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Patel N, Berggren KN, Hung M, Bates K, Dixon MM, Bax K, Adams H, Butterfield RJ, Campbell C, Johnson NE. Neurobehavioral Phenotype of Children With Congenital Myotonic Dystrophy. Neurology 2024; 102:e208115. [PMID: 38359368 DOI: 10.1212/wnl.0000000000208115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To describe the neurobehavioral phenotype of congenital myotonic dystrophy. Congenital myotonic dystrophy (CDM) is the most severe form of myotonic dystrophy, characterized by symptom presentation at birth and later, cognitive impairment, autistic features, and disordered sleep. METHODS The neurobehavioral phenotype was assessed in this cross-sectional study by a neuropsychological battery consisting of the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Weschler Intelligence Scale for Children, Fourth Edition, Vineland Adaptive Behavior Scale, Second Edition (Vineland-II), Behavior Rating Inventory of Executive Function including preschool and teacher reports, Autism Spectrum Screening Questionnaire, Social Communication Scale, and Repetitive Behavior Scale-Revised. Sleep quality was evaluated with the Pediatric Sleep Questionnaire and Pediatric Daytime Sleepiness Scale. RESULTS Fifty-five children with CDM, ages 5 weeks to 14 years, were enrolled. The mean age and (CTG)n repeats (±SD) were 6.4 ± 3.8 years and 1,263 ± 432, respectively. The mean IQ was 64.1 ± 14.9 on the Weschler scales with 65.6% of participants falling in the extremely low range for IQ. Adaptive functioning was significantly low for 57.1% of participants (n = 20). Caregiver report of executive functioning indicated 23.1% (9/39) of participants had clinically elevated levels of dysfunction, though teacher report was discrepant and indicated 53.3% of participants with CDM fell in this range (8/15). Spearman correlations were strongly positive (p ≤ 0.05) for estimated full scale IQ, overall adaptive functioning and with daily living and socialization domain standard scores on the Vineland-II ranging from r = 0.719 to r = 0.849 for all ages. Aspects of executive function were directly related to features of autism and sleep quality. Social communication was inversely related to all aspects of daily functioning, except communication, and directly related to aspects of autism behavior. DISCUSSION Depressed IQ, adaptive skills, and executive functioning, poor sleep quality, and features of autism and altered social functioning individually describe different aspects of the neurobehavioral phenotype in CDM. These neurobehavioral and sleep measures could help quantitatively measure and assess the burden of cognitive impairment in CDM.
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Affiliation(s)
- Namita Patel
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Kiera N Berggren
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Man Hung
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Kameron Bates
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Melissa M Dixon
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Karen Bax
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Heather Adams
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Russell J Butterfield
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Craig Campbell
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Nicholas E Johnson
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
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Wagner CS, Wietlisbach LE, Kota A, Villavisanis DF, Pontell ME, Barrero CE, Salinero LK, Swanson JW, Taylor JA, Bartlett SP. Genetic Subtypes of Apert Syndrome Are Associated With Differences in Airway Morphology and Early Upper Airway Obstruction. J Craniofac Surg 2023; 34:1999-2003. [PMID: 37582295 DOI: 10.1097/scs.0000000000009583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/30/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Apert syndrome is predominantly caused by 2 paternally inherited gain-of-function mutations in the FGFR2 gene, Pro253Arg, and Ser252Trp. Studies comparing phenotypic features between these 2 mutations have established differences in syndactyly severity and incidence of cleft palate. Obstructive sleep apnea can be debilitating in a subset of patients with Apert syndrome, yet is not well understood. This study aims to determine whether FGFR2 mutations impart differential effects on airway physiology and morphology. METHODS Patients with Apert syndrome and confirmatory molecular testing were reviewed for polysomnography, nasal endoscopy, microlaryngoscopy and bronchoscopy, and computed tomography imaging. Obstructive apnea-hypopnea index and oxygen saturation nadir, nasal airway volumes, choanal cross-sectional area, and midfacial cephalometric dimensions were compared across mutation types. RESULTS Twenty-four patients (13 Ser252Trp, 11 Pro253Arg) were included. Severe obstructive sleep apnea (obstructive apnea-hypopnea index>10) occurred in 8 (62%) patients with Ser252Trp mutations compared with 1 (9%) patient with Pro253Arg mutations ( P =0.009). Computed tomography imaging at 1 year of age demonstrated that nasopharyngeal airway volumes were 5302±1076 mm 3 in the Ser252Trp group and 6832±1414 mm 3 in the Pro253Arg group ( P =0.041). Maxillary length (anterior nasal spine-posterior nasal spine, P =0.026) and basion-anterior nasal spine ( P =0.007) were shorter in patients with Ser252Trp mutations. CONCLUSIONS The findings suggest that the Ser252Trp mutation in Apert syndrome is associated with higher severity obstructive sleep apnea and decreased nasopharyngeal airway volume. Heightened clinical awareness of these associations may inform treatment planning and family counseling.
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Affiliation(s)
- Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Ma Y, Niu Z, Ruan L, Xue S, Li N, Yao X, Li Q. Alterations in Amygdala/Hippocampal Volume Ratios in Children with Obstructive Sleep Apnea Syndrome Caused by Adenotonsillar Hypertrophy. Med Sci Monit 2023; 29:e937420. [PMID: 36918755 PMCID: PMC10026529 DOI: 10.12659/msm.937420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Intermittent hypoxemia can cause changes in certain brain structures. However, in pediatric patients with obstructive sleep apnea (OSA) caused by adenotonsillar hypertrophy (ATH), there is only limited information on the effect of ATH-induced OSA on brain structures. This study sought to investigate alterations in amygdala and hippocampal volumes in children with OSA by ATH. MATERIAL AND METHODS Magnetic resonance imaging scans were applied in children who had ATH-induced OSA (ATH/OSA) and in healthy children. Amygdala and hippocampus volumes and adenoid sizes were measured on MRI volumetric images. The ratio of adenoid size/nasopharyngeal depth was used to describe the severity of adenoid hypertrophy. The clinical variables of the involved subjects were investigated. RESULTS One hundred ATH/OSA children and 100 healthy children without ATH/OSA participated in the study. The ATH/OSA children had higher amygdala volumes and amygdala/hippocampus volume ratios but lower hippocampus volumes than healthy controls, and the amygdala/hippocampus volume ratios were correlated with disease duration and hypoxemia conditions. However, our data showed that amygdala/hippocampus volume ratios were not correlated with the ratios of adenoid size/nasopharyngeal depth in the ATH/OSA children. In addition, the ratio of adenoid size/nasopharyngeal depths in ATH/OSA children was higher than that in healthy children in each subgroup based on the age of participants. CONCLUSIONS Compared to healthy controls, amygdala/hippocampus volume ratios are increased in children with ATH/OSA.
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Affiliation(s)
- Yanshan Ma
- Department of Radiology, Shijiazhuang Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
| | - Zheli Niu
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lin Ruan
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Sisi Xue
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
| | - Nan Li
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
| | - Xiaoguang Yao
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
| | - Qiang Li
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
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Ji T, Ren X, Long T, Li X, Mei L, Ge W, Zhang J, Wang S, Guo Y, Xu Z, Peng Y, Liu J, Tai J, Ni X. Aberrant Topological Properties of Brain Functional Network in Children with Obstructive Sleep Apnea Derived from Resting-State fMRI. Brain Topogr 2023; 36:72-86. [PMID: 36258117 DOI: 10.1007/s10548-022-00920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/28/2022] [Indexed: 01/14/2023]
Abstract
To examine the difference in the topological properties of brain functional network between the children with obstructive sleep apnea (OSA) and healthy controls, and to explore the relationships between these properties and cognitive scores of OSA children. Twenty-four OSA children (6.5 ± 2.8 years, 15 males) and 26 healthy controls (8.0 ± 2.9 years, 11 males) underwent resting-state fMRI (rs-fMRI), based on which brain functional networks were constructed. We compared the global and regional topological properties of the network between OSA children and healthy controls. Partial correlation analysis was performed between topological properties and cognitive scores across OSA children. When comparing the OSA children with the healthy controls, lower full-scale intelligent quotient (FIQ) and verbal intelligent quotient (VIQ) were observed. Additionally, nodal degree centrality decreased in the bilateral anterior cingulate and paracingulate gyrus, but increased in the right middle frontal gyrus, the left fusiform gyrus, and the left supramarginal gyrus. Nodal efficiency decreased in the right precentral gyrus, and the bilateral anterior cingulate and paracingulate gyrus, but increased in the left fusiform gyrus. Nodal betweenness centrality increased in the dorsolateral part of the right superior frontal gyrus, the left fusiform gyrus, and the left supramarginal gyrus. Further, the nodal degree centrality in the left supramarginal gyrus was positively correlated with FIQ. In contrast, none of global topological properties showed difference between those two groups. The outcomes of OSA may impaired the regional topological properties of the brain functional network of OSA children, which may be potential neural mechanism underlying the cognitive declines of these patients.
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Affiliation(s)
- Tingting Ji
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xuemin Ren
- School of Engineering Medicine, Beihang University, Beijing, 100191, China.,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Ting Long
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Lin Mei
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yongli Guo
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Zhifei Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.,Department of Sleep Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China.
| | - Jiangang Liu
- School of Engineering Medicine, Beihang University, Beijing, 100191, China. .,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Jun Tai
- Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China. .,Department of Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Chen I, Huang JY, Chang R, Hung YM, Wei JCC. Epidemiological Study of Parental Obstructive Sleep Apnea and Subsequent Risk of ADHD in Their Children: A Nationwide Population-Based Study. J Atten Disord 2023; 27:3-13. [PMID: 36113004 DOI: 10.1177/10870547221120695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA), with daytime drowsiness, nocturnal hypoxia, could result in systemic inflammation and oxidative damage. We hypothesize that parental OSA, with chronic systemic inflammation and oxidative stress, might contribute to children's neurodevelopmental disorders, such as ADHD. METHOD By linking National Birth Registry with the National Health Insurance Research Database, Taiwan, we identified 2006-2015 birth cohort, which comprised 1,723,873 singleton live births, and conducted a nested case-control study. We included children with ADHD and compared them with non-ADHD controls matched with ADHD case on index date. Conditional logistic regression was utilized to calculate adjusted odds ratio (aOR) when investigating the association between parental diseases with risk of ADHD in their offspring. RESULTS The aOR (95% CI) of offspring's ADHD was 1.758 (1.458-2.119) with paternal OSA and 2.159 (1.442-3.233) with maternal OSA. The subgroup analysis revealed different effects of parental diseases among children's gender. CONCLUSION Our study demonstrates an association in parental OSA and offspring ADHD, which could inspire further research to clarify the mechanisms.
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Affiliation(s)
| | | | | | - Yao-Min Hung
- Chung Shan Medical University, Taichung.,Meiho University, Pingtung.,Kaohsiung Municipal United Hospital.,National Yang Ming University, Taipei
| | - James Cheng-Chung Wei
- Chung Shan Medical University Hospital, Taichung.,Chung Shan Medical University, Taichung.,China Medical University, Taichung
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Menzies B, Teng A, Burns M, Lah S. Neurocognitive outcomes of children with sleep disordered breathing: a systematic review with meta-analysis. Sleep Med Rev 2022; 63:101629. [DOI: 10.1016/j.smrv.2022.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
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Esposito M, Antinolfi L, Carotenuto M. Neuropsychological Profile in Pediatric Migraine without Aura: A Pilot Study. Brain Sci 2021; 11:brainsci11121582. [PMID: 34942884 PMCID: PMC8699751 DOI: 10.3390/brainsci11121582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Despite the high prevalence of headache in developmental age, current reports about its neuropsychological effects are still lacking. The aim of the present pilot study is to assess the neuropsychological skills among children affected by migraine without aura (MwoA). Fifteen children (7M/8F) (mean age 10.73 ± 2.13) with MwoA, consecutively referred to the Center for Childhood Headache at Università degli Studi della Campania “Luigi Vanvitelli”, underwent the Italian version of the NEPSY-2 after cognitive evaluation. Moreover, to assess the pain level and disability grade during daily activity, the VAS and PedMIDAS scales were used. MwoA children were comparable with the control group of 38 children with respect to age, gender, language, and education level. Written informed consent was obtained from all parents and from children directly, when appropriate. MwoA children differed from controls significantly among the NEPSY-2 subscales, with a relevant relationship between the frequency and intensity of the attacks. In conclusion, the results of the present pilot study may suggest that MwoA could impact significantly neuropsychological functioning in children.
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The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD). CHILDREN-BASEL 2021; 8:children8090824. [PMID: 34572256 PMCID: PMC8470037 DOI: 10.3390/children8090824] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients.
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Ji T, Li X, Chen J, Ren X, Mei L, Qiu Y, Zhang J, Wang S, Xu Z, Li H, Zheng L, Peng Y, Liu Y, Ni X, Tai J, Liu J. Brain function in children with obstructive sleep apnea: a resting-state fMRI study. Sleep 2021; 44:6155746. [PMID: 33675225 DOI: 10.1093/sleep/zsab047] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore the neural difference between children with obstructive sleep apnea (OSA) and healthy controls, together with the relation between this difference and cognitive dysfunction of children with OSA. METHODS Twenty children with OSA (7.2 ± 3.1 years, apnea hypopnea index (AHI): 16.5 ± 16.6 events/h) and 29 healthy controls (7.7 ± 2.8 years, AHI: 1.7 ± 1.2 events/h) were recruited and matched with age, gender, and handedness. All children underwent resting-state fMRI (rs-fMRI) and T1-wighted imaging. Some children were sedated for MRI scanning. We compared amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo) of children with OSA with those of healthy controls. During resting-state, the former reflects the intensity of the spontaneous neural activities, whereas the latter reflects temporal similarity of the spontaneous neural activities within a local brain region. Pearson correlation analysis was performed between these features of rs-fMRI and cognitive scores among children with OSA. RESULTS Compared with controls, children with OSA showed decreased ALFF in the left angular gyrus but increased ALFF in the right insula, and decreased ReHo in the left medial superior frontal gyrus, right lingual gyrus, and left precuneus. Additionally, among children with OSA, the ReHo value in the right lingual gyrus was negatively correlated with FIQ and VIQ, whereas that in the left medial superior frontal gyrus was positively correlated with VIQ. CONCLUSIONS Children with OSA presented abnormal neural activities in some brain regions and impaired cognitive functions with the former possibly being the neural mechanism of the latter.
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Affiliation(s)
- Tingting Ji
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Chen
- Beijing Engineering Research Center of Pediatric Surgery, Engineering and Translational Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuemin Ren
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medical Science and Engineering, Beihang University, Beijing, China.,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the, People's Republic of China, Beijing, China
| | - Lin Mei
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Qiu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhifei Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Department of Sleep Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongbin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Zheng
- Department of Sleep Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yun Peng
- Department of Radiology, Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Liu
- Department of Radiology, Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Tai
- Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Jiangang Liu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medical Science and Engineering, Beihang University, Beijing, China.,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the, People's Republic of China, Beijing, China
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10
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Sitzia E, Pianesi F, Mirante N, Marini G, Micardi M, Panatta ML, Resca A, Marsella P, De Vincentiis GC. Behavioural disorders and parental stress in children suffering from obstructive sleep apnoea syndrome: a pre- and post-adenotonsillectomy confrontation. ACTA ACUST UNITED AC 2020; 40:383-389. [PMID: 33299229 PMCID: PMC7726646 DOI: 10.14639/0392-100x-n0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
The primary goal of the present study was to compare breathing difficulties resulting from OSAS to possible cognitive-behavioural problems of the child linked to their parents’ emotional-relational aspects. There is strong evidence that sleep breathing disorders are associated with behavioural alterations, a tendency towards aggressiveness, weak school performance and a clear disorder in continuous and selective attention other than vigilance status. Not all patients suffering from OSA have cognitive and/or behavioural manifestations; furthermore, the degree of dysfunction that the patient may present does not seem to be associated with the seriousness of sleep breathing disorder (SBD). It is therefore likely that genetic susceptibility associated with particular environmental factors has a role in determining phenotypic manifestations which are unique for every single patient. Questionnaires were given to parents, one regarding executive functions and one regarding parental stress: Conners’ Rating Scale Revised; Parenting Stress Index. All parents of children who suffer from moderate to severe OSA, with a McGill score of 3 to 4 and with no exclusion criteria are included in the study; behavioural and parental stress evaluation was made during hospitalisation and at 6 months after adenotonsillectomy. The results show that resolving OSAS led to important improvements in the competence and behavioural attitudes of the patient, as well as in relational and management difficulties by parents. The identification of such indicators could represent a support to surgical programming, even in non-severe SBD. Future research will have the goal of identifying standardised risk indicators that can provide further indications for surgical treatment in children up to 5 years of age.
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Affiliation(s)
- Emanuela Sitzia
- UOC Otorinolarinogoiatria, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Federica Pianesi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Nadia Mirante
- U.O.C. Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Giulia Marini
- UOC Otorinolarinogoiatria, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Mariella Micardi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | | | - Alessandra Resca
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Pasquale Marsella
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
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11
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Macchitella L, Marinelli CV, Signore F, Ciavolino E, Angelelli P. Sleepiness, Neuropsychological Skills, and Scholastic Learning in Children. Brain Sci 2020; 10:brainsci10080529. [PMID: 32784660 PMCID: PMC7464965 DOI: 10.3390/brainsci10080529] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/25/2022] Open
Abstract
Excessive daytime sleepiness is a frequent condition among children and adolescents that may lead to several and significant daytime consequences, including impaired neurocognitive skills and scholastic performance. Here, we evaluated in one hundred and ninety-one unselected primary school children, the relationship between sleepiness and a wide range of cognitive and academic skills through a standardized neuropsychological test battery. In order to assess the statistical relationship, we performed a partial least squares path modelling, a non-parametrical approach which combined a model of paths between latent variables and the coefficients between indicators and dimensions. Results were validated through the bootstrap approach and suggest that sleepiness is not associated with all cognitive and scholastic abilities, but only with those relying on verbal abilities and complex cognitive functions (i.e., reading comprehension, oral/syntactic comprehension, spelling, and mathematic skills). Our data suggest the idea that sleepiness in children is associated mostly with “higher” (mainly verbal) cognitive function(s), while the visuospatial domain was not affected.
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12
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Marcuccio G, DI Bari MM, Precenzano F, Operto FF, Bitetti I, Motta G, Testa D. Relationship between sleep quality and rhinitis in children: role of medical treatment with isotonic and hypertonic saline. Minerva Pediatr (Torino) 2019; 73:301-306. [PMID: 31352769 DOI: 10.23736/s2724-5276.19.05563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The nose represents the port of entry, the first part of the upper airway and accounts for 50% of its total resistance. Many authors identified rhinitis as relevant factor affecting quality of life, and sleep habits of sufferers and their caregiver's, particularly between 4-17 years old children. Both allergic rhinitis and non-allergic rhinitis may represent an important risk for obstructive sleep apnea syndrome in children. We evaluated the quality of sleep and the role of nasal irrigations with saline solutions in children with sign and symptoms of rhinitis. METHODS An observational retrospective study was conducted on 58 children aged 3-6 years old receiving diagnosis of rhinitis according to clinical and amnestic evaluation. All recruited children were screened before medical topic treatment with the Pediatric Sleep Questionnaire test in order to evaluate the sleep habits and after isotonic and hypertonic saline nasal irrigation for six months. One-Way ANOVA was used for statistical analysis of the results. RESULTS Forty-nine of 58 recruited children reached the follow-up control after six months of medical treatment. Mean score at Pediatric Sleep Questionnaire before and after medical treatments was respectively 0.39 and 0.28. One-Way ANOVA test showed a significant statistical difference (P<0.05). CONCLUSIONS Nasal topic decongestant may be used only for short-term treatments, and they do not seem to have long-term results. Topic corticosteroids may be used for long term treatment and their correlations with OSA seem to have different results. This study aims to attracting the attention of pediatricians on the importance of nasal topic saline solutions irrigations in children with rhinitis in improving HRQoL decreasing snoring and apneas and so daytime symptoms.
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Affiliation(s)
- Giuseppina Marcuccio
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Matteo Matteo DI Bari
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesco Precenzano
- Unit of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesca F Operto
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro University, Bari, Italy
| | - Ilaria Bitetti
- Unit of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Gaetano Motta
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Domenico Testa
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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13
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Randler C, Kolomeichuk SN, Morozov AV, Petrashova DA, Pozharskaya VV, Martynova AA, Korostovtseva LS, Bochkarev MV, Sviryaev YV, Polouektov MG, Drake C. Psychometric properties of the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS). Heliyon 2019; 5:e02134. [PMID: 31372567 PMCID: PMC6661285 DOI: 10.1016/j.heliyon.2019.e02134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/27/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Insufficient sleep could severely impair both cognitive and learning skills. More prominent changes are found in children and adolescents. Tools used to estimate sleepiness in the adult population are commonly inappropriate for children. The objective of our study was to provide a reliable instrument to measure excessive sleepiness for upcoming studies in Russian-speaking children, applying the Russian version of Pediatric Daytime Sleepiness Scale (PDSS). The following tasks were resolved in our study: translation, validation, and analysis of psychometric properties of the Russian adaptation of the PDSS by standard tests. After the semantic validation of the instrument through a multi-stage translation process we checked its psychometric validation. A total of 552 students, consisting of N = 285 for the exploratory factor analysis (EFA), N = 267 for the confirmatory factor analysis (CFA) and N = 204 for test-retest analysis of public elementary schools located in Northern Russia completed the PDSS and Munich Chronotype Questionnaire to estimate sleep parameters in the classroom during the lessons. Response rate was 90%; excluded cases contained no data. Further, 204 of our participants completed the PDSS in a 3 months interval to check the test-retest reliability. Internal consistency was measured by Cronbach's alpha coefficients and CFA was used to test factorial validity of the tool. Concurrent validity and test-retest reliability were assessed via intra-class coefficient. Internal consistency of the PDSS scale was high (Cronbach's α = 0.8). The construct validity of the PDSS was supported by CFA (factor loadings were from 0.438 to 0.727) and the test-retest reliability demonstrated by the intra-class coefficient was 0.70. The total PDSS score was independent of sex. The mean total value of PDSS was 11.95 ± 6.24. Higher scores on PDSS were negatively correlated with sleep duration. Thus, the construct validity of the instrument remains valid and could be used for Russian-speaking youth samples in the evaluation of daytime sleepiness. It could be useful in future applications by sleep scientists and health practitioners.
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Affiliation(s)
- C Randler
- University of Tuebingen, Department of Biology, Auf der Morgenstelle 24, D-72076 Tübingen, Germany
| | - S N Kolomeichuk
- Laboratory of Genetics, Institute of Biology of the Karelian Science Center of the Russian Academy of Sciences, Petrozavodsk, Russia.,Kola Science Center of the Russian Academy of Sciences, Apatity, Murmansk Region, Russia
| | - A V Morozov
- Laboratory of Ecological Physiology of Animals, Institute of Biology of the Karelian Science Center of the Russian Academy of Sciences, Petrozavodsk, Russia
| | - D A Petrashova
- Kola Science Center of the Russian Academy of Sciences, Apatity, Murmansk Region, Russia
| | - V V Pozharskaya
- Kola Science Center of the Russian Academy of Sciences, Apatity, Murmansk Region, Russia
| | - A A Martynova
- Kola Science Center of the Russian Academy of Sciences, Apatity, Murmansk Region, Russia
| | | | - M V Bochkarev
- Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Y V Sviryaev
- Almazov National Medical Research Center, Saint-Petersburg, Russia
| | | | - C Drake
- Henry Ford Hospital Sleep Disorders and Research Center, Detroit, MI, USA
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14
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Smirni D, Carotenuto M, Precenzano F, Smirni P, Operto FF, Marotta R, Roccella M. Memory performances and personality traits in mothers of children with obstructive sleep apnea syndrome. Psychol Res Behav Manag 2019; 12:481-487. [PMID: 31303802 PMCID: PMC6611713 DOI: 10.2147/prbm.s202469] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023] Open
Abstract
Background Chronic diseases in pediatric age have been identified as stressful risk factors for parents. Studies on caregivers have documented the impact of chronic parenting stress on emotion and cognition. Aim To investigate the differences between a group of mothers of children affected by obstructive sleep apnea syndrome (OSAS) for at least 4 years and a group of mothers of typically developing children (TDC) in relation to parental stress, self-esteem, locus of control, and memory performances. Methods A group of 86 mothers (mean age 35.6±4.9, ranged between 32 and 41 years) of children with OSAS diagnosis, and a group of 52 mothers of TDC (mean age 35.9±4.2, ranged between 32 and 41 years) participated in the study. All participants were administered stress level, global self-esteem, internal/external locus of control scales, and memory assessment. Results Mothers of OSAS children, compared to mothers of TDC, had a significantly higher level of stress, lower self-esteem, more external locus of control and poorer memory performance. Conclusions The child respiratory disease, with its sudden and unpredictable features, appeared as a significant source of stress for the mother. Such stress condition may have an impact on mothers’ personality traits (self-esteem, locus of control) and on their memory performances. The data have suggested a need for psychological support programs for mothers to better manage stress associated with children’s respiratory disease.
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Affiliation(s)
- Daniela Smirni
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pietro Smirni
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Rosa Marotta
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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15
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Mir E, Kumar R, Suri TM, Suri JC, Venkatachalam VP, Sen MK, Chakrabarti S. Neurocognitive and behavioral abnormalities in Indian children with sleep-disordered breathing before and after adenotonsillectomy. Lung India 2019; 36:304-312. [PMID: 31290415 PMCID: PMC6625250 DOI: 10.4103/lungindia.lungindia_398_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: Children with untreated sleep-disordered breathing (SDB) have impaired intellectual ability and behavioral effects. Timely treatment of SDB by adenotonsillectomy (AT) may prevent this morbidity. This study was designed to assess the prevalence of neurocognitive and behavioral dysfunction in Indian children with SDB and to evaluate the impact of AT. Methods: Children recruited underwent diagnostic polysomnography (PSG), a detailed neurocognitive and behavioral assessment using a battery of validated instruments – the Malin's Intelligence Scale (MIS) for Indian children, Modified Wisconsin's Card Sorting Test, Parent Conners' Scale, and the Childhood Behavior Checklist (6–18). These children then underwent AT and subsequent reassessment at 3 and 6 months. Results: Neurocognitive impairment was common among the 33 enrolled children (mean age 9 [±2.97] years; 78.8% males). There was a significant correlation between the lowest O2 saturation and the “categories completed” (r = -0.379; P = 0.029); and the lowest O2 saturation and the “failure to maintain sets” (r = 0.386; P = 0.026) of the Modified Wisconsin's Card Sorting Test. Postsurgery, although apnea–hypopnea index (AHI) significantly decreased after surgery, 15 children still had SDB. Mean scores of most of the tested neurocognitive and behavioral domains showed improvement, although residual deficits were prevalent even after 6 months. Patients with a baseline AHI >5/h and those who had complete resolution of SDB (postoperative AHI <1/h) showed improvement in more subscales than patients with baseline AHI < 5/h and patients with incomplete resolution of SDB. Conclusion: The decreased neurocognitive performance related to SDB may be a result of hypoxemia, rather than the frequency of SDB events. Despite AT, residual disease is common and such patients may require further treatment.
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Affiliation(s)
- Elias Mir
- Department of Chest Medicine, SKIMS Medical College, Srinagar, Jammu and Kashmir, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, AlIMS, New Delhi, India
| | - Jagdish Chandra Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - V P Venkatachalam
- Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manas Kamal Sen
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shibdas Chakrabarti
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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16
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Liptzin DR, Di Maria MV, Younoszai A, Narkewicz MR, Kelly SL, Wolfe KR, Veress LA. Pulmonary Screening in Subjects after the Fontan Procedure. J Pediatr 2018; 199:140-143. [PMID: 29747936 DOI: 10.1016/j.jpeds.2018.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/21/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To review the pulmonary findings of the first 51 patients who presented to our interdisciplinary single-ventricle clinic after undergoing the Fontan procedure. STUDY DESIGN We performed an Institutional Review Board-approved retrospective review of 51 patients evaluated following the Fontan procedure. Evaluation included history, physical examination, pulmonary function testing, and 6-minute walk. Descriptive statistics were used to describe the population and testing data. RESULTS Sixty-one percent of the patients had a pulmonary concern raised during the visit. Three patients had plastic bronchitis. Abnormal lung function testing was present in 46% of patients. Two-thirds (66%) of the patients had significant desaturation during the 6-minute walk test. Patients who underwent a fenestrated Fontan procedure and those who underwent unfenestrated Fontan were compared in terms of saturation and 6-minute walk test results. Sleep concerns were present in 45% of the patients. CONCLUSIONS Pulmonary morbidities are common in patients after Fontan surgery and include plastic bronchitis, abnormal lung function, desaturations with walking, and sleep concerns. Abnormal lung function and obstructive sleep apnea may stress the Fontan circuit and may have implications for cognitive and emotional functioning. A pulmonologist involved in the care of patients after Fontan surgery can assist in screening for comorbidities and recommend interventions.
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Affiliation(s)
- Deborah R Liptzin
- Pediatric Pulmonary Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | - Michael V Di Maria
- Heart Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Adel Younoszai
- Heart Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Michael R Narkewicz
- Digestive Health Institute, Children's Hospital Colorado and Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Sarah L Kelly
- Heart Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Kelly R Wolfe
- Pediatric Neurology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Livia A Veress
- Pediatric Pulmonary Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
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17
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Liptzin DR, Hawkins SMM, Wagner BD, Deterding RR. Sleeping chILD: Neuroendocrine cell hyperplasia of infancy and polysomnography. Pediatr Pulmonol 2018; 53:917-920. [PMID: 29766677 DOI: 10.1002/ppul.24042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/17/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Neuroendocrine cell hyperplasia of infancy (NEHI) is a children's interstitial and diffuse lung disease of unknown etiology that presents in infancy with characteristic findings of tachypnea, retractions, crackles, and hypoxemia. At the present, the mainstay of treatment is oxygen supplementation to normalize oxygen saturations and decrease work of breathing. There are characteristic pulmonary function, radiographic, and histologic findings, but polysomnography (PSG) data has not been reported. We sought to report PSG data and implications for management and treatment of NEHI patients. METHODS A retrospective chart review was performed under a Colorado Institutional Review Board approved protocol for which consent was waived. Informatics for Integrating Biology and the Bedside was used to query the electronic medical record at Children's Hospital Colorado for patients with both a diagnosis of NEHI and a PSG. PSG was performed for clinical reasons. Routine sleep quality and respiratory parameters were recorded and analyzed. RESULTS Of our 77 patients with NEHI, 14 (19%) children underwent PSG during the study period. Eight children met criteria for OSA and three met criteria for CSA. Ten patients had low oxygen saturations during a study, six had low sleep efficiency, and three had periodic limb movement disorder. CONCLUSIONS Patients with NEHI may have sleep related breathing disorders that contribute to disrupted sleep, including obstructive and central sleep apnea, hypoxemia, decreased sleep efficiency, and increased periodic limb movement disorder. PSG should be considered as part of NEHI management, as it may lead to recognition of clinically significant sleep-disordered breathing.
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Affiliation(s)
- Deborah R Liptzin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen M M Hawkins
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Robin R Deterding
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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18
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Arango-Lasprilla JC, Rivera D, Nicholls E, Aguayo Arelis A, García de la Cadena C, Peñalver Guia AI, Vergara-Moragues E, Rodriguez-Lorenzana A, Marín-Morales A, Soto-Añari M, Lara L, Rodríguez-Agudelo Y, Alcazar Tebar C, Galarza-Del-Angel J, Rodriguez-Irizarry W, Ibañéz-Alfonso JA, García-Guerrero CE, Delgado-Mejía ID, Pohlenz Amador S, Sánchez-SanSegundo M. Modified Wisconsin Card Sorting Test (M-WCST): Normative data for Spanish-speaking pediatric population. NeuroRehabilitation 2018; 41:617-626. [PMID: 28946592 DOI: 10.3233/nre-172242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To generate normative data for the Modified Wisconsin Card Sorting Test (M-WCST) in Spanish-speaking pediatric populations. METHOD The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the M-WCST as part of a larger neuropsychological battery. Number of categories, perseverative errors, and total error scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS The final multiple linear regression models indicated main effects for age on all scores, such that the number of categories correct increased and total number of perseverative errors and total number of errors decrease linearly as a function of age. Age2 had a significant effect in Chile, Cuba, Ecuador, and Spain for numbers of categories; a significant effect for number of perseverative errors in Chile, Cuba, Mexico, and Spain; and a significant effect for number of total errors in Chile, Cuba, Peru, and Spain. Models showed an effect for MLPE in Cuba (total errors), Ecuador (categories and total errors), Mexico (all scores), Paraguay (perseverative errors and total error), and Spain (categories and total errors). Sex affected number of total errors for Ecuador. CONCLUSIONS This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the M-WCST with pediatric populations.
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Affiliation(s)
- J C Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - D Rivera
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - E Nicholls
- Nemours/AI DuPont Hospital for Children, Wilmington, USA
| | - A Aguayo Arelis
- Departamento de investigación, Psicología, Universidad Enrique Díaz de León, Guadalajara, Mexico
| | - C García de la Cadena
- Departamento de Psicología, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | | | - A Marín-Morales
- CIMCYC-The Mind, Brain and Behaviour Research Centre, Universidad de Granada, Granada, Spain
| | | | - L Lara
- Universidad Autónoma de Chile, Talca, Chile
| | - Y Rodríguez-Agudelo
- Instituto Nacional de Neurología y Neurocirugía, MVS, Ciudad de México, Mexico
| | | | - J Galarza-Del-Angel
- Laboratorio de Psicofisiología, Facultad de Ciencias Humanas, Universidad Autónoma de Baja California, Mexicali, México
| | | | | | | | | | - S Pohlenz Amador
- Escuela de Ciencias Psicológicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
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Meyer C, Ferrari GJ, Barbosa DG, Andrade RD, Pelegrini A, Felden ÉPG. ANALYSIS OF DAYTIME SLEEPINIESS IN ADOLESCENTS BY THE PEDIATRIC DAYTIME SLEEPINESS SCALE: A SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2017; 35:351-360. [PMID: 28977300 PMCID: PMC5606183 DOI: 10.1590/1984-0462/;2017;35;3;00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/26/2017] [Indexed: 01/25/2023]
Abstract
Objective: To systematically review the use of the Pediatric Daytime Sleepiness Scale (PDSS) in the analysis of daytime sleepiness in children and adolescents. Data source: The electronic databases PubMed and SciELO were consulted between 2003 and 2015. As inclusion criterion, studies were considered in English, Spanish and Portuguese, original articles of any type of design, articles with a sample of children and/or adolescents, articles that used the PDSS. Duplicate articles, articles with no relation to the theme, articles with another investigated population, and articles that the parents answered the instrument for their children were excluded. To find the material with these features, the terms “Daytime sleepiness” AND “adolescents” and “Daytime sleepiness” AND “children” were used in the searches. In addition, the descriptor “Pediatric Daytime Sleepiness Scale” was used to filter more specifically. Data synthesis: Initially, 986 studies related to daytime sleepiness were identified. Considering the inclusion criteria, we analyzed 26 studies composed of 18,458 subjects aged 0 to 37 years. The diurnal sleepiness score ranged from 6.7±0.6 to 25.7±0.6 points. In general, all included studies investigated other sleep variables in addition to daytime sleepiness, such as: sleep duration, sleep quality, sleep hygiene or sleep disorders (narcolepsy and cataplexy), respiratory disorders, neurological and developmental disorders. Conclusions: There was a moderate use of PDSS to evaluate daytime sleepiness. This instrument allows the monitoring of factors that influence excessive daytime sleepiness in children and adolescents.
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Affiliation(s)
- Carolina Meyer
- Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
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An Z, Wang D, Yang G, Zhang WQ, Ren J, Fu JL. Role of microRNA-130a in the pathogeneses of obstructive sleep apnea hypopnea syndrome-associated pulmonary hypertension by targeting the GAX gene. Medicine (Baltimore) 2017; 96:e6746. [PMID: 28514291 PMCID: PMC5440128 DOI: 10.1097/md.0000000000006746] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to elucidate the role of microRNA-130a (miR-130a) in obstructive sleep apnea hypopnea syndrome (OSAHS)-associated pulmonary hypertension (PHT) by targeting the growth arrest-specific homeobox (GAX) gene. METHODS A total of 108 patients with OSAHS-associated PHT were recruited as the OSAHS-associated PHT group and 110 healthy individuals were randomly selected as the normal control group. Human umbilical vein endothelial cells (HUVECs) were selected and divided into the control, miR-130a mimic, mimic negative control (NC), miR-130a inhibitor, and inhibitor-NC groups. The dual luciferase reporter gene assay was used to identify the relationship between miR-130a and the GAX gene. The quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting were applied for the relative expressions of miR-130a and the mRNA and protein expressions of GAX. Serum levels of endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), nitric oxide (NO), and super oxide dismutase (SOD) were detected. Cell apoptosis and angiogenic activity were analyzed by flow cytometry and cell tube formation assay. RESULTS GAX was a target gene of miR-130a. Compared with the normal control group, the relative expression of miR-130a and the serum levels of ET-1 and VEGF were increased, whereas the mRNA expression of GAX and the serum levels of NO and SOD were decreased in the OSAHS-associated PHT group. Compared with the control, mimic-NC, and inhibitor-NC groups, the relative expressions of miR-130a in the miR-130a mimic group were enhanced, whereas the expression of miR-130a in the miR-130a inhibitor group was reduced. However, the mRNA and protein expressions of GAX showed an opposite trend in the miR-130a mimic and miR-130a inhibitor groups. In comparison to the control, mimic-NC, and inhibitor-NC groups, the miR-130a mimic group had an increase of ET-1 and VEGF expressions, whereas the expressions of NO and SOD were reduced. However, the miR-130a inhibitor group exhibited an opposite trend. The apoptosis rate and tube formation number in the miR-130a mimic group were obviously increased, whereas the miR-130a inhibitor group showed an obvious decrease. CONCLUSION These data provided strong evidence that miR-130a may be involved in the progression of OSAHS-associated PHT by down-regulating GAX gene.
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Affiliation(s)
- Zhe An
- Department of Cardiology, China-Japan Union Hospital of Jilin University
| | - Dan Wang
- Department of Breast Surgery, The Second Hospital of Jilin University
| | - Guang Yang
- Department of Molecular Biology, College of Basic Medical Sciences, Jilin University
| | - Wen-Qi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University
| | - Jin Ren
- Department of Respiratory Medicine, the Second Hospital of Jilin University
| | - Jin-Ling Fu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, P.R. China
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Mu L, Peng L, Zhang Z, Jie J, Jia S, Yuan H. Memory and Executive Screening for the Detection of Cognitive Impairment in Obstructive Sleep Apnea. Am J Med Sci 2017; 354:399-407. [PMID: 29078845 DOI: 10.1016/j.amjms.2017.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/09/2017] [Accepted: 04/24/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is commonly associated with cognitive dysfunction, which is more apparent in severe OSA and impairs quality of life. However, the clinical screening methods for these impairments in OSA are still limited. In this study, we evaluated the feasibility of using the Memory and Executive Screening (MES) for assessing cognitive performance in OSA. MATERIALS AND METHODS Twenty-four patients with nonsevere OSA and 36 patients with severe OSA participated in this study. All participants underwent comprehensive, laboratory-based polysomnography and completed assessments of cognitive function, which included both the MES and the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ). RESULTS Both the total MES scores and 5 recall scores of the MES (MES-5R) were significantly lower in the severe OSA group than those in the nonsevere OSA group. The patients with severe OSA performed worse on the memory subtests of the MES-5R, especially on immediate recall. The sensitivity and specificity of the MES for identifying cognitive impairment in patients with OSA were 63.89% and 66.67%, respectively, for a cutoff value of <92 out of 100 points. An optimal cutoff between nonsevere and severe OSA was also set at 45 points (MES-5R) and at 0.94 points (MES ratio). Compared with the MES, the MoCA-BJ had similar sensitivity (61.11%) and specificity (66.67%). CONCLUSIONS The MES is an acceptable tool for detecting cognitive dysfunction in patients with OSA. The sensitivity and specificity of the MES were similar to those of the MoCA-BJ. The MES-5R and total MES scores can assess the presence and severity of cognitive impairment in patients with severe OSA.
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Affiliation(s)
- Li Mu
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China; Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
| | - Liping Peng
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China
| | - Zhengjiao Zhang
- Department of Neurology & Sleep Center, The People׳s Hospital of Jilin Province, Changchun, China
| | - Jing Jie
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China
| | - Siqi Jia
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China
| | - Haibo Yuan
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China.
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Nie S, Peng DC, Gong HH, Li HJ, Chen LT, Ye CL. Resting cerebral blood flow alteration in severe obstructive sleep apnoea: an arterial spin labelling perfusion fMRI study. Sleep Breath 2017; 21:487-495. [DOI: 10.1007/s11325-017-1474-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/09/2017] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
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Precenzano F, Ruberto M, Parisi L, Salerno M, Maltese A, Gallai B, Marotta R, Lavano SM, Lavano F, Roccella M. Visual-spatial training efficacy in children affected by migraine without aura: a multicenter study. Neuropsychiatr Dis Treat 2017; 13:253-258. [PMID: 28184165 PMCID: PMC5291325 DOI: 10.2147/ndt.s119648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Routinely in the clinical practice, children affected by migraine without aura (MwA) tend to exhibit severe and persistent difficulties within cognitive processes such as attention, memory, and visual-motor integration (VMI) skills. The aim of this study was to assess the visual-spatial and visual-motor abilities among a sample of children with MwA and the effects of a specific computerized training. The study population was composed of 84 patients affected by MwA (39 girls and 45 boys; mean age: 8.91±2.46 years), and they were randomly divided into two groups (group A and group B) comparable for age (P=0.581), gender (P=0.826), socioeconomic status (SES), migraine frequency (P=0.415), and intensity (P=0.323). At baseline (T0), the two groups were comparable for movement assessment battery for children (M-ABC) and VMI performances. After 6 months of treatment (T1), group A showed lower scores in the dexterity item of M-ABC test (P<0.001) and higher scores in M-ABC global performance centile (P<0.001) and total (P<0.001), visual (P=0.017), and motor (P<0.001) tasks of VMI test than group B. Moreover, at T1, group A showed higher scores in total (P<0.001) and motor (P<0.001) tasks of VMI test and in M-ABC global performance centile (P<0.001) and lower scores in the dexterity item of M-ABC test (P<0.001) than at T0. Group B showed, at T1, performances comparable to T0 for all evaluations. As reported by recent studies about alteration MwA among children in motor abilities, our study confirmed these difficulties and the efficacy of a specific software training, suggesting a new rehabilitative proposal in childhood.
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Affiliation(s)
- Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Headache Center for Children and Adolescent. Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - Lucia Parisi
- Department of Psychological, Pedagogical and Educational Sciences
| | - Margherita Salerno
- Sciences for Mother and Child Health Promotion, University of Palermo, Palermo
| | - Agata Maltese
- Department of Psychological, Pedagogical and Educational Sciences
| | - Beatrice Gallai
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia
| | | | | | | | - Michele Roccella
- Department of Psychological, Pedagogical and Educational Sciences
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Park P, Jeon HW, Han DH, Won TB, Kim DY, Rhee CS, Kim HJ. Therapeutic outcomes of mandibular advancement devices as an initial treatment modality for obstructive sleep apnea. Medicine (Baltimore) 2016; 95:e5265. [PMID: 27861349 PMCID: PMC5120906 DOI: 10.1097/md.0000000000005265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA), there is a need for alternative treatment options, such as sleep surgeries and mandibular advancement devices (MADs), to overcome the limitations of CPAP.This study aimed to analyze the therapeutic outcomes of OSA subjects who were treated with a MAD, and to estimate the clinical impact of MAD as a first-line treatment for OSA.Forty-seven patients diagnosed with OSA received an adjustable MAD as an initial treatment. Drug-induced sleep endoscopic findings and sleep parameters (both pre-MAD and post-MAD treatment), such as apnea index, oxygen saturation, and degree of daytime sleepiness, were assessed retrospectively.The MAD treatment resulted in a significant reduction in apnea-hypopnea index, and also a significant elevation in lowest oxygen saturation. Satisfactory results of MAD treatment as a first treatment modality were observed in 27 patients, and a successful outcome was reached in approximately 72% of patients. The OSA patients who had lower body mass index and upper airway narrowing at the level of palate and tongue base showed relatively higher rates of a satisfactory outcome even in cases of moderate or severe OSA.These results suggest that the use of a MAD may be an alternative treatment option in OSA patients with retropalatal and retroglossal area narrowing regardless of disease severity. Additionally, MADs can be recommended as an initial treatment modality, and the effectiveness of MADs in achieving success may not be inferior to CPAP.
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McCann M, Bayliss DM, Anderson M, Campbell C, French N, McMichael J, Reid C, Bucks RS. The relationship between sleep problems and working memory in children born very preterm. Child Neuropsychol 2016; 24:124-144. [DOI: 10.1080/09297049.2016.1235144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marie McCann
- School of Psychology, University of Western Australia, Crawley, Australia
| | - Donna M. Bayliss
- School of Psychology, University of Western Australia, Crawley, Australia
| | - Mike Anderson
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Catherine Campbell
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
| | - Noel French
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
| | - Judy McMichael
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia
| | - Corinne Reid
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Romola S. Bucks
- School of Psychology, University of Western Australia, Crawley, Australia
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Carotenuto M, Esposito M, Cortese S, Laino D, Verrotti A. Children with developmental dyslexia showed greater sleep disturbances than controls, including problems initiating and maintaining sleep. Acta Paediatr 2016; 105:1079-82. [PMID: 27173764 DOI: 10.1111/apa.13472] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/02/2016] [Accepted: 05/10/2016] [Indexed: 12/01/2022]
Abstract
AIM Although there have been frequent clinical reports about sleep disturbances in children with learning disabilities, no data are available about the prevalence of sleep disturbances in children with developmental dyslexia (DD). This study evaluated sleep disturbances in children with DD referred to a hospital clinic and compared their scores with healthy controls. METHODS We consecutively enrolled 147 children (66% male) aged 10.26 ± 2.63 years who were referred by clinical paediatricians to the Clinic for Child and Adolescent Neuropsychiatry at the Second University of Naples with DD and 766 children without DD (60% male) aged 10.49 ± 2.39 years recruited from schools in the same urban area. Sleep disturbances were assessed with the Sleep Disturbances Scale for Children (SDSC), which was filled out by the children's main carers. RESULTS Compared with the controls, the children with DD showed significantly higher rates of above threshold scores on the total SDSC score (p < 0.001) and on the subscales for disorders in initiating and maintaining sleep (p < 0.001), sleep breathing disorders (p < 0.001) and disorders of arousal (p < 0.001). CONCLUSION Sleep disorders were significantly more frequent in children with DD than in healthy controls. A possible relationship between dyslexia and sleep disorders may have relevant clinical implications.
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Affiliation(s)
- M Carotenuto
- Sleep Clinic for Developmental Age; Department of Mental Health; Physical and Preventive Medicine; Second University of Naples; Naples Italy
| | - M Esposito
- Sleep Clinic for Developmental Age; Department of Mental Health; Physical and Preventive Medicine; Second University of Naples; Naples Italy
| | - S Cortese
- Department of Psychology; Developmental Brain-Behavior Laboratory; University of Southampton; Southampton UK
- New York University Child Study Center; New York NY USA
- IRCCS Stella Maris; Calambrone Pisa Italy
| | - D Laino
- Department of Pediatrics; University of Perugia; Perugia Italy
| | - A Verrotti
- Department of Pediatrics; University of L'Aquila; Ospedale San Salvatore; L'Aquila Italy
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Abstract
OBJECTIVES Evaluate the association between pediatric sleep-disordered breathing (SDB) and executive functioning. METHODS We searched multiple electronic databases for peer-reviewed journal articles related to pediatric SDB and executive functioning. We included studies that assessed SDB via polysomnography, included objective or questionnaire measures of executive function, and had an age-matched control group. Fourteen articles met inclusion criteria with a total sample of 1697 children ages 5 to 17 years (M=9.81 years; SD=0.34). We calculated an overall effect size for each of the five executive domains (vigilance, inhibition, working memory, shifting, and generativity) as well as effect sizes according to SDB severity: mild, moderate, severe. We also calculated effect sizes separately for objective and subjective questionnaires of executive functioning. RESULTS We found a medium effect size (-0.427) for just one of five executive function domains on objective neuropsychological measures (generativity). In contrast, effect sizes on all three executive domains measured via questionnaire data were significant, with effect sizes ranging from medium (-0.64) to large (-1.06). We found no difference between executive domains by severity of SDB. CONCLUSIONS This meta-analysis of executive function separated into five domains in pediatric SDB suggested lower performance in generativity on objective neuropsychological measures. There were no differences associated with SDB severity. Questionnaire data suggested dysfunction across the three executive domains measured (inhibition, working memory, shifting). Overall, limited evidence suggested poorer performance in executive function in children with SDB according to objective testing, and subjective ratings of executive function suggested additional worsened performance. (JINS, 2016, 22, 839-850).
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Messina A, De Fusco C, Monda V, Esposito M, Moscatelli F, Valenzano A, Carotenuto M, Viggiano E, Chieffi S, De Luca V, Cibelli G, Monda M, Messina G. Role of the Orexin System on the Hypothalamus-Pituitary-Thyroid Axis. Front Neural Circuits 2016; 10:66. [PMID: 27610076 PMCID: PMC4997012 DOI: 10.3389/fncir.2016.00066] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/08/2016] [Indexed: 12/25/2022] Open
Abstract
Hypocretin/orexin (ORX) are two hypothalamic neuropeptides discovered in 1998. Since their discovery, they have been one of the most studied neuropeptide systems because of their projecting fields innervating various brain areas. The orexinergic system is tied to sleep-wakefulness cycle, and narcolepsy is a consequence of their system hypofunction. Orexinergic system is also involved in many other autonomic functions such as feeding, thermoregulation, cardiovascular and neuroendocrine regulation. The main aim of this mini review article is to investigate the relationship between ORX and thyroid system regulation. Although knowledge about the ORX system is evolving, its putative effects on hypothalamic-pituitary-thyroid (HPT) axis still appear unclear. We analyzed some studies about ORX control of HPT axis to know better the relationship between them. The studies that were analyzed suggest Hypocretin/ORX to modulate the thyroid regulation, but the nature (excitatory or inhibitory) of this possible interaction remains actually unclear and needs to be confirmed.
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Affiliation(s)
- Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of Naples Naples, Italy
| | - Carolina De Fusco
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of Naples Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of Naples Naples, Italy
| | - Maria Esposito
- Neapolitan Brain Group (NBG), Clinic of Child and Adolescent Neuropsychiatry, Department of Mental, Physical Health and Preventive Medicine, Second University of Naples Naples, Italy
| | - Fiorenzo Moscatelli
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Marco Carotenuto
- Neapolitan Brain Group (NBG), Clinic of Child and Adolescent Neuropsychiatry, Department of Mental, Physical Health and Preventive Medicine, Second University of Naples Naples, Italy
| | - Emanuela Viggiano
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of Naples Naples, Italy
| | - Sergio Chieffi
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of Naples Naples, Italy
| | - Vincenzo De Luca
- Department of Psychiatry, University of Toronto Toronto, ON, Canada
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of Naples Naples, Italy
| | - Giovanni Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Second University of NaplesNaples, Italy; Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
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Davies CR, Harrington JJ. Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure. Sleep Med Clin 2016; 11:287-98. [PMID: 27542875 DOI: 10.1016/j.jsmc.2016.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is evidence that obstructive sleep apnea (OSA) can negatively impact attention, memory, learning, executive function, and overall intellectual function in adults and children. Imaging techniques, including MRI, MR diffusion tensor imaging, MR spectroscopy, and fMRI, have provided additional insight into the anatomic and functional underpinnings of OSA-related cognitive impairment. Both animal and human studies have looked to elucidate the separate effects of oxygen desaturation and sleep fragmentation on independent aspects of cognition. Data from animal models point to neuro-inflammation and oxidative stress as driving factors of cognitive impairment.
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Affiliation(s)
- Charles R Davies
- Carle Neuroscience Institute, Carle Foundation Hospital, College of Medicine, University of Illinois at Urbana-Champaign, 602 West University Avenue, Urbana, IL 61801, USA.
| | - John J Harrington
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, 985990 Nebraska Medical Center, Omaha, NE 68159-5990, USA
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Parisi L, Di Filippo T, Roccella M. The Quality of Life in Girls with Rett Syndrome. Ment Illn 2016; 8:6302. [PMID: 27403274 PMCID: PMC4926033 DOI: 10.4081/mi.2016.6302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 12/13/2022] Open
Abstract
Nowadays, quality of life is receiving an increasing attention in all scientific areas. Rett syndrome (RTT) is a rare neurological development, affecting mainly females. The congenital disease affects the central nervous system, and is one of the most common causes of severe intellectual disability. The aim of our study is to evaluate the effect of RTT on the quality of life of people who are affected. Both parents of 18 subjects, all female, diagnosed with RTT, took part in the research. Quality of life was assessed using the Italian version of the Impact of Childhood Illness Scale. This scale consists of 30 questions that investigate the effect of illness on children, parents and families. For each question, the parent was asked to rate two variables: frequency and importance. Another questionnaire was administered to obtain medical history, diagnostic and therapeutic data of the persons with RTT. Our data show that RTT has a considerable impact on both the child’s development and the entire family. Parents’ answers demonstrated that their child’s illness had consequences for the child and how the family coped with it. For this reason, attention should be directed at psychological and social aspects, as well as attitudes, manners, reactions and effects such disturbances can have on the entire family.
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Affiliation(s)
- Lucia Parisi
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo , Italy
| | - Teresa Di Filippo
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo , Italy
| | - Michele Roccella
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo , Italy
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Ruangsri S, Jorns TP, Puasiri S, Luecha T, Chaithap C, Sawanyawisuth K. Which oropharyngeal factors are significant risk factors for obstructive sleep apnea? An age-matched study and dentist perspectives. Nat Sci Sleep 2016; 8:215-9. [PMID: 27468254 PMCID: PMC4944919 DOI: 10.2147/nss.s96450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a common sleep breathing disorder. Untreated OSA may lead to a number of cardiovascular complications. Dentists may play an important role in OSA detection by conducting careful oral examinations. This study focused on the correlation of oral anatomical features in Thai patients who presented with OSA. METHODS We conducted a prospective comparative study at a sleep/hypertension clinic and a dental clinic at Khon Kaen University in Thailand. Patients with OSA were enrolled in the study, along with age-matched patients with non-OSA (controls). Baseline characteristics, clinical data, and oropharyngeal data of all patients were compared between the two groups. Oropharyngeal measurements included tongue size, torus mandibularis, Mallampati classification, palatal space, and lateral pharyngeal wall area. Multivariate logistic regression analysis was used to identify the factors associated with OSA. RESULTS During the study period, there were 156 patients who met the study criteria; 78 were patients with OSA and the other 78 were healthy control subjects. In the OSA group, there were 43 males with a mean age of 53 (standard deviation 12.29) years and a mean BMI of 30.86 kg/mm(2). There were 37 males in the control group with a mean age of 50 (standard deviation 12.04) years and a mean BMI of 24.03 kg/mm(2). According to multivariate logistic analysis, three factors were perfectly associated with OSA, including torus mandibularis class 6, narrow lateral pharyngeal wall, and Mallampati class 4. There were two other significant factors associated with having OSA, namely, BMI and Mallampati classification. The adjusted odds ratios (95% confidence interval) of these two factors were 1.445 (1.017, 2.052) and 5.040 (1.655, 15.358), respectively. CONCLUSION Dentists may play an important role in the detection of OSA in patients with high BMI through careful oropharyngeal examination in routine dental treatment. A large torus mandibularis, Mallampati class 4, and a narrow lateral pharyngeal wall are important anatomical risk factors for OSA.
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Affiliation(s)
- Supanigar Ruangsri
- Department of Oral Biology, Faculty of Dentistry; Neuroscience Research and Development Group (NRDG)
| | - Teekayu Plangkoon Jorns
- Department of Oral Biology, Faculty of Dentistry; Neuroscience Research and Development Group (NRDG)
| | - Subin Puasiri
- Department of Community Dentistry, Faculty of Dentistry
| | | | | | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
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Li HJ, Nie X, Gong HH, Zhang W, Nie S, Peng DC. Abnormal resting-state functional connectivity within the default mode network subregions in male patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2016; 12:203-12. [PMID: 26855576 PMCID: PMC4725694 DOI: 10.2147/ndt.s97449] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Abnormal resting-state functional connectivity (rs-FC) between the central executive network and the default mode network (DMN) in patients with obstructive sleep apnea (OSA) has been reported. However, the effect of OSA on rs-FC within the DMN subregions remains uncertain. This study was designed to investigate whether the rs-FC within the DMN subregions was disrupted and determine its relationship with clinical symptoms in patients with OSA. METHODS Forty male patients newly diagnosed with severe OSA and 40 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (fMRI) examinations and clinical and neuropsychologic assessments. Seed-based region of interest rs-FC method was used to analyze the connectivity between each pair of subregions within the DMN, including the medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC), hippocampus formation (HF), inferior parietal cortices (IPC), and medial temporal lobe (MTL). The abnormal rs-FC strength within the DMN subregions was correlated with clinical and neuropsychologic assessments using Pearson correlation analysis in patients with OSA. RESULTS Compared with GSs, patients with OSA had significantly decreased rs-FC between the right HF and the PCC, MPFC, and left MTL. However, patients with OSA had significantly increased rs-FC between the MPFC and left and right IPC, and between the left IPC and right IPC. The rs-FC between the right HF and left MTL was positively correlated with rapid eye movement (r=0.335, P=0.035). The rs-FC between the PCC and right HF was negatively correlated with delayed memory (r=-0.338, P=0.033). CONCLUSION OSA selectively impairs the rs-FC between right HF and PCC, MPFC, and left MTL within the DMN subregions, and provides an imaging indicator for assessment of cognitive dysfunction in OSA patients.
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Affiliation(s)
- Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Xiao Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Hong-Han Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Wei Zhang
- Department of Pneumology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Si Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
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Joseph A, Cloutier M, Guérin A, Nitulescu R, Sikirica V. Treatment outcomes after methylphenidate in adults with attention-deficit/hyperactivity disorder treated with lisdexamfetamine dimesylate or atomoxetine. Patient Prefer Adherence 2016; 10:391-405. [PMID: 27069357 PMCID: PMC4818045 DOI: 10.2147/ppa.s98498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To compare treatment adherence, discontinuation, add-on, and daily average consumption (DACON) among adults with attention-deficit/hyperactivity disorder receiving second-line lisdexamfetamine dimesylate (LDX) or atomoxetine (ATX), following methylphenidate. PATIENTS AND METHODS A retrospective cohort study using US commercial claims databases (Q2/2009-Q3/2013). RESULTS At month 12, the LDX cohort (N=2,718) had a higher adherence level (proportion of days covered: 0.48 versus 0.30, P<0.001) and was less likely to discontinue (Kaplan-Meier estimate: 63% versus 85%, P<0.001) than the ATX cohort (N=674). There were no statistical differences in treatment add-on rates between cohorts (Kaplan-Meier estimate: 26% versus 25%, P=0.297). The LDX cohort had a lower DACON (1.10 versus 1.31, P<0.001) and was less likely to have a DACON >1 (adjusted odds ratio: 0.20, 95% confidence interval: 0.15-0.25, P<0.001) than the ATX cohort. CONCLUSION Adults with attention-deficit/hyperactivity disorder treated with LDX following methylphenidate had a higher treatment adherence and lower discontinuation and DACON relative to those treated with ATX following methylphenidate.
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Affiliation(s)
- Alain Joseph
- Global HEOR and Epidemiology, Shire, Zählerweg, Zug, Switzerland
- Correspondence: Alain Joseph, Global HEOR and Epidemiology, Shire, Zählerweg 10, 6301 Zug, Switzerland, Tel +41 41 288 4390, Fax +41 41 288 4001, Email
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Lau EYY, Choi EWM, Lai ESK, Lau KNT, Au CT, Yung WH, Li AM. Working memory impairment and its associated sleep-related respiratory parameters in children with obstructive sleep apnea. Sleep Med 2015; 16:1109-15. [PMID: 26298787 DOI: 10.1016/j.sleep.2015.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Working memory deficits in children with obstructive sleep apnea (OSA) have been reported in previous studies, but the results were inconclusive. This study tried to address this issue by delineating working memory functions into executive processes and storage/maintenance components based on Baddeley's working memory model. METHODS Working memory and basic attention tasks were administered on 23 OSA children aged 8-12 years and 22 age-, education-, and general cognitive functioning-matched controls. Data on overnight polysomnographic sleep study and working memory functions were compared between the two groups. Associations between respiratory-related parameters and cognitive performance were explored in the OSA group. RESULTS Compared with controls, children with OSA had poorer performance on both tasks of basic storage and central executive components in the verbal domain of working memory, above and beyond basic attention and processing speed impairments; such differences were not significant in the visuo-spatial domain. Moreover, correlational analyses and hierarchical regression analyses further suggested that obstructive apnea-hypopnea index (OAHI) and oxygen saturation (SpO2) nadir were associated with verbal working memory performance, highlighting the potential pathophysiological mechanisms of OSA-induced cognitive deficits. CONCLUSIONS Verbal working memory impairments associated with OSA may compromise children's learning potentials and neurocognitive development. Early identification of OSA and assessment of the associated neurocognitive deficits are of paramount importance. Reversibility of cognitive deficits after treatment would be a critical outcome indicator.
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Affiliation(s)
- Esther Yuet Ying Lau
- Sleep Laboratory, University of Hong Kong, Hong Kong; Department of Psychology, University of Hong Kong, Hong Kong; Department of Psychiatry, University of Hong Kong, Hong Kong.
| | | | | | - Kristy N T Lau
- Sleep Laboratory, University of Hong Kong, Hong Kong; Department of Psychology, University of Hong Kong, Hong Kong
| | - C T Au
- Department of Pediatrics, Prince of Wales Hospital, Hong Kong
| | - W H Yung
- School of Biomedical Sciences, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albert M Li
- Department of Pediatrics, Prince of Wales Hospital, Hong Kong
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Wang Y, Geater AF, Chai Y, Luo J, Niu X, Hai B, Qin J, Li Y. Pre- and in-therapy predictive score models of adult OSAS patients with poor adherence pattern on nCPAP therapy. Patient Prefer Adherence 2015; 9:715-23. [PMID: 26064041 PMCID: PMC4455858 DOI: 10.2147/ppa.s83105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To identify patterns of adherence to nasal continuous positive airway pressure (nCPAP) use in the first 3 months of therapy among newly diagnosed adult patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and their predictors. To develop pretherapy and in-therapy scores to predict adherence pattern. METHODS Newly diagnosed adult OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures such as Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Zung's Self-Rating Depression Scale (SDS), and The Pittsburgh Sleep Quality Index (PSQI) at baseline and at the end of 3rd-week therapy were collected. Twelve weeks' adherence data were collected from the nCPAP memory card, and K-means cluster analysis was used to explore adherence patterns. Predictive scores were developed from the coefficients of cumulative logit models of adherence patterns using variables available at baseline and after 3 weeks of therapy. Performance of the score was validated using 500 bootstrap resamples. RESULTS Seventy six patients completed a 12-week follow-up. Three patterns were revealed. Patients were identified as developing an adherence pattern that was poor (n=14, mean ± SD, 2.3±0.9 hours per night), moderate (n=19, 5.3±0.6 hours per night), or good (n=43, 6.8±0.3 hours per night). Cumulative logit regression models (good → moderate → poor) revealed independent baseline predictors to be ESS (per unit increase) (OR [95% CI], 0.763 [0.651, 0.893]), SDS (1.461 [1.238, 1.724]), and PSQI (2.261 [1.427, 3.584]); and 3-week therapy predictors to be ESS (0.554 [0.331, 0.926]), PSQI (2.548 [1.454, 4.465]), and the changes (3rd week-baseline data) in ESS (0.459 [0.243, 0.868]), FSS (3.556 [1.788, 7.070]), and PSQI (2.937 [1.273, 6.773]). Two predictive score formulas for poor adherence were developed. The area under the curve (AUC) of the receiver operating characteristics (ROC) curves for baseline and 3-week formulas were 0.989 and 0.999, respectively. Bootstrap analysis indicated positive predictive values of baseline and 3-week predictive scores in our patient population of 0.82 (95% CI [0.82, 0.83]) and 0.94 (95% CI [0.93, 0.94]), respectively. CONCLUSION A high level of prediction of poor adherence pattern is possible both before and at the first 3 weeks of therapy. The predictive scores should be further evaluated for external validity.
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Affiliation(s)
- Yeying Wang
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yanling Chai
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Jiahong Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Xiaoqun Niu
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Bing Hai
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Jingting Qin
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Yongxia Li
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
- Correspondence: Yongxia Li, Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, No 374, Dianmian Road, Kunming 650101, Yunnan Province, People’s Republic of China, Tel +86 136 5881 0805, Fax +86 871 6535 2087, Email
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Chen TY, Chou YC, Tzeng NS, Chang HA, Kuo SC, Pan PY, Yeh YW, Yeh CB, Mao WC. Effects of a selective educational system on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan. Neuropsychiatr Dis Treat 2015; 11:741-50. [PMID: 25834449 PMCID: PMC4372029 DOI: 10.2147/ndt.s77179] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of the study reported here was to clarify the effects of academic pressure on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan. METHODS This cross-sectional study enrolled 757 senior high school adolescents who were classified into four groups: Grade 1 (n=261), Grade 2 (n=228), Grade 3T (n=199; Grade 3 students who had another college entrance test to take), and Grade 3S (n=69; Grade 3 students who had succeeded in their college application). Fatigue, sleep quality, daytime sleepiness, and depression were assessed using the Chinese version of the Multidimensional Fatigue Symptom Inventory - Short Form, Pittsburgh Sleep Quality Index-Taiwan Form, the Chinese version of the Epworth Sleepiness Scale, and the Chinese version of the Beck Depression Inventory(®)-II (BDI-II), respectively. RESULTS Physical, emotional, and mental fatigue scores were all higher in higher-grade groups. The Grade 3T (test) students had the worst fatigue severity, and the Grade 3S (success) students had the least fatigue severity. More than half of the students (60.9%) went to bed after 12 am, and they had on average 6.0 hours of sleep per night. More than 30% of the students in Grade 2 (37.3%) and Grades 3T/S (30.2%/30.4%) possibly had daily sleepiness problems. The students in Grade 3T had the worst BDI-II score (13.27±9.24), and the Grade 3S students had a much lower BDI-II score (7.91±6.13). CONCLUSION Relatively high proportions of fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents were found in our study. The severities of fatigue, sleep problems, and depression were significantly diminished in the group under less academic stress (Grade 3S). Our findings may increase the understanding of the mental health of senior high school students under academic pressure in Taiwan. Further large sample size and population-based study should be done for better understanding about this topic.
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Affiliation(s)
- Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shin-Chang Kuo
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Wei Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Chung Mao
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Abstract
BACKGROUND The weightlessness caused by prolonged bed rest results in changes in cerebral circulation and thus, brain functions, which is of interest. METHODS We investigated the effects of 45-day, -6° head-down bed rest, which stimulated microgravity, on working memory in 16 healthy male participants. The 2-back task was used to test the working memory variations on the 2nd day before bed rest (R-2); on the 11th (R11), 20th (R20), 32nd (R32), and 40th (R40) days of bed rest; and on the eighth day after bed rest (R+8). The cognitive response and the physiological reactivity (such as galvanic skin response, heart rate, and heart rate variability) under the 2-back task were recorded simultaneously. RESULTS The results showed that compared with R-2, on the R+8, the participants' galvanic skin response increased significantly, and the high frequency of heart rate variability (HF), low frequency of heart rate variability (LF), and reaction time in the 2-back task decreased significantly. There were positive correlations between the participants' reaction time of working memory and the LF/HF under head-down bed rest (at R11, R20, and R32). CONCLUSION The results suggested that the prolonged head-down bed rest may have a detrimental effect on individual physiology and working memory. Physiology indices, such as galvanic skin response and heart rate variability, were sensitive to the prolonged bed rest.
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Affiliation(s)
- Qing Liu
- Beijing Key Lab of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, People's Republic of China ; Research Center of Emotion Regulation, Beijing Normal University, Beijing, People's Republic of China
| | - Renlai Zhou
- Beijing Key Lab of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, People's Republic of China ; Research Center of Emotion Regulation, Beijing Normal University, Beijing, People's Republic of China ; State Key Laboratory of Cognitive Neuroscience and Learning, International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People's Republic of China ; Department of Psychology, School of Social and Behavioral Science, Nanjing University, Nanjing, People's Republic of China
| | - Xin Zhao
- Behavior Rehabilitation Training Research Institution, School of Psychology, Northwest Normal University, Lanzhou, People's Republic of China
| | - Tian Po S Oei
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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Brand S, Kirov R, Kalak N, Gerber M, Pühse U, Lemola S, Correll CU, Cortese S, Meyer T, Holsboer-Trachsler E. Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation. Neuropsychiatr Dis Treat 2015; 11:263-71. [PMID: 25678791 PMCID: PMC4322891 DOI: 10.2147/ndt.s74905] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perfectionism is understood as a set of personality traits such as unrealistically high and rigid standards for performance, fear of failure, and excessive self-criticism. Previous studies showed a direct association between increased perfectionism and poor sleep, though without taking into account possible mediating factors. Here, we tested the hypothesis that perfectionism was directly associated with poor sleep, and that this association collapsed, if mediating factors such as stress and poor emotion regulation were taken into account. METHODS Three hundred and forty six young adult students (M=23.87 years) completed questionnaires relating to perfectionism traits, sleep, and psychological functioning such as stress perception, coping with stress, emotion regulation, and mental toughness. RESULTS Perfectionism was directly associated with poor sleep and poor psychological functioning. When stress, poor coping, and poor emotion regulation were entered in the equation, perfectionism traits no longer contributed substantively to the explanation of poor sleep. CONCLUSION Though perfectionism traits seem associated with poor sleep, the direct role of such traits seemed small, when mediating factors such as stress perception and emotion regulation were taken into account.
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Affiliation(s)
- Serge Brand
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland ; Department of Sport, Exercise and Health, Division of Sport Science, University of Basel, Basel, Switzerland
| | - Roumen Kirov
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Nadeem Kalak
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, Division of Sport Science, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, Division of Sport Science, University of Basel, Basel, Switzerland
| | - Sakari Lemola
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Christoph U Correll
- Division of Psychiatric Research, North Shore - Long Island Jewish Health System, Zucker Hillside Hospital, NY, USA
| | - Samuele Cortese
- School of Medicine, University of Nottingham, Nottingham, UK ; Centre for ADHD and Neuro-developmental Disorders Across Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, UK ; New York University Child Study Centre, New York, NY, USA
| | - Till Meyer
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
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Barja-Fernandez S, Leis R, Casanueva FF, Seoane LM. Drug development strategies for the treatment of obesity: how to ensure efficacy, safety, and sustainable weight loss. Drug Des Devel Ther 2014; 8:2391-400. [PMID: 25489237 PMCID: PMC4257050 DOI: 10.2147/dddt.s53129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The prevalence of obesity has increased worldwide, and approximately 25%-35% of the adult population is obese in some countries. The excess of body fat is associated with adverse health consequences. Considering the limited efficacy of diet and exercise in the current obese population and the use of bariatric surgery only for morbid obesity, it appears that drug therapy is the only available method to address the problem on a large scale. Currently, pharmacological obesity treatment options are limited. However, new antiobesity drugs acting through central nervous system pathways or the peripheral adiposity signals and gastrointestinal tract are under clinical development. One of the most promising approaches is the use of peptides that influence the peripheral satiety signals and brain-gut axis such as GLP-1 analogs. However, considering that any antiobesity drug may affect one or several of the systems that control food intake and energy expenditure, it is unlikely that a single pharmacological agent will be effective as a striking obesity treatment. Thus, future strategies to treat obesity will need to be directed at sustainable weight loss to ensure maximal safety. This strategy will probably require the coadministration of medications that act through different mechanisms.
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Affiliation(s)
- S Barja-Fernandez
- Grupo Fisiopatología Endocrina, Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- Departamento de Pediatría, Universidad de Santiago de Compostela (USC), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER Fisiopatologia de la Obesidad y Nutrición, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - R Leis
- Departamento de Pediatría, Universidad de Santiago de Compostela (USC), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - FF Casanueva
- CIBER Fisiopatologia de la Obesidad y Nutrición, Instituto de Salud Carlos III, Santiago de Compostela, Spain
- Laboratorio de Endocrinología Molecular y Celular, Universidad de Santiago de Compostela (USC) Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - LM Seoane
- Grupo Fisiopatología Endocrina, Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER Fisiopatologia de la Obesidad y Nutrición, Instituto de Salud Carlos III, Santiago de Compostela, Spain
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Waist-to-height ratio distinguish obstructive sleep apnea from primary snoring in obese children. Sleep Breath 2014; 19:231-7. [DOI: 10.1007/s11325-014-1001-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 11/26/2022]
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Perillo L, Esposito M, Caprioglio A, Attanasio S, Santini AC, Carotenuto M. Orthodontic treatment need for adolescents in the Campania region: the malocclusion impact on self-concept. Patient Prefer Adherence 2014; 8:353-9. [PMID: 24672229 PMCID: PMC3964173 DOI: 10.2147/ppa.s58971] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dental malocclusions can be considered not only as an oral health problem, because they are linked to quality of life perception. Many factors related to malocclusion have strong influences on the perception of facial esthetics (eg, anterior tooth alignment, tooth shape and position, lip thickness, symmetric gingival or tooth contour, lip profile, and overjet). Many reports have shown that the perception of facial esthetics can influence psychological development from early childhood to adulthood. The aim of this study is to investigate the effect of dental malocclusion on self-esteem in a sample of adolescents. MATERIALS AND METHODS The study population was composed of 516 orthodontically untreated subjects (256 males) mean ages 13.75±1.977 years recruited from schools in the Campania region of Italy between January 2011 and July 2011. To evaluate the self-esteem grade in our population, all subjects filled out the Multidimensional Self Concept Scale questionnaire and attended an orthodontic clinical evaluation to estimate dental occlusal aspects. RESULTS Pearson's analysis shows the relationship in our sample between some occlusal characteristics (crossbite and dental crowding) and aspects of self-concept evaluation (social, competence, academic, physical, and global score) of the Multidimensional Self Concept Scale questionnaire. Moreover, logistic regression analysis shows the potential role of dental crowding (odds ratio 5.359; 95% confidence interval 3.492-8.225) and crossbite (odds ratio 6.153; 95% confidence interval 3.545-10.678) as risk factors for development of global self-concept score abnormalities. CONCLUSION Our findings confirm the relationship between psychosocial well-being, self-esteem, and dental malocclusion among adolescents.
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Affiliation(s)
- Letizia Perillo
- Department of Orthodontics, Second University of Naples, Naples, Italy
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | | | | | - Annamaria Chiara Santini
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
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Schott TC, Ludwig B. Quantification of wear-time adherence of removable appliances in young orthodontic patients in relation to their BMI: a preliminary study. Patient Prefer Adherence 2014; 8:1587-95. [PMID: 25484576 PMCID: PMC4240191 DOI: 10.2147/ppa.s69586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The relationship between unhealthy body mass index (BMI) and adherence to orthodontic treatment with removable appliances has not previously been evaluated. OBJECTIVE The aim of this study was to quantify the association between BMI and wear time of removable orthodontic appliances and to evaluate BMI changes during orthodontic treatment. PATIENTS AND METHODS Fifty-three normal-weight and 39 overweight/obese children and adolescents (7-15 years old) undergoing orthodontic treatment with removable appliances were enrolled into the study. BMI categories were determined using standardized age-specific and sex-specific BMI criteria, using data measured at the beginning of therapy and once during orthodontic treatment. Wear times of removable appliances were measured at 15-minute intervals over a period of 5 months using implanted microelectronic sensors. Median wear-time values were used in the analysis with the Mann-Whitney U-test used to test statistical differences between groups. RESULTS The median wear time of removable orthodontic appliances was 9.3 hours for normal-weight patients and 9.2 hours for overweight/obese patients. No statistically significant (P>0.05) or clinically relevant differences in usage or adherence were detected between normal-weight and overweight/obese patients. BMI did not influence wear time or behavior of removable orthodontic appliances by young patients. The majority of patients showed qualitative decreases in BMI during therapy. CONCLUSION The orthodontic treatment of young patients with removable devices does not require BMI-dependent changes in the treatment strategy. However, the use of removable appliances during meal times raises the possibility of reducing food intake, and in this way the orthodontist may have an active role to play in weight reduction.
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Affiliation(s)
- Timm Cornelius Schott
- Department of Orthodontics, Eberhard Karls University, Tübingen, Germany
- Correspondence: Timm Cornelius Schott, Department of Orthodontics and Orofacial Orthopedics, University Hospital of Dentistry, Oral Medicine, and Maxillofacial Surgery, Eberhard Karls University, Tübingen, Osianderstr 2-8, 72076 Tuebingen, Germany, Tel +49 7071 29 821 62, Fax +49 7071 657 82, Email
| | - Björn Ludwig
- Private practice, Traben-Trarbach, Germany
- Department of Orthodontics University of Homburg/Saar, Germany
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Peng DC, Dai XJ, Gong HH, Li HJ, Nie X, Zhang W. Altered intrinsic regional brain activity in male patients with severe obstructive sleep apnea: a resting-state functional magnetic resonance imaging study. Neuropsychiatr Dis Treat 2014; 10:1819-26. [PMID: 25278755 PMCID: PMC4179755 DOI: 10.2147/ndt.s67805] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with abnormal brain structural deficits. However, little is known about the changes in local synchronization of spontaneous activity in patients with OSA. The primary aim of the present study was to investigate spontaneous brain activity in patients with OSA compared with good sleepers (GSs) using regional homogeneity (ReHo) analysis based on resting-state functional magnetic resonance imaging (MRI). METHODS Twenty-five untreated male patients with severe OSA and 25 male GSs matched for age and years of education were included in this study. The ReHo method was calculated to assess the strength of local signal synchrony and was compared between the two groups. The observed mean ReHo values were entered into Statistical Package for the Social Sciences software to assess their correlation with behavioral performance. RESULTS Compared with GSs, patients with OSA showed significantly lower ReHo in the right medial frontal gyrus (BA11), right superior frontal gyrus (BA10), right cluster of the precuneus and angular gyrus (BA39), and left superior parietal lobule (BA7), and higher ReHo in the right posterior lobe of the cerebellum, right cingulate gyrus (BA23), and bilateral cluster covering the lentiform nucleus, putamen, and insula (BA13). The lower mean ReHo value in the right cluster of the precuneus and angular gyrus had a significant negative correlation with sleep time (r=-0.430, P=0.032), and higher ReHo in the right posterior lobe of the cerebellum showed a significant positive correlation with stage 3 sleep (r=0.458, P=0.021) and in the right cingulate gyrus showed a significant positive correlation with percent rapid eye movement sleep (r=0.405, P=0.045). CONCLUSION Patients with OSA showed significant regional spontaneous activity deficits in default mode network areas. The ReHo method is a useful noninvasive imaging tool for detection of early changes in cerebral ReHo in patients with OSA.
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Affiliation(s)
- De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Xi-Jian Dai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China ; Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China
| | - Hong-Han Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Xiao Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Wei Zhang
- Department of Pneumology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
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McCarthy S. Pharmacological interventions for ADHD: how do adolescent and adult patient beliefs and attitudes impact treatment adherence? Patient Prefer Adherence 2014; 8:1317-27. [PMID: 25284990 PMCID: PMC4181644 DOI: 10.2147/ppa.s42145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Adherence to medication can be problematic for patients, especially so for patients with attention deficit hyperactivity disorder (ADHD). Effective medications are available for the treatment of ADHD; however, nonadherence rates for ADHD medication range from 13.2%-64%. The reasons for nonadherence can be complex. This review aims to look at how the beliefs and attitudes of adolescents and adults impact ADHD treatment adherence.
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Affiliation(s)
- Suzanne McCarthy
- School of Pharmacy, University College Cork, Cork, Ireland
- Correspondence: Suzanne McCarthy, School of Pharmacy, Cavanagh Pharmacy Building, University College Cork, College Road, Cork, Ireland, Tel +353 21 490 1714, Email
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Kalak N, Lemola S, Brand S, Holsboer-Trachsler E, Grob A. Sleep duration and subjective psychological well-being in adolescence: a longitudinal study in Switzerland and Norway. Neuropsychiatr Dis Treat 2014; 10:1199-207. [PMID: 25061305 PMCID: PMC4086771 DOI: 10.2147/ndt.s62533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adolescents' sleep duration and subjective psychological well-being are related. However, few studies have examined the relationship between sleep duration and subjective psychological well-being longitudinally across adolescence - a time of profound biological and psychosocial change. The aim of this longitudinal study was to investigate whether shorter sleep duration in adolescents is predictive of lower subjective psychological well-being 6 months and 12 months later or whether lower subjective psychological well-being is predictive of shorter sleep duration. METHODS Adolescents (age range, 10.02-15.99 years; mean age, 13.05±1.49 years; 51.8%, female) from German-speaking Switzerland (n=886) and Norway (n=715) reported their sleep duration and subjective psychological well-being on school days using self-rating questionnaires at baseline (T1), 6 months (T2), and 12 months from baseline (T3). RESULTS Cross-sectional and longitudinal analyses revealed that sleep duration decreased with age. Longer sleep duration was concurrently associated with better subjective psychological well-being. Crossed-lagged autoregressive longitudinal panel analysis showed that sleep duration prospectively predicted subjective psychological well-being while there was no evidence for the reverse relationship. CONCLUSION Sleep duration is predictive of subjective psychological well-being. The findings offer further support for the importance of healthy sleep patterns during adolescence.
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Affiliation(s)
- Nadeem Kalak
- Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Sakari Lemola
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Serge Brand
- Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland ; Department of Sport and Health Science, Division of Sport Science, University of Basel, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Alexander Grob
- Department of Psychology, University of Basel, Basel, Switzerland
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Dai XJ, Peng DC, Gong HH, Wan AL, Nie X, Li HJ, Wang YXJ. Altered intrinsic regional brain spontaneous activity and subjective sleep quality in patients with chronic primary insomnia: a resting-state fMRI study. Neuropsychiatr Dis Treat 2014; 10:2163-75. [PMID: 25484585 PMCID: PMC4238753 DOI: 10.2147/ndt.s69681] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY OBJECTIVE To prospectively explore the underlying regional homogeneity (ReHo) brain-activity deficit in patients with chronic primary insomnia (PCPIs) and its relationship with clinical features. DESIGN The ReHo method and Statistical Parametric Mapping 8 software were used to evaluate whether resting-state localized brain activity was modulated between PCPIs and good sleepers (GSs), and correlation analysis between altered regional brain areas and clinical features was calculated. PATIENTS AND PARTICIPANTS Twenty-four PCPIs (17 females, seven males) and 24 (12 females, 12 males) age-, sex-, and education-matched GSs. MEASUREMENTS AND RESULTS PCPIs disturbed subjective sleep quality, split positive mood, and exacerbated negative moods. Compared with GSs, PCPIs showed higher ReHo in left fusiform gyrus, and lower ReHo in bilateral cingulate gyrus and right cerebellum anterior lobe. Compared with female GSs, female PCPIs showed higher ReHo in the left fusiform gyrus and right posterior cingulate, and lower ReHo in the left cerebellum anterior lobe and left superior frontal gyrus. Compared with male GSs, male PCPIs showed higher ReHo in the right temporal lobe and lower ReHo in the bilateral frontal lobe. The fusiform gyrus showed strong positive correlations and the frontal lobe showed negative correlations with the clinical measurements. CONCLUSION The ReHo analysis is a useful noninvasive imaging tool for the detection of cerebral changes and the indexing of clinical features. The abnormal spontaneous activity areas provided important information on the neural mechanisms underlying emotion and sleep-quality impairment in PCPIs.
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Affiliation(s)
- Xi-Jian Dai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People's Republic of China ; Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People's Republic of China
| | - Hong-Han Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People's Republic of China
| | - Ai-Lan Wan
- Department of Psychosomatic Medicine, the First Affiliated Hospital of Nangchang University, Nangchang, Jiangxi, People's Republic of China
| | - Xiao Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People's Republic of China
| | - Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, People's Republic of China
| | - Yi-Xiang J Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Esposito M, Gallai B, Roccella M, Marotta R, Lavano F, Lavano SM, Mazzotta G, Bove D, Sorrentino M, Precenzano F, Carotenuto M. Anxiety and depression levels in prepubertal obese children: a case-control study. Neuropsychiatr Dis Treat 2014; 10:1897-902. [PMID: 25336955 PMCID: PMC4200069 DOI: 10.2147/ndt.s69795] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Childhood obesity has become a worldwide epidemic in Western and in developing countries and has been accompanied by many serious and severe comorbidities, such as diabetes, hypertension, sleep apnea syndrome, depression, dyslipidemia, impaired glucose homeostasis, steatohepatitis, and intracranial hypertension, as well as medical concerns unique to youth, such as accelerated pubertal and skeletal development and orthopedic disorders. To date, no specific studies about the psychological assessment in pediatric obesity are present. Therefore, the aim of this study was to evaluate the putative relationship between psychological troubles and obesity in a sample of school-aged children. MATERIALS AND METHODS The study population consists of 148 obese subjects (body mass index [BMI] >95th percentile) (69 males, mean age 8.9±1.23 years) consecutively referred from clinical pediatricians to the Child and Adolescent Neuropsychiatry department at the Second University of Naples. In all subjects, weight, height, and BMI z-score were evaluated. In order to assess the anxiety levels and the presence of depressive symptoms, the Children Depression Inventory (CDI) and the Italian Self-Administered Psychiatric Scales for Children and Adolescents (SAFA) were administered. The control group consisted of 273 healthy children (129 males and 144 females) (mean age 9.1±1.8 years), enrolled in schools within the Campania region of Italy. RESULTS No significant differences between the two study groups were found for age (8.9±1.23 years in the obese sample and 9.1±1.8 years in the control group) (P=0.228) or sex (ratio male/female: 69/79 in the obese group versus 129/144 in the control group) (P=0.983). Obviously, significant difference was found for the BMI z-score (2.46±0.31 in the obese group vs 0.73±0.51 in the control group) (P<0.001). The obese subjects showed significant higher level of depressive symptoms (CDI total score) (16.82±7.73 vs 8.2±2.9) (P<0.001) and anxiety (SAFA - Anxiety [SAFA-A]) scale score (58.71±11.84 vs 27.75±11.5) (P<0.001) compared with the control group. Moreover, the Pearson's correlation analysis showed a significantly positive relationship between the BMI z-score and both the CDI (r=0.677; P<0.001) and SAFA-A scores (r=0.591; P<0.001). CONCLUSION Our findings highlighted the importance of assessing the presence of internalizing problems, such as anxiety and depression, in the common management of childhood obesity.
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Affiliation(s)
- Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Beatrice Gallai
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | - Rosa Marotta
- Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Francesco Lavano
- Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | | | - Giovanni Mazzotta
- Unit of Child and Adolescent Neuropsychiatry, AUSL Umbria 2, Terni, Italy
| | - Domenico Bove
- Centro per la Diagnosi e Cura dei Disturbi dell'apprendimento e del Comportamento Associazione per la ricerca scientifica Fusis, Alvignano, Italy
| | - Michele Sorrentino
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
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Sugawara N, Yasui-Furukori N, Tomita T, Furukori H, Kubo K, Nakagami T, Kaneko S. Comparison of predictive equations for resting energy expenditure among patients with schizophrenia in Japan. Neuropsychiatr Dis Treat 2014; 10:427-32. [PMID: 24611013 PMCID: PMC3944998 DOI: 10.2147/ndt.s58019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recently, a relationship between obesity and schizophrenia has been reported. The prediction of resting energy expenditure (REE) is important to determine the energy expenditure of patients with schizophrenia. However, there is a lack of research concerning the most accurate REE predictive equations among Asian patients with schizophrenia. The purpose of the study reported here was to compare the validity of four REE equations for patients with schizophrenia taking antipsychotics. METHODS For this cross-sectional study, we recruited patients (n=110) who had a Diagnostic and Statistical Manual of Mental Disorders, fourth edition, diagnosis of schizophrenia and were admitted to four psychiatric hospitals. The mean (± standard deviation) age of these patients was 45.9±13.2 years. Anthropometric measurements (of height, weight, body mass index) were taken at the beginning of the study. REE was measured using indirect calorimetry. Comparisons between the measured and estimated REEs from the four equations (Harris-Benedict, Mifflin-St Jeor, Food and Agriculture Organization/World Health Organization/United Nations University, and Schofield) were performed using simple linear regression analysis and Bland-Altman analysis. RESULTS Significant trends were found between the measured and predicted REEs for all four equations (P<0.001), with the Harris-Benedict equation demonstrating the strongest correlation in both men and women (r=0.617, P<0.001). In all participants, Bland-Altman analysis revealed that the Harris-Benedict and Mifflin-St Jeor equations did not show a significant bias in the prediction of REE, however, a significant overestimation error was shown for the Food and Agriculture Organization/World Health Organization/United Nations University and Schofield equations. CONCLUSION When estimating REE in patients with schizophrenia taking antipsychotics, the Harris-Benedict equation appears to be the most appropriate for clinical use.
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Affiliation(s)
- Norio Sugawara
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Tetsu Tomita
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan ; Department of Psychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, Japan
| | - Hanako Furukori
- Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi, Japan
| | - Kazutoshi Kubo
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan ; Department of Psychiatry, Odate Municipal General Hospital, Odate, Japan
| | - Taku Nakagami
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan ; Department of Psychiatry, Odate Municipal General Hospital, Odate, Japan
| | - Sunao Kaneko
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
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Montoya A, Hervás A, Fuentes J, Cardo E, Polavieja P, Quintero J, Tannock R. Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat 2014; 10:1081-92. [PMID: 24966679 PMCID: PMC4063801 DOI: 10.2147/ndt.s62487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This multicenter, cluster-randomized, nonblinded study evaluated the effect of parental psychoeducation on medication persistence among children and adolescents with newly diagnosed attention-deficit/hyperactivity disorder (ADHD). METHODS Patients received standard medication alone or medication plus a parental psychoeducation program, and were followed for 12 months. The primary endpoint was time to withdrawal or termination of medication due to any cause. Secondary endpoints included change in ADHD symptom severity, functional outcome, program satisfaction, and safety. RESULTS A total of 208 patients completed the study, which was terminated early because recruitment had ceased. At 12 months, there was no significant difference between the psychoeducation and control groups in the proportion of patients who discontinued pharmacologic treatment (13.2% versus 14.3%, respectively; size effect -0.3, P=0.34; hazard ratio 0.72, 95% confidence interval 0.36-1.43). Psychoeducation was associated with a significantly greater improvement in ADHD symptoms but not in functional outcome. Parental satisfaction with psychoeducation was high, and satisfaction with pharmacologic treatment was significantly greater in the psychoeducation group. There were no safety concerns. CONCLUSION No significant advantage for parental psychoeducation plus medication over medication alone in terms of time to medication withdrawal was observed. Psychoeducation had inconsistent but interesting effects on other outcomes.
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Affiliation(s)
- Alonso Montoya
- Medical Neurosciences, Lilly Research Laboratories Canada, Toronto, ON, Canada
| | - Amaia Hervás
- Child and Adolescent Mental Health Unit, Hospital Universitari Mutua de Terrassa, and Developmental Disorders Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Joaquín Fuentes
- Child and Adolescent Psychiatry Unit, Policlinica Gipuzkoa, San Sebastian, Spain
| | - Esther Cardo
- Neuropediatric Unit, Hospital Son Llatzer, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pepa Polavieja
- Department of Clinical Research, Lilly Research Laboratories Spain, Alcobendas, Spain
| | - Javier Quintero
- Department of Psychiatry, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Rosemary Tannock
- Applied Psychology and Human Development, and Neurosciences and Mental Health Research Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Esposito M, Roccella M, Gallai B, Parisi L, Lavano SM, Marotta R, Carotenuto M. Maternal personality profile of children affected by migraine. Neuropsychiatr Dis Treat 2013; 9:1351-8. [PMID: 24049447 PMCID: PMC3775696 DOI: 10.2147/ndt.s51554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Empirical evidence of the important role of the family in primary pediatric headache has grown significantly in the last few years, although the interconnections between the dysfunctional process and the family interaction are still unclear. Even though the role of parenting in childhood migraine is well known, no studies about the personality of parents of migraine children have been conducted. The aim of the present study was to assess, using an objective measure, the personality profile of mothers of children affected by migraine without aura (MoA). MATERIALS AND METHODS A total of 269 mothers of MoA children (153 male, 116 female, aged between 6 and 12 years; mean 8.93 ± 3.57 years) were compared with the findings obtained from a sample of mothers of 587 healthy children (316 male, 271 female, mean age 8.74 ± 3.57 years) randomly selected from schools in the Campania, Umbria, Calabria, and Sicily regions. Each mother filled out the Minnesota Multiphasic Personality Inventory - second edition (MMPI-2), widely used to diagnose personality and psychological disorders. The t-test was used to compare age and MMPI-2 clinical basic and content scales between mothers of MoA and typical developing children, and Pearson's correlation test was used to evaluate the relation between MMPI-2 scores of mothers of MoA children and frequency, intensity, and duration of migraine attacks of their children. RESULTS Mothers of MoA children showed significantly higher scores in the paranoia and social introversion clinical basic subscales, and in the anxiety, obsessiveness, depression, health concerns, bizarre mentation, cynicism, type A, low self-esteem, work interference, and negative treatment indicator clinical content subscales (P < 0.001 for all variables). Moreover, Pearson's correlation analysis showed a significant relationship between MoA frequency of children and anxiety (r = 0.4903, P = 0.024) and low self-esteem (r = 0.5130, P = 0.017), while the MoA duration of children was related with hypochondriasis (r = 0.6155, P = 0.003), hysteria (r = 0.6235, P = 0.003), paranoia (r = 0.5102, P = 0.018), psychasthenia (r = 0.4806, P = 0.027), schizophrenia (r = 0.4350, P = 0.049), anxiety (r = 0.4332, P = 0.050), and health concerns (r = 0.7039, P < 0.001) MMPI-2 scores of their mothers. CONCLUSION This could be considered a preliminary study that indicates the potential value of maternal personality assessment for better comprehension and clinical management of children affected by migraine, though further studies on the other primary headaches are necessary.
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Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Second University of Naples, Naples, Italy
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