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Machado Saporiti J, Castagno D, Delpizzo Castagno C, Perpétua Mota Freitas M, Leão Goettems M, Boscato N. Pediatric obstructive sleep apnea-related risk factors: A cross-sectional study. Acta Odontol Scand 2024; 83:475-482. [PMID: 39248432 PMCID: PMC11409818 DOI: 10.2340/aos.v83.41385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 08/11/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES This study investigated obstructive sleep apnea (OSA)-related risk factors in children and adolescents. MATERIALS AND METHODS Records of 187 subjects from a private medical clinic were reviewed. Overnight polysomnography recordings and self/parent reports were gathered. Descriptive analysis of sociodemographic, anthropometric, sleep quality and sleep architecture variables and OSA diagnosis were performed. Associations between independent variables and OSA diagnosis were assessed through multivariable logistic regression with robust variance, with a significance level of 5%. Results: 132 participants were diagnosed with OSA, and 55 were classified as "no OSA" (29.41%). Those overweight or obese were 4.97 times more likely to have OSA than those with normal weight (P = 0.005). Those who reported loud snoring were 2.78 times more likely to have OSA than those who reported mild or moderate snoring intensity. A one-unit increase in arousal index leads to 1.39 increase in the odds ratio (OR) of individuals diagnosed with OSA (P < 0.001), and each one-unit increase in sleep efficiency leads to 1.09 higher odds of not having OSA (P = 0.002). CONCLUSIONS Significantly increased OSA-related risk factors among overweight/obese children and adolescents and among those who had a parental/self-report of loud snoring were found.
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Affiliation(s)
| | - Deborah Castagno
- Clinical Practice at Pelotas Sleep Institute, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Clarissa Delpizzo Castagno
- Clinical Practice at Pelotas Sleep Institute, Otorhinolaryngology and Member of the Brazilian Sleep Association, Pelotas, Brazil
| | | | - Marília Leão Goettems
- School of Dentistry, Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Noéli Boscato
- School of Dentistry, Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
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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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Inoue M, Nakajima S, Inada N, Oi H, Sato N, Miyazaki Y, Takashina H, Tagaya H, Adachi Y, Kuga H. Development of the Parenting Behavior Checklist to Promote Preschoolers' Sleep (PCPP). Behav Sleep Med 2024; 22:275-284. [PMID: 37545146 DOI: 10.1080/15402002.2023.2241590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To develop the Parenting Behavior Checklist to Promote Preschoolers' sleep (PCPP), quantify sleep-promoting parenting behaviors for children, and examine the scale's reliability and validity. METHODS The PCPP was developed based on the recommendations of the ABCs of SLEEPING for children's sleep, which is strongly supported by research evidence. Its validity and reliability were evaluated using data from 140 participants. Structural validity was estimated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency was evaluated by Cronbach's α. Hypothesis testing was evaluated by analyzing the correlations between each factor of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) and the PCPP. RESULTS Regarding structural validity, EFA was conducted because CFA showed a poor model fit. The PCPP comprised one factor and six items. The JSQ-P subfactors of insomnia or circadian rhythm sleep-wake disorders, undesirable morning symptoms and behaviors, and insufficient sleep were moderately negatively correlated with the PCPP; the subfactor of undesirable daytime behaviors related to sleep problems was weakly negatively correlated with the PCPP. Thus, the sleep-promoting parenting behaviors listed in the PCPP were associated with better sleep in children. CONCLUSIONS The PCPP showed sufficient reliability and validity. Future studies should use the scale to examine more effective interventions regarding sleep-promoting parental behaviors for children.
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Affiliation(s)
- Mari Inoue
- Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
| | - Shun Nakajima
- Faculty of Liberal Arts, Department of Psychology, Teikyo University, Tokyo, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoko Inada
- Faculty of Liberal Arts, Department of Psychology, Teikyo University, Tokyo, Japan
- Faculty of Psychology and Sociology, Taisho University, Tokyo, Japan
| | - Hitomi Oi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoko Sato
- Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Yuri Miyazaki
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hikari Takashina
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hirokuni Tagaya
- Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
| | | | - Hironori Kuga
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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Gayoso-Liviac MG, Nino G, Montgomery AS, Hong X, Wang X, Gutierrez MJ. Infants hospitalized with lower respiratory tract infections during the first two years of life have increased risk of pediatric obstructive sleep apnea. Pediatr Pulmonol 2024; 59:679-687. [PMID: 38153215 PMCID: PMC10901459 DOI: 10.1002/ppul.26810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE Lower respiratory tract infections (LRTI) during the first 2 years of life increase the risk of pediatric obstructive sleep apnea (OSA), but whether this risk varies by LRTI severity is unknown. METHODS We analyzed data from 2962 children, aged 0-5 years, with early-life LRTI requiring hospitalization (severe LRTI, n = 235), treated as outpatients (mild LRTI, n = 394) and without LRTI (reference group, n = 2333) enrolled in the Boston Birth Cohort. Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariables were used to evaluate the risk of pediatric OSA. RESULTS Compared to children without LRTI, those with mild LRTI were at a higher risk of having OSA (hazard ratio [HR] 1.44, 95% confidence interval [CI]: 1.01-2.05), and those with severe LRTI were at the highest risk (HR 2.06, 95% CI: 1.41-3.02), independently of relevant covariables (including maternal age, race, gestational age, and type of delivery). Additional risk factors linked to a higher risk of OSA included prematurity (HR 1.34, 95% CI 1.01-1.77) and maternal obesity (HR 1.82, 95% CI 1.32-2.52). The time elapsed between LRTI and OSA diagnosis was similar in mild and severe LRTI cases, with medians of 23 and 25.5 months, respectively (p = .803). CONCLUSION Infants with severe early-life LRTI have a higher risk of developing OSA, and surveillance strategies to identify OSA need to be particularly focused on this group. OSA monitoring should continue throughout the preschool years as it may develop months or years after the initial LRTI hospitalization.
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Affiliation(s)
- Mirtha G Gayoso-Liviac
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Agnes S Montgomery
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Yu MWL, Au CT, Yuen HM, Chan NY, Chan JW, Wing YK, Li AM, Chan KCC. Effects of childhood obstructive sleep apnea with and without daytime sleepiness on behaviors and emotions. Sleep Med 2024; 115:93-99. [PMID: 38350308 DOI: 10.1016/j.sleep.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate the relationship between obstructive sleep apnea (OSA) with and without excessive daytime sleepiness (EDS) and behavioral and emotional outcomes in non-obese prepubertal children. METHODS This was a retrospective analysis of children aged 5-11 years who presented to our unit for assessment of their sleep-related complaints. All children underwent polysomnography (PSG). They also completed the Pediatric Daytime Sleepiness Scale (PDSS) and a sleep diary. OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) was ≥1 event/hour. EDS was defined as PDSS >15. Behavioral and emotional outcomes were assessed using the Child Behavioral Checklist (CBCL). RESULTS Data from 391 children (mean age of 8.6 ± 1.7 years; 67 % male) were analyzed. Seventy children did not have OSA or EDS, 137 had OSA, 50 had reported having EDS but without OSA, and 134 children had both OSA and EDS. There were significantly higher CBCL total problems score in the combined group (61 ± 9) compared to the non-OSA/EDS group (54 ± 10), and the OSA-only group (54 ± 10) (p < 0.001). The presence of EDS was significantly associated with higher CBCL T score and higher odds for clinically significant behavioral problems (T score ≥65) after adjusting for age, sex, BMI z-score and average sleep duration (p < 0.001). CONCLUSION Excessive daytime sleepiness is an important contributory factor associated with suboptimal behavioral and emotional outcomes in children with OSA.
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Affiliation(s)
- Michelle Wai-Ling Yu
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun-Ting Au
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hoi-Man Yuen
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan-Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate Ching-Ching Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Gasimov E, Yılmaz B, Benbir Şenel G, Karadeniz D, Öztunç EF. Analysis of QRS complex morphology in children and adolescents with obstructive sleep apnea syndrome. Eur J Pediatr 2024; 183:1199-1207. [PMID: 38085282 DOI: 10.1007/s00431-023-05365-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 03/20/2024]
Abstract
Obstructive sleep apnea syndrome (OSAS) leads to many cardiovascular, neurologic, metabolic, and neurocognitive consequences. Conduction deficits, deviations in electrical axis, and changes in QRS morphology reflect the impairments in cardiac muscle activity and underlie the cardiovascular complications of OSAS. Here we aimed to determine the relationship between OSAS and changes in the cardiac conduction system in children and adolescents. During the 6-month duration of the study, all children having the diagnosis of OSAS in Sleep and Disorders Unit following a full-night polysomnography (PSG) were consecutively evaluated. ECGs were performed and analyzed in the Division of Pediatric Cardiology, Department of Pediatrics. The maximum spatial vector size (QRSmax), QRS electrical axis (EA), left and right ventricular hypertrophy, and the presence of fragmented QRS (fQRS) or prolonged R or S wave were examined in detail. A total of 17 boys with OSAS and 13 healthy boys participated in the study. The mean QRSmax and the QRSmax on V5 derivative were significantly lower in the patient group compared to those in the control group (p = 0.011 and p = 0.017, respectively). EA was similar between the two groups. While none of the patients with OSAS nor the control group had left ventricular hypertrophy, only one boy with OSAS had right ventricular hypertrophy according to ECG-derived analysis. The percentage of fQRS or notched R or S waves was significantly higher in patients with OSAS compared to healthy controls (p = 0.035), especially in children below the age of 5 years (p = 0.036). Conclusion: This study demonstrated that male children and adolescents with OSAS have a combination of QRS complex changes characterized by low QRS voltages, and increased frequency of fragmented QRS. These findings reflect that the electrical remodeling and structural remodeling of the myocardium are considerably affected by OSAS in children and adolescents, leading to ventricular changes and intraventricular conduction problems. What is Known: • Pediatric obstructive sleep apnea syndrome (OSAS) characterized by recurrent intermittent hypoxemia, hypercapnia, and sleep fragmentation results in sympathetic nervous system activation, increased inflammation, and hypoxic endothelial dysfunction. When left untreated, OSAS leads to many cardiovascular, neurologic, metabolic and neurocognitive consequences, and also to sudden infant death syndrome in young children, probably due to the involvement of the cardiac conduction system. What is New: • This study demonstrated that mean QRSmax was significantly lower in male children and adolescents with OSAS, reflecting the structural and electrical remodeling of the myocardium, and one boy with OSAS had RVH according to ECG-derived analysis. The percentage of fQRS or notched R or S waves was much higher in boys with OSAS, especially in children below the age of five years. These finding showed that myocardium was considerably affected to impair the intraventricular conduction in younger children with OSAS.
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Affiliation(s)
- Elnur Gasimov
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Başak Yılmaz
- Sleep and Disorders Unit, Division of Clinical Neurophysiology, Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, 34303, Turkey
| | - Gülçin Benbir Şenel
- Sleep and Disorders Unit, Division of Clinical Neurophysiology, Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, 34303, Turkey.
| | - Derya Karadeniz
- Sleep and Disorders Unit, Division of Clinical Neurophysiology, Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, 34303, Turkey
| | - Emine Funda Öztunç
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Paracha H, Parker Davidson K, Dixon C, Wilde Z. A Novel Intervention to Simultaneously Address the Dual Pathologies of Breathing Disorders During Sleep and Undiagnosed Attention Deficit Hyperactivity Disorder in School-Aged Children Ages 5-12. J Atten Disord 2024; 28:293-301. [PMID: 38031843 DOI: 10.1177/10870547231211024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE To evaluate the improvement of ADHD related symptoms in school-aged children ages 5 to 12 in treatment with a monobloc appliance (MOA) for Sleep Disordered Breathing (SDB). METHODS A retrospective review of questionnaire scores of ADHD symptoms from school-aged children being treated with a MOA for SDB. Data was obtained from parent survey questionnaires of 40 school-aged children in three dental offices in treatment with an MOA for SDB showing symptoms of ADHD yet to be confirmed with a formal diagnosis between 2019 and 2021. ADHD symptom scores were ascertained by a parent survey questionnaire completed at the initial visit before MOA treatment, and 2 to 6 months, and 7+ months during MOA treatment. RESULTS At the 7+ month endpoint, 17 of the 28 (61%) children ages 5 to 12 saw at least a 1-point drop in the sum of their questionnaire scores indicating an improvement in ADHD symptoms after initiating treatment with an MOA. Although there was a reduction of the overall average symptom score from the initial visit to 2 to 6 months (M = 4.06, SD ± 1.55), a statistically significant improvement in ADHD symptoms occurred at the 7+ month endpoint (M = 15.29, SD ± 4.50) during MOA treatment. CONCLUSIONS Treatment with an MOA may be highly effective in addressing the dual pathologies of SDB and ADHD in school-age children ages 5 to 12.
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Lee WY, Lau MN, Soh EX, Yuen SW, Ashari A, Radzi Z. Validation of the Malay version of Epworth sleepiness scale for children and adolescents (MESS-CHAD). BMC Oral Health 2023; 23:1015. [PMID: 38115099 PMCID: PMC10729393 DOI: 10.1186/s12903-023-03762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) is a valid and reliable eight-item self-administered questionnaire for the assessment of excessive daytime sleepiness and is commonly used to screen sleep-disordered breathing for children and adolescents. The cross-sectional study aimed to translate and cross-culturally adapt ESS-CHAD into a Malay version of Epworth Sleepiness Scale for Children and Adolescents (MESS-CHAD) for the Malaysian population, and to assess the validity and reliability of MESS-CHAD. METHODS Forward-backward translation method was used to translate and cross-culturally adapt ESS-CHAD. Three linguistic experts and two paediatricians content validated the translated version. Face validity was conducted through audio-recorded semi-structured in-depth interviews with 14 native Malay-speaking children and adolescents followed by thematic analysis. The revised questionnaire was then proofread by a linguistic expert. A total of 40 subjects answered the MESS-CHAD twice, 2 weeks apart, for test-retest reliability and internal consistency. For criterion validity, 148 eligible subjects and their parents answered MESS-CHAD and the Malay version of Sleep-Related Breathing Disorder scale extracted from the Paediatric Sleep Questionnaire (M-PSQ:SRBD) concurrently. Variance Inflation Factor (VIF) and P values of the model's outer weight and outer loading were analysed using SmartPLS software to assess the indicator's multicollinearity and significance for formative construct validity. RESULTS Intraclass Correlation Coefficient (ICC) ranging from 0.798 to 0.932 and Cronbach's alpha ranging from 0.813 to 0.932 confirmed good to excellent test-retest reliability and internal consistency, respectively. Spearman Correlation Coefficient value of 0.789 suggested a very strong positive correlation between MESS-CHAD and M-PSQ:SRBD. VIF ranging from 1.109 to 1.455 indicated no collinearity problem. All questionnaire items in MESS-CHAD were retained as the P value of either outer model weight or outer model loading was significant (P < 0.05). CONCLUSION ESS-CHAD has been translated and cross-culturally adapted into Malay version for the Malaysian population, and found to be valid and reliable.
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Affiliation(s)
- Wan Ying Lee
- Lanang Dental Clinic, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - May Nak Lau
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Eunice Xinwei Soh
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sze Wan Yuen
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Asma Ashari
- Centre for Family Oral Health, Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia.
| | - Zamri Radzi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
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Bamaga A, Alqarni L. Risk of Obstructive Sleep Apnea in Saudi Male Boys with Duchenne Muscular Dystrophy (DMD). Degener Neurol Neuromuscul Dis 2023; 13:45-53. [PMID: 37601287 PMCID: PMC10439780 DOI: 10.2147/dnnd.s421399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023] Open
Abstract
Background Duchenne muscular dystrophy (DMD) patients are at a high risk of developing sleep-related breathing disorders (SRBD) such as obstructive sleep apnea (OSA). This study aimed to determine the risk of developing OSA among DMD patients. Methods This cross-sectional study was conducted from February 2022 to July 2022 in a tertiary healthcare facility. As a screening tool for OSA, we used the Pediatric Sleep Questionnaire (PSQ). Results Subjects included 60 boys with DMD, mean age 10.15 ± 3.54 years. The mean BMI for all subjects was 18.9 ± 4.08 kg/m2. Of these, 22 (36.7%) children were at high risk of OSA. Children who were overweight, and on steroids tended to be at higher risk of developing OSA (P < 0.043) and (P < 0.029) respectively. Conclusion Our study shows a significant risk of OSA in DMD patients. Therefore, Sleep studies should be part of the standard of care for DMD patients.
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Affiliation(s)
- Ahmed Bamaga
- Neuromuscular Medicine Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz Univeristy and Hospital, Jeddah, Saudi Arabia
| | - Lama Alqarni
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Crowson MG, Gipson KS, Katz Kadosh O, Hartnick E, Grealish E, Keamy DG, Kinane TB, Hartnick CJ. Paediatric sleep apnea event prediction using nasal air pressure and machine learning. J Sleep Res 2023; 32:e13851. [PMID: 36807952 PMCID: PMC10363180 DOI: 10.1111/jsr.13851] [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: 08/29/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Sleep-disordered breathing is an important health issue for children. The objective of this study was to develop a machine learning classifier model for the identification of sleep apnea events taken exclusively from nasal air pressure measurements acquired during overnight polysomnography for paediatric patients. A secondary objective of this study was to differentiate site of obstruction exclusively from hypopnea event data using the model. Computer vision classifiers were developed via transfer learning to either normal breathing while asleep, obstructive hypopnea, obstructive apnea or central apnea. A separate model was trained to identify site of obstruction as either adeno-tonsillar or tongue base. In addition, a survey of board-certified and board-eligible sleep physicians was completed to compare clinician versus model classification performance of sleep events, and indicated very good performance of our model relative to human raters. The nasal air pressure sample database available for modelling comprised 417 normal, 266 obstructive hypopnea, 122 obstructive apnea and 131 central apnea events derived from 28 paediatric patients. The four-way classifier achieved a mean prediction accuracy of 70.0% (95% confidence interval [67.1-72.9]). Clinician raters correctly identified sleep events from nasal air pressure tracings 53.8% of the time, whereas the local model was 77.5% accurate. The site of obstruction classifier achieved a mean prediction accuracy of 75.0% (95% confidence interval [68.7-81.3]). Machine learning applied to nasal air pressure tracings is feasible and may exceed the diagnostic performance of expert clinicians. Nasal air pressure tracings of obstructive hypopneas may "encode" information regarding the site of obstruction, which may only be discernable by machine learning.
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Affiliation(s)
- Matthew G. Crowson
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye & Ear, Boston, Massachusetts
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kevin S. Gipson
- Department of Pediatric Pulmonary Medicine, MassGeneral Hospital for Children, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Orna Katz Kadosh
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye & Ear, Boston, Massachusetts
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | | | | | - Donald G. Keamy
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye & Ear, Boston, Massachusetts
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Thomas Bernard Kinane
- Department of Pediatric Pulmonary Medicine, MassGeneral Hospital for Children, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Hartnick
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye & Ear, Boston, Massachusetts
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
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Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [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: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
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Huang X, Shirahama K, Irshad MT, Nisar MA, Piet A, Grzegorzek M. Sleep Stage Classification in Children Using Self-Attention and Gaussian Noise Data Augmentation. SENSORS (BASEL, SWITZERLAND) 2023; 23:3446. [PMID: 37050506 PMCID: PMC10098613 DOI: 10.3390/s23073446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
The analysis of sleep stages for children plays an important role in early diagnosis and treatment. This paper introduces our sleep stage classification method addressing the following two challenges: the first is the data imbalance problem, i.e., the highly skewed class distribution with underrepresented minority classes. For this, a Gaussian Noise Data Augmentation (GNDA) algorithm was applied to polysomnography recordings to seek the balance of data sizes for different sleep stages. The second challenge is the difficulty in identifying a minority class of sleep stages, given their short sleep duration and similarities to other stages in terms of EEG characteristics. To overcome this, we developed a DeConvolution- and Self-Attention-based Model (DCSAM) which can inverse the feature map of a hidden layer to the input space to extract local features and extract the correlations between all possible pairs of features to distinguish sleep stages. The results on our dataset show that DCSAM based on GNDA obtains an accuracy of 90.26% and a macro F1-score of 86.51% which are higher than those of our previous method. We also tested DCSAM on a well-known public dataset-Sleep-EDFX-to prove whether it is applicable to sleep data from adults. It achieves a comparable performance to state-of-the-art methods, especially accuracies of 91.77%, 92.54%, 94.73%, and 95.30% for six-stage, five-stage, four-stage, and three-stage classification, respectively. These results imply that our DCSAM based on GNDA has a great potential to offer performance improvements in various medical domains by considering the data imbalance problems and correlations among features in time series data.
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Affiliation(s)
- Xinyu Huang
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Kimiaki Shirahama
- Department of Informatics, Kindai University, 3-4-1 Kowakae, Higashiosaka City 577-8502, Osaka, Japan
| | - Muhammad Tausif Irshad
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of IT, University of the Punjab, Lahore 54000, Pakistan
| | | | - Artur Piet
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Knowledge Engineering, University of Economics, Bogucicka 3, 40287 Katowice, Poland
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13
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Campos AI, Ingold N, Huang Y, Mitchell BL, Kho PF, Han X, García-Marín LM, Ong JS, Law MH, Yokoyama JS, Martin NG, Dong X, Cuellar-Partida G, MacGregor S, Aslibekyan S, Rentería ME. Discovery of genomic loci associated with sleep apnea risk through multi-trait GWAS analysis with snoring. Sleep 2023; 46:6918774. [PMID: 36525587 PMCID: PMC9995783 DOI: 10.1093/sleep/zsac308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Despite its association with severe health conditions, the etiology of sleep apnea (SA) remains understudied. This study sought to identify genetic variants robustly associated with SA risk. METHODS We performed a genome-wide association study (GWAS) meta-analysis of SA across five cohorts (NTotal = 523 366), followed by a multi-trait analysis of GWAS (multi-trait analysis of genome-wide association summary statistics [MTAG]) to boost power, leveraging the high genetic correlation between SA and snoring. We then adjusted our results for the genetic effects of body mass index (BMI) using multi-trait-based conditional and joint analysis (mtCOJO) and sought replication of lead hits in a large cohort of participants from 23andMe, Inc (NTotal = 1 477 352; Ncases = 175 522). We also explored genetic correlations with other complex traits and performed a phenome-wide screen for causally associated phenotypes using the latent causal variable method. RESULTS Our SA meta-analysis identified five independent variants with evidence of association beyond genome-wide significance. After adjustment for BMI, only one genome-wide significant variant was identified. MTAG analyses uncovered 49 significant independent loci associated with SA risk. Twenty-nine variants were replicated in the 23andMe GWAS adjusting for BMI. We observed genetic correlations with several complex traits, including multisite chronic pain, diabetes, eye disorders, high blood pressure, osteoarthritis, chronic obstructive pulmonary disease, and BMI-associated conditions. CONCLUSION Our study uncovered multiple genetic loci associated with SA risk, thus increasing our understanding of the etiology of this condition and its relationship with other complex traits.
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Affiliation(s)
- Adrian I Campos
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Nathan Ingold
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Brittany L Mitchell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pik-Fang Kho
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Xikun Han
- Program in Genetic Epidemiology and Statistical Genetics, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Luis M García-Marín
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jue-Sheng Ong
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Matthew H Law
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jennifer S Yokoyama
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA.,Weill Institute of Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Xianjun Dong
- Genomics and Bioinformatics Hub, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Miguel E Rentería
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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14
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Abijay CA, Kemper WC, Pham A, Johnson RF, Mitchell RB. Pediatric Obstructive Sleep Apnea and Sickle Cell Disease: Demographic and Polysomnographic Features. Laryngoscope 2023. [PMID: 36883666 DOI: 10.1002/lary.30638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/29/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is prevalent in children with sickle cell disease (SCD). We compared the demographic, clinical, and polysomnographic characteristics of children with and without SCD. METHODS This retrospective chart review included children with SCD (n = 89) and without SCD (n = 192) ages 1-18 years referred for polysomnography (PSG) for OSA. RESULTS Children with SCD were predominantly African American when compared to the non-SCD group (95% vs. 28%, p < 0.001). The non-SCD group had a higher BMI z-score (1.3 vs. 0.1, p < 0.001) and a higher percentage of patients classified as obese (52% vs. 13%, p < 0.001). In children with SCD, 43% had severe OSA and 5.6% had no OSA. In the non-SCD group, 67% had severe OSA and 4.7% had no OSA. The SCD compared to the non-SCD group had a lower mean apnea-hypopnea index (AHI) (13.6 vs. 22.4, p = 0.006) but a higher percent sleep time below 90% oxygen saturation (10.5% vs. 3.5%, p < 0.001). Predicted probability for severe OSA in children with SCD decreased with increasing age (OR = 0.81, 95% CI: 0.70-0.93). CONCLUSION Children with SCD referred for PSG are at risk for severe OSA. Compared with the non-SCD group, most children were African American with lower rates of obesity and lower AHIs but longer periods of nocturnal hypoxemia. Likelihood for severe OSA decreased with increasing age for the SCD group. LEVEL OF EVIDENCE Level III, retrospective comparative study Laryngoscope, 2023.
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Affiliation(s)
| | | | - An Pham
- Children's Medical Center Dallas, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Romaine F Johnson
- Children's Medical Center Dallas, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ron B Mitchell
- Children's Medical Center Dallas, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
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15
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Alosaimi RM, Musslem MT, Filfilan FF, Alqarni GS, Alazmi EA, Alghamdi TY, Alsaedi JR, Amoodi H. Knowledge and Awareness of Parents Attending Pediatric Clinic Regarding Pediatric Obstructive Sleep Apnea in Jeddah: A Cross-Sectional Study. Cureus 2023; 15:e35339. [PMID: 36994265 PMCID: PMC10042548 DOI: 10.7759/cureus.35339] [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: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by chronic, recurrent episodes of partial or complete airway obstruction during sleep. It has a negative impact on quality of life and behavior and can lead to adverse neurological and cardiovascular outcomes if left untreated. This study aims to assess the awareness and knowledge of pediatric OSA among parents attending a general pediatric clinic in Jeddah, Saudi Arabia. METHODS An observational cross-sectional study was conducted from October 2022 to December 2022, on parents who attended the pediatric clinic at Dr. Soliman Fakeeh Hospital in Jeddah. Participants were asked to complete a self-administered questionnaire, either using a tablet or a paper-based survey. The questionnaire consisted of sociodemographic information and questions assessing the parents' knowledge and awareness of pediatric OSA. RESULTS The study included 146 participants. The mean knowledge score was 15.38 ± 6. Only 20% of the participants had a good knowledge level, while 80% had a poor level of knowledge. Furthermore, regarding the definition of OSA, 60 out of 146 participants answered correctly. Enlargement of adenoids was the most recognized risk factor, and restless sleep was the most recognized symptom. The majority of participants agreed that consulting an expert doctor was the best method to raise awareness about childhood OSA. CONCLUSION The result of our study reveals the low level of awareness and knowledge of pediatric OSA among parents attending a pediatric clinic in Jeddah. This highlights the need for health education programs and sensitization campaigns to improve awareness of pediatric obstructive sleep apnea.
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Affiliation(s)
| | | | | | | | | | | | | | - Hosam Amoodi
- Otolaryngology-Head and Neck Surgery, University of Jeddah, Jeddah, SAU
- Otolaryngology-Head and Neck Surgery, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
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16
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Nocera E, Connolly H. Pediatric obstructive sleep apnea syndrome and hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2023. [DOI: 10.1016/j.ppedcard.2023.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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17
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Evaluating symptoms and polysomnographic findings among male and female children with obesity with and without obstructive sleep apnea. Sleep Med 2022; 100:56-63. [PMID: 36027663 DOI: 10.1016/j.sleep.2022.07.013] [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: 05/16/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Limited data regarding sex-based differences in the presentation and phenotype of obstructive sleep apnea (OSA) exists among children with obesity. The study objectives were to compare reported symptoms and polysomnogram (PSG) findings between children with obesity 1) with and without OSA and 2) males and females with OSA. PATIENTS/METHODS This cross-sectional study included children with obesity, aged 8-18 years, with a diagnostic PSG between 2015 and 2021, referred for evaluating sleep-related breathing. Patient demographics, anthropometrics, and PSG data were recorded. Symptoms were evaluated using Epworth Sleepiness Scale and Pediatric Sleep Questionnaire. Pubertal staging was collected using Tanner Stage questionnaire. PSG parameters, symptoms and pubertal stage were compared between sexes with and without OSA. RESULTS Of 148 children, 61 (41%) had OSA. Within the OSA group, 41/62 (69%) were male (p = 0.002). Males with OSA reported higher Pediatric Sleep Questionnaire scores compared to males without OSA (0.38 ± 0.2 vs 0.23 ± 0.1; p = 0.002). Males with OSA reported more trouble breathing (p = 0.04) and mouth breathing (p = 0.008) compared to females with OSA. Females with OSA showed longer sleep onset latency (45.8 ± 40.6 min vs 22.4 ± 26.7; p = 0.02) and higher supine obstructive-apnea hypopnea index (32.9 ± 31.1 vs 20.4 ± 18.4 events/hour; p = 0.02) compared to males with OSA. A significant interaction was found between male sex and waist-to-height ratio (β = 15.34, R2 = 0.18, p = 0.05). CONCLUSIONS Sex differences in symptoms and phenotype of OSA exist among children with obesity. Such information is beneficial for early diagnosis and management to mitigate adverse outcomes and comorbidities.
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18
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Cordani R, Veneruso M, Napoli F, Di Iorgi N, Milanaccio C, Consales A, Disma N, De Grandis E, Maghnie M, Nobili L. Sleep Disturbances in Pediatric Craniopharyngioma: A Systematic Review. Front Neurol 2022; 13:876011. [PMID: 35651342 PMCID: PMC9150678 DOI: 10.3389/fneur.2022.876011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Craniopharyngiomas are rare brain tumors of the sellar region and are the most common non-neuroepithelial intracerebral neoplasm in children. Despite a low-grade histologic classification, craniopharyngiomas can have a severe clinical course due to hypothalamic involvement. The hypothalamus plays a crucial role in regulating vital functions, and it is a critical component of the sleep-wake regulatory system. This systematic review aims to provide an overview of the current knowledge on sleep disorders in patients with craniopharyngioma to unravel their underlying mechanisms and identify possible therapeutic strategies. A comprehensive electronic literature search of the PubMed/MEDLINE and Scopus databases was conducted in accordance with the PRISMA® statement. Extensively published, peer-reviewed articles involving patients with childhood craniopharyngioma and focused on this specific topic were considered eligible for inclusion. Thirty-two articles were included; a high prevalence of excessive daytime sleepiness was reported in CP patients, with wide variability (25–100%) depending on the diagnostic method of detection (25–43% by subjective measures, 50–100% by objective investigations). In particular, secondary narcolepsy was reported in 14–35%, sleep-disordered breathing in 4–46%. Moreover, sleep-wake rhythm dysregulation has been notified, although no prevalence data are available. Possible mechanisms underlying these disorders are discussed, including hypothalamic injury, damage to the suprachiasmatic nucleus, low melatonin levels, hypocretin deficiency, and hypothalamic obesity. The diagnosis and management of sleep disorders and associated comorbidities are challenging. This review summarizes the pathophysiology of sleep disorders in childhood-onset CP and the main treatment options. Finally, a possible diagnostic algorithm in order to accurately identify and treat sleep disorders in these patients is proposed.
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Affiliation(s)
- Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Unit for Research & Innovation in Anesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Veneruso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Flavia Napoli
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Natascia Di Iorgi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Nicola Disma
- Unit for Research & Innovation in Anesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisa De Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Mohamad Maghnie
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Lino Nobili
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Helligsoe ASL, Weile KS, Kenborg L, Henriksen LT, Lassen-Ramshad Y, Amidi A, Wu LM, Winther JF, Pickering L, Mathiasen R. Systematic Review: Sleep Disorders Based on Objective Data in Children and Adolescents Treated for a Brain Tumor. Front Neurosci 2022; 16:808398. [PMID: 35273474 PMCID: PMC8902496 DOI: 10.3389/fnins.2022.808398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tumors of the central nervous system (CNS) are the most common solid childhood malignancy. Over the last decades, treatment developments have strongly contributed to the improved overall 5-year survival rate, which is now approaching 75%. However, children now face significant long-term morbidity with late-effects including sleep disorders that may have detrimental impact on everyday functioning and quality of life. The aims of this study were to (1) describe the symptoms that lead to polysomnographic evaluation; (2) describe the nature of sleep disorders diagnosed in survivors of childhood CNS tumor using polysomnography (PSG); and (3) explore the association between tumor location and diagnosed sleep disorder. Methods An extensive literature search following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) was conducted. Inclusion criteria were children and adolescents diagnosed with a CNS tumor age <20 years having a PSG performed after end of tumor treatment. The primary outcome was sleep disorder confirmed by PSG. Results Of the 1,658 studies identified, 11 met the inclusion criteria. All the included articles were appraised for quality and included in the analysis. Analyses indicated that sleep disorders commonly occur among childhood CNS tumor survivors. Symptoms prior to referral for PSG were excessive daytime sleepiness (EDS), fatigue, irregular breathing during sleep and snoring. The most common sleep disorders diagnosed were sleep-related breathing disorders (i.e., obstructive sleep apnea) and central disorders of hypersomnolence (i.e., narcolepsy). Conclusion Our findings point to the potential benefit of systematically registering sleep disorder symptoms among CNS tumor patients together with tumor type and treatment information, so that at-risk patients can be identified early. Moreover, future rigorous and larger scale controlled observational studies that include possible modifiable confounders of sleep disorders such as fatigue and obesity are warranted. Clinical Trial Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021243866, identifier [CRD42021243866].
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathrine Synne Weile
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Tram Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa Maria Wu
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line Pickering
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
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20
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Nosetti L, Zaffanello M, Katz ES, Vitali M, Agosti M, Ferrante G, Cilluffo G, Piacentini G, Grutta SL. Twenty-year follow-up of children with obstructive sleep apnea. J Clin Sleep Med 2022; 18:1573-1581. [PMID: 35164899 DOI: 10.5664/jcsm.9922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in children is associated with acute metabolic, cardiovascular, and neuro-cognitive abnormalities. The long-term outcomes of childhood OSA into adulthood has not been established. We performed a 20-year follow-up of patients with polysomnographically documented OSA in childhood compared to a healthy control group to evaluate the long-term anthropometric, sleep, cognitive, and cardiovascular outcomes. METHODS Children diagnosed to have severe OSA between the ages of 1 - 17 years (4.87 ± 2.77) were prospectively contacted by telephone as young adults after approximately 20 years. Data collected included reported anthropometric, educational level, health history, and the Berlin questionnaire. RESULTS Young adults with confirmed severe OSA in childhood had significantly higher adulthood BMI (p=0.038), lower academic degrees (p<0.001), and more snoring (p=0.045) compared to controls. The AHI during childhood trended towards predicting cardiovascular outcomes and the Berlin questionnaire in adulthood. CONCLUSIONS Adults with history of severe childhood OSA have a high risk of having snoring, elevated BMI, and lower academic achievement in adulthood. Thus, children with severe OSA may be at increased risk of chronic diseases later in life. The intervening COVID-19 pandemic has introduced considerable additional neurobehavioral morbidity complicating the identification of the full long-term consequences of childhood OSA.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | | | - Eliot S Katz
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston MA.,Harvard Medical School, Boston, MA
| | - Maddalena Vitali
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Massimo Agosti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | | | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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21
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Thomas S, Patel S, Gummalla P, Tablizo MA, Kier C. You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020261. [PMID: 35204981 PMCID: PMC8870274 DOI: 10.3390/children9020261] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 12/25/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) has been shown to not only affect the quality of sleep, but also overall health in general. Untreated or inadequately treated OSA can lead to long-term sequelae involving cardiovascular, endothelial, metabolic, endocrine, neurocognitive, and psychological consequences. The physiological effects of pediatric OSA eventually become pathological. As the complex effects of pediatric OSA are discovered, they must be identified early so that healthcare providers can be better equipped to treat and even prevent them. Ultimately, adequate management of OSA improves overall quality of life.
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Affiliation(s)
- Selena Thomas
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY 11794, USA;
| | - Shefali Patel
- Department of Pediatrics, Valley Children’s Hospital, Madera, CA 93636, USA; (S.P.); (M.A.T.)
| | - Prabhavathi Gummalla
- Department of Pediatric Sleep Medicine, Valley Hospital, Ridgewood, NJ 07450, USA;
| | - Mary Anne Tablizo
- Department of Pediatrics, Valley Children’s Hospital, Madera, CA 93636, USA; (S.P.); (M.A.T.)
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY 11794, USA;
- Correspondence:
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22
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Damian A, Gozal D. Pediatric Obstructive Sleep Apnea: What’s in a Name? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:63-78. [PMID: 36217079 DOI: 10.1007/978-3-031-06413-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea is a highly prevalent disease across the lifespan and imposes substantial morbidities, some of which may become irreversible if the condition is not diagnosed and treated in a timely fashion. Here, we focus on the clinical and epidemiological characteristics of pediatric obstructive sleep apnea, describe some of the elements that by virtue of their presence facilitate the emergence of disrupted sleep and breathing and its downstream consequences, and also discuss the potential approaches to diagnosis in at-risk children.
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Affiliation(s)
- Allan Damian
- Departments of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
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Rueda-Etxebarria M, Mugueta-Aguinaga I, Rueda JR, Lascurain-Aguirrebena I. Respiratory muscle training for obstructive sleep apnoea. Hippokratia 2021. [DOI: 10.1002/14651858.cd015039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology; Biocruces Health Research Institute, Cruces University Hospital; Barakaldo Spain
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health; University of the Basque Country; Leioa Spain
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Liu SJ, Liu ZZ, Wang ZY, Liu BP, Cheng S, Liu X, Jia CX. Sleep disordered breathing symptoms are associated with depressive symptoms: A longitudinal study of Chinese adolescents. J Affect Disord 2021; 293:492-501. [PMID: 34329858 DOI: 10.1016/j.jad.2021.05.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/04/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the prospective association between sleep disordered breathing (SDB) and depressive symptoms in Chinese adolescents. This study examined the independent predictive role of SDB symptoms in depressive symptoms in a large sample of adolescents. METHODS A total of 11831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort and 7072 adolescents who were resurveyed 1 year later were included for the analyses. Adolescents completed a self-administered questionnaire about demographics, mental health, sleep problems, and family environment. SDB symptoms were assessed by 3 items about loud snoring, breathing pauses, and snorting/gasping. The Chinese Youth Self-Report anxious/depressed subscale was used to assess depressive symptoms. RESULTS In the cross-sectional analyses, 11.8% adolescents had depressive symptoms, and elevated frequency of SDB symptoms were significantly associated with depressive symptoms. In the longitudinal study, 4.5% of adolescents had persistent depressive symptoms, the incidence rate of depressive symptoms at 1-year follow-up was 6.5%, and elevated frequency of any SDB symptoms (often: OR=2.23, 95%CI:1.50-3.32) at baseline was significantly associated with incident depressive symptoms after adjusting for potential confounders. The associations between SDB symptoms and depressive symptoms were similar for boys and girls. LIMITATION SDB symptoms and depressive symptoms were measured by self-report. CONCLUSION SDB symptoms are an independent and significant predictor of depressive symptoms in adolescents. Further research is needed to understand the biological mechanisms between SDB and mood dysregulation in adolescents.
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Affiliation(s)
- Shu-Juan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Zhen-Zhen Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Ze-Ying Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Shuo Cheng
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Xianchen Liu
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China.
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The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD). CHILDREN-BASEL 2021; 8:children8090824. [PMID: 34572256 PMCID: PMC8470037 DOI: 10.3390/children8090824] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients.
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Garcia A, Clark EA, Rana S, Preciado D, Jeha GM, Viswanath O, Urits I, Kaye AD, Abdallah C. Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy. Cureus 2021; 13:e13101. [PMID: 33728122 PMCID: PMC7935262 DOI: 10.7759/cureus.13101] [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] [Indexed: 12/02/2022] Open
Abstract
Background Midazolam is commonly used preoperatively for anxiety. Adverse effects data in pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy (T&A) is limited. Aims We hypothesized that preoperative midazolam increases the time to emergence from anesthesia and postoperative discharge. Secondary objectives assessed if patients receiving midazolam experienced increased side effects or complications from treatment. Methods This study was a retrospective chart review of patients undergoing T&A from July 2014 to December 2015. Midazolam receiving patients (midazolam group: MG) were compared to patients who did not (non-midazolam group: NMG). Multivariable analyses were performed and adjusted for predefined potential cofounder variables. Results Emergence and discharge times were 5.2 minutes (95% CI [-7.1, 17.4]; p=0.41) and 10.1 minutes (95% CI [-6.7, 26.8]; p=0.24) longer in MG. These results were not statistically significant. Comparing by OSA status, there was no statistical difference in emergence and discharge times between mild, moderate and severe OSA groups or between MG and NMG within each OSA group. Emergence and discharge times in moderate OSA was 6.1 minutes (95% CI [-17.6, 29.8]; p=0.61) and 18.8 minutes (95% CI [-16.4, 53.9]; p=0.29) longer than mild OSA, and in the severe OSA group, 2.6 minutes (95% CI [-19.9, 25.1]; p=0.82) shorter and 2.8 minutes (95% CI [-30.3, 35.9]; p=0.87) longer. The incidence of postoperative complications was comparable between MG and NMG groups. Conclusions Premedication with midazolam was not associated with prolonged emergence or discharge time or higher incidence of complications after anesthesia for T&A in patients with OSA.
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Affiliation(s)
- Andrew Garcia
- Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Elizabeth A Clark
- Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Sohel Rana
- Anesthesiology, Children's National Medical Center, Washington, D.C., USA
| | - Diego Preciado
- Otolaryngology - Head and Neck Surgery, Children's National Medical Center, Washington, D.C., USA
| | - George M Jeha
- Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants Envision Physician Services, Phoenix, USA
| | - Ivan Urits
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Claude Abdallah
- Anesthesiology, Children's National Medical Center, Washington, D.C., USA
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Pinilla L, Barbé F, de Gonzalo-Calvo D. MicroRNAs to guide medical decision-making in obstructive sleep apnea: A review. Sleep Med Rev 2021; 59:101458. [PMID: 33582532 DOI: 10.1016/j.smrv.2021.101458] [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: 07/08/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is a common and frequently underdiagnosed sleep disorder tightly associated with a wide range of morbidities and an elevated risk of the main causes of mortality. This condition represents a major public health concern due to its increasing worldwide prevalence and its serious pathological consequences. Current clinical guidelines support the importance of effective diagnosis and treatment of OSA and emphasize the unmet need for biomarkers to guide medical decision-making. In recent years, the noncoding transcriptome has emerged as a new opportunity for biomarker discovery. In this review, we provide a brief overview of the current understanding of noncoding RNAs, specifically microRNAs (miRNAs). Then, we carefully address the potential role of miRNAs as novel indicators for the management of both pediatric and adult OSA, highlighting their translational applicability, particularly for diagnosis and therapy allocation. Finally, we identify the gaps in the research state-of-art, discuss current methodological and conceptual limitations and propose future key steps and perspectives for the incorporation of miRNAs into routine clinical practice.
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Affiliation(s)
- Lucía Pinilla
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
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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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Ahmad L, Kapoor P, Bhaskar S, Khatter H. Screening of obstructive sleep apnea (OSA) risk in adolescent population and study of association with craniofacial and upper airway morphology. J Oral Biol Craniofac Res 2020; 10:807-813. [PMID: 33224724 DOI: 10.1016/j.jobcr.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing with high prevalence and associated co-morbidities. It still goes largely under-reported due to events occurring in sleep and difficulty in identifying predisposing factors. Aims To perform questionnaire-based screening of OSA-risk in adolescents and study association of OSA-risk with craniofacial and upper airway morphology. Material and methods Modified STOP-BANG questionnaire was used for screening OSA-risk in adolescent orthodontic patients (10-19 years) in a government dental hospital in India. Patients were categorised into two groups: OSA-risk and non-risk, based on the questionnaire scores, and were subsequently evaluated for craniofacial and upper airway morphology, both on examination and on lateral cephalometric radiographs. Results Documented a high prevalence of 14% for OSA-risk in adolescent orthodontic patients. The extra-oral and intra-oral parameters found significantly associated with OSA-risk were convex profile [Odd's ratio (OR) - 3.824], steep mandibular plane angle [MPA] (OR- 79.75), Type 3/4 faucial pillars (OR- 11.227), Class II molar relationship (OR - 4.518), ovoid upper arch form (OR - 13.750). In addition, the cephalometric parameters: ANB (p- 0.025), SN-MP (p- 0.007), BA-SN (p- 0.020), PNS-AD1 (p < 0.001), PNS-AD2 (p - 0.001) also showed highly significant association to OSA-risk. The ROC curves demonstrated high sensitivity and specificity for PNS-AD1 (60%,83.3%), PNS-AD2 (73.3%, 70%) and SN-MP (60%,70%), respectively for OSA-risk. Conclusions The study supported applicability of modified STOP-BANG questionnaire for OSA-risk in Indian adolescents. The parameters [extra-oral, intra-oral, cephalometric and upper airway (PNS-AD1, PNS-AD2, SN-MP)] significantly associated with OSA-risk, were identified.
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Affiliation(s)
- Lubna Ahmad
- Intern, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Priyanka Kapoor
- Professor, Department of Orthodontics & Dentofacial Orthopedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Sejal Bhaskar
- Final Year Student, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Himani Khatter
- Biostatistician, Dept of Neurology, Christian Medical College & Hospital, Ludhiana, 141008, India
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Di Carlo G, Zara F, Rocchetti M, Venturini A, Ortiz-Ruiz AJ, Luzzi V, Cattaneo PM, Polimeni A, Vozza I. Prevalence of Sleep-Disordered Breathing in Children Referring for First Dental Examination. A Multicenter Cross-Sectional Study Using Pediatric Sleep Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228460. [PMID: 33207543 PMCID: PMC7698058 DOI: 10.3390/ijerph17228460] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022]
Abstract
Background: Sleep-related breathing disorders (SRDB) are a group of pathological conditions characterized by a dysfunction of the upper airways. The value of SRDB's prevalence, in the pediatric population, ranges from 2 to 11% depending on the different methodologies used in measure and the difficulties in the diagnosis. The aim of this study was to assess the prevalence of SRDB using the Pediatric Sleep Questionnaire (PSQ). Methods: 668 patients were enrolled from the Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy and from the Unit of Integrated Pediatric Dentistry, University of Murcia, Spain. The questionnaires were administered to patients with no previous orthodontic and surgical treatment who attended on the first visit at the two units of pediatric dentistry. Data regarding general health status were extracted from the standard anamnestic module for first visit. Prevalence and logistic regression models were computed. Results: The ages ranged from 2 to 16 years old (average 7 years old). The prevalence of SRDB was 9.7% for the entire sample. The models showed a positive correlation between three variables (snoring, bad habits, and anxiety) and SRDB. Conclusions: The prevalence obtained demonstrates the relevance of sleep disorders in the pediatric population and highlights the central role of pediatric dentists in the earlier diagnosis of these disorders.
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Affiliation(s)
- Gabriele Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
- Department of Dentistry, Section of Orthodontics, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark;
- Correspondence:
| | - Francesca Zara
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Milena Rocchetti
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Angelica Venturini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Antonio José Ortiz-Ruiz
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, University of Murcia, 30008 Murcia, Spain;
| | - Valeria Luzzi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Paolo Maria Cattaneo
- Department of Dentistry, Section of Orthodontics, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark;
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Iole Vozza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 11:CD013449. [PMID: 33141943 PMCID: PMC8094400 DOI: 10.1002/14651858.cd013449.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. OBJECTIVES To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. SELECTION CRITERIA We included RCTs that recruited adults and children with a diagnosis of OSA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. MAIN RESULTS We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.
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Affiliation(s)
- José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Jordi Vilaró
- Department of Health Sciences, Ramon Lull University, Barcelona, Spain
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Rossi C, Templier L, Miguez M, De La Cruz J, Curto A, Albaladejo A, Lagravère Vich M. Comparison of screening methods for obstructive sleep apnea in the context of dental clinics: A systematic review. Cranio 2020; 41:245-263. [PMID: 32981480 DOI: 10.1080/08869634.2020.1823104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review the available bibliographic data to identify the best screening methods to detect potential obstructive sleep apnea (OSA) patients during dental clinical practice. METHODS Relevant studies published up to April 2020 were sourced from PubMed, Embase, MEDLINE, Cochrane, and LILACS databases. RESULTS Thirty studies were selected. For adults, the screening methods available to the dentist included questionnaires, scales, indexes, pulse oximetry, and anatomical factors. A combination of questionnaires is potentially the most reliable method to detect OSA risk. For children, only information on questionnaires and anatomical factors was found; two questionnaires accurately identified potential OSA risk cases. Anatomical factors also displayed a significant relation with OSA for both populations. CONCLUSION Dentists have a fundamental role in early detection of potential OSA cases since they can use the methods identified in this review to perform an initial screening of the population. ABBREVIATIONS OSA: Obstructive sleep apnea; PSG: Polysomnography; HST: Home sleep study; BMI: Body mass index; PPV: Positive predictive value; NPV: Negative predictive value; AHI: Apnea hypopnea index; RDI: Respiratory disturbance index; ODI: Oxygen desaturation index; PSQ: Pediatric Sleep Questionnaire; SRBD: Sleep-related breathing disorder; CSHQ: Children's Sleep Habits Questionnaire; ESS: Epworth Sleepiness Scale; PSQI: Pittsburgh Sleep Quality Index.
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Affiliation(s)
- Cecilia Rossi
- Department of Orthodontics, University of Alfonso X El Sabio, Madrid, Spain
- PhD Student of Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Laura Templier
- Department of Orthodontics, University of Alfonso X El Sabio, Madrid, Spain
- PhD Student of Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Manuel Miguez
- Dental Sleep Medicine Program, Catholic University of Murcia UCAM, Murcia, Spain
| | - Javier De La Cruz
- Department of Orthodontics, University of Alfonso X El Sabio, Madrid, Spain
| | - Adrián Curto
- Department of Pediatric Dentistry, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Albaladejo
- Orthodontics, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Manuel Lagravère Vich
- Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
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Jansen EC, Dunietz GL, Matos-Moreno A, Solano M, Lazcano-Ponce E, Sánchez-Zamorano LM. Bedtimes and Blood Pressure: A Prospective Cohort Study of Mexican Adolescents. Am J Hypertens 2020; 33:269-277. [PMID: 31840156 DOI: 10.1093/ajh/hpz191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/07/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Hypertension affects up to 5% of children worldwide and predicts later cardiovascular morbidity. Associations of short sleep and hypertension have been frequently reported in adults but less consistently in children. This study aims to examine the role of late bedtimes, a marker of short sleep duration, and potentially misaligned circadian rhythms, on incident elevated blood pressure (BP) in a large cohort of Mexican children. METHODS Participants included 2,033 adolescents recruited from public schools in Morelos, Mexico, free from elevated BP (<90th sex, age, and height-standardized percentile). Fourteen months later, all adolescents had a second BP assessment. We abstracted baseline habitual bedtimes from questionnaires to evaluate the association between bedtime and elevated BP incidence (≥90th percentile). Risk ratios and 95% confidence intervals were estimated with discrete-time mixed survival models, adjusting for potential confounders and accounting for clustering by school. RESULTS Participants were 12.5 (SD = 0.6) years old at baseline. At the follow-up visit 10% of adolescents had developed elevated BP. Compared to participants with a habitual weekday bedtime between 9 and 10 pm, those with a weekday bedtime 11 pm or later had a 1.87 times higher risk of developing elevated BP over the follow-up period (95% CI = 1.09, 2.21), after accounting for confounders. Participants with earlier weekday bedtimes also had a higher risk of elevated BP (RR = 1.96; 95% CI = 1.27, 3.01). The associations persisted after accounting for wake time. CONCLUSION These data showed a U-shaped association between weekday bedtime and elevated/high BP risk among Mexican adolescents.
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Affiliation(s)
- Erica C Jansen
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amilcar Matos-Moreno
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Maritsa Solano
- Department of Chronic Disease, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Eduardo Lazcano-Ponce
- Department of Chronic Disease, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Abstract
A systematic review and meta-analysis is conducted for children with obstructive sleep apnea (OSA) treated with rapid maxillary expansion (RME). The study systematically and independently reviewed extracted articles from 2009 to 2019. The quality evaluation and selection of these studies was based on the high quality of NICE criteria. EMBASE, Scopus and other five databases were used to extract international publications. The findings indicated that the apnea-hypopnea index was enhanced after rapid maxillary expansion among children with OSA. It revealed that apnea hypopnea index enhances to 73% in children with obstructive sleep apnea after ≤ three years follow-up, while it was 77% in children with obstructive sleep apnea after > 3 years. The articles included in this meta-analysis reported differential outcomes based on different inclusion or exclusion criteria and diverse patient populations. Critical evaluation of previous literature suggests diagnosing the disorder at an early stage for reducing the adverse health outcomes and formulating an appropriate treatment plan.
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Hippokratia 2019. [DOI: 10.1002/14651858.cd013449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- José-Ramón Rueda
- University of the Basque Country; Department of Preventive Medicine and Public Health; Barrio Sarriena S.N. Leioa Bizkaia Spain E-48080
| | - Iranzu Mugueta-Aguinaga
- Biocruces Health Research Institute, Cruces University Hospital; Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology; Barakaldo Spain
| | - Jordi Vilaró
- Ramon Lull University; Department of Health Sciences; Padilla, 326-332 Barcelona Spain 08025
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