1
|
Ahmad Z, Krüger K, Lautermann J, Lippert B, Tenenbaum T, Tigges M, Tisch M. Adenoid hypertrophy-diagnosis and treatment: the new S2k guideline. HNO 2023; 71:67-72. [PMID: 37491540 PMCID: PMC10409824 DOI: 10.1007/s00106-023-01299-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
Collapse
Affiliation(s)
- Z Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Bundeswehr Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - K Krüger
- Institute of General Medicine, Berlin Charité Hospital, Berlin, Germany
| | - J Lautermann
- Department of Otolaryngology-Head and Neck Surgery, Plastic Surgery, Martha-Maria Halle-Dölau Hospital, Halle-Dölau, Germany
| | - B Lippert
- Department of Otolaryngology-Head and Neck Surgery, Plastic Surgery, SLK-Kliniken Heilbronn GmbH am Gesundbrunnen, Heilbronn, Germany
| | - T Tenenbaum
- Department of Paediatric and Adolescent Medicine, Sana Klinikum Lichtenberg, Berlin, Germany
| | - M Tigges
- Department of Otolaryngology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - M Tisch
- Department of Otolaryngology-Head and Neck Surgery, Bundeswehr Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| |
Collapse
|
2
|
Ahmad Z, Krüger K, Lautermann J, Lippert B, Tenenbaum T, Tigges M, Tisch M. [Adenoids-diagnosis and treatment: the new German S2k guideline]. HNO 2023; 71:285-293. [PMID: 37071194 PMCID: PMC10125940 DOI: 10.1007/s00106-023-01298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
Collapse
Affiliation(s)
- Z Ahmad
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - K Krüger
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Lautermann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau, Deutschland
| | - B Lippert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, SLK-Kliniken Heilbronn GmbH - Standort Gesundbrunnen, Heilbronn, Deutschland
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - M Tigges
- Hals-Nasen-Ohrenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - M Tisch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| |
Collapse
|
3
|
Williamson AA, Mindell JA. Cumulative socio-demographic risk factors and sleep outcomes in early childhood. Sleep 2021; 43:5573929. [PMID: 31555826 DOI: 10.1093/sleep/zsz233] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/22/2019] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES To examine associations between cumulative socio-demographic risk factors, sleep health habits, and sleep disorder symptoms in young children. METHODS Two hundred five caregiver-child dyads (child mean age ± SD: 3.3 ± 1.1 years; 53.7% girls; 62.9% black, 22.4% non-Hispanic/Latinx white, 4.4% Hispanic/Latinx; 85.4% maternal caregiver reporter) completed caregiver-rated sleep measures (Brief Child Sleep Questionnaire [BCSQ]; Pediatric Sleep Questionnaire [PSQ] snoring subscale), which were used to generate indexes of poor sleep health habits, pediatric insomnia symptoms, and obstructive sleep apnea (OSA) symptoms. A cumulative risk index was created reflecting caregiver, family, and neighborhood risks. RESULTS Overall, 84.5% of children had ≥ 1 poor sleep health habit, 62.9% had ≥ 1 insomnia symptom, and 40.0% had ≥ 1 OSA symptom. Poisson regression indicated that each increase in the number of cumulative risk factors was associated with a 10% increase in poor sleep health habits, a 9% increase in insomnia symptoms, and an 18% increase in OSA symptoms. Specific caregiver risks (depressive symptoms, lower educational attainment) and family risks (single caregiver, crowded home) were most predictive of poor sleep outcomes. CONCLUSIONS Poor sleep health habits and sleep disorder symptoms are highly prevalent in early childhood, particularly among families experiencing cumulative socio-demographic risks. Findings underscore the need for targeted screening and prevention for modifiable sleep behaviors and efforts to tailor such strategies for at-risk children and families, especially those living in crowded conditions, or with caregivers who are single or have a lower educational attainment or depressive symptoms.
Collapse
Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jodi A Mindell
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Psychology, Saint Joseph's University, Philadelphia, PA
| |
Collapse
|
4
|
Harding R, Haszard JJ, Schaughency E, Drummond B, Galland B. Parent report of children's sleep disordered breathing symptoms and limited academic progress in reading, writing, and math. Sleep Med 2019; 65:105-112. [PMID: 31739228 DOI: 10.1016/j.sleep.2019.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To estimate via questionnaire within a population sample of New Zealand (NZ) children aged 6-to-10 years, the prevalence of sleep disordered breathing (SDB) and those struggling academically, and to identify individual and shared risk factors (health and demographic) for parent-reported SDB symptoms and academic difficulties. METHODS In this cross-sectional study, parents/caregivers of children were recruited through schools and social media to complete an online questionnaire covering health and demographic factors, their children's SDB symptoms (Pediatric Sleep Questionnaire; PSQ) and parental ratings of academic performance based on teacher feedback relative to expected progress in the national curriculum (well below/below/at/above) in reading, writing, and math. RESULTS A total of 1205 children (53% male) aged (mean) eight years two months were included, comprising 79.4% NZ European/other and 15.0% Māori. The survey-weighted prevalence of SDB (based on the PSQ) was 17.5%. This was higher amongst those with academic difficulties rated 'below/well below' expected progress for reading, writing and math (estimated at 24.0%, 31.0% and 27.5% respectively), with increased odds (adjusted odds ratios) for poor progress of 1.9 (95% CI: 1.2, 3.0), 1.8 (95% CI: 1.2, 2.7) and 2.4 (95% CI: 1.6, 3.7) respectively. There were no shared risk factors common to both SDB and academic difficulties identified from multivariate analyses. CONCLUSIONS The findings suggest that children with parent-reported SDB symptoms may be at high risk for poor progress in reading, writing, and math. Future research could examine whether treatment of SDB reduces barriers to learning and offsets educational risk.
Collapse
Affiliation(s)
- Rebecca Harding
- Department of Women's & Children's Health, University of Otago, New Zealand; Department of Psychology, University of Otago, New Zealand
| | - Jillian J Haszard
- Department of Women's & Children's Health, University of Otago, New Zealand; The Centre for Biostatistics, University of Otago, New Zealand
| | | | - Bernadette Drummond
- Department of Oral Sciences, University of Otago, New Zealand; Department of Paediatric Dentistry, University of Leeds, UK
| | - Barbara Galland
- Department of Women's & Children's Health, University of Otago, New Zealand.
| |
Collapse
|
5
|
Sembiring K, Ramayani OR, Lubis M. Mean Blood Pressure Difference among Adolescents Based on Dyssomnia Types. Open Access Maced J Med Sci 2018. [PMID: 29531591 PMCID: PMC5839435 DOI: 10.3889/oamjms.2018.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND: Dyssomnia is the most frequent sleep disturbance and associated with increased blood pressure. There has been no study determining the difference in mean blood pressure based on dyssomnia types among adolescents. OBJECTIVE: To determine the difference in mean blood pressure among adolescents based on dyssomnia types. METHODS: Cross-sectional study was conducted in SMP Negeri 1 Muara Batang Gadis in April 2016. Samples were students having sleep disturbance based on Sleep Disturbance Scale for Children (SDSC) questionnaire. Stature and blood pressure data were collected along with demographic data and sleep disorder questionnaire. Analyses were done with Kruskal-Wallis test and logistic regression. P - value < 0.05 was considered significant. RESULTS: Seventy-six samples were obtained with mean age 13.9 (SD 1.14) years - old. Dyssomnia proportion and hypertension were 72/76 and 20/76 respectively. Mean systolic (SBP) and diastolic blood pressure (DBP) was 111.1 (SD 16.46) mmHg and 70.3 (SD 11.98) mmHg respectively. Mean SDSC score was 49.7 (SD 8.96), and the most frequent dyssomnia type was disorders of initiating and maintaining sleep. Age and sex were not the risk factors of hypertension in dyssomnia. There was a significant difference in mean SBP (P = 0.006) and DBP (P = 0.022) based on dyssomnia types. Combination dyssomnia type had the highest mean blood pressure among dyssomnia types. CONCLUSION: There is a significant difference in mean blood pressure among adolescents based on dyssomnia types.
Collapse
Affiliation(s)
- Krisnarta Sembiring
- Department of Child Health, Medical School, University of Sumatera Utara, Medan, Indonesia
| | - Oke Rina Ramayani
- Department of Child Health, Medical School, University of Sumatera Utara, Medan, Indonesia
| | - Munar Lubis
- Department of Child Health, Medical School, University of Sumatera Utara, Medan, Indonesia
| |
Collapse
|
6
|
Bonuck KA, Goodlin-Jones BL, Schechter C, Owens J. Modified Children's sleep habits questionnaire for behavioral sleep problems: A validation study. Sleep Health 2017; 3:136-141. [PMID: 28526249 DOI: 10.1016/j.sleh.2017.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Behavioral sleep problems (BSPs) are prevalent and consequential in young children. There is a need for screening tools that identify BSPs-which are often rooted in the parent-young child relationship-and typically respond to behavior management. Such a tool would increase capacity to identify and treat BSPs. We sought to validate a short-form version of the widely used Children's Sleep Habits Questionnaire (SF-CSHQ) that omitted items that would not be responsive to behavioral strategies. METHODS The original 33-item CSHQ elicits parent report of "behaviorally-based" and "medically-based" sleep items (eg, parasomnias and sleep disordered breathing). We conducted analyses to develop a SF-CSHQ that excludes its "medically-based" items, to determine (a) the SF-CSHQ threshold score corresponding to the full CSHQ clinical cut-off score (≥41), and (b) preliminary validity of this SF-CSHQ. Data were re-analyzed from the original data that established the CSHQ's psychometric properties in 4-10 year olds, and a second dataset that established its validity in 24-66 month olds. RESULTS In both datasets, a threshold score of 30 had correlations of 0.90-0.94 with the original cut-off. This 23-item SF-CSHQ cut-off functioned as well as the full CSHQ cut-off in discriminating between children with vs without a parent-reported behavioral sleep problem, and with vs without prolonged sleep latency (per actigraphy). CONCLUSION We established preliminary validity of modified version of the widely-used CSHQ. This SF-CSHQ may be useful for widening screening and first-line guidance for behavioral sleep problems in young children, among professionals who are not sleep medicine specialists.
Collapse
Affiliation(s)
- Karen A Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.
| | - Beth L Goodlin-Jones
- Department of Psychiatry & Behavioral Sciences, UC Davis MIND Institute, Sacramento, CA 95817
| | - Clyde Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461
| | - Judith Owens
- Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| |
Collapse
|
7
|
Bonuck KA, Blank A, True-Felt B, Chervin R. Promoting Sleep Health Among Families of Young Children in Head Start: Protocol for a Social-Ecological Approach. Prev Chronic Dis 2016; 13:E121. [PMID: 27584877 PMCID: PMC5008861 DOI: 10.5888/pcd13.160144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Inadequate or poor quality sleep in early childhood impairs social-emotional and cognitive function via effects on the developing brain and increases obesity risk via hormonal and endocrine effects. The prevalence of short sleep duration, behavioral sleep problems, and sleep-disordered breathing among children aged 3 to 5 years is 20% to 50%. Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness of sleep-disordered breathing symptoms leads to its timely treatment. We designed a study that aims to empower families whose children are in early childhood programs with the knowledge and skills needed to obtain healthy sleep and to recognize a sleep problem. We used the social-ecological framework to guide individual, interpersonal, organizational, community, and policy interventions. This study builds on the Sweet Dreamzzz, Inc, Early Childhood Sleep Education Program (ECSEP) in Head Start. A stepped-wedge-cluster randomized trial will test effects on child, parent, and classroom outcomes; a policy evaluation will assess the impact of knowledge-translation strategies. The study has 3 aims. The first is to adapt educational materials into multimedia formats and build the capacity of Head Start agencies to implement the study. The second aim is to enroll 540 parent-child dyads in a primary prevention trial of sleep health promotion in Head Start and to analyze effects on children's sleep duration (primary outcome); parents' knowledge, attitudes, self-efficacy, and behavior; and children's sleep difficulties. The third aim is to conduct a secondary prevention feasibility study of screening and guidance for sleep problems. Secondary outcomes are changes in classroom behaviors and policies. Integrating sleep health literacy into early childhood programs could affect the life-course development of millions of children.
Collapse
Affiliation(s)
- Karen A Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.
| | - Arthur Blank
- Albert Einstein College of Medicine, Bronx, New York
| | | | | |
Collapse
|
8
|
|
9
|
Galland B, Spruyt K, Dawes P, McDowall PS, Elder D, Schaughency E. Sleep Disordered Breathing and Academic Performance: A Meta-analysis. Pediatrics 2015; 136:e934-46. [PMID: 26347434 DOI: 10.1542/peds.2015-1677] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance. METHODS Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I(2)) were conducted. RESULTS Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES -0.31; P < .001; I(2) = 74%), math (ES -0.33; P < .001; I(2) = 55%), and science (ES -0.29; P = .001; I(2) = 0%), and with unsatisfactory progress/learning problems (ES -0.23; P < .001; I(2) = 0%) but not general school performance. CONCLUSIONS Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.
Collapse
Affiliation(s)
| | - Karen Spruyt
- Department of Developmental and Behavioral Pediatrics, Jiao Tong University School of Medicine, Shanghai, China; Faculty of Psychology, Vrije Universiteit Brussel and School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Patrick Dawes
- Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Philippa S McDowall
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and
| | - Dawn Elder
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and
| | | |
Collapse
|
10
|
Bonuck K, Chervin RD, Howe LD. Sleep-disordered breathing, sleep duration, and childhood overweight: a longitudinal cohort study. J Pediatr 2015; 166:632-9. [PMID: 25499598 PMCID: PMC4344922 DOI: 10.1016/j.jpeds.2014.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/06/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine independent associations between sleep-disordered breathing (SDB), sleep duration from birth through 6.75 years, and body mass index (BMI) through 15 years of age in a population-based cohort. STUDY DESIGN The Avon Longitudinal Study of Parents and Children collected parent questionnaire data on child sleep duration and SDB symptoms from birth through 6.75 years and child BMI from the Avon Longitudinal Study of Parents and Children research clinics (n = 1899). For SDB, logistic regression models-minimal, confounder, and confounder + sleep duration adjusted-examined associations with BMI at 7, 10, and 15 years of age. For short sleep duration (≤10th percentile), comparable SDB-adjusted models examined associations with BMI at 15 years of age. RESULTS Children with the worst SDB symptoms vs asymptomatic children, had increased odds of overweight at 7 (OR = 2.08, 95% CI = 1.04-4.17), 10 (OR = 1.79, 95% CI = 1.02-3.16), and 15 years of age (OR = 2.25, 95% CI = 1.27-3.97) in models adjusted for sleep duration. Similarly, short sleep duration at ≈5-6 years was associated with overweight at 15 years, independent of SDB. Children with short sleep duration at 4.75 years were more likely to be overweight at 15 years in minimally (OR = 2.21, 95% CI = 1.52-3.20), confounder (OR = 1.99, 95% CI = 1.34-2.96), and SDB-adjusted (OR = 2.04, 95% CI = 1.36-3.04) models. CONCLUSIONS Both SDB and short sleep duration significantly and independently increase children's odds of becoming overweight. Findings underscore the potential importance of early identification and remediation of SDB, along with insufficient sleep, as strategies for reducing childhood obesity.
Collapse
Affiliation(s)
- Karen Bonuck
- Department of Family Medicine and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
11
|
Ullman N, Anas NG, Izaguirre E, Haugen W, Ortiz H, Arguello O, Nickerson B, Mink RB. Usefulness of cerebral NIRS in detecting the effects of pediatric sleep apnea. Pediatr Pulmonol 2014; 49:1036-42. [PMID: 24339172 DOI: 10.1002/ppul.22962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/14/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with sleep apnea have increased morbidity if the sleep apnea is untreated. Polysomnography (PSG) is used to detect sleep apnea, but in children, there are technical difficulties that make the diagnosis more difficult. Cerebral near infrared spectroscopy (NIRS) has the ability to detect tissue hypoxia by measuring regional oxygen saturation (rSO2 ). We hypothesized that when used as an adjunct to PSG testing, cerebral NIRS would better detect the effects of sleep apnea in children than arterial pulse oximetry (SpO2 ). Specifically, we aimed to show that the apnea/hypopnea index (AHI) calculated with rSO2 from the NIRS would be greater than that calculated with SpO2 . METHODS Forty-seven patients under 18 years of age who underwent PSG testing for sleep apnea were evaluated. Cerebral NIRS was utilized in addition to PSG. The AHI was calculated using SpO2 and compared to the AHI calculated using the rSO2 . A pediatric pulmonologist who was unaware of the NIRS data evaluated each patient for sleep apnea. Data are median (interquartile range). RESULTS The median AHI(rSO2 ) was 2.4(1.2,5.1), significantly greater (P < 0.0001) than the AHI(SpO2 ) of 0.7(0.4,1.2). Four patients were diagnosed with sleep apnea; however, only one had an AHI(SpO2 ) ≥ 5, a typical threshold for the diagnosis of sleep apnea. All 4 subjects had an AHI(rSO2 ) ≥ 5 but 10 patients without sleep apnea had a value ≥5. The sensitivity and specificity for using the AHI(rSO2 ) to diagnose sleep apnea was 100% and 76.7%, respectively. CONCLUSION Consistent with the ability of NIRS to detect tissue hypoxia, we found that the AHI calculated with rSO2 was greater than that using SpO2 . We conclude that NIRS has potential as a valuable adjunct to PSG in evaluating patients for sleep apnea and warrants further investigation for this purpose.
Collapse
Affiliation(s)
- Nachman Ullman
- Harbor-UCLA Medical Center, Torrance, California; CHOC Children's, Orange, California
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Wilson KE, Miller AL, Lumeng JC, Chervin RD. Sleep environments and sleep durations in a sample of low-income preschool children. J Clin Sleep Med 2014; 10:299-305. [PMID: 24634628 DOI: 10.5664/jcsm.3534] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep duration is commonly studied in children, but less is known about the potential impact of adverse sleep environments, particularly at preschool ages. We examined the frequency of suboptimal sleep environments and tested for associations with sleep duration or nocturnal sleep time among low-income preschool children. METHODS Parents of Head Start preschoolers in Michigan (Detroit and greater Lansing) completed questionnaires on children's sleep schedules and sleep environments. Respondents indicated how often their children slept in a place "too bright," "too loud," "too cold," or "too hot" on a scale of 1 = never to 5 = always. A suboptimal sleep environment (SSE) was defined when one or more of these conditions were reported for ≥ 1-2 nights/week. Weeknight sleep duration or reported time that the child went to sleep was regressed on SSE as an explanatory variable, with adjustment for age, race/ethnicity, gender, maternal education, and average daily nap duration. RESULTS Among 133 preschool children, mean age was 4.1 ± 0.5 (SD), 48% were male, 39% were white, and 52% were black; 34% of parents had ≤ a high school degree. Parents reported that 26 (20%) of the children slept in a SSE ≥ 1-2 nights per week. In regression models, SSE was associated with 27 minutes shorter sleep duration (β = -0.45, SE = 0.22, p = 0.044) and 22 minutes later time child "fell asleep" (β = 0.37, SE = 0.19, p = 0.048) on weeknights. CONCLUSIONS Among these Head Start preschool children, environmental challenges to adequate sleep are not uncommon, and they may have consequences. Clinician or preschool assessment of sleep environments may open opportunities to improve sleep at early ages. CITATION Wilson KE; Miller AL; Lumeng JC; Chervin RD. Sleep environments and sleep durations in a sample of low-income preschool children.
Collapse
Affiliation(s)
| | - Alison L Miller
- Center for Human Growth and Development ; Department of Health Education and Health Behavior, School of Public Health
| | - Julie C Lumeng
- Center for Human Growth and Development ; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
13
|
Salmon K, Brown DA. Medical Settings as a Context for Research on Cognitive Development. JOURNAL OF COGNITION AND DEVELOPMENT 2013. [DOI: 10.1080/15248372.2013.772514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|