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Wisniewski B, Witt R, Cole M, Gurbani N, Huang G, Hossain MM, Simakajornboon N. 0505 Maintenance of Wakefulness Test Characteristics In Pediatric Populations With Central Hypersomnia. Sleep 2022. [DOI: 10.1093/sleep/zsac079.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Children with central hypersomnia often have residual daytime sleepiness despite treatment with medical therapies. The Maintenance of Wakefulness Test (MWT) is an objective measure used to assess daytime alertness and responsiveness to treatment in patients with hypersomnia. There are limited data on MWT characteristics among pediatric populations. The purpose of this study was to: (1.) Compare MWT characteristics and subjective assessment between patients who passed and failed the MWT; (2.) Determine clinical management changes following MWT.
Methods
A retrospective review was conducted of all children who underwent MWT at Cincinnati Children’s Hospital Medical Center from September, 2008 to June, 2021. Pass and fail assessment designations were determined by the clinician as recorded in the medical record. Demographics, Epworth Sleepiness Scores (ESS), MWT characteristics, and pharmacological modifications were recorded. A majority of patients underwent MWT prior to driving. Descriptive statistics as well as Chi-square, Fisher’s exact, and Wilcoxon rank-sum testing were utilized. All variables were reported as medians with interquartile ranges.
Results
109 MWTs were performed on 79 children with a median age of 17.7 years [16.6, 18.6]. MWTs were indicated for 4 primary diagnoses: hypersomnia (n=5), idiopathic hypersomnia (n=11), narcolepsy type 1 (n=56), and narcolepsy type 2 (n=37). 55 (50.5%) were documented as pass (P) and 54 as fail (F). No differences in age (17.5 years) [16.2,18.5] (P) vs. (17.8) [16.9,18.9] (F) (p=NS) or other demographics existed between the two groups. As expected, mean sleep latency was significantly higher among those who passed (37.3 minutes) [31.2,40.0] (P) vs. (10.8) [7.9,16.6] (F) (p<0.001). However, no significant differences were observed in ESS 12.0 [8.0,17.0] (P) vs. 11.0 (6.0,14.0) (F) (p=NS). Pharmacologic adjustments were made in 42/54 (77.8%) (F) vs. 17/54 (31.5%) (P). Medications were not modified in 12/54 (22.2%) (F) assessments.
Conclusion
MWT provides useful objective assessment and often leads to management changes in adolescents with central hypersomnia. A subjective sleepiness assessment (ESS) does not correlate with objective MWT assessments. We speculate that an altered perception of sleepiness in children with hypersomnia may play a role in the inaccuracy of subjective assessments commonly utilized in clinical practice.
Support (If Any)
Cincinnati Children’s Research Foundation.
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Affiliation(s)
- Benjamin Wisniewski
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rochelle Witt
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Division of Neurology, Cincinnati Children’s Hospital Medical Center; Cincinnati, Ohio
| | - Melissa Cole
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Neepa Gurbani
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Md Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Witt R, Wisniewski B, Cole M, Gurbani N, Huang G, Hossain MM, Simakajornboon N. 0410 Utility of the Urine Drug Screen in Maintenance of Wakefulness Testing Interpretation - A Single-Center, Retrospective Analysis in Pediatric Patients. Sleep 2022. [DOI: 10.1093/sleep/zsac079.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Accurate assessment of hypersomnia depends upon consideration of several factors, including use of medications that affect alertness and sleep organization. Urine drug screens (UDS) are recommended when assessing hypersomnia, but there is little standardization with respect to screening methods, types of substances detected, and use in maintenance of wakefulness test (MWT) interpretation, in part because there is scant literature relating UDS results to patients’ characteristics, MWT findings and implications.
Methods
A retrospective analysis was performed in adolescents evaluated at Cincinnati Children's Sleep Center between 2008 and 2021 who underwent MWT with concurrent UDS to determine the adequacy of hypersomnia treatment. UDS in our laboratory were performed by Qualitative Immunoassay/Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry.
Results
A total of 109 MWTs were accompanied by UDS in 79 patients. Patients were 17.7 [16.6, 18.6] years old (median, [IQ range]), 41.3% female, 68.8% White, 25.7% Black, 5.5% Other, with a BMI of 25.8 [22.1, 31.8] kg/m2. 85.3% had narcolepsy. In addition to prescribed medications, caffeine was positive in 54.1% of UDS, and diphenhydramine was positive in 58.7%. No patients reported use of caffeine or diphenhydramine on the day of MWT. There were no significant demographic differences between those who tested positive and negative for caffeine. The median sleep latency in those with caffeine-positive UDS was longer than those with caffeine-negative UDS, although it did not reach statistical significance (27.3 [14.7, 38.3] vs 19.1 [9.8, 36.1] minutes; P=0.15). Patients with a positive UDS for diphenhydramine all took modafinil/armodafinil. In addition, 80% of patients taking modafinil/armodafinil had diphenhydramine-positive results. Nicotine and cannabinoids were detected in 2 UDS.
Conclusion
Two unexpected substances (caffeine and diphenhydramine) were found on UDS during MWTs in a significant proportion of our cohort. Caffeine may influence the results of MWTs, although further investigations are warranted. The unexpected presence of diphenhydramine is a false positive for those patients on modafinil/armodafinil (supported by literature and confirmed by our laboratory director). Sleep clinicians should be aware of these findings and the implications of unexpected substances when interpreting MWTs.
Support (If Any)
Cincinnati Children's Hospital Research Fund
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Wisniewski B, Witt R, Dye T, Arya R, Simakajornboon N. 0830 A Pediatric Case of Myoclonic Seizures Precipitating Central Sleep Apnea And Sequences of Periodic Breathing During Sleep. Sleep 2022. [DOI: 10.1093/sleep/zsac079.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Myoclonic seizures are known to be influenced by the sleep-wake cycle. Although myoclonic seizures have been shown to alter sleep architecture, little is known about their influence on sleep-disordered breathing.
Report of Cases: A 7-year-old male with a history of generalized epilepsy of unknown etiology with absence as well as myoclonic seizures, poor impulse control, and fine motor delay was referred for restless sleep and frequent nocturnal awakenings. A routine electroencephalography (EEG) performed 33 months prior to presentation, at an outside institution, reportedly showed 3.0 Hz generalized frontally dominant spike and wave discharges lasting less than two seconds. Video EEG (vEEG) revealed diffuse bilateral poly-spike and slow wave discharges, predominantly during sleep, and myoclonic seizures with abrupt whole-body jerks. Polysomnography, at this time, was characterized by mild central sleep apnea (AHI: 3.7; OAHI: 0.0; CAI: 2.8; REM AHI: 14.4). His lamotrigine dosing was increased to from 1.8 mg/kg/day to 3.6 mg/kg/day, at presentation, with seizure control for three months but he developed a recurrence of myoclonic seizures in the setting of sleep deprivation. A repeat vEEG was similar to previous findings and his lamotrigine was increased further and clobazam was added. Due to worsening behaviors, clobazam was discontinued and a weaning plan for lamotrigine was formulated. Repeat polysomnography demonstrated worsening central sleep apnea (AHI: 18.3, OAHI: 2.3), without hypoventilation, characterized by sequences of periodic breathing that occurred in conjunction with myoclonic seizures. The majority of seizure-induced periodic breathing episodes were observed during a one-hour period of NREM sleep near the end of the study. Stereotyped epileptiform activity occurred in conjunction with a resumption of hyperventilatory respirations following apneic events. The increased respiratory drive, however, did not appear to be clinically epileptic in nature as the epileptiform activity either preceded or trailed the respirations. A variable REM and then NREM predominance of central events on successive polysomnograms further suggests that his central events are not intrinsic but that they are precipitated by epileptiform activity. Zonisamide, an anticonvulsant with carbonic anhydrase
inhibitory properties was initiated and is being titrated to therapeutic goal.
Conclusion
This case illustrates an unusual presentation of myoclonic seizure-induced periodic breathing during sleep.
Support (If Any)
Cincinnati Children’s Research Foundation.
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Affiliation(s)
- Benjamin Wisniewski
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rochelle Witt
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Thomas Dye
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ravindra Arya
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Narong Simakajornboon
- Sleep Center, Division of Pulmonology & Sleep Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Shrestha CL, Zhang S, Wisniewski B, Häfner S, Elie J, Meijer L, Kopp BT. (R)-Roscovitine and CFTR modulators enhance killing of multi-drug resistant Burkholderia cenocepacia by cystic fibrosis macrophages. Sci Rep 2020; 10:21700. [PMID: 33303916 PMCID: PMC7728753 DOI: 10.1038/s41598-020-78817-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023] Open
Abstract
Cystic fibrosis (CF) is characterized by chronic bacterial infections and heightened inflammation. Widespread ineffective antibiotic use has led to increased isolation of drug resistant bacterial strains from respiratory samples. (R)-roscovitine (Seliciclib) is a unique drug that has many benefits in CF studies. We sought to determine roscovitine’s impact on macrophage function and killing of multi-drug resistant bacteria. Human blood monocytes were isolated from CF (F508del/F508del) and non-CF persons and derived into macrophages (MDMs). MDMs were infected with CF clinical isolates of B. cenocepacia and P. aeruginosa. MDMs were treated with (R)-roscovitine or its main hepatic metabolite (M3). Macrophage responses to infection and subsequent treatment were determined. (R)-roscovitine and M3 significantly increased killing of B. cenocepacia and P. aeruginosa in CF MDMs in a dose-dependent manner. (R)-roscovitine-mediated effects were partially dependent on CFTR and the TRPC6 channel. (R)-roscovitine-mediated killing of B. cenocepacia was enhanced by combination with the CFTR modulator tezacaftor/ivacaftor and/or the alternative CFTR modulator cysteamine. (R)-roscovitine also increased MDM CFTR function compared to tezacaftor/ivacaftor treatment alone. (R)-roscovitine increases CF macrophage-mediated killing of antibiotic-resistant bacteria. (R)-roscovitine also enhances other macrophage functions including CFTR-mediated ion efflux. Effects of (R)-roscovitine are greatest when combined with CFTR modulators or cysteamine, justifying further clinical testing of (R)-roscovitine or optimized derivatives.
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Affiliation(s)
- Chandra L Shrestha
- Division of Pulmonary Medicine, Center for Microbial Pathogenesis, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Shuzhong Zhang
- Division of Pulmonary Medicine, Center for Microbial Pathogenesis, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Benjamin Wisniewski
- Division of Pulmonary Medicine, Center for Microbial Pathogenesis, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Stephanie Häfner
- Rudolf-Boehm-Institut F. Pharmakologie U. Toxikologie Medizinische Fakultät, Universität Leipzig, Leipzig, Germany
| | - Jonathan Elie
- ManRos Therapeutics, Perharidy Peninsula, Roscoff, France
| | - Laurent Meijer
- ManRos Therapeutics, Perharidy Peninsula, Roscoff, France
| | - Benjamin T Kopp
- Division of Pulmonary Medicine, Center for Microbial Pathogenesis, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Abstract
We report an anal metastasis from a lung cancer which was diagnosed on symptoms mimicking an acute anal abcess. The diagnosis was based on specific immunohistochemistry.
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Affiliation(s)
- Benjamin Wisniewski
- Service de Proctologie Médico-Chirurgicale, Hôpital des Diaconesses, F-75571 Paris Cedex 12
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Abstract
Pancreatic leiomyoma is rare. We report a new case in a 52-year old man. A tumor of the pancreatic head was diagnosed after a primary diabetic decompensation. No precise diagnosis was obtained with additional tests. Although the condition appeared to be benign, a diagnostic and therapeutic Whipple procedure was performed.
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Abstract
The field of application for endoscopic hemoclips has been increasingly extended, especially thanks to improvements in clips and additional clinical indications. Hemoclips are used more frequently for upper gastrointestinal (GI) bleeding and sometimes after therapeutic endoscopy. We report the successful use of endoscopic hemoclips in the management of two cases of postoperative colonic haemorrhage.
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Labayle D, Lambaré B, Wisniewski B. [Attitude of general hospital hepato-gastroenterologists towards end-of-life care]. Gastroenterol Clin Biol 2005; 29:1307-8. [PMID: 16518300 DOI: 10.1016/s0399-8320(05)82234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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Wisniewski B, Rautou PE, Al Sirafi Y, Lambare-Narcy B, Drouhin F, Constantini D, Fischer D, Labayle D, Denis J. [Diagnosis of spontaneous ascites infection in patients with cirrhosis: reagent strips]. Presse Med 2005; 34:997-1000. [PMID: 16225251 DOI: 10.1016/s0755-4982(05)84098-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To evaluate the sensitivity, specificity, and predictive values of dipstick testing (DT) for detecting spontaneous bacterial peritonitis (SBP), defined by an ascites neutrophil polymorphonuclear cell count > or = 250/mm3, in patients with cirrhosis. METHODS The study includes all patients with cirrhosis and ascites admitted to our general hospital on the southern outskirts of the Paris metropolitan area (France) from June 2003 to May 2004 (n = 47:27 men and 20 women). Diagnostic abdominal paracentesis was performed on admission, and a Multistix SG (Bayer Pharma) reagent strip was immersed in one ascitic sample from each patient. Readings after 120 s were either negative (DT-) or positive (DT+, with 4 levels of positivity: trace, +, ++, or +++). In case of cytologically-proven SBP, patients were treated with cefotaxime, and subsequent paracentesis with DT and cytologic testing took place every 48 hours, until recovery. RESULTS Six of the 47 patients had proven SBP, all with clinical signs of SBP (fever and/or abdominal pain); five of these patients were DT+ and one was DT-. In the five patients initially DT+, the DT became negative at the same time as the cytologic criteria for SBP disappeared. Forty-one patients did not meet the cytologic criteria for SBP: 34 were DT- and 7 were DT+ (traces: 4, ++: 2, +++:1); two of these had clinical signs suggestive of SBP. CONCLUSION Although the sensitivity (83%), specificity (83%) and negative predictive value (97%) of DTwere satisfactory, its positive predictive value (42%) was low. Dipstick testing of ascitic fluid is easy to perform and inexpensive and may be recommended for diagnosis and follow-up of SBP, especially in emergency settings.
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Affiliation(s)
- B Wisniewski
- Service d'hépatogastroentérologie, Centre hospitalier sud-francilien, Quartier du Canal-Courcouronnes, 91014 Evry Cedex.
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Wisniewski B, Vadrot J, D'Hubert E, Drouhin F, Fischer D, Denis J, Labayle D. [Spontaneous splenic rupture secondary to cholesterol embolisms: a case study]. ACTA ACUST UNITED AC 2004; 28:922-4. [PMID: 15523235 DOI: 10.1016/s0399-8320(04)95162-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wisniewski B, Tordjman G, Tran Van Nhieu J, Bettan L, Courillon-Mallet A. [Cholangiocarcinoma developing in von Meyenburg complexes in haemochromatosis]. Gastroenterol Clin Biol 2002; 26:922-4. [PMID: 12434102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
A 63-year-old man with genetic haemochromatosis underwent resection of a cholangiocarcinoma that developed in von Meyenburg complexes; the liver was not cirrhotic. Patients with an association of genetic haemochromatosis and von Meyenburg complexes might have a predisposition to cholangiocarcinoma, even before cirrhosis occurs. Patients with this association should undergo regular and early hepatic surveillance of hemochromatosis.
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Affiliation(s)
- Benjamin Wisniewski
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, France
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Wisniewski B, Perlemuter G, Buffet C. [Acute hepatitis following intravenous buprenorphine injection as a substitute drug in a drug-addict]. Gastroenterol Clin Biol 2001; 25:328-9. [PMID: 11395686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- B Wisniewski
- Service d'Hépato-Gastroentérologie, Hôpital de Bicêtre, 78, rue du Général-Leclerc, 94270 le Kremlin-Bicêtre Cedex
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