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Magnusdottir S, Hill EA. Prevalence of obstructive sleep apnea (OSA) among preschool aged children in the general population: A systematic review. Sleep Med Rev 2024; 73:101871. [PMID: 37976758 DOI: 10.1016/j.smrv.2023.101871] [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: 06/01/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Untreated pediatric obstructive sleep apnea (OSA) is associated with significant morbidities affecting behavior, neurocognitive development, endocrine and metabolic health. This systematic review evaluated prevalence of OSA reported in population-based studies among preschoolers as early intervention may have positive effects on health and quality of life. Thirty studies were included. High degrees of heterogeneity in methods and definitions were observed between the studies. Seven studies confirmed OSA by implementing objective methods after screening for habitual snoring with only two studies utilizing polysomnography, the reference standard, testing 1.2% of the combined cohorts (n = 82/4575) to confirm disease. Diagnosis of OSA was based on utilizing retired thresholds of the apnea-hypopnea-index (AHI), AHI4%≥5/hour of sleep (hrSleep), reporting prevalence of 1.8% and 6.4%, respectively. The remaining five studies implemented relatively insensitive objective recording methods to confirm disease in a limited number of children (n = 449/2486; 18.0%), estimating prevalence in the range of 0.7%-13.0%. The remaining literature is based on implementing questionnaires only to evaluate OSA. Studies published before 2014 reported 3.3%-9.4% prevalence, while more recent studies published 2016-2023 report higher prevalence, 12.8%-20.4%, when excluding outliers. This trend suggests that prevalence of OSA may possibly have been increasing in preschoolers over the past decade.
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Affiliation(s)
- Solveig Magnusdottir
- MyCardio LLC, SleepImage®, 3200 E Cherry Creek South Drive, Denver, CO, 80209, USA.
| | - Elizabeth A Hill
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Dorothy Crowfoot Hodgkin Building, South Parks Road, Oxford, OX1 3QU, UK
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Sosso FAE, Matos E, Papadopoulos D. Social disparities in sleep health of African populations: A systematic review and meta-analysis of observational studies. Sleep Health 2023; 9:828-845. [PMID: 37880077 DOI: 10.1016/j.sleh.2023.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/29/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To document the relationship between socioeconomic status (SES) and sleep health in African populations. METHODS Observational cross-sectional or cohort studies examining the association between SES indicators and sleep outcomes in participants from African countries were included. The search was performed in the MEDLINE, Embase, and Web of Science Core Collection electronic databases in June 2021. Selection, confounding, attrition/exclusion, detection, and selective reporting bias were assessed using the OHAT Risk of Bias Tool. Random effects meta-analysis was used for summarizing the effect estimates. RESULTS Forty-three reports were selected, having sampled 153,372 Africans from 26 countries. Education was the most frequent SES indicator and composite measures of sleep quality or disturbances was the most common sleep outcome. Low educational attainment was significantly associated with lower odds of short sleep (odds ratio [OR]=0.65, 95% confidence intervals [0.50, 0.84], p = .001) and higher odds of insomnia (OR=1.53, [1.18, 1.99], p = .001) or poor sleep quality (OR=1.60, [1.17, 2.18], p = .003). Low levels of income/assets were related to higher odds of insomnia (OR=1.38, [1.02, 1.86], p = .04) and low occupational/employment status was linked to lower odds of short sleep duration (OR=0.49, [0.30, 0.79], p = .004). CONCLUSIONS Socioeconomic disadvantage was a significant predictor of insomnia and poor sleep quality, while it was associated with longer sleep duration. Significant heterogeneity in terms of exposure and outcomes, scarcity of longitudinal designs, lack of objective outcome measurement, and low representation of rural samples and participants from low-income countries limit the quality of evidence.
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Affiliation(s)
| | - Elsa Matos
- Sleep Laboratory of Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Senbanjo IO, Salisu MA, Oshikoya KA, Adediji UO, Akinola AO. Nigerian sleep study found that children slept less and had more problems than children in other countries. Acta Paediatr 2018. [PMID: 29527732 DOI: 10.1111/apa.14313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM We studied sleep patterns, sleep problems and associated socio-demographic factors among children aged one year to 12 years in Lagos, Nigeria. METHODS This prospective hospital-based study involved 432 children (55% males) who came for routine paediatric care at the Lagos State University Teaching Hospital. Information on socio-demographics, sleeping patterns and specific sleep disorders was obtained. RESULTS The mean age of the subjects was 5.4 ± 3.3 years. Night sleep duration decreased significantly with age from 9.6 ± 1.3 hours at one to four years to 8.7 ± 1.0 hours at nine years to 12 years (p < 0.001). There was no significant gender difference in bedtimes (p = 0.057), rise times (p = 0.095) and night sleep duration (p = 0.191). Most (70%) napped during the day, and 26% of these did so on a regular basis. The most common sleep problems were enuresis (42%), afraid of sleeping alone (38%), snoring (28%) and sleep talking (24%). There was no significant association between sleep duration (p > 0.05), sleep problems (p > 0.05) and socio-demographic characteristics. Comparisons with other studies showed that the children had shorter sleep duration than peers in other countries and regions and a higher prevalence of sleep disorders. CONCLUSION Children in Nigeria had shorter sleep duration and more sleep problems than children in other international studies.
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Affiliation(s)
- Idowu O. Senbanjo
- Department of Paediatrics and Child Health; Lagos State University College of Medicine; Ikeja Lagos Nigeria
| | - Mohammed A. Salisu
- Department of Paediatrics and Child Health; Lagos State University College of Medicine; Ikeja Lagos Nigeria
| | - Kazeem A. Oshikoya
- Department of Pharmacology and Therapeutics; Lagos State University College of Medicine; Ikeja Lagos Nigeria
| | - Uchechukwu O. Adediji
- Department of Paediatrics and Child Health; Lagos State University Teaching Hospital, GRA; Ikeja Lagos Nigeria
| | - Ayodeji O. Akinola
- Department of Paediatrics and Child Health; Lagos State University Teaching Hospital, GRA; Ikeja Lagos Nigeria
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Shahveisi K, Jalali A, Moloudi MR, Moradi S, Maroufi A, Khazaie H. Sleep Architecture in Patients With Primary Snoring and Obstructive Sleep Apnea. Basic Clin Neurosci 2018; 9:147-156. [PMID: 29967674 PMCID: PMC6026090 DOI: 10.29252/nirp.bcn.9.2.147] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: This study aimed to investigate sleep architecture in patients with primary snoring and obstructive sleep apnea. Methods: In this study, we analyzed polysomnographic data of 391 clients who referred to Sleep Disorders Research Center (SDRS). These people were classified into three groups based on their Apnea-Hypopnea Index (AHI) and snoring; control, Primary Snoring (PS), and Obstructive Sleep Apnea (OSA) group. Sleep architecture variables were then assessed in all groups. Results: The results of this study indicated a decrease in deep sleep or Slow Waves Sleep (SWS) and increase in light sleep or stage 1 of non-REM sleep (N1) in OSA patients compared with the control and PS groups. After controlling the effects of confounding factors, i.e. age and Body Mass Index (BMI) (which was performed through multiple regression analysis) significant differences were observed among the three groups with regard to N1. However, with regard to SWS, after controlling confounding variables (age and BMI), no significant difference was found among the groups. Conclusion: The results indicated that OSA, regardless of age and BMI, may increase light (N1) sleep possibly via a decline in blood oxygen saturation (SpO2
). Such increase in N1 may be responsible for brain arousal. In addition, by controlling confounding factors (age and BMI), OSA did not affect SWS in OSA patients. However, further research is necessary to determine sleep architecture in more detail in the patients with OSA.
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Affiliation(s)
- Kaveh Shahveisi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Department of Psychiatric Nursing, Faculty of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shahla Moradi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azad Maroufi
- Neurosciences Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Akanbi MO, Agaba PA, Ozoh OB, Ocheke AN, Gimba ZM, Ukoli CO, Agaba EI. Obesity and obstructive sleep apnea risk among Nigerians. ACTA ACUST UNITED AC 2017; 19:110-115. [PMID: 29177137 PMCID: PMC5701752 DOI: 10.4103/jomt.jomt_17_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria. Materials and Methods An analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m2. Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors. Results There were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46–30.9] respondents were obese (BMI ≥30 kg/m2). A total of 307 (41.3%, 95% CI 37.7–44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6–6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44–33.9) in persons with BMI >35 kg/m2 compared to those with a BMI range of 18.5–24.99. Conclusion Obesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.
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Affiliation(s)
- Maxwell O Akanbi
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Nigeria.,Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA
| | - Patricia A Agaba
- Department of Family Medicine, Faculty of Medical Sciences, University of Jos, Nigeria
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Nigeria
| | - Amaka N Ocheke
- Department Obstetrics Gynecology, Faculty of Medical Sciences, University of Jos, Nigeria
| | - Zumnan M Gimba
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Nigeria
| | - Christiana O Ukoli
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Nigeria
| | - Emmanuel I Agaba
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Nigeria
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Machado-Júnior AJ, Zancanella E, Crespo AN. Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis. Med Oral Patol Oral Cir Bucal 2016; 21:e465-9. [PMID: 27031063 PMCID: PMC4920460 DOI: 10.4317/medoral.21073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/27/2016] [Indexed: 12/18/2022] Open
Abstract
Background OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child’s development. Adenotonsillectomy and, in select cases, continuous positive airwaypressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. Objetive: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. Material and Methods We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conductedusing PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillaryexpansion. Studies were included in the meta-analysisif they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apnea-hypopnea index (AHI) before and after the intervention, submitted RME only. Results In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years,of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p <0.0001). Conclusions We concluded that rapid maxillary expansion (RME) in children with OSAS appears to be an effective treatment for this syndrome. Further randomized clinical studies are needed to determine the effectiveness of RME in adults. Key words:Rapid maxillary expansión, obstructive sleep apnea, meta-analysis.
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Affiliation(s)
- A-J Machado-Júnior
- Rua Maria Monteiro, 841 ap 11 Cambuí, 13025-151 Campinas, 551932535472SP - Brazil,
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Villa MP, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M, Marino A, Malagola C. Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med 2015; 16:709-16. [PMID: 25934539 DOI: 10.1016/j.sleep.2014.11.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/19/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives of this study were to confirm the efficacy of rapid maxillary expansion in children with moderate adenotonsillar hypertrophy in a larger sample and to evaluate retrospectively its long-term benefits in a group of children who underwent orthodontic treatment 10 years ago. METHODS After general clinical examination and overnight polysomnography, all eligible children underwent cephalometric evaluation and started 12 months of therapy with rapid maxillary expansion. A new polysomnography was performed at the end of treatment (T1). Fourteen children underwent clinical evaluation and Brouilette questionnaire, 10 years after the end of treatment (T2). RESULTS Forty patients were eligible for recruitment. At T1, 34/40 (85%) patients showed a decrease of apnea-hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined responders. Only 6/40 (15%) showed a decrease <20% of AHI at T1 and were defined as non-responders (ΔAHI -53.47% ± 61.57%). Moreover, 57.5% of patients presented residual OSA (AHI > 1 ev/h) after treatment. Disease duration was significantly lower (2.5 ± 1.4 years vs 4.8 ± 1.9 years, p <0.005) and age at disease onset was higher in responder patients compared to non-responders (3.8 ± 1.5 years vs 2.3 ± 1.9 years, p <0.05). Cephalometric variables showed an increase of cranial base angle in non-responder patients (p <0.05). Fourteen children (mean age 17.0 ± 1.9 years) who ended orthodontic treatment 10 years previously showed improvement of Brouilette score. CONCLUSION Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
| | - Alessandra Rizzoli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Manuela Cecili
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Alessandra Marino
- Orthodontic Clinic Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Caterina Malagola
- Orthodontic Clinic Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
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Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children. J Am Dent Assoc 2014; 145:165-78. [DOI: 10.14219/jada.2013.26] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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