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Alqudah AM, Elwali A, Kupiak B, Hajipour F, Jacobson N, Moussavi Z. Obstructive sleep apnea detection during wakefulness: a comprehensive methodological review. Med Biol Eng Comput 2024; 62:1277-1311. [PMID: 38279078 PMCID: PMC11021303 DOI: 10.1007/s11517-024-03020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic condition affecting up to 1 billion people, globally. Despite this spread, OSA is still thought to be underdiagnosed. Lack of diagnosis is largely attributed to the high cost, resource-intensive, and time-consuming nature of existing diagnostic technologies during sleep. As individuals with OSA do not show many symptoms other than daytime sleepiness, predicting OSA while the individual is awake (wakefulness) is quite challenging. However, research especially in the last decade has shown promising results for quick and accurate methodologies to predict OSA during wakefulness. Furthermore, advances in machine learning algorithms offer new ways to analyze the measured data with more precision. With a widening research outlook, the present review compares methodologies for OSA screening during wakefulness, and recommendations are made for avenues of future research and study designs.
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Affiliation(s)
- Ali Mohammad Alqudah
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Ahmed Elwali
- Biomedical Engineering Program, Marian University, 3200 Cold Sprint Road, Indianapolis, IN, 46222-1997, USA
| | - Brendan Kupiak
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | | | - Natasha Jacobson
- Biosystems Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
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2
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Yang L, Ding Z, Zhou J, Zhang S, Wang Q, Zheng K, Wang X, Chen L. Algorithmic detection of sleep-disordered breathing using respiratory signals: a systematic review. Physiol Meas 2024; 45:03TR02. [PMID: 38387048 DOI: 10.1088/1361-6579/ad2c13] [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: 09/10/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
Background and Objective. Sleep-disordered breathing (SDB) poses health risks linked to hypertension, cardiovascular disease, and diabetes. However, the time-consuming and costly standard diagnostic method, polysomnography (PSG), limits its wide adoption and leads to underdiagnosis. To tackle this, cost-effective algorithms using single-lead signals (like respiratory, blood oxygen, and electrocardiogram) have emerged. Despite respiratory signals being preferred for SDB assessment, a lack of comprehensive reviews addressing their algorithmic scope and performance persists. This paper systematically reviews 2012-2022 literature, covering signal sources, processing, feature extraction, classification, and application, aiming to bridge this gap and provide future research references.Methods. This systematic review followed the registered PROSPERO protocol (CRD42022385130), initially screening 342 papers, with 32 studies meeting data extraction criteria.Results. Respiratory signal sources include nasal airflow (NAF), oronasal airflow (OAF), and respiratory movement-related signals such as thoracic respiratory effort (TRE) and abdominal respiratory effort (ARE). Classification techniques include threshold rule-based methods (8), machine learning models (13), and deep learning models (11). The NAF-based algorithm achieved the highest average accuracy at 94.11%, surpassing 78.19% for other signals. Hypopnea detection sensitivity with single-source respiratory signals remained modest, peaking at 73.34%. The TRE and ARE signals proved to be reliable in identifying different types of SDB because distinct respiratory disorders exhibited different patterns of chest and abdominal motion.Conclusions. Multiple detection algorithms have been widely applied for SDB detection, and their accuracy is closely related to factors such as signal source, signal processing, feature selection, and model selection.
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Affiliation(s)
- Liqing Yang
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, People's Republic of China
- Chongqing Medical Electronics Engineering Technology Research Center, Chongqing University, Chongqing, People's Republic of China
| | - Zhimei Ding
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, People's Republic of China
- Chongqing Medical Electronics Engineering Technology Research Center, Chongqing University, Chongqing, People's Republic of China
| | - Jiangjie Zhou
- Chongqing Medical Electronics Engineering Technology Research Center, Chongqing University, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Artificial Intelligence and Service Robot Control Technology, Chongqing, People's Republic of China
| | - Siyuan Zhang
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, People's Republic of China
- Chongqing Medical Electronics Engineering Technology Research Center, Chongqing University, Chongqing, People's Republic of China
| | - Qi Wang
- Chongqing Medical Electronics Engineering Technology Research Center, Chongqing University, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Artificial Intelligence and Service Robot Control Technology, Chongqing, People's Republic of China
| | - Kaige Zheng
- Chongqing Medical Electronics Engineering Technology Research Center, Chongqing University, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Artificial Intelligence and Service Robot Control Technology, Chongqing, People's Republic of China
| | - Xing Wang
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Artificial Intelligence and Service Robot Control Technology, Chongqing, People's Republic of China
| | - Lin Chen
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Artificial Intelligence and Service Robot Control Technology, Chongqing, People's Republic of China
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Wilson A, Hartnett C, Kilner D, Davies K, Slee N, Chawla J, Iyer K, Kevat A. Real-world utility of overnight oximetry for the screening of obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2024; 178:111892. [PMID: 38387157 DOI: 10.1016/j.ijporl.2024.111892] [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: 11/26/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common problem in children and can result in developmental and cognitive complications if untreated. The gold-standard tool for diagnosis is polysomnography (PSG); however, it is an expensive and time-consuming test to undertake. Overnight oximetry has been suggested as a faster and cheaper initial test in comparison to PSG as it can be performed at home using limited, reusable equipment. AIM This retrospective case control study aims to evaluate the effectiveness of a home oximetry service (implemented in response to extended waiting times for routine PSG) in reducing the time between patient referral and treatment. METHODS Patients undergoing diagnostic sleep evaluation for suspected OSA who utilized the Queensland Children's Hospital screening home oximetry service in the first year since its inception in 2021 (n = 163) were compared to a historical group of patients who underwent PSG in 2018 (n = 311). Parameters compared between the two groups included time from sleep physician review to sleep test, ENT review, and definitive treatment in the form of adenotonsillectomy surgery (or CPAP initiation for those who had already undergone surgery). RESULTS The time from sleep physician review and request of the sleep-related study to ENT surgical treatment was significantly reduced (187 days for the HITH oximetry group vs 359 days for the comparable PSG group; p-value <0.05), and time from sleep study request to the report of results was significantly lower for patients in the oximetry group compared to those in the PSG group (11 days vs 105 days; p-value <0.05). CONCLUSION These results suggest that for children referred to a tertiary sleep center for possible obstructive sleep disordered breathing, a home oximetry service can be effective in assisting sleep evaluation and reducing the time to OSA treatment.
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Affiliation(s)
- Alice Wilson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Chloe Hartnett
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - David Kilner
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - Kate Davies
- Department of General Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - Nicola Slee
- Department of Otolaryngology Head and Neck Surgery, Queensland Children's Hospital, Brisbane, Australia.
| | - Jasneek Chawla
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - Kartik Iyer
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Ajay Kevat
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
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Leconte CE, Ng JW, Manzardo AM, Douglass MM. A Pediatric Patient with Severe Obstructive Sleep Apnea and Comorbid Depression and Substance Abuse. Case Rep Psychiatry 2023; 2023:9985503. [PMID: 38028754 PMCID: PMC10656197 DOI: 10.1155/2023/9985503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Obstructive sleep apnea (OSA), depression, and substance abuse problems share similar symptomatology and have significant interplay. An underlying diagnosis of OSA can often be overlooked in patients with significant psychiatric illness and polysubstance use. Pediatric OSA is often associated with adenotonsillar hypertrophy and frequently requires surgical intervention for resolution of symptoms. Untreated OSA can worsen mental status and encourage polysubstance abuse as a form of self-medication. Proper identification and management of OSA plays an important role in treating psychiatric conditions. We report a 16-year-old with major depressive disorder (MDD), suicide attempts, polysubstance use disorder, and severe OSA admitted to an inpatient psychiatric facility. History included sleep and mood disturbances started at age 12. Patient presented with apnea-hypopnea index greater than 50 and started on bilevel-positive airway pressure (BiPAP) prior to admission. Management of OSA led to significant improvement of MDD, insomnia, and polysubstance abuse. OSA can often be overlooked in patients with MDD or substance abuse. Among adolescent patients with poorly managed psychiatric conditions, significant sleep disturbances, and polysubstance abuse, providers should maintain a high degree of suspicion for OSA, as its proper management will aid in the management of the other conditions.
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Affiliation(s)
- Caitlin E. Leconte
- University of Kansas School of Medicine, 2060 W 39th Avenue, Kansas City, KS 66103, USA
| | - Joshua W. Ng
- University of Kansas School of Medicine-Wichita, 1010 N Kansas Street, Wichita, KS 67214, USA
| | - Ann M. Manzardo
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66103, USA
| | - Mitchell M. Douglass
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66103, USA
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Liu Y, Zhao T, Ngan P, Qin D, Hua F, He H. The dental and craniofacial characteristics among children with obstructive sleep apnoea: a systematic review and meta-analysis. Eur J Orthod 2023; 45:346-355. [PMID: 36763565 DOI: 10.1093/ejo/cjac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Paediatric obstructive sleep apnoea (OSA) is a sleep breathing disorder which may have dramatic effects on childhood behaviour, neurodevelopment, metabolism, and overall health in children. Malocclusion and craniofacial morphology may be related to paediatric OSA, and therefore provide information for clinicians to recognize, evaluate and treat patients with this sleeping disorder. OBJECTIVE The aim of this systematic review was to summarize evidence regarding the association between paediatric OSA and children's dental and craniofacial characteristics. SEARCH METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to 1 June 2022. SELECTION CRITERIA Cross-sectional studies, comparing dental or craniofacial characteristics using clinical dental examinations or radiographic findings between OSA children (less than 18 year, diagnosed with overnight polysomnography) and healthy children, were included. DATA COLLECTION AND ANALYSIS The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used to assess the quality of included studies. RevMan software was used for performing the Meta-analyses. RESULTS Sixteen studies were included. Meta-analyses showed that the overjet (MD = 0.86, 95% CI: 0.20 to 1.51; P = 0.01), the saggital skeletal jaw discrepancy (ANB; MD = 1.78, 95% CI: 1.04 to 2.52; P < 0.00001) and mandibular plane angle (FH-MP; MD = 3.65, 95% CI: 2.45 to 4.85; P < 0.00001) were greater in OSA-affected children. In contrast, the upper molar arch width (upper first deciduous molar width; MD = -1.86, 95% CI: -3.52 to -0.20; P = 0.03), (Upper second deciduous molar width; MD = -1.06, 95% CI: -1.88 to -0.24; P = 0.01), SNB (MD = -2.10, 95% CI: -3.11 to -1.09; P < 0.0001), and maxillary length (ANS-PNS; MD = -1.62, 95% CI: -2.66 to -0.58; P = 0.002) were smaller in the OSA group. CONCLUSIONS This review shows that OSA-affected children tend to present with mandibular retroposition or retrognathia, increased mandibular plane angle and excess anterior overjet. However, these findings need to be viewed with caution as the corresponding differences may not be significant clinically. REGISTRATION PROSPERO (CRD42020162274).
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Affiliation(s)
- Yanxiaoxue Liu
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Tingting Zhao
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, School of Dentistry, Morgantown, WV, USA
| | - Danchen Qin
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hong He
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Xu Q, Wang X, Li N, Wang Y, Xu X, Guo J. Craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea in Chinese children. Front Pediatr 2023; 11:1124610. [PMID: 37063671 PMCID: PMC10102523 DOI: 10.3389/fped.2023.1124610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Objectives To identify craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea (OSA) in children. Methods This study consisted of 82 OSA children and 77 controls (age 5-10 years). All subjects underwent cephalograms and were divided into a 5-7 age group and an 8-10 age group. Cephalometric variables were compared between OSA children and controls, and hierarchical regression analysis was performed to examine the relationship between cephalometric variables and OSA severity [expressed by the obstructive apnea-hypopnea index (OAHI)] in different age groups. Results Increased A/N ratio, narrowed posterior airway space, decreased SNA and SNB angles, and shortened ramus height were observed among OSA children in different age groups. In the 5-7 age group, the A/N ratio and a lower gonial angle explained 40.0% and 14.7% of the variance in the OAHI, respectively. In the 8-10 age group, the BMI z-score and A/N ratio explained 25.2% and 6.6% of the variance in the OAHI, followed by a lower gonial angle and the hyoid-retrognathion distance (19.1% in total). Conclusions Adenoid hypertrophy was a major factor associated with OSA in preschool children, whereas obesity replaced adenoid hypertrophy as the main contributor to OSA in late childhood. Several craniofacial skeletal variables such as the SNB angle, ramus height, lower gonial angle, and hyoid position are also associated with the presence and/or severity of OSA, which could be used to help recognize children at a higher risk for OSA.
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Affiliation(s)
- Qiuping Xu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
- Department of Stomatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoya Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Na Li
- Department of Orthodontics, Ningbo Stomatology Hospital & Savaid Stomatology School, Hangzhou Medical College, Ningbo, China
| | - Ying Wang
- Department of Orthodontics, Ningbo Stomatology Hospital & Savaid Stomatology School, Hangzhou Medical College, Ningbo, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
- Department of Orthodontics, Ningbo Stomatology Hospital & Savaid Stomatology School, Hangzhou Medical College, Ningbo, China
- Correspondence: Jing Guo
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Chiu HY, Chou KT, Su KC, Lin FC, Liu YY, Shiao TH, Chen YM. Obstructive sleep apnea in young Asian adults with sleep-related complaints. Sci Rep 2022; 12:20582. [PMID: 36447027 PMCID: PMC9708676 DOI: 10.1038/s41598-022-25183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate the proportion of young OSA adults with sleep-related complaints in a sleep center, affiliated with a tertiary medical center for over a decade. This study presents a chronicle change in the numbers of young adults receiving polysomnography (PSG) and young patients with OSA from 2000 to 2017. We further analyzed 371 young patients with OSA among 2378 patients receiving PSG in our sleep center from 2016 to 2017 to capture their characteristics. Young adults constituted a substantial and relatively steady portion of examinees of PSG (25.1% ± 2.8%) and confirmed OSA cases (19.8 ± 2.4%) even though the total numbers increased with the years. Young adults with OSA tend to be sleepier, have a greater body mass index, and have a higher percentage of cigarette smoking and alcohol consumption. They also complained more about snoring and daytime sleepiness. They had a higher apnea-hypopnea index on average and experienced more hypoxemia during their sleep, both in terms of duration and the extent of desaturation. Even though the prevalence of comorbidities increased with age, hypertension in young male adults carried higher risks for OSA. Young adults with OSA have constituted a relatively constant portion of all confirmed OSA cases across time. The young adults with OSA were heavier, more symptomatic, and with more severe severity.Clinical trial: The Institutional Review Board of Taipei Veterans General Hospital approved the study (VGHIRB No. 2018-10-002CC). The study is registered with ClinicalTrials.gov, number NCT03885440.
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Affiliation(s)
- Hwa-Yen Chiu
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.278247.c0000 0004 0604 5314Department of Internal Medicine, Taipei Veterans General Hospital Hsinchu Branch, Zhudong, Hsinchu County Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kun-Ta Chou
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kang-Cheng Su
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Chi Lin
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Yang Liu
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsu-Hui Shiao
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Min Chen
- grid.278247.c0000 0004 0604 5314Center of Sleep Medicine, Taipei Veterans General Hospital, 14F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Caldarelli V, Porcaro F, Filippo PD, Attanasi M, Fainardi V, Gallucci M, Mazza A, Ullmann N, La Grutta S. Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1700. [PMID: 36360427 PMCID: PMC9688784 DOI: 10.3390/children9111700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 12/09/2023]
Abstract
Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.
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Affiliation(s)
- Valeria Caldarelli
- Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Paola Di Filippo
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Valentina Fainardi
- Cystic Fibrosis Unit, Department of Paediatrics, Parma University Hospital, 43126 Parma, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
| | - Angelo Mazza
- Department of Pediatrics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Stefania La Grutta
- Institute of Traslational Pharmacology IFT, National Research Council, 90146 Palermo, Italy
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Ribot C, Morell-Garcia D, Piérola J, Peña-Zarza JA, Sanchís P, Muñiz J, de la Peña M, Alonso-Fernández A, Barceló A. Surfactant protein D concentration in a pediatric population with suspected sleep disorder. Pediatr Pulmonol 2022; 57:285-292. [PMID: 34559461 DOI: 10.1002/ppul.25697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/06/2022]
Abstract
Obstructive sleep apnea (OSA) affects between 2% and 4% in children and there is a search for new biomarkers that can be useful both in the diagnosis and in the evolution of the disease. The surfactant protein D (SP-D) is a collection that is part of the innate immune system exerting an anti-inflammatory and antimicrobial effect. Thus, the objective of this study was to evaluate the concentration of SP-D in the suspect OSA pediatric population. A total of 178 children were recruited in this prospective study. Blood samples, sleep parameters, feeding habits, anthropometric, sociodemographic, and family data were collected. Specific biochemical determinations were made, and the plasmatic concentrations of SP-D were measured by enzyme-linked immunosorbent assay. We found no statistical correlation between the SP-D concentration and the apnea-hypopnea index (AHI) from the data. Nevertheless, the changes in SP-D levels could be correlated to a large extent by the arousals that often go along with hypopneas (r = -0.258, p = 0.011 unadjusted; r = -0.258, p = 0.014 adjusted by age and body mass inded [BMI] Z-score). Intermittent hypoxia was correlated with C-reactive protein levels (r = 0.547, p < 0.001 unadjusted; r = 0.542, p < 0.001 adjusted by age and BMI Z-score). Although AHI and SP-D did not appear to correlate, a secondary analysis suggests that sleep fragmentation, which is produced by arousals, may do, and further research is needed to determine the mechanisms by which changes in SP-D occur in OSA.
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Affiliation(s)
- Caterina Ribot
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Javier Piérola
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - José A Peña-Zarza
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,Department of Pediatrics, Sleep Unit, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Pilar Sanchís
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Jesús Muñiz
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Mónica de la Peña
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Alberto Alonso-Fernández
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonia Barceló
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.,Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.,CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain
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10
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Yuan Y, Zhou Q, Wang C, Zhou W, Gu W, Zheng B. Clinical and molecular characterization of a patient with MBTPS1 related spondyloepiphyseal dysplasia: Evidence of pathogenicity for a synonymous variant. Front Pediatr 2022; 10:1056141. [PMID: 36714646 PMCID: PMC9874673 DOI: 10.3389/fped.2022.1056141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A novel autosomal recessive skeletal dysplasia resulting from pathogenic variants in membrane-bound transcription factor peptidase, site 1 (MBTPS1) has been recently delineated. To date, only three patients have been reported. METHODS In this study, we reported the clinical and molecular features of a Chinese boy who was diagnosed with spondyloepiphyseal dysplasia. The effects of variants on mRNA splicing were analyzed through transcript analysis in vivo and minigene splice assay in vitro. RESULTS The proband mainly showed short stature, special facial features, cataract, hernias, and serious sleep apnea syndrome. Growth hormone stimulation tests suggested the boy had growth hormone deficiency. Imaging examinations suggested abnormal thoracolumbar vertebrae and severely decreased bone mineral density. Genetic analysis of MBTPS1 gene revealed two novel heterozygous variants, a nonsense mutation c.2656C > T (p.Q886*, 167) in exon 20 and a synonymous variant c.774C > T (p.A258=) in exon 6. The transcript analysis in vivo exhibited that the synonymous variant c.774C > T caused exon 6 skipping. The minigene splice assay in vitro confirmed the alteration of MBTPS1 mRNA splicing and the exon skipping was partially restored by an antisense oligonucleotide (ASO) treatment. CONCLUSION Notably, we report a Chinese rare case of spondyloepiphyseal dysplasia and validate its pathogenic synonymous variant in the MBTPS1 gene.
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Affiliation(s)
- Yeqing Yuan
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qiaoli Zhou
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Chunli Wang
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhou
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Bixia Zheng
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
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11
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Duong K, Noga M, MacLean JE, Finlay WH, Martin AR. Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas. Respir Res 2021; 22:289. [PMID: 34758818 PMCID: PMC8579677 DOI: 10.1186/s12931-021-01880-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background For children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Though effective, CPAP masks can be uncomfortable to patients, contributing to adherence concerns. Recently, nasal high flow (NHF) therapy has been investigated as an alternative, especially in CPAP-intolerant children. The present study aimed to compare and contrast the positive airway pressures and expired gas washout generated by NHF versus CPAP in child nasal airway replicas. Methods NHF therapy was investigated at a flow rate of 20 L/min and compared to CPAP at 5 cmH2O and 10 cmH2O for 10 nasal airway replicas, built from computed tomography scans of children aged 4–8 years. NHF was delivered with three different high flow nasal cannula models provided by the same manufacturer, and CPAP was delivered with a sealed nasal mask. Tidal breathing through each replica was imposed using a lung simulator, and airway pressure at the trachea was recorded over time. For expired gas washout measurements, carbon dioxide was injected at the lung simulator, and end-tidal carbon dioxide (EtCO2) was measured at the trachea. Changes in EtCO2 compared to baseline values (no intervention) were assessed. Results NHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH2O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH2O generated by nominally 5 cmH2O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO2 decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO2 was found between the three high flow nasal cannulas. Conclusion In child airway replicas, NHF at 20 L/min generated average PEEP similar to CPAP at 5 cm H2O. Variation in tracheal pressure was higher between airway replicas for NHF than for CPAP. The delivery of NHF yielded expired gas washout, whereas CPAP impeded expired gas washout due to the increased dead space of the sealed mask. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01880-z.
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Affiliation(s)
- Kelvin Duong
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Michelle Noga
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Joanna E MacLean
- Department of Pediatrics and Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Stollery Children's Hospital, Edmonton, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada. .,10-324 Innovation Centre for Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada.
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12
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The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art. CHILDREN-BASEL 2021; 8:children8100921. [PMID: 34682186 PMCID: PMC8535044 DOI: 10.3390/children8100921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.
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13
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Alharbi LN, Alsaikhan MA, Al-Haj Ali SN, Farah RI. Pediatric Obstructive Sleep Apnea: Knowledge and Attitudes of Medical and Dental Students and Fresh Graduates from Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2021; 8:768. [PMID: 34572200 PMCID: PMC8471539 DOI: 10.3390/children8090768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to assess the knowledge level and attitudes of graduating Saudi medical and dental students and fresh graduates from those faculties about pediatric obstructive sleep apnea (OSA), and the relation of their knowledge level to sociodemographic variables. In this cross-sectional study, 722 graduating students and fresh graduates were requested to answer a questionnaire pretested for validity and reliability. The data were analyzed statistically. Results revealed that medical participants scored 15.45 (out of 22), with 38% of them showing good knowledge about pediatric OSA, while dental participants scored 14.59, with 25.2% of them showing good knowledge. By regression analysis, medical participants (odds ratio (OR): 1.529) were more likely to have good knowledge than dental participants, while participants who belonged to institutions located in the central region (OR: 0.546) were less likely to have good knowledge than those from southern region institutions. In addition, participants from public institutions (OR: 0.290) were less likely to have good knowledge than those from private institutions. Regarding attitudes, medical participants scored 14.13 (out of 20), and dental participants scored 14.64. We detected a significant positive correlation between knowledge and attitude scores of dental participants. Given these findings, the knowledge level of graduating Saudi medical and dental students and fresh graduates about pediatric OSA was not optimal. The college type, institution sector, and location in the kingdom were factors associated with good knowledge. There is a need for further education and training about pediatric OSA in the undergraduate Saudi medical and dental curricula and continuing professional development programs about the topic after graduation.
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Affiliation(s)
- Lamyaa N. Alharbi
- College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia; (L.N.A.); (M.A.A.)
| | - Mashail A. Alsaikhan
- College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia; (L.N.A.); (M.A.A.)
| | - Sanaa N. Al-Haj Ali
- Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia
| | - Ra’fat I. Farah
- Department of Prosthetic Dental Sciences, College of Dentistry, Qassim University, Qassim 51452, Saudi Arabia;
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14
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Astara K, Siachpazidou D, Vavougios GD, Ragias D, Vatzia K, Rapti G, Alexopoulos E, Gourgoulianis KI, Xiromerisiou G. Sleep disordered breathing from preschool to early adult age and its neurocognitive complications: A preliminary report. Sleep Sci 2021; 14:140-149. [PMID: 35082983 PMCID: PMC8764947 DOI: 10.5935/1984-0063.20200098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/15/2021] [Indexed: 01/19/2023] Open
Abstract
Objective The onset and development of sleep disordered breathing (SDB) remains unclear in an age - dependent manner. Despite treatment, persistent symptoms such as snoring and excessive daytime sleepiness, as well as cognitive impairment may be present. The aim of the research was to determine the prevalence of residual symptoms of SDB in adolescence and early adulthood, the predisposing factors and its neurocognitive complications. Methods In the present pilot study-cohort, a questionnaire was utilized to 154 people (average age: 17.9 ± 3), who as children (mean age: 5.3 ± 1.4) had AHI ≥2.5 episodes/h. They were divided into two groups based on AHI = 5 episodes/h. Depending on the results, they were invited to undergo a repeated polysomnography (PSG) and complete the Montreal Cognitive Assessment (MoCA) test. Statistical analysis was made with IBM SPSS software. Results Out of the total, 35.7% claimed to still snore. AHI was negatively correlated to the severity of residual symptoms (Mann-Witney U test, p <0.005). According to repeated PSGs, 9/17 met the criteria for OSAS, while high BMI was associated with the severity of new AHI (chi squared test, p<0.005). Additionally, 7/16 scored below the MoCA baseline (<26/30). The characteristics of cognitive declines were mapped, with most prominent having been visuospatial, short - term memory and naming/language deficits. Discussion A significant percentage of children with sleep breathing disorder present with residual symptoms during their transition to early adulthood, as well as undiagnosed neurocognitive complications. Clinicians suspicion for the underlying neurocognitive complications is required, even in young adults, while guidelines on monitoring pediatric OSAS patients after treatment should be addressed.
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Affiliation(s)
- Kyriaki Astara
- School of Medicine, University of Thessaly - Larissa - Thessaly - Greece
| | - Dimitra Siachpazidou
- University of Thessaly, Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences - Larissa - Thessaly - Greece
| | - George D Vavougios
- Athens Naval Hospital, Department of Neurology - Athens - Athens - Greece
| | - Dimitrios Ragias
- School of Medicine, University of Thessaly - Larissa - Thessaly - Greece
| | - Konstantina Vatzia
- School of Medicine, University of Thessaly - Larissa - Thessaly - Greece
| | - Georgia Rapti
- School of Medicine and Larissa University Hospital, Sleep Disorders Laboratory, University of Thessaly - Larissa - Thessaly - Greece
| | - Emmanouil Alexopoulos
- School of Medicine and Larissa University Hospital, Sleep Disorders Laboratory, University of Thessaly - Larissa - Thessaly - Greece
| | - Konstantinos I Gourgoulianis
- University of Thessaly, Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences - Larissa - Thessaly - Greece
| | - Georgia Xiromerisiou
- University of Thessaly, University Hospital of Larissa, Department of Neurology - Larissa - Thessaly - Greece
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15
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Leung TN, Cheng JW, Chan AK. Paediatrics: how to manage obstructive sleep apnoea syndrome. Drugs Context 2021; 10:dic-2020-12-5. [PMID: 33828609 PMCID: PMC8007210 DOI: 10.7573/dic.2020-12-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/19/2021] [Indexed: 02/02/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.
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Affiliation(s)
- Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - James Wch Cheng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong SAR, China
| | - Anthony Kc Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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16
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An Y, Gao F, Su X, Zhou C, Huang J, Chen S, Liu T, Lu Z. Characteristics of pharyngeal paraesthesia symptoms in patients with obstructive sleep apnoea. Sleep Breath 2021; 25:2163-2169. [PMID: 33604802 DOI: 10.1007/s11325-021-02325-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate pharyngeal paraesthesia symptoms in patients with obstructive sleep apnoea (OSA). MATERIAL AND METHODS Patients with snoring and suspected OSA as well as age-matched controls were recruited. All participants underwent nocturnal polysomnography (PSG) and pharyngeal paraesthesia assessment using the Glasgow-Edinburgh throat scale (GETS). The incidence and severity of pharyngeal paraesthesia symptoms were compared between the groups. RESULTS A total of 280 patients who snored or were suspected of having OSA and 35 healthy, age-matched controls were recruited. The total pharyngeal paraesthesia symptom score was significantly higher in the OSA group than in the healthy group (12 [5, 23] vs. 3 [0, 9]; p < 0.001). The most frequent pharyngeal paraesthesia symptoms in the snore patients were Q7 (catarrh down the throat) and Q3 (discomfort/irritation in the throat), which are related to the irritability of the throat. The incidence of Q7 (OSA, 58% vs. controls, 14%; χ2 = 23.66; p < 0.001), Q3 (OSA, 46% vs. controls, 3%; χ2 = 23.07; p < 0.001), Q1 (feeling of something stuck in the throat; OSA, 33% vs. controls, 6%; χ2 = 11.00; p = 0.001), Q6 (swelling in the throat; OSA, 31% vs. controls, 0%; χ2 = 14.53; p < 0.001), Q9 (want to swallow all the time; OSA, 20% vs. controls, 6%; χ2 = 6.28; p = 0.012), Q5 (throat closing off; OSA, 24% vs. controls, 6%; χ2 = 6.16; p = 0.013), and Q2 (pain in the throat; OSA, 23% vs. controls, 6%; χ2 = 5.32; p = 0.021) was significantly higher in the OSA group than in the controls CONCLUSIONS: Patients with obstructive sleep apnoea have higher pharyngeal paraesthesia symptoms scores and tend to have irritated throats compared to healthy controls. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03506178.
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Affiliation(s)
- Yunsong An
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China.
| | - Fei Gao
- Department of Otolaryngology-Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, China.,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Xiaomei Su
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Chuan Zhou
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Jiayu Huang
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Tao Liu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China.
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17
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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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18
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Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of Pulmonary Hypertension in Pediatric Patients With Obstructive Sleep Apnea and a Cardiology Evaluation: A Retrospective Analysis. J Clin Sleep Med 2020; 15:1081-1087. [PMID: 31482829 DOI: 10.5664/jcsm.7794] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Pulmonary hypertension (PH) has been reported as a serious complication of obstructive sleep apnea (OSA) in children; however, estimated prevalence rates vary widely (zero to 85%). The purpose of this study is to determine the prevalence of PH in children with OSA and identify factors that may predict an increased PH risk in children with OSA. METHODS A retrospective review of all pediatric beneficiaries (88,058) in the San Antonio Military Health System with a diagnosis of OSA and a clinical evaluation by a pediatric cardiologist. OSA severity and nadir oxygen saturation were recorded from overnight polysomnography. Reason for referral, comorbid disorders, echocardiogram results, and cardiac diagnoses were obtained from cardiology records. RESULTS OSA was identified in 2,020 pediatric patients (2.3%). A pediatric cardiology consultation was reported for 296 patients with OSA. After excluding 95 patients for incorrect OSA diagnoses, incomplete data, or OSA treatment before cardiology evaluation, 163 patients were included in the final analysis. A diagnosis of PH was found in 3 patients with OSA (1.8%). Two of these patients had obesity, and all three had comorbid cardiac disorders. CONCLUSIONS Prevalence of PH in pediatric patients with OSA is low and none of the patients with PH had severe OSA. Current guidelines recommend PH screening in patients with severe OSA, yet OSA severity may not accurately predict risk. Factors evaluated in this study did not demonstrate an increased PH risk; additional research is necessary to improve screening in pediatric patients with OSA. CITATION Burns AT, Hansen SL, Turner ZS, Aden JK, Black AB, Hsu DP. Prevalence of pulmonary hypertension in pediatric patients with obstructive sleep apnea and a cardiology evaluation: a retrospective analysis. J Clin Sleep Med. 2019;15(8):1081-1087.
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Affiliation(s)
- Antoinette T Burns
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Shana L Hansen
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Zachary S Turner
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - James K Aden
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Alexander B Black
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Daniel P Hsu
- Department of Sleep Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
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Nguyen VT. Knowledge, attitude, and clinical practice of dentists toward obstructive sleep apnea: A literature review. Cranio 2020; 41:238-244. [PMID: 32870761 DOI: 10.1080/08869634.2020.1816408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review the knowledge, attitude, and clinical practice of dentists and dental specialists toward obstructive sleep apnea (OSA). METHODS A literature search was performed on PubMed and ScienceDirect databases. Peer-reviewed English publications were reviewed. No time limit was applied. RESULTS Four articles were included for the review. Years in the profession, specialist training, and gender were associated with the level of knowledge about OSA. Weight control was the most recognizable treatment for patients with OSA. Dentists agreed that OSA is a life-threatening disease, and they could be involved in detecting and treating OSA. Most dentists had no clinical experience of managing patients with OSA. CONCLUSION Dentists had a certain level of knowledge about OSA and were willing to deal with OSA. However, they lacked clinical experience. They were also enthusiastic about further education on OSA.
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Gerdung C, Rodriguez-Lopez S, Palkowski S, Keto-Lambert D, Sebastianski M, Castro Codesal ML. Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol. BMJ Open 2020; 10:e039655. [PMID: 32830118 PMCID: PMC7445331 DOI: 10.1136/bmjopen-2020-039655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA. METHODS AND ANALYSIS A systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed. ETHICS AND DISSEMINATION There are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.
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Affiliation(s)
- Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sara Rodriguez-Lopez
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Maria Luisa Castro Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
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Khaytin I, Tapia IE, Xanthopoulos MS, Cielo C, Kim JY, Smith J, Matthews EC, Beck SE. Auto-titrating CPAP for the treatment of obstructive sleep apnea in children. J Clin Sleep Med 2020; 16:871-878. [PMID: 32039753 PMCID: PMC7849672 DOI: 10.5664/jcsm.8348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES In-laboratory titration polysomnography (PSG) is standard to determine optimal therapeutic continuous positive airway pressure (CPAP) in children with obstructive sleep apnea (OSA). The use of auto-titrating CPAP devices (autoCPAP) as an alternative to CPAP titration has not been well studied in children. We hypothesized that autoCPAP-derived pressures (PMEAN, PPEAKMEAN, P90) would be similar to titration PSG pressure (PPSG). METHODS This is a retrospective study of children with OSAS initiated on autoCPAP between 2007 and 2017, who used autoCPAP for at least 2 h/night and who had adequate titration PSG were included in the analysis. AutoCPAP-derived pressures were obtained from use downloads and compared with PPSG. PPSG predictive factors were analyzed by median regression. Nonparametric methods were used for analysis. RESULTS Of 110 children initiated on autoCPAP, 44 satisfied the inclusion criteria. Age (median (interquartile range)) was 13.01 (9.98-16.72) years, and 63.6% were obese. PPSG median (interquartile range) was 8 (7-11) cmH₂O, mean autoCPAP-derived pressure (PMEAN) was 6.2 (5.6-7.6) cmH₂O, peak mean pressure (PPEAKMEAN) was 9.4 (7.7-11.1) cmH₂O, and average device pressure ≤ 90% of the time (P90) was 8.1 (7.2-9.7) cmH₂O. AutoCPAP-derived pressures correlated with PPSG (P < .05). PMEAN was lower than the other 3 pressures (P < .0002). Median regression analysis demonstrated that after adjusting for patient characteristics such as age, sex, and obesity status, autoCPAP-derived pressures remained significant predictors of PPSG (P < .05). There were no significant interactions between these patient characteristics and autoCPAP-derived pressures. CONCLUSIONS This study demonstrates that autoCPAP-derived pressures correlate with the titration PSG-derived pressures. These results indicate that autoCPAP can be used in the pediatric population and can determine pressures that are close to the titration pressures.
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Affiliation(s)
- Ilya Khaytin
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ignacio E. Tapia
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher Cielo
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ji Young Kim
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julianne Smith
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward C. Matthews
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suzanne E. Beck
- Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Chong J, Bajpai R, Teoh OH, Pugalenthi A, Allen JC, Cheng ZR, Tan SG, Lim M, Tan J, Goh A, Tan YH, Thomas B. Predictive equation for optimal continuous positive airway pressure in children with obstructive sleep apnoea. ERJ Open Res 2020; 6:00312-2019. [PMID: 32537463 PMCID: PMC7276523 DOI: 10.1183/23120541.00312-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/10/2020] [Indexed: 12/22/2022] Open
Abstract
Aim A subgroup of children with obstructive sleep apnoea (OSA) requires treatment with continuous positive airway pressure (CPAP). This study's aims were: 1) to determine if the optimal CPAP for the treatment of OSA in children correlates with body mass index (BMI); 2) to determine the correlation between polysomnographic variables and optimal CPAP in children with OSA; and 3) to develop a CPAP predictive equation for children with OSA. Methods This was a retrospective study of children with OSA who underwent CPAP titration studies. Patients with craniofacial abnormalities (except Down syndrome) and neuromuscular diseases were excluded. Polysomnograms were done using Sandman Elite. Correlations between optimal CPAP, clinical and polysomnographic variables were analysed. A multivariable linear regression model for optimal CPAP was developed. Results 198 children (mean±sd age 13.1±3.6 years) were studied. Optimal CPAP had a significant positive correlation with age (rho=0.216, p=0.002), obstructive apnoea-hypopnoea index (rho=0.421, p<0.001), 3% oxygen desaturation index (rho=0.417, p<0.001), rapid eye movement respiratory disturbance index (rho=0.378, p<0.001) and BMI z-score (rho=0.160, p=0.024); and a significant negative correlation with arterial oxygen saturation measured by pulse oximetry nadir (rho= −0.333, p<0.001). The predictive equation derived was: Optimal CPAP (cmH2O)=6.486+0.273·age (years)−0.664·adenotonsillectomy (no=1, yes=0)+2.120·Down syndrome (yes=1, no=0)+0.280·BMI z-score. Conclusion The equation developed may help to predict optimal CPAP in children with OSA. Further studies are required to validate this equation and to determine its applicability in different populations. A predictive equation may help derive the optimal CPAP for the treatment of obstructive sleep apnoea in childrenhttp://bit.ly/2wTf6Bw
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Affiliation(s)
- Joelle Chong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore.,School of Primary, Community and Social Care, Keele University, Newcastle under Lyme, UK
| | - Oon Hoe Teoh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Arun Pugalenthi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Zai Ru Cheng
- Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Soh Gin Tan
- Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Meilan Lim
- Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jasmine Tan
- Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Anne Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yi Hua Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Biju Thomas
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Paediatric Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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23
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Lo Bue A, Salvaggio A, Insalaco G. Obstructive sleep apnea in developmental age. A narrative review. Eur J Pediatr 2020; 179:357-365. [PMID: 31940071 DOI: 10.1007/s00431-019-03557-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023]
Abstract
Sleep is a physiological function that undergoes, at different stages of life, to considerable variations in neurophysiological and behavioral functions. The developmental age is a period characterized by a continuous process of physical and neuropsychological changes and synaptic remodeling processes that are the neurophysiological basis of brain plasticity, typical of this developmental phase, occurring mainly during sleep. In the description of obstructive sleep apnea (OSA) in children, two main points should be highlighted: its variability in different age groups, and its specificity compared with OSA in adults. The definition and criteria used for the diagnosis of OSA in adults are not applicable to OSA in developmental age. Although the adenotonsillar hypertrophy is the most common risk factor for pediatric OSA, obesity is becoming an increasingly prevalent risk factor, mostly in early childhood (6-9 years) and adolescence. OSA has been shown to affect cognitive function in children and adults. However, OSA impact on cognitive function in children is more severe since acting on the plastic brain structures can change the neuro-psychic development, learning skills, and social interactions. There is a clear difference in the definition of pathology between developmental age and adulthood according to the instrumental parameters: an AHI ≥ 5, which represents, in the pediatric age, the cut-off for a therapeutic pathway necessary to avoid a long-term effect on the child, instead, it represents in adulthood, the lower limit value for the definition of disease. This is a narrative review concerning obstructive sleep apnea in developmental age.Conclusions: OSA is a common disorder in children and those at risk must be identified, studied, and treated promptly because untreated OSA can be responsible for cardiovascular, metabolic, and neurocognitive morbidities and may induce, sometimes, non-reversible deficits given his insistence on a period of physical and neuro-psychic development.What is Known:•This is a review concerning Obstructive Sleep Apnea in developmental age•Clinical manifestation, diagnostic and therapeutic criteria of sleep apnea in developmental ageWhat is New:•This is a "narrative" review•This narrative review describes sleep apnea comparing and analyzing the different ages of life.
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Affiliation(s)
- Anna Lo Bue
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy.
| | - Adriana Salvaggio
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
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Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2020; 1:CD007074. [PMID: 31978261 PMCID: PMC6984442 DOI: 10.1002/14651858.cd007074.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is characterised by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy being the most common underlying risk factor. Surgical removal of enlarged adenoids or tonsils is the currently recommended first-line treatment for OSA due to adenotonsillar hypertrophy. Given the perioperative risk and an estimated recurrence rate of up to 20% following surgery, there has recently been an increased interest in less invasive alternatives to adenotonsillectomy. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory drugs have been proposed as a potential non-surgical treatment option in children with OSA. OBJECTIVES To assess the efficacy and safety of anti-inflammatory drugs for the treatment of OSA in children. SEARCH METHODS We identified trials from searches of the Cochrane Airways Group Specialised Register, CENTRAL and MEDLINE (1950 to 2019). For identification of ongoing clinical trials, we searched ClinicalTrials.gov and the World Health Organization (WHO) trials portal. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing anti-inflammatory drugs against placebo in children between one and 16 years with objectively diagnosed OSA (apnoea/hypopnoea index (AHI) ≥ 1 per hour). DATA COLLECTION AND ANALYSIS Two authors independently performed screening, data extraction, and quality assessment. We separately pooled results for the comparisons 'intranasal steroids' and 'montelukast' against placebo using random-effects models. The primary outcomes for this review were AHI and serious adverse events. Secondary outcomes included the respiratory disturbance index, desaturation index, respiratory arousal index, nadir arterial oxygen saturation, mean arterial oxygen saturation, avoidance of surgical treatment for OSA, clinical symptom score, tonsillar size, and adverse events. MAIN RESULTS We included five trials with a total of 240 children aged one to 18 years with mild to moderate OSA (AHI 1 to 30 per hour). All trials were performed in specialised sleep medicine clinics at tertiary care centres. Follow-up time ranged from six weeks to four months. Three RCTs (n = 137) compared intranasal steroids against placebo; two RCTs compared oral montelukast against placebo (n = 103). We excluded one trial from the meta-analysis since the patients were not analysed as randomised. We also had concerns about selective reporting in another trial. We are uncertain about the difference in AHI (MD -3.18, 95% CI -8.70 to 2.35) between children receiving intranasal corticosteroids compared to placebo (2 studies, 75 participants; low-certainty evidence). In contrast, children receiving oral montelukast had a lower AHI (MD -3.41, 95% CI -5.36 to -1.45) compared to those in the placebo group (2 studies, 103 participants; moderate-certainty evidence). We are uncertain whether the secondary outcomes are different between children receiving intranasal corticosteroids compared to placebo: desaturation index (MD -2.12, 95% CI -4.27 to 0.04; 2 studies, 75 participants; moderate-certainty evidence), respiratory arousal index (MD -0.71, 95% CI -6.25 to 4.83; 2 studies, 75 participants; low-certainty evidence), and nadir oxygen saturation (MD 0.59%, 95% CI -1.09 to 2.27; 2 studies, 75 participants; moderate-certainty evidence). Children receiving oral montelukast had a lower respiratory arousal index (MD -2.89, 95% CI -4.68 to -1.10; 2 studies, 103 participants; moderate-certainty evidence) and nadir of oxygen saturation (MD 4.07, 95% CI 2.27 to 5.88; 2 studies, 103 participants; high-certainty evidence) compared to those in the placebo group. We are uncertain, however, about the difference in desaturation index (MD -2.50, 95% CI -5.53 to 0.54; 2 studies, 103 participants; low-certainty evidence) between the montelukast and placebo group. Adverse events were assessed and reported in all trials and were rare, of minor nature (e.g. nasal bleeding), and evenly distributed between study groups. No study examined the avoidance of surgical treatment for OSA as an outcome. AUTHORS' CONCLUSIONS There is insufficient evidence for the efficacy of intranasal corticosteroids for the treatment of OSA in children; they may have short-term beneficial effects on the desaturation index and oxygen saturation in children with mild to moderate OSA but the certainty of the benefit on the primary outcome AHI, as well as the respiratory arousal index, was low due to imprecision of the estimates and heterogeneity between studies. Montelukast has short-term beneficial treatment effects for OSA in otherwise healthy, non-obese, surgically untreated children (moderate certainty for primary outcome and moderate and high certainty, respectively, for two secondary outcomes) by significantly reducing the number of apnoeas, hypopnoeas, and respiratory arousals during sleep. In addition, montelukast was well tolerated in the children studied. The clinical relevance of the observed treatment effects remains unclear, however, because minimal clinically important differences are not yet established for polysomnography-based outcomes in children. Long-term efficacy and safety data on the use of anti-inflammatory medications for the treatment of OSA in childhood are still not available. In addition, patient-centred outcomes like concentration ability, vigilance, or school performance have not been investigated yet. There are currently no RCTs on the use of other kinds of anti-inflammatory medications for the treatment of OSA in children. Future RCTs should investigate sustainability of treatment effects, avoidance of surgical treatment for OSA, and long-term safety of anti-inflammatory medications for the treatment of OSA in children and include patient-centred outcomes.
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Affiliation(s)
- Stefan Kuhle
- Dalhousie UniversityDepartments of Pediatrics and Obstetrics & GynaecologyHalifaxNSCanada
| | - Dorle U Hoffmann
- University Medical Centre of the Johannes Gutenberg UniversityDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Langenbeckstrausse 1MainzRhineland‐PalatinateGermany55131
| | - Souvik Mitra
- Dalhousie University & IWK Health CentreDepartments of Pediatrics, Community Health & EpidemiologyG‐2214, 5850/5980 University AvenueHalifaxNova ScotiaCanadaB3K 6R8
| | - Michael S Urschitz
- University Medical Centre of the Johannes Gutenberg UniversityDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Langenbeckstrausse 1MainzRhineland‐PalatinateGermany55131
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An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:1347-1353. [PMID: 31538606 PMCID: PMC6760391 DOI: 10.5664/jcsm.7756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/20/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system. METHODS A total of 32 patients with OSA and 18 healthy control patients were included in the study. All participants were selected based on medical history, physical examination, and nocturnal polysomnography (PSG) and divided into two groups. The palatal sensory status of participants was examined with a Neurometer current perception threshold (CPT) system. The system was used to deliver an electrical stimulus at three different frequencies (2,000 Hz, 250 Hz, and 5 Hz) by an investigator blinded to the PSG results. RESULTS There were no significant differences in the CPT values of the hard palate between the patients with OSA and control patients at any of the three stimulation frequencies. The differences in the CPT values of the soft palate between these groups failed to show any statistical significance at 250 Hz and 5 Hz. However, the patients with OSA showed significantly higher CPT values of the soft palate at 2,000 Hz than the age-matched healthy control patients (256.56 ± 129.34 versus 372.13 ± 152.06; P = .009). CONCLUSIONS Our study revealed an impairment of 2,000 Hz-related sensory nerve function of the soft palate among patients with OSA. The CPT test could be a useful tool for the quantitative and selective assessment of the sensory nerve function in patients with OSA. Additional research is required to evaluate the different types of sensory nerve dysfunctions among such patients. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: The Effects of Nasal Airflow on Upper Airway Dilator Muscles During Sleep; Identifier: NCT03506178; URL: https://clinicaltrials.gov/ct2/show/NCT03506178. CITATION An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative evaluation of the function of the sensory nerve fibers of the palate in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(9):1347-1353.
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Affiliation(s)
- Yunsong An
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Fei Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Xiu Ding
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
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Objective sleep quality and metabolic risk in healthy weight children results from the randomized Childhood Adenotonsillectomy Trial (CHAT). Sleep Breath 2019; 23:1197-1208. [PMID: 30798410 DOI: 10.1007/s11325-019-01802-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesized that cardiopulmonary coupling (CPC) sleep quality reflects cardiovascular and cardiometabolic health, in healthy weight children. METHODS Retrospective signal analysis of existing ECG data utilizing CPC, FDA cleared, software as medical device (SaMD). ECG signals were extracted from baseline polysomnography studies in the prospective Childhood Adenotonsillectomy Trial database, multicenter, single-blind, randomized controlled trial of 5.0-9.9-year-old children identified with obstructive sleep apnea syndrome without severe hypoxemia. Healthy weight was defined as age- and gender-specific BMI in the 5th-85th percentile range and overweight above the 85th percentile. The cohort was stratified based on CPC sleep quality Index (SQI) defined as high sleep quality (SQI ≥ 80) or low sleep quality (SQI < 60). Cardiovascular, cardiometabolic, quality of life, and cognition were compared between the sleep quality groups. RESULTS Healthy weight children with low sleep quality had more fragmented sleep with significantly higher arousal index (10.0 ± 4.3 vs.7.2 ± 3.1; p = 0.00) and eLFCBB (12.4 ± 4.9 vs. 0.9 ± 1.0; p < 0.001) CPC indicator of sleep fragmentation, higher average heart rate during sleep (84.5 ± 10.6 vs. 79.4 ± 7.1; p = 0.03) and worse insulin/glucose ratio (1.7 ± 1.6 vs. 1.1 ± 1.1; p = 0.03) and fasting insulin levels (7.9 ± 7.2 vs.5.3 ± 5.5; p = 0.05) when compared to healthy weight children with high sleep quality. SQI significantly correlates with average heart rate during sleep, insulin and triglyceride levels; for a unit increase in SQI, there is 0.154 unit decrease in average heart rate during sleep, 0.109 unit in insulin levels and 0.332 unit in triglyceride levels, respectively. CONCLUSION CPC sleep quality offers insights into pediatric sleep and how it affects cardiovascular and cardiometabolic health. ECG is simple signal to collect, which makes this method practical for testing sleep, over multiple nights, and on multiple occasions providing information on sleep dynamics not possible before. TRIAL REGISTRATION NCT00560859.
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SleepOMICS: How Big Data Can Revolutionize Sleep Science. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020291. [PMID: 30669659 PMCID: PMC6351921 DOI: 10.3390/ijerph16020291] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/22/2022]
Abstract
Sleep disorders have reached epidemic proportions worldwide, affecting the youth as well as the elderly, crossing the entire lifespan in both developed and developing countries. "Real-life" behavioral (sensor-based), molecular, digital, and epidemiological big data represent a source of an impressive wealth of information that can be exploited in order to advance the field of sleep research. It can be anticipated that big data will have a profound impact, potentially enabling the dissection of differences and oscillations in sleep dynamics and architecture at the individual level ("sleepOMICS"), thus paving the way for a targeted, "one-size-does-not-fit-all" management of sleep disorders ("precision sleep medicine").
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Uddin MB, Chow CM, Su SW. Classification methods to detect sleep apnea in adults based on respiratory and oximetry signals: a systematic review. Physiol Meas 2018; 39:03TR01. [DOI: 10.1088/1361-6579/aaafb8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Araslanova R, Paradis J, Rotenberg B. Publication trends in obstructive sleep apnea: Evidence of need for more evidence. World J Otorhinolaryngol Head Neck Surg 2017; 3:72-78. [PMID: 29204582 PMCID: PMC5683624 DOI: 10.1016/j.wjorl.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Published research in obstructive sleep apnea (OSA) appears limited despite OSA being a highly prevalent adult and pediatric disease leading to many adverse outcomes if left untreated. We aimed to quantify the deficit in OSA scientific literature in order to provide a novel way of identifying gaps in knowledge and a need for further research inquiry. METHODS This was a Bibliometric analysis study. Using Ovid Medline database we analyzed and compared research output (medical and surgical) between adult OSA and similarly prevalent chronic conditions (Type II diabetes (T2DM), coronary artery disease (CAD) and osteoarthritis (OA)) from December 2016 up to fifty years prior. Linear graphs were utilized to trend collected data. Utilizing same strategy, we compared publication trends for pediatric OSA to asthma and gastroesophageal reflux (GER). RESULTS Adult OSA publications (n = 9314) were significantly underrepresented when compared to T2DM (n = 66,023), CAD (n = 31,526) and OA (n = 34,123). Linear plots demonstrated that despite increasing number of publications this disparity persisted annually. Surgical literature composed 10.4% (n = 972) of adult OSA publications and reached a plateau in the last ten years. Pediatric OSA (n = 2994) had less research output when compared to asthma (n = 47,442) and GER (n = 6705). However, over past five years pediatric OSA surpassed GER in annual number of publications. Surgical literature represented 23.1% (n = 693) of pediatric OSA publications and continued increasing over past ten years. Study methodologies for both adult and pediatric OSA showed a lack of randomized controlled trials and meta-analyses in comparison to other diseases. CONCLUSION Our review shows substantial deficit in total, annual and surgical adult OSA published research compared to similarly prevalent diseases. This trend is not entirely observed in pediatric OSA literature.
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Affiliation(s)
| | | | - B.W. Rotenberg
- Department of Otolaryngology – Head and Neck Surgery, Western University, London, Ontario, Canada
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