1
|
Masoud AI, Adavadkar PA, Park C, Gowharji LF, Alwadei AH, Carley DW. Comparing two pediatric sleep questionnaires: The Pediatric Sleep Questionnaire (PSQ) and a set of 6 hierarchically arranged questions (6Q). Cranio 2022; 40:303-312. [DOI: 10.1080/08869634.2020.1792221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ahmed I. Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pranshu A. Adavadkar
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, IL, USA
| | - Chang Park
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL, USA
| | - Lena F. Gowharji
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdurahman H. Alwadei
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - David W. Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL, USA
| |
Collapse
|
2
|
Adavadkar PA, Pappalardo AA, Glassgow AE, Zhang C, Schwartz A, Brooks LJ, Martin MA. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med 2022; 18:2001-2007. [PMID: 35621126 PMCID: PMC9340607 DOI: 10.5664/jcsm.10064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. METHODS Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least one CMC from a large metropolitan area. The study population (N=16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. RESULTS Fourteen percent of the population (mean age of 9.1 years [SD= 5.2]; 35.8% African American (AA); 56.4% male; 77 with more than one CMC) received a sleep disorder diagnosis. The most frequent diagnosis was SDB (11.2%), followed by nocturnal enuresis (1.2%), and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with one CMC (19.7% vs. 5.8%; p <0.001). Insomnia rates in Hispanic/Latinx (1.2%) and AA (0.8%) children and adolescents were significantly lower (both p<0.001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. CONCLUSIONS Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests under-diagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Under-recognition of sleep disorders have short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs.
Collapse
Affiliation(s)
- Pranshu A Adavadkar
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Christina Zhang
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois
| | - Lee J Brooks
- Department of Pediatrics, Rowan SOM, Stratford, NJ
| | - Molly A Martin
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
3
|
Incerti Parenti S, Fiordelli A, Bartolucci ML, Martina S, D'Antò V, Alessandri-Bonetti G. Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in children: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101464. [PMID: 33827032 DOI: 10.1016/j.smrv.2021.101464] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/24/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
This systematic review and meta-analysis evaluated the diagnostic accuracy of screening questionnaires for pediatric obstructive sleep apnea (OSA). Studies comparing any questionnaire with polysomnography for OSA detection in subjects aged ≤18 y were considered eligible for qualitative analysis. The quality assessment of diagnostic accuracy studies (QUADAS-2) tool was used for bias assessment. Only questionnaires adopted by at least four studies using the currently accepted diagnostic threshold of apnea-hypopnea index (AHI) ≥1 were included for further selective quantitative analyses. A bivariate meta-analysis was performed to calculate sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio; summary receiver operator characteristic curves were constructed. 37 studies (20 questionnaires) were eligible for qualitative analysis; none were considered of low quality. Among these articles, 13 studies and two questionnaires (sleep-related breathing disorder scale of the pediatric sleep questionnaire (SRBD-PSQ) and OSA-18) satisfied the criteria for quantitative synthesis. SRBD-PSQ had higher sensitivity (0.76) than OSA-18 (0.56), while OSA-18 exhibited higher specificity (0.73) than SRBD-PSQ (0.43). SRBD-PSQ performed well and was the most sensitive screening questionnaire using the diagnostic threshold of AHI ≥1 for pediatric OSA. However, further well-designed studies are still required to assess the role of SRBD-PSQ in real-world clinical populations.
Collapse
Affiliation(s)
- Serena Incerti Parenti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Andrea Fiordelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Maria L Bartolucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Vincenzo D'Antò
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy.
| |
Collapse
|
4
|
Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 138:110320. [PMID: 32889438 DOI: 10.1016/j.ijporl.2020.110320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. METHODS This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. RESULTS A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). CONCLUSION We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.
Collapse
|
5
|
Lee SA, Kim HJ, Lee Y. Subjective nocturnal symptoms have different associations with depressive symptoms and anxiety than with daytime sleepiness in patients with obstructive sleep apnea. Sleep Med 2020; 69:58-64. [PMID: 32045855 DOI: 10.1016/j.sleep.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We determined the relationships among the subjective symptoms of sleep apnea and daytime sleepiness, depressive symptoms, and anxiety in adults with obstructive sleep apnea (OSA). METHODS We developed the Subjective Apnea Severity Questionnaire (SASQ) to measure subjective OSA symptoms during the night and on waking in the morning. Construct validity and reliability were assessed. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and State Scale of State Trait Anxiety Inventory (STAI-S) were applied. Multiple linear regression analyses were performed, and the results were adjusted for several confounders. RESULTS A total of 337 OSA patients were included. The SASQ consists of eight items with three domains. Cronbach's α for the SASQ was 0.657. The mean SASQ score was 1.35 ± 0.59. Symptoms related to nocturnal breathing difficulties were associated with polysomnographic (PSG) respiratory parameters. In the adjusted models, total SASQ scores were associated with ESS scores but not with BDI or STAI-S scores. Unlike other symptom groups, nocturnal breathing difficulties tended toward a positive relationship with ESS scores (p = 0.076), but were negatively related to BDI scores (p = 0.003) and STAI-S scores (p = 0.012). Symptoms related to nocturnal awakening or morning waking were either positively related or unrelated to ESS, BDI, and STAI-S scores. CONCLUSIONS The subjective OSA symptoms measured via the SASQ were associated with daytime sleepiness in adults with OSA, but not with depressive symptoms or anxiety. Nocturnal breathing difficulties were positively related to daytime sleepiness, but negatively related to depressive symptoms and anxiety.
Collapse
Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoojin Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Dewberry L, Khoury J, Schmiege S, Jenkins T, Boles R, Inge T. Gastrointestinal symptoms in relation to quality of life after metabolic surgery in adolescents. Surg Obes Relat Dis 2020; 16:554-561. [PMID: 32122816 DOI: 10.1016/j.soard.2019.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adolescent obesity is associated with significant co-morbidities, including decreased quality of life (QOL). QOL improves after metabolic and bariatric surgery (MBS), but recent studies have demonstrated that certain gastrointestinal symptoms (GIS) worsen after surgery, including reflux symptoms, nausea, bloating, and diarrhea. OBJECTIVE The aim of this study was to evaluate QOL and the effect of these symptoms on QOL after bariatric surgery. SETTING Five academic centers that perform adolescent MBS in the United States. METHODS We prospectively studied 228 adolescents undergoing MBS using the Teen-Longitudinal Assessment of Bariatric Surgery cohort. GIS and QOL scores were assessed before surgery, at 6 months, and yearly to 5 years after surgery. Analysis involved linear models examining QOL and the association between GIS and QOL adjusting for a priori determined covariates. RESULTS Adjusting for body mass index change over time, the physical component score (PCS) of the Short Form-36 (SF-36) increased after surgery from 44.2 at baseline to 54.4 at 5 years (P < .0001). The mental component score did not significantly change over time. The SF-36 domains that showed the biggest increase after surgery were physical functioning, physical role functioning, and general health. The SF-36 PCS decreased significantly over time post surgery in those with GIS of reflux, nausea, and diarrhea but remained higher than baseline SF-36 PCS. There was no statistically significant change in mental component score or impact of weight on quality of life-KIDS scores in those with or without GIS. CONCLUSION QOL, specifically the SF-36 PCS, increases after MBS. Reflux symptoms, nausea, and diarrhea reduce the degree of improvement in QOL in adolescents after MBS. Patients should be monitored and treated for these symptoms to address this decreased QOL.
Collapse
Affiliation(s)
- Lindel Dewberry
- Department of Surgery, University of Colorado, Aurora, Colorado.
| | - Jane Khoury
- Department of Statistics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Sarah Schmiege
- Department of Biostatistics, University of Colorado, Aurora, Colorado
| | - Todd Jenkins
- Department of Statistics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Richard Boles
- Department of Psychology, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas Inge
- Department of Surgery, Children's Hospital Colorado, Aurora, Colorado
| |
Collapse
|
7
|
Michelet D, Julien-Marsollier F, Vacher T, Bellon M, Skhiri A, Bruneau B, Fournier J, Diallo T, Luce V, Brasher C, Dahmani S. Accuracy of the sleep-related breathing disorder scale to diagnose obstructive sleep apnea in children: a meta-analysis. Sleep Med 2019; 54:78-85. [DOI: 10.1016/j.sleep.2018.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022]
|
8
|
Katz SL, MacLean JE, Barrowman N, Hoey L, Horwood L, Bendiak GN, Kirk VG, Hadjiyannakis S, Legault L, Foster BJ, Constantin E. Long-Term Impact of Sleep-Disordered Breathing on Quality of Life in Children With Obesity. J Clin Sleep Med 2018; 14:451-458. [PMID: 29458697 DOI: 10.5664/jcsm.6998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES (1) To determine baseline quality of life (QOL) among children with obesity and newly diagnosed moderate-severe sleep-disordered breathing (SDB) and to compare it to the reported QOL of children with obesity or SDB alone and healthy children. (2) To evaluate QOL change after 1 year. METHODS A prospective multicenter cohort study was conducted in children (8-16 years) with obesity, prescribed positive airway pressure (PAP) therapy for moderate-severe SDB. Outcomes included parent-proxy and self-report total and subscale scores on the PedsQL questionnaire (baseline and 1-year). RESULTS Total PedsQL scores were indicative of impaired QOL in 69% of cases based on parent-report and in 62% on self-report. Parents reported significantly lower QOL in our cohort than that reported in other studies for children with obesity or SDB alone or healthy children, on total PedsQL score and on social and psychosocial subscales. PedsQL total scores for participants were significantly higher (mean difference 7.3 ± 15.3, P = .03) than those reported by parents. Parents reported significant improvements in total PedsQL (mean change 7.29 ± 13.73, P = .04) and social functioning (mean change 17.65 ± 24.69, P = .04) scores after 1 year. No significant differences were found by children's self-report or by PAP adherence. CONCLUSIONS QOL of children with obesity and SDB is lower than in children with obesity or SDB alone or healthy children. One year later, children reported no significant changes in QOL; parents reported significant improvements in total PedsQL and social functioning scores. PAP adherence did not significantly affect QOL change in this population. COMMENTARY A commentary on this article appears in this issue on page 307.
Collapse
Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Linda Horwood
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Glenda N Bendiak
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Valerie G Kirk
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Laurent Legault
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bethany J Foster
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Overweight and obesity add to behavioral problems in children with sleep-disordered breathing. Sleep Med 2017; 39:62-69. [DOI: 10.1016/j.sleep.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022]
|
10
|
Elahmedi MO, Alqahtani AR. Evidence Base for Multidisciplinary Care of Pediatric/Adolescent Bariatric Surgery Patients. Curr Obes Rep 2017; 6:266-277. [PMID: 28755177 DOI: 10.1007/s13679-017-0278-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Severe childhood obesity, defined as having a body mass index (BMI) greater than the 99th percentile for age and gender, is rising in most countries and is associated with early morbidity and mortality. Optimal management of the health of the child with obesity requires a multidisciplinary approach that identifies and treats associated derangements. RECENT FINDINGS Lifestyle interventions such as diet, exercise, and behavioral therapy for the severely obese pediatric patient are generally not effective. Few centers worldwide offer bariatric surgery for adolescents in a multidisciplinary setting, and we are the only center that offers a multidisciplinary approach that incorporates bariatric surgery for severely obese children and adolescents across all age groups. In this paper, we review up-to-date evidence in this subject including ours, and provide details on the multidisciplinary approach to pediatric obesity that accommodates bariatric surgery for children across all age groups.
Collapse
Affiliation(s)
- Mohamed O Elahmedi
- Department of Surgery, College of Medicine, King Saud University, 1 Baabda, Riyadh, 11472, Saudi Arabia
| | - Aayed R Alqahtani
- Department of Surgery, College of Medicine, King Saud University, 1 Baabda, Riyadh, 11472, Saudi Arabia.
| |
Collapse
|
11
|
Baker M, Scott B, Johnson RF, Mitchell RB. Predictors of Obstructive Sleep Apnea Severity in Adolescents. JAMA Otolaryngol Head Neck Surg 2017; 143:494-499. [PMID: 28241176 DOI: 10.1001/jamaoto.2016.4130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Untreated obstructive sleep apnea has severe health consequences, yet little is known about predictors of sleep apnea severity in the adolescent population. Objective To evaluate clinical and demographic factors associated with obstructive sleep apnea severity in adolescents. Design, Setting, and Participants A retrospective case series of 224 children (53% male), ages 12 to 17 years who underwent polysomnography from January 1, 2013, to June 4, 2015. The study was carried out in a large tertiary referral children's hospital associated with an academic medical center in Dallas, Texas. Children were excluded if they were missing clinical data (eg, tonsil size), had major comorbidities (eg, chromosomal abnormalities), or had previously undergone tonsillectomy and adenoidectomy. The mean (SD) age was 14.6 (1.7) years (range, 12.0-17.9 years), and the patients were 55% Hispanic, 30% African American, 13% white, and 2% other. Exposures Electronic medical records were reviewed for demographic, clinical, and polysomnographic parameters. Main Outcomes and Measures Correlation between demographic and clinical characteristics and the apnea hypopnea index. Results In 224 adolescents (53% male) aged 12 to 17 years, the mean (SD) apnea hypopnea index was 14.9 (28.7) (range, 0.0-187.7) and was positively correlated with CDC-defined weight categories (P = .04) and tonsillar hypertrophy (P < .001). Sex, ethnicity, and age were not associated with the apnea hypopnea index. Severe obstructive sleep apnea (apnea hypopnea index >10) was more common in males (OR, 1.8; 95% CI, 1.0-3.2), patients with tonsillar hypertrophy (OR, 3.2; 95% CI, 1.8-5.8), and patients in a heavier CDC weight class (OR, 2.0; 95% CI, 1.3-3.2). Age and ethnicity did not predict severe obstructive sleep apnea. Conclusions and Relevance Obstructive sleep apnea in adolescents is associated with obesity and tonsillar hypertrophy in this study. Severe obstructive sleep apnea is more likely in adolescents who are male or obese, or who have tonsillar hypertrophy. This study supports routine polysomnography in obese male adolescents with tonsillar hypertrophy and symptoms of sleep-disordered breathing to screen for and treat severe obstructive sleep apnea.
Collapse
Affiliation(s)
- Mark Baker
- University of Texas Southwestern Medical Center, Dallas
| | - Brian Scott
- University of Texas Southwestern Medical Center, Dallas
| | - Romaine F Johnson
- University of Texas Southwestern Medical Center, Dallas2Children's Health, Children's Medical Center Dallas, Dallas, Texas
| | - Ron B Mitchell
- University of Texas Southwestern Medical Center, Dallas2Children's Health, Children's Medical Center Dallas, Dallas, Texas
| |
Collapse
|
12
|
Erdim I, Erdur O, Oghan F, Mete F, Celik M. Blood count values and ratios for predicting sleep apnea in obese children. Int J Pediatr Otorhinolaryngol 2017; 98:85-90. [PMID: 28583511 DOI: 10.1016/j.ijporl.2017.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To detect whether the mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are contributing factors in the diagnosis and severity of sleep apnea in obese children. INTRODUCTION Obesity is a public health problem, and its prevalence increases daily. Although PSG is the gold standard test in the investigation of sleep apnea, the application of this test requires equipment, personnel, time, and cost. There is no simple laboratory test for diagnosing and determining the severity of sleep apnea. Recently, MPV, NLR, and PLR, known as the inflammatory markers in CBC test parameters, have been investigated in some studies. We aim to investigate whether these parameters could provide a method for diagnosing and determining the severity of OSAS in obese children. METHODS Clinical records of 180 patients were evaluated. All subjects had venous blood samples collected from the antecubital vein in the morning, after an overnight fasting, one day before PSG. Hemoglobin, RDW, MPV, PLT, platelet distribution width (PDW), and WBC count were measured. After anthropometric and laboratory analysis, 127 obese children were assessed for sleep study. Eighty-three patients who met the required polysomnographic criteria were divided into three groups as follows: group A [non-OSAS, apnea-plus-hypopnea index (AHI) < 1], groupB (1 ≤ AHI < 5), and groupC (AHI ≥ 5). RESULTS Total recording time, total sleep time, sleep efficiency, REM, and NREM sleep stage latency values were not statistically significant among groups. However, the number of awakenings, AHI, oxygen desaturation events, mean oxygen saturation, lowest oxygen saturation, average desaturation, and snoring time values had significant difference among the groups. There was no statistically significant difference among the groups in terms of WBC, Hemoglobin, platelets, PDW, neutrophil, and lymphocyte values. However, RDW values showed a statistically significant difference between groups A and C. Although there was no statistically significant difference of MPV values among groups, NLR and PLR values were statistically significant between groups A and C. CONCLUSION According to our study, NLR, PLR, and RDW were found to be significantly higher in children whose AHI was ≥5 than in children from the other groups. However, no correlation was found between MPV levels and OSAS in children.
Collapse
Affiliation(s)
- Ibrahim Erdim
- Department of Otolaryngology, Erbaa Government Hospital, Tokat, Turkey.
| | - Omer Erdur
- Department of Otolaryngology, Selcuk University, Konya, Turkey.
| | - Fatih Oghan
- Department of Otolaryngology, Dumlupinar University, Kutahya, Turkey.
| | - Fatih Mete
- Pediatric Clinic, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey.
| | - Mustafa Celik
- Department of Otolaryngology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey.
| |
Collapse
|
13
|
Isacco L, Roche J, Quinart S, Thivel D, Gillet V, Nègre V, Mougin F. Cardiometabolic risk is associated with the severity of sleep-disordered breathing in children with obesity. Physiol Behav 2016; 170:62-67. [PMID: 27993515 DOI: 10.1016/j.physbeh.2016.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity. METHODS Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScoreBMI and MetScoreWC). RESULTS Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScoreBMI and MetScoreWC (p<0.05) in obese children. There is no association between SDB and PAL. CONCLUSIONS In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.
Collapse
Affiliation(s)
- Laurie Isacco
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France.
| | - Johanna Roche
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France; Sleep and Health Medicine Center, Franois, France, Ellipse. 9 chemin des quatre Journaux, 25770 Franois, France.
| | - Sylvain Quinart
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Pediatric Obesity Prevention and Rehabilitation Department, Besançon, France, RéPPOP-FC-CHRU St Jacques, 2 place St Jacques, F-25000, Besançon cedex, France.
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, Campus Universitaire des Cézeaux, 5 impasse Amélie Murat, 63178 Aubière cedex, France; Auvergne Research Center for Human Nutrition (CRNH), 58 Rue Montalembert, 63009 Clermont-Ferrand, France.
| | - Valérie Gillet
- Sleep and Health Medicine Center, Franois, France, Ellipse. 9 chemin des quatre Journaux, 25770 Franois, France.
| | - Véronique Nègre
- Pediatric Obesity Prevention and Rehabilitation Department, Besançon, France, RéPPOP-FC-CHRU St Jacques, 2 place St Jacques, F-25000, Besançon cedex, France.
| | - Fabienne Mougin
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France.
| |
Collapse
|
14
|
Ryu HS, Lee SA, Lee GH, Chung YS, Kim WS. Subjective apnoea symptoms are associated with daytime sleepiness in patients with moderate and severe obstructive sleep apnoea: a retrospective study. Clin Otolaryngol 2016; 41:395-401. [PMID: 27086649 DOI: 10.1111/coa.12659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Most previous studies have failed to show a relation between daytime sleepiness and apnoea severity in patients with obstructive sleep apnoea (OSA). We determined the relation between daytime sleepiness and subjective and objective apnoea severity in newly diagnosed patients with moderate-to-severe OSA. DESIGN Retrospective cross-sectional study. SETTING Tertiary referral centre. PARTICIPANTS A total of 559 adults with newly diagnosed moderate and severe OSA. MAIN OUTCOME MEASURES Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). Subjective and objective apnoea severities were assessed using the Sleep Breathing Scale (SBS) and polysomnography respectively. Sleep quality and depressive symptoms were evaluated using Medical Outcomes Study-Sleep Scale and Beck Depression Inventory (BDI) respectively. RESULTS The mean ESS score was 9.8 (SD 5.0). ESS score was correlated with SBS score (P < 0.001), apnoea-hypopnoea index (AHI) (P = 0.027), minimal oxygen saturation (MinSaO2 ) (P = 0.021), body mass index (BMI) (P = 0.007) and BDI score (P < 0.001). Linear regression analysis showed that higher SBS (P = 0.005) and BDI scores (P < 0.001) were associated with higher ESS score after controlling for gender, BMI and AHI. Apnoea-hypopnoea index, MinSaO2 and BMI were not independently related to ESS score. CONCLUSIONS Daytime sleepiness was related to subjective OSA symptoms but not objective apnoea severity measured by polysomnography in patients with moderate-to-severe OSA. These findings suggest the usefulness of the subjective apnoea severity as an indicator of OSA disease severity.
Collapse
Affiliation(s)
- H S Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S A Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G H Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y S Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W S Kim
- Department of Pulmonary Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Erdim I, Akcay T, Yilmazer R, Erdur O, Kayhan FT. Is Metabolic Syndrome Associated with Obstructive Sleep Apnea in Obese Adolescents? J Clin Sleep Med 2015; 11:1371-6. [PMID: 26156956 DOI: 10.5664/jcsm.5266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate whether there is an association between metabolic syndrome and obstructive sleep apnea syndrome (OSAS) in obese adolescents. METHODS In total, 240 pubertal children or prepubertal children older than 11 y recruited consecutively from the pediatric endocrinology unit, obesity clinic. Patients with tonsillar and adenoid hypertrophy (grade 3/4), systemic illnesses, or chronic drug usage were excluded. After anthropometric measurement and laboratory study, patients were divided into two groups according to metabolic syndrome (MS): MS and non-MS. Overnight polysomnographic evaluation was performed and 104 subjects were included for statistical analysis. The two groups were compared in terms of sleep efficiency, number of awakenings per night, oxygen desaturation index, snoring time, and obstructive/central/ mixed apnea-hypopnea index (AHI). RESULTS Of the obese adolescents, 51 had MS and 53 did not. The AHI was ≥ 1 in 25 of the 53 non-MS children (47.2%) and in 25 of the 51 MS children (49%). The median obstructive AHI value was 0.9 (0.2-2.4) and total AHI was 0.9 (0.2-2.5) in the MS group; these values were 0.9 (0.25-3.55) and 0.9 (0.3-3.55), respectively, in the non-MS group. Obstructive, central, mixed, and total AHI values in the MS and non-MS groups were not statistically significantly different (p > 0.05). CONCLUSIONS In our study, we did not find an association between MS and sleep apnea in obese adolescents.
Collapse
Affiliation(s)
- Ibrahim Erdim
- Otorhinolaryngologist, Erbaa Government Hospital, Erbaa, Tokat, Turkey
| | - Teoman Akcay
- Associate Professor of Pediatric Endocrinology, Kanuni Sultan Suleyman Education and Research Hospital, Kucukcekmece, Istanbul, Turkey
| | - Rasim Yilmazer
- Assistant Professor, Department of Otolaryngology, Istanbul Medipol University, Neurotology Fellow, Miller School of Medicine, University of Miami, Miami, FL
| | - Omer Erdur
- Otorhinolaryngologist, Konya Education and Research Hospital, Meram, Konya, Turkey
| | - Fatma Tulin Kayhan
- Professor of Otorhinolaryngology, Bakirkoy Dr Sadi Konuk Education and Research Hospital, Bakirkoy, Istanbul, Turkey
| |
Collapse
|
16
|
Lee SA, Paek JH, Han SH, Ryu HU. The utility of a Korean version of the REM sleep behavior disorder screening questionnaire in patients with obstructive sleep apnea. J Neurol Sci 2015; 358:328-32. [PMID: 26392292 DOI: 10.1016/j.jns.2015.09.347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/19/2015] [Accepted: 09/11/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To explore the utility of a Korean version of the rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ-K) to discriminate patients with idiopathic REM sleep behavior disorder (iRBD) from patients with obstructive sleep apnea (OSA) and healthy subjects. METHODS Participants with iRBD (n=47) and OSA (n=213) were diagnosed by polysomnography. In healthy subjects (n=58), RBD was excluded by medical history without polysomnography. Receiver operating characteristic curve analysis was used to identify the optimal cutoff value of the RBDSQ-K for iRBD. RESULTS RBDSQ-K score was higher in iRBD subjects than in OSA subjects and healthy subjects (both p<0.001). The optimal cutoff was 6.5 to distinguish iRBD subjects from OSA subjects and 4.5 to distinguish iRBD subjects from healthy subjects. The corresponding sensitivity and specificity was high for detecting iRBD from OSA and healthy subjects. The percentages of individuals with RBDSQ-K scores ≥5 and ≥7 were higher in OSA subjects with daytime sleepiness (36.1% and 13.8%, respectively) than in OSA subjects without daytime sleepiness (12.0% and 3.1%, respectively). Apnea-hypopnea index had no influence on RBDSQ-K score. Cronbach's alpha for the RBDSQ-K was 0.768, indicating a high degree of internal consistency. CONCLUSIONS The RBDSQ-K had acceptable sensitivity and specificity for screening persons with probable RBD from healthy subjects and OSA subjects when the cutoff score was 4.5 and 6.5 points, respectively. However, attention must be paid to the possibility of false positives when using this scale, especially in OSA subjects with daytime sleepiness.
Collapse
Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Joon-Hyun Paek
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su-Hyun Han
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han-Uk Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Neurology, Chonbuk National University Medical School, Jeonju, Republic of Korea
| |
Collapse
|
17
|
Graef DM, Janicke DM, McCrae CS. Sleep patterns of a primarily obese sample of treatment-seeking children. J Clin Sleep Med 2014; 10:1111-7. [PMID: 25317092 DOI: 10.5664/jcsm.4112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the sleep patterns and the role of day of the week and school break in these patterns within a primarily obese sample of children. METHODS Participants included 143 obese children (8-12 years) and their parents initiating treatment in a weight-management study in a community-based setting. Demographics, anthropometrics, and objectively measured sleep (i.e., with use of Sensewear Armbands) were collected prior to treatment. RESULTS Sleep duration was insufficient in our sample, as approximately 88% obtained less than 8 hours of sleep (mean = 6.92, standard deviation = 0.85). Those with lower total sleep time included older children, those identified as African American (compared to those identified as Caucasian), and those identified as Non-Hispanic (compared to those identified as Hispanic). Children on school break initiated sleep later than those in school the week of measurement. Children woke later on weekends and when on school break. There were no differences in day of the week or school break in predicting child sleep duration and total wake time (p's > 0.05). CONCLUSIONS This study is one of the first to examine sleep patterns within a primarily obese sample of treatment-seeking rural children. There is a need for research to develop a better understanding of how sleep may affect health functioning and weight management, as well as quality of life and psychosocial functioning of children who are overweight or obese.
Collapse
Affiliation(s)
- Danielle M Graef
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL ; Department of Pediatrics, University of Florida, Gainesville, FL
| | - Christina S McCrae
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| |
Collapse
|
18
|
Mathew JL, Narang I. Sleeping too close together: obesity and obstructive sleep apnea in childhood and adolescence. Paediatr Respir Rev 2014; 15:211-8. [PMID: 24094775 DOI: 10.1016/j.prrv.2013.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To review the current available literature exploring the prevalence, severity, consequences and treatments for obesity related OSA in children and adolescents. The published literature was searched through EMBASE and Pubmed using a pre-defined search strategy. There is evidence showing that OSA occurs more frequently and may be more severe in children and adolescents who are overweight or obese compared with lean children. Obesity and OSA are independently associated with adverse cardiovascular, metabolic, and neuropsychological consequences. The magnitude of these abnormalities when obesity and OSA co-exist is not well established. Treatment options for obesity related OSA includes adenotonsillectomy, but it does not cure OSA in over 50% of obese children. Positive airway pressure (PAP) therapy delivered through continuous or bi-level modes is successful, but limited by generally poor compliance. There is increasing experience with bariatric surgical techniques which are effective for the treatment of obesity and its related complications. As obesity related OSA is highly prevalent, more research is needed to understand the interaction of these two conditions with regards to pathophysiology, adverse consequences and optimal management strategies.
Collapse
Affiliation(s)
- Joseph L Mathew
- Pediatric Pulmonology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India 160012
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Canada.
| |
Collapse
|
19
|
Graef DM, Janicke DM, McCrae CS, Silverstein JH. Quality of Life in Obese Youth With and Without Sleep Problems. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2014.850875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Jennum P, Ibsen R, Kjellberg J. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax 2013; 68:949-54. [DOI: 10.1136/thoraxjnl-2012-202561] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
21
|
Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714-55. [PMID: 22926176 DOI: 10.1542/peds.2012-1672] [Citation(s) in RCA: 928] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
Collapse
|
22
|
Childhood obesity and obstructive sleep apnea. J Nutr Metab 2012; 2012:134202. [PMID: 22957216 PMCID: PMC3432382 DOI: 10.1155/2012/134202] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/31/2012] [Indexed: 11/18/2022] Open
Abstract
The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA), occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG), is characterised by snoring, recurrent partial (hypopneas) or complete (apneas) obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.
Collapse
|
23
|
Kralovic S, Spilsbury JC, Ievers-Landis CE, Cuttler L, Narasimhan S, Rosen C. Parent-Reported Habitual Snoring and Depressive Symptoms Among Children and Adolescents Who Are Obese. CHILDRENS HEALTH CARE 2012. [DOI: 10.1080/02739615.2012.685045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
24
|
Ievers-Landis CE, Kuhn BR. Commentary: Introduction to the Special Issue on Pediatric Behavioral Sleep Medicine. CHILDRENS HEALTH CARE 2012. [DOI: 10.1080/02739615.2012.685037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
25
|
Lewandowski AS, Toliver-Sokol M, Palermo TM. Evidence-based review of subjective pediatric sleep measures. J Pediatr Psychol 2011; 36:780-93. [PMID: 21227912 PMCID: PMC3146754 DOI: 10.1093/jpepsy/jsq119] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/19/2010] [Accepted: 12/09/2010] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This manuscript provides an evidence-based psychometric review of parent and child-report pediatric sleep measures using criteria developed by the American Psychological Association (APA) Division 54 Evidence-Based Assessment (EBA) Task Force. METHODS Twenty-one measures were reviewed: four measures of daytime sleepiness, four measures of sleep habits/hygiene, two measures assessing sleep-related attitudes/cognitions, five measures of sleep initiation/maintenance, and six multidimensional sleep measures. RESULTS Six of the 21 measures met "well-established" evidence-based assessment criteria. An additional eight measures were rated as "approaching well-established" and seven were rated as "promising." CONCLUSIONS Overall, the multidimensional sleep measures received the highest ratings. Strengths and weaknesses of the measures are described. Recommendations for future pediatric sleep assessment are presented including further validation of measures, use of multiple informants, and stability of sleep measures over time.
Collapse
Affiliation(s)
- Amy S Lewandowski
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, WA, USA.
| | | | | |
Collapse
|
26
|
Wise MS, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, D'Andrea LA, Hoban TF. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep 2011; 34:389-98AW. [PMID: 21359088 PMCID: PMC3041716 DOI: 10.1093/sleep/34.3.389] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This comprehensive, evidence-based review provides a systematic analysis of the literature regarding the validity, reliability, and clinical utility of polysomnography for characterizing breathing during sleep in children. Findings serve as the foundation of practice parameters regarding respiratory indications for polysomnography in children. METHODS A task force of content experts performed a systematic review of the relevant literature and graded the evidence using a standardized grading system. Two hundred forty-three evidentiary papers were reviewed, summarized, and graded. The analysis addressed the operating characteristics of polysomnography as a diagnostic procedure in children and identified strengths and limitations of polysomnography for evaluation of respiratory function during sleep. RESULTS The analysis documents strong face validity and content validity, moderately strong convergent validity when comparing respiratory findings with a variety of relevant independent measures, moderate-to-strong test-retest validity, and limited data supporting discriminant validity for characterizing breathing during sleep in children. The analysis documents moderate-to-strong test-retest reliability and interscorer reliability based on limited data. The data indicate particularly strong clinical utility in children with suspected sleep related breathing disorders and obesity, evolving metabolic syndrome, neurological, neurodevelopmental, or genetic disorders, and children with craniofacial syndromes. Specific consideration was given to clinical utility of polysomnography prior to adenotonsillectomy (AT) for confirmation of obstructive sleep apnea syndrome. The most relevant findings include: (1) recognition that clinical history and examination are often poor predictors of respiratory polygraphic findings, (2) preoperative polysomnography is helpful in predicting risk for perioperative complications, and (3) preoperative polysomnography is often helpful in predicting persistence of obstructive sleep apnea syndrome in patients after AT. No prospective studies were identified that address whether clinical outcome following AT for treatment of obstructive sleep apnea is improved in association with routine performance of polysomnography before surgery in otherwise healthy children. A small group of papers confirm the clinical utility of polysomnography for initiation and titration of positive airway pressure support. CONCLUSIONS Pediatric polysomnography shows validity, reliability, and clinical utility that is commensurate with most other routinely employed diagnostic clinical tools or procedures. Findings indicate that the "gold standard" for diagnosis of sleep related breathing disorders in children is not polysomnography alone, but rather the skillful integration of clinical and polygraphic findings by a knowledgeable sleep specialist. Future developments will provide more sophisticated methods for data collection and analysis, but integration of polysomnographic findings with the clinical evaluation will represent the fundamental diagnostic challenge for the sleep specialist.
Collapse
Affiliation(s)
- Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN, USA
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Mak KK, Ho SY, Thomas GN, Lo WS, Cheuk DKL, Lai YK, Lam TH. Smoking and sleep disorders in Chinese adolescents. Sleep Med 2010; 11:268-73. [PMID: 20176504 DOI: 10.1016/j.sleep.2009.07.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/27/2009] [Accepted: 07/21/2009] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the association between adolescent smoking and sleep disorders. METHODS In the Hong Kong student obesity surveillance project, 29,397 Chinese students, aged 12-18 years, completed a health survey. Insomnia was defined as having any of the following three symptoms: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The presence of snoring and difficulty breathing during sleep (DBS) was also reported. Logistic regression yielded adjusted odds ratios (ORs) for each sleep disorder by smoking status. RESULTS Compared with never smokers, the ORs (95% CI) of insomnia were 1.39 (1.25-1.54) for experimenters (smoked once or a few times) and 0.91 (0.83-1.00) for current smokers. The corresponding ORs were 1.42 (1.16-1.74) and 3.58 (3.15-4.06) for snoring (P for trend<0.001) and 1.40 (1.10-1.79) and 3.39 (2.97-4.03) for DBS (P for trend<0.001). Current smokers compared with never smokers were less likely to report DIS (OR=0.43, 95% CI=0.38-0.50, P<0.001) and EMA (OR=0.83, 95% CI=0.73-0.94, P=0.003), but more likely to report DMS (OR=1.45, 95% CI=1.28-1.63, P<0.001). CONCLUSIONS In terms of dosage, adolescent smoking was associated with snoring and DBS, with increasing ORs from never smokers to experimental and current smokers. Current smoking was associated positively with DMS, but negatively with DIS and EMA.
Collapse
Affiliation(s)
- Kwok-Kei Mak
- School of Public Health, The University of Hong Kong, Hong Kong
| | | | | | | | | | | | | |
Collapse
|
28
|
Noronha AC, de Bruin VMS, Nobre e Souza MA, de Freitas MR, Araújo RDP, Mota RMS, de Bruin PFC. Gastroesophageal reflux and obstructive sleep apnea in childhood. Int J Pediatr Otorhinolaryngol 2009; 73:383-9. [PMID: 19108903 DOI: 10.1016/j.ijporl.2008.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 11/09/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea syndrome (OSAS) with polysomnographic alterations and symptom severity. PATIENTS AND METHODS Eighteen children aged from 6 to 12 years (8.14+/-1.75) with adenotonsillar hypertrophy and OSAS were evaluated with the OSA-18 questionnaire nasofibrolaringoscopy and full overnight polysomnography performed simultaneously with esophageal pH monitoring. RESULTS OSAS (Apnea-index (AI)>or=1/hour) was present in all cases. Reflux parameters did not correlate to OSAS severity and a temporal relationship between GER and apnea-hypopnea events was not observed. Body mass index was lower than 18 in 9 cases (52.9%) and 7 children (41.1%) presented a history of abnormal behavior during sleep. In most cases oxygen desaturation and reduction of sleep efficiency were mild. Sleep architecture was similar to the young adult pattern. Seven children (41.1%) presented pH monitoring values below 4 during more than 10% of total sleep time. pH monitoring values were correlated to emotional distress (p=0.008) and to daytime problems (p=0.03) as evaluated by the OSA-18. CONCLUSIONS GER is frequent and should be assessed in children from 6 to 12 years with OSAS. Emotional distress and daytime problems are correlated to increased GER severity.
Collapse
|