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Hansen C, Sonnesen L, Markström A. Signal quality of home polygraphy in children and adolescents. Acta Paediatr 2023; 112:2583-2588. [PMID: 37661830 DOI: 10.1111/apa.16964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
AIM The aims of the study were to examine the signal quality (SQ) of home polygraphy (PG) in children and adolescents and to compare automatic and manual scoring of the PGs. METHODS Clinical Trials Registration: NCT04964830. Participants and caregivers were instructed to set up the equipment and perform home PGs themselves. The PGs were analysed according to SQ and their interpretability and differences in automatic vs. manual scoring regarding apnoea-hypopnoea index (AHI), apnoea index (AI), hypopnoea index (HI) and oxygen desaturation index (ODI) were examined. RESULTS 54 healthy children aged 9-14 years participated in the study. 86% of the PGs were interpretable with mean SQ of 79.1% (CI 95%: 73.5%; 84.8%). Significant differences between the automatic and manual scoring were found for AHI, AI, HI and ODI (p < 0.0001). CONCLUSION Home PGs of children and adolescents are feasible to be performed with good SQ. Significantly higher markers of sleep-disordered breathing were achieved in the automatic scoring in comparison with the manual scoring.
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Affiliation(s)
- Camilla Hansen
- Section of Orthodontics and Dental Sleep Clinic, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics and Dental Sleep Clinic, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agneta Markström
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Cielo CM, Kelly A, Xanthopoulos M, Pipan M, Arputhan A, Walega R, Ward M, Falvo J, Roman Y, Xiao R, Tapia IE. Feasibility and performance of home sleep apnea testing in youth with Down syndrome. J Clin Sleep Med 2023; 19:1605-1613. [PMID: 37185265 PMCID: PMC10476042 DOI: 10.5664/jcsm.10610] [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: 12/01/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
STUDY OBJECTIVES In-laboratory polysomnography is recommended for the evaluation of obstructive sleep apnea (OSA) in youth with Down syndrome. However, insufficient sleep laboratories are available, particularly for youth with neurocognitive disabilities such as Down syndrome. We hypothesized that level II home sleep apnea testing (HSAT) would be feasible, acceptable, and accurate in detecting polysomnography-defined moderate-severe OSA in youth with Down syndrome. METHODS Youth 6 to 25 years old with Down syndrome were recruited to undergo in-home level II HSAT with electroencephalogram and in-lab polysomnography. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored blinded to polysomnography result, were compared to reference polysomnography. RESULTS Forty-three youth (23 female) aged [median (range)] 15.5 (6.1, 25.1) years participated in the study. Forty-one participants were able to complete HSAT and 41 completed polysomnography, with 40 who underwent both tests. HSAT was preferred to polysomnography by 73.7% of parents. Total sleep time for HSAT was 437 ± 123 minutes vs 366 ± 90 minutes for polysomnography (P = .003). Obstructive apnea-hypopnea index by polysomnography was 12.7 events/h (0.2, 113.8), and 32 youth (80%) who completed all testing had OSA. Compared to polysomnography, sensitivity of HSAT was: 0.81, specificity was 0.75, accuracy was 0.8 including 2 youth whose HSAT demonstrated OSA when polysomnography did not. CONCLUSIONS In youth with Down syndrome, level II HSAT was well-tolerated, preferred compared to in-lab polysomnography, and had good accuracy for detecting moderate-severe OSA. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with Down syndrome. CITATION Cielo CM, Kelly A, Xanthopoulos M, et al. Feasibility and performance of home sleep apnea testing in youth with Down syndrome J Clin Sleep Med. 2023;19(9):1605-1613.
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Affiliation(s)
- Christopher M. Cielo
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Xanthopoulos
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Pipan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Trisomy 21 Program, Division of Developmental Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ahtish Arputhan
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Walega
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Ward
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Falvo
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yaelis Roman
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ignacio E. Tapia
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Fumo-Dos-Santos C, Smith AK, Togeiro SMGP, Tufik S, Moreira GA. Obstructive sleep apnea in asthmatic children: a cross-sectional study about prevalence and risk factors. J Pediatr (Rio J) 2023; 99:443-448. [PMID: 37148908 PMCID: PMC10492151 DOI: 10.1016/j.jped.2023.03.005] [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: 09/19/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVES Primary objectives were to analyze the prevalence of obstructive sleep apnea in (1) boys and girls, and (2) severe asthma versus moderate and mild cases. The authors hypothesized that girls and severe asthma would have a higher prevalence of obstructive sleep apnea. METHODS Cross-sectional evaluation of asthmatic children attending a tertiary Pediatric Pulmonology clinic. The authors performed a history, physical examination, pulmonary function test, and home sleep apnea test. RESULTS The authors studied 80 consecutive patients, 7-18 years old, mean age of 11.6 years (standard deviation 2.7), 51.3% female, and 18.5% obese. Pulmonary function tests were obtained from 80 volunteers, 45% with obstruction pattern. Home sleep apnea tests were available from 76 volunteers, with a mean obstructive respiratory index of 1.8 events/h. Obstructive sleep apnea was found in 49 volunteers (61.2%). The authors did not find associations between obstructive sleep apnea and sex or asthma severity. CONCLUSIONS Obstructive sleep apnea was frequent among these asthmatic children. Sex and asthma severity were not risk factors. Considering the interrelationship of both diseases, it is worth keeping in mind the possibility of obstructive sleep apnea among children and teenagers with asthma.
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Affiliation(s)
| | - Anna K Smith
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Sonia M G P Togeiro
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Departamento de Medicina Interna, São Paulo, SP, Brazil.
| | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Gustavo A Moreira
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil
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4
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Williamson AA, Amin RS, Meltzer LJ, Laposky A, Fiks AG, Tapia IE. Defining and Promoting Pediatric Pulmonary Health: Understanding Sleep and Ventilatory Health. Pediatrics 2023; 152:e2023062292D. [PMID: 37656027 PMCID: PMC10484307 DOI: 10.1542/peds.2023-062292d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/02/2023] Open
Abstract
Healthy sleep and optimal ventilatory control begin in early development and are crucial for positive child outcomes. This paper summarizes information presented at the Sleep and Ventilatory Control sessions of the National Heart, Lung, and Blood-sponsored 2021 Defining and Promoting Pediatric Pulmonary Health workshop. These sessions focused on pediatric sleep health, screening for sleep health and sleep disorders in primary care using the electronic health record, infant sleep and ventilatory control, and home sleep testing. Throughout this summary, we discuss key gaps in and barriers to promoting sleep and ventilatory health that were identified during the workshop sessions. We conclude with strategies to address these gaps and barriers and directions for future multidisciplinary research, patient care, and training.
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Affiliation(s)
- Ariel A. Williamson
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raouf S. Amin
- Cincinnati Children’s Medical Center, Cincinnati, Ohio
| | | | - Aaron Laposky
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alexander G. Fiks
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Borrelli M, Corcione A, Cimbalo C, Annunziata A, Basilicata S, Fiorentino G, Santamaria F. Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1331. [PMID: 37628330 PMCID: PMC10452996 DOI: 10.3390/children10081331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.
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Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Chiara Cimbalo
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Anna Annunziata
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Simona Basilicata
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Giuseppe Fiorentino
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
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Ioan I, Renard E, Da Mota S, Bonabel C, Tiotiu A, Franco P, Coutier L, Schweitzer C. Unattended home sleep studies for the diagnosis of obstructive sleep apnea in a population of French children. Sleep Med 2023; 102:117-122. [PMID: 36640557 DOI: 10.1016/j.sleep.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/31/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
BACKGROUND Ambulatory exams were preferred in children during the COVID-19 pandemic. Polysomnography (PSG), the gold standard for obstructive sleep apnea (OSA) diagnosis, requires several leads and sensors to be attached to the child's body. Children are more comfortable with respiratory polygraphic (RP) recording, which needs fewer sensors. OBJECTIVE To compare respiratory parameters obtained by home RP with those obtained by home PSG with the device installed at the child's home by a trained sleep nurse from a national health care provider. METHODS Data from home PSGs performed in children aged 2-19 years were retrospectively included. The obstructive apnea-hypopnea index (OAHI) was computed in PSG and then in RP after removing the sleep signals. The two indexes were compared using non-parametric paired Wilcoxon rank test, Bland-Altman analysis and sensitivity-specificity analysis. RESULTS 44 PSGs of 44 children were included with only 34 (77%) PSGs interpretable. Median (min-max) OAHI was significantly underestimated in RP than in PSG (2.2 (0-25) vs 4.0 (0.4-28), p < 0.0001), confirmed also by the Bland-Altman diagram, the magnitude of the difference being mean ± standard deviation -1.7 ± 1.7. The sensitivity and specificity of OAHI in RP to identify an OAHI ≥2/h in PSG was 0.91 for both. CONCLUSION Unattended ambulatory RP performed at child's house and installed under carefully controlled conditions is a useful exam for diagnosing OSA in children with or without comorbidities. However, RP must be installed in a supervised environment and interpreted with caution as it tends to underestimate OSA severity.
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Affiliation(s)
- Iulia Ioan
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, France; EA3450-DevAH, Faculté de Médecine, Université de Lorraine, France.
| | - Emeline Renard
- Service de Médecine Infantile, Centre Hospitalier Universitaire de Nancy, France
| | - Sofia Da Mota
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, France
| | - Claude Bonabel
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, France; EA3450-DevAH, Faculté de Médecine, Université de Lorraine, France
| | - Angelica Tiotiu
- EA3450-DevAH, Faculté de Médecine, Université de Lorraine, France; Service de Pneumologie, Centre Hospitalier Universitaire de Nancy, France
| | - Patricia Franco
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; U1028, CNRL, Université de Lyon 1, France
| | - Laurianne Coutier
- U1028, CNRL, Université de Lyon 1, France; Service de pneumologie infantile, Allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Cyril Schweitzer
- EA3450-DevAH, Faculté de Médecine, Université de Lorraine, France; Service de Médecine Infantile, Centre Hospitalier Universitaire de Nancy, France
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7
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Pedersen MJ, Leonthin H, Mahler B, Rittig S, Jennum PJ, Kamperis K. Two nights of home polysomnography in healthy 7-14-year-old children - Feasibility and intraindividual variability. Sleep Med 2023; 101:87-92. [PMID: 36368073 DOI: 10.1016/j.sleep.2022.10.027] [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: 09/12/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Attended polysomnography (PSG) is the gold standard for childhood sleep evaluation. There is, however, only limited information regarding repeated ambulatory PSG in children. We aimed to test whether in hospital attached level 2 home PSG is feasible and reproducible in healthy children. METHODS We recruited healthy children aged 7-14 years to undergo two nights of full level 2 PSG. The PSG equipment was attached at the hospital on the day of the sleep test and all recordings were performed at home. Subjective sleep quality, nocturnal urine production, sleep time and number of awakenings were documented for a week in connection to the first PSG night. RESULTS Thirty-three children were recruited of whom 32 children (aged 11 ± 2.1 years) underwent two nights of PSG. All 64 PSGs were technically adequate for sleep evaluation. We found mean sleep efficiency of 94% and mean total sleep time of 8.4 h. Sleep stages distribution with 5.9% N1, 46.8% N2, 24.3% N3 and 22.8% REM sleep. We found poorer subjective sleep quality, more self-reported awakenings, and shorter total sleep time on nights with PSG compared to nights without PSG with no differences between PSG study nights. No differences in nocturnal urine production were found between nights with and without PSG. The comparison of PSG variables between the two PSG nights revealed no first night effect. CONCLUSIONS Type 2 PSG recording is feasible for sleep evaluation in children 7-14 years of age producing good data quality. We found no first night effect on PSG variables. www. CLINICALTRIALS gov Registration number: NCT03477812.
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Affiliation(s)
| | - Helle Leonthin
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Birgitte Mahler
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Søren Rittig
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Konstantinos Kamperis
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
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8
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Perfect MM, Silva GE, Chin CN, Wheeler MD, Frye SS, Mullins V, Quan SF. Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemp Clin Trials 2023; 124:106929. [PMID: 36441106 DOI: 10.1016/j.cct.2022.106929] [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: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
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Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America.
| | - Graciela E Silva
- College of Nursing, University of Arizona, Tucson, AZ 85721, United States of America
| | - Cindy N Chin
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Mark D Wheeler
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Sara S Frye
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Vicky Mullins
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Stuart F Quan
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, United States of America; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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Sleep disordered breathing and its relation to stroke and pulmonary hypertension in children with sickle cell disease: a single-center cross-sectional study. Ann Hematol 2023; 102:271-281. [PMID: 36645459 PMCID: PMC9889484 DOI: 10.1007/s00277-023-05099-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
Sleep disordered breathing (SDB) is a common underdiagnosed sequela of sickle cell disease (SCD) that has been linked to the frequency of vaso-occlusive crises. To determine the frequency of SDB in children with SCD and its association to SCD-related complications, thirty children and adolescents with SCD at their steady state underwent clinical, laboratory, and radiological assessment using transcranial duplex (TCD) and echo assessment of tricuspid regurge velocity (TRV). All participants had an overnight polysomnography after completing the modified STOP-Bang questionnaire. The mean age of the studied cohort was 10.2 years, with male: female ratio 1.7:1. Six children (20%) had high-risk for obstructive sleep apnea (OSA), while nine (30%) were at intermediate risk. Sleep apnea defined as apnea (AHI) > 1 event/hour was found among 18/30 (60%) subjects (14 males and 4 females). Children with AHI > 5 (moderate to severe OSA) had significantly higher TRV (p = 0.007) and left MCA flow velocity (p = 0.049) when compared to those with AHI < 5. Children with AHI > 5 were at higher risk of OSA according to the modified STOP-Bang questionnaire (p = 0.02). AHI positively correlated with TRV (r = 0.53, p = 0.003), right MCA flow velocity (r = 0.45, p = 0.013), and left MCA flow velocity (r = 0.55, p = 0.002), and negatively correlated to BMI-SDS (r = - 0.48, p = 0.008). The high frequency of OSA in the studied cohort with SCD and its association with increasing risk of PH and TCD changes highlights the importance of early detection and management of OSA in children with SCD.
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10
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Season is related to the slow wave and sigma activity of infants and toddlers. Sleep Med 2022; 100:364-377. [PMID: 36201888 DOI: 10.1016/j.sleep.2022.09.006] [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: 05/29/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE/BACKGROUND Slow wave activity (SWA) and sigma frequency activity (SFA) are hallmarks of NREM sleep EEG and important indicators of neural plasticity, development of the central nervous system, and cognition. However, little is known about the factors that modulate these sleep EEG activities, especially in small children. PATIENTS/METHODS We analyzed the power spectral densities of SWA (1-4 Hz) and SFA range (10-15 Hz) from six EEG derivations of 56 infants (8 months) and 60 toddlers (24 months) during their all-night sleep and during the first and the last half of night sleep. The spectral values were compared between the four seasons. RESULTS In the spring group of infants, compared with the darker seasons, SFA was lower in the centro-occipital EEG derivations during both halves of the night. The SWA findings of the infants were restricted to the last half of the night (SWA2) and frontally, where SWA2 was higher during winter than spring. The toddlers presented less frontal SWA2 during winter compared with autumn. Both age groups showed a reduction in both SWA and SFA towards the last half of the night. CONCLUSIONS The sleep EEG spectral power densities are more often associated with seasons in infants' SFA range. The results might stem from seasonally changing light exposure, but the exact mechanism warrants further study. Moreover, contrary to the adult-like increment of SFA, the SFA at both ages was lower at the last part of the night sleep. This suggests different regulation of spindle activity in infants and toddlers.
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11
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Griffiths A, Mukushi A, Adams AM. Telehealth-supported level 2 pediatric home polysomnography. J Clin Sleep Med 2022; 18:1815-1821. [PMID: 35393937 DOI: 10.5664/jcsm.9982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The gold standard for diagnosis of pediatric obstructive sleep apnea is level 1 polysomnography (PSG). Some children are selected for unattended level 2 home sleep apnea testing (HSAT) with telehealth support, and we sought to review this home service. METHODS A retrospective audit was conducted from 2013 to 2020. All level 2 HSAT reports in children aged 5-18 years referred for suspected OSA were analyzed. American Academy of Sleep Medicine compliant portable PSG acquisition equipment with EEG was used. The primary outcome was the proportion of technically successful tests achieved, and of these the % with potential underestimation of diagnostic category. Secondary outcomes included sleep quality and parental acceptance by non-validated service-specific questionnaire. Data were analyzed using descriptive & inferential statistics. χ² tests were used for categorical variables. RESULTS There were 233 (139 male, 59.6%) patients studied between 2013 and 2020 (7 years). The mean age was 10.8 (SD 3.6) years. 67 patients (28.8%) had comorbidities. Technically successful studies were obtained in almost 90% (209/233) and failed studies occurred in just over 10% (24/233). One failed study still achieved a diagnosis. There was no significant difference between failed studies set up by HITH nurses compared with Sleep scientists (p=0.2). Overall, an accurate diagnosis was made in 80% (167/209) of patients, with potential for under-estimation in 20% (42/209). Six hours or more of sleep was obtained in 89.5%. Parental questionnaires revealed 89.3% perceived high-level care, 91% perceived increased convenience and 76% good/excellent telehealth support. CONCLUSIONS Telehealth-supported pediatric HSAT achieves technical success in almost 90% of patients investigated for OSA, with 89.5% achieving ≥6 hours sleep duration, and excellent family acceptability.
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Affiliation(s)
- Amanda Griffiths
- Sleep Unit, Department of Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Department of Paediatrics, Melbourne, Australia
| | - Amanda Mukushi
- Oximetry and Sleep Services, Department of Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Anne-Marie Adams
- Sleep Unit, Department of Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Department of Paediatrics, Melbourne, Australia
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12
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Green A, Nagel N, Kemer L, Dagan Y. Comparing in-lab full polysomnography for diagnosing sleep apnea in children to home sleep apnea tests (HSAT) with an online video attending technician. Sleep Biol Rhythms 2022; 20:397-401. [PMID: 35309258 PMCID: PMC8917253 DOI: 10.1007/s41105-022-00384-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/24/2022] [Indexed: 12/02/2022]
Abstract
The main study aim was to compare the validity of children sleep apnea data obtained from standard polysomnography (PSG) to a home sleep apnea test (HSAT) accompanied by an attending online video technician. Our study population was comprised of 100 children, 54 boys and 46 girls, ages 3–11 (average age 5.2, SD 1.2) assigned randomly either to in-lab full PSG or to a HSAT with real-time, online technical support to rule out obstructive sleep apnea (OSA). A t test comparison did not yield significant differences between data obtained from the in-lab PSG and HSAT with real-time, online, technical support for any of the following measures: Apnea–Hypopnea Index, Oxygen desaturation Index, baseline O2, or minimum O2 parameters. However, a significant difference was found for time in bed and total sleep time, which was significantly longer in the HAST. Online HSAT can provide a safe, convenient and a reliable way to perform sleep studies in young children for diagnosing OSA in their familiar home environment.
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Affiliation(s)
- Amit Green
- The Sleep and Fatigue Institute, Assuta Medical Center, 96 Yigal Alon Street, 67891 Tel Aviv, Israel
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, 1220800 Tel Hai, Israel
| | - Noam Nagel
- The Sleep and Fatigue Institute, Assuta Medical Center, 96 Yigal Alon Street, 67891 Tel Aviv, Israel
| | - Lilach Kemer
- The Sleep and Fatigue Institute, Assuta Medical Center, 96 Yigal Alon Street, 67891 Tel Aviv, Israel
| | - Yaron Dagan
- The Sleep and Fatigue Institute, Assuta Medical Center, 96 Yigal Alon Street, 67891 Tel Aviv, Israel
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, 1220800 Tel Hai, Israel
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13
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Withers A, Maul J, Rosenheim E, O’Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med 2022; 18:393-402. [PMID: 34323688 PMCID: PMC8804994 DOI: 10.5664/jcsm.9576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children; validate home T2PSG in children with suspected OSA. METHODS Eighty-one participants (ages 6-18) with suspected OSA had simultaneous T1PSG and T2PSG in the sleep laboratory, 47 participants (ages 5-16) had T1PSG in the sleep laboratory and T2PSG performed at home. Sleep scientists staged and scored polysomnography data, and pediatric sleep physicians assigned a diagnosis of normal or OSA. Participant demographics, polysomnography variables, and diagnoses were compared using chi-square and Fisher's exact tests for nominal variables, t test for continuous variables and Cohen's kappa to assess concordance. RESULTS Acceptable recordings were obtained for every home T2PSG. When T1PSG and T2PSG were simultaneous, correlation between the number of arousals, respiratory disturbance index, and sleep stages was excellent. T2PSG at home demonstrated less stage 2 sleep, more rapid eye movement sleep, and higher sleep efficiency. Comparison of home T2PSG to T1PSG for diagnosing OSA showed a false-positive rate of 6.6% and false-negative rate of 3% for those performed at home. CONCLUSIONS T2PSG in the home is feasible with excellent concordance with T1PSG for the purposes of diagnosing OSA in children aged 5-18 years. Home T2PSG may be more representative of a "normal" night for children and could benefit those suspected of having OSA by reducing waiting times for laboratory PSG, improving access to PSG and possibly reducing costs of investigating and treating OSA. CITATION Withers A, Maul J, Rosenheim E, O'Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med. 2022;18(2):393-402.
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Affiliation(s)
- Adelaide Withers
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Wal-yan Respiratory Research Centre, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia,Address correspondence to: Adelaide Withers, MBBS, Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Hospital Ave, Nedlands WA 6009, Australia;
| | - Jennifer Maul
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Anne O’Donnell
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Andrew Wilson
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia,Division of Paediatrics and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Stick
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Wal-yan Respiratory Research Centre, Perth, Western Australia, Australia,Division of Paediatrics and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia,University of Western Australia, Perth, Western Australia, Australia
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14
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Sabil A, Launois S. Tracheal Sound Analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:265-280. [PMID: 36217090 DOI: 10.1007/978-3-031-06413-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tracheal sound sensors provide multiple respiratory signals that are valuable for studying upper airway characteristics. This chapter reviews the original work and ongoing research on tracheal sound analysis in relation to upper airway obstruction during sleep. Past and current research suggest that being associated with other sleep study recording sensors and advanced signal processing techniques, tracheal sound analysis can extensively contribute to the diagnosis and assessment of sleep-disordered breathing.
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15
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Russo K, Greenhill J, Burgess S. Home (Level 2) polysomnography is feasible in children with suspected sleep disorders. Sleep Med 2021; 88:157-161. [PMID: 34753042 DOI: 10.1016/j.sleep.2021.10.024] [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: 08/12/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
AIM To audit the feasibility and patient experience of home polysomnography (sleep study) for the investigation of a sleep disorder in children. METHODS The signal quality and outcomes of a Level 2 (home) polysomnography in young people undergoing investigation between September 2020 and January 2021 in a single centre was reviewed. A successful home polysomnogram was defined as a study with ≥6 h of sleep and all channels (EEG, thoraco-abdominal bands, calculated airflow, and pulse oximetry) present for at least 90% of the study time. Feedback from the guardian and young person was collected following the study using a questionnaire. RESULTS Fifty-five patients, aged 4 months to 18 years, were included. A successful polysomnogram, on the first attempt, was achieved for 48/55 (87%) subjects. There were no differences in success when accounting for neurodevelopmental conditions, OSA severity or age. The majority (76%) of guardians felt that their child slept the same or better than normal and only 12% found having the study conducted at home difficult. Following the study, only 8% would have preferred a hospital sleep study in retrospect. CONCLUSIONS Home polysomnography produced a technically adequate study for the majority of subjects. Most families also found the experience of having a home sleep study to be positive. These data support the use of home sleep studies as an alternative to an in-patient sleep study, in appropriate circumstances, for young people undergoing investigation of a sleep disorder.
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Affiliation(s)
| | | | - Scott Burgess
- Queensland Children's Lung and Sleep Specialists, Australia.
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16
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Stražišar BG. Sleep Measurement in Children-Are We on the Right Track? Sleep Med Clin 2021; 16:649-660. [PMID: 34711388 DOI: 10.1016/j.jsmc.2021.08.004] [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: 10/20/2022]
Abstract
Sleep plays a critical role in the development of healthy children. Detecting sleep and sleep disorders and the effectiveness of interventions for improving sleep in children require valid sleep measures. Assessment of sleep in children, in particular infants and young children, can be a quite challenging task. Many subjective and objective methods are available to evaluate various aspects of sleep in childhood, each with their strengths and limitations. None can, however, replace the importance of thorough clinical interview with detailed history and clinical examination by a sleep specialist.
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Affiliation(s)
- Barbara Gnidovec Stražišar
- Pediatric Department, Centre for Pediatric Sleep Disorders, General Hospital Celje, Oblakova ulica 5, Celje 3000, Slovenia; College of Nursing in Celje, Celje, Slovenia; Medical Faculty, University of Maribor, Maribor, Slovenia.
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17
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Ye G, Yin H, Chen T, Chen H, Cui L, Zhang X. FENet: A Frequency Extraction Network for Obstructive Sleep Apnea Detection. IEEE J Biomed Health Inform 2021; 25:2848-2856. [PMID: 33434137 DOI: 10.1109/jbhi.2021.3050113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a highly prevalent but inconspicuous disease that seriously jeopardizes the health of human beings. Polysomnography (PSG), the gold standard of detecting OSA, requires multiple specialized sensors for signal collection, hence patients have to physically visit hospitals and bear the costly treatment for a single detection. Recently, many single-sensor alternatives have been proposed to improve the cost efficiency and convenience. Among these methods, solutions based on RR-interval (i.e., the interval between two consecutive pulses) signals reach a satisfactory balance among comfort, portability and detection accuracy. In this paper, we advance RR-interval based OSA detection by considering its real-world practicality from energy perspectives. As photoplethysmogram (PPG) pulse sensors are commonly equipped on smart wrist-worn wearable devices (e.g., smart watches and wristbands), the energy efficiency of the detection model is crucial to fully support an overnight observation on patients. This creates challenges as the PPG sensors are unable to keep collecting continuous signals due to the limited battery capacity on smart wrist-worn devices. Therefore, we propose a novel Frequency Extraction Network (FENet), which can extract features from different frequency bands of the input RR-interval signals and generate continuous detection results with downsampled, discontinuous RR-interval signals. With the help of the one-to-multiple structure, FENet requires only one-third of the operation time of the PPG sensor, thus sharply cutting down the energy consumption and enabling overnight diagnosis. Experimental results on real OSA datasets reveal the state-of-the-art performance of FENet.
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18
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Macaulay GC, Galland BC, Boucher SE, Wiltshire EJ, Haszard JJ, Campbell AJ, Black SM, Smith C, Elder D, Wheeler BJ. Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case-control study. Sleep 2021; 43:5580781. [PMID: 31583407 DOI: 10.1093/sleep/zsz226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/03/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. METHODS Participants included 82 children (5-18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. RESULTS There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = -40 minutes; 95% confidence interval = -77, -3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). CONCLUSIONS Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.
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Affiliation(s)
- Grace C Macaulay
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Angela J Campbell
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Stephanie M Black
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Claire Smith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
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Prero MY, Birnkrant DJ, Carter JC. Albeit ever more technological, there's no place like home. J Clin Sleep Med 2021; 16:999-1000. [PMID: 32445308 DOI: 10.5664/jcsm.8602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Moshe Y Prero
- Sleep Fellowship Program, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Pediatric Pulmonary Fellowship Program, University Hospitals Cleveland Medical Center and Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - David J Birnkrant
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John C Carter
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
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20
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Olmo Arroyo J, De Sanctis L, Sidhoum L, Amaddeo A, Griffon L, Khirani S, Fauroux B. Quality of poly(somno)graphy recordings in children. J Sleep Res 2021; 30:e13241. [PMID: 33675114 DOI: 10.1111/jsr.13241] [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: 06/23/2020] [Revised: 09/01/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
The aim of the study was to assess the scorability of the signals of four poly(somno)graphy devices and transcutaneous carbon dioxide tracings (PtcCO2 ) of one device in children. The presence (0%, < 25%, 25%-50%, 50%-75%, 75%-99%, 100% of recording time) and quality (bad, average, good) of the signal of each sensor were analysed. During a 5-month period, 364 poly(somno)graphies were performed in 12 different hospital units. Forty-one children had poor/bad cooperation, and 13 severe behaviour disorders. Seventy-one and 293 poly(somno)graphies were performed in children aged ≤ 2 and > 2 years, respectively; nine poly(somno)graphies failed. For the four poly(somno)graphy devices, the signal was present during 99% of recording time for the electroencephalogram, 99% for thoracic belt, 97% for abdominal belt, 97% for body position, 95% for the microphone, 92% for pulse oximetry, 87% for tracheal sound, 71% for oronasal thermistor, 52% (41% for ≤ 2 years, 55% for > 2 years old) for nasal pressure and 86% for PtcCO2 . The signal was of good quality in 98% of poly(somno)graphies for body position, 96% for microphone, 96% for thoracic belt, 95% for pulse oximetry, 91% for abdominal belt, 91% for tracheal sound, 82% for oronasal thermistor, 78% for electroencephalogram, 73% for nasal pressure and 46% of PtcCO2 recordings. The scorability was comparable between devices. Nasal pressure and oronasal thermistor had the lowest scorability, especially in children aged ≤ 2 years. This underlines the necessity of the development or improvement of alternative, ideally face-free, sensors, or miniaturized devices adapted for infants and children.
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Affiliation(s)
- Jorge Olmo Arroyo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Livio De Sanctis
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Lynda Sidhoum
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,VIFASOM, Université de Paris, Paris, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,VIFASOM, Université de Paris, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,VIFASOM, Université de Paris, Paris, France.,ASV Santé, Gennevilliers, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,VIFASOM, Université de Paris, Paris, France
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21
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Pedersen J, Rasmussen MGB, Olesen LG, Kristensen PL, Grøntved A. Self-administered electroencephalography-based sleep assessment: compliance and perceived feasibility in children and adults. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-021-00059-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep is a crucial part of our lives and insufficient sleep has been linked to several health disorders in both children and adults. However, most studies are based on single night laboratory polysomnography, actigraphy, or sleep diaries. The primary aim of this study was to evaluate compliance to and perceived feasibility of the Zmachine insight+ for assessment of habitual sleep parameters in a sample of children and adults for six nights. The secondary aim was to report sleep parameters derived from the Zmachine.
Methods
We analyzed data from 12 families who participated in the SCREENS pilot trial (2018–2019). Children (n=14) and adults (n=19) had to undergo three nights of EEG-based sleep assessment at baseline and follow-up. We assessed compliance to the sleep assessment protocol and summarized perceived feasibility in children and adults. Summary estimates were computed for total sleep time, sleep onset latency, wake after sleep onset, light sleep, deep sleep, and rapid eye movement sleep.
Results
Compliance to the sleep assessment protocol was high with 92.9 and 89.4% of children and adults meeting the a priori specified compliance goal of at least two out of three nights of complete sleep data at both baseline and follow-up. In general, the protocol was perceived as feasible, with low prevalence of sleep disruption and only minor issues, e.g. difficulties with removing sensors. Results on sleep parameters indicate large within group variation.
Conclusions
Our findings support the use of a self-administered EEG-based habitual sleep assessment protocol, including multiple days of measurement, in children and adults.
Trial registration
Cilinicaltrials.gov: NCT03788525 [Secondary outcome measures; Retrospectively registered; 27th December, 2018].
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22
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Night-to-night variability in respiratory parameters in children and adolescents examined for obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 137:110206. [PMID: 32896337 DOI: 10.1016/j.ijporl.2020.110206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The diagnosis of obstructive sleep apnea (OSA) is routinely based on just a single night's sleep examination. The night-to-night variability in children and adolescents has previously been investigated using type 4 sleep monitors or PSG. However, there is a lack of studies investigating the night-to-night variability when using type 3 sleep monitors. Therefore, the main purpose was to investigate the night-to-night variability in respiratory parameters in children and adolescents using a portable type 3 monitor. Furthermore, the purpose was to investigate the clinical relevance of night-to-night variability. METHODS The study population was recruited from an ongoing research project concerning the effect of weight loss in children and adolescents with OSA and overweight/obesity. The inclusion criterion was the successful recording of two consecutive nights of sleep. Sleep examinations were recorded at home using the Nox T3 device and then blindly scored by the same registered polysomnographic technologist. To compare the respiratory parameters measured each night, a paired t-test or a Wilcoxon signed-rank test was used. The apnea-hypopnea index (AHI) was further described graphically with a scatter plot and a Bland-Altman plot. The presence and severity of OSA were described in tables. RESULTS A total of 30 children and adolescents with a median age of 14.8 years were included. When comparing respiratory parameters between nights, all p-values derived from paired t-tests and Wilcoxon signed-rank tests were >0.05. When considering the graphical depictions of AHI, it was evident that for some participants AHI measurements varied widely from night to night. Regarding the presence of OSA, 27% of participants changed diagnostic category between nights and 40% of those with a normal AHI on the first night had OSA on the second night. Regarding OSA severity, 50% of participants changed severity category between nights. CONCLUSIONS AHI measurements varied widely between nights in some children and adolescents leading to frequent changes in both diagnosis and severity of OSA from night to night. We therefore suggest the presence of a clinically relevant night-to-night variability which should be taken into account when diagnosing pediatric OSA.
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Cardiorespiratory Monitoring Data during Sleep in Healthy Canadian Infants. Ann Am Thorac Soc 2020; 17:1238-1246. [DOI: 10.1513/annalsats.201909-703oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Satomaa AL, Mäkelä T, Saarenpää-Heikkilä O, Kylliäinen A, Huupponen E, Himanen SL. Slow-wave activity and sigma activities are associated with psychomotor development at 8 months of age. Sleep 2020; 43:5813737. [PMID: 32227230 DOI: 10.1093/sleep/zsaa061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/09/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES The electrophysiological properties of non-rapid eye movement sleep (NREM) EEG are homeostatically modulated on global and local use-dependent levels. Furthermore, the local NREM quality reflects age-dependent brain maturation and individual, age-independent, and psychomotor potential. Cortical maturation and its electrophysiological marker, Slow-wave activity (SWA), as well as sleep spindles are known to change in topography and quality during the early years of life, but their associations with psychomotor development in infants are unknown. Therefore, we aimed to evaluate the local properties of SWA and spindles (sigma power) and ascertain whether they correlate with psychomotor development in 8-month-old infants. METHODS Ambulatory polysomnographies were recorded in 56 infants at 8 months of age to calculate the local SWA and sigma powers. The associations between the SWA and sigma powers and psychomotor development (Bayley-III) were examined in 36 of these infants. RESULTS In both hemispheres, the highest SWA and sigma powers were found occipitally and centrally, respectively, with higher powers in the right hemisphere than in the left. The Bayley-III correlated with local SWA and sigma powers: the occipital SWA and centro-occipital sigma correlated with cognitive scales, and the frontal and occipital SWA and centro-occipital sigma correlated with language and fine motor scales. Most of the correlations were unilateral. CONCLUSIONS In 8-month-old infants, the NREM sleep quality shows local differences that are mostly attributable to the topical phase of brain maturation. The local NREM parameters correlate with psychomotor development.
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Affiliation(s)
- Anna-Liisa Satomaa
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Tiina Mäkelä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Outi Saarenpää-Heikkilä
- Center for Child Health Research, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Anneli Kylliäinen
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Eero Huupponen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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25
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Sabil A, Marien C, LeVaillant M, Baffet G, Meslier N, Gagnadoux F. Diagnosis of sleep apnea without sensors on the patient's face. J Clin Sleep Med 2020; 16:1161-1169. [PMID: 32267226 DOI: 10.5664/jcsm.8460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals. METHODS Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas. RESULTS Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen's kappa coefficient of 0.96. CONCLUSIONS Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors.
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Affiliation(s)
| | - Caroline Marien
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France
| | - Marc LeVaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | | | - Nicole Meslier
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,Inserm UMR 1063, Université d'Angers, Angers, France; *Contributed equally
| | - Frédéric Gagnadoux
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,Inserm UMR 1063, Université d'Angers, Angers, France; *Contributed equally
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Ioan I, Weick D, Schweitzer C, Guyon A, Coutier L, Franco P. Feasibility of parent-attended ambulatory polysomnography in children with suspected obstructive sleep apnea. J Clin Sleep Med 2020; 16:1013-1019. [PMID: 32056538 PMCID: PMC7954050 DOI: 10.5664/jcsm.8372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Due to a limited number of pediatric sleep centers, the aim was to test the feasibility of ambulatory polysomnography (PSG-home) in a group of French children suspected of OSA. METHODS Children undergoing one-night PSG-home, with the device installed at the pediatric sleep physician's office, were prospectively included. General failure was considered when PSG-home recording captured < 5 h of artifact-free sleep or when ≥ 1 channel (nasal flow, thoraco-abdominal belts, oximetry) presented artifacts > 75% of the recording time. No-OSA was defined as an obstructive apnea-hypopnia index (OAHI) < 1 event/h and respiratory-related arousals index (RAI) < 1 event/h. OSA was defined as upper airways resistance syndrome (UARS) with OAHI < 1 event/h with RAI ≥ 1 event/h, or mild OSA (OAHI ≥ 1 event/h-5 events/h), moderate OSA (OAHI ≥ 5 events/h-10 events/h), or severe OSA (OAHI ≥ 10 events/h). Parents completed a severity hierarchy score questionnaire, Conners Parent Rating Scale, and an adapted Epworth Sleepiness Scale. RESULTS Fifty-seven children aged 3 through 16 years were included. PSG-home was technically acceptable in 46 (81%). Failure due to nasal cannula was observed in 11% (n = 6), oximetry in 7% (n = 4), and both in 2% (n = 1) of cases. No difference in feasibility was found according to age, sex, OSA severity, or comorbidities. There were 14 (25%) children categorized as no-OSA, 43 (75%) as OSA, 4 (7%) as UARS, 26 (46%) as mild, 6 (10%) as moderate, and 7 (12%) as severe OSA. Neither questionnaires nor clinical and physical examination predicted OSA diagnosis. CONCLUSIONS When equipment is installed at the professional's office and a parent monitors the child, PSG-home is feasible and technically acceptable in children aged 3 through 16 years old. The short delay and feasibility provided by PSG-home could improve the management of children suspected of OSA.
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Affiliation(s)
- Iulia Ioan
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
- Faculté de Médecine, Université de Lorraine, Nancy, France
- Contributed equally
| | - Diane Weick
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Contributed equally
| | - Cyril Schweitzer
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
- Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Aurore Guyon
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Laurianne Coutier
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Service de pneumologie infantile, allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, CNRL, Université de Lyon 1, France
| | - Patricia Franco
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, CNRL, Université de Lyon 1, France
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27
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Kärki A, Paavonen EJ, Satomaa AL, Saarenpää-Heikkilä O, Himanen SL. Sleep architecture is related to the season of PSG recording in 8-month-old infants. Chronobiol Int 2020; 37:921-934. [PMID: 32338075 DOI: 10.1080/07420528.2020.1754845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To date, little is known about the impact of season on infant sleep. In higher latitudes, the duration of daily light time varies substantially between different seasons, and environmental light is one potential factor affecting sleep. In this cohort study, one-night polysomnography (PSG) was performed on 72 healthy 8-month-old infants in 2012 and 2013 to study the effect of season on the sleep architecture of young infants in Finland. The children were divided into four subgroups, according to the amount of light during their birth season and the amount of light during the season of the PSG recordings, corresponding to spring, summer, autumn, and winter. We found that the season of birth did not have an impact on the infants' sleep architecture at 8 months of age, but the season of the PSG recording did have an effect on several sleep variables. In the PSGs conducted during the spring, there was less N3 sleep and more N2 sleep than in the PSGs conducted during the autumn. In addition, there was more fragmented sleep during spring than autumn. According to our data, the season has an effect on the sleep architecture of young infants and should, therefore, be considered when evaluating the PSG findings of young infants. The exact mechanisms behind this novel finding remain unclear, however. The findings imply that infants` sleep is affected by the season or light environment, as is the case in adult sleep. Since potential explanatory factors, such as direct natural or artificial light exposure and the melatonin levels of the infants, were not controlled, more research is needed in the future to better understand this phenomenon.
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Affiliation(s)
- Anja Kärki
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy , Tampere, Finland
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare , Helsinki, Finland
| | - Anna-Liisa Satomaa
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy , Tampere, Finland
| | - Outi Saarenpää-Heikkilä
- Center for Child Health Research Tampere University, Tampere University Hospital , Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy , Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
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28
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Akkari M, Yildiz S, Marianowski R, Monteyrol PJ, Chalumeau F, Fayoux P, Leboulanger N, Franco P, Couloigner V, Mondain M. Role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome (POSAHS). Part 3: sleep recordings. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:405-410. [PMID: 32107171 DOI: 10.1016/j.anorl.2020.02.001] [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: 10/24/2022]
Abstract
OBJECTIVES The authors present the clinical practice guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) concerning the role of the ENT specialist in the management of pediatric obstructive sleep apnea hypopnea syndrome (POSAHS). Part 3 is dedicated to the place of sleep recordings in the diagnosis of POSAHS. METHODS A multidisciplinary work group was commissioned to carry out a review of the scientific literature on the above topic. Based on the articles retrieved and the group members' individual experience, guidelines were drafted and graded as A, B or C or Expert Opinion by decreasing level of evidence, then reviewed by an editorial group independent of the work group. RESULTS Sleep recordings are presented according to the American Sleep Disorders Association's classification as type 1, 2, 3 or 4. Their modalities, interpretation, indications, advantages and limitations are detailed.
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Affiliation(s)
- M Akkari
- UAM d'ORL pédiatrique, département d'ORL et chirurgie cervico-faciale, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - S Yildiz
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, Paris, France
| | - R Marianowski
- Département d'ORL et chirurgie cervico-faciale, hôpital Morvan, CHU de Brest, Brest, France
| | - P J Monteyrol
- Département d'ORL et chirurgie cervico-faciale, polyclinique du tondu et clinique du sommeil, hôpital Pellegrin, Bordeaux, France
| | | | - P Fayoux
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France
| | - N Leboulanger
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, Paris, France
| | - P Franco
- Unité de sommeil pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - V Couloigner
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, Paris, France
| | - M Mondain
- UAM d'ORL pédiatrique, département d'ORL et chirurgie cervico-faciale, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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29
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Elrokhsi SH, Bluez GP, Chin CN, Wheeler MD, Silva GE, Perfect MM. Differences in sleep architecture according to body mass index in children with type 1 diabetes. Pediatr Diabetes 2020; 21:98-105. [PMID: 31498940 DOI: 10.1111/pedi.12918] [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: 02/20/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
Slow wave sleep (SWS), or deep sleep, is thought to be the most restorative stage of sleep and may be of a particular interest in the pathophysiology of obesity. The aim of this study was to investigate differences in sleep architecture based on body mass index (BMI) among a pediatric population with type 1 diabetes mellitus (T1DM). We hypothesized that children with T1DM who are obese would have less SWS than those who are not obese. Of 105 children with T1DM (mean age 13.54 years, 49.5% females) in this study, 19% were obese, 22% were overweight, and 59% had a normal BMI (81% non-obese). The overall SWS% among the participants was 13.2%. In contrast to our hypothesis, there was no significant difference in SWS% between obese and non-obese participants. However, the percent of time spent in rapid eye movement (REM) sleep among obese participants was significantly lower than those who were not obese (P = .022), which remained after adjusting the result for multiple covariates. While we found no significant association between the SWS time and BMI, obese adolescents with T1DM spent less time in REM sleep than those who were not obese. This study adds to the growing body of evidence supporting the importance of addressing sleep in clinical care of youth with T1DM.
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Affiliation(s)
- Salaheddin H Elrokhsi
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Grai P Bluez
- Disability and Psychoeducational Studies, University of Arizona, Tucson, Arizona
| | - Cindy N Chin
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Mark D Wheeler
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | | | - Michelle M Perfect
- Disability and Psychoeducational Studies, University of Arizona, Tucson, Arizona
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30
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Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183235. [PMID: 31487798 PMCID: PMC6765844 DOI: 10.3390/ijerph16183235] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 12/27/2022]
Abstract
The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management.
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31
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Kärki A, Paavonen EJ, Satomaa AL, Saarenpää-Heikkilä O, Huhtala H, Himanen SL. Sleep architecture is related to birth season in 1-month-old infants. Chronobiol Int 2019; 36:1217-1226. [PMID: 31267784 DOI: 10.1080/07420528.2019.1629449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Individual variation in sleep quality, quantity, and architecture is pronounced in small infants. Reasons for this remain largely unclear, even though environmental and genetic factors have been suggested to play a role. In order to study the effect of birth seasons on infant sleep architecture, 85 healthy 1-month-old infants underwent an overnight polysomnography (PSG). The PSGs were conducted in 2011-2013. The cohort was divided into four subgroups according to the amount of seasonal light at the time of birth, with each group covering a period of approximately three months. The groups were labeled IL (increasing light), L (light), ID (increasing darkness), and D (dark), corresponding to spring, summer, autumn, and winter, respectively. We found the amount of stage R sleep (precursor of REM sleep, formerly active sleep) to be the highest in infants born in summer, whereas infants born in winter presented the smallest amount of stage R sleep. Infants born in summer presented the smallest amount of stage T sleep (transitional sleep), while stage T sleep was most abundant in infants born in winter. In addition, infants born in summer showed the shortest total sleep time (TST) and the smallest number of awakenings during the study night. This was the first PSG study to find out that birth season modifies the sleep architecture of infants.
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Affiliation(s)
- Anja Kärki
- a Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District , Tampere , Finland
| | - E Juulia Paavonen
- b Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,c Department of Public Health Solutions, National Institute for Health and Welfare , Helsinki , Finland
| | - Anna-Liisa Satomaa
- a Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District , Tampere , Finland
| | | | - Heini Huhtala
- e Faculty of Social Sciences, Tampere University , Tampere , Finland
| | - Sari-Leena Himanen
- a Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District , Tampere , Finland.,f Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland
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32
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Masoud AI, Patwari PP, Adavadkar PA, Arantes H, Park C, Carley DW. Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients. J Clin Sleep Med 2019; 15:733-742. [PMID: 31053204 DOI: 10.5664/jcsm.7764] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) is considered the gold standard in the diagnosis of sleep apnea. In pediatric patients, because of limited availability and access to laboratory-based PSG, there can be significant delays in the diagnosis and management of sleep apnea that can result in progressive associated comorbidities. The main objective of the current study was to test the diagnostic value of a portable sleep monitor (PM), the MediByte, in comparison with laboratory PSG in pediatric patients wearing both setups simultaneously. METHODS A consecutive series of pediatric patients referred to the University of Illinois Sleep Science Center wore the MediByte during simultaneous PSG. The apnea-hypopnea index (AHI) was calculated for PSG and both manual and autoscoring functions of the PM. Pearson correlation and Bland-Altman plots were assessed. RESULTS A total of 70 patients successfully completed simultaneous PSG and PM studies (median age 10.8 years). The AHI obtained both manually and automatically scored PM studies strongly correlated with the AHI obtained from the PSG (r ≥ .932, P < .001). The oxygen saturation obtained by the PM showed significant correlation with that obtained by PSG among children aged 12 to 17 years (P < .001), but not among children aged 7 to 11 years (P ≥ .24). The sensitivity and specificity for detection of severe sleep apnea diagnosed by PSG (AHI ≥ 10 events/h) using both PM scoring methods was very high (> 93% for both). CONCLUSIONS Although PSG is still recommended for the diagnosis of sleep apnea, PMs can play a valuable role in diagnosing moderate and severe sleep apnea, especially in older pediatric patients. COMMENTARY A commentary on this article appears in this issue on page 685.
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Affiliation(s)
- Ahmed I Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Pallavi P Patwari
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois.,Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois
| | - Pranshu A Adavadkar
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois
| | - Henry Arantes
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois.,Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois
| | - Chang Park
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois
| | - David W Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois
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Gudnadottir G, Hafsten L, Redfors S, Ellegård E, Hellgren J. Respiratory polygraphy in children with sleep-disordered breathing. J Sleep Res 2019; 28:e12856. [PMID: 30932252 DOI: 10.1111/jsr.12856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
At-home respiratory polygraphy has been shown to be a reliable substitute for in-laboratory polysomnography in adults for diagnosing obstructive sleep apnea, but this is less well studied in children. One aim of this study was to examine the quality of at-home respiratory polygraphy in children with sleep-disordered breathing and to evaluate the interrater reliability of the results. Another aim was to study whether calibrated respiratory inductance plethysmography (RIP) flow can be used for the scoring of respiratory events when the airflow measurements are unreliable. Children aged 4-10 years, with sleep-disordered breathing, underwent at-home respiratory polygraphy. Of 113 polygraphies, only 46% were of acceptable quality, with missing nasal airflow being the most common problem (40%). The median recorded time with artifact-free signal present in three traces simultaneously was 228 min (0-610 min). Seventeen polygraphy studies were selected for further study. Each study was scored by two independent scorers, with and without the nasal airflow signal present, the latter relying on RIP flow for the scoring of respiratory events. The apnea-hypopnea index (AHI) from the four different measurements was compared using intraclass correlation coefficients (ICC). Comparison of the two scorers showed moderate agreement, with (ICC = 0.66) and without (ICC = 0.53) nasal airflow. One scorer had good agreement between AHI with and without nasal airflow (ICC = 0.81), whereas the other had poor agreement (ICC = 0.12). In conclusion, the scoring of respiratory events based on RIP flow is scorer dependent even for experienced scorers. The nasal airflow signal is frequently missing in paediatric respiratory polygraphies, which limits the usefulness of the method.
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Affiliation(s)
- Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Louise Hafsten
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Staffan Redfors
- Queen Silvia's Children's Hospital at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Ellegård
- Department of Otorhinolaryngology, Halland's Hospital, Kungsbacka, Sweden
| | - Johan Hellgren
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Sabil A, Glos M, Günther A, Schöbel C, Veauthier C, Fietze I, Penzel T. Comparison of Apnea Detection Using Oronasal Thermal Airflow Sensor, Nasal Pressure Transducer, Respiratory Inductance Plethysmography and Tracheal Sound Sensor. J Clin Sleep Med 2019; 15:285-292. [PMID: 30736876 DOI: 10.5664/jcsm.7634] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/24/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Evaluation of apnea detection using a tracheal sound (TS) sensor during sleep in patients with obstructive sleep apnea. METHODS Polysomnographic recordings of 32 patients (25 male, mean age 66.7 ± 15.3 years, and mean body mass index 30.1 ± 4.5 kg/m2) were analyzed to compare the detection of apneas by four different methods of airflow signals: oronasal thermal airflow sensor (thermistor), nasal pressure transducer (NP), respiratory inductance plethysmography (RIPsum) and TS. The four used signals were scored randomly and independently from each other according to American Academy of Sleep Medicine rules. Results of apnea detection using NP, RIPsum and TS signals were compared to those obtained by thermistor as a reference signal. RESULTS The number of apneas detected by the thermistor was 4,167. The number of apneas detected using the NP was 5,416 (+29.97%), using the RIPsum was 2,959 (-29.71%) and using the TS was 5,019 (+20.45%). The kappa statistics (95% confidence interval) were 0.72 (0.71 to 0.74) for TS, 0.69 (0.67 to 0.70) for NP, and 0.57 (0.55 to 0.59) for RIPsum. The sensitivity/specificity (%) with respect to the thermistor were 99.23/69.27, 64.07/93.06 and 96.06/76.07 for the NP, RIPsum and TS respectively. CONCLUSIONS With the sensor placed properly on the suprasternal notch, tracheal sounds could help detecting apneas that are underscored by the RIPsum and identify apneas that may be overscored by the NP sensor due to mouth breathing. In the absence of thermistor, TS sensors can be used for apnea detection. CLINICAL TRIAL REGISTRATION Registry: German Clinical Trials Register (DRKS), Title: Using the tracheal sound probe of the polygraph CID102 to detect and differentiate obstructive, central, and mixed sleep apneas in patients with sleep disordered breathing, Identifier: DRKS00012795, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012795.
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Affiliation(s)
| | - Martin Glos
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Günther
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schöbel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Veauthier
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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35
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Combs D, Goodwin JL, Quan SF, Morgan WJ, Hsu CH, Edgin JO, Parthasarathy S. Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. J Clin Sleep Med 2019; 15:111-117. [PMID: 30621839 PMCID: PMC6329554 DOI: 10.5664/jcsm.7582] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Parent report or child report is commonly used to obtain information on sleep in children. Data are lacking comparing the validity of parent-reported versus child-reported sleep parameters. METHODS A total of 285 children (age 9 to 17 years) from the Tucson Children's Assessment of Sleep Apnea community cohort study were assessed. Parent report and child report of total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) for a single night were compared to polysomnography (PSG). Intraclass correlations (ICCs) were used to evaluate agreement between child report, parent report, and PSG findings. RESULTS When compared to PSG, children overestimated TST by a median of 32 minutes (interquartile range [IQR] 6 to 68), whereas parents overestimated TST by 36 minutes (IQR 13-70) (P = .006). Children overestimated SL by 4 minutes (IQR -8 to 20), whereas parents overestimated SL by 2 minutes (IQR -10 to 13) (P = .001). Children overestimated SE by 5% (IQR 0% to 11%), whereas parents overestimated SE by 6% (IQR 2% to 11%, P = .04). Both child-reported TST (ICC 0.722, P < .001) and parent-reported TST (ICC 0.776, P < .001) agreed substantially with PSG. Child-reported SL (ICC 0.467, P < .001) and parent-reported SL (r = .419, P < .001) moderately agreed with PSG. Least agreement with PSG was seen between child-reported SE (ICC 0.404, P < .001) and parent-reported SE (ICC 0.473, P < .001), but significant agreement was still present. CONCLUSIONS When compared to PSG, children overestimate TST to a smaller degree than their parents and overestimate SL to a larger degree than their parents, but these differences appear small. Child and parent reports appear to be equally valid for TST, SL, and SE.
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Affiliation(s)
- Daniel Combs
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, Arizona
- Department of Medicine, University of Arizona, Tucson, Arizona
- University of Arizona Health Sciences Center for Sleep & Circadian Sciences and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona
| | - James L. Goodwin
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Stuart F. Quan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Wayne J. Morgan
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, Arizona
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Jamie O. Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tucson, Arizona
- University of Arizona Health Sciences Center for Sleep & Circadian Sciences and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona
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Hakim M, Shafy SZ, Miller R, Jatana KR, Splaingard M, Tumin D, Tobias JD, Raman VT. Sleep-disordered breathing and reaction time in children. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:413-417. [PMID: 30588131 PMCID: PMC6296195 DOI: 10.2147/mder.s186647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB) in children exceeds the availability of polysomnography (PSG) to definitively diagnose OSA and identify children at higher risk of perioperative complications. As sleep deficits are associated with slower reaction times (RTs), measuring RT may be a cost-effective approach to objectively identify SDB symptoms. Aim The aim of this study is to compare RT on a standard 10-minute psychomotor vigilance test (PVT) based on children’s history of OSA/SDB. Methods Children, 6–11 years of age, were enrolled from two different clinical groups. The SDB group included children undergoing adenotonsillectomy with a clinical history of SDB, OSA, or snoring. The control group included children with no history of SDB, OSA, or snoring who were scheduled for surgery other than adenotonsillectomy. RT was measured via 10-minute PVT (Ambulatory Monitoring Inc., Ardsley, NY, USA). Median RT was calculated for each patient based on all responses to stimuli during the PVT assessment and was compared to published age-sex-specific norms. The proportion of children exceeding RT norms was compared between study groups. Results The study included 72 patients (36/36 male/female, median age 7 years), 46 with SDB and 26 without SDB. There was no difference in the RT between the two groups. Fifty-four percent of patients with SDB exceeded norms for median RT vs 42% of control patients (95% CI of difference: – 12, 36; P=0.326). Conclusion Approximately half of the patients in both groups exceeded published norms for median RT on PVT. Despite its convenience, measurement of RT did not distinguish between patients with probable SDB/OSA for preoperative risk stratification.
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Affiliation(s)
- Mohammed Hakim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Shabana Zainab Shafy
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Rebecca Miller
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Kris R Jatana
- Department of Pediatric Otorhinolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Splaingard
- Department of Sleep Disorders Centre, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, Ohio State University, Columbus, OH, USA
| | - Vidya T Raman
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, Ohio State University, Columbus, OH, USA
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Fishman H, Massicotte C, Li R, Zabih W, McAdam LC, Al-Saleh S, Amin R. The Accuracy of an Ambulatory Level III Sleep Study Compared to a Level I Sleep Study for the Diagnosis of Sleep-Disordered Breathing in Children With Neuromuscular Disease. J Clin Sleep Med 2018; 14:2013-2020. [PMID: 30518444 DOI: 10.5664/jcsm.7526] [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: 04/12/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) surveillance recommendations are not being met for children with neuromuscular disease (NMD) because of limited diagnostic facilities. We evaluated the diagnostic accuracy of an ambulatory level III device as compared to a level I PSG. METHODS A cross-sectional study was conducted at a tertiary pediatric institution. Eligibility criteria included: (1) children with NMD; (2) age 6 to 18 years; (3) booked for a clinically indicated overnight level I PSG. Participants were randomized to an overnight level I PSG followed by an ambulatory level III study with end tidal carbon dioxide (etCO2) or vice versa. Sensitivity and specificity of the ambulatory level III device to diagnose sleep-disordered breathing (SDB) at an apnea-hypopnea index (AHI) cutoff of > 1.0 events/h was the primary outcome. RESULTS Moderate to severe SDB was found in 46% of participants (13/28). The device's sensitivity and specificity to detect SDB was 61.5% and 86.7%, respectively. The positive predictive value of the level III study was 80.0% and the negative predictive value was 72.0%. Fifty percent of the cohort were either missing or had incomplete or falsely low ambulatory etCO2 data. CONCLUSIONS A level III device with etCO2 is not yet able to be implemented in clinical practice as a diagnostic tool for SDB in pediatric patients with NMD. COMMENTARY A commentary on this article appears in this issue on page 1973.
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Affiliation(s)
- Haley Fishman
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rhonda Li
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Weeda Zabih
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Laura C McAdam
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Li X, Pang X, Liu Z, Zhang Q, Sun C, Yang J, Li Y. Joint effect of less than 1 h of daytime napping and seven to 8 h of night sleep on the risk of stroke. Sleep Med 2018; 52:180-187. [DOI: 10.1016/j.sleep.2018.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
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Ahmed S, Hasani S, Koone M, Thirumuruganathan S, Diaz-Abad M, Mitchell R, Isaiah A, Das G. An Empirical Study of Questionnaires for the Diagnosis of Pediatric Obstructive Sleep Apnea. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4097-4100. [PMID: 30441257 DOI: 10.1109/embc.2018.8513389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric Obstructive Sleep Apnea (OSA) is a chronic disorder characterized by the disruption in sleep due to involuntary and temporary cessation of breathing. Definitive diagnosis of OSA requires an intrusive and expensive approach based on polysomnography where the children spend a night in the hospital under the supervision of a sleep technician. The prevalence of OSA is increasing, making the traditional diagnostic approach prohibitively expensive. There has been increasing interest in designing inexpensive approaches to screen children such as the use of questionnaires. In this paper, we study the efficacy of five widely used and representative questionnaires on their ability to diagnose and stratify OSA. Our experiments show that the diagnostic ability of each of these questionnaires is insufficient for widespread clinical use. Using techniques from data mining, we identify the most informative questions and propose a new questionnaire. We show that machine learning models trained based on the answers to our questionnaire can stratify OSA with higher accuracy.
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40
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Hughes BH, Brinton JT, Ingram DG, Halbower AC. The Impact of Altitude on Sleep-Disordered Breathing in Children Dwelling at High Altitude: A Crossover Study. Sleep 2018; 40:3932553. [PMID: 28934528 DOI: 10.1093/sleep/zsx120] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Study Objectives Sleep-disordered breathing (SDB) is prevalent among children and is associated with adverse health outcomes. Worldwide, approximately 250 million individuals reside at altitudes higher than 2000 meters above sea level (masl). The effect of chronic high-altitude exposure on children with SDB is unknown. This study aims to determine the impact of altitude on sleep study outcomes in children with SDB dwelling at high altitude. Methods A single-center crossover study was performed to compare results of high-altitude home polysomnography (H-PSG) with lower altitude laboratory polysomnography (L-PSG) in school-age children dwelling at high altitude with symptoms consistent with SDB. The primary outcome was apnea-hypopnea index (AHI), with secondary outcomes including obstructive AHI; central AHI; and measures of oxygenation, sleep quality, and pulse rate. Results Twelve participants were enrolled, with 10 included in the final analysis. Median altitude was 1644 masl on L-PSG and 2531 masl on H-PSG. Median AHI was 2.40 on L-PSG and 10.95 on H-PSG. Both obstructive and central respiratory events accounted for the difference in AHI. Oxygenation and sleep fragmentation were worse and pulse rate higher on H-PSG compared to L-PSG. Conclusions These findings reveal a clinically substantial impact of altitude on respiratory, sleep, and cardiovascular outcomes in children with SDB who dwell at high altitude. Within this population, L-PSG underestimates obstructive sleep apnea and central sleep apnea compared to H-PSG. Given the shortage of high-altitude pediatric sleep laboratories, these results suggest a role for home sleep apnea testing for children residing at high altitude.
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Affiliation(s)
- Benjamin H Hughes
- School of Medicine, Department of Pediatrics, The University of Colorado Anschutz Medical Campus, Aurora, CO.,The Breathing Institute, Section of Pediatric Pulmonary Medicine, Children's Hospital Colorado, Aurora, CO
| | - John T Brinton
- School of Medicine, Department of Pediatrics, The University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - David G Ingram
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO.,Department of Pulmonology and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Ann C Halbower
- School of Medicine, Department of Pediatrics, The University of Colorado Anschutz Medical Campus, Aurora, CO.,The Breathing Institute, Section of Pediatric Pulmonary Medicine, Children's Hospital Colorado, Aurora, CO
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Quan SF, Combs D, Parthasarathy S. Impact of Sleep Duration and Weekend Oversleep on Body Weight and Blood Pressure in Adolescents. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2018; 16:31-41. [PMID: 29375933 DOI: 10.13175/swjpcc150-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Weekend oversleep or catchup sleep is a frequent occurrence in children, but there are relatively little data concerning its impact on weight and blood pressure. The aim of this study was to assess the association between sleep duration and oversleep, and weight and blood pressure in adolescents. Methods Sleep duration, weight and blood pressure of 327 children (51.4% boys, mean age 13.3 ± 1.7 years) who had polysomnograms performed during both exam cycles of the Tucson Children's Assessment of Sleep Apnea study (TuCASA) were analyzed. Sleep duration on school nights and non-school nights was used to compute a weighted average of child and parent reported overall sleep duration respectively. Oversleep was defined as the difference between self and parent reported weekend sleep and weekday sleep separately. Simple correlations between overall sleep duration, sleep on school and non-school nights and oversleep, and blood pressure, standardized body mass index (BMI), snoring, respiratory disturbance index (RDI) and age were calculated. Significant bivariate associations then were used to develop multivariate partial correlation models. Results Unadjusted negative correlations with BMI were noted for parent reported total sleep duration at the 1st exam cycle, parent and child reported total sleep and school night sleep duration, and parent reported non-school night sleep duration at the 2nd exam cycle. Additionally, for BMI, positive correlations were observed for log RDI at both exam cycles and snoring at the 2nd exam cycle. For blood pressure, there were positive associations with age, parent reported oversleep, caffeine consumption and snoring. Additionally, for blood pressure, negative relationships were observed with parent reported total sleep duration at the 1st exam cycle, and parent and child reported total sleep and school night sleep durations at the 2nd exam cycle. Partial correlations found that BMI was negatively correlated with parent reported total sleep duration at the 1st exam cycle and parent reported total sleep duration at the 2nd exam cycle, and positively correlated with snoring and log RDI at both exam cycles. Systolic blood pressure was only associated with age and snoring. Diastolic blood pressure was positively correlated with age and caffeine consumption, and negatively correlated with parent reported total and school night sleep duration. Oversleep and child reported sleep duration were not represented in any of these models. Conclusion Lower amounts of sleep especially on school nights is associated with higher body weight and blood pressure. Oversleep was not associated with either body weight or blood pressure.
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Affiliation(s)
- Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ
| | - Daniel Combs
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ.,Center for Sleep and Circadian Sciences, University of Arizona Health Sciences Center, Tucson, AZ
| | - Sairam Parthasarathy
- Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ.,Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.,Center for Sleep and Circadian Sciences, University of Arizona Health Sciences Center, Tucson, AZ
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Satomaa AL, Saarenpää-Heikkilä O, Huupponen E, Kirjavainen T, Heinonen J, Himanen SL. Local changes in computational non-rapid eye movement sleep depth in infants. Clin Neurophysiol 2018; 129:448-454. [PMID: 29304420 DOI: 10.1016/j.clinph.2017.09.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/22/2017] [Accepted: 09/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Deep NREM sleep and its hallmark EEG phenomenon slow wave activity (SWA) are under homeostatic control in adults. SWA is also locally regulated as it increases in the brain areas that have been used intensively. Moreover, in children, SWA is a marker of cortical maturation. In the present study the local properties of NREM sleep depth were evaluated using the quantitative mean frequency method. We aimed to study if age is related to NREM sleep depth in young infants. In addition, we studied if young infants have local differences in their NREM sleep. METHODS Ambulatory over-night polysomnographies were recorded in 59 healthy and full-term infants at the age of one month. The infants were divided into two age groups (<44 weeks and ≥44 weeks) to allow maturational evaluations. RESULTS The quantitative sleep depth analysis showed differences between the age groups. In addition, there were local sleep depth differences within the age groups. CONCLUSIONS The sleep depth change with age is most likely related to cortical maturation, whereas the local sleep depth gradients might also reflect the use-dependent properties of SWA. SIGNIFICANCE The results support the idea that young infants have frontal cortical processing.
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Affiliation(s)
- Anna-Liisa Satomaa
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland.
| | | | - Eero Huupponen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Turkka Kirjavainen
- Helsinki University Hospital, Department of Pediatrics, Helsinki, Finland
| | - Juhani Heinonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Quante M, Kaplan ER, Cailler M, Rueschman M, Wang R, Weng J, Taveras EM, Redline S. Actigraphy-based sleep estimation in adolescents and adults: a comparison with polysomnography using two scoring algorithms. Nat Sci Sleep 2018; 10:13-20. [PMID: 29403321 PMCID: PMC5779275 DOI: 10.2147/nss.s151085] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Actigraphy is widely used to estimate sleep-wake time, despite limited information regarding the comparability of different devices and algorithms. We compared estimates of sleep-wake times determined by two wrist actigraphs (GT3X+ versus Actiwatch Spectrum [AWS]) to in-home polysomnography (PSG), using two algorithms (Sadeh and Cole-Kripke) for the GT3X+ recordings. SUBJECTS AND METHODS Participants included a sample of 35 healthy volunteers (13 school children and 22 adults, 46% male) from Boston, MA, USA. Twenty-two adults wore the GT3X+ and AWS simultaneously for at least five consecutive days and nights. In addition, actigraphy and PSG were concurrently measured in 12 of these adults and another 13 children over a single night. We used intraclass correlation coefficients (ICCs), epoch-by-epoch comparisons, paired t-tests, and Bland-Altman plots to determine the level of agreement between actigraphy and PSG, and differences between devices and algorithms. RESULTS Each actigraph showed comparable accuracy (0.81-0.86) for sleep-wake estimation compared to PSG. When analyzing data from the GT3X+, the Cole-Kripke algorithm was more sensitive (0.88-0.96) to detect sleep, but less specific (0.35-0.64) to detect wake than the Sadeh algorithm (sensitivity: 0.82-0.91, specificity: 0.47-0.68). Total sleep time measured using the GT3X+ with both algorithms was similar to that obtained by PSG (ICC=0.64-0.88). In contrast, agreement between the GT3X+ and PSG wake after sleep onset was poor (ICC=0.00-0.10). In adults, the GT3X+ using the Cole-Kripke algorithm provided data comparable to the AWS (mean bias=3.7±19.7 minutes for total sleep time and 8.0±14.2 minutes for wake after sleep onset). CONCLUSION The two actigraphs provided comparable and accurate data compared to PSG, although both poorly identified wake episodes (i.e., had low specificity). Use of actigraphy scoring algorithm influenced the mean bias and level of agreement in sleep-wake times estimates. The GT3X+, when analyzed by the Cole-Kripke, but not the Sadeh algorithm, provided comparable data to the AWS.
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Affiliation(s)
- Mirja Quante
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Emily R Kaplan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Cailler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rui Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School and The Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Elsie M Taveras
- Harvard Medical School, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School and The Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ulate-Campos A, Tsuboyama M, Loddenkemper T. Devices for Ambulatory Monitoring of Sleep-Associated Disorders in Children with Neurological Diseases. CHILDREN (BASEL, SWITZERLAND) 2017; 5:E3. [PMID: 29295578 PMCID: PMC5789285 DOI: 10.3390/children5010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/18/2017] [Accepted: 12/18/2017] [Indexed: 12/30/2022]
Abstract
Good sleep quality is essential for a child's wellbeing. Early sleep problems have been linked to the later development of emotional and behavioral disorders and can negatively impact the quality of life of the child and his or her family. Sleep-associated conditions are frequent in the pediatric population, and even more so in children with neurological problems. Monitoring devices can help to better characterize sleep efficiency and sleep quality. They can also be helpful to better characterize paroxysmal nocturnal events and differentiate between nocturnal seizures, parasomnias, and obstructive sleep apnea, each of which has a different management. Overnight ambulatory detection devices allow for a tolerable, low cost, objective assessment of sleep quality in the patient's natural environment. They can also be used as a notification system to allow for rapid recognition and prompt intervention of events like seizures. Optimal monitoring devices will be patient- and diagnosis-specific, but may include a combination of modalities such as ambulatory electroencephalograms, actigraphy, and pulse oximetry. We will summarize the current literature on ambulatory sleep devices for detecting sleep disorders in children with neurological diseases.
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Affiliation(s)
- Adriana Ulate-Campos
- Department of Neurology, National Children's Hospital Dr. Carlos Saenz Herrera, 10103 San José, Costa Rica.
| | - Melissa Tsuboyama
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Zaffanello M, Piacentini G, Pietrobelli A, Fava C, Lippi G, Maffeis C, Gasperi E, Nosetti L, Bonafini S, Tagetti A, Antoniazzi F. Ambulatory clinical parameters and sleep respiratory events in a group of obese children unselected for respiratory problems. World J Pediatr 2017; 13:577-583. [PMID: 28702869 DOI: 10.1007/s12519-017-0054-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/12/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obstructive sleep apnea in children is frequently due to tonsil and adenoid hypertrophy. This study aimed to investigate the relationship between ambulatory clinical parameters and sleep respiratory events in obese children. METHODS We carried out a prospective respiratory sleep study between 2013 and 2015. Nails obstruction, tonsils enlargement and palate position were subjectively measured. Italian attention deficit hyperactivity disorder (ADHD) rating scale for parents was also performed. The polygraph study was performed using a portable ambulatory device. RESULTS Forty-four obese children were consecutively recruited into this study. Mild sleep respiratory disturbance was showed in 31.8 % of patients; 18.2% previously had an adeno (tonsillectomy). In 50% of these obese children, both apnea-hypopnea index and oxygen desaturation index showed polygraph abnormal results. ADHD rating scale for parents scores were positive in 9.1% of patients. CONCLUSIONS We found a high rate of mild sleep respiratory disturbance and ADHD-like symptoms referred by parents. The respiratory disturbance was not totally cured by surgery. Finally, otorhinolaryngology variables were not able to explain mild sleep respiratory disturbance.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Cristiano Fava
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Department of Neuroscience, Biomedicine and Movement, Chemistry and Clinical Microscopy Section, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Sara Bonafini
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Angela Tagetti
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Kirk V, Baughn J, D'Andrea L, Friedman N, Galion A, Garetz S, Hassan F, Wrede J, Harrod CG, Malhotra RK. American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children. J Clin Sleep Med 2017; 13:1199-1203. [PMID: 28877820 DOI: 10.5664/jcsm.6772] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The purpose of this position paper is to establish the American Academy of Sleep Medicine's (AASM) position on the use of a home sleep apnea test (HSAT) for the diagnosis of obstructive sleep apnea (OSA) in children (birth to 18 years of age). METHODS The AASM commissioned a task force of 8 experts in sleep medicine to review the available literature on the use of an HSAT to diagnose OSA in children. The task force developed the position statement based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statement. POSITION STATEMENT Use of a home sleep apnea test is not recommended for the diagnosis of obstructive sleep apnea in children. The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.
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Affiliation(s)
| | | | - Lynn D'Andrea
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Anjalee Galion
- Children's Hospital of Orange County, Orange, California
| | - Susan Garetz
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Joanna Wrede
- Seattle Children's Hospital, Seattle, Washington
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Pamula Y, Nixon GM, Edwards E, Teng A, Verginis N, Davey MJ, Waters K, Suresh S, Twiss J, Tai A. Australasian Sleep Association clinical practice guidelines for performing sleep studies in children. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
Tracheal sounds have been the subject of many research studies. In this review, we describe the state of the art, original work relevant to upper airways obstruction during sleep, and ongoing research concerning the methods used when analysing tracheal sounds. Tracheal sound sensors are a simple and noninvasive means of measurement and are more reliable than other breathing sensors. Developments in acoustic processing techniques and enhancements in tracheal sound signals over the past decade have led to improvements in the accuracy and clinical relevance of diagnoses based on this technology. Past and current research suggests that they may have a significant role in the diagnosis of obstructive sleep apnoea. Tracheal sounds analysis may have a significant role in the diagnosis of obstructive sleep apnoeahttp://ow.ly/f7ax30cAcnP
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Affiliation(s)
- Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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49
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Stehling F, Keull J, Olivier M, Große-Onnebrink J, Mellies U, Stuck BA. Validation of the screening tool ApneaLink ® in comparison to polysomnography for the diagnosis of sleep-disordered breathing in children and adolescents. Sleep Med 2017; 37:13-18. [PMID: 28899523 DOI: 10.1016/j.sleep.2017.05.018] [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: 02/28/2017] [Revised: 05/06/2017] [Accepted: 05/30/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE While out-of-center testing was introduced as an alternative for the diagnosis of obstructive sleep apnea in adults, polysomnography (PSG) is still considered mandatory in the diagnosis of sleep-disordered breathing (SDB) in children. The purpose of this study was to validate the outpatient screening device ApneaLink® in comparison to PSG in children and adolescents for the diagnosis of SDB. METHODS Sixty consecutive children and adolescents (10.4 ± 6.2, 0-22 years) with suspected SDB admitted to the sleep laboratory underwent simultaneous recording with full PSG and the screening device ApneaLink® based on flow measurement and oxygen saturation. RESULTS The mean apnea-hypopnea index (AHI) was 11.8 ± 19.7 in PSG and 10.3 ± 12.0 in ApneaLink®. When the AHI threshold was set to 5/h to diagnose SDB, the overall sensitivity for ApneaLink® was 79% and the specificity was 63%. After reducing the AHI threshold to 1/h, the sensitivity and specificity were 94% and 29%. In children older than 10 years, the performance of ApneaLink® improved (AHI 5/h: sensitivity 80%, specificity 64%; AHI 1/h: sensitivity 100%, specificity 50%). CONCLUSION These results show that the outpatient screening device ApneaLink® reliably identifies SDB in preselected children older than 10 years. In contrast, it may not be used for the exclusion of SDB.
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Affiliation(s)
- Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Judith Keull
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Jörg Große-Onnebrink
- Department of General Pediatrics, Pediatric Respiratory Medicine Unit, University Children's Hospital Muenster, Muenster, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps Universität Marburg, Germany
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Abstract
BACKGROUND Children with achondroplasia often have breathing problems, especially during sleep. The most important treatments are adenotonsillectomy (for treating upper obstruction) and/or neurosurgery (for resolving cervicomedullar junction stenosis). DATA SOURCES We reviewed the scientific literature on polysomnographic investigations which assessed the severity of respiratory disorders during sleep. RESULTS Recent findings have highlighted the importance of clinical investigations in patients with achondroplasia, differentiating between those that look for neurological patterns and those that look for respiratory problems during sleep. In particular, magnetic resonance imaging (MRI) and somatosensory evoked potentials are the main tools to evaluate necessary neurosurgery and over myelopathy, respectively. CONCLUSIONS The use of polysomnography enables clinicians to identify children with upper airway obstruction and to quantify disease severity; it is not suitable for MRI and/or neurosurgery considerations.
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