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Gileles-Hillel A, Bhattacharjee R, Gorelik M, Narang I. Advances in Sleep-Disordered Breathing in Children. Clin Chest Med 2024; 45:651-662. [PMID: 39069328 DOI: 10.1016/j.ccm.2024.03.004] [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] [Indexed: 07/30/2024]
Abstract
Pediatric sleep-disordered breathing disorders are a group of common conditions, from habitual snoring to obstructive sleep apnea (OSA) syndrome, affecting a significant proportion of children. The present article summarizes the current knowledge on diagnosis and treatment of pediatric OSA focusing on therapeutic and surgical advancements in the field in recent years. Advancements in OSA such as biomarkers, improving continuous pressure therapy adherence, novel pharmacotherapies, and advanced surgeries are discussed.
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Affiliation(s)
- Alex Gileles-Hillel
- Neonatal Pulmonology Service, Pediatric Pulmonary and Sleep Unit; Pediatric Division, Hadassah Medical Center, Jerusalem 911111, Israel; The Faculty of Medicine, Hebrew University of Jerusalem; The Wohl Translational Research Institute, Hadassah Medical Center, Kiryat Hadassah, Ein Kerem, Jerusalem 911111, Israel.
| | - Rakesh Bhattacharjee
- Division of Respiratory Medicine, Department of Pediatrics, Rady Children's Hospital, UCSD, San Diego, CA 92123, USA
| | - Michael Gorelik
- Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Indra Narang
- Division of Respiratory Medicine, Faculty Development and EDI, Department of Paediatrics, Translational Medicine, Research Institute, Hospital for Sick Children; Department of Paediatrics, University of Toronto, 51 Banff Road, Toronto M4S2V6, Canada
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Zaffanello M, Ferrante G, Piazza M, Nosetti L, Tenero L, Piacentini G. Exploring the Relationship between Inhaled Corticosteroid Usage, Asthma Severity, and Sleep-Disordered Breathing: A Systematic Literature Review. Adv Respir Med 2024; 92:300-317. [PMID: 39194421 DOI: 10.3390/arm92040029] [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: 06/11/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
(1) Background: Sleep-disordered breathing and asthma are often interrelated. Children and adults with asthma are more susceptible to sleep apnea. Inhaled corticosteroids effectively reduce inflammation and prevent structural changes in the airways. Objective: to explore the existing literature to determine whether inhaled corticosteroids play a role in sleep-disordered breathing in patients with asthma. (2) Methods: We conducted a thorough search of the PubMed, Scopus, and Web of Science databases for English-language articles published up to 12 May 2024. We utilized the ROBINS-E tool to assess the risk of bias. (4) Conclusions: 136 articles were discerned upon conducting the literature search. A total of 13 articles underwent exhaustive full-text scrutiny, resulting in 6 being considered non-relevant. The remaining seven articles, assessed for eligibility, were incorporated into the final analysis. Five studies were identified in adults and two in children. In adult patients, inhaled corticosteroids, especially at high doses, appear to increase the risk of sleep apnea in a dose-dependent manner. Moreover, the properties of inhaled corticosteroids, such as particle size, may impact the risk of developing sleep apnea. In children, the severity of asthma is a key factor affecting the prevalence of sleep apnea, whereas inhaled corticosteroids appear to be a less significant risk factor compared to adults. All of the studies reviewed were classified as having a high risk of bias or some concerns regarding bias. Each study revealed at least one type of bias that raised notable concerns. This research highlights a complex interaction between the use of inhaled corticosteroids, the severity of asthma, and the onset of sleep apnea. Additional research is necessary to investigate these relationships further.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy
| | - Laura Tenero
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
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García-Vicente C, Gutiérrez-Tobal GC, Jiménez-García J, Martín-Montero A, Gozal D, Hornero R. ECG-based convolutional neural network in pediatric obstructive sleep apnea diagnosis. Comput Biol Med 2023; 167:107628. [PMID: 37918264 DOI: 10.1016/j.compbiomed.2023.107628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Obstructive sleep apnea (OSA) is a prevalent respiratory condition in children and is characterized by partial or complete obstruction of the upper airway during sleep. The respiratory events in OSA induce transient alterations of the cardiovascular system that ultimately can lead to increased cardiovascular risk in affected children. Therefore, a timely and accurate diagnosis is of utmost importance. However, polysomnography (PSG), the standard diagnostic test for pediatric OSA, is complex, uncomfortable, costly, and relatively inaccessible, particularly in low-resource environments, thereby resulting in substantial underdiagnosis. Here, we propose a novel deep-learning approach to simplify the diagnosis of pediatric OSA using raw electrocardiogram tracing (ECG). Specifically, a new convolutional neural network (CNN)-based regression model was implemented to automatically predict pediatric OSA by estimating its severity based on the apnea-hypopnea index (AHI) and deriving 4 OSA severity categories. For this purpose, overnight ECGs from 1,610 PSG recordings obtained from the Childhood Adenotonsillectomy Trial (CHAT) database were used. The database was randomly divided into approximately 60%, 20%, and 20% for training, validation, and testing, respectively. The diagnostic performance of the proposed CNN model largely outperformed the most accurate previous algorithms that relied on ECG-derived features (4-class Cohen's kappa coefficient of 0.373 versus 0.166). Specifically, for AHI cutoff values of 1, 5, and 10 events/hour, the binary classification achieved sensitivities of 84.19%, 76.67%, and 53.66%; specificities of 46.15%, 91.39%, and 98.06%; and accuracies of 75.92%, 86.96%, and 91.97%, respectively. Therefore, pediatric OSA can be readily identified by our proposed CNN model, which provides a simpler, faster, and more accessible diagnostic test that can be implemented in clinical practice.
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Affiliation(s)
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Jorge Jiménez-García
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Adrián Martín-Montero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - David Gozal
- Office of The Dean, Joan C. Edwards School of Medicine, Marshall University, 1600 Medical Center Dr, Huntington, WV, 25701, USA
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
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Martín-Montero A, Armañac-Julián P, Gil E, Kheirandish-Gozal L, Álvarez D, Lázaro J, Bailón R, Gozal D, Laguna P, Hornero R, Gutiérrez-Tobal GC. Pediatric sleep apnea: Characterization of apneic events and sleep stages using heart rate variability. Comput Biol Med 2023; 154:106549. [PMID: 36706566 DOI: 10.1016/j.compbiomed.2023.106549] [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: 09/19/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 01/16/2023]
Abstract
Heart rate variability (HRV) is modulated by sleep stages and apneic events. Previous studies in children compared classical HRV parameters during sleep stages between obstructive sleep apnea (OSA) and controls. However, HRV-based characterization incorporating both sleep stages and apneic events has not been conducted. Furthermore, recently proposed novel HRV OSA-specific parameters have not been evaluated. Therefore, the aim of this study was to characterize and compare classic and pediatric OSA-specific HRV parameters while including both sleep stages and apneic events. A total of 1610 electrocardiograms from the Childhood Adenotonsillectomy Trial (CHAT) database were split into 10-min segments to extract HRV parameters. Segments were characterized and grouped by sleep stage (wake, W; non-rapid eye movement, NREMS; and REMS) and presence of apneic events (under 1 apneic event per segment, e/s; 1-5 e/s; 5-10 e/s; and over 10 e/s). NREMS showed significant changes in HRV parameters as apneic event frequency increased, which were less marked in REMS. In both NREMS and REMS, power in BW2, a pediatric OSA-specific frequency domain, allowed for the optimal differentiation among segments. Moreover, in the absence of apneic events, another defined band, BWRes, resulted in best differentiation between sleep stages. The clinical usefulness of segment-based HRV characterization was then confirmed by two ensemble-learning models aimed at estimating apnea-hypopnea index and classifying sleep stages, respectively. We surmise that basal sympathetic activity during REMS may mask apneic events-induced sympathetic excitation, thus highlighting the importance of incorporating sleep stages as well as apneic events when evaluating HRV in pediatric OSA.
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Affiliation(s)
- Adrián Martín-Montero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain.
| | - Pablo Armañac-Julián
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Eduardo Gil
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO, USA
| | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Jesús Lázaro
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Raquel Bailón
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO, USA
| | - Pablo Laguna
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain; Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
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Li Y, Lu Y, Li X, Zhao L, Guo J, Yu L, Feng J, Li B, Li X, Liu Y. Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial. BMJ Open 2022; 12:e055964. [PMID: 35473736 PMCID: PMC9045055 DOI: 10.1136/bmjopen-2021-055964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Orthodontic treatment and adenotonsillectomy (AT) are both conventional treatments for paediatric obstructive sleep apnoea (OSA). Each approach has distinct treatment advantages; however, there is currently a lack of solid evidence to support their efficacy comparison. We hypothesise that the objective effect of orthodontic treatment is not inferior to AT in children with moderate OSA and mandibular retrognathia, but orthodontic treatment has the advantage of promoting dentofacial growth. METHODS AND ANALYSIS This is a randomised, open-label, parallel-group, active controlled trial that will study the efficacy of orthodontic treatment versus AT in children with moderate OSA accompanied by tonsillar adenoid hypertrophy and mandibular retrognathia. A total of 98 patients will be enrolled and randomised in a 2:1 ratio to either orthodontic treatment or AT group. Participants will be recruited at Shanghai Stomatological Hospital, Shanghai Children's Hospital of Shanghai Jiaotong University and Children's Hospital of Fudan University, which are all located in Shanghai, China. The primary endpoint is the per cent change in the obstructive apnoea-hypopnoea index from baseline (month 0) to the primary endpoint (month 7), and the mean reduction in A point, nasion and B point angle on cephalometric measurements by lateral X-ray films. Important secondary efficacy endpoints include sleep duration with oxygen saturation below 90% according to polysomnography and subjective symptoms (assessed by the OSA-20 questionnaire), etc. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION The study was approved by the ethics committees of Shanghai Stomatological Hospital (approval no. (2021)002), Shanghai Children's Hospital of Shanghai Jiaotong University (approval no. 2021R046-F01) and Children's Hospital of Fudan University (approval no. (2021)136). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2000037288.
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Affiliation(s)
- Yuanyuan Li
- Shanghai Stomatological Hospital, Department of Pediatric Dentistry, Fudan University Affliated Stomatological Hospital, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yun Lu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
| | - Xuan Li
- Children's National Medical Center, Department of Stomatology, Children's Hospital of Fudan University, Shanghai, China
| | - Limin Zhao
- Shanghai Children's Hospital, Department of Otolaryngology and Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghan Guo
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
| | - Liming Yu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
| | - Jinqiu Feng
- Shanghai Stomatological Hospital, Department of Pediatric Dentistry, Fudan University Affliated Stomatological Hospital, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Bing Li
- Children's National Medical Center, Department of Stomatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoyan Li
- Shanghai Children's Hospital, Department of Otolaryngology and Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Liu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
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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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Martín-Montero A, Gutiérrez-Tobal GC, Gozal D, Barroso-García V, Álvarez D, del Campo F, Kheirandish-Gozal L, Hornero R. Bispectral Analysis of Heart Rate Variability to Characterize and Help Diagnose Pediatric Sleep Apnea. ENTROPY (BASEL, SWITZERLAND) 2021; 23:1016. [PMID: 34441156 PMCID: PMC8394544 DOI: 10.3390/e23081016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) is a breathing disorder that alters heart rate variability (HRV) dynamics during sleep. HRV in children is commonly assessed through conventional spectral analysis. However, bispectral analysis provides both linearity and stationarity information and has not been applied to the assessment of HRV in pediatric OSA. Here, this work aimed to assess HRV using bispectral analysis in children with OSA for signal characterization and diagnostic purposes in two large pediatric databases (0-13 years). The first database (training set) was composed of 981 overnight ECG recordings obtained during polysomnography. The second database (test set) was a subset of the Childhood Adenotonsillectomy Trial database (757 children). We characterized three bispectral regions based on the classic HRV frequency ranges (very low frequency: 0-0.04 Hz; low frequency: 0.04-0.15 Hz; and high frequency: 0.15-0.40 Hz), as well as three OSA-specific frequency ranges obtained in recent studies (BW1: 0.001-0.005 Hz; BW2: 0.028-0.074 Hz; BWRes: a subject-adaptive respiratory region). In each region, up to 14 bispectral features were computed. The fast correlation-based filter was applied to the features obtained from the classic and OSA-specific regions, showing complementary information regarding OSA alterations in HRV. This information was then used to train multi-layer perceptron (MLP) neural networks aimed at automatically detecting pediatric OSA using three clinically defined severity classifiers. Both classic and OSA-specific MLP models showed high and similar accuracy (Acc) and areas under the receiver operating characteristic curve (AUCs) for moderate (classic regions: Acc = 81.0%, AUC = 0.774; OSA-specific regions: Acc = 81.0%, AUC = 0.791) and severe (classic regions: Acc = 91.7%, AUC = 0.847; OSA-specific regions: Acc = 89.3%, AUC = 0.841) OSA levels. Thus, the current findings highlight the usefulness of bispectral analysis on HRV to characterize and diagnose pediatric OSA.
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Affiliation(s)
- Adrián Martín-Montero
- Biomedical Engineering Group, University of Valladolid, 47002 Valladolid, Spain; (G.C.G.-T.); (V.B.-G.); (D.Á.); (F.d.C.); (R.H.)
| | - Gonzalo C. Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, 47002 Valladolid, Spain; (G.C.G.-T.); (V.B.-G.); (D.Á.); (F.d.C.); (R.H.)
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO 65212, USA; (D.G.); (L.K.-G.)
| | - Verónica Barroso-García
- Biomedical Engineering Group, University of Valladolid, 47002 Valladolid, Spain; (G.C.G.-T.); (V.B.-G.); (D.Á.); (F.d.C.); (R.H.)
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, 47002 Valladolid, Spain; (G.C.G.-T.); (V.B.-G.); (D.Á.); (F.d.C.); (R.H.)
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Félix del Campo
- Biomedical Engineering Group, University of Valladolid, 47002 Valladolid, Spain; (G.C.G.-T.); (V.B.-G.); (D.Á.); (F.d.C.); (R.H.)
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, 47012 Valladolid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health and the Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO 65212, USA; (D.G.); (L.K.-G.)
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, 47002 Valladolid, Spain; (G.C.G.-T.); (V.B.-G.); (D.Á.); (F.d.C.); (R.H.)
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
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Abstract
Healthy sleep, including proper amounts in the 24-hour day/night period, is crucial for developing children. Sleep development in infants and children is characterized by increased amounts of sleep, including rapid eye movement and non-rapid eye movement (NREM) slow-wave sleep. Expected changes as well as deviations may contribute to sleep problems, which are common in typically developing children and very common in those with neurodevelopmental disorders and often are chronic. Periodic screening of children for sleep problems is important for timely and effective management of these.
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Affiliation(s)
- Samiya F Ahmad
- Department of Pediatrics, Baylor College of Medicine, 315 North San Saba Street, Suite 1135, San Antonio, TX 78207, USA.
| | - Ashura W Buckley
- Sleep and Neurodevelopmental Service, Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, NIH, Magnuson Clinical Center, Room 1C250, Bethesda, MD 20814, USA
| | - Daniel G Glaze
- Department of Pediatrics, Baylor College of Medicine, TXCL-1250, Houston, TX 77030, USA; Department of Neurology, Baylor College of Medicine, TXCL-1250, Houston, TX 77030, USA
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9
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Matlen LB, Whitney DG, Whibley D, Jansen EC, Chervin RD, Dunietz GL. Obstructive sleep apnea and fractures in children and adolescents. J Clin Sleep Med 2021; 17:1853-1858. [PMID: 33928906 DOI: 10.5664/jcsm.9318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine, among girls and boys, associations between site-specific extremity fracture and sleep apnea diagnosis or treatment. METHODS A cross-sectional analysis of claims data from 2016-2018 for children aged 2-18. Children with sleep apnea, continuous positive airway pressure, adenotonsillectomy, and fracture were identified using ICD10, CPT and HCPCS codes. We examined sex-stratified associations between site-specific fracture, sleep apnea and sleep apnea treatment. RESULTS Among 2,327,104 children, 9,547 (0.41%) had sleep apnea and nearly 61% were treated. Girls with sleep apnea, treated or untreated, had increased odds of lower, but not upper, extremity fracture compared to those without sleep apnea (treated 1.56, 95% CI 1.11, 2.21; untreated OR 1.63, 95% CI 1.09, 2.44). Only boys untreated for sleep apnea had increased odds of lower extremity fracture in comparison to those without a diagnosis of sleep apnea (OR 1.65, 95% CI 1.20,2.27). Interestingly, boys treated for sleep apnea but not those untreated, in comparison to boys without sleep apnea, had different (reduced) odds of upper extremity fracture (OR 0.74, 95% CI 0.59, 0.95). CONCLUSIONS These large datasets provide evidence that both boys and girls with untreated sleep apnea have higher odds of lower extremity fractures. However, treatment for sleep apnea was associated with improved odds of lower extremity fracture only in boys. Upper extremity data were less clear. These data are cross-sectional and cannot show causality, but they suggest that treatment for sleep apnea may lower risk for extremity fractures in boys.
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Affiliation(s)
- Lisa B Matlen
- Department of Pediatrics and Sleep Disorders Centers, University of Michigan, Ann Arbor, MI
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Erica C Jansen
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Ronald D Chervin
- Department of Neurology, Division of Sleep Medicine, University of Michigan, Ann Arbor, MI
| | - Galit Levi Dunietz
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.,Department of Neurology, Division of Sleep Medicine, University of Michigan, Ann Arbor, MI
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Diskin C, McVeigh TP, Cox DW. Sleep disordered breathing in children with Down syndrome in the Republic of Ireland. Am J Med Genet A 2020; 182:2847-2856. [PMID: 32902194 DOI: 10.1002/ajmg.a.61855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022]
Abstract
Down syndrome (DS) is associated with a complex respiratory phenotype, including obstructive sleep apnea syndrome (OSAS). The study explored parent-reported prevalence and presentation of OSAS symptoms in children and adolescents with DS in Ireland. It also investigated treatment and compliance in those who have OSAS. A cross-sectional survey was distributed to parents registered with Down Syndrome Ireland (DSI) (n = 1,343). Data was collated and analyzed using SPSS v23. The response rate was 393 (29%). Twenty-one percent of parents (n = 84) reported a diagnosis of OSAS in their child. The parents of children reported as compliant with continuous positive airway pressure (CPAP) were more likely to report a perceived benefit of treatment (p = .018). Ninety-two percent (n = 212) of children without a formal diagnosis of OSAS had at least one symptom (median 4 symptoms) of the condition. This, the largest survey of parental reporting of OSAS or its symptoms, demonstrates a high reported prevalence of symptoms in children and adolescents with DS in Ireland without a formal diagnosis of OSAS, indicating under-recognition. In treated patients, perception of the benefit of CPAP correlated with reported compliance, suggesting a need for tailored education.
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Affiliation(s)
- Catherine Diskin
- Department of Respiratory Medicine, Children's Hospital Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Des W Cox
- Department of Respiratory Medicine, Children's Hospital Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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11
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Li Y, Wu J, Guo J, Yu L, Wang J, Li X, Xu S, Zhu M, Feng J, Liu Y. The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial. Trials 2020; 21:595. [PMID: 32605655 PMCID: PMC7329444 DOI: 10.1186/s13063-020-04398-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia. Methods A sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway. Discussion The results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS. Trial registration ClinicalTrials.gov: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).
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Affiliation(s)
- Yuanyuan Li
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Jiali Wu
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghan Guo
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Liming Yu
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Jing Wang
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuhua Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Min Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jinqiu Feng
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Yuehua Liu
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China. .,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.
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12
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Assessment of Airflow and Oximetry Signals to Detect Pediatric Sleep Apnea-Hypopnea Syndrome Using AdaBoost. ENTROPY 2020; 22:e22060670. [PMID: 33286442 PMCID: PMC7517204 DOI: 10.3390/e22060670] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
Abstract
The reference standard to diagnose pediatric Obstructive Sleep Apnea (OSA) syndrome is an overnight polysomnographic evaluation. When polysomnography is either unavailable or has limited availability, OSA screening may comprise the automatic analysis of a minimum number of signals. The primary objective of this study was to evaluate the complementarity of airflow (AF) and oximetry (SpO2) signals to automatically detect pediatric OSA. Additionally, a secondary goal was to assess the utility of a multiclass AdaBoost classifier to predict OSA severity in children. We extracted the same features from AF and SpO2 signals from 974 pediatric subjects. We also obtained the 3% Oxygen Desaturation Index (ODI) as a common clinically used variable. Then, feature selection was conducted using the Fast Correlation-Based Filter method and AdaBoost classifiers were evaluated. Models combining ODI 3% and AF features outperformed the diagnostic performance of each signal alone, reaching 0.39 Cohens's kappa in the four-class classification task. OSA vs. No OSA accuracies reached 81.28%, 82.05% and 90.26% in the apnea-hypopnea index cutoffs 1, 5 and 10 events/h, respectively. The most relevant information from SpO2 was redundant with ODI 3%, and AF was complementary to them. Thus, the joint analysis of AF and SpO2 enhanced the diagnostic performance of each signal alone using AdaBoost, thereby enabling a potential screening alternative for OSA in children.
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13
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Yanney MP, Prayle AP, Rowbotham NJ, Kurc M, Tilbrook S, Ali N. Observational Study of Pulse Transit Time in Children With Sleep Disordered Breathing. Front Neurol 2020; 11:316. [PMID: 32457689 PMCID: PMC7225317 DOI: 10.3389/fneur.2020.00316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Pulse transit time (PTT) is a non-invasive measure of arousals and respiratory effort for which we aim to identify threshold values that detect sleep disordered breathing (SDB) in children. We also compare the sensitivity and specificity of oximetry with the findings of a multi-channel study. Methods: We performed a cross-sectional observational study of 521 children with SDB admitted for multi-channel sleep studies (pulse oximetry, ECG, video, sound, movement, PTT) in a secondary care centre. PTT data was available in 368 children. Studies were categorised as normal; primary snoring; upper airway resistance syndrome (UARS); obstructive sleep apnoea (OSA), and "abnormal other." Receiver operator characteristic curves were constructed for different PTT (Respiratory swing; Arousal index) thresholds using a random sample of 50% of children studied (training set); calculated thresholds of interest were validated against the other 50% (test set). Study findings were compared with oximetry categories (normal, inconclusive, abnormal) using data (mean and minimum oxygen saturations; oxygen desaturations > 4%) obtained during the study. Results: Respiratory swing of 17.92 ms identified SDB (OSA/UARS) with sensitivity: 0.80 (C.I. 0.62-0.90) and specificity 0.79 (C.I. 0.49-0.87). PTT arousal index of 16.06/ hour identified SDB (OSA/UARS) with sensitivity: 0.85 (95% C.I. 0.67-0.92) and specificity 0.37 (95% C.I. 0.17-0.48). Oximetry identified SDB (OSA) with sensitivity: 0.38 (C.I. 0.31-0.46) and specificity 0.98 (C.I. 0.97-1.00). Conclusions: PTT is more sensitive but less specific than oximetry at detecting SDB in children. The additional use of video and sound enabled detection of SDB in twice as many children as oximetry alone.
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Affiliation(s)
- Michael P Yanney
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Andrew P Prayle
- Division of Child Health, Obstetrics and Gynaecology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Nicola J Rowbotham
- Division of Child Health, Obstetrics and Gynaecology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Miguel Kurc
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Sean Tilbrook
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Nabeel Ali
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
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14
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Blackshaw H, Springford LR, Zhang LY, Wang B, Venekamp RP, Schilder AG. Tonsillectomy versus tonsillotomy for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2020; 4:CD011365. [PMID: 32347984 PMCID: PMC7193676 DOI: 10.1002/14651858.cd011365.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obstructive sleep-disordered breathing (oSDB) is a condition encompassing breathing problems when asleep due to upper airway obstruction. In children, hypertrophy of the tonsils and/or adenoids is thought to be the commonest cause. As such, (adeno)tonsillectomy has long been the treatment of choice. A rise in partial removal of the tonsils over the last decade is due to the hypothesis that tonsillotomy is associated with lower postoperative morbidity and fewer complications. OBJECTIVES To assess whether partial removal of the tonsils (intracapsular tonsillotomy) is as effective as total removal of the tonsils (extracapsular tonsillectomy) in relieving signs and symptoms of oSDB in children, and has lower postoperative morbidity and fewer complications. SEARCH METHODS We searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The search date was 22 July 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of (adeno)tonsillectomy with (adeno)tonsillotomy in children aged 2 to 16 years with oSDB. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods and assessed the certainty of the evidence for our pre-defined outcomes using GRADE. Our primary outcomes were disease-specific quality of life, peri-operative blood loss and the proportion of children requiring postoperative medical intervention (with or without hospitalisation). Secondary outcomes included postoperative pain, return to normal activity, recurrence of oSDB symptoms as a result of tonsil regrowth and reoperation rates. MAIN RESULTS We included 22 studies (1984 children), with predominantly unclear or high risk of bias. Three studies used polysomnography as part of their inclusion criteria. Follow-up duration ranged from six days to six years. Although 19 studies reported on some of our outcomes, we could only pool the results from a few due both to the variety of outcomes and the measurement instruments used, and an absence of combinable data. Disease-specific quality of life Four studies (540 children; 484 (90%) analysed) reported this outcome; data could not be pooled due to the different outcome measurement instruments used. It is very uncertain whether there is any difference in disease-specific quality of life between the two surgical procedures in the short (0 to 6 months; 3 studies, 410 children), medium (7 to 13 months; 2 studies, 117 children) and long term (13 to 24 months; 1 study, 67 children) (very low-certainty evidence). Peri-operative blood loss We are uncertain whether tonsillotomy reduces peri-operative blood loss by a clinically meaningful amount (mean difference (MD) 14.06 mL, 95% CI 1.91 to 26.21 mL; 8 studies, 610 children; very low-certainty evidence). In sensitivity analysis (restricted to three studies with low risk of bias) there was no evidence of a difference between the groups. Postoperative complications requiring medical intervention (with or without hospitalisation) The risk of postoperative complications in the first week after surgery was probably lower in children who underwent tonsillotomy (4.9% versus 2.6%, risk ratio (RR) 1.75, 95% CI 1.06 to 2.91; 16 studies, 1416 children; moderate-certainty evidence). Postoperative pain Eleven studies (1017 children) reported this outcome. Pain was measured using various scales and scored by either children, parents, clinicians or study personnel. When considering postoperative pain there was little or no difference between tonsillectomy and tonsillotomy at 24 hours (10-point scale) (MD 1.09, 95% CI 0.88 to 1.29; 4 studies, 368 children); at two to three days (MD 0.93, 95% CI -0.14 to 2.00; 3 studies, 301 children); or at four to seven days (MD 1.07, 95% CI -0.40 to 2.53; 4 studies, 370 children) (all very low-certainty evidence). In sensitivity analysis (restricted to studies with low risk of bias), we found no evidence of a difference in mean pain scores between groups. Return to normal activity Tonsillotomy probably results in a faster return to normal activity. Children who underwent tonsillotomy were able to return to normal activity four days earlier (MD 3.84 days, 95% CI 0.23 to 7.44; 3 studies, 248 children; moderate-certainty evidence). Recurrence of oSDB and reoperation rates We are uncertain whether there is a difference between the groups in the short (RR 0.26, 95% CI 0.03 to 2.22; 3 studies, 186 children), medium (RR 0.35, 95% CI 0.04 to 3.23; 4 studies, 206 children) or long term (RR 0.21 95% CI 0.01 to 4.13; 1 study, 65 children) (all very low-certainty evidence). AUTHORS' CONCLUSIONS For children with oSDB selected for tonsil surgery, tonsillotomy probably results in a faster return to normal activity (four days) and in a slight reduction in postoperative complications requiring medical intervention in the first week after surgery. This should be balanced against the clinical effectiveness of one operation over the other. However, this is not possible to determine in this review as data on the long-term effects of the two operations on oSDB symptoms, quality of life, oSDB recurrence and need for reoperation are limited and the evidence is of very low quality leading to a high degree of uncertainty about the results. More robust data from high-quality cohort studies, which may be more appropriate for detecting differences in less common events in the long term, are required to inform guidance on which tonsil surgery technique is best for children with oSDB requiring surgery.
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Affiliation(s)
- Helen Blackshaw
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Laurie R Springford
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Lai-Ying Zhang
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Betty Wang
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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15
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Gozal D, Tan HL, Kheirandish-Gozal L. Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision. J Clin Med 2020; 9:jcm9030888. [PMID: 32213932 PMCID: PMC7141493 DOI: 10.3390/jcm9030888] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.
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Affiliation(s)
- David Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
- Correspondence:
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK;
| | - Leila Kheirandish-Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
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16
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Abstract
OBJECTIVES Although pediatric obstructive sleep apnea (OSA) is estimated to affect 2-3% of the general population, its prevalence in sickle cell disease (SCD) is much higher, with research suggesting a prevalence rate of upwards of 40%. Despite the similar underlying pathophysiological mechanisms of neurocognitive effects in pediatric OSA and SCD, there is a scarcity of information on how these two conditions interact. The aim of this study was to better understand the contribution of sleep apnea to neurocognitive deficits in children diagnosed with SCD. METHOD This study assessed cognitive function in 26 children with comorbid SCD and OSA, 39 matched comparisons with SCD only, and 59 matched comparisons in children without a chronic health condition. RESULTS There were significant differences on measures of processing speed and reading decoding, with children without a chronic health condition scoring better than both chronic health condition groups. Additionally, the no chronic health condition group performed better on a test of quantitative knowledge and reasoning and a test of visual-spatial construction than the SCD-only group. Contrary to our hypotheses, there were no between-group differences suggesting an additive impact of OSA on cognition. Exploratory analyses revealed associations within the group that had OSA showing that more severe OSA correlated with lower performance on measures of processing speed and quantitative knowledge/reasoning. CONCLUSIONS Children with comorbid OSA and SCD do not present with greater deficits in cognitive functioning than children with SCD alone. However, severe OSA may confer additional risk for neurocognitive impairments.
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17
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Molero-Ramirez H, Maximiliano TK, Baroody F, Bhattacharjee R. Polysomnography Parameters Assessing Gas Exchange Best Predict Postoperative Respiratory Complications Following Adenotonsillectomy in Children With Severe OSA. J Clin Sleep Med 2019; 15:1251-1259. [PMID: 31538596 PMCID: PMC6760392 DOI: 10.5664/jcsm.7914] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Adenotonsillectomy (AT) is the treatment of choice for obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy. Severe OSA, identified by the apnea-hypopnea index (AHI), is a risk factor for surgical complications and AHI thresholds are used by surgeons to decide elective postoperative hospital admissions. The objective of this study was to identify the prevalence of surgical complications of AT in children with severe OSA and determine their association with specific parameters of polysomnography (PSG). METHODS Retrospective evaluation of respiratory and nonrespiratory complications in children undergoing AT for severe OSA was performed. Events were then compared to several individual PSG indices. PSG indices included classic parameters such as AHI, and obstructive apnea indexes (OAI) as well as gas exchange parameters including the oxygen desaturation index (ODI), lowest oxyhemoglobin saturation (lowest SpO₂), peak end-tidal CO₂ (peak ETCO₂), the percentage of the total sleep time (%TST) with ETCO₂ > 50 mmHg (%TST ETCO₂ > 50 mmHg) and oxygen saturation < 90% (%TST O₂ < 90%). RESULTS A total of 158 children were identified with severe OSA. Major respiratory complications occurred in 21.5% and were only associated with the ODI (P = .014), lowest SpO₂ (P = .001) and %TST O₂ < 90% (P < .001). Minor respiratory complications occurred in 19.6% and these were not associated with any PSG parameters. Major nonrespiratory complications occurred in 4.4% and also were not associated with any PSG parameters; however, minor nonrespiratory complications occurring in 37.3%, and were associated with %TST O₂ < 90% (P < 0.001). CONCLUSIONS PSG measures of gas exchange are strongly associated with postoperative complications of AT and are better suited for postoperative planning than classic indices such as AHI. CITATION Molero-Ramirez H, Tamae Kakazu M, Baroody F, Bhattacharjee R. Polysomnography parameters assessing gas exchange best predict postoperative respiratory complications following adenotonsillectomy in children with severe OSA. J Clin Sleep Med. 2019;15(9):1251-1259.
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Affiliation(s)
- Helena Molero-Ramirez
- Deparment of Pediatrics, Division of Pediatric Pulmonology, University of Minnesota, Minneapolis, Minnesota
| | | | - Fuad Baroody
- Departments of Surgery, Section of Otolaryngology-Head and Neck Surgery, and Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Rakesh Bhattacharjee
- Department of Pediatrics, Division of Respiratory Medicine, University of California-San Diego and Rady Children's Hospital of San Diego, San Diego, California
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18
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Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, Visconti IC, Meccariello G, Cammaroto G, De Vito A, Gobbi R, Bellini C, Firinu E, Pace A, Colizza A, Pelucchi S, Magliulo G. Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3235. [PMID: 31487798 PMCID: PMC6765844 DOI: 10.3390/ijerph16183235] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 12/27/2022]
Abstract
The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management.
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Affiliation(s)
- Giampiero Gulotta
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Giannicola Iannella
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy.
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy.
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, University "Sapienza", 00185 Rome, Italy
| | - Antonio Greco
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | | | | | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Chiara Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Elisabetta Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Annalisa Pace
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Andrea Colizza
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Stefano Pelucchi
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Giuseppe Magliulo
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
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19
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Joyce A, Hill CM, Karmiloff-Smith A, Dimitriou D. A Cross-Syndrome Comparison of Sleep-Dependent Learning on a Cognitive Procedural Task. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:339-353. [PMID: 31199684 DOI: 10.1352/1944-7558-124.4.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sleep plays a key role in the consolidation of newly acquired information and skills into long term memory. Children with Down syndrome (DS) and Williams syndrome (WS) frequently experience sleep problems, abnormal sleep architecture, and difficulties with learning; thus, we predicted that children from these clinical populations would demonstrate impairments in sleep-dependent memory consolidation relative to children with typical development (TD) on a cognitive procedural task: The Tower of Hanoi. Children with DS (n = 17), WS (n = 22) and TD (n = 34) completed the Tower of Hanoi task. They were trained on the task either in the morning or evening, then completed it again following counterbalanced retention intervals of daytime wake and night time sleep. Children with TD and with WS benefitted from sleep for enhanced memory consolidation and improved their performance on the task by reducing the number of moves taken to completion, and by making fewer rule violations. We did not find any large effects of sleep on learning in children with DS, suggesting that these children are not only delayed, but atypical in their learning strategies. Importantly, our findings have implications for educational strategies for all children, specifically considering circadian influences on new learning and the role of children's night time sleep as an aid to learning.
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Affiliation(s)
- Anna Joyce
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
| | - Catherine M Hill
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
| | - Annette Karmiloff-Smith
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
| | - Dagmara Dimitriou
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
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Pires PJ, Mattiello R, Lumertz MS, Morsch TP, Fagondes SC, Nunes ML, Gozal D, Stein RT. Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.013] [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] Open
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Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire. J Pediatr (Rio J) 2019; 95:231-237. [PMID: 29501352 DOI: 10.1016/j.jped.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To validate the Pediatric Obstructive Sleep Apnea Screening tool for use in Brazil. MATERIALS AND METHODS The Brazilian version of this questionnaire, originally validated and tested in the United States, was developed as follows: (a) translation; (b) back-translation; (c) completion of the final version; (d) pre-testing. The questionnaire was applied prior to polysomnography to children aged 3-9 years from October 2015 to October 2016, and its psychometric properties (i.e., validity and reliability) were evaluated. The accuracy was assessed from comparisons between polysomnographic results and corresponding questionnaire scores. RESULTS Sixty patients were enrolled, and based on polysomnographic findings, 48% patients had normal apnea-hypopnea index, while the remaining 52% met the criteria for obstructive sleep apnea. Minimum O2 saturation level was significantly lower among obstructive sleep apnea children (p=0.021). Satisfactory concordance was found between individual apnea-hypopnea index and questionnaire scores. Bland-Altman plot-derived bias was 0.1 for the difference between measures, with 5.34 (95% CI: 4.14-6.55) and -5.19 (95%CI: -6.39 to -3.98) for the upper and lower agreement range. Internal consistency derived from Cronbach's alpha was 0.84 (95%CI: 0.78-0.90). CONCLUSION The questionnaire was translated to and validated into Brazilian-Portuguese version, and showed good reliability and concordance with apnea-hypopnea index. This questionnaire offers a reliable screening option for sleep-disordered breathing in children.
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Stabouli S, Gidaris D, Printza N, Dotis J, Papadimitriou E, Chrysaidou K, Papachristou F, Zafeiriou D. Sleep disorders and executive function in children and adolescents with chronic kidney disease. Sleep Med 2019; 55:33-39. [DOI: 10.1016/j.sleep.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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23
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Longlalerng K, Sonsuwan N, Uthaikhup S, Kumsaiyai W, Sitilertpisan P, Traisathit P, Pratanaphon S. Translation, cross-cultural adaptation and psychometric properties of the Sleep-Related Breathing Disordered−Pediatric Sleep Questionnaire for obese Thai children with obstructive sleep apnea. Sleep Med 2019; 53:45-50. [DOI: 10.1016/j.sleep.2018.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 01/06/2023]
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Comorbid obstructive sleep apnea and increased risk for sickle cell disease morbidity. Sleep Breath 2018; 22:797-804. [DOI: 10.1007/s11325-018-1630-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 01/19/2023]
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Yerushalmy-Feler A, Tauman R, Derowe A, Averbuch E, Ben-Tov A, Weintraub Y, Weiner D, Amir A, Moran-Lev H, Cohen S. Gluten-free diet may improve obstructive sleep apnea-related symptoms in children with celiac disease. BMC Pediatr 2018; 18:35. [PMID: 29415685 PMCID: PMC5803930 DOI: 10.1186/s12887-018-1039-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Background Enlarged tonsils and adenoids are the major etiology of obstructive sleep apnea (OSA) in children. Lymphatic hyperplasia is common to both OSA and celiac disease. We aimed to investigate the effect of a gluten-free diet on OSA symptoms in children with celiac disease. Methods Children with celiac disease aged 2–18 years were prospectively recruited before the initiation of a gluten-free diet. Children with negative celiac serology who underwent gastrointestinal endoscopies for other indications served as controls. All participants completed a validated OSA-related symptoms questionnaire and the pediatric sleep questionnaire (PSQ) at baseline and 6 months later. Results Thirty-four children with celiac disease (mean age 6.6 ± 3.5 years) and 24 controls (mean age 7.3 ± 4.6 years, P = 0.5) were recruited. There were no significant differences in gender, body mass index or season at recruitment between the two groups. The rate of positive PSQ scores was higher (more OSA-related symptoms) in the control group compared to the celiac group, both at recruitment and at the 6-month follow-up (33.3% vs. 11.8%, P = 0.046, and 16.7% vs. 0, P = 0.014, respectively). PSQ scores improved significantly in both groups at the 6-month follow-up (P < 0.001 for both). Improvement was significantly higher in the celiac group compared to controls (0.1 ± 0.09 vs.0.06 ± 0.06, respectively, P = 0.04). Conclusions Children with celiac disease had fewer OSA-related symptoms than controls, but the degree of improvement following the initiation of a gluten-free diet was significantly higher. These findings suggest that a gluten-free diet may improve OSA-related symptoms in children with celiac disease.
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Affiliation(s)
- Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riva Tauman
- Pediatric Sleep Center, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Derowe
- Pediatric ENT Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Averbuch
- Pediatric ENT Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ben-Tov
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Weintraub
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Weiner
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Achiya Amir
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Moran-Lev
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Durdik P, Sujanska A, Suroviakova S, Evangelisti M, Banovcin P, Villa MP. Sleep Architecture in Children With Common Phenotype of Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:9-14. [PMID: 29198306 DOI: 10.5664/jcsm.6868] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In children, the effect of the common phenotype of obstructive sleep apnea (OSA) on sleep architecture is not adequately documented. The aim of this study was to evaluate sleep architecture in a pediatric population with the common phenotype of OSA. METHODS The prospective cross-sectional study included 116 children in the age range of 3 to 8 years with suspected OSA and 51 healthy children. All children underwent standard overnight in-laboratory video polysomnography. Patients with obstructive apnea-hypopnea index ≥ 1, adenotonsillar hypertrophy, a long face, narrow palate or minor malocclusions, and no obesity were defined as a common phenotype. Polysomnographic parameters of sleep architecture and sleep clinical record were statistically analyzed according to OSA and its severity. RESULTS In total, 94 pediatric patients (59.60% male) received the diagnosis of the common phenotype of OSA (mean age of 5.25 ± 1.39 years). A lower percentage of stage N3 sleep (27.70 ± 3.76% versus 31.02 ± 4.23%; P < .05), a greater percentage of stage N1 sleep (8.40 ± 3.98% versus 2.68 ± 3.02%, P < .01), reduced deep sleep efficiency (46.01 ± 4.98% versus 50.25 ± 3.72%; P < .05) and longer sleep latency (18.40 ± 8.48 minutes versus 9.90 ± 11.55 minutes, P < .01) were found in children with the common phenotype of OSA compared with healthy controls. No significant differences were found in total sleep time, sleep efficiency, and percentage of stage R sleep and stage N2 sleep between groups and in sleep stage distribution and cyclization. CONCLUSIONS These findings suggest that the most common phenotype of pediatric OSA has a negative effect on the structure of sleep, but other clinical studies are needed to confirm this result.
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Affiliation(s)
- Peter Durdik
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia
| | - Anna Sujanska
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia.,Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Stanislava Suroviakova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia
| | - Melania Evangelisti
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Peter Banovcin
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia
| | - Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Joyce A, Dimitriou D. Sleep-disordered breathing and cognitive functioning in preschool children with and without Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:778-791. [PMID: 28612424 DOI: 10.1111/jir.12387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/28/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sleep affects children's cognitive development, preparedness for school and future academic outcomes. People with Down syndrome (DS) are particularly at risk for sleep-disordered breathing (SDB). To our knowledge, the association between SDB and cognition in preschoolers with DS is unknown. METHODS We assessed sleep by using cardiorespiratory polygraphy in 22 typically developing (TD) preschoolers and 22 with DS. Cognition was assessed by using the Mullen Scales of Early Learning and behaviour by using the Strengths and Difficulties Questionnaire (SDQ). The MacArthur Communicative Development Inventory (MCDI) measured language level. We predicted that sleep problems would be associated with lower cognitive and behavioural functioning. RESULTS In TD children, longer sleep duration was associated with higher scores on MCDI expressive language and fewer emotional symptoms such as fear and unhappiness on the SDQ, whilst SDB was associated with increased conduct problems and less prosocial behaviour on the SDQ. Conversely, for children with DS, SDB was associated with increased language understanding and use of actions and gestures on the MCDI. CONCLUSIONS The findings in the TD group support our hypotheses. We recommend that sleep problems are screened for and treated as even mild SDB may prompt poorer cognition and behaviour. For children with DS, we expect that multiple factors in this complex syndrome mask or mediate the association between sleep and cognitive development and tighter controls are necessary to uncover effects of sleep. We propose longitudinal studies as a necessary tool to assess the precise impact of sleep on cognitive development in accounting for individual differences in DS.
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Affiliation(s)
- A Joyce
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, Coventry, UK
| | - D Dimitriou
- Lifespan Learning & Sleep Lab, Department of Psychology and Human Development, UCL Institute of Education, London, UK
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Mohamed AS, Sharshar RS, Elkolaly RM, Serageldin SM. Upper airway muscle exercises outcome in patients with obstructive sleep apnea syndrome. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kist C, Gier A, Tucker J, Barbieri TF, Johnson-Branch S, Moore L, Picard S, Lukasiewicz G, Coleman N. Physical Activity in Clinical Pediatric Weight Management Programs: Current Practices and Recommendations. Clin Pediatr (Phila) 2016; 55:1219-1229. [PMID: 26692469 DOI: 10.1177/0009922815620772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Physical activity (PA) is essential for youth weight management. FOCUS on a Fitter Future (FFF), a group of health care professionals from 25 children's hospitals, sponsored by the Children's Hospital Association, examined current care practices for overweight and obese youth with the goal of building consensus on outcome measurements and quality improvement for pediatric weight management programs (WMPs). WMPs completed a survey regarding PA practices, including testing, assessment and intervention. Consistency in general treatment practices was noted with variability in implementation. All programs included PA assessment and counseling. A majority of programs measured aerobic fitness, and more than half evaluated muscular fitness. Most offered group exercise sessions. Programs differed in availability of resources, assessment tools, interventions and outcome measures. Based on current practice and research, the FFF PA subgroup recommends key components for inclusion in a pediatric WMP: exercise testing, body composition assessment, PA and sedentary behaviors measures, individual exercise counseling, and group exercise programming.
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Affiliation(s)
- Christopher Kist
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amanda Gier
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jared Tucker
- Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Teresa F Barbieri
- Healthy Hearts Clinic, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Lindy Moore
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital for Children, Orlando, FL, USA
| | - Sarah Picard
- Optimal Weight for Life Program, Boston Children's Hospital, Boston, MA, USA
| | | | - Nailah Coleman
- The Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
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Evangelisti M, Shafiek H, Rabasco J, Forlani M, Montesano M, Barreto M, Verhulst S, Villa MP. Oximetry in obese children with sleep-disordered breathing. Sleep Med 2016; 27-28:86-91. [PMID: 27938925 DOI: 10.1016/j.sleep.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Obesity is an important risk factor for obstructive sleep apnea syndrome (OSAS), and obese children with OSAS have frequently shown oxygen desaturations when compared with normal-weight children. The aim of our study was to investigate the oximetry characteristics in children with obesity and sleep-disordered breathing (SDB). METHODS Children referred for suspected OSAS were enrolled in the study. All children underwent sleep clinical record (SCR), pulse oximetry, and polysomnography (PSG). RESULTS A total of 248 children with SDB were recruited (128 obese and 120 normal-weight children). Obese children showed higher oxygen desaturation index (ODI) and lower nadir oxygen saturation (nadir SaO2) compared to non-obese children (p < 0.05). ODI and nadir SaO2 correlated with obesity (p < 0.05). The SCR evaluation showed that deep bite and overjet were more common among obese children (p < 0.05), whereas habitual nasal obstruction and arched palate were more common among non-obese children (p < 0.05). Furthermore, skeletal malocclusion and tonsillar hypertrophy were significant risk factors in obese children associated with severe desaturation (p < 0.05). CONCLUSION Obese children with SDB have a more significant oxygen desaturation; adeno-tonsillar hypertrophy is not the only important risk factor for its development but also the presence of malocclusions.
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Affiliation(s)
- Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Hanaa Shafiek
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jole Rabasco
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Martina Forlani
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marilisa Montesano
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mario Barreto
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Stijn Verhulst
- Department of Pediatric Pulmonology, Cystic Fibrosis Clinic and Pediatric Sleep Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
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Jackson GW. Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient. Case Rep Dent 2016; 2016:5473580. [PMID: 27668098 PMCID: PMC5030400 DOI: 10.1155/2016/5473580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022] Open
Abstract
A case report is presented which demonstrates the effectiveness of comprehensive orthodontic treatment combined with orthognathic surgery in the correction of malocclusion and reduction in the sequelae of Obstructive Sleep Apnea (OSA). The patient's severe OSA was improved to very mild as evaluated by full overnight polysomnogram. The orthodontic treatment included the expansion of both dental arches and mandibular advancement surgery. There was significant improvement in the patient's sleep continuity and architecture with the elimination of obstructive apneas.
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Affiliation(s)
- Gregory W. Jackson
- Department of Orthodontics (M/C 841), College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Chicago, IL 60612, USA
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Pediatric Sleep Apnea Syndrome: An Update. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:852-61. [PMID: 27372597 DOI: 10.1016/j.jaip.2016.02.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 01/04/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) may be central neurologic (<5%) or obstructive (>95%) in origin and is a relatively prevalent condition in children. It affects 1%-5% of children aged 2-8 years and is caused by a variety of different pathophysiologic abnormalities. Cardiovascular, metabolic, and neurocognitive comorbidities can occur in both children and adults when left untreated. It also can cause severe behavioral problems in children. The American Academy of Pediatrics recommends that all children be screened with an appropriate history and physical examination for symptoms and signs suggestive of OSAS. The diagnosis is primarily made clinically and confirmed by polysomnographic findings. Treatment depends on the child's age, underlying medical problems, polysomnography findings, and whether or not there is upper airway obstruction usually secondary to enlarged adenoids and/or tonsils, allergic and nonallergic rhinitis, acute and chronic sinusitis, and other upper airway pathology. If enlarged adenoid or tonsils or both conditions exist, an adenoidectomy, tonsillectomy, or adenotonsillectomy remains the treatment of choice. Pharmacotherapy of OSAS has shown some effect in children with mild symptoms. This paper reviews the prevalence, pathophysiology, clinical presentation, diagnosis, and treatment of OSAS.
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Tan HL, Kheirandish-Gozal L, Abel F, Gozal D. Craniofacial syndromes and sleep-related breathing disorders. Sleep Med Rev 2016; 27:74-88. [PMID: 26454241 PMCID: PMC5374513 DOI: 10.1016/j.smrv.2015.05.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/22/2015] [Accepted: 05/28/2015] [Indexed: 01/15/2023]
Abstract
Children with craniofacial syndromes are at risk of sleep disordered breathing, the most common being obstructive sleep apnea. Midface hypoplasia in children with craniosynostosis and glossoptosis in children with Pierre Robin syndrome are well recognized risk factors, but the etiology is often multifactorial and many children have multilevel airway obstruction. We examine the published evidence and explore the current management strategies in these complex patients. Some treatment modalities are similar to those used in otherwise healthy children such as adenotonsillectomy, positive pressure ventilation and in the refractory cases, tracheostomy. However, there are some distinct approaches such as nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis in children with Pierre Robin sequence, and midface advancement in children with craniosynostoses. Clinicians should have a low threshold for referral for evaluation of sleep-disordered-breathing in these patients.
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Affiliation(s)
- Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Leila Kheirandish-Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - François Abel
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
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Tan HL, Kheirandish-Gozal L, Gozal D. Obstructive sleep apnea in children: update on the recognition, treatment and management of persistent disease. Expert Rev Respir Med 2016; 10:431-439. [PMID: 26949836 DOI: 10.1586/17476348.2016.1163224] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adenotonsillectomy (AT) is the recommended first-line treatment for pediatric obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy. It is now clearly established that AT results in improvement in the severity of OSA in most children. However, a significant number of OSA children undergoing AT exhibit residual persistent OSA post-surgery. Patients at increased risk of persistent OSA include those with severe disease at initial review, older or obese patients, children with underlying asthma or allergic rhinitis, and those who have concurrent underlying medical conditions, such as Trisomy 21, craniofacial syndromes or cerebral palsy. Here, we aim to highlight recent research findings into those who have persistent OSA disease, and suggest a practical approach to the management of these children.
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Affiliation(s)
- Hui-Leng Tan
- a Department of Paediatric Respiratory Medicine , Royal Brompton Hospital , London , UK
| | - Leila Kheirandish-Gozal
- b Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine , The University of Chicago , Chicago , IL , USA
| | - David Gozal
- b Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine , The University of Chicago , Chicago , IL , USA
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Villa MP, Shafiek H, Evangelisti M, Rabasco J, Cecili M, Montesano M, Barreto M. Sleep clinical record: what differences in school and preschool children? ERJ Open Res 2016; 2:00049-2015. [PMID: 27730168 PMCID: PMC5005151 DOI: 10.1183/23120541.00049-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/29/2015] [Indexed: 11/24/2022] Open
Abstract
The sleep clinical record (SCR) may be a valid method for detecting children with obstructive sleep apnoea (OSA). This study aimed to evaluate whether there were differences in SCR depending on age and to identify the possible risk factors for OSA development. We enrolled children with sleep disordered breathing between 2013 and 2015, and divided them according to age into preschool- and school-age groups. All patients underwent SCR and polysomnography. OSA was detected in 81.1% and 83.6% of preschool- and school-age groups, respectively. Obesity, malocclusions, nasal septal deviation and inferior turbinate hypertrophy were significantly more prevalent in school-age children (p<0.05); however, only tonsillar hypertrophy had significant hazard ratio (2.3) for OSA development. Saddle nose, nasal hypotonia, oral breathing and tonsillar hypertrophy were significantly more prevalent for development of OSA in preschoolers (p<0.03). The SCR score was significantly higher among preschool children than in school-age children (8.4±2.22 versus 7.9±2.6; p=0.044). Further, SCR score >6.5 had a sensitivity of 74% in predicting OSA in preschool children with positive predictive value of 86% (p=0.0001). Our study confirms the validity of the SCR as a screening tool for patient candidates for a PSG study for suspected OSA, in both school and preschool children. The differences in sleep clinical record between school and preschool children suspected to have OSAhttp://ow.ly/X778Q
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Affiliation(s)
- Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Hanaa Shafiek
- Dept of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Jole Rabasco
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Manuela Cecili
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marilisa Montesano
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mario Barreto
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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Abstract
Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel.
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Affiliation(s)
- Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, England
| | - Leila Kheirandish-Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.
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Sleep-disordered breathing in children with chronic kidney disease. Pediatr Nephrol 2015; 30:2135-43. [PMID: 26156709 DOI: 10.1007/s00467-015-3155-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of our study was to ascertain the prevalence and type of sleep-disordered breathing (SDB) in paediatric patients with severe chronic kidney disease (CKD) based on the results of polysomnograms (PSGs). METHODS Overnight PSGs were conducted on children with CKD stages 3-5 (dialysis dependent). Data were collected on patient demographics from the medical records. Study participants and/or their caregivers completed the paediatric modification of the Epworth Sleepiness Scale Score, the Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory at the time of the PSG. RESULTS Nineteen children were included in the study, of whom seven were on dialysis. The median (interquartile range) age at the time of the PSG was 13.5 (5.4-16.5) years, and eight (42%) of the children were male. There was a 37% (n = 7) prevalence of SDB in this cohort based on the PSG results. Central sleep apnea and obstructive sleep apnea were found in three children each. The PSQ scores did not correlate with the obstructive apnea-hypopnea index. CONCLUSIONS There was a high prevalence of SDB in this cohort of children with CKD. The PSG and validated sleep questionnaires yielded discordant results, reinforcing the limitations of diagnosing SDB in the CKD population based solely on sleep questionnaires.
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Roles of interleukin (IL)-6 gene polymorphisms, serum IL-6 levels, and treatment in obstructive sleep apnea: a meta-analysis. Sleep Breath 2015; 20:719-31. [DOI: 10.1007/s11325-015-1288-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/21/2015] [Accepted: 11/02/2015] [Indexed: 12/20/2022]
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Villa MP, Sujanska A, Vitelli O, Evangelisti M, Rabasco J, Pietropaoli N, Banovcin P, Kheirandish-Gozal L, Gozal D. Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment. Sleep Breath 2015; 20:321-9. [PMID: 26564170 DOI: 10.1007/s11325-015-1287-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of our study was to evaluate the utility of the sleep clinical record (SCR) in the follow-up of children with obstructive sleep apnea (OSA) after treatment. METHODS SCR was completed and overnight polysomnography (PSG) was performed in all enrolled children (T0), with SCR considered positive for scores ≥6.5, as previously validated. Patients underwent adenotonsillectomy (T&A), rapid maxillary expansion (RME), and medical therapy according to severity of OSA and clinical features. Six months after completing therapy, the second overnight PSG and SCR (T1) were performed. RESULTS For all subjects, both Apnea-Hypopnea Index (AHI) and total SCR score decreased significantly (<0.005) from T0 to T1. For SCR items, clinical examination (item 1) and reported sleep respiratory symptoms (item 2) ameliorated significantly (<0.005). However, hyperactivity or inattention (item 3) decreased significantly (<0.005) after treatment only in T&A group, while no differences in AHI and SCR scores occurred in the medically treated group. At T1, SCR was positive in 95.6 % of children with AHI ≥1, with a concordance of 100 % in the T&A and RME groups, resulting in a positive predictive value of 100 %. A poor concordance (38.3 % in T&A group and 53.4 % in RME group) was found when SCR < 6.5. Children with SCR ≥ 6.5 at T1 showed higher AHI compared to patients with SCR < 6.5 (5.7 ± 5.9 ev/h vs 1.78 ± 1.76 ev/h; p < 0.005). CONCLUSIONS SCR emerges as a potentially useful instrument for follow-up of children with OSA after treatment.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Anna Sujanska
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Melania Evangelisti
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Peter Banovcin
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA
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Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AGM. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015; 2015:CD011165. [PMID: 26465274 PMCID: PMC9242010 DOI: 10.1002/14651858.cd011165.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause of oSDB. As such, tonsillectomy - with or without adenoidectomy - is considered an appropriate first-line treatment for most cases of paediatric oSDB. OBJECTIVES To assess the benefits and harms of tonsillectomy with or without adenoidectomy compared with non-surgical management of children with oSDB. SEARCH METHODS We searched the Cochrane Register of Studies Online, PubMed, EMBASE, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the search was 5 March 2015. SELECTION CRITERIA Randomised controlled trials comparing the effectiveness and safety of (adeno)tonsillectomy with non-surgical management in children with oSDB aged 2 to 16 years. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Three trials (562 children) met our inclusion criteria. Two were at moderate to high risk of bias and one at low risk of bias. We did not pool the results because of substantial clinical heterogeneity. They evaluated three different groups of children: those diagnosed with mild to moderate OSAS by polysomnography (PSG) (453 children aged five to nine years; low risk of bias; CHAT trial), those with a clinical diagnosis of oSDB but with negative PSG recordings (29 children aged two to 14 years; moderate to high risk of bias; Goldstein) and children with Down syndrome or mucopolysaccharidosis (MPS) diagnosed with mild to moderate OSAS by PSG (80 children aged six to 12 years; moderate to high risk of bias; Sudarsan). Moreover, the trials included two different comparisons: adenotonsillectomy versus no surgery (CHAT trial and Goldstein) or versus continuous positive airway pressure (CPAP) (Sudarsan). Disease-specific quality of life and/or symptom score (using a validated instrument): first primary outcomeIn the largest trial with lowest risk of bias (CHAT trial), at seven months, mean scores for those instruments measuring disease-specific quality of life and/or symptoms were lower (that is, better quality of life or fewer symptoms) in children receiving adenotonsillectomy than in those managed by watchful waiting:- OSA-18 questionnaire (scale 18 to 126): 31.8 versus 49.5 (mean difference (MD) -17.7, 95% confidence interval (CI) -21.2 to -14.2);- PSQ-SRBD questionnaire (scale 0 to 1): 0.2 versus 0.5 (MD -0.3, 95% CI -0.31 to -0.26);- Modified Epworth Sleepiness Scale (scale 0 to 24): 5.1 versus 7.1 (MD -2.0, 95% CI -2.9 to -1.1).No data on this primary outcome were reported in the Goldstein trial.In the Sudarsan trial, the mean OSA-18 score at 12 months did not significantly differ between the adenotonsillectomy and CPAP groups. The mean modified Epworth Sleepiness Scale scores did not differ at six months, but were lower in the surgery group at 12 months: 5.5 versus 7.9 (MD -2.4, 95% CI -3.1 to -1.7). Adverse events: second primary outcomeIn the CHAT trial, 15 children experienced a serious adverse event: 6/194 (3%) in the adenotonsillectomy group and 9/203 (4%) in the control group (RD -1%, 95% CI -5% to 2%).No major complications were reported in the Goldstein trial.In the Sudarsan trial, 2/37 (5%) developed a secondary haemorrhage after adenotonsillectomy, while 1/36 (3%) developed a rash on the nasal dorsum secondary to the CPAP mask (RD -3%, 95% CI -6% to 12%). Secondary outcomesIn the CHAT trial, at seven months, mean scores for generic caregiver-rated quality of life were higher in children receiving adenotonsillectomy than in those managed by watchful waiting. No data on this outcome were reported by Sudarsan and Goldstein.In the CHAT trial, at seven months, more children in the surgery group had normalisation of respiratory events during sleep as measured by PSG than those allocated to watchful waiting: 153/194 (79%) versus 93/203 (46%) (RD 33%, 95% CI 24% to 42%). In the Goldstein trial, at six months, PSG recordings were similar between groups and in the Sudarsan trial resolution of OSAS (Apnoea/Hypopnoea Index score below 1) did not significantly differ between the adenotonsillectomy and CPAP groups.In the CHAT trial, at seven months, neurocognitive performance and attention and executive function had not improved with surgery: scores were similar in both groups. In the CHAT trial, at seven months, mean scores for caregiver-reported ratings of behaviour were lower (that is, better behaviour) in children receiving adenotonsillectomy than in those managed by watchful waiting, however, teacher-reported ratings of behaviour did not significantly differ.No data on these outcomes were reported by Goldstein and Sudarsan. AUTHORS' CONCLUSIONS In otherwise healthy children, without a syndrome, of older age (five to nine years), and diagnosed with mild to moderate OSAS by PSG, there is moderate quality evidence that adenotonsillectomy provides benefit in terms of quality of life, symptoms and behaviour as rated by caregivers and high quality evidence that this procedure is beneficial in terms of PSG parameters. At the same time, high quality evidence indicates no benefit in terms of objective measures of attention and neurocognitive performance compared with watchful waiting. Furthermore, PSG recordings of almost half of the children managed non-surgically had normalised by seven months, indicating that physicians and parents should carefully weigh the benefits and risks of adenotonsillectomy against watchful waiting in these children. This is a condition that may recover spontaneously over time.For non-syndromic children classified as having oSDB on purely clinical grounds but with negative PSG recordings, the evidence on the effects of adenotonsillectomy is of very low quality and is inconclusive.Low-quality evidence suggests that adenotonsillectomy and CPAP may be equally effective in children with Down syndrome or MPS diagnosed with mild to moderate OSAS by PSG.We are unable to present data on the benefits of adenotonsillectomy in children with oSDB aged under five, despite this being a population in whom this procedure is often performed for this purpose.
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Affiliation(s)
- Roderick P Venekamp
- University Medical Center UtrechtJulius Center for Health Sciences and Primary Care & Department of OtorhinolaryngologyHeidelberglaan 100UtrechtNetherlands3508 GA
| | - Benjamin J Hearne
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
| | | | - Helen Blackshaw
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
| | - Jerome Lim
- Medway Maritime HospitalEar, Nose and Throat DepartmentWindmill RoadGillinghamKentUKME7 5NY
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
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Mukherjee S, Patel SR, Kales SN, Ayas NT, Strohl KP, Gozal D, Malhotra A. An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities. Am J Respir Crit Care Med 2015; 191:1450-8. [PMID: 26075423 DOI: 10.1164/rccm.201504-0767st] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Despite substantial public interest, few recommendations on the promotion of good sleep health exist to educate health care providers and the general public on the importance of sleep for overall health. OBJECTIVES The aim of this American Thoracic Society (ATS) statement is to provide a review of the current scientific literature to assist health care providers, especially pulmonologists and sleep physicians, in making recommendations to patients and the general public about the importance of achieving good quality and adequate quantity of sleep. METHODS ATS members were invited, based on their expertise in sleep medicine, and their conclusions were based on both empirical evidence identified after comprehensive literature review and clinical experience. MAIN RESULTS We focus on sleep health in both children and adults, including the impact of occupation on sleep, the public health implications of drowsy driving, and the common sleep disorders of obstructive sleep apnea and insomnia. This ATS statement also delineates gaps in research and knowledge that should be addressed and lead to new focused research priorities to advance knowledge in sleep and sleep health. CONCLUSIONS Good quality and quantity of sleep are essential for good health and overall quality of life; therefore a strong recommendation was made for the implementation of public education programs on the importance of sleep health.
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Šujanská A, Ďurdík P, Rabasco J, Vitelli O, Pietropaoli N, Villa MP. SURGICAL AND NON-SURGICAL THERAPY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN CHILDREN. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 57:135-41. [PMID: 25938896 DOI: 10.14712/18059694.2015.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Interventions of paediatric obstructive sleep apnea syndrome are complex, varied and multidisciplinary. The goal of the treatment is to restore optimal breathing during the night and to relieve associated symptoms. Evidence suggests that the surgical intervention with removal of the tonsils and adenoids will lead to significant improvements in the most incomplicated cases, as recently reported from a meta-analysis. However, post-operative persistence of this syndrome in paediatric population is more frequent than expected, which supports the idea of the complexity of this syndrome. Adenotomy alone may not be sufficient in children with OSAS, because it does not address oropharyngeal obstruction secondary to tonsillar hyperplasia. Continuous positive airway pressure can effectively treat this syndrome in selected groups of children, improving both nocturnal and daytime symptoms, but poor adherence is a limiting factor. For this reason, CPAP is not recommended as first-line therapy for OSAS when adenotonsillectomy is an option. It is now being investigated the incorporation of nonsurgical approaches for milder forms and for residual OSAS after surgical intervention. Althought adeno-tonsillar hypertrophy is the most common for OSAS in children; obesity is emerging as an equally important etiological factor. Therefore an intensive weight reduction program and adequate sleep hygiene are also important lifestyle changes that may be very effective in mitigating the symptoms of this syndrome. Pharmacological therapy (leukotriene antagonists, topical nasal steroids) is usually use for mild forms of OSAS and in children with associated allergic diseases. Special orthodontic treatment and oropharyngeal exercises are a relatively new and promising alternative therapeutic modality used in selected groups of children with OSAS.
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Affiliation(s)
- Anna Šujanská
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava, Martin, Slovak Republic
| | - Peter Ďurdík
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava, Martin, Slovak Republic.
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Philby MF, Aydinoz S, Gozal D, Kilic S, Bhattacharjee R, Bandla HP, Kheirandish-Gozal L. Pupillometric findings in children with obstructive sleep apnea. Sleep Med 2015; 16:1187-91. [PMID: 26429743 DOI: 10.1016/j.sleep.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) leads to intermittent hypoxia, activation of the sympathetic nervous system, and eventually cardiovascular morbidity. Alterations in autonomic nervous system (ANS) tone and reflexes are likely to play major roles in OSA-associated morbidities, and have been identified in a subset of children with OSA. OBJECTIVES To evaluate whether pupillometry, a noninvasive and rapid bedside test for the assessment of autonomic nervous system dysfunction (ANS), would detect abnormal ANS function in children with OSA. METHODS Children ages 2-12 years underwent polysomnography (PSG), and were divided based on PSG findings into two groups; Habitual Snorers (HS; AHI < 1 h/TST, n = 17) and OSA (AHI > 1 h/TST, n = 49), the latter then sub-divided into AHI severity categories (>1 but <5, >5 but <10, and >10 h/TST). Pupillometric measurements were performed during the clinic visit in a dark room using an automated pupillometer device. RESULTS A total of 66 subjects with a mean age of 7.3 ± 2.6 years were recruited. There were no statistically significant differences between any of the groups, even when comparing severe OSA (n = 15) and HS in any of the measures related to pupillary reflexes. However, mild, yet significant increases in systolic blood pressure and morning plasma norepinephrine levels were detected in the severe OSA group. CONCLUSION Although ANS perturbations are clearly present in a proportion of children with OSA, particularly those with severe disease, pupillary responses do not appear to provide a sensitive method for the detection of ANS dysfunction in OSA children.
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Affiliation(s)
- Mona F Philby
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA
| | - Secil Aydinoz
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA; Department of Pediatrics, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA; Section of Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA
| | - Selim Kilic
- Department of Pediatrics, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Rakesh Bhattacharjee
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA; Section of Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA
| | - Hari P Bandla
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA; Section of Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA
| | - Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL, USA.
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Intracranial hypertension associated with obstructive sleep apnea: a discussion of potential etiologic factors. Med Hypotheses 2014; 83:792-7. [PMID: 25456788 DOI: 10.1016/j.mehy.2014.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 09/07/2014] [Accepted: 10/14/2014] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea has been shown to increase intracranial pressure, and to be a secondary cause of intracranial hypertension. There are a few theories that attempt to explain this relationship, however there is little data, and even less recognition among physicians that this actually occurs. This paper discusses multiple pieces of data, from anatomical correlates to biochemical information involving neuro-excitotoxicity, as well as hematologic factors and issues surrounding brain edema and blood-brain barrier dysfunction. A complex paradigm for how obstructive sleep apnea may lead to increased intracranial pressure is thus proposed. In addition, suggestions are made for how obstructive sleep apnea must as a result be managed differently in the setting of idiopathic intracranial hypertension.
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Chamorro R, Algarín C, Garrido M, Causa L, Held C, Lozoff B, Peirano P. Night time sleep macrostructure is altered in otherwise healthy 10-year-old overweight children. Int J Obes (Lond) 2014; 38:1120-5. [PMID: 24352291 PMCID: PMC4190838 DOI: 10.1038/ijo.2013.238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 11/21/2013] [Accepted: 12/08/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Epidemiological evidence shows an inverse relationship between sleep duration and overweight/obesity risk. However, there are few polysomnographic studies that relate the organization of sleep stages to pediatric overweight (OW). We compared sleep organization in otherwise healthy OW and normal-weight (NW) 10-year-old children. SUBJECTS Polysomnographic assessments were performed in 37 NW and 59 OW children drawn from a longitudinal study beginning in infancy. Weight and height were used to evaluate body mass index (BMI) according to international criteria. Non-rapid eye movement (NREM) sleep (stages N1, N2 and N3), rapid eye movement (REM) sleep (stage R) and wakefulness (stage W) were visually scored. Sleep parameters were compared in NW and OW groups for the whole sleep period time (SPT) and for each successive third of it using independent Student's t-tests or nonparametric tests. The relationship between BMI and sleep variables was evaluated by correlation analyses controlling for relevant covariates. RESULTS The groups were similar in timing of sleep onset and offset, and sleep period time. BMI was inversely related to total sleep time (TST) and sleep efficiency. OW children showed reduced TST, sleep efficiency and stage R amount, but higher stage W amount. In analysis by thirds of the SPT, the duration of stage N3 episodes was shorter in the first third and longer in the second third in OW children as compared with NW children. CONCLUSIONS Our results show reduced sleep amount and quality in otherwise healthy OW children. The lower stage R amount and changes involving stage N3 throughout the night suggest that OW in childhood is associated with modifications not only in sleep duration, but also in the ongoing night time patterns of NREM sleep and REM sleep stages.
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Affiliation(s)
- Rodrigo Chamorro
- Sleep Laboratory, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Cecilia Algarín
- Sleep Laboratory, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Marcelo Garrido
- Sleep Laboratory, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Leonardo Causa
- Electrical Engineering Department, University of Chile, Santiago, Chile
| | - Claudio Held
- Electrical Engineering Department, University of Chile, Santiago, Chile
| | - Betsy Lozoff
- Center for Human Growth and Development and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Patricio Peirano
- Sleep Laboratory, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
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48
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Austeng ME, Øverland B, Kværner KJ, Andersson EM, Axelsson S, Abdelnoor M, Akre H. Obstructive sleep apnea in younger school children with Down syndrome. Int J Pediatr Otorhinolaryngol 2014; 78:1026-9. [PMID: 24809771 DOI: 10.1016/j.ijporl.2014.03.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to assess the prevalence of obstructive sleep apnea (OSA) in 8 year old school children with Down syndrome (DS). While the prevalence in otherwise healthy children is below 5%, the prevalence estimates in children with DS are uncertain (30-80%). OSA directly affects cognitive development and school performance. STUDY DESIGN Population based cross sectional study in a limited geographical area. METHODS Polysomnography (PSG) with video and audio recordings was performed in 8-year-old children with DS in a pediatric sleep unit according to the guidelines of American Academy of Sleep Medicine. Twenty-nine of all 32 children with DS within a restricted area comprising >50% of the Norwegian population and 54% of the children with DS born in Norway in 2002 were enrolled. RESULTS This study reports an apnea hypopnea index AHI>1.5 in 28 of 29 children and an obstructive apnea index (OAI)>1 in 24 of 29 children. 19 children (66%) had an AHI>5 and 17 children (59%) had an OAI>5 which indicated moderate to severe OSA. No correlation was found between OSA and obesity or gender. CONCLUSION The high prevalence of disease found in these previously undiagnosed 8-year-old children underlines the importance of performing OSA diagnostics in children with DS throughout childhood. These findings suggest that the prevalence of OSA remains high up to early school years. In contrast to earlier publications, this current study has the advantage of being population based, the study is performed on children of a narrow age band to estimate prevalence of disease and the diagnostic gold standard of PSG is applied.
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Affiliation(s)
- Marit Erna Austeng
- Østfold Hospital Trust, Department of Otorhinolaryngology, Head and Neck Surgery, Norway; Department of Health Economics and Health Management, University of Oslo, Norway.
| | - Britt Øverland
- Sleep Unit, Department of Otorhinolaryngology/Head and Neck Surgery, Lovisenberg Diakonale Hospital, Norway
| | - Kari Jorunn Kværner
- Department of Health Economics and Health Management, University of Oslo, Norway; Research, Innovation and Education Unit, Oslo University Hospital, Norway
| | - Els-Marie Andersson
- TAKO-Centre, Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Norway
| | - Stefan Axelsson
- TAKO-Centre, Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Norway
| | - Michael Abdelnoor
- Centre of Clinical Research, Unit of Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Harriet Akre
- Sleep Unit, Department of Otorhinolaryngology/Head and Neck Surgery, Lovisenberg Diakonale Hospital, Norway
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Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AGM. Tonsillectomy or adenotonsillectomy versus non-surgical management for sleep-disordered breathing in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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50
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Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, Pietropaoli N, Martella S. Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath 2014; 19:281-9. [PMID: 24859614 DOI: 10.1007/s11325-014-1011-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/30/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study evaluated the efficacy of oropharyngeal exercises in children with symptoms of obstructive sleep apnea syndrome (OSA) after adenotonsillectomy. METHODS Polysomnographic recordings were performed before adenotonsillectomy and 6 months after surgery. Patients with residual OSA (apnea-Hypopnea Index, AHI > 1 and persistence of respiratory symptoms) after adenotonsillectomy were randomized either to a group treated with oropharyngeal exercises (group 1) or to a control group (group 2). A morphofunctional evaluation with Glatzel and Rosenthal tests was performed before and after 2 months of exercises. All the subjects were re-evaluated after exercise through polysomnography and clinical evaluation. The improvement in OSA was defined by ΔAHI: (AHI at T1 - AHI at T2)/AHI at T1 × 100. RESULTS Group 1 was composed of 14 subjects (mean age, 6.01 ± 1.55) while group 2 was composed of 13 subjects (mean age, 5.76 ± 0.82). The AHI was 16.79 ± 9.34 before adenotonsillectomy and 4.72 ± 3.04 after surgery (p < 0.001). The ΔAHI was significantly higher in group 1 (58.01 %; range from 40.51 to 75.51 %) than in group 2 (6.96 %; range from -23.04 to 36.96 %). Morphofunctional evaluation demonstrated a reduction in oral breathing (p = 0.002), positive Glatzel test (p < 0.05), positive Rosenthal test (p < 0.05), and increased labial seal (p < 0.001), and lip tone (p < 0.05). CONCLUSIONS Oropharyngeal exercises may be considered as complementary therapy to adenotonsillectomy to effectively treat pediatric OSA.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Via Grottarossa 1035/1039, 00189, Rome, Italy,
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