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Gutiérrez-Tobal GC, Alonso-Álvarez ML, Álvarez D, del Campo F, Terán-Santos J, Hornero R. Diagnosis of pediatric obstructive sleep apnea: Preliminary findings using automatic analysis of airflow and oximetry recordings obtained at patients’ home. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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152
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Mase CA, Chen ML, Horn DL, Parikh SR. Supraglottoplasty for sleep endoscopy diagnosed sleep dependent laryngomalacia. Int J Pediatr Otorhinolaryngol 2015; 79:511-5. [PMID: 25698459 DOI: 10.1016/j.ijporl.2015.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the polysomnographic outcomes of supraglottoplasty (SGP) performed for sleep endoscopy diagnosed sleep dependent laryngomalacia as treatment for obstructive sleep apnea syndrome (OSAS). METHODS Nine subjects aged 6-55 months underwent supraglottoplasty for sleep dependent laryngomalacia. All subjects underwent both pre- and post-procedural polysomnograms. RESULTS Supraglottoplasty for sleep dependent laryngomalacia resulted in improvement of OSAS as measured by collective improvements in 8 different primary polysomnogram parameters: apnea-hypopnea index (AHI), minimum (nadir) and mean oxygen saturation, mean and maximum carbon dioxide, total sleep time, sleep efficiency, arousal index, as well as improvement in weight for length percentiles. Subjects had a significant 80% decrease in percentage change in AHI (p<0.005), with decrease in mean AHI from 23.4 to 4.8 following supraglottoplasty. Seven of 9 subjects demonstrated improvement in nadir saturations, 6 of 9 subjects had improvement in sleep efficiency, and 7 of 8 subjects under 4 years of age had improvement in weight for length percentile. CONCLUSIONS Supraglottoplasty for sleep dependent laryngomalacia is an effective treatment of OSAS, and can be readily diagnosed using sleep endoscopy. Further investigation is warranted to increase awareness and outcomes related to sleep dependent laryngomalacia.
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Affiliation(s)
- Caitlin A Mase
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, United States
| | - Maida L Chen
- Division of Pediatric Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - David L Horn
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, United States; Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA, United States
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, United States; Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA, United States.
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153
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Pierre Robin sequence: review of diagnostic and treatment challenges. Int J Pediatr Otorhinolaryngol 2015; 79:451-64. [PMID: 25704848 DOI: 10.1016/j.ijporl.2015.01.035] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 11/23/2022]
Abstract
Pierre Robin sequence is not a rare condition and paediatric specialists caring for respiratory related issues are likely to encounter cases in their practice. There have been a few recent reviews on the topic, mostly focusing on the surgical interventions performed for cases with severe airway obstruction. In the present review, we will highlight the different challenges that remain today in the global evaluation of infants afflicted with this condition through a thorough review of the medical literature, giving the clinician a full scope of the disease and of the various management options. The need for an improved objective evaluation of airway obstruction and for a better classification will be emphasized. We are therefore proposing a novel classification scheme that will better account for respiratory and feeding difficulties in these infants. Finally, many knowledge gaps persist regarding this condition, underlining the necessity for further research both in the genetic field and regarding the outcome of therapy.
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154
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Kaditis AG, Katsouli G, Malakasioti G, Kaffe K, Gemou-Engesaeth V, Alexopoulos EI. Infants with viral bronchiolitis demonstrate two distinct patterns of nocturnal oxyhaemoglobin desaturation. Acta Paediatr 2015; 104:e106-11. [PMID: 25492521 DOI: 10.1111/apa.12896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 11/29/2014] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to demonstrate that viral bronchiolitis is associated with intermittent oxygen saturation of haemoglobin (SpO2 ) drops (≥3%) and low basal SpO2 between episodes of haemoglobin desaturation. METHODS Infants with bronchiolitis underwent pulse oximetry during the first night following hospital admission and a subgroup of them underwent repeat oximetry before hospital discharge. Oximetry was also performed in infants with partial upper airway obstruction (UAO) and without lung disease and in control participants without UAO or lung disease. RESULTS We enrolled 53 infants: 21 with bronchiolitis, 11 with UAO and 21 healthy controls. Participants with bronchiolitis had lower basal SpO2 (median 93.7% [10th-90th percentiles: 91.1-96.8]) than the subjects with UAO (96.9% [95.3-98.1]; p < 0.01) or the controls (98.7% [96.9-99.3]; p < 0.01). The bronchiolitis group was not different from the UAO group regarding the desaturation index (23.3 episodes/hour [10.3-46.6] and 15.5 episodes/hour [5.4-36.4], respectively; p = 0.08), but differed significantly from the controls (3.1 episodes/hour [0.3-5.5]; p < 0.01). The basal SpO2 and desaturation index improved in 10 subjects with bronchiolitis who had follow-up oximetry before discharge, but these indices remained abnormal when compared to values in the control group. CONCLUSION Bronchiolitis was characterised by low nocturnal basal SpO2 and intermittent SpO2 drops.
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Affiliation(s)
- Athanasios G. Kaditis
- Paediatric Pulmonology and Allergy Units; Sleep Disorders Laboratory; First Department of Paediatrics; National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital; Athens Greece
| | - Georgia Katsouli
- Paediatric Pulmonology and Allergy Units; Sleep Disorders Laboratory; First Department of Paediatrics; National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital; Athens Greece
| | - Georgia Malakasioti
- Paediatric Pulmonology and Allergy Units; Sleep Disorders Laboratory; First Department of Paediatrics; National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital; Athens Greece
| | - Katerina Kaffe
- Department of Paediatrics; Lamia General Hospital; Lamia Greece
| | - Vasiliki Gemou-Engesaeth
- Paediatric Pulmonology and Allergy Units; Sleep Disorders Laboratory; First Department of Paediatrics; National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital; Athens Greece
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155
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Álvarez D, Gutierrez-Tobal GC, Alonso ML, Teran J, del Campo F, Hornero R. Statistical and nonlinear analysis of oximetry from respiratory polygraphy to assist in the diagnosis of Sleep Apnea in children. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:1860-3. [PMID: 25570340 DOI: 10.1109/embc.2014.6943972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a sleep related breathing disorder that has important consequences in the health and development of infants and young children. To enhance the early detection of OSAHS, we propose a methodology based on automated analysis of nocturnal blood oxygen saturation (SpO(2)) from respiratory polygraphy (RP) at home. A database composed of 50 SpO(2) recordings was analyzed. Three signal processing stages were carried out: (i) feature extraction, where statistical features and nonlinear measures were computed and combined with conventional oximetric indexes, (ii) feature selection using genetic algorithms (GAs), and (iii) feature classification through logistic regression (LR). Leave-one-out cross-validation (loo-cv) was applied to assess diagnostic performance. The proposed method reached 80.8% sensitivity, 79.2% specificity, 80.0% accuracy and 0.93 area under the ROC curve (AROC), which improved the performance of single conventional indexes. Our results suggest that automated analysis of SpO(2) recordings from at-home RP provides essential and complementary information to assist in OSAHS diagnosis in children.
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156
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Qubty WF, Mrelashvili A, Kotagal S, Lloyd RM. Comorbidities in infants with obstructive sleep apnea. J Clin Sleep Med 2014; 10:1213-6. [PMID: 25325583 DOI: 10.5664/jcsm.4204] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/25/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE The clinical characteristics of obstructive sleep apnea (OSA) in infants have been insufficiently characterized. Our aim was to describe identifiable comorbidities in infants with obstructive sleep apnea, which may assist in recognizing these patients earlier in their disease course and help improve management. METHODS This was a single-center, retrospective study involving infants 0-17 months of age with a diagnosis of OSA on the basis of clinical features and nocturnal polysomnography (PSG) at the Mayo Clinic Center for Sleep Medicine between 2000 and 2011. Patients were excluded if they had central apnea accounting for greater than 50% of respiratory events. OSA severity was determined by the apnea-hypopnea index (AHI). RESULTS One hundred thirty-nine patients were included. Based upon the AHI, they were subdivided into mild (AHI <5; 30%), moderate (AHI 5-9; 30%), or severe (AHI >10; 40%) categories. Comorbidities included gastroesophageal reflux in 95/139 (68%), periodic limb movements in sleep in 59/139 (42%), craniofacial abnormalities in 52/139 (37%), neuromuscular abnormalities in 47/139 (34%), prematurity in 41/139 (29%), genetic syndromes in 41/139 (29%), laryngomalacia / tracheomalacia in 38/139 (27%), and epilepsy in 23/139 (17%) of subjects. Severity of OSA correlated with prematurity, having a genetic syndrome, or neuromuscular abnormality. Multispecialty evaluation was needed for 119/139 (86%). CONCLUSION Comorbidities in infants with OSA differ from those of older children. Based upon the comorbidities identified in our study population, it appears that appropriate management of infants with OSA requires a multidisciplinary approach involving genetics, gastroenterology, pulmonology, otolaryngology, neurology, and general pediatrics.
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Affiliation(s)
| | | | - Suresh Kotagal
- Division of Child Neurology, Mayo Clinic, Rochester, MN and Center for Sleep Medicine, Mayo Clinic, Rochester, MN
| | - Robin M Lloyd
- Division of Pediatrics, Mayo Clinic, Rochester, MN and Center for Sleep Medicine, Mayo Clinic, Rochester, MN
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Baldi I, Gulati A, Lorenzoni G, Natarajan K, Ballali S, Kameswaran M, Rajeswaran R, Gregori D, Sethi G. Public health implications of obstructive sleep apnea burden. Indian J Pediatr 2014; 81 Suppl 1:55-62. [PMID: 25139389 DOI: 10.1007/s12098-014-1539-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the implications of obstructive sleep apnea (OSA) burden among Indian children. METHODS MonteCarlo simulations were performed in order to estimate the number of OSA related obesity cases among Indian children (1-14 y of age) and the number of cases of stroke, coronary heart disease (CHD) and type 2 diabetes, considered as main adverse outcomes of OSA related childhood obesity, according to untreated and treated [adenotonsillectomy (AT) alone and AT associated to continuous positive airway pressure (CPAP)] pediatric OSA. Data used to perform MonteCarlo simulations were derived from a review about current literature exploring OSA related obesity. RESULTS The analysis on the number of adverse outcomes according to treated and untreated obesity related to OSA showed that treatments reduce the number of obesity cases, resulting in a great reduction of the amount of stroke, CHD and type 2 diabetes cases. However, the cost for treating adverse outcome was higher in patients treated for obesity related to OSA compared to those not receiving any treatment. CONCLUSIONS The reduction in the number of adverse outcomes due to treatment of obesity related OSA implicates the urgent need for public health policies in providing screening for OSA among children population: an early detection and a consequently prompt reaction to pediatric OSA could improve the burden of OSA related obesity.
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Affiliation(s)
- Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan, 18, 35121, Padova, Italy,
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Ramgopal S, Kothare SV, Rana M, Singh K, Khatwa U. Obstructive sleep apnea in infancy: a 7-year experience at a pediatric sleep center. Pediatr Pulmonol 2014; 49:554-60. [PMID: 24039250 DOI: 10.1002/ppul.22867] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/21/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate the common indications for polysomnogram (PSG) associated co-morbid conditions, evaluation strategies, treatment options, and outcomes in a series of infants diagnosed with obstructive sleep apnea (OSA) by a PSG. METHODS Retrospective chart review of infants who underwent PSG over a 7-year period was done. Infants with PSG diagnosed OSA were included in this study. RESULTS A total of 97 infants (59 males, mean age 4.6 months, standard deviation 3.3 months) were diagnosed with OSA (AHI ≥ 1/hr) based on PSG. The most common indication for PSG in infants were excessive snoring (53%) followed by nocturnal desaturations (24%). Associated co-morbid conditions included gastro-esophageal reflux (30%), laryngomalacia (24%), and craniofacial abnormalities (16%). Genetic abnormalities were found in 53%, of which trisomy 21 was the most common. Surgical treatments were employed in 36% and oxygen therapy in 15%. Thirty-eight patients were followed up with a repeat sleep study after a median interval of 8 months (range 1-24 months), of whom 26/38 had resolution of symptoms. Twenty-seven patients (28%) were followed clinically after a mean interval of 5 months of intervention (range, 1-34.5 months), in whom the symptoms resolved in 23/27 patients. Seven patients were deceased at review. Causes of death included status epilepticus, respiratory failure, hepatic failure, kidney failure, or unknown causes. CONCLUSION The etiologies of OSA in infants are different when compared to older children. PSG is feasible and a valuable tool in the diagnosis of OSA in infants and may help determine timely and appropriate evaluation and interventions. Clinical improvement in symptoms and resolution of PSG parameters were noted following medical and/or surgical interventions. Prospective studies need to be done to ascertain the long-term outcome of infants diagnosed with OSA to assess the benefits of early intervention on their neurocognitive development.
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Affiliation(s)
- Sriram Ramgopal
- Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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159
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Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One 2013; 8:e78666. [PMID: 24205291 PMCID: PMC3808373 DOI: 10.1371/journal.pone.0078666] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/14/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. METHODS In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age: toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. RESULTS The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. CONCLUSIONS Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, R.O.C.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, R.O.C.
| | - Chen-Han Chou
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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160
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Affiliation(s)
- Susanna A McColley
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
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161
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Robison JG, Wilson C, Otteson TD, Chakravorty SS, Mehta DK. Analysis of outcomes in treatment of obstructive sleep apnea in infants. Laryngoscope 2013; 123:2306-14. [DOI: 10.1002/lary.23685] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/28/2012] [Accepted: 07/25/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Jacob G. Robison
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
| | - Caleb Wilson
- University of Pittsburgh College of Medicine; Pittsburgh; Pennsylvania; U.S.A
| | - Todd D. Otteson
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
| | - Sangeeta S. Chakravorty
- Department of Pediatrics; Division of Pediatric Pulmonology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
| | - Deepak K. Mehta
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
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162
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Muzumdar H, Arens R. Physiological effects of obstructive sleep apnea syndrome in childhood. Respir Physiol Neurobiol 2013; 188:370-82. [PMID: 23707879 DOI: 10.1016/j.resp.2013.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 01/30/2023]
Abstract
Sleep disordered breathing in children refers to a group of respiratory disorders that occur or are exacerbated during sleep. Obstructive sleep apnea syndrome (OSAS) is one of the most significant disorders in this group. OSAS can present in all age groups from early infancy to adolescent years. The cardinal feature of OSAS is limitation of inspiratory flow and volume during sleep resulting in abnormal gas exchange and/or alteration of sleep patterns. When OSAS is a chronic condition it often results in adverse physiological effects that impact on health and development. The present review discusses genesis of OSAS in children and consequent end organ injury with special emphasis on behavior and cognition, cardiovascular function, autonomic regulation, inflammation, endothelial function and metabolic syndrome.
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Affiliation(s)
- Hiren Muzumdar
- Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467, USA; Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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163
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Obstructive sleep apnea syndrome (OSAS) in children with Class III malocclusion: involvement of the PHOX2B gene. Sleep Breath 2013; 17:1275-80. [PMID: 23536260 DOI: 10.1007/s11325-013-0833-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this study is to provide new molecular approaches to the children with obstructive sleep apnea syndrome by evaluating the possible involvement of the PHOX2B gene, notoriously associated to congenital central hypoventilation syndrome (CCHS), in Class III malocclusion. METHODS Fifty subjects with Class III malocclusion, aged from 8 to 14 years, and with history of sleep apneic episodes, and 20 age-matched controls were submitted to genomic DNA examination from oral cells to specifically analyze the PHOX2B genotype. RESULTS Point "silent" mutations affecting different nucleotides of the PHOX2B gene were observed in 32 % of patients with Class III malocclusion and never in controls (0 %). CONCLUSION The genetic data obtained in this study in children with Class III malocclusion and sleep-related breathing disorders provide new information useful to the genetic characterization of this pathology. The PHOX2B gene silent mutations can lead to structural and functional modification of their product providing to a group of children with Class III malocclusion similar features to those of CCHS (sleep apnea episodes and craniofacial malformations).
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164
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Zhang J, Veasey S. Making sense of oxidative stress in obstructive sleep apnea: mediator or distracter? Front Neurol 2012; 3:179. [PMID: 23293626 PMCID: PMC3530694 DOI: 10.3389/fneur.2012.00179] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/03/2012] [Indexed: 01/01/2023] Open
Abstract
Obstructive sleep apnea is increasingly recognized as an important contributor to cognitive impairment, metabolic derangements, and cardiovascular disease and mortality. Identifying the mechanisms by which this prevalent disorder influences health outcomes is now of utmost importance. As the prevalence of this disorder steadily increases, therapies are needed to prevent or reverse sleep apnea morbidities now more than ever before. Oxidative stress is implicated in cardiovascular morbidities of sleep apnea. What role oxidative stress plays in neural injury and cognitive impairments has been difficult to understand without readily accessible tissue to biopsy in persons with and without sleep apnea. An improved understanding of the role oxidative stress plays in neural injury in sleep apnea may be developed by integrating information gained examining neural tissue in animal models of sleep apnea with key features of redox biochemistry and clinical sleep apnea studies where extra-neuronal oxidative stress characterizations have been performed. Collectively, this information sets the stage for developing and testing novel therapeutic approaches to treat and prevent, not only central nervous system injury and dysfunction in sleep apnea, but also the cardiovascular and potentially metabolic conditions associated with this prevalent, disabling disorder.
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Affiliation(s)
- Jing Zhang
- Department of Pulmonary Medicine, Peking University First Hospital Beijing, China ; Center for Sleep and Circadian Neurobiology, School of Medicine, University of Pennsylvania Philadelphia, PA, USA
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