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Gyapay R, Ioan I, Thieux M, Guyon A, Ayari S, Hullo E, Franco P, Coutier L. Gas exchange parameters for the prediction of obstructive sleep apnea in infants. J Clin Sleep Med 2024; 20:1059-1067. [PMID: 38372169 PMCID: PMC11217622 DOI: 10.5664/jcsm.11064] [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: 07/04/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
STUDY OBJECTIVES Sleep laboratory polysomnography is the gold standard for obstructive sleep apnea (OSA) diagnosis in infants, but its access remains limited. Oximetry-capnography is another simple and widely used tool that can provide information on the presence of desaturations and alveolar hypoventilation. However, its reliability is debated. This study aimed at examining its use in determining OSA severity in infants. METHODS This retrospective study was conducted in a sleep unit in a tertiary hospital in infants < 4 months old with clinical signs of OSA or Pierre Robin sequence who underwent a 1-night polysomnography coupled with oximetry-capnography. RESULTS Among the 78 infants included (median [interquartile range] age: 61 [45-89] days at polysomnography), 44 presented with Pierre Robin sequence and 34 presented with isolated airway obstruction. The clinical, sleep, and respiratory characteristics were not significantly different between the 2 subgroups. In the entire cohort, 63.5% had severe OSA. The median obstructive apnea-hypopnea index was 14.5 (7.4-5.9) events/h, peripheral oxygen saturation (SpO2) was 97.4% (96.5-98.1%), and transcutaneous carbon dioxide pressure (PtcCO2) was 41.1 mmHg (38.3-44.9). The optimal threshold to predict an obstructive apnea-hypopnea index > 10 events/h was 6 events/h for an oxygen desaturation index ≥ 3% (sensitivity, 95.7%; specificity, 51.9%) and 2 events/h for an oxygen desaturation index ≥ 4% (sensitivity, 95.7%; specificity, 48.1%). CONCLUSIONS Whereas transcutaneous capnography does not appear to be sufficient in predicting severe OSA in infants < 4 months old with Pierre Robin sequence or clinical signs of OSA, oximetry may be a useful alternative for the screening of severe OSA in infants in the absence of polysomnography. CITATION Gyapay R, Ioan I, Thieux M, et al. Gas exchange parameters for the prediction of obstructive sleep apnea in infants. J Clin Sleep Med. 2024;20(7):1059-1067.
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Affiliation(s)
- Romane Gyapay
- Service de Pneumologie Infantile, Allergologie et Centre De Référence En Mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Iulia Ioan
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Marine Thieux
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, Centre de Recherche en Neurosciences de Lyon, Université de Lyon 1, Lyon, France
| | - Aurore Guyon
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, Centre de Recherche en Neurosciences de Lyon, Université de Lyon 1, Lyon, France
| | - Sonia Ayari
- Service de Chirurgie Oto-Rhino-Laryngologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Eglantine Hullo
- Service de Pneumologie Infantile, Hôpital Couple-Enfant, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Patricia Franco
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, Centre de Recherche en Neurosciences de Lyon, Université de Lyon 1, Lyon, France
| | - Laurianne Coutier
- Service de Pneumologie Infantile, Allergologie et Centre De Référence En Mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, Centre de Recherche en Neurosciences de Lyon, Université de Lyon 1, Lyon, France
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Haighton C, Watson RM, Wilson JA, Powell S. Caregiver acceptability of a UK trial for paediatric sleep disordered breathing: A qualitative interview study. Clin Otolaryngol 2024; 49:254-257. [PMID: 37968090 DOI: 10.1111/coa.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Catherine Haighton
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Rose Mary Watson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- The Department of Otolaryngology (Ear, Nose and Throat) Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Lörinczi F, Vanderka M, Lörincziová D, Kushkestani M. Nose vs. mouth breathing- acute effect of different breathing regimens on muscular endurance. BMC Sports Sci Med Rehabil 2024; 16:42. [PMID: 38336799 PMCID: PMC10858538 DOI: 10.1186/s13102-024-00840-6] [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: 04/27/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND It has been reported that the way we breathe (whether through the nose or mouth) can influence many aspects of our health and to some extent, sport performance. The purpose of this study was to evaluate the acute effects of different breathing regimens on muscular endurance and physiological variables. METHODS A randomized experiment to verify the acute effect of different breathing regimens (NN- inhaling and exhaling through the nose; NM- inhaling through the nose, exhaling through the mouth; MM- inhaling and exhaling through the mouth) on the muscular endurance performance was conducted. 107 physically active college students (68 males, 39 females) performed repeated bench press testing protocol (repetitions to failure (RTF) with 60% of body weight for males (BP60), respectively 40% of body weight for females (BP40)) with various breathing regimens (NN, NM, MM) in random order. Heart rate (HR), blood oxygen saturation (SpO2) and perceived exertion by Borg scale (RPE) were measured as well. A short questionnaire, given after the testing protocol and observation during familiarization, was used to detect each subject's normal breathing approach during resistance training. RESULTS In both genders, no significant differences in RTF, RPE and SpO2 were found. No individual case of deviation of arterial oxygen saturation outside the physiological norm was recorded. In the male group, significantly lower HR values were found during the NN trials, compared to during the NM (p = 0.033) and MM (p = 0.047) trials with no significant differences in females. The HR differences in the males demonstrated a small effect size (NN < NM, d = 0.32; NN < MM, d = 0.30). Questionnaire results suggest that 80% of our participants use NM breathing, 15% use MM breathing and 5% use NN breathing during resistance training. CONCLUSION It seems, that various breathing regimens have none or only minor effect on muscular endurance performance and selected physiological parameters. NN seems to be as efficient as other two regimens, which are mostly used in practice (NM, MM).
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Affiliation(s)
- František Lörinczi
- Faculty of Physical Education and Sport, Comenius University in Bratislava, Bratislava, Slovakia.
| | - Marián Vanderka
- Faculty of Physical Education and Sport, Comenius University in Bratislava, Bratislava, Slovakia
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Paracha H, Parker Davidson K, Dixon C, Wilde Z. A Novel Intervention to Simultaneously Address the Dual Pathologies of Breathing Disorders During Sleep and Undiagnosed Attention Deficit Hyperactivity Disorder in School-Aged Children Ages 5-12. J Atten Disord 2024; 28:293-301. [PMID: 38031843 DOI: 10.1177/10870547231211024] [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] [Indexed: 12/01/2023]
Abstract
PURPOSE To evaluate the improvement of ADHD related symptoms in school-aged children ages 5 to 12 in treatment with a monobloc appliance (MOA) for Sleep Disordered Breathing (SDB). METHODS A retrospective review of questionnaire scores of ADHD symptoms from school-aged children being treated with a MOA for SDB. Data was obtained from parent survey questionnaires of 40 school-aged children in three dental offices in treatment with an MOA for SDB showing symptoms of ADHD yet to be confirmed with a formal diagnosis between 2019 and 2021. ADHD symptom scores were ascertained by a parent survey questionnaire completed at the initial visit before MOA treatment, and 2 to 6 months, and 7+ months during MOA treatment. RESULTS At the 7+ month endpoint, 17 of the 28 (61%) children ages 5 to 12 saw at least a 1-point drop in the sum of their questionnaire scores indicating an improvement in ADHD symptoms after initiating treatment with an MOA. Although there was a reduction of the overall average symptom score from the initial visit to 2 to 6 months (M = 4.06, SD ± 1.55), a statistically significant improvement in ADHD symptoms occurred at the 7+ month endpoint (M = 15.29, SD ± 4.50) during MOA treatment. CONCLUSIONS Treatment with an MOA may be highly effective in addressing the dual pathologies of SDB and ADHD in school-age children ages 5 to 12.
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Whitney K, Felt B, Collins-Anderson A, Bonuck K. The Feasibility of Screening for Sleep Problems in Early Childhood Education Programs. Behav Sleep Med 2024; 22:28-38. [PMID: 36751036 PMCID: PMC10404644 DOI: 10.1080/15402002.2023.2177294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Assess the feasibility and staff experience of screening for behavioral sleep problems (BSP) and sleep disordered breathing (SDB) in early childhood education (ECE) settings; examine BSP/SDB prevalence and caregivers' knowledge/attitudes, perception of child sleep problems, and sleep health engagement in this sample. METHOD Eight staff representatives from four ECE sites involved with sleep problem screening procedures within a larger RCT on ECE sleep health, discussed their experiences in a focus group; transcript content reviewed. A random subset of caregiver-child dyads (n = 59) from the four ECE sites completed sleep problem measures (BSP: Children's Sleep Habits Questionnaire, Short form [SF-CSHQ], Tayside Children's Sleep Questionnaire [TCSQ-sleep disturbance and difficulty] and SDB: Pediatric Sleep Questionnaire [PSQ], in addition to RCT measures (Parent Knowledge/Attitude/Self-efficacy/Beliefs survey and sleep health goals). Caregiver sleep health engagement was measured by the sleep health goals set. RESULTS ECE staff reported sleep problem screening as self-explanatory and doable but sometimes administratively burdensome. BSPs were identified in 44% (SF-CSHQ) to 63% (TCSQ-sleep disturbance) of children; SDBs in 13%. Only 11% of caregivers endorsed their child having a sleep "difficulty" (TCSQ). Sleep health goals were set by 85% of caregivers; 63% employed educational materials' language. CONCLUSION Sleep problem screening in ECE is feasible, and problems are elicited. While caregivers readily engage in setting healthy sleep goals, few endorse sleep as difficult. ECE education could improve caregiver understanding/recognition of sleep problems.
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Affiliation(s)
- Kimberly Whitney
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY
| | - Barbara Felt
- University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI
| | | | - Karen Bonuck
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY
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Sleep-Disordered Breathing among Saudi Primary School Children: Incidence and Risk Factors. Healthcare (Basel) 2023; 11:healthcare11050747. [PMID: 36900753 PMCID: PMC10000777 DOI: 10.3390/healthcare11050747] [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: 01/11/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
This study aimed to identify the incidence and risk factors of sleep-disordered breathing (SDB) using an Arabic version of the pediatric sleep questionnaire (PSQ). A total of 2000 PSQs were circulated to children aged 6-12 years who were randomly selected from 20 schools in Al-Kharj city, Saudi Arabia. The questionnaires were filled out by the parents of participating children. The participants were further divided into two groups (younger group: 6-9 years and older group: 10-12 years). Out of 2000 questionnaires, 1866 were completed and analyzed (93.3% response rate), of which 44.2% were from the younger group and 55.8% were from the older group. Among all the participants, a total of 1027 participants were female (55%) and 839 were male (45%) with a mean age of 9.67 ± 1.78 years. It showed that 13% of children were suffering from a high risk of SDB. Chi-square test and logistic regression analyses within this study cohort showed a significant association between SDB symptoms (habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting) and risk of developing SDB. In conclusion: habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting strongly contribute the to development of SDB.
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Williamson AA, Johnson TJ, Tapia IE. Health disparities in pediatric sleep-disordered breathing. Paediatr Respir Rev 2023; 45:2-7. [PMID: 35277358 PMCID: PMC9329494 DOI: 10.1016/j.prrv.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.
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Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Papadopoulos D, Sosso FAE. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med 2023; 19:605-620. [PMID: 36239056 PMCID: PMC9978435 DOI: 10.5664/jcsm.10336] [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: 05/17/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship. METHODS Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions. RESULTS Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship. CONCLUSIONS Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes. CITATION Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.
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Masoud AI, Mosli RH. Arabic translation and validation of a pediatric sleep questionnaire to assess the prevalence of sleep-disordered breathing among Saudi pre-school children. BMC Pediatr 2023; 23:50. [PMID: 36721123 PMCID: PMC9890847 DOI: 10.1186/s12887-022-03820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/26/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES (1) To translate to Arabic a validated pediatric sleep questionnaire, (2) To assess the validity and reliability of the translated questionnaire, and (3) To assess the prevalence of sleep-disordered breathing (SDB) among a group of pre-school children in Jeddah, Saudi Arabia. METHODS Using forward and back-translation, a set of 6 hierarchically arranged questions that comprise the Gozal sleep questionnaire was translated into Arabic. Validity was assessed using face validity and content validity for consistency and clarity, using both item-level and scale-level content validity indices (I-CVI, S-CVI). Consent forms were sent to 1783 mothers recruited from 8 different pre-schools in Jeddah between October 2017 and April 2018, and 209 signed and returned the consent forms. Out of this sample, 34 mothers were contacted to assess internal consistency using Cronbach's alpha, and test-retest reliability using Interclass correlation coefficient (ICC). Finally, all 209 mothers were contacted to answer the questionnaire to obtain the prevalence of SDB. RESULTS Using face validity and content validity, the translated questionnaire proved to be valid with perfect I-CVI and S-CVI. Internal consistency (Cronbach's Alpha 0.64-0.89) and test-retest reliability (ICC=0.87, p<0.001) showed the translated questionnaire to have good to favorable reliability. Depending on the severity of SDB, the prevalence of SDB was 7.7%, 5.7%, and 3.8% for mild, moderate and severe cut-off values respectively. CONCLUSION A validated pediatric sleep questionnaire to assess SDB was translated into Arabic and the translation proved to be valid and reliable. The prevalence of SDB was found to be very comparable to other areas in the world.
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Affiliation(s)
- Ahmed I Masoud
- grid.412125.10000 0001 0619 1117Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, PO Box 80209, Jeddah, 21589 Saudi Arabia
| | - Rana H Mosli
- grid.412125.10000 0001 0619 1117Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, PO Box 80209, Jeddah, 21589 Saudi Arabia
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Ajith A, Balu R, Kumar M, Panikkar S. The Impact of Adenotonsillectomy on Sleep and Behavior of Children with Obstructive Sleep Apnea. Indian J Otolaryngol Head Neck Surg 2022; 74:329-333. [PMID: 36213472 PMCID: PMC9535063 DOI: 10.1007/s12070-021-02593-x] [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: 01/28/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
Adenotonsillar hypertrophy (ATHt) is a common cause of chronic airway obstruction (UAO) in children and may cause obstructive sleep apnea syndrome (OSAS). Surgical correction in the form of Adenotonsillectomy (AdTyb) may significantly improve the sleep and behavior patterns of children, and enhance their quality of life. To test the effect of adenotonsillectomy on sleep and behavioral disorders in children with adenotonsillar hypertrophy. Prospective observational study; children ≤ 14 years diagnosed with symptomatic adenotonsillar hypertrophy planned for surgery were included. Parents were asked to complete Connor's revised parent rating scale and Children's sleep habit questionnaire pre-operatively and 3 months after surgery. This was done to evaluate the children's sleep habits, disturbances and behavior. A total of 77 children were included in the study. The age range was 4 - 14 years. Fifty-two were male and rest, female. There was a significant reduction in Sleep score after surgery (mean pre-operative sleep score 51.3 ± 8.9 vs. post-operative 37.29 ± 7.1; p value < 0.001). Similarly, there was a statistically significant improvement in the behaviour score also after surgery (mean pre-operative behavior score 28.96 ± 9.8 vs. post-operative 23.13 ± 7.9; p value < 0.001). The sleep and behaviour scores were not related to the age or gender of the participants. Adenotonsillar hypertrophy causes documentable sleep disturbances and obstructive sleep apnea leading to neurobehavioral issues in children. The standard of care is surgery which leads to significant improvement in these aspects and quality of life.
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Affiliation(s)
- Arya Ajith
- Department Of ENT Amrita Institute of Medical Sciences Kochi, Kerala Kochi, India
| | - Renuka Balu
- Department Of ENT Amrita Institute of Medical Sciences Kochi, Kerala Kochi, India
| | - Madhumita Kumar
- Department Of ENT Amrita Institute of Medical Sciences Kochi, Kerala Kochi, India
| | - Siddharth Panikkar
- Department Of ENT Amrita Institute of Medical Sciences Kochi, Kerala Kochi, India
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Towards A Socioeconomic Model of Sleep Health among the Canadian Population: A Systematic Review of the Relationship between Age, Income, Employment, Education, Social Class, Socioeconomic Status and Sleep Disparities. Eur J Investig Health Psychol Educ 2022; 12:1143-1167. [PMID: 36005229 PMCID: PMC9407487 DOI: 10.3390/ejihpe12080080] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/05/2022] Open
Abstract
A better understanding of the contribution of the socioeconomic status (SES) in sleep health could guide the development of population-based interventions aiming to reduce “the silent public health issue” that are sleep disturbances. PRISMA was employed to identify relevant studies having examined the association between social class, social capital, education, income/assets, occupation/employment status, neighborhood deprivation and sleep health. Sixteen cross-sectional and three longitudinal studies were selected, having sampled 226,029 participants aged from 2 months to 85 years old. Findings showed that: (1) sleep health disparities among children and adolescent are strongly correlated to parental socioeconomic indicators; (2) poor parental income, poor family SES and poor parental education are associated with higher sleep disturbances among children and adolescents; (3) lower education is a predictor of increased sleep disturbances for adults; (4) low SES is associated with high sleep disturbances in adults and old people and; (5) low income and full-time employment was significantly associated with short sleep among adults and old people. In conclusion, sleep health should be an important public health target. Such intervention would be beneficial for populational health, for all taxpayers and public administrations, which would see a reduction in absenteeism and productivity losses attributable to sleep-related health problems in the global economy.
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Masoud AI, Adavadkar PA, Park C, Gowharji LF, Alwadei AH, Carley DW. Comparing two pediatric sleep questionnaires: The Pediatric Sleep Questionnaire (PSQ) and a set of 6 hierarchically arranged questions (6Q). Cranio 2022; 40:303-312. [DOI: 10.1080/08869634.2020.1792221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ahmed I. Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pranshu A. Adavadkar
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, IL, USA
| | - Chang Park
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL, USA
| | - Lena F. Gowharji
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdurahman H. Alwadei
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - David W. Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL, USA
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Cooper JN, Koppera S, Bliss AJ, Lind MN. Characteristics associated with caregiver willingness to consider tonsillectomy for a child's obstructive sleep disordered breathing: Findings from a survey of families in an urban primary care network. Int J Pediatr Otorhinolaryngol 2022; 158:111143. [PMID: 35552164 DOI: 10.1016/j.ijporl.2022.111143] [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: 09/28/2021] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Tonsillectomy use is lower among Black children than White children in the U.S. despite their higher prevalence of obstructive sleep disordered breathing (oSDB). We aimed to identify factors associated with parents' willingness to consider tonsillectomy for their child's oSDB and to identify whether parents of Black children are less willing than parents of non-Black children to be willing to consider the procedure. STUDY DESIGN Prospective cohort study. SETTING Primary care network of a tertiary children's hospital. METHODS We surveyed parents/guardians of children aged 2-10 years with oSDB, to assess their knowledge about oSDB and tonsillectomy, perceived severity of their child's oSDB, perceived level of their child's sleep disturbance, perceived risks and benefits of tonsillectomy, stress, trust in their child's primary care physician and physicians in general, and health literacy. We also assessed child clinical and sociodemographic characteristics. Associations between these characteristics and parent/guardian willingness to consider tonsillectomy for their child's oSDB were assessed. RESULTS Of the 59 parents/guardians included, 90% were mothers and 71% were Black. Only 58% of caregivers of Black children but 85% of caregivers of non-Black children were willing to consider tonsillectomy (p = 0.04). Caregivers with another child who had undergone tonsillectomy and caregivers who perceived their child's sleep to be more disturbed were more often willing to consider tonsillectomy (both p = 0.02). CONCLUSIONS Parents of Black children are less willing to consider tonsillectomy for their child's oSDB, but this was not explained by any factors assessed in this study. Future studies should evaluate additional factors that may explain this difference and that might be targeted to ensure appropriate and equitable access to tonsillectomy among children with oSDB.
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Affiliation(s)
- Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra J Bliss
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Meredith N Lind
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, OH, USA
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Lim K, Quante M, Dijkstra TMH, Hilbert-Moessner G, Wiechers C, Dargaville P, Poets CF. Should obstructive hypopneas be included when analyzing sleep studies in infants with Robin Sequence? Sleep Med 2022; 98:9-12. [PMID: 35764010 DOI: 10.1016/j.sleep.2022.06.010] [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: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We have used an obstructive apnea index of ≥3 as treatment indication for infants with Robin sequence (RS), while the obstructive apnea-hypopnea index (OAHI) and a threshold of ≥5 is often used internationally. We wanted to know whether these two result in similar indications, and what the interobserver variability is with either asessement. METHODS Twenty lab-based overnight sleep recordings from infants with isolated RS (median age: 7 days, range 2-38) were scored based on the 2020 American Academy of Sleep Medicine guidelines, including or excluding obstructive hypopneas. RESULTS Median obstructive apnea index (OAI) was 18 (interquartile range: 7.6-38) including only apneas, and 35 (18-54) if obstructive hypopneas were also considered as respiratory events (OAHI). Obstructive sleep apnea (OSA) severity was re-classified from moderate to severe for two infants when obstructive hypopneas were also considered, but this did not lead to a change in clinical treatment decisions for either infant. Median interobserver agreement was 0.86 (95% CI 0.70-0.94) for the OAI, and 0.60 (0.05-0.84) for the OAHI. CONCLUSION Inclusion of obstructive hypopneas when assessing OSA severity in RS infants doubled the obstructive event rate, but impaired interobserver agreement and would not have changed clinical management.
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Affiliation(s)
- Kathleen Lim
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mirja Quante
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany
| | - Tjeerd M H Dijkstra
- Department of Translational Bioinformatics, University of Tübingen, Tübingen, Germany; Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Gabriele Hilbert-Moessner
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Cornelia Wiechers
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Peter Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christian F Poets
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.
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15
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Perspectives on paediatric sleep-disordered breathing in the UK: a qualitative study. The Journal of Laryngology & Otology 2022; 136:520-526. [DOI: 10.1017/s0022215121004242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThere is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children.MethodThe study comprised in-depth qualitative interviews (n = 22) with parents of children (2–9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically.ResultsGeneral practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed.ConclusionGuidelines for the management of paediatric sleep-disordered breathing are needed.
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16
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An epidemiologic study of sleep-disordered breathing in a large sample of Chinese adolescents. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Liu SJ, Liu ZZ, Wang ZY, Liu BP, Cheng S, Liu X, Jia CX. Sleep disordered breathing symptoms are associated with depressive symptoms: A longitudinal study of Chinese adolescents. J Affect Disord 2021; 293:492-501. [PMID: 34329858 DOI: 10.1016/j.jad.2021.05.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/04/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the prospective association between sleep disordered breathing (SDB) and depressive symptoms in Chinese adolescents. This study examined the independent predictive role of SDB symptoms in depressive symptoms in a large sample of adolescents. METHODS A total of 11831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort and 7072 adolescents who were resurveyed 1 year later were included for the analyses. Adolescents completed a self-administered questionnaire about demographics, mental health, sleep problems, and family environment. SDB symptoms were assessed by 3 items about loud snoring, breathing pauses, and snorting/gasping. The Chinese Youth Self-Report anxious/depressed subscale was used to assess depressive symptoms. RESULTS In the cross-sectional analyses, 11.8% adolescents had depressive symptoms, and elevated frequency of SDB symptoms were significantly associated with depressive symptoms. In the longitudinal study, 4.5% of adolescents had persistent depressive symptoms, the incidence rate of depressive symptoms at 1-year follow-up was 6.5%, and elevated frequency of any SDB symptoms (often: OR=2.23, 95%CI:1.50-3.32) at baseline was significantly associated with incident depressive symptoms after adjusting for potential confounders. The associations between SDB symptoms and depressive symptoms were similar for boys and girls. LIMITATION SDB symptoms and depressive symptoms were measured by self-report. CONCLUSION SDB symptoms are an independent and significant predictor of depressive symptoms in adolescents. Further research is needed to understand the biological mechanisms between SDB and mood dysregulation in adolescents.
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Affiliation(s)
- Shu-Juan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Zhen-Zhen Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Ze-Ying Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Shuo Cheng
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Xianchen Liu
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China.
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18
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Harding R, Schaughency E, Haszard JJ, Gill AI, Luo R, Lobb C, Dawes P, Galland B. Sleep-Related Breathing Problem Trajectories Across Early Childhood and Academic Achievement-Related Performance at Age Eight. Front Psychol 2021; 12:661156. [PMID: 34267700 PMCID: PMC8276242 DOI: 10.3389/fpsyg.2021.661156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Childhood sleep disordered breathing (SDB) has been linked to poorer academic performance; however, research has not investigated the extent improvement in SDB may alter outcomes across key academic skills. This study aimed to investigate if children's early SDB status could predict later academic outcomes, and if an improvement in SDB status across the early childhood years would coincide with better, later performance in key academic skills related to reading, numeracy, and listening comprehension. Methods: Eighty five case children with an SDB symptom score >25 (maximum 77) were matched to 85 control children (score <12) at recruitment (age 3). SDB severity (symptom history and clinical assessment) was evaluated at ages 3, 4, 6, and 8 years and performance on individually-administered academic skills assessed at age 8 (91% retention from age 3). Case children were categorized into “improved” or “not-improved” groups based on SDB trajectories over the 5 years. Contributions of SDB status and trajectory group to academic performance were determined using regression analysis adjusted for demographic variables. Results: History of SDB from age 3 predicted significantly poorer performance on some key academic skills (oral reading and listening skills) at age 8. Children whose SDB improved (45%) performed better in oral reading fluency than those whose SDB did not improve, but difficulties with specific tasks involving oral language (listening retell) remained when compared to controls. Conclusion: Findings support links between early SDB and worse academic outcomes and suggest key academic areas of concern around oral language. Findings highlight the need for child mental health professionals to be aware of children's sleep problems, particularly SDB (past and present), when assessing potential barriers to children's achievement, to assist with appropriate and timely referrals for evaluation of children's sleep difficulties and collaborative evaluation of response to intervention for sleep difficulties.
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Affiliation(s)
- Rebecca Harding
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Jillian J Haszard
- The Centre for Biostatistics, University of Otago, Dunedin, New Zealand
| | - Amelia I Gill
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Rebekah Luo
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Carmen Lobb
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Patrick Dawes
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Barbara Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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19
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Katila M, Saarenpää-Heikkilä O, Saha MT, Vuorela N, Huhtala H, Korhonen LS, Lukkarinen M, Tuulari JJ, Karlsson L, Karlsson H, Paavonen EJ. Prevalence and evolution of snoring and the associated factors in two-year-old children. Sleep Med 2021; 84:275-282. [PMID: 34186453 DOI: 10.1016/j.sleep.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the prevalence and persistence of snoring during the first two years of life in two Finnish birth cohorts and to assess the associated factors. STUDY DESIGN The study population comprised 947 children from the CHILD-SLEEP (CS) and 1393 children from the FinnBrain (FB) birth cohorts. Questionnaires were provided to both parents when the child was 24 months of age. The questionnaire consisted of parts concerning the child's sleep and environmental factors. RESULTS The combined prevalence of habitual snoring in the two birth cohorts at the age of 24 months was 2.3% (95% CI 1.5-3.1), which is markedly lower than reported previously. Children suffering from recurrent infections (CS odds ratio (OR) 3.9, 95% CI 1.2-12.5) or asthma (FB OR 4.3, 1.4-13.5) snored habitually more often. Both the mother's (CS OR 3.2, 1.2-9.0) and father's (CS OR 3.4, 1.4-8.0) snoring every night added to the risk of the child snoring. In the multivariate models, parental snoring (CS adjusted odds ratio (ORa) 2.8, 1.1-6.8), the mother's lower level of education (CS ORa 2.9, 1.2-7.5, FB ORa 2.1, 1.0-4.5), and the mother's lower monthly income (FB ORa 2.9, 1.3-6.3) associated with the child's habitual snoring. CONCLUSIONS The prevalence of habitual snoring in two Finnish birth cohorts is lower than reported previously. The independent risk factors for habitual snoring at the age of two years were the parents' snoring and the mother's low income and low education.
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Affiliation(s)
- Maija Katila
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Outi Saarenpää-Heikkilä
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Marja-Terttu Saha
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Nina Vuorela
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Laura S Korhonen
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Lukkarinen
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland; Turku Collegium for Science, Medicine and Technology, University of Turku, Turku, Finland; Department of Psychiatry, University of Oxford, UK (Sigrid Juselius Fellowship), United Kingdom
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
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20
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Ehsan Z, Glynn EF, Hoffman MA, Ingram DG, Al-Shawwa B. Small sleepers, big data: leveraging big data to explore sleep-disordered breathing in infants and young children. Sleep 2021; 44:5905265. [PMID: 32926133 DOI: 10.1093/sleep/zsaa176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Infants represent an understudied minority in sleep-disordered breathing (SDB) research and yet the disease can have a significant impact on health over the formative years of neurocognitive development that follow. Herein we report data on SDB in this population using a big data approach. METHODS Data were abstracted using the Cerner Health Facts database. Demographics, sleep diagnoses, comorbid medication conditions, healthcare utilization, and economic outcomes are reported. RESULTS In a cohort of 68.7 million unique patients, over a 9-year period, there were 9,773 infants and young children with a diagnosis of SDB (obstructive sleep apnea [OSA], nonobstructive sleep apnea, and "other" sleep apnea) who met inclusion criteria, encompassing 17,574 encounters, and a total of 27,290 diagnoses across 62 U.S. health systems, 172 facilities, and 3 patient encounter types (inpatient, clinic, and outpatient). Thirty-nine percent were female. Thirty-nine percent were ≤1 year of age (6,429 infants), 50% were 1-2 years of age, and 11% were 2 years of age. The most common comorbid diagnoses were micrognathia, congenital airway abnormalities, gastroesophageal reflux, chronic tonsillitis/adenoiditis, and anomalies of the respiratory system. Payor mix was dominated by government-funded entities. CONCLUSIONS We have used a novel resource, large-scale aggregate, de-identified EHR data, to examine SDB. In this population, SDB is multifactorial, closely linked to comorbid medical conditions and may contribute to a significant burden of healthcare costs. Further research focusing on infants at highest risk for SDB can help target resources and facilitate personalized management.
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Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Earl F Glynn
- Research Informatics, Children's Mercy Research Institute, Children's Mercy-Kansas City, Kansas City, MO
| | - Mark A Hoffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO.,Research Informatics, Children's Mercy Research Institute, Children's Mercy-Kansas City, Kansas City, MO
| | - David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Baha Al-Shawwa
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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21
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van Eeden C, Tamana SK, Narang I, Hammam N, Chikuma J, Lefebvre DL, Azad MB, Moraes TJ, Subbarao P, Becker AB, Turvey SE, Sears MR, Rasmussen C, Pei J, Mandhane PJ. Development and Validation of SDBeasy Score as a Predictor of Behavioral Outcomes in Childhood. Am J Respir Crit Care Med 2021; 203:718-725. [PMID: 32898424 DOI: 10.1164/rccm.202002-0363oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale: There are limited tools to identify which children are at greatest risk for developing sleep-disordered breathing (SDB)-associated behavioral morbidity.Objectives: To examine associations between age of onset and duration of parent-reported symptoms of SDB and behavioral problems at the age of 5 years.Methods: Data were collected and analyses were completed for participants in the CHILD (Canadian Healthy Infant Longitudinal Development) cohort at the Edmonton and Toronto sites. We generated an SDBeasy score on the basis of the age of onset and duration of SDB symptoms as reported by parents completing the Pediatric Sleep Questionnaire. Using CHILD-Edmonton data, we completed multivariate linear regression to determine whether the SDBeasy score was associated with behavioral problems at the age 5 years of age as assessed by using the Child Behavior Checklist (CBCL). We then validated the SDBeasy score using CHILD-Toronto data.Measurements and Main Results: At the 5-year visit, 581 of 716 (81%) CHILD-Edmonton participants still enrolled had CBCL data. Of the 581 children with data, 77% (446 of 581) had an SDBeasy score of 0 (never had SDB symptoms), whereas 20 of 581 children (3.4%) had persistent SDB symptoms from infancy through 5 years of age (SDBeasy score of 24). Children had a 0.35-point-higher CBCL total behavioral score at 5 years for each 1-point increase in their SDBeasy score (95% confidence interval, 0.24-0. 5; P < 0.01). We found consistent results among CHILD-Toronto participants; children had a 0.26-point-higher CBCL total behavioral score at 5 years for each 1-point increase in their SDBeasy score (95% confidence interval, 0.08-0.44; P = 0.005).Conclusions: The SDBeasy score, based on the Pediatric Sleep Questionnaire, enables identification of children with higher behavioral-problem scores.
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Affiliation(s)
| | | | - Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Theo J Moraes
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Jacqueline Pei
- Department of Education Psychology, University of Alberta, Edmonton, Alberta, Canada
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22
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Zhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health 2021; 21:108. [PMID: 33691678 PMCID: PMC7944632 DOI: 10.1186/s12903-021-01458-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mouth breathing is closely related to the facial skeletal development and malocclusion. The purpose of this systematic review and meta-analysis was to assess the effect of mouth breathing on facial skeletal development and malocclusion in children. METHODS An electronic search in PubMed, the Cochrane Library, Medline, Web of Science, EMBASE and Sigle through February 23rd, 2020, was conducted. Inclusion criteria were children under 18 years of age with maxillofacial deformities due to mouth breathing. The risk of bias in nonrandomized studies of interventions (ROBINS-I) tool for controlled clinical trials. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used for the quality assessment. The included indicators were SNA, SNB, ANB, SN-OP, SN-PP, PP-MP, SNGoGn, MP-H, 1-NA, 1. NA, 1. NB, 1-NB, Overjet, Overbite, SPAS, PAS, and C3-H. Data concerning the mean difference in mesial molar movement and extent of canine retraction were extracted for statistical analysis. The mean differences and 95% confidence intervals were analyzed for continuous data. Review Manager 5.3, was used to synthesize various parameters associated with the impact of mouth breathing on facial skeletal development and malocclusion. RESULTS Following full-text evaluations for eligibility, 10 studies were included in the final quantitative synthesis. In Sagittal direction, SNA (MD: - 1.63, P < 0.0001), SNB (MD: - 1.96, P < 0.0001) in mouth-breathing children was lower than that in nasal-breathing children. ANB (MD: 0.90, P < 0.0001), 1. NA (MD: 1.96, P = 0.009), 1-NA (MD: 0.66, P = 0.004), and 1-NB (MD: 1.03, P < 0.0001) showed higher values in children with mouth breathing. In vertical direction, SN-PP (MD: 0.68, P = 0.0050), SN-OP (MD: 3.05, P < 0.0001), PP-MP (MD: 4.92, P < 0.0001) and SNGoGn (MD: 4.10, P < 0.0001) were higher in mouth-breathing individuals. In airway, SPAS (MD: - 3.48, P = 0.0009), PAS (MD: - 2.11, P < 0.0001), and C3-H (MD: - 1.34, P < 0.0001) were lower in mouth breathing group. CONCLUSIONS The results showed that the mandible and maxilla rotated backward and downward, and the occlusal plane was steep. In addition, mouth breathing presented a tendency of labial inclination of the upper anterior teeth. Airway stenosis was common in mouth-breathing children. Trial registration crd-register@york.ac.uk, registration number CRD42019129198.
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Affiliation(s)
- Ziyi Zhao
- The Affiliated Stomatology Hospital of Chongqing Medical University, No.426 Songshi North Road, Yubei district, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Leilei Zheng
- The Affiliated Stomatology Hospital of Chongqing Medical University, No.426 Songshi North Road, Yubei district, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Xiaoya Huang
- The Affiliated Stomatology Hospital of Chongqing Medical University, No.426 Songshi North Road, Yubei district, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Caiyu Li
- The Affiliated Stomatology Hospital of Chongqing Medical University, No.426 Songshi North Road, Yubei district, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Jing Liu
- The Affiliated Stomatology Hospital of Chongqing Medical University, No.426 Songshi North Road, Yubei district, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China
| | - Yun Hu
- The Affiliated Stomatology Hospital of Chongqing Medical University, No.426 Songshi North Road, Yubei district, Chongqing, 401147, China.
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 401147, China.
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 401147, China.
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23
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Lushington K, Biggs S, Martin AJ, Kennedy JD. Sleep disordered breathing in children: which symptoms do parents consider a problem? Sleep Med 2021; 81:33-41. [PMID: 33636542 DOI: 10.1016/j.sleep.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Parents tend to under-report symptoms suggestive of sleep disordered breathing (SDB) at medical consultation. It is thought that a contributing factor may be whether parents view SDB symptoms as a problem. The aim of the study was to examine to what extent parents view SDB symptoms as a problem in children recruited from the general community and especially in children who currently have symptoms suggestive of SDB. METHODS Parents of 1639 children aged 5-10 y attending middle school in South Australia completed a questionnaire which included demographics and assessed the frequency over the previous school week of 32 sleep habits including six SDB sleep habit items. The sample was restricted to typically developing children and excluded children with medical problems likely to impact SDB. The final sample included 1610 children without a prior diagnosis of SDB and 29 with a prior diagnosis and/or treatment of SDB. Parents were asked to rate children's sleep habits using a 4-pt scale (never, rarely, sometimes and usually) and if the sleep habit was perceived to be a problem (yes/no). Children who sometimes or usually reported a sleep habit item were labelled as symptomatic. RESULTS Parents of children with, compared to those without, a prior diagnosis of SDB, were more likely to report the presence of SDB symptoms which were more frequently viewed as a problem. In children without a prior diagnosis of SDB, parents of symptomatic children viewed most SDB symptoms as a problem ranging from 91% for apnoea, 63% snorted/gasped, 63% watched child breathing at night, 58% snored loudly, 49% snored to 32% breathing heavily at night. Additional analyses in the combined sample revealed that a prior diagnosis of SDB, gender, socioeconomic status and ethnicity were weak predictors of whether parents viewed SDB sleep symptoms as a problem. CONCLUSION In children with symptoms suggestive of SDB, most parents viewed most SDB symptoms as a problem especially apnoea. The high frequency is contrary to that expected given the under-reporting of SDB symptoms at medical consultation. This suggests that additional factors other than whether parents consider SDB symptoms as a problem might better explain the under-reporting of SDB symptoms at medical consultation. Given the important impact on child health and medical service provision, future studies examining the factors that prompt parents to discuss SDB symptoms at medical consultation are warranted.
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Affiliation(s)
| | - Sarah Biggs
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Alfred James Martin
- University of Adelaide, Adelaide, Australia; Women's and Children's Hospital Adelaide, Australia
| | - John Declan Kennedy
- University of Adelaide, Adelaide, Australia; Women's and Children's Hospital Adelaide, Australia
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Sosso FAE, Khoury T. Socioeconomic status and sleep disturbances among pediatric population: a continental systematic review of empirical research. Sleep Sci 2021; 14:245-256. [PMID: 35186203 PMCID: PMC8848532 DOI: 10.5935/1984-0063.20200082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
To this day, no consensus has been established on the definition and the conceptualization of the socioeconomic status (SES), since all the available studies on the relation between SES and health did not use the same conceptual framework and operationalization to assess SES. While literature reported that SES markers (such as income, social support networks, education, employment or occupation) influence the health of populations by shaping living conditions; empirical research does not tell us which SES markers affect more strongly the sleep components of the individuals, as well as which sleep disorders (SD) are affected and how. Even though several original studies have tried to assess how changes in socioeconomic status of parents may affect the psychosocial environment and mental health of an individual directly or through his community, no systematic reviews on the influence of SES on children's sleep are available. This systematic review make an update on the different measures of SES and sleep disturbances used for pediatric population across the different regions of the world. Recommendations for a future standardization of SES measures is proposed, for a better understanding of its influence on sleep disturbances.
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Affiliation(s)
- FA Etindele Sosso
- Department on Global Health and Ecoepidemiology,Redavi Institute, Montréal, Canada. ,Corresponding author: FA Etindele Sosso E-mail:
| | - Tommy Khoury
- Université de Montréal, Faculté de Médecine - Montréal - Québec - Canada
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Ramirez FD, Groner JA, Ramirez JL, McEvoy CT, Owens JA, McCulloch CE, Cabana MD, Abuabara K. Prenatal and Childhood Tobacco Smoke Exposure Are Associated With Sleep-Disordered Breathing Throughout Early Childhood. Acad Pediatr 2021; 21:654-662. [PMID: 33161115 PMCID: PMC8096866 DOI: 10.1016/j.acap.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether prenatal and childhood tobacco smoke exposure (TSE) are each independently associated with mild sleep-disordered breathing (SDB) symptoms throughout early childhood, and whether the association between childhood TSE and SDB differs according to the level of prenatal exposure. METHODS Longitudinal cohort study, using data from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort from the United Kingdom. Primary exposures were repeated measures of mother-reported prenatal and childhood TSE through age 7 years. Outcomes were mother-reported measures of mild SDB symptoms, including snoring, mouth breathing, and witnessed apnea, repeated annually through age 7 years. RESULTS A total of 12,030 children were followed for a median duration of 7 years. About 24.2% were exposed to prenatal tobacco smoke, 46.2% were exposed at least once in childhood, and 20.6% were exposed during both periods. Both prenatal and childhood TSE were associated with SDB symptoms throughout early childhood (adjusted OR [aOR] for any prenatal TSE 1.23; 95% confidence interval [CI] 1.08, 1.40; aOR for any childhood TSE 1.17; 95% CI 1.06, 1.29). We observed a dose-response effect between TSE and SBD symptoms, and found evidence of effect modification for those exposed during both time periods (combined high level exposure both prenatally and during childhood: aOR snoring 2.43 [95% CI 1.50, 3.93], aOR apnea 2.65 [95% CI 1.46, 4.82]). CONCLUSIONS Prenatal and childhood TSE were both independently associated with mild SDB symptoms throughout early childhood in a dose-dependent manner, further supporting the critical importance of maintaining a tobacco-free environment throughout gestation and childhood.
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Affiliation(s)
- Faustine D. Ramirez
- University of California, San Francisco, Department of Pediatrics, 550 16th Street, 4th Floor, San Francisco, CA 94158
| | - Judith A. Groner
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL 60143,Nationwide Children’s Hospital, Department of Pediatrics, 700 Children’s Drive, Columbus, OH, 43205
| | - Joel L. Ramirez
- University of California, San Francisco, Department of Surgery, 400 Parnassus Avenue, A-581, San Francisco, CA 94143
| | - Cindy T. McEvoy
- Oregon Health and Science University, Department of Pediatrics, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Judith A. Owens
- Boston Children’s Hospital, Center for Pediatric Sleep Disorders, 300 Longwood Avenue Boston, MA 02115,Boston Children's Hospital, Harvard Medical School, Department of Neurology, 9 Hope Avenue, Waltham, MA 02453
| | - Charles E. McCulloch
- University of California, San Francisco, Department of Epidemiology & Biostatistics, 550 16th Street, 2nd Floor, San Francisco, CA 94158
| | - Michael D. Cabana
- Albert Einstein College of Medicine, Department of Pediatrics, 3411 Wayne Avenue Bronx, NY 10467,Children’s Hospital at Montefiore, Department of Pediatrics, 3411 Wayne Avenue Bronx, NY 10467
| | - Katrina Abuabara
- University of California, San Francisco, Department of Dermatology, Program for Clinical Research, 2340 Sutter Street, N421, San Francisco, CA 94115
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Bonuck K. Sleep problem screening of young children by speech-language pathologists: A mixed-methods feasibility study. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:23969415211035066. [PMID: 36381521 PMCID: PMC9620683 DOI: 10.1177/23969415211035066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND & AIMS Poor sleep in young children imperils language learning and use. Both sleep and language problems are prevalent in early childhood. Speech-language pathologists are in a unique position to expand surveillance of sleep problems, which in turn may contribute to communication difficulties. We conducted a feasibility study of speech-language pathologist screening for behavioral sleep problems and sleep-disordered breathing symptoms at a multidisciplinary evaluation and treatment center. METHODS Speech-language pathologists administered screeners to parents of 2-6-year-olds: the Short Form-Children's Sleep Habits Questionnaire (for behavioral sleep problems) which includes an item asking if the child has a sleep problem (yes/no), and the pediatric sleep questionnaire (for sleep-disordered breathing). Speech-language pathologists participated in pre- and post-screening focus groups. Pre-screening topics included professional preparation and clinical experience regarding pediatric sleep issues. Post-screening, speech-language pathologists provided feedback about the screening experience and feasibility of incorporating such screening into practice. RESULTS Among 51 children, 31% (16/51) screened positive for sleep-disordered breathing, 78% for behavioral sleep problems (40/51), and 43% (12/28) per parent report. Parent-reported problems were associated with sleep-disordered breathing (p = 0.00) but not behavioral sleep problems (p = 0.24). During focus groups, speech-language pathologists reported no formal pediatric sleep training, high parent concern about sleep, and agreed that screening fit their professional mandate. Speech-language pathologists affirmed that the ≤15 min screenings integrated seamlessly into practice but that additional training, particularly for sleep-disordered breathing, was needed. CONCLUSIONS The prevalence of sleep problems in 2-6-year-olds presenting to speech-language pathologists was higher than in community samples, but consistent with data from young children with developmental disabilities. Speech-language pathologists endorsed the utility and feasibility of sleep problem screening and education in their clinical practice. IMPLICATIONS Integrating sleep problem screening and education into speech-language pathologist practice is feasible and could widen surveillance of both sleep problems and risk factors for developmental language disorders. Further research should include larger samples and other settings, e.g. home or school.
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Affiliation(s)
- Karen Bonuck
- Kathleen McGrath, Department of Family and
Social Medicine, Albert Einstein College of Medicine, 1225 Morris Park Ave,
Bronx, NY, USA.
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Ferry AM, Wright AE, Ohlstein JF, Khoo K, Pine HS. Efficacy of a Pediatric Sleep Questionnaire for the Diagnosis of Obstructive Sleep Apnea in Children. Cureus 2020; 12:e12244. [PMID: 33500863 PMCID: PMC7819429 DOI: 10.7759/cureus.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a source of significant morbidity in children. Polysomnography (PSG), the gold standard diagnostic tool for OSA, is often unavailable due to patient financial and geographic constraints. Our objective is to analyze the relationship between a patient's subjective complaints and the results from their PSG to determine the diagnostic value of the Pediatric Sleep Questionnaire (PSQ) for detecting OSA in children. METHODS A retrospective chart review was conducted for pediatric patients with suspected OSA from March 2012 to January 2014. Preoperative PSQ scores were compared with the results from PSG in the form of Apnea-Hypopnea Index (AHI) and Respiratory Disturbance Index (RDI) values. AHI and RDI values ranging from 1 to 5 were classified as mild OSA while values ranging from 5 to 10 were classified as moderate OSA. RESULTS A total of 161 patients were recruited for this study with 63 patients (39%) both completing the PSQ and undergoing PSG. Sensitivity of the positive questionnaire was higher in patients with AHI and RDI values indicative of moderate OSA (95% and 100% respectively) versus values indicative of mild OSA (83% and 86% respectively). Conversely, the positive predictive value of the positive questionnaire (n=49) was lower in patients with AHI and RDI values indicative of moderate OSA (39% and 46% respectively) versus values indicative of mild OSA (70% and 80% respectively). CONCLUSION The PSQ has high diagnostic value for screening patients with suspected OSA. We recommend the use of the PSQ in the primary care setting for children with suspected OSA.
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Affiliation(s)
- Andrew M Ferry
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Alex E Wright
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Jason F Ohlstein
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Kim Khoo
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Harold S Pine
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
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Kim KM, Kim JH, Kim D, Lim MH, Joo H, Yoo SJ, Kim E, Ha M, Paik KC, Kwon HJ. Associations among High Risk for Sleep-disordered Breathing, Related Risk Factors, and Attention Deficit/Hyperactivity Symptoms in Elementary School Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2020; 18:553-561. [PMID: 33124587 PMCID: PMC7609213 DOI: 10.9758/cpn.2020.18.4.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
Objective : Habitual snoring is a common problem in children. We evaluated the association between a high risk for sleep-disordered breathing and attention deficit/hyperactivity symptoms. Methods Parents of 13,560 children aged 6 to 12 years responded to questionnaires including items on habitual snoring and the Korean attention deficit/hyperactivity disorder rating scale. The snoring score comprised the number of "yes" responses to habitual-snoring items, and a high risk for sleep-disordered breathing was defined as a snoring score ≥ 2. Results The odds ratio (OR) of a high risk for sleep-disordered breathing was significantly higher in boys (OR = 1.47; p < 0.001), overweight children (OR = 2.20; p < 0.001), and children with current secondhand-smoking exposure (OR = 1.38; p < 0.001). The Korean attention deficit/hyperactivity disorder rating scale score increased significantly with the snoring score (0 vs. 1, B = 1.56, p < 0.001; 0 vs. 2, B = 2.44, p < 0.001; 0 vs. 3, B = 2.48, p < 0.001; 0 vs. 4, B = 3.95; p < 0.001). Conclusion Our study confirms several risk factors of sleep-disordered breathing, namely male sex, overweight, and exposure to tobacco smoking, and found a positive association between habitual snoring and attention deficit/hyperactivity symptoms.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea
| | - Jee Hyun Kim
- Department of Neurology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dohyun Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Public Human Resources, Dankook University, Cheonan, Korea
| | - Hyunjoo Joo
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seung-Jin Yoo
- Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Eunjung Kim
- Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ki Chung Paik
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea.,Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.,Environmental Health Center, Dankook University Medical Center, Cheonan, Korea
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Bonuck K, Collins-Anderson A, Ashkinaze J, Karasz A, Schwartz A. Environmental Scan of Sleep Health in Early Childhood Programs. Behav Sleep Med 2020; 18:598-610. [PMID: 31318273 PMCID: PMC6980449 DOI: 10.1080/15402002.2019.1640222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To ascertain how sleep health knowledge is translated to early care and education (ECE) programs, using a multi-component environmental scan. METHODS A website scan identified organizations' sleep content re: recommended practices, developmental effects, and "actionable" ratings (0-2). ECE staff surveys assessed preparedness, practices, and beliefs about addressing sleep health and sleep problems in ECE programs. Semi-structured interviews with stakeholders from the ECE, pediatric and sleep communities assessed awareness, priorities, and practices at their organizations. RESULTS Of 15 websites scanned, half lacked sleep content on links to development, optimal duration, or scientific background. ECE staff (n = 31) were comfortable speaking to parents about healthy sleep, and with incorporating sleep education and guidance into ECE. Stakeholders (n = 15) rated healthy sleep as a high relevance, but lower priority issue. Within ECE settings stakeholders reported that knowledge about specific links to health and development was poor and that sleep health was often obscured by "safe sleep" issues. Their recommendations included: linking sleep health to "hot topics" such as obesity or preschool suspensions and expulsions, integrating it with the teaching of routines, and raising public awareness. CONCLUSION Despite understanding that healthy sleep promotes school readiness, there is insufficiently specific, actionable information in ECE training, programs, or policies. Findings suggest a need for an awareness campaign with clear, actionable messaging, dissemination of turnkey materials, and integration with policy and professional training systems. TRIAL REGISTRATION - ClinicalTrials.Gov: NCT03556462.
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Affiliation(s)
- Karen Bonuck
- Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY, USA
| | | | | | - Alison Karasz
- Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY
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30
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31
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The role of sleep laboratory polygraphy in the evaluation of obstructive sleep apnea syndrome in Robin infants. Sleep Med 2020; 72:59-64. [PMID: 32554055 DOI: 10.1016/j.sleep.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Currently, obstructive sleep apnea syndrome (OSAS) management in Robin sequence (RS) infants has not been standardized. Sleep laboratory polysomnography (PSG) is the gold standard for OSAS diagnosis, however, access is restricted. This study aimed to compare the respiratory indexes measured in a sleep laboratory using PSG as well as a possible alternative, polygraphy (PG). PATIENTS/METHODS This retrospective study was conducted between 2015 and 2017 in a tertiary hospital. PSG performed in RS infants in the sleep laboratory was analysed by a single reviewer. After sleep data removal, anonymized raw data were analysed to obtain only PG data. Respiratory indexes were compared for (i) PSG and PG and (ii) patients with or without OSAS clinical signs. RESULTS Among the 20 RS (median [IQR] age: 43 [25-114] days at evaluation), 70% of the patients had OSAS clinical signs but all of them had severe OSAS. The median mixed obstructive apnea hypopnea index was not significantly different between PSG and PG (27/h [18-38] versus 26/h [18-56], p = 0.43). The median obstructive apnea index was higher with no significant difference between PG and PSG (19/h [15-31] versus 7/h [4-25], p = 0.05). The median obstructive hypopnea index was significantly lower on PG than on PSG (2/h [0-3] versus 8/h [8-19], p = 0.01). No difference on PSG or PG was observed for patients with and without clinical signs of OSAS. CONCLUSION Although PSG remains the gold standard for OSA evaluation, a PG seems to be a useful alternative to measure OSA in RS infants because of their OSAS severity. This evaluation should be recommended in all RS infants, even in the absence of OSAS clinical signs. CLINICAL TRIAL REGISTRATION Not applicable.
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Bains A, Abraham E, Hsieh A, Rubin BR, Levi JR, Cohen MB. Characteristics and Frequency of Children With Severe Obstructive Sleep Apnea Undergoing Elective Polysomnography. Otolaryngol Head Neck Surg 2020; 163:1055-1060. [PMID: 32539583 DOI: 10.1177/0194599820931084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the prevalence and demographics features of pediatric patients with severe obstructive sleep apnea (OSA) who would not undergo preoperative polysomnography (PSG) under current American Academy of Otolaryngology (AAO) guidelines. STUDY DESIGN In this retrospective cohort study, we identified patients from the electronic medical record who underwent elective polysomnography for evaluation of sleep-disordered breathing between 2012 and 2018. SETTING Urban tertiary safety net hospital. SUBJECTS AND METHODS A total of 456 patients with a mean (SD) age of 5.7 (3.2) years (263 male, 193 female). Demographic factors (age, sex, race, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate analysis. RESULTS Of 456 patients identified, 66 (14.5%) were found to have severe OSA. African American patients had 3.7 times the odds of severe OSA compared to white patients (95% CI, 1.2-10.8). Patients aged 2 to 3 years had 2.2 times the odds of severe OSA compared to patients aged 4 to 6 years (95% CI, 1.2-4.0). Sex, ethnicity, language, and insurance type were not significantly associated with severity of OSA. The presence of apneic episodes and tonsil size were not found to be statistically significant. CONCLUSION Up to 14.5% of healthy pediatric patients with sleep-disordered breathing may have severe OSA; young age and African American race are statistically significant predictors. Clinical findings, such as tonsil size and symptom severity, were not found to be statistically significant predictors.
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Affiliation(s)
- Ashank Bains
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Adam Hsieh
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Batsheva R Rubin
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael B Cohen
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Owens JA, Babcock D, Weiss M. Evaluation and Treatment of Children and Adolescents With Excessive Daytime Sleepiness. Clin Pediatr (Phila) 2020; 59:340-351. [PMID: 32167377 PMCID: PMC7160754 DOI: 10.1177/0009922820903434] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Judith A. Owens
- Boston Children’s Hospital, Harvard
Medical School, Waltham, MA, USA,Judith A. Owens, Division of Neurology,
Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115, USA.
| | - Debra Babcock
- Packard Children’s Health Alliance,
Stanford Children’s Health, Los Altos, CA, USA
| | - Miriam Weiss
- Children’s National Health System,
Washington, DC, USA
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Kohn JL, Rubin SJ, Patel J, Dia R, Levi JR, Cohen MB. Factors affecting completion of sleep studies in pediatric patients with sleep‐disordered breathing. Laryngoscope 2020; 130:E258-E262. [DOI: 10.1002/lary.28091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/05/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jocelyn L. Kohn
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Samuel J. Rubin
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Jay Patel
- Boston University School of Medicine Boston Massachusetts U.S.A
| | - Reem Dia
- University of Massachusetts Boston Boston Massachusetts U.S.A
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Michael B. Cohen
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
- Department of Otolaryngology–Head and Neck SurgeryVeterans Affairs Hospital Boston Boston Massachusetts U.S.A
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Moroco AE, Saadi RA, Wilson MN. Post-tonsillectomy respiratory complications in children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2020; 131:109852. [PMID: 31901486 DOI: 10.1016/j.ijporl.2019.109852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A common indication for tonsillectomy in children is clinically diagnosed sleep disordered breathing (SDB) without confirmation of obstructive sleep apnea (OSA) by polysomnography (PSG). Our goal was to review rates of post-tonsillectomy respiratory complications in children with SDB without prior PSG in order to develop recommendations for postoperative monitoring and safe hospital discharge in this population. METHODS Following Institutional Review Board (IRB) approval at Penn State Milton S. Hershey Medical Center, a database query using Current Procedural Terminology (CPT) codes for tonsillectomy with or without adenoidectomy (42820, 42821, 42825, 42826) between January 1, 2012 and December 31, 2017 was performed. International Classification of Diseases (ICD) codes for sleep disordered breathing (G47.30), snoring (R06.83), and obstructive sleep apnea (G47.33) were applied for further selection. Charts were individually reviewed to confirm the inclusion criteria of pediatric patients (≤18 years) who underwent tonsillectomy without prior PSG and were monitored overnight. Demographic, operative, and relevant postoperative hospital course data (including desaturations, supplemental oxygen requirements, and upgraded level of care) were collected. RESULTS A total of 1874 unique patient encounters were identified by our database search and 364 children met inclusion criteria. The average age of the patient population was 6.5 ± 3.1 years and 52.2% of children were female. Mean z-score for the population was 0.6. The rate of overnight oxygen desaturation events (<95%) was 2.2%, with no severe complications found in this population. Children with desaturation events were supplemented with oxygen and resolved prior to hospital discharge. Only race was found to be significantly related to risk of mild overnight desaturations (P = 0.023). CONCLUSION A lack of significant postoperative respiratory complications or alterations in the clinical management of children with SDB without prior PSG supports the idea that such patients may safely be discharged from the hospital following tonsillectomy without overnight oxygen monitoring.
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Affiliation(s)
- Annie E Moroco
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert A Saadi
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| | - Meghan N Wilson
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Slim M, Westmacott R, Toutounji S, Singh J, Narang I, Weiss S, Krishnan P, Grbac E, Surmava AM, Andres K, MacGregor D, deVeber G, Moharir M, Dlamini N. Obstructive sleep apnea syndrome and neuropsychological function in pediatric stroke. Eur J Paediatr Neurol 2020; 25:82-89. [PMID: 31787553 DOI: 10.1016/j.ejpn.2019.11.006] [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: 01/07/2019] [Revised: 06/04/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the prevalence of obstructive sleep apnea syndrome (OSAS) in children with arterial ischemic stroke (AIS) and to evaluate its association with neuropsychological outcomes. METHODS We conducted a cross-sectional study of sleep health and neuropsychological outcome in children with AIS. A consecutive cohort of children attending a stroke clinic were assessed using a standardized pediatric sleep questionnaire (PSQ) and standardized measures of pediatric stroke outcome and intellectual, executive and adaptive function. High risk for OSAS was defined as PSQ score ≥0.33. RESULTS Overall, 102 children were included (55% males, median age: 9 years [interquartile-range [IQR]: 6-14]). The prevalence of OSAS in children with AIS was significantly higher compared to published normative prevalence rate (25.5% vs 5%, p < 0.001). Children with OSAS were more likely to have infarcts affecting both the anterior and posterior circulation (37.5% vs 9.5%, p = 0.021). In addition, children with OSAS had significantly higher median Pediatric Stroke Outcome Measure (PSOM) scores (2 [IQR: 0-2] vs 1 [IQR: 1-3.5], p = 0.01) and were more likely to be prescribed concomitant medications affecting sleep architecture (50% vs 22.4%, p = 0.007). OSAS was associated with significantly lower scores on intellectual, memory, cognitive, behavioral, attention, executive and adaptive function scales. The association between PSQ and intellectual ability and working memory remained statistically significant upon controlling for potential confounding factors including stroke related characteristics (neurologic impairment and arterial territory). CONCLUSIONS The prevalence of OSAS in children with AIS compared to healthy controls is significantly elevated and is associated with poor neuropsychological outcomes. We highlight the importance of regular screening for OSAS - a modifiable risk factor - in children with AIS. The specific risk factors for OSAS and the potential benefits of therapeutic interventions in this patient population warrant further investigation.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Sandra Toutounji
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Jaspal Singh
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Shelly Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Pradeep Krishnan
- Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Elena Grbac
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Ann-Marie Surmava
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Kathleen Andres
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Daune MacGregor
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Gabrielle deVeber
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
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Sadras I, Reiter J, Fuchs N, Erlichman I, Gozal D, Gileles-Hillel A. Prematurity as a Risk Factor of Sleep-Disordered Breathing in Children Younger Than Two Years: A Retrospective Case-Control Study. J Clin Sleep Med 2019; 15:1731-1736. [PMID: 31855158 PMCID: PMC7099182 DOI: 10.5664/jcsm.8072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is a highly prevalent condition affecting 2% to 4% of children. However, the prevalence and characteristics of SDB in children younger than 2 years and the effect of prematurity as a risk factor remains unclear. METHODS Children younger than 24 months referred for PSG at two medical centers between the years 2014 to 2018 were included in this retrospective analysis. We excluded children with genetic syndromes. Polysomnography (PSG) was performed and scored according to American Academy of Sleep Medicine guidelines. RESULTS Ninety-eight children were included (age 14.1 ± 6.4 [2-23] months), with 31 born prematurely (PRETERM; 24 to 34 weeks gestational age). PRETERM had increased odds of SDB (age and sex adjusted), using a cutoff of AHI ≥ 5 events/h with an odds ratio of 4.3 (95% confidence interval 1.5-12.9). Gestational age was the only significant predictor for SDB in this cohort, every additional week of gestation reducing the odds of SDB by 12.5%. PRETERM SDB was also characterized by more severe nocturnal hypoxemia, increased frequency of central apnea, and altered sleep architecture. CONCLUSIONS Current findings underscore the importance of prematurity antecedents as a risk factor for SDB in young symptomatic children younger than 2 years referred for a PSG. Future studies focused on improved estimates of the prevalence of SDB among nonreferral young children appear warranted.
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Affiliation(s)
- Ido Sadras
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joel Reiter
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Pediatric Pulmonology, Sleep and CF Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Nitzan Fuchs
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Ira Erlichman
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
- Neonatal Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Gozal
- Department of Child Health, MU Women’s and Children’s Hospital, University of Missouri School of Medicine, Columbia, Missouri
| | - Alex Gileles-Hillel
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Pediatric Pulmonology, Sleep and CF Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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Tang H, Liu Q, Lin JH, Zeng H. [Three-dimensional morphological analysis of the palate of mouth-breathing children in mixed dentition]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:389-393. [PMID: 31512831 DOI: 10.7518/hxkq.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study the effects of mouth-breathing on maxillary arch development by comparing the palatal morphology of mouth- and nose-breathing children in mixed dentition. METHODS Children in mixed dentition were enrolled and categorized into mouth-breathing (test group) and nose-breathing groups (control group) according to their breathing patterns. Children's plaster models were scanned with 3D laser scanner, and the 3D data were reconstructed and measured using Minics 15.0 and Geomagic 12.0 software. Measurement data (inter-molar width, palatal height, palatal volume, and palatal surface area) of the two groups were compared, and the correlation among the four measurement items was analyzed. RESULTS The participants were 73 children (37 in test group and 36 in control group) with a mean age of (8.63±0.78) years old. The test group had significantly smaller inter-molar width, palatal volume, and palatal surface area but significantly higher palatal height than the control group (P<0.05). Inter-molar width and palatal volume were positively correlated with the palatal surface area in the test group (P<0.05). Inter-molar width and palatal height were positively correlated with the palatal surface area in the control group (P<0.01). CONCLUSIONS Mouth-breathing children have significantly reduced inter-molar width, palatal volume, and surface, and substantially increased palatal height, leading to different developmental patterns of the palatal morphology.
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Affiliation(s)
- Huan Tang
- Dept. of Pediatric Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Qiao Liu
- Dept. of Pediatric Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Ju-Hong Lin
- Dept. of Pediatric Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Huan Zeng
- Dept. of Pediatric Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
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Katila M, Saarenpää‐Heikkilä O, Saha M, Vuorela N, Paavonen EJ. Parental reports showed that snoring in infants at three and eight months associated with snoring parents and smoking mothers. Acta Paediatr 2019; 108:1686-1694. [PMID: 30791132 DOI: 10.1111/apa.14758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/06/2023]
Abstract
AIM This prospective study examined the prevalence of snoring during infancy and the prenatal and postnatal risk factors for this condition. METHODS The study population comprised 1388 infants from the CHILD-SLEEP birth cohort, who were recruited in the Pirkanmaa Hospital District, Finland, between 2011 and 2013. Sleep and background factor questionnaires were filled out prenatally by parents and when the infant was three and eight months old. RESULTS The prevalence of habitual snoring was 3.2% at the age of three months and 3.0% at eight months, and snoring infants had more sleeping difficulties at those ages, with odds ratios (ORs) of 3.11 and 4.63, respectively. At three months, snoring infants slept for a shorter length of time (p = 0.001) and their sleep was more restless (p = 0.004). In ordinal logistic regression models, parental snoring (adjusted OR = 1.65 and 2.60) and maternal smoking (adjusted OR = 2.21 and 2.17) were significantly associated with infant snoring at three and eight months, while formula feeding and dummy use (adjusted OR = 1.48 and 1.56) were only associated with infant snoring at three months. CONCLUSION Parental snoring and maternal smoking increased the risk of snoring. Infants who snored also seemed to suffer more from other sleep difficulties.
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Affiliation(s)
- Maija Katila
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Outi Saarenpää‐Heikkilä
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Marja‐Terttu Saha
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | | | - E. Juulia Paavonen
- Pediatric Research Center Child Psychiatry University of Helsinki and Helsinki University Hospital Helsinki Finland
- National Institute for Health and Welfare Helsinki Finland
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Harding R, Haszard JJ, Schaughency E, Drummond B, Galland B. Parent report of children's sleep disordered breathing symptoms and limited academic progress in reading, writing, and math. Sleep Med 2019; 65:105-112. [PMID: 31739228 DOI: 10.1016/j.sleep.2019.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To estimate via questionnaire within a population sample of New Zealand (NZ) children aged 6-to-10 years, the prevalence of sleep disordered breathing (SDB) and those struggling academically, and to identify individual and shared risk factors (health and demographic) for parent-reported SDB symptoms and academic difficulties. METHODS In this cross-sectional study, parents/caregivers of children were recruited through schools and social media to complete an online questionnaire covering health and demographic factors, their children's SDB symptoms (Pediatric Sleep Questionnaire; PSQ) and parental ratings of academic performance based on teacher feedback relative to expected progress in the national curriculum (well below/below/at/above) in reading, writing, and math. RESULTS A total of 1205 children (53% male) aged (mean) eight years two months were included, comprising 79.4% NZ European/other and 15.0% Māori. The survey-weighted prevalence of SDB (based on the PSQ) was 17.5%. This was higher amongst those with academic difficulties rated 'below/well below' expected progress for reading, writing and math (estimated at 24.0%, 31.0% and 27.5% respectively), with increased odds (adjusted odds ratios) for poor progress of 1.9 (95% CI: 1.2, 3.0), 1.8 (95% CI: 1.2, 2.7) and 2.4 (95% CI: 1.6, 3.7) respectively. There were no shared risk factors common to both SDB and academic difficulties identified from multivariate analyses. CONCLUSIONS The findings suggest that children with parent-reported SDB symptoms may be at high risk for poor progress in reading, writing, and math. Future research could examine whether treatment of SDB reduces barriers to learning and offsets educational risk.
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Affiliation(s)
- Rebecca Harding
- Department of Women's & Children's Health, University of Otago, New Zealand; Department of Psychology, University of Otago, New Zealand
| | - Jillian J Haszard
- Department of Women's & Children's Health, University of Otago, New Zealand; The Centre for Biostatistics, University of Otago, New Zealand
| | | | - Bernadette Drummond
- Department of Oral Sciences, University of Otago, New Zealand; Department of Paediatric Dentistry, University of Leeds, UK
| | - Barbara Galland
- Department of Women's & Children's Health, University of Otago, New Zealand.
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Meerkov MS, Hassan F, Chervin RD, Barks JD, Carlson MD, Shellhaas RA. Sleep-disordered breathing is common among term and near term infants in the NICU. Pediatr Pulmonol 2019; 54:557-562. [PMID: 30688037 PMCID: PMC6486415 DOI: 10.1002/ppul.24266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/09/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Among older infants and children, sleep-disordered breathing (SDB) has negative neurocognitive consequences. We evaluated the frequency and potential impact of SDB among newborns who require intensive care. STUDY DESIGN Term and near-term newborns at risk for seizures underwent 12-h attended polysomnography in the neonatal intensive care unit (NICU). Bayley Scales of Infant Development, third edition (Bayley-III) were administered at 18-22 months. RESULT The 48 newborns (EGA 39.3 ± 1.6) had a median pediatric apnea-hypopnea index (AHI) of 10.1 (3.3-18.5) and most events were central (vs obstructive). Maternal and prenatal factors were not associated with AHI. Moreover, neonatal PSG results were not associated with Bayley-III scores (P > 0.05). CONCLUSION SDB is common among term and near-term newborns at risk for seizures. Follow-up at ages when more nuanced testing can be performed may be necessary to establish whether neonatal SDB is associated with long-term neurodevelopmental disability.
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Affiliation(s)
- Meera S Meerkov
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Fauziya Hassan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.,Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - John D Barks
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Martha D Carlson
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Renée A Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Honaker SM, Street A, Daftary AS, Downs SM. The Use of Computer Decision Support for Pediatric Obstructive Sleep Apnea Detection in Primary Care. J Clin Sleep Med 2019; 15:453-462. [PMID: 30853049 DOI: 10.5664/jcsm.7674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/15/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To (1) describe outcomes from a computer decision support system (CDSS) for pediatric obstructive sleep apnea (OSA) detection in primary care; and (2) identity the prevalence of children meeting criteria for an OSA referral. METHODS A CDSS for OSA was implemented in two urban primary care clinics. Parents of children (age 2 to 11 years) presenting to the clinic were asked if their child snored regularly, with a positive response resulting in six additional OSA screening items. Primary care providers (PCPs) received a prompt for all snoring children, listing applicable OSA signs and symptoms and recommending further evaluation and referral for OSA. RESULTS A total of 2,535 children were screened for snoring, identifying 475 snoring children (18.7%). Among snoring children, PCPs referred 40 (15.4%) for further evaluation. The prevalence of additional OSA signs and symptoms ranged from 3.5% for underweight to 43.7% for overweight. A total of 74.7% of snoring children had at least one additional sign or symptom and thus met American Academy of Pediatrics guidelines criteria for an OSA referral. CONCLUSIONS A CDSS can be used to support PCPs in identifying children at risk for OSA. Most snoring children met criteria for further evaluation. It will be important to further evaluate this referral threshold as well as the readiness of the sleep medicine field to meet this need. CLINICAL TRIALS REGISTRATION Registry: ClinicalTrials.gov, Title: Evidence-based Diagnosis and Management of Pediatric Obstructive Sleep Apnea in Primary Care, Identifier: NCT02781376, URL: https://clinicaltrials.gov/ct2/show/NCT02781376.
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Affiliation(s)
- Sarah M Honaker
- Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.,Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ashley Street
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ameet S Daftary
- Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen M Downs
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Sun K, Guo Y, Zhang Y, Jiang X. Breastfeeding and risk of habitual snoring in children: A meta-analysis. MATERNAL AND CHILD NUTRITION 2019; 15:e12799. [PMID: 30809934 DOI: 10.1111/mcn.12799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/30/2019] [Accepted: 02/15/2019] [Indexed: 01/11/2023]
Abstract
Research regarding the effects of breastfeeding on habitual snoring in children has yielded conflicting results. Therefore, a meta-analysis was carried out to evaluate the effect of breastfeeding on the risk of habitual snoring in children. Relevant studies published in English or Chinese were identified by a search of PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, China Biology Medical literature, and Wanfang databases up to October 2018. Random effects model was used to pool the findings, and results were expressed as odds ratios (OR) with 95% CIs. Eleven studies with 71,622 participants were included in the present meta-analysis. The pooled OR of habitual snoring for more versus less breastfeeding (duration) was 0.74 (95% CI [0.62, 0.90]), and the result remained significant in cohort studies (OR, 0.74; 95%CI [0.66, 0.84]). We found no evidence of publication bias. This meta-analysis of observational studies indicates that breastfeeding for a long time is associated with reduced risk of habitual snoring in children. The finding needs to be investigated in well-designed prospective studies.
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Affiliation(s)
- Ke Sun
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
| | - Yan Guo
- Department of Pharmacy, Qingdao No.6 People's Hospital, Qingdao, Shandong Province, China
| | - Yue Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
| | - Xiubo Jiang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
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Abstract
BACKGROUND AND OBJECTIVES Early microbial colonization has a key impact on infant health through nutritional, immunological, and metabolic programming. The origin of child snoring is multifactorial and complex, and may thereby also generate long-term health problems. The link between child snoring and gut microbes remains unclear, although indirect evidence exists regarding this relationship. This study aimed to characterize the connection between gut microbiota and child snoring. METHODS In a prospective, observational CHILD-SLEEP birth cohort study, gut microbiota in a subcohort of 43 of these children at 2 years of life was profiled with 16S ribosomal RNA gene amplicon sequencing. RESULTS A higher abundance of the Proteobacteria phylum, the Enterobacteriaceae family, and Erysipelotrichaceae family, as well as a higher ratio of Firmicutes to Bacteroidetes were detected in snorers as compared to controls. Furthermore, snorers showed significantly lower microbial diversity and richness than non-snorers. CONCLUSIONS The snoring children manifest different gut microbiota as compared with healthy children. Considering that snoring and sleep disorders can be a source of long-term consequences, including cardiovascular, metabolic, immunological, neurocognitive and behavioral consequences, our results proposes early microbiota as a new treatment target.
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Coutier L, Guyon A, Reix P, Franco P. Impact of prone positioning in infants with Pierre Robin sequence: a polysomnography study. Sleep Med 2019; 54:257-261. [DOI: 10.1016/j.sleep.2018.10.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
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Abstract
Sleep-Disordered Breathing in Childhood Abstract. One out of ten healthy children is a habitual snorer, and one fourth of snoring children suffer from obstructive sleep apnea syndrome (OSAS). While OSAS is widely recognized as a relevant social and health problem due to its negative impact on behavior and neurocognitive development, the medical significance of habitual snoring remains debated. Sleep-disordered breathing remains underestimated and underdiagnosed in childhood, in part due to the variability of clinical manifestations. This is particularly true for children with an underlying syndromal morbidity such as Down syndrome or Prader-Willi syndrome. This review summarizes the essential key points of Sleep-Disordered Breathing (SDB) in childhood.
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Affiliation(s)
- Daniel Trachsel
- 1 Zentrum für Schlafmedizin der Basler Universitätskliniken USB, UKBB, UPK, Basel
- 2 Abteilung für pädiatrische Pneumologie und Intensivmedizin, Universitäts-Kinderspital beider Basel, Universität Basel
| | - Alexandre N Datta
- 1 Zentrum für Schlafmedizin der Basler Universitätskliniken USB, UKBB, UPK, Basel
- 3 Abteilung für Neuro- und Entwicklungspädiatrie, Universitäts-Kinderspital beider Basel, Universität Basel
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47
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Kamal M, Tamana SK, Smithson L, Ding L, Lau A, Chikuma J, Mariasine J, Lefebvre DL, Subbarao P, Becker AB, Turvey SE, Sears MR, Pei J, Mandhane PJ. Phenotypes of sleep-disordered breathing symptoms to two years of age based on age of onset and duration of symptoms. Sleep Med 2018; 48:93-100. [DOI: 10.1016/j.sleep.2018.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 02/08/2023]
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48
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Idris G, Galland B, Robertson CJ, Gray A, Farella M. Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial. J Dent 2018; 71:9-17. [DOI: 10.1016/j.jdent.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 12/16/2022] Open
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Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children. Int J Pediatr Otorhinolaryngol 2018; 107:37-41. [PMID: 29501308 DOI: 10.1016/j.ijporl.2018.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) - as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption - in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep. METHODS A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015. RESULTS 4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p < 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively). Habitual snoring and habitual mouth breathing were highly associated with more frequent bouts of rhinosinusitis, ear infections, and antibiotic use (p < 0.0001 for each parameter). CONCLUSIONS Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.
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50
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Tamana SK, Smithson L, Lau A, Mariasine J, Young R, Chikuma J, Lefebvre DL, Subbarao P, Becker AB, Turvey SE, Sears MR, Pei J, Mandhane PJ. Parent-Reported Symptoms of Sleep-Disordered Breathing Are Associated With Increased Behavioral Problems at 2 Years of Age: The Canadian Healthy Infant Longitudinal Development Birth Cohort Study. Sleep 2018; 41:4584537. [PMID: 29099980 PMCID: PMC5806574 DOI: 10.1093/sleep/zsx177] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Objectives To examine the association between the age of onset and duration of parent-reported symptoms of sleep-disordered breathing (SDB) and behavioral problems at age 2. Methods Parent-reported SDB symptoms were assessed quarterly between 3 months and 2 years among 583 Canadian Healthy Infant Longitudinal Development Edmonton-site participants. Parent-reported SDB symptoms were clustered into phenotypes using group-based trajectory analysis based on age of onset and duration of symptoms. Home-based polysomnography (PSG) was completed at 1 year. The Child Behavior Checklist preschool-version (Mean T-score 50, standard deviation 10 points) assessed total, externalizing (attention), and internalizing (anxiety, depression) behaviors at 2 years. Results Four phenotypes were identified: no SDB (64.7%), early-onset SDB (15.7%, peak symptoms at 9 months), late-onset (14.2%, peak symptoms at 18 months), and persistent SDB symptoms (5.3%, peak symptoms from 3 through 24 months). Persistent SDB (9.5 points, 95% CI 1.7, 17.2; p = .02) predicted the greatest magnitude of effect of total behavior problems, compared with children without SDB. Children with early-onset SDB (3.5 points, 95% CI 1.6, 5.4; p ≤ .001) and late-onset SDB (6.1 points 95% CI 4.0, 8.3; p ≤ .001) had increased total behavioral problems than children without SDB to 2 years. Additional analyses showed that the SDB phenotypes' trajectories were important for internalizing but not for externalizing behavior problems. There were no significant associations between home-PSG and parent-reported behavior problems. Conclusions Findings suggest that the age of onset and duration of parent-reported SDB symptoms prior to age 2 have adverse consequences for overall behavior problems.
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Affiliation(s)
| | - Lisa Smithson
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Amanda Lau
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | | | - Rochelle Young
- Sleep Medicine, Alberta Health Services, Edmonton, Canada
| | - Joyce Chikuma
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Diana L Lefebvre
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Malcolm R Sears
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Jacqueline Pei
- Educational Psychology, University of Alberta, Edmonton, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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