autism spectrum disorder. Sleep disturbances are common in children with ASD. This literature review aims to gather and analyze available studies on the relationship between SDB and children with autism spectrum disorder. We comprehensively searched the literature using major search engines (PubMed, Scopus, and Web of Science). After removing duplicates, we extracted a total of 96 records. We selected 19 studies for inclusion after a thorough title and abstract screening process. Seven articles were ultimately incorporated into this analysis. The research findings presented herein emphasize the substantial influence of sleep-disordered breathing on pediatric individuals diagnosed with autism spectrum disorder (ASD). These findings reveal a high incidence of SDB in children with ASD, emphasizing the importance of early diagnosis and specialized treatment. Obesity in this population further complicates matters, requiring focused weight management strategies. Surgical interventions, such as adenotonsillectomy, have shown promise in improving behavioral issues in children with ASD affected by OSA, regardless of their obesity status. However, more comprehensive studies are necessary to investigate the benefits of A&T treatment, specifically in children with ASD and OSA. The complex relationship between ASD, SDB, and other factors, such as joint hypermobility and muscle hypotonia, suggests a need for multidisciplinary treatment approaches. Physiotherapy can play a critical role in addressing these intricate health issues. Early sleep assessments and tailored weight management strategies are essential for timely diagnosis and intervention in children with ASD. Policy initiatives should support these efforts to enhance the overall well-being of this population. Further research is crucial to understand the complex causes of sleep disturbances in children with ASD and to develop effective interventions considering the multifaceted nature of these conditions.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy;
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, “F. Del Ponte” Hospital, Insubria University, 21100 Varese, Italy;
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy;
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Ohuche IO, Iloanusi NI, Dike CM, Chime EN. Clinical presentation, radiographic findings, and treatment outcomes in children with adenoid hypertrophy in a paediatric outpatient clinic in Enugu, Nigeria. Ghana Med J 2023; 57:204-209. [PMID: 38957679 PMCID: PMC11216733 DOI: 10.4314/gmj.v57i3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objectives To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting. Design A retrospective study. Setting The paediatric clinic of a private hospital in Enugu. Participants 51 children, aged 2 to 108 months, with suggestive clinical features and radiographic report of adenoid hypertrophy who presented over 3 years. Interventions Clinical information was obtained from the patient's medical records. Data was analysed for the clinical characteristics of the patients, the relationship between the degree of airway narrowing on a postnasal space (PNS) radiograph and treatment outcomes. Main outcome measures Degree of airway narrowing as measured on a PNS radiograph, the type of and outcomes of treatment. Results There was an almost equal male (54.7%): female (45.1%) ratio in the occurrence of adenoid hypertrophy, with a mean age of occurrence of 31.50 ± 3.64 months. Noisy breathing was the commonest symptom (94.1%); history of atopic rhinitis in 64.7% of cases and hyperactive airway disease in 45.1% more than 50% of cases with airway narrowing resolved with medical management only. Conclusion Adenoid hypertrophy should be considered in evaluating the upper airway in children under five. Paediatricians should be conversant with diagnosing and managing this common cause of upper airway obstruction. Funding None declared.
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Affiliation(s)
- Ijeoma O Ohuche
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu
- Department of Paediatrics, Niger Foundation Hospital and Diagnostic Centre, Enugu
| | - Nneka I Iloanusi
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu
| | - Chinedu M Dike
- Department of Family Medicine, Niger Foundation Hospital and Diagnostic Centre, Enugu
| | - Ethel N Chime
- Department of Otorhinolaryngology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu
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Nosetti L, Zaffanello M, De Bernardi di Valserra F, Simoncini D, Beretta G, Guacci P, Piacentini G, Agosti M. Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1426. [PMID: 37628425 PMCID: PMC10453215 DOI: 10.3390/children10081426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Adenotonsillar hypertrophy has been well-acknowledged as the primary instigator of sleep-disordered breathing in the pediatric population. This condition spans a spectrum, from typical age-related growth that the immune system influences to persistent pathological hypertrophy. Reduction in air spaces, metabolic changes, neurobehavioral alterations, and chronic inflammation characterizes the latter form. As the go-to treatment, adenotonsillectomy has proven effective. However, it is not a guarantee for all patients, leaving us without reliable predictors of treatment success. Evidence suggests a connection between adenotonsillar hypertrophy and specific oral breathing patterns resulting from craniofacial development. This finding implies an intricate interdependence between the two, hinting at a self-sustaining vicious cycle that persists without proper intervention. The theories regarding the relationship between craniofacial conformation and sleep-disordered breathing have given rise to intriguing perspectives. In particular, the "gracilization theory" and the "gravitational hypothesis" have provided fascinating insights into the complex interaction between craniofacial conformation and SDB. Further investigation is crucial to unraveling the underlying pathophysiological mechanisms behind this relationship. It is also vital to explore the risk factors linked to adenotonsillectomy failure, study the long-term effects of adenotonsillar hypertrophy on craniofacial growth, and devise innovative diagnostic techniques to detect upper airway compromise early. Moreover, to assess their efficacy, we must delve into novel therapeutic approaches for cases that do not respond to traditional treatment, including positional therapy and orofacial myofunctional therapy. Though complex and unpredictable, these challenges promise to enhance our understanding and treatment of adenotonsillar hypertrophy and its related complications in children. By taking on this task, we can pave the way for more effective and targeted interventions, ultimately improving affected individuals' well-being and quality of life.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Francesca De Bernardi di Valserra
- Division of Otorhinolaryngology, Department of Biotechnologies and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Daniela Simoncini
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Pietro Guacci
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Giorgio Piacentini
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
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11
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Khadgi A, Koirala K, Maharjan S, Chalise K, Dhungana I, Babu Karki B. Correlation of Conductive Hearing Impairment With Sizes of Adenoids in the Pediatric Age Group: An Observational Case-Control Study. Cureus 2023; 15:e44439. [PMID: 37791228 PMCID: PMC10544040 DOI: 10.7759/cureus.44439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION When adenoids enlarge and elicit symptoms it is referred to as symptomatic adenoids, which is a preventable cause of hearing loss and nasal obstruction in the pediatric age group. This study was done to correlate conductive hearing loss with the size of adenoids and to emphasize the importance of screening in the pediatric age group. METHODS An observational case-control study was conducted to analyze the degree of hearing impairment in children with adenoid hypertrophy. In total, 98 patients with at least one symptom of adenoid hypertrophy aged between 5 and <15 years were recruited. Those with conductive hearing loss were in the case group and those with normal hearing were in the control group. Audiometry, tympanogram, X-ray, and fibreoptic nasal endoscopy were conducted and compared. RESULTS The mean age of presentation of conductive hearing loss with adenoids was 7.67 years. The mean conductive hearing loss on audiometry was 31.69 dB. Tympanogram showed a type B curve in 40.81% of ears and type C in 26.53%. On X-ray nasopharynx, the majority of cases had grade III hypertrophy followed by grade II and grade IV. In nasal endoscopy, most cases had second-degree adenoid hypertrophy followed by third degree, first degree, and then fourth degree. The highest degree of hearing loss of 32-48 dB was present with fourth-degree adenoids. Conductive hearing loss was five times more in patients with third- and fourth-degree adenoids. CONCLUSIONS In our study, adenoid hypertrophy has a positive correlation with conductive hearing loss in pediatric patients. So proper screening and early management should be done to prevent hearing loss in children.
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Affiliation(s)
- Ashish Khadgi
- Department of Otolaryngology, Head and Neck Surgery, Buddha International Hospital, Ghorahi, NPL
| | - Krishna Koirala
- Department of Otolaryngology, Head and Neck Surgery, Manipal College of Medical Sciences, Pokhara, NPL
| | - Sanjay Maharjan
- Department of Otolaryngology, Head and Neck Surgery, Tulsipur City Hospital, Tulsipur, NPL
| | - Kamana Chalise
- Department of Otolaryngology, Head and Neck Surgery, BP Koirala Memorial Cancer Hospital, Chitwan, NPL
| | - Inclub Dhungana
- Department of Otolaryngology, Head and Neck Surgery, Hetauda Hospital, Hetauda, NPL
| | - Bikram Babu Karki
- Department of Otolaryngology, Head and Neck Surgery, Fishtail Hospital, Pokhara, NPL
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12
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Bravo-Quelle N, Sáez-Ansotegui A, Bellón-Alonso S, Lowy-Benoliel A, García-Santiago S, Ribeiro-Arold C, Prieto-Montalvo J. [Prevalence of childhood obstructive sleep apnoea syndrome in a referral sleep unit]. Rev Neurol 2023; 76:279-285. [PMID: 37102252 PMCID: PMC10478145 DOI: 10.33588/rn.7609.2023076] [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: 04/12/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Obstructive sleep apnoea syndrome (OSAS) affects between 1% and 6% of children. Its diagnosis includes: a) snoring and/or apnoea; and b) an apnoea and hypopnoea index >3/hour obtained by polysomnography (PSG). The main aim of this work is to determine the prevalence of OSAS in our study population. PATIENTS AND METHODS We conducted a descriptive study with a sample of 151 children aged between 1 and 12 years, who had been referred to the sleep unit of the Hospital General Universitario Gregorio Maranon for a PSG. We analysed the demographic variables sex and age; the clinical variables snoring, apnoeas and tonsillar hypertrophy; and the presence of OSAS based on the polysomnographic diagnostic criterion of an apnoea and hypopnoea index >3/hour. RESULTS The mean age of the sample was 5.37 years (standard deviation: 3.05) and 64.9% were males. In 90.1% of cases, the reason for the visit was suspected OSAS. Snoring, apnoeas and tonsillar hypertrophy were observed in 73.5, 48.7 and 60% of cases, respectively. OSAS was diagnosed en 19 children (12.6%); in 13.5% of snorers; in 15.1% of those with apnoeas; and in 15.6% of the children with tonsillar hypertrophy. CONCLUSIONS In our study, the prevalence of OSAS in children was 12.6%, which is higher than that reported in most epidemiological studies that include PSG for the diagnosis of OSAS.
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Affiliation(s)
| | - Aiala Sáez-Ansotegui
- Servicio de Neurofisiología ClínicaServicio de Neurofisiología ClínicaServicio de Neurofisiología ClínicaMadridEspaña
| | - Sara Bellón-Alonso
- Unidad de Neumología Pediátrica. Servicio de Pediatría. Hospital Materno Infantil Gregorio Marañón. Madrid, EspañaHospital Materno Infantil Gregorio MarañónHospital Materno Infantil Gregorio MarañónMadridEspaña
| | - Alejandro Lowy-Benoliel
- Sección de Otorrinolaringología Pediátrica. Servicio de Otorrinolaringología. Hospital General Universitario Gregorio MarañónHospital General Universitario Gregorio MarañónHospital General Universitario Gregorio MarañónMadridEspaña
| | | | | | - Julio Prieto-Montalvo
- Servicio de Neurofisiología ClínicaServicio de Neurofisiología ClínicaServicio de Neurofisiología ClínicaMadridEspaña
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13
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Williamson A, McArdle EH, Morrow VR, Zalzal HG, Carr MM, Coutras SW. Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2023; 168:839-847. [PMID: 35439065 DOI: 10.1177/01945998221094211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Drug-induced sleep endoscopy-directed lingual tonsillectomy and midline posterior glossectomy have been employed for the treatment of obstructive sleep apnea in children. The purpose of this study is to evaluate outcomes in children undergoing lingual tonsillectomy, midline posterior glossectomy, or combined base of tongue reduction procedures for obstructive sleep apnea. STUDY DESIGN Case series with chart review. SETTING Tertiary care academic medical center. METHODS A case series was performed with chart review of pediatric patients with obstructive sleep apnea who underwent base of tongue surgery as directed by drug-induced sleep endoscopy. Pre- and postoperative obstructive apnea-hypopnea index (oAHI) was compared. Age, sex, body mass index z score, and medical history were also evaluated. RESULTS A total of 168 children were included, with a mean ± SD age of 8.3 ± 3.6 years. Of these patients, 101 underwent lingual tonsillectomy alone; 25, midline posterior glossectomy alone; and 42, both. Their mean oAHI improvement was 3.52 ± 8.39, 2.55 ± 5.59, and 3.70 ± 6.07, respectively. Each surgical group experienced significant improvement in sleep apnea when pre- and postoperative oAHI was compared (P < .01). Overall surgical success, as defined by oAHI <1 (or <5 without clinical symptoms), was 75% (126 patients). CONCLUSION When guided by drug-induced sleep endoscopy, pediatric tongue base surgery can significantly improve oAHI and thus demonstrates promising success in treating pediatric obstructive sleep apnea.
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Affiliation(s)
- Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Erica H McArdle
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Vincent R Morrow
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Habib G Zalzal
- Department of Otolaryngology-Head and Neck Surgery, Children's National Hospital, Washington, DC, USA
| | - Michele M Carr
- Department of Otolaryngology-Head Neck Surgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Steven W Coutras
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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14
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Jafar NKA, Bennett CJ, Moran LJ, Mansfield DR. Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health. Semin Reprod Med 2023; 41:45-58. [PMID: 38113883 DOI: 10.1055/s-0043-1777724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae that affects 8 to 13% of reproductive-aged women and 3 to 11% of adolescent girls. Sleep is often compromised in women with PCOS due to increased rates of sleep problems, with the most established problem being obstructive sleep apnea (OSA). OSA is highly prevalent in reproductive-aged adult women with PCOS, but not so in adolescence. The international evidence-based PCOS guideline to improve health outcomes in women with PCOS indicated routine screening to identify and alleviate symptoms of OSA. The guidelines, however, did not weigh other multidimensional constructs of sleep health such as sleep disturbances (e.g., sleep quality and quantity), beyond OSA. This is perhaps due to the lack of research and existing mixed findings in the area of PCOS and sleep health. This narrative review summarizes the current knowledge about OSA and expands further to include the limited knowledge about other sleep problems in PCOS among reproductive-aged women and adolescent girls. We broadly cover the prevalence, risk factors, and mechanisms of sleep problems in PCOS and their relationship with cardiometabolic and psychological health. A brief summary on treatment and intervention strategies for sleep problems in PCOS and future recommendations will be deliberated.
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Affiliation(s)
- Nur K Abdul Jafar
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christie J Bennett
- Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Darren R Mansfield
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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15
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Williamson AA, Johnson TJ, Tapia IE. Health disparities in pediatric sleep-disordered breathing. Paediatr Respir Rev 2023; 45:2-7. [PMID: 35277358 PMCID: PMC9329494 DOI: 10.1016/j.prrv.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.
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Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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16
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Role of Laryngopharyngeal Reflux Changes in Children with Adenoid Hypertrophy: A Randomized Controlled Prospective Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:5628551. [PMID: 36793763 PMCID: PMC9925235 DOI: 10.1155/2023/5628551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 02/09/2023]
Abstract
Objectives This prospective randomized controlled analysis aimed to assess the changes in laryngopharyngeal reflux (LPR) in children with adenoid hypertrophy (AH). Study design: a prospective, randomized, and controlled analysis. Methods The reflux symptom index (RSI) and the reflux finding score (RFS) scores were used to evaluate the laryngopharyngeal reflux changes in children diagnosed with adenoid hypertrophy. The pepsin concentration in salivary samples was examined, and the positive pepsin was used to assess the sensitivity and specificity of RSI, RFS, and RSI combined with RFS in forecasting LPR. Results In 43 children with AH, the sensitivity of the RSI and RFS scale (used alone or in combination) in diagnosing pharyngeal reflux in children with adenoid hypertrophy was lower. Pepsin expression was identified in 43 items of salivary samples, with a total positive rate of 69.77%, most of which were optimistic. The expression level of pepsin was positively correlated with the grade of adenoid hypertrophy (r = 0.576, P < 0.01). Based on the positive rate of pepsin, we found that the sensitivity and specificity of RSI and RFS were 5.77%, 35.03%, and 91.74%, 55.89%. Moreover, there was a noticeable distinction in the number of acid reflux episodes between the LPR-positive and LPR-negative groups. Conclusion There is a special connection between LPR change and children's AH. LPR exerts a crucial role in the progression of children's AH. Because of the low sensitivity of RSI and RFS, it is not suitable for LPR children to choose AH.
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17
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Ambulatory Blood Pressure Variability after Adenotonsillectomy in Childhood Sleep Apnea. Laryngoscope 2022; 132:2491-2497. [PMID: 35156724 DOI: 10.1002/lary.30058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the influence of adenotonsillectomy (T&A) on ambulatory blood pressure (BP) variability in children with obstructive sleep apnea (OSA). STUDY DESIGN Prospective, interventional study. METHODS Children with OSA symptoms were recruited from a tertiary center. After OSA diagnosis was confirmed (ie, apnea-hypopnea index [AHI] > 1), these children underwent T&A for treatment. We performed polysomnography and 24-hour recordings of ambulatory BP before and 3 to 6 months postoperatively. Ambulatory BP variability was presented as the standard deviation of mean blood pressure in the 24-hour monitoring of ambulatory BP. Differences in BP variability among different subgroups were tested using a multivariable linear mixed model. RESULTS A total of 190 children were enrolled (mean age: 7.8 ± 3.3 years; 73% were boys; 34% were obese). The AHI significantly decreased from 12.3 ± 17.0 to 2.7 ± 5.5 events/hr after T&A. Overall, daytime, and nighttime ambulatory BP did not significantly change postoperatively, and overall, daytime, and nighttime ambulatory BP variability did not differ significantly preoperatively and postoperatively. In the subgroup analysis, children aged <6 years demonstrated a significantly greater decrease in ambulatory BP variability postoperatively than those aged >6 years (nighttime diastolic BP variability: 9.9 to 7.7 vs. 8.9 to 9.4). Children with hypertension also showed a significantly greater decrease in ambulatory BP variability than those without hypertension. CONCLUSIONS We concluded that overall ambulatory BP variability does not significantly change after T&A in children with OSA. Moreover, young-aged and hypertensive children demonstrate a significant decrease in BP variability after T&A. LEVEL OF EVIDENCE 4 Laryngoscope, 132:2491-2497, 2022.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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18
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Kourelis K, Marazioti A, Kourelis T, Stathopoulos GT. Haematologic Markers and Tonsil-to-Body Weight Ratio to Assist Adenotonsillar Hypertrophy Diagnosis. Indian J Otolaryngol Head Neck Surg 2022; 74:5604-5610. [PMID: 36742935 PMCID: PMC9895696 DOI: 10.1007/s12070-021-02943-9] [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: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Aims Diagnosis of Adenotonsillar Hypertrophy (ATH), the leading cause of pediatric Obstructive Sleep Apnea (OSA), depends on physical exam via Brodsky's staging of tonsils. This study investigates the associations of ATH with patient parameters, and balances in-office tonsil hypertrophy appraisal against true organ mass. Materials and Methods A prospective cohort was formed of 103 children operated for ATH, and 31 matched controls. Demographic, clinical and tympanographic data, as well as Complete Blood Count (CBC) indices were compared. Absolute and relative to total body weight tonsil specimen mass were correlated with Brodsky's score. Results Tonsillar size indices were significantly raised in ATH patients. Elevated leukocytes (P = 0.012) and increased neutrophil percentage (P = 0.025) conveyed higher ATH risk. Subjective evaluation of tonsils graded 1 or 2 correlated significantly with absolute (P = 0.001) and relative (P = 0.006) objective measurements. Brodsky's score 3 and 4 displayed marginal significant association with relative (P = 0.050) but not with true (P = 0.989) mass. Conclusion An occult hematologic inflammatory response was detected in ATH children. Clinical estimation of severely hypertrophic tonsils should be adjusted for total body weight. Trial Registration Number: NCT03541434 (clinicaltrials.gov).
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Affiliation(s)
- Konstantinos Kourelis
- Department of Otolaryngology, Children’s Hospital of Patras “Karamandaneio”, Erythrou Stavrou 40 Str., 26331 Patras, Achaia Greece
| | - Antonia Marazioti
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, Biomedical Sciences Research Center, University of Patras, 1 Asklepiou Str., University Campus, 26504 Rio, Achaia Greece
| | - Theodoros Kourelis
- Department of Medical Oncology, “Olympion” General Hospital, Volou & Meilichou Str., 26443 Patras, Achaia Greece
| | - Georgios T. Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, Biomedical Sciences Research Center, University of Patras, 1 Asklepiou Str., University Campus, 26504 Rio, Achaia Greece
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Hsueh WY, Kang KT, Yao CCJ, Chen YJ, Weng WC, Lee PL, Chang CW, Hsu WC. Measurements of craniofacial morphology using photogrammetry in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2022; 162:111287. [PMID: 36029654 DOI: 10.1016/j.ijporl.2022.111287] [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: 05/06/2022] [Revised: 07/20/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the craniofacial morphology in children with sleep-disordered breathing (SDB) using nonradiation and readily accessible photogrammetry technique. METHODS Included children aged 3-18 years with SDB-related symptoms from April 2019 to February 2020 in a tertiary center. All participants underwent craniofacial photogrammetry and overnight polysomnography (PSG). Participants were stratified into 2 groups (obstructive sleep apnea [OSA] group: apnea-hypopnea index [AHI] ≥ 1 and non-OSA group: AHI <1). Craniofacial photogrammetry was performed to derive variables of craniofacial features in standardized frontal and profile views. The 2 groups were propensity score matched based on age, sex, and body mass index (BMI) percentiles. Associations between craniofacial feature variables and OSA (AHI ≥1) likelihood were examined using logistic regression test. intraclass correlation coefficient (ICC) was used to evaluate the intrarater and interrater reliability. RESULTS In total, 58 children were enrolled for the analysis after matching. All 3 variables representing the mandibular plane angle in the profile view were increased in the OSA group (mego-tn: 34.85 ± 5.99 vs 31.65 ± 5.96°, odds ratio [OR]: 1.10, 95% CI:1.02 to 1.18, P = .01; tn-gogn: 28.65 ± 6.38 vs 25.91 ± 5.38°, OR: 1.08, 95% CI:1.02 to 1.15, P = .012; and gome-tsup: 26.71 ± 6.13 vs 22.20 ± 5.89°, OR: 1.13, 95% CI:1.04 to 1.23, P = .003). CONCLUSIONS Craniofacial photogrammetry revealed increased mandibular inclination in children with OSA. A steep mandibular plane with craniofacial photogrammetry is considered a potential predictor of pediatric OSA. Further investigation with a large sample size is required to clarify the validity of photogrammetry in evaluating pediatric OSA.
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Affiliation(s)
- Wan-Yi Hsueh
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Wei Chang
- Division of Endodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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20
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Jurado MJ, Sampol G, Quintana M, Romero O, Cambrodí R, Ferré A, Sampol J. Nasal cannula use during polysomnography in children aged under three with suspected sleep apnea. Sleep Med 2022; 99:41-48. [PMID: 35947888 DOI: 10.1016/j.sleep.2022.07.009] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Early diagnosis of obstructive sleep apnea (OSA) in children is important. The use of a nasal cannula as an airflow sensor during polysomnography has not been evaluated in younger children. The study aims to evaluate the use of nasal cannula in detecting respiratory events in children under three with suspected OSA during daytime nap studies. METHODS A total of 185 patients were prospectively included. Respiratory events were scored using nasal cannula alone, thermistor alone, and both methods simultaneously as the airflow sensor. Agreement and diagnostic accuracy were assessed. RESULTS One hundred and seventy-two children were finally analyzed and 110 (64.0%) presented OSA. Total sleep time with an uninterpretable signal was longer with the nasal cannula than with the thermistor (17.8% vs 1.9%; p < 0.001), and was associated with poor sensor tolerance and adenotonsillar hypertrophy. In the estimation of the apnea-hypopnea index, the nasal cannula showed lower agreement than the thermistor with the joint use of the two sensors (intraclass correlation coefficient: 0.79 vs 0.996 with thermistor). Compared with the thermistor, the nasal cannula presented lower sensitivity for detecting OSA (82.7% vs 95.5%) and a lower negative predictive value (76.5% vs 92.4%). Overall, fewer children were diagnosed with severe OSA with the nasal cannula (19.8% vs 30.8% with the thermistor, and 32.6% with both). CONCLUSIONS In children under the age of three, the ability of the nasal cannula to detect obstructive events was relatively low. Therefore, other non-invasive measurements for identifying respiratory events during sleep may be of additional value.
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Affiliation(s)
- María José Jurado
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Gabriel Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Odile Romero
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Roser Cambrodí
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Alex Ferré
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Júlia Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
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21
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Kang JH, Kim HJ, Song SI. Obstructive sleep apnea and anatomical structures of the nasomaxillary complex in adolescents. PLoS One 2022; 17:e0272262. [PMID: 35925992 PMCID: PMC9352039 DOI: 10.1371/journal.pone.0272262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of the present study was to reveal the associations between skeletal and soft tissue features of the nasomaxillary complex and development and severity of obstructive sleep apnea (OSA) in adolescents. A total of 100 adolescents (mean age, 14.9 ± 1.4 years; age range, 13–17 years) were enrolled. All participants underwent full-night polysomnography and had an assessment of size and position of the tongue, tonsillar size, body mass index (BMI), and circumference of the waist, neck, and hip. The skeletal features of the nasomaxillary complex, including the zygomatic arch width, nasal cavity width, nasal base width, intercanine width, intermolar width, maxillary dental arch length, palatal vault angle, palatal depth, and SNA were measured on the three-dimensional images constructed with computed tomography data. Participants with an apnea and hypopnea index (AHI) of lower than 5 (AHI ≤ 5) were classified as control and participants while those with an AHI of greater than 5 were classified as OSA group. Each variable with a significant outcome in the independent T-test and age and sex factors were integrated into the multivariate linear regression and the dependent variable was AHI. There were significant differences in the BMI and hip circumference between two groups. The width of nasal base, palatal vault angle and SNA also showed significant differences between groups. The results from multivariate linear regression demonstrated that the BMI, width of the nasal base, and SNA showed significant contributions to the severity of OSA in adolescents. The features of the nasomaxillary complex seemed to have significant influences on development and severity of OSA.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
| | - Hyun Jun Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Gyeonggi-do, Korea (ROK)
| | - Seung Il Song
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
- * E-mail:
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22
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Friedman NR, Meier M, Tholen K, Crowder R, Hoefner-Notz R, Nguyen T, Derieg S, Campbell K, McLeod L. Tonsillectomy for Obstructive Sleep-Disordered Breathing: Should They Stay, or Could They Go? Laryngoscope 2022; 132:1675-1681. [PMID: 34672364 DOI: 10.1002/lary.29909] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Children who do not require oxygen beyond 3 hours after surgery and pass a sleep room air challenge (SRAC) are safe for discharge regardless of polysomnogram (PSG) results or comorbidities. STUDY DESIGN Cross-sectional prospective study. METHODS All children observed overnight undergoing an adenotonsillectomy for obstructive sleep-disordered breathing were prospectively recruited. Demographic, clinical, and PSG characteristics were stratified by whether the patient had required oxygen beyond 3 hours postoperatively (prolonged oxygen requirement [POR]) and compared using t test, chi-squared test, or Fisher's exact test depending on distribution. Optimal cut points for predicting POR postsurgery were calculated using receiver operating characteristic curves. The primary analysis was performed on the full cohort via logistic regression using POR as the outcome. Significant characteristics were analyzed in a logistic regression model, with significance set at P < .05. RESULTS A total of 484 participants met the inclusion criteria. The mean age was 5.65 (standard deviation = 4.02) years. Overall, 365 (75%) did not have a POR or any other adverse respiratory event. In multivariable logistic regression, risk factors for POR were an asthma diagnosis (P < .001) and an awake SpO2 <96% (P = .005). The probability of a POR for those without asthma and a SpO2 ≥ 96% was 18% (95% confidence interval: 14-22). Age, obesity, and obstructive apnea/hypopnea index were not associated with POR. CONCLUSIONS In conclusion, all children in our study who are off oxygen within 3 hours of surgery and passed a SRAC were safe for discharge from a respiratory standpoint regardless of age, obesity status, asthma diagnosis, and obstructive apnea/hypopnea index. Additional investigations are necessary to confirm our findings. LEVEL OF EVIDENCE 3 Laryngoscope, 132:1675-1681, 2022.
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Affiliation(s)
- Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaitlyn Tholen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Renee Crowder
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Regina Hoefner-Notz
- Perioperative Services, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Thanh Nguyen
- Division of Pediatric Anesthesia, Children's Hospital Colorado, Aurora, Colorado, U.S.A
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Sarah Derieg
- Ambulatory Services, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Lisa McLeod
- Pediatric Center of Excellence, Global Product Development, Pfizer, Inc., New York, New York, U.S.A
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23
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Obstructive sleep apnea and amyloid-β42 in adolescents: The results of a pilot study. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Obstructive sleep apnea (OSA) is a chronic condition characterized by repetitive collapse of the upper airway during sleep leading to intermittent hypoxia, excessive arousals and disrupt of sleep homeostasis. OSA is associated with obesity as well as pathological dynamics of cerebral beta-amyloid and dementia.The aim. Comparative assessment of the plasma beta-amyloid 42 levels in adolescents, depending on the presence or absence of OSA and obesity.Materials and methods. Seventy-four obese and non-obese male adolescents were included in the study. All participants underwent polysomnography to verify OSA and measure sleep parameters, and venipuncture for the assessment of betaamyloid 42 by enzyme-linked immunosorbent assay (ELISA).Results. After polysomnography all adolescents have been divided into four study groups: OSA obese (group 1; n = 28); non-OSA obese (group 2; n = 20); OSA non-obese (group 3; n = 11), and non-OSA non-obese (group 4 – control; n = 15). OSA obese adolescents had significant elevations in beta-amyloid 42 plasma levels compared with participants from three other groups (р = 0.007, p = 0.047 and p = 0.0002, correspondingly). Compared to both OSA non-obese adolescents and the control group, non-OSA obese patients had similar beta-amyloid 42 blood concentrations (p = 0.167 and p = 0.155, correspondingly). However, patients from the group 3 showed significantly higher beta-amyloid 42 plasma levels than controls (p = 0.004).Conclusions. Thus, OSA, accompanied by intermittent nocturnal hypoxia, and particularly OSA and obesity comorbidity, in adolescents is associated with increased beta-amyloid 42 circulating concentrations, which has a major role in pathogenesis of dementia. Beta-amyloid 42 plasma level may be recommended for use as early biomarker of cognitive impairment and neurodegenerative diseases, but future researches are needed.
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24
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Kang KT, Weng WC, Chiu SN, Lee PL, Hsu WC. Office Blood Pressure Monitoring in Children with Obesity and Obstructive Sleep Apnea. J Pediatr 2022; 246:138-144.e2. [PMID: 35314156 DOI: 10.1016/j.jpeds.2022.03.024] [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: 11/27/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the relative contributions of obesity and obstructive sleep apnea (OSA) to unfavorable blood pressure in children. STUDY DESIGN Children aged 3-18 years with OSA-related symptoms were recruited. All children underwent office blood pressure (BP) monitoring and full-night polysomnography. Obesity was defined as a body mass index ≥95th percentile. OSA severity was divided into primary snoring (apnea-hypopnea index [AHI] <1), mild OSA (5> AHI ≥1), and moderate to severe OSA (AHI ≥5). Age- and sex-adjusted logistic regression analysis was performed to determine the associations among OSA, obesity, and elevated BP. RESULTS This cross-sectional study enrolled 1689 children (66% boys), with a mean age of 7.9 years. Compared with children with primary snoring, children with moderate to severe OSA had significantly higher systolic BP (108.1 mmHg vs 105.6 mmHg), diastolic BP (75.0 mmHg vs 70.4 mmHg), systolic BP percentile (75.0 vs 70.4), and diastolic BP percentile (74.0 vs 69.2). The rate of unfavorable BP (ie, elevated BP or hypertension level BP) also was significantly higher in children with more severe OSA. Children with obesity had higher BP and BP percentile. Logistic regression analysis revealed that children with obesity and moderate to severe OSA have a 3-fold greater risk of unfavorable BP compared with children without obesity and primary snoring. CONCLUSIONS We identified a 3-fold greater risk of unfavorable BP in children with obesity and moderate to severe OSA.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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25
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Kang KT, Weng WC, Lee PL, Hsu WC. Age- and gender-related characteristics in pediatric obstructive sleep apnea. Pediatr Pulmonol 2022; 57:1520-1526. [PMID: 35304830 DOI: 10.1002/ppul.25900] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/29/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Age and gender disparities in polysomnographic findings in children are not well understood. OBJECTIVE This study determined age and gender-related characteristics in pediatric obstructive sleep apnea (OSA). METHOD Retrospectively, data were collected. We analyzed polysomnographic data in the following age groups: 3-6 years (n = 681), 6-9 years (n = 553), 9-12 years (n = 297), 12-15 years (n = 200), and 15-18 years (n = 111). RESULTS A total of 1842 children were included (mean age: 8.0 years; boys: 67%; obesity: 21%). The apnea-hypopnea index (AHI) gradually increased with age (3-6, 6-9, 9-12, 12-15, and 15-18 years groups: 6.2, 5.9, 6.5, 8.1, and 9.9 event/h, respectively; p trend = 0.002). In all age groups, boys had a higher AHI than girls (7.8 vs. 4.1 events/h, p < 0.001). Children with obesity had a higher AHI than those without (12.9 vs. 4.9 events/h, p < 0.001). The mean AHI in the boys increased with age (3-6 to 15-18 years groups: 7.0-13.6 events/h, respectively; p trend < 0.001), whereas the mean AHI in the girls was not significantly different between ages (p trend = 0.492). In moderation analyses, gender was a moderator in the association between obesity and AHI, and the association between age and AHI during 12-15 and 15-18 years of ages. CONCLUSION Male gender and obesity increase risk of OSA. Regarding age disparities, this study discovered a higher AHI in male adolescents than in young boys.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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26
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Liu CN, Kang KT, Yao CCJ, Chen YJ, Lee PL, Weng WC, Hsu WC. Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA. JAMA Otolaryngol Head Neck Surg 2022; 148:621-629. [PMID: 35616957 DOI: 10.1001/jamaoto.2022.0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. Objective To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. Design, Setting, and Participants This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. Exposures All participants underwent CBCT and PSG before and after adenotonsillectomy. Main Outcomes and Measures Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. Results A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. Conclusions and Relevance These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.
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Affiliation(s)
- Chin-Nung Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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27
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Burska Z, Burghard M, Brożek-Mądry E, Sierdziński J, Krzeski A. Oral cavity morphology among children at risk of sleep disordered breathing. Eur Arch Paediatr Dent 2022; 23:429-435. [PMID: 35366217 DOI: 10.1007/s40368-022-00701-1] [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: 09/13/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB). METHODS The study included children 3-17 years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum. RESULTS A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1 years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group. CONCLUSION The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.
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Affiliation(s)
- Z Burska
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland
| | - M Burghard
- Medical Center in Ostrołęka, Ostroleka, Poland
| | - E Brożek-Mądry
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland.
| | - J Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - A Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland
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28
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Improved diagnostic accuracy for pediatric obstructive sleep apnea using an out-of-center sleep test. Auris Nasus Larynx 2022; 49:980-985. [DOI: 10.1016/j.anl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/20/2022]
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29
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Kang KT, Lin YS, Lin CY, Lee CH, Hsu WC. Epidemiology of pediatric tracheotomy: A population-based study using National Health Insurance Research Database in Taiwan. Int J Pediatr Otorhinolaryngol 2022; 152:110989. [PMID: 34861553 DOI: 10.1016/j.ijporl.2021.110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/03/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Tracheostomy in children is a surgical procedure with considerable morbidity and mortality. However, there is still a lack of population-based survey in pediatric tracheostomy. This study analyses population-based data in pediatric tracheostomy among different ages in Taiwan. METHODS This study used National Health Insurance Research Database in Taiwan. All children (aged <18 years) who underwent tracheostomy during 1997-2016 were identified. We retrieved data regarding baseline characteristics, perioperative care, and mortality associated with pediatric tracheostomy, and compared differences in variables between different age groups. RESULTS We observed that 2300 children received tracheostomy (mean age, 8.7 years; 64% boys). Regarding the age group distribution of the patients, 585 (25.4%) were infants (<1 year), 227 (9.9%) were toddlers (1-3 years), 175 (7.6%) were preschool-aged children (3-6 years), 317 (13.8%) were school-aged children (6-12 years), and 996 (43.3%) were adolescents (12-18 years). Surgical indications included pulmonary disorders (64.9%), neurological disorders (38.4%), trauma (32.3%), head injury (25.2%), and congenital anomalies (21.5%). Of these patients, 94.9% required intensive care unit (ICU) care, with the mean length of ICU stay being 63.8 days. The mean length of hospital stay was 74.5 days. The overall mortality at the last follow-up was 43.96% (1011/2300), and the tracheostomy related mortality at the last follow-up was 1.43% (33/2300). Compared with adolescents, infants more commonly underwent tracheostomy in the northern area (66.7% vs 37.2%, P < .001), more commonly received tracheostomy indicated by congenital anomalies (53.7 vs 4.6%, P < .001), had longer ICU stays, had longer hospital stays (100.7 vs 57.5 days, P < .001), and had a higher 5-year mortality rate (42.4 vs 29.6%, P < .001). Multivariable logistic and Cox regression models revealed that young age was associated with an increased risk of prolonged hospital stay and long-term mortality, respectively. CONCLUSIONS This study elaborates the epidemiology of pediatric tracheostomy in different age groups.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Che-Yi Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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30
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Johnson C, Leavitt T, Daram SP, Johnson RF, Mitchell RB. Obstructive Sleep Apnea in Underweight Children. Otolaryngol Head Neck Surg 2021; 167:566-572. [PMID: 34784263 DOI: 10.1177/01945998211058722] [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: 11/17/2022]
Abstract
OBJECTIVES To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA. STUDY DESIGN Case-control study. SETTING University of Texas Southwestern Medical Center and Children's Medical Center of Dallas. METHODS Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P < .05. RESULTS An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA. CONCLUSION Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.
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Affiliation(s)
- Courtney Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Taylor Leavitt
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shiva P Daram
- Department of Otolaryngology-Head and Neck Surgery, University of Texas, Medical Branch, Galveston, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
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Voora RS, Carvalho D, Jiang W. Impact of Tonsillectomy on Obesity in Pediatric Patients With Sleep-Disordered Breathing. OTO Open 2021; 5:2473974X211059105. [PMID: 34870061 PMCID: PMC8637722 DOI: 10.1177/2473974x211059105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Both tonsillar hypertrophy and obesity contribute to pediatric sleep-disordered breathing (SDB). Tonsillectomy addresses anatomical obstruction causing SDB; however, it may adversely affect the obesity profile postoperatively. Herein, we investigate posttonsillectomy body mass index (BMI) changes in pediatric patients. STUDY DESIGN Retrospective case series. SETTING Tertiary, pediatric urban academic center. METHODS All patients undergoing tonsillectomy from January 1, 2016, to December 31, 2016, were included. Patients' age, sex, surgical indication, and preoperative BMI were recorded. Postoperative BMI data were collected between March 1, 2016, and December 31, 2017. Statistical analysis was performed using a generalized regression model, using BMI percentile-for-age weight status. RESULTS A total of 1153 patients were included (50% female), with age ranging from 2.0 to 19.5 years (mean [SD], 7.6 [4.0]). The majority (87.8%) had tonsillectomy for SDB. Of the cohort, 560 (48.6%) had available follow-up BMI data. The BMI percentile on the day of the surgery had a median of 65.8, and the BMI percentile on follow-up had a median of 76.4. The median time to follow-up was 197 days with a range of 50 to 605 days. Higher postoperative BMI percentile strongly correlated to higher preoperative BMI percentile (P < .001), as well as younger age (P < .001), male sex (P = .0005), and SDB as a surgical indication (P = .003). CONCLUSION We observed a significant increase in BMI percentile following tonsillectomy, which accounted for a significantly higher proportion of the cohort being classified as overweight or obese postoperatively. These findings necessitate greater preoperative counseling, closer follow-up, and adjunctive measures for obesity management in pediatric patients undergoing tonsillectomy.
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Affiliation(s)
- Rohith S. Voora
- School of Medicine, University of
California, San Diego, San Diego, California, USA
- Pediatric Otolaryngology, Rady
Children’s Hospital San Diego, San Diego, California, USA
| | - Daniela Carvalho
- Pediatric Otolaryngology, Rady
Children’s Hospital San Diego, San Diego, California, USA
- Department of Otolaryngology,
University of California, San Diego, San Diego, California, USA
| | - Wen Jiang
- Pediatric Otolaryngology, Rady
Children’s Hospital San Diego, San Diego, California, USA
- Department of Otolaryngology,
University of California, San Diego, San Diego, California, USA
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Gunnlaugsson S, Abul MH, Wright L, Petty CR, Permaul P, Gold DR, Gaffin JM, Phipatanakul W. Associations of Snoring and Asthma Morbidity in the School Inner-City Asthma Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3679-3685.e1. [PMID: 34102347 PMCID: PMC8511301 DOI: 10.1016/j.jaip.2021.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inner-city children are disproportionately affected by asthma and sleep-disordered breathing (SDB). However, little is known about the association of SDB symptoms with asthma morbidity in this vulnerable population. OBJECTIVE Assess the relationship between snoring frequency and asthma morbidity. METHODS This study was part of the School Inner-City Asthma Study, a longitudinal prospective cohort study of children with persistent asthma who attended schools in the Northeast United States from 2008 to 2013. Participants had baseline assessments of asthma symptoms, snoring, and allergy status. Caregivers completed quarterly surveys for 12 months on symptoms of asthma, snoring, and health care outcomes. Snoring frequency (non-, rare-, sometimes-, habitual-snoring) and its relationship with asthma symptoms and asthma morbidity were assessed by mixed-effects models. RESULTS There were 1186 observations from 339 subjects. Mean age was 7.9 years; roughly half were male, and most were of minority race. Half were overweight or obese, and 65.5% had atopy. At initial snoring assessment, 24.8% reported habitual snoring, but report of snoring frequency varied over the study period. Multivariate analyses revealed increased odds of maximum asthma symptom days for habitual snoring compared with nonsnoring (1.58; 95% CI, 1.19-2.10; P < .002) and all other snoring categories. Habitual snoring was associated with greater odds of health care utilization (incidence rate ratio, 1.72; 95% CI, 1.10-2.69; P = .02) and worse asthma control (odds ratio, 1.49; 95% CI, 1.05-2.11; P = .03) compared with nonsnoring. CONCLUSIONS Snoring is common among inner-city school-age children with asthma, and habitual snoring is associated with increased asthma symptom burden and health care utilization.
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Affiliation(s)
- Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Mehtap Haktanir Abul
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lakiea Wright
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Perdita Permaul
- Division of Pulmonology, Allergy and Immunology, NY-Presbyterian Hospital/Weill Cornell Medicine, Weill Cornell Medical College, New York, NY
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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Abulhamail A, AlShebli A, Merdad L, Wali S, Jastaniah W, Abaalkhail B. Prevalence of and risk factors for obstructive sleep apnea in children with sickle cell: a multicentric cross sectional study. Ann Hematol 2021; 101:43-57. [PMID: 34505943 DOI: 10.1007/s00277-021-04646-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
The prevalence of obstructive sleep apnea syndrome (OSAS) is elevated in some high-risk populations. Children with sickle cell disease (SCD) are known to have many comorbidities, including OSAS. The objectives of this study were to assess the prevalence of and risk factors for OSAS among children with SCD in two major tertiary health care facilities in Jeddah, Saudi Arabia. This multicenter cross-sectional study took place in two major tertiary health care facilities-King Abdulaziz University Hospital and King Khalid National Guard Hospital, Jeddah, Saudi Arabia. Children with SCD who were admitted between January 2010 and December 2017 were enrolled. The Pediatric Sleep Questionnaire (PSQ) was used to screen for OSAS. Data were collected from 150 children with SCD aged between 2 and 18 years. Eighty-five percent of the children had sickle cell anemia (SCA) with HbSS, and the rest had sickle beta-thalassemia (HbS/ß-thalassemia). Based on the PSQ, 33 of the 150 (22%) children had OSAS (score ≥ 7). The average score on the PSQ was 3.8/22 (± 3.8). A history of adenotonsillar hypertrophy was found to be a significant risk factor in bivariate and multivariate analyses [aOR 5.5; 95% CI 1.84-16.35 (P < 0.001)]. The odds of having OSAS were ninefold higher in children who had periodic limb movements than in those who did not after adjustment [95% CI 1.75-48.03 (P < 0.001)]. OSAS is a highly prevalent disease among children with SCD. Many factors were associated with OSAS in the bivariate analysis, including nationality, education level, a history of adenotonsillar hypertrophy, and a history of periodic limb movements.
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Affiliation(s)
- Albraa Abulhamail
- College of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Ahmad AlShebli
- College of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Leeena Merdad
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Siraj Wali
- College of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wasil Jastaniah
- Pediatric and Pediatric Hematology/Oncology, BMT College of Medicine, Jeddah, Saudi Arabia
| | - Bahaa Abaalkhail
- Department of Family & Community Medicine, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
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Qiao Y, Chen J. Efficacy of Low-Temperature Plasma-Assisted Unilateral/Bilateral Tonsillectomy and Adenoidectomy in Children with Obstructive Sleep Apnea Hypopnea Syndrome. Med Sci Monit 2021; 27:e930792. [PMID: 34497259 PMCID: PMC8439120 DOI: 10.12659/msm.930792] [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] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to investigate the efficacy of low-temperature plasma-assisted bilateral or unilateral tonsillectomy (LTPABT or LTPAUT) and adenoidectomy in treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS). Material/Methods The present observational cohort study included a total of 244 children with OSAHS during December 2017 to December 2018. The patients were divided into the LTPABT group, the LTPAUT group, and the control group that received traditional bilateral tonsillectomy and adenoidectomy. The apnea hypopnea index (AHI) and the lowest oxygen saturation (LSaO2) were measured. The patients’ pain condition was determined using the Visual Analog Score (VAS) and intraoperative indices were collected. Patients’ quality of life was assessed by OSA-18 scale and patients’ immune function was determined. Results The postoperative VAS scores were remarkably lower in the LTPABT and LTPAUT groups. At 6 months after surgery, the AHI significantly had decreased and LSaO2 levels were significantly enhanced for all groups, and the AHI was significantly lower and LSaO2 was markedly higher in the LTPABT group. The ratio of patients with efficacy of cured and remarkably effective was remarkably higher in the LTPABT group. The rates of postoperative hemorrhage and infection were significantly lower in the LTPABT and LTPAUT groups, and 4 cases showed tonsillar hyperplasia. OSA-18 scores were lowest in the LTPABT group. No significant difference was found in levels of IgM, IgA and IgG, and T lymphocyte subtypes. Conclusions The low-temperature plasma-assisted bilateral tonsillectomy combined with adenoidectomy had the best efficacy. None of the surgery methods influenced the patients’ immune function.
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Affiliation(s)
- Yi Qiao
- Department of Otorhinolaryngology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Jie Chen
- Department of Otorhinolaryngology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
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Zaw M, Hein L, Martinez AC, Ascher KB, Abreu AR, Chediak AD. Gender Differences in Sleep Disordered Breathing—a Review of Literature. CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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C-reactive protein in children with obstructive sleep apnea and effects of adenotonsillectomy. Auris Nasus Larynx 2021; 49:92-99. [PMID: 34272056 DOI: 10.1016/j.anl.2021.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA. METHODS Children with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery. RESULTS This study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1-5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03-0.25) vs 0.03 (0.02-0.14) vs 0.04 (0.01-0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02-0.22) to 0.08 (0.03-0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11-2.78) to 0.20 (0.07-1.04), P = 0.043]. CONCLUSION Children with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy.
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Effect of adenotonsillectomy on blood pressure in children with obstructive sleep apnea: a meta-analysis. Sleep Med 2021; 84:334-342. [PMID: 34225175 DOI: 10.1016/j.sleep.2021.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While adenotonsillectomy (T&A) is widely recognized as the first-line therapy for pediatric obstructive sleep apnea (OSA), effects of T&A on blood pressure (BP) remain unclear. This meta-analysis evaluates the associations between T&A and BP in children with OSA. METHODS The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, Medline, EMBASE, and Cochrane databases. The keywords used were "sleep apnea syndromes," "adenotonsillectomy," and "child." A random-effects model was applied to determine office systolic BP (SBP), diastolic BP (DBP), and ambulatory BP changes. RESULT Twelve studies with 1193 children were analyzed (mean age: 7.6 y; 54% boys). The apnea-hypopnea index significantly reduced of 9.4 events/h (95% CI, -12.0 to -6.8) after T&A. Office SBP (-0.24 mmHg; 95% CI, -1.64 to 1.16) and DBP (-1.65 mmHg; 95% CI, -3.47 to 0.17) did not decrease significantly after surgery. No significant decreases were observed in 24-h ambulatory BP after T&A. Subgroup analysis showed a significant postoperative decrease in office SBP (-6.23 mmHg; 95% CI, -7.78 to -4.67) and DBP (-7.93 mmHg; 95% CI, -10.37 to -5.48) among children with hypertension but a slight increase in office SBP (2.50 mmHg; 95% CI, 1.14 to 3.86) and DBP (1.98 mmHg; 95% CI, -0.02 to 3.98) in those without (P for heterogeneity < 0.001). CONCLUSION This meta-analysis suggests the office and ambulatory BP changes after T&A in children with OSA are trivial. Moreover, children with hypertension experience a significantly greater decrease in office BP than children without hypertension.
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Tursun S, Şimşek G, Bayar Muluk N, Taş MB, Erel Ö. The efficacy of adenotonsillectomy on oxidative stress evaluated by thiol / disulfide balance. Pediatr Int 2021; 63:454-458. [PMID: 32654339 DOI: 10.1111/ped.14389] [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: 05/04/2020] [Revised: 06/26/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oxidative stress plays a role in the pathogenesis of many chronic diseases. Upper airway obstruction has been identified as a risk factor for increased oxidative stress-related disorders such as obstructive sleep apnea. The effect of adenotonsillar hypertrophy, which may result in a narrowing of the upper airways, on oxidative stress can be a valuable subject of research. This study aimed to investigate the efficacy of adenotonsillectomy on oxidative stress evaluated using the thiol / disulfide balance. METHODS Thirty children who underwent adenotonsillectomy and 30 healthy controls, all aged from 3 to 18 years, were included in the study. Blood samples were taken preoperatively and 3 months postoperatively in the study group; in the control group, baseline blood samples were taken and samples were again taken 3 months later. Thiol / disulfide homeostasis items were analyzed. Antioxidant markers were native thiol, total thiol, and native / total thiol. Oxidative stress markers were disulfide, disulfide / native thiol, and disulfide / total thiol. RESULTS At the preoperative period, oxidative stress parameters of thiol / disulfide homeostasis were higher in the study group than in the control group (P < 0.05) and antioxidant activity parameters were lower than in the control group (P < 0.05). Three months postoperatively, oxidative stress parameters were lower than in the control group (P < 0.05), and antioxidant parameters were no different from those in the control group (P > 0.05). In the adenotonsillectomy group considered separately, oxidative stress markers of disulfide and disulfide / native thiol decreased (P < 0.05) and antioxidant markers of native thiol and total thiol increased in the postoperative measurements (P < 0.05). CONCLUSIONS Oxidative stress related to adenotonsillar hypertrophy decreased after adenotonsillectomy. The antioxidant parameters of the thiol homeostasis increased after adenotonsillectomy. We concluded that adenotonsillectomy operations should be planned and applied timeously to prevent the adverse effects of adenotonsillar hypertrophies on thiol homeostasis.
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Affiliation(s)
- Serkan Tursun
- Departments of, Pediatrics, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Gökçe Şimşek
- Department of, ENT, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Department of, ENT, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | | | - Özcan Erel
- Department of Medical Biochemistry, Atatürk Training and Research Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Scholes M, Jensen E, Meier M, Friedman N. Effect of adenotonsillectomy in children with obstructive sleep apnea and major psychiatric disorders on obstructive apnea-hypopnea index and Epworth Sleepiness Scale scores. J Clin Sleep Med 2021; 17:685-689. [PMID: 33206042 DOI: 10.5664/jcsm.9012] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES This study evaluates the effectiveness of adenotonsillectomy in the treatment of obstructive sleep apnea in children with major psychiatric disorders as measured by polysomnography and the Epworth Sleepiness Scale (ESS) at a tertiary children's hospital. Adults with major psychiatric disorders often have higher rates of obstructive sleep apnea and decreased response to treatment. The goal was to determine if children with serious mental illness had outcomes similar to their adult counterparts. METHODS A retrospective chart review was undertaken to identify children with obstructive sleep apnea and major psychiatric disorders who underwent adenotonsillectomy as part of their treatment for obstructive sleep apnea and had undergone preoperative and postoperative polysomnography as well as ESS. A multivariable model was run for each of the postoperative outcomes (ESS, obstructive apnea-hypopnea index, or body mass index percentile), adjusting for their respective preoperative value, age, and group. RESULTS There were 34 patients who qualified for this study and who were matched with 66 controls. There was no significant difference between the 2 groups in terms of change in ESS, obstructive apnea-hypopnea index, or body mass index percentile, both before and after adjusting for age. The only significant findings were that preoperative ESS and body mass index percentile were predictive of postoperative ESS and body mass index percentile for both groups. CONCLUSIONS Children with psychiatric disorders in our institution respond to surgical management of obstructive sleep apnea similar to pediatric controls without mental illness despite comorbidities and central-acting medications that may alter sleep.
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Affiliation(s)
- Melissa Scholes
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Emily Jensen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Maxene Meier
- Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Norman Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
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Rayasam S, Johnson R, Lenahan D, Abijay C, Mitchell RB. Obstructive Sleep Apnea in Children Under 3 Years of Age. Laryngoscope 2021; 131:E2603-E2608. [PMID: 33764521 DOI: 10.1002/lary.29536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify predictors of severe obstructive sleep apnea (OSA) in children under 3 years of age and to compare demographics, comorbidities, and polysomnographic characteristics of infants and toddlers with OSA. STUDY DESIGN Retrospective case series. METHODS We examined children under 3 years of age who had polysomnogram between August 2012 and March 2020. Demographics, clinical, and polysomnographic parameters were compared in children age 0-1 versus 1-3 years and 0-2 versus 2-3 years and severe versus mild-moderate OSA. Univariate analysis was used to compare age groups; multiple logistic regression for predictors of severe OSA. Significance was set at P < .05. RESULTS Of the 413 children, 267 (65%) were male and 131 (32%) obese. The population included Hispanic (41%), African American (28%), and Caucasian (25%) children. A total of 98.5% had OSA and 35% had severe OSA. Children under 1 year of age more commonly had gastroesophageal reflux disease (GERD) (38% vs. 23%; P = .014); tonsillar hypertrophy was more common in children over 2 years of age (56% vs. 34%, P = .001). Down syndrome (odds ratio (OR): 3.16, 95% confidence interval (CI) = 1.14-8.68, P = .026) and tonsillar hypertrophy (OR: 1.97, 95% CI = 1.28-3.02, P = .002) were predictors of severe OSA. CONCLUSION Children under 3 years of age with OSA are more likely to be male and have GERD. Down syndrome and tonsillar hypertrophy are predictors of severe OSA, and children with these conditions should be prioritized for polysomnography. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2603-E2608, 2021.
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Affiliation(s)
| | - Romaine Johnson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center, Dallas, Texas, U.S.A
| | - Danielle Lenahan
- University of Southern California Medical Center, Los Angeles, California, U.S.A
| | - Claire Abijay
- UT Southwestern Medical School, Dallas, Texas, U.S.A
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center, Dallas, Texas, U.S.A
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Dhakal CK, Khadka S. Heterogeneities in Consumer Diet Quality and Health Outcomes of Consumers by Store Choice and Income. Nutrients 2021; 13:1046. [PMID: 33804858 PMCID: PMC8063805 DOI: 10.3390/nu13041046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Obesity and other diet-related health conditions have received much attention in the public health literature over the past two decades. This study investigates the relationship between household food budget shares at different food outlets with diet quality and weight-related health outcomes in the United States. Our analysis used event-level food purchase data from the national household food acquisition and purchases survey (FoodAPS). We find that, after controlling for observables, food purchase location is significantly associated with diet quality and body mass index (BMI). Our findings indicate that larger food budget shares at convenience stores and restaurants are linked with poor diet quality based on the healthy eating index-2015 (HEI-2015) scores and higher BMI. We further explored potential heterogeneity on outcomes of interest across income groups. Results suggest heterogeneous effects may exist across income groups: low-income households, who spent a larger share of their food budget at convenience stores and fast-food restaurants are related to poor diet quality and more likely to be obese. Our findings will help improve understanding of the causes of diet-related health problems and may illuminate potential avenues of intervention to address obesity.
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Affiliation(s)
- Chandra K. Dhakal
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA 30602, USA;
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Gunnlaugsson S, Greco KF, Petty CR, Sierra GC, Stamatiadis NP, Thayer C, Hammond AG, Giancola LM, Katwa U, Simoneau T, Baxi SN, Gaffin JM. Sex differences in the relationship of sleep-disordered breathing and asthma control among children with severe asthma. J Asthma 2021; 59:1148-1156. [PMID: 33653218 DOI: 10.1080/02770903.2021.1897838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Children with severe asthma are underrepresented in studies of the relationship of sleep-disordered breathing (SDB) and asthma and little is known about sex differences of these relationships. We sought to determine the relationship of SDB with asthma control and lung function among boys and girls within a pediatric severe asthma cohort. METHODS Patients attending clinic visits at the Boston Children's Hospital Pediatric Severe Asthma Program completed the Pediatric Sleep Questionnaire (PSQ), Asthma Control Test (ACT) and Spirometry. The prevalence of SDB was defined as a PSQ score >0.33. We analyzed the association between PSQ score and both ACT score and spirometry values in mixed effect models, testing interactions for age and sex. RESULTS Among 37 subjects, mean age was 11.8 years (4.4) and 23 (62.2%) were male, the prevalence of SDB was 43.2% (16/37). Including all 80 observations, there was a moderate negative correlation between PSQ and ACT scores (r=-0.46, p < 0.001). Multivariable linear regression models revealed a significant sex interaction with PSQ on asthma control (p = 0.003), such that for each 0.10 point increase in PSQ there was a 1.88 point decrease in ACT score for females but only 0.21 point decrease in ACT score for males. A positive PSQ screen was associated with a 9.44 point (CI 5.54, 13.34, p < 0.001) lower ACT score for females and a 3.22 point (CI 0.56, 5.88, p = 0.02) lower score for males. CONCLUSIONS SDB is common among children with severe asthma. Among children with severe asthma, SDB in girls portends to significantly worse asthma control than boys. Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.1897838.
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Affiliation(s)
- Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Gabriella C Sierra
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Christine Thayer
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Adam G Hammond
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lauren M Giancola
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Umakanth Katwa
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sachin N Baxi
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. 24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea. Laryngoscope 2021; 131:2126-2132. [PMID: 33599298 DOI: 10.1002/lary.29455] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/06/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA). STUDY DESIGN Case series study. METHODS Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability. RESULTS A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status. CONCLUSIONS OSA in children is associated with increased BP and BP variability. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2126-2132, 2021.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Volkov SI, Ginter OV, Covantev S, Corlateanu A. Adenoid Hypertrophy, Craniofacial Growth and Obstructive Sleep Apnea: A Crucial Triad in Children. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201202122440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Age-related (physiological) AH is an important problem in pediatric otorhinolaryngology.
Since the beginning of the 70s, there has been an increase in the proportion of children with
pharyngeal tonsil hypertrophy. Functional disorders of the oropharynx in children occupy the second
place based on their incidence (after disorders of the musculoskeletal system). In previous
years, there has been an increase in the incidence and prevalence of obstructive sleep apnea syndrome
(OSAS) among children. In most cases of pediatric OSAS, upper airway obstruction occurs
from the nasopharynx to the oropharynx, caused by upper airway stenosis. Consequences of untreated
OSAS in children can be inattention and behavioral problems, daytime sleepiness, and in
more severe cases are associated with a variety of comorbidities. The current review discusses the
links between hypertrophied adenoids, craniofacial development and OSAS in children taking into
account physiological and pathophysiological aspects as well as clinical evaluation of the problem.
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Affiliation(s)
- Stanislav I. Volkov
- Department of Endocrinology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Olga V. Ginter
- Department of Neurology, Schon Klinik, Bad Aibling, Germany
| | - Serghei Covantev
- Department of General Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State Medical and Pharmaceutical University of “N. Testimetanu”, Chisinau, Moldova, Republic of
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Abraham EJ, Bains A, Rubin BR, Cohen MB, Levi JR. Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms. Ann Otol Rhinol Laryngol 2021; 130:1029-1035. [PMID: 33544624 DOI: 10.1177/0003489421990156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence and characteristics of children with normal elective polysomnography for obstructive sleep disordered breathing (oSDB) based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. STUDY DESIGN In this retrospective cohort study, we identified patients ages 2 to 18 who underwent diagnostic polysomnography (PSG) ordered by our otolaryngology department for SDB between 2012 and 2018. SETTING All patients were seen by otolaryngologists at an urban tertiary safety net hospital. SUBJECTS AND METHODS There were a total of 456 patients studied (average age 5.66 ± 3.19; 263 (57.7%) males, 193 (42.3%) females. Demographic factors (age, gender, race, ethnicity, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate and multivariate analysis. RESULTS Two hundred four patients (44.7%) had no obstructive sleep apnea (OSA) based on AHI<2 on PSG. Children with a larger tonsil size had 3.18 times the odds of OSA compared to those with a medium tonsil size (95% CI 1.64, 6.19) when adjusting for symptoms, age category, and race (P = .0007). Children ages 4 to 6 years had 0.25 times the odds of OSA compared to those ages 2-3 years (95% CI 0.12, 1.54) when adjusting for symptoms, tonsil size, and race (P = .0011). White children had 0.28 times the odds of OSA compared to Black children (95% CI 0.14, 0.57) when adjusting for symptoms, tonsil size, and age category (P = .0004). CONCLUSION Among our patient population, 44.7% had normal sleep studies. Younger children (ages 2-3) were less likely to have normal polysomnography. This research demonstrates that obtaining sleep studies in otherwise healthy children with SDB can affect management decisions, and they should be discussed with families with a focus on patient centered decision making.
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Affiliation(s)
| | - Ashank Bains
- Boston University School of Medicine, Boston, MA, USA
| | - Batsheva R Rubin
- Boston University School of Medicine, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Michael B Cohen
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Veterans Affairs Hospital, Boston, MA, USA.,Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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Al Ehaideb AA, Almufadhi NM, Ab Alhassn GM, Fallatah AA, Adnan S, Alsubaie AA. Sleep-disordered breathing among Saudi children seeking orthodontic treatment. J Family Med Prim Care 2021; 10:205-212. [PMID: 34017727 PMCID: PMC8132852 DOI: 10.4103/jfmpc.jfmpc_1918_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/24/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
Aims The aim of this research is to assess the prevalence of sleep disordered breathing (SDB) and evaluate the risks and symptoms in children seeking orthodontic treatment in a Saudi dental center. Settings and Design It is a cross-sectional survey-based study. Methods and Material Pediatric sleep questionnaire (PSQ) was used to survey 285 children and adolescents aged 5 to 18 years old who are undergoing orthodontic screening in a Saudi Dental Center. Statistical Analysis Used PSQ scores were tested with multiple variables including gender, parents' education, academic performance using Mann-Whitney-U test. Correlation of study sample scores with age were calculated using the Spearman rank correlation coefficient (rho). Results In this study 136 (47.7%) of the participants were deemed to be high risk for developing SDB and 149 (52.3%) were low risk, males were significantly at higher risk compared to females (P ≤ 0.05). Participants with previous adenoidectomy surgery were more likely to be identified as high-risk for SDB (P-value = 0.000) as well as participants with a family history of snoring (P-value = 0.000). Conclusions Sleep disordered breathing was prevalent among Saudi children seeking orthodontic therapy, it is important to screen children and adolescents in dental pediatric and orthodontic clinics for SDB risk as this is a prevalent disorder among this population, early detection of SDB will improve patients' quality of life and prevent future complications associated to this disorder.
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Affiliation(s)
- Ali A Al Ehaideb
- Assistant Professor, Preventive Dental Science Department, College of Dentistry, Qassim University, Saudi Arabia
| | - Norah M Almufadhi
- Dental Intern, College of Dentistry, Qassim University, Saudi Arabia
| | - Ghaida M Ab Alhassn
- General Dental Practitioner, Collage of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Amal A Fallatah
- Dental Intern, Collage of Dentistry, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Shazia Adnan
- Lecturer, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Areej A Alsubaie
- Psychology Specialist, College of Education, Princess Nourah bint Abdulrahman University, Saudi Arabia
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Kim KM, Kim JH, Kim D, Lim MH, Joo H, Yoo SJ, Kim E, Ha M, Paik KC, Kwon HJ. Associations among High Risk for Sleep-disordered Breathing, Related Risk Factors, and Attention Deficit/Hyperactivity Symptoms in Elementary School Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2020; 18:553-561. [PMID: 33124587 PMCID: PMC7609213 DOI: 10.9758/cpn.2020.18.4.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
Objective : Habitual snoring is a common problem in children. We evaluated the association between a high risk for sleep-disordered breathing and attention deficit/hyperactivity symptoms. Methods Parents of 13,560 children aged 6 to 12 years responded to questionnaires including items on habitual snoring and the Korean attention deficit/hyperactivity disorder rating scale. The snoring score comprised the number of "yes" responses to habitual-snoring items, and a high risk for sleep-disordered breathing was defined as a snoring score ≥ 2. Results The odds ratio (OR) of a high risk for sleep-disordered breathing was significantly higher in boys (OR = 1.47; p < 0.001), overweight children (OR = 2.20; p < 0.001), and children with current secondhand-smoking exposure (OR = 1.38; p < 0.001). The Korean attention deficit/hyperactivity disorder rating scale score increased significantly with the snoring score (0 vs. 1, B = 1.56, p < 0.001; 0 vs. 2, B = 2.44, p < 0.001; 0 vs. 3, B = 2.48, p < 0.001; 0 vs. 4, B = 3.95; p < 0.001). Conclusion Our study confirms several risk factors of sleep-disordered breathing, namely male sex, overweight, and exposure to tobacco smoking, and found a positive association between habitual snoring and attention deficit/hyperactivity symptoms.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea
| | - Jee Hyun Kim
- Department of Neurology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dohyun Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Public Human Resources, Dankook University, Cheonan, Korea
| | - Hyunjoo Joo
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seung-Jin Yoo
- Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Eunjung Kim
- Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ki Chung Paik
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea.,Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.,Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
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The Effect of Pre-operative Obstructive Sleep Apnea (OSA) Severity on the Change of Sleep Patterns in Children Undergoing Adenotonsillectomy. Indian J Pediatr 2020; 87:955. [PMID: 32338348 DOI: 10.1007/s12098-020-03282-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 138:110320. [PMID: 32889438 DOI: 10.1016/j.ijporl.2020.110320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. METHODS This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. RESULTS A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). CONCLUSION We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.
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Childhood Obesity and its Influence on Sleep Disorders: Kids-Play Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217948. [PMID: 33138179 PMCID: PMC7663090 DOI: 10.3390/ijerph17217948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022]
Abstract
Background: Sleep disorders are associated with overweight and obese children, and could decrease life quality with limitations to normal daily activities. The purpose of the study is to describe the prevalence of sleep disorders in a cohort of overweight/obese children using respiratory polygraphy. Methods: A descriptive cross-sectional study was conducted in Granada (Spain) on a sample of 98 children with overweight or obesity. The presence of sleep disorders was determined by respiratory polygraphy. Results: Regarding apnoea–hypopnea-index (AHI) results, 44% of affected children had severe sleep apnoea–hypopnea syndrome (SAHS), and the remaining 56% had a mild form of the disorder. With respect to oxygen-desaturation index, 56% of the same group had severe SAHS, 32% had mild SAHS, and the remaining 12% did not suffer from SAHS. Among participants, average scores of 13.8 obstructive apnoea, 7.7 central apnoea, and 13.6 hypopnoea were recorded. Conclusions: Respiratory polygraphy can provide conclusive results in the diagnosis of SAHS in overweight/obese children. Interventional programmes designed and implemented to reduce overweight and obesity can improve quality of sleep and life in children.
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