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Xu J, Wu M, Duan B, Ni Y, Wang A. The Analgesic Effect of a Transdermal Lappaconitine Patch Combined With Ibuprofen Suspension for Children After Adenoidectomy and Tonsillectomy: A Randomized Clinical Trial. J Perianesth Nurs 2024:S1089-9472(24)00124-2. [PMID: 38980239 DOI: 10.1016/j.jopan.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To study the analgesic effects and side effects of a transdermal lappaconitine (TLA) patch, ibuprofen suspension (IS), and TLA combined with IS (TLACIS) after adenoidectomy and tonsillectomy. DESIGN Prospective, randomized clinical trial. METHODS The patients were randomized into three groups defined by different analgesic drug regimens: the TLA group, the IS group, and the TLACIS group. Pain scores at 2, 12, and 24 hours after surgery and adverse-event reports within the first postoperative week were collected. RESULTS Ultimately, this study included 102 cases in the TLA group, 101 cases in the IS group, and 101 cases in the TLACIS group. At 2 hours after surgery, the pain scores of the TLA and the TLACIS groups were both significantly lower than that of the IS group (all P < .05). At 12 and 24 hours after surgery, the pain score of the TLACIS group was significantly lower than those of the TLA and IS groups (all P < .05); furthermore, the pain score of the IS group was significantly lower than that of the TLA group (P < .05). Within 1 week after the operation, there was no significant difference in the incidence of adverse events. CONCLUSIONS The addition of a TLA patch can speed the onset of analgesia. In terms of analgesic effects, IS alone is more advantageous than TLA alone, while the combination of TLA and IS has the best analgesic effect. No significant differences were found in the incidence of adverse events among the three regimens.
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Affiliation(s)
- Jiayuan Xu
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
| | - Min Wu
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
| | - Bo Duan
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
| | - Yihua Ni
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
| | - Anken Wang
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China.
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Fauroux B, Cozzo M, MacLean J, Fitzgerald DA. OSA type-III and neurocognitive function. Paediatr Respir Rev 2024:S1526-0542(24)00053-8. [PMID: 38908984 DOI: 10.1016/j.prrv.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/24/2024]
Abstract
Obstructive sleep apnea (OSA) due to a hypertrophy of the adenoids and/or the tonsils in otherwise healthy children is associated with neurocognitive dysfunction and behavioural disorders with various degrees of hyperactivity, aggressiveness, sometimes evolving to a label of attention-deficit hyperactivity disorder. Children with anatomical and/or functional abnormalities of the upper airways represent a very specific population which is at high risk of OSA (also called complex OSA or OSA type III). Surprisingly, the neurocognitive consequences of OSA have been poorly studied in these children, despite the fact that OSA is more common and more severe than in their healthy counterparts. This may be explained by that fact that screening for OSA and sleep-disordered breathing is not systematically performed, the performance of sleep studies and neurocognitive tests may be challenging, and the respective role of the underlining disease, OSA, but also poor sleep quality, is complex. However, the few studies that have been performed in these children, and mainly children with Down syndrome, tend to show that OSA, but even more disruption of sleep architecture and poor sleep quality, aggravate the neurocognitive impairment and abnormal behaviour in these patients, underlining the need for a systematic and early in life assessment of sleep and neurocognitive function and behaviour in children with OSA type III.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Noninvasive Ventilation And Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France; EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris University, Paris, France.
| | - Mathilde Cozzo
- Pediatric Noninvasive Ventilation And Sleep Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Joanna MacLean
- Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia
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Noda M, Koshu R, Dias M, Saito C, Ito M. Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea With High-Risk Comorbid Disease Conditions: A Case Series. Cureus 2024; 16:e61621. [PMID: 38966476 PMCID: PMC11222335 DOI: 10.7759/cureus.61621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE Pediatric obstructive sleep apnea (OSA) caused by adenoids or an enlarged palatine tonsil has a negative impact on physical and mental growth. Surgical removal of the tissue is effective but entails a life-threatening risk of postoperative bleeding, which is up to 30 times higher in chronic pediatric disease cases. However, endoscopes and resection devices provide safe, reliable surgical methods. Here, we report the efficacy and safety of endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) for pediatric OSA in patients with high-risk comorbidities. METHODS This retrospective case series included pediatric patients with OSA who underwent PITA at a single tertiary medical center between April 2017 and May 2023. Ten patients (three males and seven females; mean age 6.4 years, range 2-12 years) were included; all met the Japanese criteria for complex chronic pediatric conditions. RESULTS The average operative time was 61 min; a microdebrider was used in eight cases and a coblator in two cases. Although there was no postoperative bleeding, one case experienced regrowth. CONCLUSIONS Our data show that an endoscopic PITA approach could reduce the risk of severe bleeding and relieve the sleeping conditions of pediatric patients with complex chronic OSA.
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Affiliation(s)
- Masao Noda
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Ryota Koshu
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Mari Dias
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Chizu Saito
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Makoto Ito
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
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4
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Awadalla TO, Igwe O, Okeafor CU, Attarian HP. Improvement of attention deficit disorder symptoms after treatment of obstructive sleep apnea in an adult: a case report and mini review. J Clin Sleep Med 2024; 20:825-827. [PMID: 38230976 PMCID: PMC11063700 DOI: 10.5664/jcsm.11034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
Sparse literature exists on the effects of obstructive sleep apnea (OSA) treatment on symptoms of attention deficit hyperactivity disorder (ADHD) in adults. This article aims to bring to the fore the relationship between ADHD and OSA in adults and the implications of the treatment of OSA on the symptoms of ADHD. A case of an adult who was previously diagnosed with attention deficit disorder in childhood with symptom improvement following OSA treatment is reported. Considering the complex relationship between ADHD and sleep problems, the recommendation to screen for OSA and other sleep problems among persons being assessed for ADHD should be upheld. This article advocates for more research on the effect of the treatment of OSA on ADHD symptoms. CITATION Awadalla TO, Igwe O, Okeafor CU, Attarian HP. Improvement of attention deficit disorder symptoms after treatment of obstructive sleep apnea in an adult: a case report and mini review. J Clin Sleep Med. 2024;20(5):825-827.
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Affiliation(s)
- Tanzeel O. Awadalla
- Department of Family Medicine, United Health Services Hospitals, Binghamton, New York
| | - Ogechi Igwe
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Chukwuma U. Okeafor
- Department of Neuropsychiatry, University of Port Harcourt Teaching Hospital, Choba, Nigeria
| | - Hrayr P. Attarian
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Zaffanello M, Pietrobelli A, Zoccante L, Sacchetto L, Nosetti L, Piazza M, Piacentini G. Insights into Pediatric Sleep Disordered Breathing: Exploring Risk Factors, Surgical Interventions, and Physical and Scholastic Performance at Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2024; 11:388. [PMID: 38671605 PMCID: PMC11049613 DOI: 10.3390/children11040388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
(1) Background: Sleep-disordered breathing represents a growing public health concern, especially among children and adolescents. The main risk factors for pediatric sleep-disordered breathing in school-age children are tonsillar and adenoid hypertrophy. Adenoidectomy, often in combination with tonsillectomy, is the primary treatment modality for pediatric sleep-disordered breathing. This study aims to comprehensively investigate various risk and protective factors in children with sleep-disordered breathing undergoing adenotonsillar or adenoidal surgeries. We also aim to explore the differences in neuropsychological profiles. (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy in children referred to our center. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. The Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) screen sleep-disordered breathing and quality of life, respectively. The data were statistically analyzed using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL, USA). (3) Results: The study involved 138 patients, but only 100 children participated. A higher percentage of patients with sleep-disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep-disordered breathing habitually used a pacifier. A rise in physical score was associated with a reduced PSQ at follow-up (p = 0.051). An increase in the overall academic score was related to a decrease in the PSQ at follow-up (p < 0.001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth. (4) This comprehensive study delves into the intricate interplay of risk and protective factors impacting children with sleep-disordered breathing undergoing adenotonsillectomy and adenoidectomy.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy;
| | - Luca Sacchetto
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, 37126 Verona, Italy;
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy;
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
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Elwell Z, Mancuso D, Wolter NE, Propst EJ, Valdez T, Scheffler P. Post-tonsillectomy outcomes in children with mucopolysaccharidosis and obstructive sleep apnea. J Otolaryngol Head Neck Surg 2023; 52:87. [PMID: 38142272 DOI: 10.1186/s40463-023-00685-y] [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: 09/18/2022] [Accepted: 12/04/2023] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE To describe the incidence of respiratory complications, postoperative hemorrhage, length of stay, and cost of care in children with mucopolysaccharidosis (MPS) undergoing adenotonsillectomy (AT). METHODS Analysis of the 2009, 2012, and 2016 editions of the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) identified 24,700 children who underwent AT (40 children with MPS). Demographics, respiratory complications, postoperative hemorrhage, length of stay, and total cost were compared across children with and without MPS. RESULTS Children with MPS had a higher likelihood of being male (P < 0.017). There was a higher rate of respiratory complications in children with MPS compared with children without MPS [6/40 (15%) vs. 586/24,660 (2.4%), P < 0.001], which remained significant after adjusting for sex [adjusted odds ratio 6.88 (95% CI 2.87-16.46)]. There was also a higher risk of postoperative hemorrhage [4/40 (10%) vs. 444/24,660 (1.8%), P < 0.001), with sex-adjusted odds ratio of 5.97 (95% CI 2.12-16.86). Median (IQR) length of stay was increased in children with MPS (3 days, 1-4) compared with children without MPS (1 day, 1-2, P < 0.001). There was an increase in median (IQR) charges for hospital stay in children with MPS compared with their peers [$33,016 ($23,208.50-$72,280.50 vs. $15,383 ($9937-$24,462), P < 0.001]. CONCLUSIONS Children with MPS undergoing AT had an increased risk of respiratory complications, postoperative hemorrhage, longer length of stay, and a higher cost of treatment when compared with children without MPS. This information may help inform interventional, perioperative, and postoperative decision making.
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Affiliation(s)
- Zachary Elwell
- Department of Otolaryngology - Head and Neck Surgery, University of Arizona College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
| | - David Mancuso
- School of Molecular Sciences, Arizona State University, Tempe, AZ, USA
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Tulio Valdez
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, CA, USA
| | - Patrick Scheffler
- Division of Otolaryngology - Head and Neck Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona - Phoenix College of Medicine, Phoenix, AZ, USA
- Department of Surgery, Creighton University School of Medicine, Phoenix, AZ, USA
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Stilo G, Lo Faro C, Pollicina I, Falcone L, Campagna P, Felis S, Crimi S, La Mantia I, Leonardi R, Bianchi A. Mood, Behavioral Impairment, and Sleep Breathing Disorders in Obstructive Sleep Apnea Syndrome Patients Treated with Maxillomandibular Advancement: Reflection on a Case Series and Review of Literature. J Pers Med 2023; 13:1425. [PMID: 37888036 PMCID: PMC10607968 DOI: 10.3390/jpm13101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
The correlation between depressive and cognitive symptoms and OSAS (obstructive sleep apnea syndrome) is between 5 and 63%. We reported the case of two patients with severe OSAS and its associated depressive symptoms that were intolerant to continuous positive airway pressure (C-PAP) and underwent maxillomandibular advancement (MMA) surgery. The severity of cognitive and depressive symptoms was assessed using validated questionnaires (Beck Depression Inventory, Beck Anxiety Inventory, Epworth Sleepiness Scale, and quality of life), medical observation, and patient-reported symptoms. We performed pre- and post-treatment polysomnography. Six months after treatment, the value of the apnea-hypopnea index (AHI) had returned to the normal range and, together with it, the depressive component was considerably reduced and the patients' overall quality of life (BDI, BAI, ESS, and qol) improved. Conclusion: We described significant improvement in all the analyzed parameters, such as physical and mental functioning, and depression and anxiety rates.
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Affiliation(s)
- Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (G.S.); (I.P.); (S.F.); (I.L.M.)
| | - Carmelo Lo Faro
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (G.S.); (I.P.); (S.F.); (I.L.M.)
| | - Isabella Pollicina
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (G.S.); (I.P.); (S.F.); (I.L.M.)
| | - Loredana Falcone
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (L.F.); (P.C.)
| | - Paola Campagna
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (L.F.); (P.C.)
| | - Silvia Felis
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (G.S.); (I.P.); (S.F.); (I.L.M.)
| | - Salvatore Crimi
- Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic “G. Rodolico-San Marco” University Hospital, University of Catania, 95100 Catania, Italy; (S.C.); (R.L.); (A.B.)
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (G.S.); (I.P.); (S.F.); (I.L.M.)
| | - Rosalia Leonardi
- Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic “G. Rodolico-San Marco” University Hospital, University of Catania, 95100 Catania, Italy; (S.C.); (R.L.); (A.B.)
| | - Alberto Bianchi
- Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic “G. Rodolico-San Marco” University Hospital, University of Catania, 95100 Catania, Italy; (S.C.); (R.L.); (A.B.)
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Chen Y, Xu J, Yin G, Ye J. Effectiveness and safety of (adeno) tonsillectomy for pediatric obstructive sleep apnea in different age groups: A systematic review and meta-analysis. Sleep Med Rev 2023; 69:101782. [PMID: 37121134 DOI: 10.1016/j.smrv.2023.101782] [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: 05/06/2022] [Revised: 02/14/2023] [Accepted: 03/18/2023] [Indexed: 05/02/2023]
Abstract
This meta-analysis aimed to assess the effectiveness and safety of (adeno)tonsillectomy (AT) for uncomplicated pediatric obstructive sleep apnea (OSA) across different age groups. Four electronic databases were searched until April 2022, and 93 studies (9087 participants) were selected, including before-after studies, cohort studies, and randomized controlled trials. It has been suggested that age, disease severity, and length of follow-up are associated with surgical effects. Compared with older children (>7 years), patients receiving AT surgery before the age of 7 exhibited a significantly greater release of disease severity, as well as a greater decrease in hypoxemic burden, improvement in sleep quality, and better cardiovascular function. Cognitive/behavioral performance also improved after AT, although it was more related to the length of follow-up than the age at surgery. Notably, the surgical complication rate was considerably higher in patients younger than 3 years old. Overall, we suggest that the age of 3-7 years might be optimal for AT in polysomnography-diagnosed uncomplicated OSA to maximize potential benefits for both disease and comorbidities and balance the risks of surgery.
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Affiliation(s)
- Yijing Chen
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China
| | - Jinkun Xu
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China
| | - Guoping Yin
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China
| | - Jingying Ye
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China; Institute of Precision Medicine, Tsinghua University, China.
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9
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Norman MB, Harrison HC, Sullivan CE, Milross MA. Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children. J Clin Sleep Med 2022; 18:1649-1656. [PMID: 35216652 PMCID: PMC9163608 DOI: 10.5664/jcsm.9946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The success of surgical treatment for pediatric sleep-disordered breathing is typically assessed using the mixed and obstructive apnea-hypopnea index (MOAHI). Although an important metric, previous work has shown that snoring and stertor are also associated with sleep disruption. Our aim was to assess the efficacy of surgery using the Sonomat (Sonomedical Pty Ltd), a noncontact sleep assessment system, that accurately records complete and partial upper airway obstruction. METHODS Forty children (< 18 years) had a Sonomat study, in their own beds, before and after surgery. As an MOAHI ≥ 1 event/h is considered abnormal, the same threshold was applied to snore/stertor runs. Median (interquartile range) values are reported. RESULTS Respiratory event-induced movements decreased from 12.0 (8.7-19.0) to 0.5 (0.1-3.2) events/h (P < .01), with no significant change in spontaneous movements: 12.8 (9.8-17.9) to 16.5 (13.7-26.1) events/h (P = .07). The MOAHI decreased from 4.5 (1.9-8.6) to 0.0 (0.0-0.4) events/h (P < .01). Snoring and/or stertor runs decreased from 32.8 (23.4-44.4) to 3.0 (0.2-14.6) events/h (P < .01). Thirty-four children had an MOAHI < 1 event/h following surgery; however, 20 had snore and/or stertor runs ≥ 1 event/h and 11 had snore and/or stertor runs ≥ 5 events/h. Only 14 (35%) children had a postsurgery MOAHI < 1 event/h combined with snoring and/or stertor < 1 runs/h. CONCLUSIONS Although surgery is effective in improving breathing, success rates are overestimated using the MOAHI. Our results indicate that snoring and/or stertor are still present at levels that may disrupt sleep despite a normalization of the MOAHI and that when obstructed breathing was objectively measured, there was a large variation in its response to surgery. CITATION Norman MB, Harrison HC, Sullivan CE, Milross MA. Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children. J Clin Sleep Med. 2022;18(6):1649-1656.
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Affiliation(s)
| | | | - Colin E. Sullivan
- Sonomedical, Balmain, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Maree A. Milross
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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10
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Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome. Eur J Pediatr 2022; 181:1689-1697. [PMID: 35006374 DOI: 10.1007/s00431-021-04366-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED Obstructive sleep apnea syndrome (OSAS) in childhood is a complex disease primarily due both to adenotonsillar hypertrophy and pediatric obesity. Notably, inflammation has been recognized as one of the most important shared pathogenic factor between obesity and OSAS resulting in an increased cardiometabolic risk for these patients. To date, evidence is still limited in non-obese population with OSAS. We aimed to evaluate the cardiometabolic risk profile of a pediatric population of non-obese subjects affected by OSAS. A total of 128 school-aged children (mean age 9.70 ± 3.43) diagnosed with OSAS and 213 non-OSAS children (mean age 9.52 ± 3.35) as control group were enrolled. All subjects underwent a complete clinical and biochemical assessment (including white blood cell count (WBC), platelet count (PLT), mean platelet volume (MPV), % of neutrophils (NEU%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), uric acid, fasting insulin, iron, ferritin, and transferrin levels). A significant association between inflammation markers (including WBC, PLT, MPV, NEU%, ferritin, CPR, and ESR) and OSAS was found (all p < 0.001). Children with OSAS also showed increased transaminase, glucose, uric acid, and insulin levels (all p < 0.001) compared to healthy controls. CONCLUSION Taken together, these findings suggested a worse cardiometabolic profile in non-obese children with OSAS. Given the pivotal pathogenic role of inflammation both for hypoxiemia and metabolic derangements, therapeutic strategies for OSAS might also counteract the increased cardiometabolic risk of these patients, by improving their long-term quality of life. WHAT IS KNOWN • Pediatric OSAS has shown a close relationship with obesity and its cardiometabolic comorbidities. • Inflammation represents the hallmark of both obesity and OSAS. WHAT IS NEW • Non obese children with OSAS presented with a worse cardiometabolic risk profile. • OSAS treatment might serve as an effective approach also for the increased cardiometabolic risk of these children.
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11
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Pollicina I, Maniaci A, Lechien JR, Iannella G, Vicini C, Cammaroto G, Cannavicci A, Magliulo G, Pace A, Cocuzza S, Di Luca M, Stilo G, Di Mauro P, Bianco MR, Murabito P, Bannò V, La Mantia I. Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art. Behav Sci (Basel) 2021; 11:bs11120180. [PMID: 34940115 PMCID: PMC8698492 DOI: 10.3390/bs11120180] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic–pituitary–adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature. Methods: We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered. Results: Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function. Conclusions: CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.
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Affiliation(s)
- Isabella Pollicina
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Antonino Maniaci
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium; (A.M.); (J.R.L.)
| | - Jerome R. Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium; (A.M.); (J.R.L.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFRSimone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Giannicola Iannella
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
- Department of “Organi di Senso”, University “Sapienza”, 00185 Rome, Italy;
- Correspondence:
| | - Claudio Vicini
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Giovanni Cammaroto
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Angelo Cannavicci
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Giuseppe Magliulo
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Annalisa Pace
- Department of “Organi di Senso”, University “Sapienza”, 00185 Rome, Italy;
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Paola Di Mauro
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Maria Rita Bianco
- Otolaryngology, Department of Health Science, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy;
| | - Paolo Murabito
- Department of Surgery and Medical and Surgical Specialties—Section of Anaesthesiology and Intensive Care, University of Catania (Italy), 95123 Catania, Italy;
| | - Vittoria Bannò
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
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Sica E, De Bernardi F, Nosetti L, Martini S, Cosentino M, Castelnuovo P, Marino F. Catecholamines and children obstructive sleep apnea: a systematic review. Sleep Med 2021; 87:227-232. [PMID: 34638100 DOI: 10.1016/j.sleep.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder in children and is characterized by recurrent total or partial upper airway collapse episodes during sleep. OSA is associated with cardiovascular, metabolic and neurobehavioural complications related to sympathetic nervous system (SNS) activation. A key role in originating these complications and in underlying pathophysiologic mechanisms can be attributed to altered catecholamines (CAs) metabolism. METHODS A systematic review was performed according to the PRISMA Statement guidelines for research studies correlating OSA in children with catecholamines. RESULTS Only 13 studies out of 151 reports were included in the review. Most studies (9 out of 13) showed increased secretion for some catecholamines in patients with a sleep-related breathing disorder or OSA compared to a control group or post treatment control group. CONCLUSION OSA can activate the sympathetic nervous system (SNS) and increase catecholamines (CAs) production, perhaps contributing to increased morbidity. However, underlying pathophysiologic mechanisms remain still unclear.
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Affiliation(s)
- Eleonora Sica
- PhD Course in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy; Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
| | | | - Luana Nosetti
- Department of Paediatrics, University of Insubria, Varese, Italy
| | - Stefano Martini
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Marco Cosentino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Franca Marino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
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Sitzia E, Pianesi F, Mirante N, Marini G, Micardi M, Panatta ML, Resca A, Marsella P, De Vincentiis GC. Behavioural disorders and parental stress in children suffering from obstructive sleep apnoea syndrome: a pre- and post-adenotonsillectomy confrontation. ACTA ACUST UNITED AC 2020; 40:383-389. [PMID: 33299229 PMCID: PMC7726646 DOI: 10.14639/0392-100x-n0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
The primary goal of the present study was to compare breathing difficulties resulting from OSAS to possible cognitive-behavioural problems of the child linked to their parents’ emotional-relational aspects. There is strong evidence that sleep breathing disorders are associated with behavioural alterations, a tendency towards aggressiveness, weak school performance and a clear disorder in continuous and selective attention other than vigilance status. Not all patients suffering from OSA have cognitive and/or behavioural manifestations; furthermore, the degree of dysfunction that the patient may present does not seem to be associated with the seriousness of sleep breathing disorder (SBD). It is therefore likely that genetic susceptibility associated with particular environmental factors has a role in determining phenotypic manifestations which are unique for every single patient. Questionnaires were given to parents, one regarding executive functions and one regarding parental stress: Conners’ Rating Scale Revised; Parenting Stress Index. All parents of children who suffer from moderate to severe OSA, with a McGill score of 3 to 4 and with no exclusion criteria are included in the study; behavioural and parental stress evaluation was made during hospitalisation and at 6 months after adenotonsillectomy. The results show that resolving OSAS led to important improvements in the competence and behavioural attitudes of the patient, as well as in relational and management difficulties by parents. The identification of such indicators could represent a support to surgical programming, even in non-severe SBD. Future research will have the goal of identifying standardised risk indicators that can provide further indications for surgical treatment in children up to 5 years of age.
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Affiliation(s)
- Emanuela Sitzia
- UOC Otorinolarinogoiatria, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Federica Pianesi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Nadia Mirante
- U.O.C. Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Giulia Marini
- UOC Otorinolarinogoiatria, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Mariella Micardi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | | | - Alessandra Resca
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Pasquale Marsella
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
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