1
|
Kalyoncu M, Namlı N, Yegit CY, Yanaz M, Gulieva A, Ergenekon AP, Selçuk M, Atağ E, İkizoğlu NB, Sabancı M, Lale K, Gokdemir Y, Ersu R, Karakoç F, Karadag B, Eralp EE. Is the Pediatric Sleep Questionnaire sensitive for sleep-disordered breathing in children with complex chronic disease? Sleep Breath 2024; 28:331-337. [PMID: 37733254 DOI: 10.1007/s11325-023-02915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Sleep-disordered breathing (SDB) is a disease defined by breathing or breathing irregularities while asleep. The current study examines the association between results of polysomnography (PSG) and the Pediatric Sleep Questionnaire (PSQ), and the specificity and sensitivity of the PSQ for obstructive sleep apnea (OSA) in patients with chronic illnesses. METHODS Demographic and clinical attributes, in addition to PSQ and PSG outcomes were examined retrospectively among patients who underwent polysomnography (PSG) at our facility between 2012 and 2021. RESULTS Of 745 patients included in the study, 462 (62%) were male. The median age was 81 months (34-151 months). 117 of the patients (15/8%) had chronic lung disease, and 80 (10.7%) had cerebral palsy. The most common indications for PSG were symptoms of OSA (n = 426; 57.1%). According to obstructive apnea-hypopnea index (AHI), 361 patients (48.5%) had normal PSG. The median PSQ score was 0.40 (0.22-0.57). The sensitivity and specificity of the PSQ were 71.8% and 40.4%, respectively, for individuals aged 2 to 18 years. Among the disease subgroups, the cerebral palsy group had the highest sensitivity of PSQ (88.8%) for diagnosis of OSA. CONCLUSION Questionnaires for evaluating SDB are not sensitive or specific for identification of OSA in children with chronic conditions, and PSG remains the best method.
Collapse
Affiliation(s)
- Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey.
| | - Nurtuğ Namlı
- Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Muruvvet Yanaz
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Merve Selçuk
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Emine Atağ
- Division of Pediatric Pulmonology, Başkent University School of Medicine, Istanbul, Turkey
| | - Nilay Baş İkizoğlu
- Division of Pediatric Pulmonology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Meltem Sabancı
- Sleep Laboratory of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kadir Lale
- Sleep Laboratory of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fazilet Karakoç
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| |
Collapse
|
2
|
Zaffanello M, Ersu RH, Nosetti L, Beretta G, Agosti M, Piacentini G. Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:208. [PMID: 38397319 PMCID: PMC10887195 DOI: 10.3390/children11020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and -I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.
Collapse
Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
| | - Refika Hamutcu Ersu
- Division of Pediatric Respirology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
| |
Collapse
|
3
|
Oros M, Baranga L, Glangher A, Adina-Diana M, Jugulete G, Pavelescu C, Mihaltan F, Plaiasu V, Gheorghe DC. A Diagnostic Challenge in an Adolescent with Collagen VI-Related Myopathy and Emotional Disorder-Case Report. J Pers Med 2023; 13:1577. [PMID: 38003892 PMCID: PMC10672723 DOI: 10.3390/jpm13111577] [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: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Collagen VI-related disorders constitute a spectrum of severities from the milder Bethlem myopathy (BM) to the Ullrich congenital muscular dystrophy (UCMD), which is more severe, and an intermediate form characterized by muscle weakness that begins in infancy. Affected children are able to walk, although walking becomes increasingly difficult starting in early adulthood. They develop contractures in the ankles, elbows, knees, and spine in childhood. In some affected cases, the respiratory muscles are weakened, requiring mechanical ventilation, particularly during sleep. Individuals with collagen VI-related myopathy are at risk of restrictive lung disease and sleep-disordered breathing due to the development of scoliosis associated with neuromuscular weakness. Typical signs of respiratory failure are not always present, and some patients are unaware that their respiratory muscles have become weaker. Here, we report a case of an intermediate form of collagen VI-related myopathy confirmed by next-generation sequencing. The girl presented morning headache, irritability, and aggressiveness, and because of these main symptoms, she was referred by the neurologist for respiratory evaluation. The result of spirometry was associated with hypoventilation shown during sleep studies, indicating the necessity to initiate home non-invasive ventilation (NIV) with immediate improvement in the symptoms. Neuromuscular disorders (NMDs) have a great impact on sleep, but only very few studies evaluating sleep quality in young patients with collagen VI-related myopathy have been described. Daytime symptoms of sleep-disordered breathing may include irritability, emotional lability, and poor attentiveness, but these can be overseen by the severity of other complex medical problems in patients with collagen VI-related myopathy. We underline the importance of the close monitoring of respiratory function, sleep evaluation, and decision making to support the NIV treatment of other collagen VI-related myopathy variant-specific patients. Early recognition of sleep disturbances and initiation of respiratory support can preserve or enhance the quality of life for patients and their caregivers. Routine screening for identification of emotional distress should be instituted in the clinical practice using validated psychological measures in a multidisciplinary approach with different intervention strategies for both patient and parent when necessary.
Collapse
Affiliation(s)
- Mihaela Oros
- Ponderas Academic Hospital, No. 85A, Nicolae G. Caramfil Street, 014142 Bucharest, Romania; (M.O.); (L.B.); (A.G.)
- Physiology, Department of Preclinical Sciences, Faculty of Medicine, Titu Maiorescu University, No. 67A, Gheorghe Petrascu Street, 3rd District, 031593 Bucharest, Romania;
| | - Lucica Baranga
- Ponderas Academic Hospital, No. 85A, Nicolae G. Caramfil Street, 014142 Bucharest, Romania; (M.O.); (L.B.); (A.G.)
| | - Adelina Glangher
- Ponderas Academic Hospital, No. 85A, Nicolae G. Caramfil Street, 014142 Bucharest, Romania; (M.O.); (L.B.); (A.G.)
| | - Moldovan Adina-Diana
- Physiology, Department of Preclinical Sciences, Faculty of Medicine, Titu Maiorescu University, No. 67A, Gheorghe Petrascu Street, 3rd District, 031593 Bucharest, Romania;
- Medlife SA, 365 Grivitei Bvd, 010719 Bucharest, Romania
| | - Gheorghita Jugulete
- Faculty of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania; (C.P.); (D.C.G.)
- “Matei Balş” National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Carmen Pavelescu
- Faculty of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania; (C.P.); (D.C.G.)
| | - Florin Mihaltan
- Faculty of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania; (C.P.); (D.C.G.)
- National Institute of Pneumology Marius Nasta, 050159 Bucharest, Romania
| | - Vasilica Plaiasu
- Regional Center of Medical Genetics, INSMC Alessandrescu-Rusescu, 020395 Bucharest, Romania
| | - Dan Cristian Gheorghe
- Faculty of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania; (C.P.); (D.C.G.)
- ENT Department “MS Curie” Hospital Bucharest, “Carol Davila” University of Medicine, 050474 Bucharest, Romania
| |
Collapse
|
4
|
Salem J, Blumenow W, Markey A, Hogg ES, McCann E, Yassaie E, Hennedige A, De S, Sharma SD. The Role of Airway Management on Feeding Difficulties in Children With Pfeiffer Syndrome. J Craniofac Surg 2023; 34:1985-1988. [PMID: 37477198 DOI: 10.1097/scs.0000000000009541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/19/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Pfeiffer syndrome is characterized by craniosynostosis, mid-face hypoplasia, broad thumbs, and often multilevel airway obstruction. Airway management is often required, including the use of positive airway ventilation, nasopharyngeal airway (NPA), or tracheostomy. OBJECTIVE The objective of this study was to assess the impact an airway adjunct can have on feeding difficulties in children with Pfeiffer syndrome. METHODS Retrospective review of patients diagnosed with Pfeiffer syndrome from January 1998 to January 2020 at one of England's 4 supraregional Craniofacial Units, Alder Hey Children's Hospital. Speech & Language Therapy case notes and medical notes were used to gather data, as well as the Oral Feeding Score component of the UK Craniofacial Outcome Score. RESULTS Eleven patients were included. Six patients had no airway adjunct (55%): 3 had tracheostomy (27%) and 2 patients had NPA (18%). All patients with airway adjuncts were percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy fed. Those who did not require an airway adjunct had an Oral Feeding Score of 4.60 (SD: 0.49). The children who went on to have an airway adjunct had a mean preintervention Oral Feeding Score of 2.4 (SD: 0.8). The mean feeding score (postairway adjunct) in the NPA group was 2.0, compared with the tracheostomy group scoring 3.0. CONCLUSIONS Children with Pfeiffer syndrome who require airway intervention have more significant feeding problems requiring feeding intervention. Although there were small numbers included in this study, there is a suggestion that airway adjuncts can contribute to feeding difficulties, particularly NPAs.
Collapse
Affiliation(s)
- Joseph Salem
- Department of Paediatric ENT Surgery, Alder Hey Children's NHS Foundation Trust
| | - Wendy Blumenow
- Department of Paediatric Speech and Language Therapy, Alder Hey Children's NHS Foundation Trust
| | - Anne Markey
- Department of Paediatric ENT Surgery, Alder Hey Children's NHS Foundation Trust
| | - Emma S Hogg
- Department of Paediatric ENT Surgery, Alder Hey Children's NHS Foundation Trust
| | - Emma McCann
- Liverpool Centre of Genomic Medicine, Liverpool Women's Hospital Foundation Trust
| | - Emily Yassaie
- Department of Craniofacial Maxillofacial Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anusha Hennedige
- Department of Craniofacial Maxillofacial Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sujata De
- Department of Paediatric ENT Surgery, Alder Hey Children's NHS Foundation Trust
| | - Sunil D Sharma
- Department of Paediatric ENT Surgery, Alder Hey Children's NHS Foundation Trust
| |
Collapse
|
5
|
Roccella M, Vetri L, Carotenuto M, Costanza C. The Complex Association between Sleep Quality, Psychological Wellbeing, and Neurodevelopmental Disorders in Childhood. J Clin Med 2023; 12:jcm12103417. [PMID: 37240521 DOI: 10.3390/jcm12103417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
During child development, the psychophysiological state is influenced by factors such as family routine, school experiences, stressful life events, or, in general, the environmental context in which the child grows up [...].
Collapse
Affiliation(s)
- Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Luigi Vetri
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Carola Costanza
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, 90128 Palermo, Italy
| |
Collapse
|
6
|
Zaffanello M, Franchini M, Piacentini G. Pediatric Sleep-Disordered Breathing and Long-Term Complications: Clinical and Health Implications. J Clin Med 2022; 11:jcm11175178. [PMID: 36079107 PMCID: PMC9457297 DOI: 10.3390/jcm11175178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
- Correspondence:
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| |
Collapse
|