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Myette RL, Flynn JT. The ongoing impact of obesity on childhood hypertension. Pediatr Nephrol 2024; 39:2337-2346. [PMID: 38189961 DOI: 10.1007/s00467-023-06263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
Obesity rates among children have been steadily rising over the past several decades. This epidemic has been accompanied by an increase in the prevalence of childhood hypertension, with children in low- and middle-income countries being affected to the same extent as children in high-income countries. This review will examine the trends in childhood blood pressure and the relationship between excess body weight and the development of hypertension. In addition, distinct mechanisms of obesity-related hypertension will be discussed. There will be an emphasis on recent studies conducted since the publication of new guidelines by the American Academy of Pediatrics in 2017 which resulted in the adoption of lower normative blood pressure cutoffs. The overall intent of this review is to provide the reader with an understanding of the ongoing impact, and complexities, of obesity-related hypertension.
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Affiliation(s)
- Robert L Myette
- The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
- Kidney Research Center, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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2
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Gerdung CA, Ofosu DB, Rodriguez-Lopez S, Palkowski S, Keto-Lambert D, Lin M, Castro-Codesal ML. Positive Airway Pressure and Metabolic Markers in Children With Obstructive Sleep Apnea. Respir Care 2024; 69:999-1010. [PMID: 38653555 PMCID: PMC11298216 DOI: 10.4187/respcare.11679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Increasing evidence suggests an association between childhood obstructive sleep apnea (OSA) and metabolic syndrome, with more research available on the potential impacts of positive airway pressure (PAP) on metabolic markers in children. The purpose of this systematic review is to provide a systematic synthesis of the evidence on the effect of PAP use on metabolic markers in children with OSA. METHODS A search strategy with terms for "OSA" and metabolic markers in pediatrics was run to systematically assess 5 databases until August 26, 2022. Two reviewers independently screened eligible articles, extracted data, and conducted quality appraisal. Meta-analysis was done using random-effects models. Body mass index (BMI), glycemic, lipid, cardiovascular, and other metabolic and inflammatory markers were reported. RESULTS Sixteen studies (N = 1,213) were included, 15 observational studies and 1 randomized controlled trial (RCT); most reported outcomes in children with obesity. Meta-analysis of 4 studies found no changes in BMI at median average follow-up of 12 months after PAP initiation. A reduction in heart rate and blood pressure parameters was demonstrated in several studies in children with OSA with and without obesity at a median average follow-up of 4.9 months after PAP initiation. Research in echocardiographic outcomes is limited, including one RCT in children with Down syndrome and OSA showing no changes in heart rate variability parameters. Evidence of improvements in glycemic and/or lipid control, liver enzymes, and inflammatory markers with PAP therapy is even more limited and of limited clinical importance. Risk of bias was moderate to critical and outcome evidence very low. CONCLUSIONS Although evidence on effects of PAP on metabolic markers in children with OSA is encouraging, available literature is limited. Longitudinal studies are still required to further assess the long-term influence of PAP on metabolic and inflammatory markers, particularly in children with obesity.
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Affiliation(s)
| | - Daniel B Ofosu
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Stefan Palkowski
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research Support Unit, Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Meng Lin
- Alberta Strategy for Patient-Oriented Research Support Unit, Data and Research Services, Alberta Health Services, Edmonton, Alberta, Canada
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3
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Inoue M, Sakata S, Arima H, Yamato I, Oishi E, Ibaraki A, Goto K, Kitazono T. Sleep-related breathing disorder in a Japanese occupational population and its association with hypertension-stratified analysis by obesity status. Hypertens Res 2024; 47:1470-1478. [PMID: 38438727 PMCID: PMC11150150 DOI: 10.1038/s41440-024-01612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Sleep-related breathing disorder (SRBD) causes hypertension, and obesity has been highly associated with SRBD, which has become a serious health problem in young and middle-aged Japanese males. However, the relation between SRBD and hypertension considering the effects of obesity remains unknown. In this cross-sectional study, we examined the relationship between SRBD and hypertension, with consideration for the effects of obesity, in Japanese occupational population. Using 3% oxygen desaturation index (3%ODI) obtained by simplified polysomnography (PSG), participants were classified into low (0 ≤ 3%ODI < 5), medium (5 ≤ 3%ODI < 15), and high (15 ≤ 3%ODI) 3%ODI groups. We excluded employees who had not undergone medical examination with simplified PSG in the same year from 2012 to 2018. Logistic regression analysis was performed to calculate odds ratios for having hypertension according to 3%ODI levels. In total, 2532 employees were included. Among them, 25% and 4% were categorized into the medium and high 3%ODI groups, respectively. The odds ratio for hypertension increased significantly with higher 3%ODI levels after adjustment for age, sex, alcohol drinking status and smoking status (p for trend < 0.0001). However, further adjustment for obesity status (body mass index ≥ 25 kg/m2) attenuated the associations. When we performed the stratified analysis by obesity status, the odds ratio for hypertension increased significantly with higher 3%ODI only for non-obese individuals, with significant interaction (p for interaction = 0.014). Higher 3%ODI was significantly associated with higher prevalence of hypertension especially in non-obese participants, suggesting the importance of vigilance for the presence of SRBD even in non-obese individuals. We investigated the association between SRBD and hypertension considering the effects of obesity, which would suggest the need to keep in mind the presence of SRBD even in non-obese individuals.
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Affiliation(s)
- Minako Inoue
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Satoko Sakata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Ikumi Yamato
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Emi Oishi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ai Ibaraki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Goto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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4
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White B, Ng SM, Agwu JC, Barrett TG, Birchmore N, Kershaw M, Drew J, Kavvoura F, Law J, Moudiotis C, Procter E, Paul P, Regan F, Reilly P, Sachdev P, Sakremath R, Semple C, Sharples K, Skae M, Timmis A, Williams E, Wright N, Soni A. A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus. BMC Med 2024; 22:144. [PMID: 38561783 PMCID: PMC10986054 DOI: 10.1186/s12916-024-03349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.
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Affiliation(s)
- Billy White
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S M Ng
- Mersey And West Lancashire Teaching Hospitals NHS Trust, Ormskirk, UK
| | - J C Agwu
- Wye Valley NHS Trust, Hereford, UK
| | - T G Barrett
- Birmingham Women's And Children NHS Foundation Trust, Birmingham, UK
| | - N Birchmore
- Great Ormond Street Hospital For Children, NHS Foundation Trust, London, UK
| | - M Kershaw
- Birmingham Women's And Children NHS Foundation Trust, Birmingham, UK
| | - J Drew
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - F Kavvoura
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - J Law
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - C Moudiotis
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - E Procter
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - P Paul
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - F Regan
- Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - P Reilly
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - P Sachdev
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - R Sakremath
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - C Semple
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - M Skae
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - A Timmis
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - E Williams
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - N Wright
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S102TH, UK
| | - A Soni
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S102TH, UK.
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Carr ST, Saito ER, Walton CM, Saito JY, Hanegan CM, Warren CE, Trumbull AM, Bikman BT. Ceramides Mediate Insulin-Induced Impairments in Cerebral Mitochondrial Bioenergetics in ApoE4 Mice. Int J Mol Sci 2023; 24:16635. [PMID: 38068958 PMCID: PMC10706658 DOI: 10.3390/ijms242316635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Alzheimer's disease (AD) is the most common form of neurodegenerative disease worldwide. A large body of work implicates insulin resistance in the development and progression of AD. Moreover, impairment in mitochondrial function, a common symptom of insulin resistance, now represents a fundamental aspect of AD pathobiology. Ceramides are a class of bioactive sphingolipids that have been hypothesized to drive insulin resistance. Here, we describe preliminary work that tests the hypothesis that hyperinsulinemia pathologically alters cerebral mitochondrial function in AD mice via accrual of the ceramides. Homozygous male and female ApoE4 mice, an oft-used model of AD research, were given chronic injections of PBS (control), insulin, myriocin (an inhibitor of ceramide biosynthesis), or insulin and myriocin over four weeks. Cerebral ceramide content was assessed using liquid chromatography-mass spectrometry. Mitochondrial oxygen consumption rates were measured with high-resolution respirometry, and H2O2 emissions were quantified via biochemical assays on brain tissue from the cerebral cortex. Significant increases in brain ceramides and impairments in brain oxygen consumption were observed in the insulin-treated group. These hyperinsulinemia-induced impairments in mitochondrial function were reversed with the administration of myriocin. Altogether, these data demonstrate a causative role for insulin in promoting brain ceramide accrual and subsequent mitochondrial impairments that may be involved in AD expression and progression.
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Affiliation(s)
| | | | | | | | | | | | | | - Benjamin T. Bikman
- Department of Cell Biology and Physiology, Brigham Young University, Provo, UT 84602, USA; (S.T.C.); (E.R.S.); (C.M.W.); (A.M.T.)
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Ergenekon AP, Gokdemir Y, Ersu R. Medical Treatment of Obstructive Sleep Apnea in Children. J Clin Med 2023; 12:5022. [PMID: 37568423 PMCID: PMC10419369 DOI: 10.3390/jcm12155022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent complete or partial obstruction of the upper airway. The prevalence is 1-4% in children aged between 2 and 8 years and rising due to the increase in obesity rates in children. Although persistent OSA following adenotonsillectomy is usually associated with obesity and underlying complex disorders, it can also affect otherwise healthy children. Medical treatment strategies are frequently required when adenotonsillectomy is not indicated in children with OSA or if OSA is persistent following adenotonsillectomy. Positive airway pressure treatment is a very effective modality for persistent OSA in childhood; however, adherence rates are low. The aim of this review article is to summarize medical treatment options for OSA in children.
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Affiliation(s)
- Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey; (A.P.E.); (Y.G.)
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey; (A.P.E.); (Y.G.)
| | - Refika Ersu
- Division of Respirology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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7
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Constantin E, MacLean JE, Barrowman N, Horwood L, Bendiak GN, Kirk VG, Hadjiyannakis S, Legault L, Foster BJ, Katz SL. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence. J Clin Sleep Med 2023; 19:555-562. [PMID: 36541207 PMCID: PMC9978431 DOI: 10.5664/jcsm.10386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Behavioral characteristics and outcomes of positive airway pressure (PAP) therapy in children with obesity and moderate-severe sleep-disordered breathing (SDB) have not been reported. Our aims were to 1) determine baseline behavioral/emotional symptoms of this population and characterize changes over time with PAP, and 2) examine associations between baseline behavioral/emotional symptoms and PAP adherence. METHODS This multicenter prospective cohort study of children with obesity prescribed PAP for moderate-severe SDB assessed PAP adherence (≥ 4 h/night, >50% of nights, usage diaries, downloads) and compared behavioral/emotional characteristics with parent- and child-reported Conners Rating Scale (Conners) and the Child Behavior Checklist (CBCL) at baseline and 1 year after PAP prescription between adherent and nonadherent participants; scores at baseline were compared retrospectively between adherence groups. RESULTS Twenty-four children were included (median 14.1 years [IQR:12.4,16.0]; 87.5% males). Baseline Conners and CBCL scores were elevated (parent- and child-reported Conners inattention and hyperactivity subscales and CBCL subscales [total, internalizing, externalizing]). Baseline parent-reported Conners scores were significantly more elevated in the nonadherent than adherent group (inattention: 73.3 ± 8.5 vs 60.5 ± 14.6, P = .01; hyperactivity: 70.9 ± 11.1 vs 59.1 ± 16.0, P = .05). This difference was present 1 year later for inattention (P = .01) but not for hyperactivity (P = .09). Parent-reported CBCL scores improved over 1 year in adherent but not nonadherent participants. CONCLUSIONS We found that children with obesity and moderate-severe SDB have elevated symptoms of behavioral/emotional concerns on standardized testing. Parent-reported emotional characteristics improved in the adherent but not in the nonadherent group. Children with greater inattention/hyperactivity at baseline were less adherent to PAP, suggesting this may contribute to PAP nonadherence. CITATION Constantin E, MacLean JE, Barrowman N, et al. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence. J Clin Sleep Med. 2023;19(3):555-562.
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Affiliation(s)
- Evelyn Constantin
- Montreal Children’s Hospital/McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanna E. MacLean
- Stollery Children’s Hospital/University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Barrowman
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Linda Horwood
- Montreal Children’s Hospital/McGill University Health Centre, Montreal, Quebec, Canada
| | - Glenda N. Bendiak
- Alberta Children’s Hospital/University of Calgary, Calgary, Alberta, Canada
| | - Valerie G. Kirk
- Alberta Children’s Hospital/University of Calgary, Calgary, Alberta, Canada
| | - Stasia Hadjiyannakis
- Children’s Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
| | - Laurent Legault
- Montreal Children’s Hospital/McGill University Health Centre, Montreal, Quebec, Canada
| | - Bethany J. Foster
- Montreal Children’s Hospital/McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherri L. Katz
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
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8
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Sawunyavisuth B, Ngamjarus C, Sawanyawisuth K. Adherence to Continuous Positive Airway Pressure Therapy in Pediatric Patients with Obstructive Sleep Apnea: A Meta-Analysis. Ther Clin Risk Manag 2023; 19:143-162. [PMID: 36761690 PMCID: PMC9904217 DOI: 10.2147/tcrm.s358737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/22/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a public health problem that affects children. Although continuous positive airway pressure (CPAP) therapy is effective, the CPAP adherence rate in children is varied. This study aimed to evaluate the CPAP adherence rate and factors associated with CPAP adherence in children with OSA using a systematic review. Methods The inclusion criteria were observational studies conducted in children with OSA and assessed adherence of CPAP using objective evaluation. The literature search was performed in four databases. Meta-analysis using fixed-effect model was conducted to combine results among included studies. Results In all, 34 studies that evaluated adherence rate and predictors of CPAP adherence in children with OSA were included, representing 21,737 patients with an average adherence rate of 46.56%. There were 11 calculations of factors predictive of CPAP adherence: age, sex, ethnicity, body mass index, obesity, income, sleep efficiency, the apnea-hypopnea index (AHI), severity of OSA, residual AHI, and lowest oxygen saturation level. Three different factors were linked to children with adherence and non-adherence to CPAP: age, body mass index, and AHI. Conclusion The CPAP adherence rate in children with OSA was 46.56%. Young age, low body mass index, and high AHI were associated with acceptable CPAP adherence in children with OSA.
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Affiliation(s)
- Bundit Sawunyavisuth
- Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, Thailand
| | - Chetta Ngamjarus
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Kittisak Sawanyawisuth, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Tel +66-43-363664, Fax +66-43-348399, Email
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9
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Okorie CUA, Afolabi-Brown O, Tapia IE. Pediatric pulmonary year in review 2021: Sleep medicine. Pediatr Pulmonol 2022; 57:2298-2305. [PMID: 35779240 DOI: 10.1002/ppul.26047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Pediatric pulmonology publishes original research, review articles, and case reports on a wide variety of pediatric respiratory disorders. In this article, we summarized the past year's publications in sleep medicine and reviewed selected literature from other journals in this field. We focused on original research articles exploring aspects of sleep-disordered breathing in patients with underlying conditions such as cystic fibrosis, asthma, and sickle cell disease. We also explored sleep-disordered breathing risk factors, monitoring, diagnosis, and treatment; and included recent recommendations for drug-induced sleep endoscopy and ways to monitor and improve PAP adherence remotely.
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Affiliation(s)
- Caroline U A Okorie
- Division of Pediatric Pulmonology, Asthma and Sleep Medicine, Stanford Children's Health, Stanford, California, USA
| | - Olufunke Afolabi-Brown
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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10
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Myette RL, Feber J, Blinder H, Bendiak GN, Foster BJ, MacLean JE, Constantin E, Katz SL. Blood pressure variability in children with obesity and sleep-disordered breathing following positive airway pressure treatment. Pediatr Res 2022; 92:810-815. [PMID: 34785780 DOI: 10.1038/s41390-021-01841-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/14/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022]
Abstract
Obese youth with sleep-disordered breathing are treated with positive airway pressure to improve sleep and cardiovascular status. While improvements in sleep parameters have been confirmed, a study by Katz et al. showed no major improvement in ambulatory blood pressure. The aim of this ancillary study was to analyze short-term blood pressure variability, following positive airway pressure treatment, as a more sensitive marker of cardiovascular health. We analyzed 24-h blood pressure variability data in 17 children, taken at baseline and after 12 months of treatment. These data were derived from an already published prospective, multicenter cohort study conducted in 27 youth (8-16 years) with obesity who were prescribed 1-year of positive airway pressure for moderate-severe sleep-disordered breathing. Significant decreases were found in 24 h systolic blood pressure (p = 0.040) and nighttime diastolic blood pressure (p = 0.041) average real variability, and diastolic blood pressure (p = 0.035) weighted standard deviation. Significant decreases were noted in nighttime diastolic blood pressure time rate variability (p = 0.007). Positive airway pressure treatment resulted in a significant decrease in blood pressure variability, suggesting a clinically significant improvement of sympathetic nerve activity in youth with obesity and sleep-disordered breathing. IMPACT: Cardiovascular variability, as measured by blood pressure variability, is improved in children following positive airway pressure treatment. Our novel findings of improved blood pressure time rate variability are the first described in the pediatric literature. Future studies aimed at analyzing target organ damage in this patient population will allow for a better understanding as to whether alterations in blood pressure variability translate to decreasing target organ damage in children, as seen in adults.
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Affiliation(s)
- Robert L Myette
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.,Kidney Research Center, Department of Cellular and Molecular Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Janusz Feber
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. .,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Glenda N Bendiak
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Bethany J Foster
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Montreal Children's Hospital of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Evelyn Constantin
- Pediatric Sleep Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada.,Division of Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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11
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Xanthopoulos MS, Williamson AA, Tapia IE. Positive airway pressure for the treatment of the childhood obstructive sleep apnea syndrome. Pediatr Pulmonol 2022; 57:1897-1903. [PMID: 33647183 PMCID: PMC8408267 DOI: 10.1002/ppul.25318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Abstract
In this review, we have summarized the benefits of treatment with positive airway pressure for the childhood obstructive sleep apnea syndrome and presented a socio-ecological framework to enhance our understanding of positive airway pressure adherence predictors and important targets of comprehensive positive airway pressure treatment models across different pediatric populations. Although positive airway pressure is clearly a beneficial treatment for pediatric obstructive sleep apnea syndrome, additional research is needed to evaluate how socio-ecological factors may interact to predict positive airway pressure adherence, with more attention to the impact of the broader healthcare setting and on treatment approaches and outcomes in special pediatric populations.
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Affiliation(s)
- Melissa S Xanthopoulos
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariel A Williamson
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ignacio E Tapia
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Fauroux B, Abel F, Amaddeo A, Bignamini E, Chan E, Corel L, Cutrera R, Ersu R, Installe S, Khirani S, Krivec U, Narayan O, MacLean J, Perez De Sa V, Pons-Odena M, Stehling F, Trindade Ferreira R, Verhulst S. ERS Statement on pediatric long term noninvasive respiratory support. Eur Respir J 2021; 59:13993003.01404-2021. [PMID: 34916265 DOI: 10.1183/13993003.01404-2021] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/03/2021] [Indexed: 11/05/2022]
Abstract
Long term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced pediatric multidisciplinary team. This Statement written by experts in the field of pediatric long term CPAP/NIV aims to emphasize on the most recent scientific input and should open up to new perspectives and research areas.
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Affiliation(s)
- Brigitte Fauroux
- AP-HP, Hôpital Necker, Pediatric noninvasive ventilation and sleep unit, Paris, France .,Université de Paris, EA 7330 VIFASOM, Paris, France
| | - François Abel
- Respiratory Department, Sleep & Long-term Ventilation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alessandro Amaddeo
- Emergency department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit Regina Margherita Hospital AOU Città della Salute e della Scienza Turin Italy
| | - Elaine Chan
- Respiratory Department, Sleep & Long-term Ventilation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Linda Corel
- Pediatric ICU, Centre for Home Ventilation in Children, Erasmus university Hospital, Rotterdam, the Netherlands
| | - Renato Cutrera
- Pediatric Pulmonology Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Refika Ersu
- Division of Respiratory Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa Canada
| | - Sophie Installe
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Sonia Khirani
- AP-HP, Hôpital Necker, Pediatric noninvasive ventilation and sleep unit, Paris, France.,Université de Paris, EA 7330 VIFASOM, Paris, France.,ASV Santé, Gennevilliers, France
| | - Uros Krivec
- Department of Paediatric Pulmonology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Omendra Narayan
- Sleep and Long Term Ventilation unit, Royal Manchester Children's Hospital and University of Manchester, Manchester, UK
| | - Joanna MacLean
- Division of Respiratory Medicine, Department of Pediatrics, University of Alberta, Edmonton Canada
| | - Valeria Perez De Sa
- Department of Pediatric Anesthesia and Intensive Care, Children's Heart Center, Skåne University Hospital, Lund, Sweden
| | - Marti Pons-Odena
- Pediatric Home Ventilation Programme, University Hospital Sant Joan de Déu, Barcelona, Spain.,Respiratory and Immune dysfunction research group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Childreńs Hospital, University of Duisburg-Essen, Essen, Germany
| | - Rosario Trindade Ferreira
- Pediatric Respiratory Unit, Department of Paediatrics, Hospital de Santa Maria, Academic Medical Centre of Lisbon, Portugal
| | - Stijn Verhulst
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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13
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Hady KK, Okorie CUA. Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea. CHILDREN 2021; 8:children8110979. [PMID: 34828692 PMCID: PMC8625888 DOI: 10.3390/children8110979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder of breathing during sleep, characterized by intermittent or prolonged upper airway obstruction that can disrupt normal ventilation and/or sleep patterns. It can affect an estimated 2–4% of children worldwide. Untreated OSAS can have far reaching consequences on a child’s health, including low mood and concentration as well as metabolic derangements and pulmonary vascular disease. Most children are treated with surgical intervention (e.g., first-line therapy, adenotonsillectomy); however, for those for whom surgery is not indicated or desired, or for those with postoperative residual OSAS, positive airway pressure (PAP) therapy is often employed. PAP therapy can be used to relieve upper airway obstruction as well as aid in ventilation. PAP therapy is effective in treatment of OSAS in children and adults, although with pediatric patients, additional considerations and limitations exist. Active management and care for various considerations important to pediatric patients with OSAS can allow PAP to be an effective and safe therapy in this population.
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Affiliation(s)
- Kelly K. Hady
- Department of Pediatrics, Valley Children’s Healthcare, Fresno, CA 93636, USA;
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Caroline U. A. Okorie
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence:
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14
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Blinder H, Momoli F, Holland SH, Blinder A, Radhakrishnan D, Katz SL. Clinical predictors of nonadherence to positive airway pressure therapy in children: a retrospective cohort study. J Clin Sleep Med 2021; 17:1183-1192. [PMID: 33590820 PMCID: PMC8314672 DOI: 10.5664/jcsm.9162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Despite the importance of treating sleep-disordered breathing, positive airway pressure adherence rates in children are low. Identifying readily available predictors of nonadherence would enable the development of targeted interventions and supports, but literature is limited. Our objective was to identify baseline clinical predictors of 6-month positive airway pressure therapy nonadherence in children with SDB through a retrospective cohort study. METHODS This study evaluated children (ages 8-17 years) prescribed positive airway pressure therapy for sleep-disordered breathing between 2011 and 2017 at a single pediatric tertiary hospital. The primary outcome was nonadherence at 6 months, measured using both machine downloads and self-report. Candidate baseline predictors included demographics, comorbidities, and sleep-disordered breathing characteristics. Relative risks (RR) and 95% confidence intervals (CI) were estimated using a modified Poisson regression. Missing data were imputed prior to analysis. RESULTS The study included 104 children. The independent predictors most strongly associated with greater nonadherence were older age (RR = 1.08 for a 1-year increase; 95% CI, 1.00-1.16) and higher oxygen saturation nadir (RR = 1.03 for a 1% increase; 95% CI, 1.00-1.05), whereas those most strongly associated with lower nonadherence were higher arousal index (RR = 0.97 for a 1 event/h increase; 95% CI, 0.95-1.00), developmental delay (RR = 0.58; 95% CI, 0.30-1.13), and asthma (RR = 0.72; 95% CI, 0.44-1.17). CONCLUSIONS Overall, children who are older, have less-severe sleep-disordered breathing, or less-disrupted sleep at baseline are more likely to be nonadherent to positive airway pressure therapy and may benefit from additional supports to acclimatize to therapy. As clinical predictors were only weakly associated with nonadherence, nonclinical characteristics may play a larger role in predicting adherence.
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Affiliation(s)
- Henrietta Blinder
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen H. Holland
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anna Blinder
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dhenuka Radhakrishnan
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Division of Respirology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital—Civic Campus, Ottawa, Ontario, Canada
| | - Sherri L. Katz
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Division of Respirology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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15
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Kirk VG, Edgell H, Joshi H, Constantin E, Katz SL, MacLean JE. Cardiovascular changes in children with obstructive sleep apnea and obesity after treatment with noninvasive ventilation. J Clin Sleep Med 2020; 16:2063-2071. [PMID: 32808921 PMCID: PMC7848931 DOI: 10.5664/jcsm.8760] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES Adults with obesity and obstructive sleep apnea (OSA) are at risk for cardiometabolic disease, and this risk likely extends to children with both conditions. Noninvasive ventilation (NIV; including continuous and bilevel positive airway pressure) is often used to treat OSA in children with obesity. The aim of this study was to examine the impact of NIV treatment on heart rate variability (HRV), as a marker of cardiovascular risk, in children with obesity and newly diagnosed OSA. METHODS A prospective multicenter cohort study was conducted in children with obesity prescribed NIV therapy for newly diagnosed moderate-severe OSA. Measurements of HRV were derived from polysomnography recordings at baseline and after 12 months of treatment. HRV parameters were examined by sleep stage, before and after arousal and oxygen desaturation events. HRV parameters were compared between time points using pair t tests as well as mixed model analysis. RESULTS Twelve children had appropriate data for analysis at baseline and 12 months. Heart rate decreased by 4.5 beats/min after NIV treatment, with no change in HRV parameters. HRV parameters differed by sleep stage and showed an increase in arousal-related sympathetic-parasympathetic balance after 12 months of NIV treatment. HRV parameters did not differ before and after oxygen desaturation events. CONCLUSIONS NIV for the treatment in children with obesity and OSA resulted in a small decrease in heart rate and an increase in arousal-related sympathetic-parasympathetic balance. These findings suggest small, potentially positive impacts of NIV on cardiovascular risk in children with concurrent obesity and OSA.
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Affiliation(s)
- Valerie G. Kirk
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Evelyn Constantin
- Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
| | - Sherri L. Katz
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanna E. MacLean
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
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16
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Rodriguez-Lopez S, Palkowski S, Gerdung C, Keto-Lambert D, Sebastianski M, Castro-Codesal ML. Does obstructive sleep apnoea contribute to obesity, hypertension and kidney dysfunction in children? A systematic review protocol. BMJ Open 2020; 10:e039342. [PMID: 32868367 PMCID: PMC7462153 DOI: 10.1136/bmjopen-2020-039342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Childhood obstructive sleep apnoea (OSA) is a highly prevalent disorder that may directly contribute to the development of obesity, hypertension and renal injury. Although those associations seem to be clearer in adults, studies in children have revealed conflicting results and updated synthesis of the evidence is lacking. The aim of this systematic review is to summarise the available evidence on the effect of OSA on obesity, systemic blood pressure and kidney function, to help to elucidate whether respiratory interventions to correct OSA would have the potential to improve those outcomes. METHODS AND ANALYSIS A systematic literature review search was created by a medical librarian and peer-reviewed by a second librarian prior to running. Ovid Medline, Ovid Embase, CINAHL via EbscoHOST, Wiley Cochrane Library and ProQuest Dissertations and Theses Global were searched on 25 February 2020. Titles and abstracts will be screened by two independent reviewers for inclusion, followed by full-text screening of relevant articles. Studies in children will be included if they report data on OSA and weight, systemic blood pressure or kidney parameters. The extracted data will be combined for analysis and the information subcategorised in groups based on outcome. Risk of bias will be determined using tools specific to study methodology and certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. ETHICS AND DISSEMINATION This study will provide essential information for healthcare professionals to better understand the relationship between childhood OSA and changes in body mass index, systemic blood pressure and kidney function indicators. Our findings will be disseminated through conferences and publications. The results of this review may guide the initiation of new strategies and the development of future research studies. This research did not involve human subjects and therefore did not undergo research ethical review. PROSPERO REGISTRATION NUMBER CRD42020171186.
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Affiliation(s)
- Sara Rodriguez-Lopez
- Nephrology, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Respiratory Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Luisa Castro-Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Respiratory Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
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17
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Siriwat R, Wang L, Shah V, Mehra R, Ibrahim S. Obstructive sleep apnea and insulin resistance in children with obesity. J Clin Sleep Med 2020; 16:1081-1090. [PMID: 32118578 DOI: 10.5664/jcsm.8414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVES Because existing data investigating obstructive sleep apnea (OSA) and insulin resistance (IR) are inconsistent, we examine OSA and IR in a pediatric obesity clinic. METHODS Children (2-18 years) in the obesity clinic (2013-2017) undergoing polysomnography (PSG), anthropometric measurements, and fasting laboratory tests were included. Linear regression assessed OSA defined by the obstructive apnea-hypopnea index (oAHI) with the homeostatic model assessment of insulin resistance (HOMA-IR). Secondary aims assessed oxygen desaturation index (ODI) and age interactions with HOMA-IR. Logistic regression models and receiver operating characteristic analysis were performed to investigate optimal oAHI and ODI cutoffs relative to HOMA-IR ≥ 3. RESULTS Eighty children were included (mean age, 11.4 ± 4.0 years; 56% female; 46% Caucasian; median body mass index [BMI], 34.6 kg/m² [interquartile ratio, 29.9-40.1], median BMI z-score, 2.5 [interquartile ratio, 2.3-2.8); 46% with oAHI ≥ 5 events/h. HOMA-IR was higher in the OSA group (oAHI ≥ 5 events/h): 5 vs 3.8 (P = .034). After adjustment for sex, race, and BMI z-score, oAHI ≥ 5 events/h retained significance with HOMA-IR (P = .041). HOMA-IR increased in older children (age ≥ 12 years) when adjusting for waist circumference z-score and waist-height ratio (statistical interaction, P = .020 and .034, respectively). Receiver operating characteristic showed optimal cut points of oAHI and ODI for predicting significant IR 4.9 (area under the curve, 0.70; 95% confidence interval, 0.57-0.83; sensitivity, 0.76; specificity, 0.66) and 4.6 (area under the curve, 0.68; 95% confidence interval, 0.55-0.80; sensitivity, 0.70; specificity, 0.67), respectively. CONCLUSIONS In a clinic-based pediatric cohort with obesity, OSA is associated with increased IR even after adjusting for confounders including obesity defined by the BMI z-score. Age ≥ 12 years was associated with AHI relative to IR after adjustment for waist circumference z-score and waist-height ratio. Significant IR could be discriminated by oAHI ≥ 4.9 with moderate sensitivity/specificity. Future studies are needed to verify these findings.
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Affiliation(s)
| | - Lu Wang
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Vaishal Shah
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland, Ohio
| | - Sally Ibrahim
- Division of Pulmonary, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital of University Hospitals, Cleveland, Ohio
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18
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Katz SL, Kirk VG, MacLean JE, Bendiak GN, Harrison MA, Barrowman N, Hoey L, Horwood L, Hadjiyannakis S, Legault L, Foster BJ, Constantin E. Factors related to positive airway pressure therapy adherence in children with obesity and sleep-disordered breathing. J Clin Sleep Med 2020; 16:733-741. [PMID: 32029068 DOI: 10.5664/jcsm.8336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVES Positive airway pressure (PAP) is used to treat children with concurrent obesity and sleep-disordered breathing (SDB), but achieving adherence remains challenging. We aimed to identify factors associated with PAP adherence in a prospective cohort of children with obesity prescribed PAP for newly diagnosed SDB. METHODS A questionnaire to assess factors related to PAP adherence was administered to participants and their parent ≥12 months after enrollment. Adherence (PAP use ≥4 hours/night on >50% of nights) was measured with PAP machine downloads, diaries, and physician assessments. Questionnaire responses were compared between adherent/nonadherent participants and between children/parents. Age, total and obstructive apnea-hypopnea index (OAHI), lowest oxygen saturation, and highest carbon dioxide were compared between adherent/nonadherent children with univariate differences of medians, with 95% confidence intervals. RESULTS Fourteen children (median age: 14.3 years; 93% male; all with obstructive sleep apnea) were included. Eleven (79%) were adherent to PAP. SDB symptom improvement was reported in 9 of 14 children (64%); 8 of 14 children (57%) had positive experiences with PAP. Most children assumed an active role in PAP initiation and felt supported by the clinical team. Responses between adherent/nonadherent groups and between children/parents were similar. Oxygen saturation nadir (median difference between nonadherent and adherent groups: 8.9%; 95% confidence interval: 1.7, 16.1), but not age, apnea-hypopnea index, OAHI, or maximum carbon dioxide, was associated with PAP adherence. CONCLUSIONS Children with obesity-related SDB with lower nocturnal oxygen saturation nadir were more likely to adhere to PAP therapy. Ensuring adequate understanding of PAP therapy and medical team support are key factors in PAP success.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Valerie G Kirk
- Alberta Children's Hospital/University of Calgary, Calgary, Alberta, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital/University of Alberta, Edmonton, Alberta, Canada
| | - Glenda N Bendiak
- Alberta Children's Hospital/University of Calgary, Calgary, Alberta, Canada
| | - Mary-Ann Harrison
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Linda Horwood
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
| | - Laurent Legault
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
| | - Bethany J Foster
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada
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19
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Khan MA, Mathur K, Barraza G, Sin S, Yang CJ, Arens R, Sutton N, Mahgerefteh J. The relationship of hypertension with obesity and obstructive sleep apnea in adolescents. Pediatr Pulmonol 2020; 55:1020-1027. [PMID: 32068974 DOI: 10.1002/ppul.24693] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/30/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the independent relationships of obesity and obstructive sleep apnea (OSA) with hypertension/elevated blood pressure (EBP) in adolescent patients. STUDY DESIGN A retrospective cohort analysis was performed on 501 patients (age 13-21 years) with three separate blood pressure measurements within 6 months of polysomnography. EBP was defined as average systolic blood pressure (SBP) ≤120 mm Hg; obesity as body mass index Z-score ≤1.65; and OSA as obstructive apnea-hypopnea index <1. Pearson correlations and multivariable analyses were performed to assess the independent effects of the apnea-hypopnea index and body mass index Z-score on SBP. RESULTS Of 501 patients (mean age 16 ± 2 years), 246 (49%) were male. OSA was present in 329 (66%) patients, obesity in 337 (67%), and EBP in 262 (52%). EBP was present in 70% of obese adolescents and 60% of adolescents with OSA. Univariable correlation showed a significant relationship between SBP, body mass index Z-score, and apnea-hypopnea index. Multivariable linear regression analysis showed blood pressure was significantly associated with body mass index Z-score (β = .46; P < .01), age (β = .25; P < .01), and height Z-score (β = .14; P < .01), but not apnea-hypopnea index (β = .01; P = .72). CONCLUSIONS The relationship between OSA and EBP in adolescents is most closely associated with the degree of obesity. Further studies are needed to assess the effect of the treatment of obesity and OSA on blood pressure in adolescents.
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Affiliation(s)
- Masrur A Khan
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Kanika Mathur
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Heart Center/Mount Sinai School of Medicine, New York, New York
| | - Giselle Barraza
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Sanghun Sin
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Pediatric Otorhinolaryngology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Nicole Sutton
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
| | - Joseph Mahgerefteh
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
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20
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Watach AJ, Xanthopoulos MS, Afolabi-Brown O, Saconi B, Fox KA, Qiu M, Sawyer AM. Positive airway pressure adherence in pediatric obstructive sleep apnea: A systematic scoping review. Sleep Med Rev 2020; 51:101273. [PMID: 32120165 DOI: 10.1016/j.smrv.2020.101273] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
Positive airway pressure (PAP) therapy is a commonly prescribed treatment for pediatric obstructive sleep apnea (OSA). Negative health consequences associated with untreated OSA make understanding the utilization of PAP therapy imperative. The aim of this review was to describe PAP use in children and adolescents with OSA, explore factors that influence use, and describe published scientific or clinical approaches to improve use. Among 20 studies, average PAP adherence was 56.9% (range, 24-87%). PAP use averaged 4.0 h (SD = 3.1) to 5.2 h (SD = 3.4) per night. Cautious consideration of summary estimates of PAP use is necessary as studies were heterogeneous and adherence definitions widely varied across studies. Age, sex, and developmental delay were the only factors associated with PAP use in more than one study. The majority of approaches to improve use were program evaluations rather than scientifically tested interventions. This review identified critical gaps in the existing literature and sets forth a research agenda for the future.
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Affiliation(s)
- Alexa J Watach
- University of Pennsylvania, Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
| | | | | | - Bruno Saconi
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Kathleen A Fox
- University of Pennsylvania, Biomedical Library, Philadelphia, PA, USA
| | - Maylene Qiu
- University of Pennsylvania, Biomedical Library, Philadelphia, PA, USA
| | - Amy M Sawyer
- University of Pennsylvania, Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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21
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Blinder H, Momoli F, Bokhaut J, Bacal V, Goldberg R, Radhakrishnan D, Katz SL. Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis. Sleep Med 2020; 69:19-33. [PMID: 32045851 DOI: 10.1016/j.sleep.2019.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND While positive airway pressure (PAP) is effective for treating sleep-disordered breathing (SDB) in children, adherence is poor. Studies evaluating predictors of PAP adherence have inconsistent findings, and no rigorous reviews have been conducted. This systematic review aims to summarize the literature on predictors of PAP therapy adherence in children. METHODS Studies evaluating baseline predictors of PAP therapy adherence in children (≤20 years) with SDB were included. We searched MEDLINE, Embase, CENTRAL, CINAHL, Clinicaltrials.gov, and the last four years of conference abstracts. Results were described narratively, with random-effects meta-analyses performed where feasible. Risk of bias and confidence in the evidence were assessed. RESULTS We identified 50 factors evaluated across 28 studies (21 full text articles, seven abstracts). The highest rates of PAP therapy adherence were most consistently found with female sex, younger age, Caucasian race, higher maternal education, greater baseline apnea-hypopnea index (AHI), and presence of developmental delay. Pooled estimates included odds ratios of 1.48 (95%CI: 0.75-2.93) favoring female sex, 1.26 (95%CI: 0.68-2.36) favoring Caucasian race, and a mean difference in AHI of 4.32 (95%CI: -0.61-9.26) events/hour between adherent and non-adherent groups. There was low quality evidence to suggest that psychosocial factors like health cognitions and family environment may predict adherence. CONCLUSION In this novel systematic review, we identified several factors associated with increased odds of PAP therapy adherence in children. These findings may help guide clinicians to identify and support children less likely to adhere to PAP therapy and should be considered when developing interventions to improve adherence.
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Affiliation(s)
- Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Julia Bokhaut
- Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Vanessa Bacal
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; Department of Obstetrics and Gynecology, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Reuben Goldberg
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Department of Family Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; ICES uOttawa, Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
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22
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Heffernan A, Malik U, Cheng R, Yo S, Narang I, Ryan CM. Transition to Adult Care for Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8122120. [PMID: 31810317 PMCID: PMC6947540 DOI: 10.3390/jcm8122120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Abstract
Obstructive sleep apnea may occur throughout the lifespan, with peak occurrences in early childhood and during middle and older age. Onset in childhood is overwhelmingly due to adeno-tonsillar hypertrophy, while in adulthood, contributors include risk factors, such as obesity, male sex, and aging. More recently, there has been a precipitous increase in the prevalence of obstructive sleep apnea in youth. Drivers of this phenomenon include both increasing obesity and the survival of children with complex medical conditions into adulthood. Appropriate treatment and long-term management of obstructive sleep apnea is critical to ensure that these youth maintain well-being unfettered by secondary comorbidities. To this end, patient engagement and seamless transition of care from pediatric to adult health care systems is of paramount importance. To date, this is an unacknowledged and unmet need in most sleep programs. This article highlights the need for guideline-driven sleep disorder transition processes and illustrates the authors’ experience with the development of a program for sleep apnea.
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Affiliation(s)
- Austin Heffernan
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Uzair Malik
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Russell Cheng
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Shaun Yo
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Indra Narang
- Department of Pediatrics, Division of Respirology, University of Toronto, Toronto, ON M5G1X8, Canada;
- Sleep Laboratory, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Clodagh M. Ryan
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
- Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON M5G2N2, Canada
- Correspondence:
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23
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Parmar A, Baker A, Narang I. Positive airway pressure in pediatric obstructive sleep apnea. Paediatr Respir Rev 2019; 31:43-51. [PMID: 31130426 DOI: 10.1016/j.prrv.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by snoring, recurrent obstruction (apneas) of the upper airway which disrupts normal ventilation during sleep. In the last decade, there has been a increase in children diagnosed with persistent, severe OSA attributed to (1) the obesity epidemic as 25-60% of obese children will have obesity related OSA (2) advances in medical technology that have increased life expectancy of medically complex children (3) improved diagnostics and (4) increased awareness. Positive airway pressure (PAP) is commonly used to treat persistent, severe OSA. PAP devices deliver pressurized air via nasal or oronasal interfaces to distend the upper airway and ameliorate OSA. Although effective in treating OSA, PAP adherence is suboptimal. This review article provides an overview of (1) PAP use in pediatric OSA (2) PAP devices (3) PAP adherence, (4) strategies and interventions to improve adherence and (5) Optimizing PAP delivery during pediatric to adult transition.
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Affiliation(s)
- Arpita Parmar
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Adele Baker
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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24
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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25
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MacLean JE. Assessment and treatment of pediatric obstructive sleep apnea in Canada: history and current state of affairs. Sleep Med 2019; 56:23-28. [PMID: 30745075 DOI: 10.1016/j.sleep.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 02/07/2023]
Abstract
AIM To highlight Canada's contributions to the assessment and treatment of pediatric obstructive sleep apnea as well as outline the current state of pediatric obstructive sleep apnea in Canada. METHODS A search was conducted in MEDLINE (Ovid) using Medical Subject Headings (MeSH) and free-text terms for 'child' and 'obstructive sleep apnea' with subsequent 'human' limit. The results were reviewed to identify publications where any author's listed a Canadian institution. RESULTS Canadian contributions to the field of pediatric obstructive sleep apnea have grown over the last 30 years with an increase in number of contributors and centres. Much of the early work stemmed from McGill University with important contributions in examining alternatives to polysomnography and post-adenotonsillectomy respiratory compromise. Today, contributors from centres across the country are engaged in the field and come from a greater diversity of disciplines. With continued challenges and opportunities, Canada will continue to help advance the field of pediatric OSA. CONCLUSION Canada has a strong community of people invested in continuing to work to improve the lives of Canadian children with pediatric OSA.
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Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
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26
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Ivy TL, Kemp JS. Quality of Life With PAP Therapy for Obese Children. J Clin Sleep Med 2018; 14:307-308. [PMID: 29458709 PMCID: PMC5837831 DOI: 10.5664/jcsm.6966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Tracy L. Ivy
- Allergy, Immunology, and Pulmonary Division, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - James S. Kemp
- Allergy, Immunology, and Pulmonary Division, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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27
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Katz SL, MacLean JE, Barrowman N, Hoey L, Horwood L, Bendiak GN, Kirk VG, Hadjiyannakis S, Legault L, Foster BJ, Constantin E. Long-Term Impact of Sleep-Disordered Breathing on Quality of Life in Children With Obesity. J Clin Sleep Med 2018; 14:451-458. [PMID: 29458697 DOI: 10.5664/jcsm.6998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES (1) To determine baseline quality of life (QOL) among children with obesity and newly diagnosed moderate-severe sleep-disordered breathing (SDB) and to compare it to the reported QOL of children with obesity or SDB alone and healthy children. (2) To evaluate QOL change after 1 year. METHODS A prospective multicenter cohort study was conducted in children (8-16 years) with obesity, prescribed positive airway pressure (PAP) therapy for moderate-severe SDB. Outcomes included parent-proxy and self-report total and subscale scores on the PedsQL questionnaire (baseline and 1-year). RESULTS Total PedsQL scores were indicative of impaired QOL in 69% of cases based on parent-report and in 62% on self-report. Parents reported significantly lower QOL in our cohort than that reported in other studies for children with obesity or SDB alone or healthy children, on total PedsQL score and on social and psychosocial subscales. PedsQL total scores for participants were significantly higher (mean difference 7.3 ± 15.3, P = .03) than those reported by parents. Parents reported significant improvements in total PedsQL (mean change 7.29 ± 13.73, P = .04) and social functioning (mean change 17.65 ± 24.69, P = .04) scores after 1 year. No significant differences were found by children's self-report or by PAP adherence. CONCLUSIONS QOL of children with obesity and SDB is lower than in children with obesity or SDB alone or healthy children. One year later, children reported no significant changes in QOL; parents reported significant improvements in total PedsQL and social functioning scores. PAP adherence did not significantly affect QOL change in this population. COMMENTARY A commentary on this article appears in this issue on page 307.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Linda Horwood
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Glenda N Bendiak
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Valerie G Kirk
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Laurent Legault
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bethany J Foster
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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28
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Koren D. PAP Therapy's Effect on Cardiometabolic Risk Markers in Pediatric Patients. J Clin Sleep Med 2017; 13:1025-1027. [PMID: 28818155 DOI: 10.5664/jcsm.6714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Dorit Koren
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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