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Costa M, Correia-Costa L, Santos AC, Azevedo I. Obstructive sleep related breathing disorders and cardiometabolic risk factors - A Portuguese birth cohort. Respir Med 2024; 222:107531. [PMID: 38246393 DOI: 10.1016/j.rmed.2024.107531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Pediatric obstructive sleep related breathing disorders (SRBD) are an important under-diagnosed health problem with associated cardiometabolic comorbidities, demonstrated with polysomnographic studies in selected samples. Our main goal was to assess the prevalence of SRBD in a population-based cohort and to analyze its association with cardiometabolic risk factors, in general and by sex. METHODS Pediatric Sleep Questionnaire (PSQ) was applied to parents of 7-years-old children evaluated in the birth cohort, Generation XXI. Sex, anthropometrics, blood pressure (BP), lipid profile, glucose, insulin, HOMA-IR, and high-sensitivity C-reactive protein were compared among children with/without SRBD, using Chi-square, Mann-Whitney tests and logistic regression models. RESULTS A total of 1931 children (51.2 % boys) were included; 17.5 % were overweight and 15.7 % obese. The prevalence of SRBD was 13.4 %, more frequent among boys (15.7 % vs.10.9 %, p = 0.002) and in overweight/obese children (22.0 % vs.13.6 % vs.11.3 % in obese, overweight and normal weight group, respectively, p < 0.001). Children with SRBD had higher systolic BP (107 ± 8 vs.105±9 mmHg; p = 0.001) and lower HDL-cholesterol levels (54 ± 11 vs.56 ± 11 mg/dL; p = 0.04) than children without SRBD. After adjustment for sex, age, birthweight-for-gestational age and maternal age, children with SRBD had higher BMI-z-score, systolic BP, insulin and HOMA-IR levels, and lower HDL-cholesterol, when compared to those without SRBD, but these associations were lost when adjusting to BMI z-score. Analyzing obese children with the same regression model, those with SRBD presented lower HDL-cholesterol than those without SRBD. CONCLUSIONS Our results identified a male predominance of SRBD in pre-pubertal children and highlighted the potential contribution of SRBD to cardiovascular risk in obese children.
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Affiliation(s)
- Mariana Costa
- Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar de Leiria, Portugal
| | - Liane Correia-Costa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.
| | - Ana Cristina Santos
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Inês Azevedo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
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Li X, Chen J, Du H, Zhang Y, Hua J, Cheng Y, Li X, Chen X. Association between Obstructive Sleep Apnea and Intracranial Artery Calcification Stratified by Gender and Body Mass Index: A Hospital-Based Observational Study. Neuroepidemiology 2023; 57:391-399. [PMID: 37660685 DOI: 10.1159/000533843] [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: 05/18/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial arterial calcification (IAC) has been validated as a marker for subclinical cerebrovascular disease. However, the relationship between OSA with IAC was less studied compared with its established association with coronary artery calcification. In this study, we aimed to investigate the association between the severity of OSA and the degree of IAC in hospitalized patients without preexisting cardiovascular disease. METHODS This hospital-based observational study was conducted from June 1, 2017, to May 1, 2019. In total, 901 consecutive patients who underwent head computed tomography scans and portable sleep monitoring were included. On the basis of the apnea-hypopnea index (AHI), patients were divided into four OSA severity groups (normal: AHI <5/h; mild: 5≤ AHI <15/h; moderate: 15≤ AHI <30/h; severe: AHI ≥30/h). Associations of OSA with IAC scores were assessed by using multivariate logistic regression analysis. RESULTS Of the 901 patients, 484 (53.7%) were men; the mean (SD) age was 66.1 (10.0) years. The non-OSA group included 207 (23.0%) patients; mild OSA, 209 (23.2%); moderate OSA, 235 (26.1%); and severe OSA, 169 (18.8%). Mean IAC scores were higher in the severe OSA group compared with non-, mild, and moderate OSA groups (4.79 vs. 2.58; 4.79 vs. 2.94; 4.79 vs. 3.39; p < 0.001). Multivariate analysis adjusted for confounding factors revealed that only severe OSA was associated with a higher IAC score (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.43-1.91; p < 0.001). In stratified analyses by BMI, among participants with a BMI <25 kg/m2, the positive association between AHI values and IAC scores was found in the moderate OSA group (OR: 1.23; 95% CI: 1.05, 1.43; p = 0.01) and the severe OSA group (OR: 1.96; 95% CI: 1.55, 2.48; p < 0.001). When stratified by gender, in women, the positive association was found in the moderate OSA group (adjusted OR: 1.21; 95% CI: 1.02-1.51; p = 0.016) and the severe OSA group (adjusted OR: 1.76; 95% CI: 1.36-2.25; p < 0.001). For the men group, a positive association between IAC scores and AHI was only observed in the severe OSA group. DISCUSSION These findings suggest that OSA, in particular severe OSA (AHI ≥30), is independently associated with higher IAC scores. Women and no-obesity individuals appeared more susceptible to adverse OSA-related subclinical cerebrovascular disease as measured by IAC scores.
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Affiliation(s)
- Xuelong Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China,
| | - Junru Chen
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China
| | - Yujing Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiewei Hua
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangyang Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China
| | - Xianliang Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China
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Yoon A, Gozal D, Kushida C, Pelayo R, Liu S, Faldu J, Hong C. A roadmap of craniofacial growth modification for children with sleep-disordered breathing: a multidisciplinary proposal. Sleep 2023; 46:zsad095. [PMID: 37014012 PMCID: PMC10424160 DOI: 10.1093/sleep/zsad095] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
Craniofacial modification by orthodontic techniques is increasingly incorporated into the multidisciplinary management of sleep-disordered breathing in children and adolescents. With increasing application of orthodontics to this clinical population it is important for healthcare providers, families, and patients to understand the wide range of available treatments. Orthodontists can guide craniofacial growth depending on age; therefore, it is important to work with other providers for a team-based approach to sleep-disordered breathing. From infancy to adulthood the dentition and craniofacial complex change with growth patterns that can be intercepted and targeted at critical time points. This article proposes a clinical guideline for application of multidisciplinary care with emphasis on dentofacial interventions that target variable growth patterns. We also highlight how these guidelines serve as a roadmap for the key questions that will influence future research directions. Ultimately the appropriate application of these orthodontic techniques will not only provide an important therapeutic option for children and adolescents with symptomatic sleep-disordered breathing but may help also mitigate or prevent its onset.
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Affiliation(s)
- Audrey Yoon
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - David Gozal
- Department of Child Health, and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Clete Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rafael Pelayo
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jasmine Faldu
- Division of Orthodontics, Department of Orofacial Science, School of Dentistry, the University of California San Francisco, San Francisco, CA, USA
| | - Christine Hong
- Division of Orthodontics, Department of Orofacial Science, School of Dentistry, the University of California San Francisco, San Francisco, CA, USA
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Bhosale TB, Shetty V, Bhandary M, Nayak PP. Salivary biomarker C-reactive protein levels in children with sleep problems and Class II malocclusion before and after twin-block therapy. J Indian Soc Pedod Prev Dent 2023; 41:190-196. [PMID: 37861632 DOI: 10.4103/jisppd.jisppd_338_23] [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: 10/21/2023] Open
Abstract
Context Disturbances in sleep affects the overall quality of a child's life, with several short- and long-lasting consequences. Hence, early diagnosis and monitoring is crucial in the management of sleep disorders in children. Aims The aim of this study was to evaluate salivary C-reactive protein (CRP) levels in a group of children with Class II malocclusion and sleep problems before and after twin-block appliance therapy. Settings and Design The study was a prospective clinical study with a 9-month follow-up period. Subjects and Methods Eleven children aged 8-12 years with skeletal Class II malocclusion and at least one sleep disorder were enrolled in the study. All children were subjected to a recording of their sleep history and a clinical as well as radiographic examination. Pretreatment levels of salivary CRP were recorded. A twin-block appliance was custom made and delivered to every child. At the end of 9-month follow-up, all children were recalled for a re-evaluation of salivary biomarker levels. Statistical Analysis Pretreatment and posttreatment changes in biomarker levels were assessed statistically using the students paired t-test. Results Levels of salivary biomarker CRP were significantly decreased in children following myofunctional therapy using a twin-block appliance (P < 0.001). There was a considerable improvement in the clinical symptoms such as a decrease in snoring and noisy breathing in most children post-twin-block therapy. Conclusion The measurement of salivary biomarker CRP could be used as an alternative and noninvasive method to evaluate prognosis of oral myofunctional therapy for children with sleep disordered breathing.
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Affiliation(s)
- Trupti B Bhosale
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Vabitha Shetty
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Meghna Bhandary
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Prajna P Nayak
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Chen Y, Xu J, Yin G, Ye J. Effectiveness and safety of (adeno) tonsillectomy for pediatric obstructive sleep apnea in different age groups: A systematic review and meta-analysis. Sleep Med Rev 2023; 69:101782. [PMID: 37121134 DOI: 10.1016/j.smrv.2023.101782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 02/14/2023] [Accepted: 03/18/2023] [Indexed: 05/02/2023]
Abstract
This meta-analysis aimed to assess the effectiveness and safety of (adeno)tonsillectomy (AT) for uncomplicated pediatric obstructive sleep apnea (OSA) across different age groups. Four electronic databases were searched until April 2022, and 93 studies (9087 participants) were selected, including before-after studies, cohort studies, and randomized controlled trials. It has been suggested that age, disease severity, and length of follow-up are associated with surgical effects. Compared with older children (>7 years), patients receiving AT surgery before the age of 7 exhibited a significantly greater release of disease severity, as well as a greater decrease in hypoxemic burden, improvement in sleep quality, and better cardiovascular function. Cognitive/behavioral performance also improved after AT, although it was more related to the length of follow-up than the age at surgery. Notably, the surgical complication rate was considerably higher in patients younger than 3 years old. Overall, we suggest that the age of 3-7 years might be optimal for AT in polysomnography-diagnosed uncomplicated OSA to maximize potential benefits for both disease and comorbidities and balance the risks of surgery.
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Affiliation(s)
- Yijing Chen
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China
| | - Jinkun Xu
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China
| | - Guoping Yin
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China
| | - Jingying Ye
- Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China; Institute of Precision Medicine, Tsinghua University, China.
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Prabhu N, Shetty V. Inflammatory Biomarkers for Children with Sleep Disorders: A Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1742371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Introduction Obstructive sleep apnea (OSA) syndrome is a highly prevalent problem in children. Unfortunately sleep disorders in children remain largely unreported and underdiagnosed due to various reasons. Overnight in-laboratory polysomnography (PSG) is the gold standard diagnostic method for OSA; however, it has several drawbacks. Hence there is a need for simple alternative diagnostic methods, such as biomarkers. Children with OSA seem to have an inflammatory aspect to its pathophysiology; thus the rationale for evaluating inflammatory biomarkers.
Objective This narrative review aimed to evaluate the existing knowledge regarding inflammatory biomarkers for children with sleep disorders.
Materials and Methods An extensive search of all literature linked to the topic was performed in PubMed, Medline, EBSCOhost, Cochrane library database CENTRAL, and Google Scholar search engine. Keywords used in the search included combinations of the following: inflammation, sleep disorders, children, and biomarkers. Studies in the list of references of relevant literature were also included. A total of 155 articles published in the period from 1997 to 2021 were initially included in this review. Selected articles comprised original research, meta-analysis, and systematic reviews.
Results Studies have mainly centered their investigations on serum inflammatory biomarkers, namely interleukin-6, tumor necrosis factor-α, and C-reactive protein. Very few studies investigated salivary inflammatory biomarkers in children.
Conclusion Evidence suggests that children with sleep disorders have elevated levels of salivary as well as serum inflammatory biomarkers in comparison to normal healthy children. Also increased levels of these biomarkers correlate with disease severity. However, more studies are needed to determine the sensitivity and specificity of salivary inflammatory biomarkers for children with sleep disorders.
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Affiliation(s)
- Nagashree Prabhu
- Department of Pediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Vabitha Shetty
- Department of Pediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
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Burton ZA, Lewis R, Bennett T, McLernon DJ, Engelhardt T, Brooks PB, Edwards MR. Prevalence of PErioperAtive CHildhood obesitY in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study. Br J Anaesth 2021; 127:953-961. [PMID: 34627621 DOI: 10.1016/j.bja.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Childhood obesity has become a serious global healthcare challenge. No UK data currently define its anaesthetic and perioperative implications. We aimed to determine obesity prevalence amongst UK children undergoing general anaesthesia and the incidence of predefined adverse perioperative events, and to compare perioperative obesity rates with National Child Measurement Programme (NCMP) data. METHODS During a site-selected consecutive 7-day study period, all children (2-16 yr) undergoing general anaesthesia were included. Anonymised hospital, surgical, and procedural details; demographic data; and adverse perioperative events were collected prospectively by Paediatric Anaesthesia Trainee Research Network (PATRN) collaborators. RESULTS For this study, 102 UK hospitals participated and 4232 cases were included in the final analysis; 76% of hospitals did not routinely calculate BMI. In addition, 3030 (71.6%; 95% confidence interval [CI]: 70.2-73.0%) children of healthy weight were compared with 537 (12.7%; 11.7-13.7%) children who were overweight and 478 (11.3%; 10.3-12.2%) children with obesity. Children with obesity (n=71; 14.9%) more commonly underwent (adeno)tonsillectomy than children of healthy weight (n=282; 9.3%; P<0.001; odds ratio [OR] 2.15; 95% CI: 1.58-2.92). Fewer children with obesity (n=365; 77% vs n=2552; 85%) were anaesthetised by consultant anaesthetists (OR 0.62; 95% CI: 0.48-0.79). Mask ventilation was difficult for 3.7% of children with obesity vs 0.6% of children of healthy weight (difference 3.0%; 95% CI: 1.3-4.7%; P<0.001). Comparison with NCMP data demonstrated an over-representation of obesity amongst the paediatric surgical population. CONCLUSIONS This large multicentre cohort study suggests a concerning prevalence of children with obesity presenting for anaesthesia. These results should be used to inform optimal provision of care for this population and support perioperative healthcare initiatives to address the burden of childhood obesity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03994419.
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Affiliation(s)
- Zoë A Burton
- Department of Anaesthesia, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
| | - Rosie Lewis
- Department of Anaesthesia, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Tom Bennett
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Thomas Engelhardt
- McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada
| | - Peter B Brooks
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mark R Edwards
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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C-reactive protein in children with obstructive sleep apnea and effects of adenotonsillectomy. Auris Nasus Larynx 2021; 49:92-99. [PMID: 34272056 DOI: 10.1016/j.anl.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA. METHODS Children with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery. RESULTS This study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1-5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03-0.25) vs 0.03 (0.02-0.14) vs 0.04 (0.01-0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02-0.22) to 0.08 (0.03-0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11-2.78) to 0.20 (0.07-1.04), P = 0.043]. CONCLUSION Children with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy.
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Oceja E, Rodríguez P, Jurado MJ, Luz Alonso M, del Río G, Villar MÁ, Mediano O, Martínez M, Juarros S, Merino M, Corral J, Luna C, Kheirandish-Gozal L, Gozal D, Durán-Cantolla J. Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology. Methods Protoc 2021; 4:9. [PMID: 33477929 PMCID: PMC7838960 DOI: 10.3390/mps4010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.
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Affiliation(s)
- Esther Oceja
- Domiciliary Hospitalization, Sleep Unit, OSI Araba University Hospital, 01004 Vitoria, Spain;
| | - Paula Rodríguez
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
| | - María José Jurado
- Sleep Unit, Hospital Universitario Valle de Hebrón, 08035 Barcelona, Spain;
| | - Maria Luz Alonso
- Sleep Unit, Complejo Hospitalario de Burgos, 09006 Burgos, Spain
| | | | | | - Olga Mediano
- Sleep Unit, Hospital de Guadalajara, 19002 Guadalajara, Spain;
| | - Marian Martínez
- Sleep Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Santiago Juarros
- Sleep Unit, Hospital Universitario de Valladolid, 47012 Valladolid, Spain;
| | - Milagros Merino
- Sleep Unit, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Jaime Corral
- Sleep Unit, Complejo Hospitalario de Cáceres, 100003 Cáceres, Spain;
| | - Carmen Luna
- Sleep Unit, Hospital Universitario 12 de Octubre, 280035 Madrid, Spain;
| | - Leila Kheirandish-Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - Joaquín Durán-Cantolla
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
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Bhattacharjee R, Benjafield AV, Armitstead J, Cistulli PA, Nunez CM, Pepin JLD, Woehrle H, Yan Y, Malhotra A. Adherence in children using positive airway pressure therapy: a big-data analysis. LANCET DIGITAL HEALTH 2019; 2:e94-e101. [PMID: 33334566 PMCID: PMC7847310 DOI: 10.1016/s2589-7500(19)30214-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Positive airway pressure (PAP) has become a prominent treatment for children with sleep-disordered breathing. However, there are no large-scale studies to clarify whether PAP is well tolerated in children, and which factors are associated with better adherence to PAP therapy. In this study, we aimed to clarify adherence patterns of PAP therapy in a large paediatric population. METHODS We did a cross-sectional big-data analysis in children from Oct 1, 2014, to Aug 1, 2018, using existing data derived from PAP devices uploaded nightly in the AirView cloud database. The AirView database is a usage tracking system available to all patients who are assigned PAP therapy, which requires consent from the patient or parent or guardian. All patients older than 4 years and younger than 18 years who used continuous or automated PAP devices were evaluated. Only patients living in the USA and enrolled with a single insurance company were included. If patients were participating in an engagement programme, programme onset must have been within 7 days of therapy onset. Our primary outcome was the proportion of patients who used PAP continuously over 90 days. The primary outcome was assessed in all patients who met the age inclusion criterion and had reliable age data available. Data on missing PAP use were imputed as zero, but data on other metrics were not imputed and excluded from analysis. FINDINGS We used data recorded from Oct 1, 2014, to Aug 1, 2018. Of 40 140 children screened, 36 058 (89·8%) were US residents and 20 553 (90·1%) of them met the eligibility criteria and had accessible data (mean age 13·0 years [SD 3·7]). On the basis of 90 days of monitoring data, 12 699 (61·8%) patients continuously used PAP. Factors significantly associated with adherence included age group, residual apnoea-hypopnoea index, use and onset of patient engagement programmes, PAP pressure, and nightly median PAP mask leak, all over the 90-day study period. INTERPRETATION To our knowledge, our study represents the largest analysis of children using PAP therapy to date. The findings suggest that adherence to PAP therapy is lower than in previous reports from adults. However, numerous actionable factors were associated with improvements in adherence and should be used strategically in clinical decision making to improve PAP adherence in children. FUNDING ResMed.
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Affiliation(s)
- Rakesh Bhattacharjee
- Rady Children's Hospital and Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
| | | | | | - Peter A Cistulli
- Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Jean-Louis D Pepin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France; EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Holger Woehrle
- Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Germany
| | - Yang Yan
- ResMed Science Center, Singapore, Singapore
| | - Atul Malhotra
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
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11
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Miano S, Amato N, Garbazza C, Abbafati M, Foderaro G, Pezzoli V, Ramelli GP, Manconi M. Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder. Sleep 2019; 42:5540162. [DOI: 10.1093/sleep/zsz167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/28/2019] [Indexed: 02/04/2023] Open
Abstract
Abstract
Study Objectives
Sleep-related slow-wave activity (SWA) has been recognized as a marker of synaptic plasticity. In children affected by attention deficit hyperactivity disorder (ADHD), SWA is mainly located in the central rather than frontal regions, reflecting a maturational delay. A detailed subjective and objective sleep investigation, including a full night video-polysomnography (PSG-HD-EEG), was performed on 30 consecutive drug naïve outpatients with a diagnosis of ADHD. They received a diagnosis of sleep disorders in 29/30 cases, and most of them had a past history of sleep problems. They had a higher apnea–hypopnea index at PSG, and slept less than 9 hr at actigraphy. We aimed to describe the SWA behavior in the same group of children with ADHD.
Materials and Methods
The full-night PSG-HD EEG of children with ADHD was compared with the one of the 25 healthy controls. The scalp SWA mapping, the decrease of SWA during the night, and the EEG source of SWA were analyzed.
Results
At scalp topography, the focus of SWA was observed over the centro–parietal–occipital regions in participants with ADHD (p < 0.01), which remained significant in the subgroups divided between subgroups according to the sleep diagnosis (p < 0.01). The physiological decrease in SWA was more evident in control participants. The source analysis revealed a greater delta power over the posterior cingulate in participants with ADHD (p < 0.01).
Conclusions
Our results confirm static and dynamic changes in SWA behavior in children with ADHD, which may reflect a maturational delay occurring at a vulnerable age, as a consequence of chronic sleep deprivation.
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Affiliation(s)
- Silvia Miano
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Ninfa Amato
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Manuel Abbafati
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Giuseppe Foderaro
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Valdo Pezzoli
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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12
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Rivera N, Flores C, Morales M, Padilla O, Causade S, Brockmann PE, Castro-Rodriguez JA. Preschoolers with recurrent wheezing have a high prevalence of sleep disordered breathing. J Asthma 2019; 57:584-592. [PMID: 30950302 DOI: 10.1080/02770903.2019.1599385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Sleep-disordered breathing (SDB) is highly prevalent in school children with poorly-controlled asthma. However, this association has not been assessed in preschoolers with recurrent wheeze, nor in those at risk for asthma. We hypothesized that preschoolers with asthma risk (positive asthma predictive index [API]) have a higher prevalence of SDB and higher inflammatory biomarkers (blood-hsCRP and urinary-LTE4) levels than those with negative API.Method: Children 2 to 5 years of age with recurrent wheezing were classified as positive or negative API. SDB was determined by the pediatric sleep questionnaire (PSQ) and its subscale (PSQSub6). Demographic characteristics, spirometry, blood hsCRP and urinary LTE4 were assessed.Results: We enrolled 101 preschoolers: 70 completed all measurements, 55.4% were males, mean age 4.07 ± 0.87 years, 45% overweight or obese, 70% had positive API, 87.5% had rhinitis. The prevalence of SDB measured by PSQ was 40.8% and by PSQSub6 was 29.6%. However, the proportion of SDB was similar between positive and negative API groups. The hsCRP (mean ± SD) was higher in the positive than in negative API (3.58 ± 0.58 and 1.32 ± 0.36 mg/L, p = 0.69, respectively); moreover, no differences in urinary LTE4 were found between groups. No correlation of PSQ (+) or PSQSub6 (+) with hsCRP and uLTE4 was found. However, preschoolers with positive API had significantly more post-bronchodilator percentage change in FEF25-75 than negative API (24.14 ± 28.1 vs. 4.13 ± 21.8, respectively, p = 0.01).Conclusions: In preschoolers with recurrent wheezing, we should be investigating for the coexistence of SDB, using early screening methods for detecting those conditions.
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Affiliation(s)
- Natalia Rivera
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Flores
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maureen Morales
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oslando Padilla
- Division of Public Health, School of Medicine, Pontificia Universidad Católica de Chile
| | - Solange Causade
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo E Brockmann
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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13
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Shi Y, Luo H, Liu H, Hou J, Feng Y, Chen J, Xing L, Ren X. Related biomarkers of neurocognitive impairment in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2019; 116:38-42. [PMID: 30554705 DOI: 10.1016/j.ijporl.2018.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Different experiment approaches have demonstrated that children with obstructive sleep apnea (OSA) exhibit neurocognitive and behavioral deficits. This review summarized the potential biomarkers of OSA-associated neurocognitive impairment in children. METHODS A scoping review of studies on children with OSA that evaluated the potential value of different markers in identifying neurocognitive impairment was undertaken. Additionally, the biomarkers were categorized according to the different research methods, including brain imaging studies, serological indicators and urine markers. RESULTS Majority of the studies that evaluated blood biomarkers, plasma insulin growth factor-1 (IGF-1) and Alzheimer's disease (AD)-related biomarkers appeared to exhibit a favorable profile, and could discriminate between OSA children with or without neurocognitive impairments. Brain imaging studies and urinary neurotransmitters could also be helpful for screening OSA cognitive morbidity in children. CONCLUSION Due to limited research methods available in children, the cognitive susceptibility of children with OSA has been rarely studied. The main reason for this may be the limited research methods in children. Numerous study populations of children and complex psychological tests are required, which involve major labor and costs.Multi-center prospective studies are needed to identify suitable biomarkers for the timely prediction and effective intervention to prevent neurocognitive impairment in children with OSA and to explore further opportunities in this arena.
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Affiliation(s)
- Yewen Shi
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Huanan Luo
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Haiqin Liu
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jin Hou
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Yani Feng
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jinwei Chen
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Liang Xing
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China.
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Alonso-Álvarez ML, Brockmann PE, Gozal D. Treatment of Obstructive Sleep Apnea Syndrome in Children: More Options, More Confusion. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2017.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Gozal D, Brockmann PE, Alonso-Álvarez ML. Morbidity of Pediatric Obstructive Sleep Apnea in Children: Myth, Reality, or Hidden Iceberg? Arch Bronconeumol 2018; 54:253-254. [DOI: 10.1016/j.arbres.2017.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022]
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16
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Alonso-Álvarez ML, Brockmann PE, Gozal D. Treatment of Obstructive Sleep Apnea Syndrome in Children: More Options, More Confusion. Arch Bronconeumol 2018; 54:409-411. [PMID: 29422344 DOI: 10.1016/j.arbres.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- María Luz Alonso-Álvarez
- Sleep Unit, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Carlos III, Hospital Universitario de Burgos (HUBU), Burgos, España
| | - Pablo E Brockmann
- Sleep Medicine Center, Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, Estados Unidos de América.
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17
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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18
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Koren D. PAP Therapy's Effect on Cardiometabolic Risk Markers in Pediatric Patients. J Clin Sleep Med 2017; 13:1025-1027. [PMID: 28818155 DOI: 10.5664/jcsm.6714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Dorit Koren
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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19
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Alonso-Álvarez ML, Terán-Santos J, Gonzalez Martinez M, Cordero-Guevara JA, Jurado-Luque MJ, Corral-Peñafiel J, Duran-Cantolla J, Ordax Carbajo E, MasaJimenez F, Kheirandish-Gozal L, Gozal D. Metabolic biomarkers in community obese children: effect of obstructive sleep apnea and its treatment. Sleep Med 2017; 37:1-9. [DOI: 10.1016/j.sleep.2017.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022]
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20
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Gozal D, Khalyfa A, Qiao Z, Smith DL, Philby MF, Koren D, Kheirandish-Gozal L. Angiopoietin-2 and soluble Tie-2 receptor plasma levels in children with obstructive sleep apnea and obesity. Obesity (Silver Spring) 2017; 25:1083-1090. [PMID: 28474375 PMCID: PMC5532873 DOI: 10.1002/oby.21859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a prevalent condition, especially in children with obesity, and is associated with increased risk for metabolic syndrome (MetS). Angiopoietins have been identified as potential biomarkers of endothelial dysfunction and MetS. In adults, angiopoietin-2 (Ang-2) and its soluble receptor (sTie-2) are associated with diabetes, hypertension, and obesity and could be increased in children with OSA and obesity, particularly those with evidence of cardiometabolic alterations. METHODS One hundred twenty-six children (7.4 ± 2.0 years) were consecutively recruited and underwent overnight polysomnography, as well as endothelial function and BMI z score assessments and a fasting blood draw the morning after the sleep study. In addition to lipid profile, glucose and insulin levels, and homeostatic model assessment of insulin resistance (HOMA-IR), Ang-2 and sTie-2 concentrations were determined. RESULTS Children with obesity and OSA had significantly elevated plasma Ang-2 and sTie-2 levels compared to corresponding controls with and without obesity. Furthermore, endothelial function (Tmax) and HOMA-IR were linearly and independently associated with Ang-2 and sTie-2 levels. In a small subset of children (n = 14), treatment of OSA by adenotonsillectomy resulted in reductions of Ang-2 and sTie-2 (P < 0.01). CONCLUSIONS Ang-2 and sTie-2 plasma levels are increased in pediatric OSA and obesity, particularly when endothelial dysfunction or insulin resistance is detectable, and appear to decrease upon OSA treatment.
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Affiliation(s)
- David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Abdelnaby Khalyfa
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Zhuanghong Qiao
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Dale L Smith
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Mona F Philby
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Dorit Koren
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
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Abstract
Sleep disordered breathing (SDB) in childhood is linked with significant end-organ dysfunction across various systems, particularly with cardiovascular, neurocognitive and metabolic consequences. If we understand the pathophysiology of SDB, diagnose it promptly and treat appropriately, we may be able to prevent morbidity associated with SDB and also save health resources around the world. In this article, we highlight articles on this topic published in medical journals in the past year. Prematurity, obesity and adenotonsillar hypertrophy are risk factors for sleep disordered breathinghttp://ow.ly/W47FU
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Affiliation(s)
- Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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Kheirandish-Gozal L, Gozal D. Pediatric OSA Syndrome Morbidity Biomarkers: The Hunt Is Finally On! Chest 2016; 151:500-506. [PMID: 27720883 DOI: 10.1016/j.chest.2016.09.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/12/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022] Open
Abstract
Since initial reports 40 years ago on pediatric OSA syndrome (OSAS) as a distinct and prevalent clinical entity, substantial advances have occurred in the delineation of diagnostic and treatment approaches. However, despite emerging and compelling evidence that OSAS increases the risk for cognitive, cardiovascular, and metabolic end-organ morbidities, routine assessment of such morbidities is seldom conducted in clinical practice. One of the major reasons for such discrepancies resides in the relatively labor-intensive and onerous steps that would be required to detect the presence of any of such morbidities, further adding to the already elevated cost of diagnosing the disorder. To circumvent these obstacles, the search for biomarker signatures of pediatric OSA and its cognitive and cardiometabolic consequences was launched, and considerable progress has occurred since then. Here, we review the current evidence for the presence of morbidity-related biomarkers among children with OSAS, and explore future opportunities in this promising arena.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL.
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL
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Propst EJ, Amin R, Talwar N, Zaman M, Zweerink A, Blaser S, Zaarour C, Luginbuehl I, Karsli C, Aziza A, Forrest C, Drake J, Narang I. Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success. Laryngoscope 2016; 127:757-763. [DOI: 10.1002/lary.26104] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Evan J. Propst
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, Hospital for Sick Children; Toronto Canada
- Department of Otolaryngology-Head and Neck Surgery; Hospital for Sick Children; Toronto Canada
| | - Reshma Amin
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Natasha Talwar
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Michele Zaman
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Allison Zweerink
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Susan Blaser
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, Hospital for Sick Children; Toronto Canada
- Department of Diagnostic Imaging; Hospital for Sick Children; Toronto Canada
| | - Christian Zaarour
- Department of Anesthesia; Hospital for Sick Children; Toronto Canada
| | - Igor Luginbuehl
- Department of Anesthesia; Hospital for Sick Children; Toronto Canada
| | - Cengiz Karsli
- Department of Anesthesia; Hospital for Sick Children; Toronto Canada
| | - Albert Aziza
- Department of Diagnostic Imaging; Hospital for Sick Children; Toronto Canada
| | | | - James Drake
- Division of Neurosurgery; Hospital for Sick Children; Toronto Canada
| | - Indra Narang
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
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Tan HL, Kheirandish-Gozal L, Gozal D. Obstructive sleep apnea in children: update on the recognition, treatment and management of persistent disease. Expert Rev Respir Med 2016; 10:431-439. [PMID: 26949836 DOI: 10.1586/17476348.2016.1163224] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adenotonsillectomy (AT) is the recommended first-line treatment for pediatric obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy. It is now clearly established that AT results in improvement in the severity of OSA in most children. However, a significant number of OSA children undergoing AT exhibit residual persistent OSA post-surgery. Patients at increased risk of persistent OSA include those with severe disease at initial review, older or obese patients, children with underlying asthma or allergic rhinitis, and those who have concurrent underlying medical conditions, such as Trisomy 21, craniofacial syndromes or cerebral palsy. Here, we aim to highlight recent research findings into those who have persistent OSA disease, and suggest a practical approach to the management of these children.
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Affiliation(s)
- Hui-Leng Tan
- a Department of Paediatric Respiratory Medicine , Royal Brompton Hospital , London , UK
| | - Leila Kheirandish-Gozal
- b Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine , The University of Chicago , Chicago , IL , USA
| | - David Gozal
- b Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine , The University of Chicago , Chicago , IL , USA
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25
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The Status of Pediatric Obstructive Sleep Apnea in 2015: Progress? YES!! More Questions? Definitely YES!! CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0033-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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