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Kalyoncu M, Namlı N, Yegit CY, Yanaz M, Gulieva A, Ergenekon AP, Selçuk M, Atağ E, İkizoğlu NB, Sabancı M, Lale K, Gokdemir Y, Ersu R, Karakoç F, Karadag B, Eralp EE. Is the Pediatric Sleep Questionnaire sensitive for sleep-disordered breathing in children with complex chronic disease? Sleep Breath 2024; 28:331-337. [PMID: 37733254 DOI: 10.1007/s11325-023-02915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Sleep-disordered breathing (SDB) is a disease defined by breathing or breathing irregularities while asleep. The current study examines the association between results of polysomnography (PSG) and the Pediatric Sleep Questionnaire (PSQ), and the specificity and sensitivity of the PSQ for obstructive sleep apnea (OSA) in patients with chronic illnesses. METHODS Demographic and clinical attributes, in addition to PSQ and PSG outcomes were examined retrospectively among patients who underwent polysomnography (PSG) at our facility between 2012 and 2021. RESULTS Of 745 patients included in the study, 462 (62%) were male. The median age was 81 months (34-151 months). 117 of the patients (15/8%) had chronic lung disease, and 80 (10.7%) had cerebral palsy. The most common indications for PSG were symptoms of OSA (n = 426; 57.1%). According to obstructive apnea-hypopnea index (AHI), 361 patients (48.5%) had normal PSG. The median PSQ score was 0.40 (0.22-0.57). The sensitivity and specificity of the PSQ were 71.8% and 40.4%, respectively, for individuals aged 2 to 18 years. Among the disease subgroups, the cerebral palsy group had the highest sensitivity of PSQ (88.8%) for diagnosis of OSA. CONCLUSION Questionnaires for evaluating SDB are not sensitive or specific for identification of OSA in children with chronic conditions, and PSG remains the best method.
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Affiliation(s)
- Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey.
| | - Nurtuğ Namlı
- Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Muruvvet Yanaz
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Merve Selçuk
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Emine Atağ
- Division of Pediatric Pulmonology, Başkent University School of Medicine, Istanbul, Turkey
| | - Nilay Baş İkizoğlu
- Division of Pediatric Pulmonology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Meltem Sabancı
- Sleep Laboratory of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kadir Lale
- Sleep Laboratory of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fazilet Karakoç
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No:41 Pendik, Istanbul, Turkey
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Roberts J, Tenaglia A, Bellissimo E, Kim H. Treatment of oromandibular dystonia with botulinum toxin A improves apnea in a teenager with quadriplegic cerebral palsy: A case report. J Pediatr Rehabil Med 2024; 17:125-129. [PMID: 37522227 PMCID: PMC10977355 DOI: 10.3233/prm-220105] [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: 10/10/2022] [Accepted: 04/18/2023] [Indexed: 08/01/2023] Open
Abstract
This report describes a 15-year-old female with known spastic and dystonic quadriplegic cerebral palsy (CP), Gross Motor Function Classification System IV, and obstructive sleep apnea (OSA). She experienced decreased apneic episodes after receiving onabotulinumtoxin A (BoNT-A) injections for the treatment of oromandibular dystonia (OMD). After her OSA diagnosis, she initially received injections to the bilateral masseter and temporalis muscles with no effect on the frequency of nightly apneic episodes. Subsequently, the bilateral lateral pterygoid muscles were added and she was later noted to have fewer apneic episodes overnight. This case report describes the use of BoNT-A in the muscles of mastication for management of OMD and the ensuing improvement in OSA in a teenager with CP.
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Affiliation(s)
| | - Amy Tenaglia
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elisabeth Bellissimo
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Heakyung Kim
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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El-Moatasem AM, Abbass ME. Effect of intrathoracic oscillations on pulmonary functions in children with cerebral palsy. J Taibah Univ Med Sci 2023; 18:1254-1260. [PMID: 37250813 PMCID: PMC10209537 DOI: 10.1016/j.jtumed.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/10/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives This study was aimed at investigating the effects of intrathoracic oscillations on pulmonary function in children with spastic quadriplegic cerebral palsy. Methods This study comprised 24 boys and girls 6-8 years of age with spastic quadriplegic cerebral palsy. According to the modified Ashworth scale, the degree of spasticity was 2 to 2+. The children were able to sit independently and follow instructions. The children were randomly divided into a study group and control group. A spirometer was used to examine each child before and after 6 weeks. Children in the control group received traditional chest physiotherapy (postural drainage and percussion), whereas children in the study group underwent quake device training. For 6 weeks, both groups received four sessions per week. After treatment, the results were collected. Paired t-test and independent-samples t-test were applied to compare the means for each group. p-values <0.05 were considered significant. Results The post-treatment results of forced expiratory volume at 1 s, peak expiratory flow, forced vital capacity, and the ratio of forced expiratory volume at 1 s to forced vital capacity demonstrated significant differences favoring the study group over the control group (p < 0.001, p < 0.001, p = 0.002, and p = 0.023, respectively). Conclusion Intrathoracic oscillations may improve pulmonary function in children with quadriplegic cerebral palsy.
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Affiliation(s)
- Alaa M. El-Moatasem
- Department of Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mai E. Abbass
- Department of Physical Therapy for Paediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Wolter NE, Scheffler P, Li C, End C, McKinnon NK, Narang I, Amin R, Chiang J, Matava C, Propst EJ. Adenotonsillectomy for obstructive sleep apnea in children with cerebral palsy: Risks and benefits. Int J Pediatr Otorhinolaryngol 2023; 174:111743. [PMID: 37748322 DOI: 10.1016/j.ijporl.2023.111743] [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: 05/27/2023] [Revised: 07/24/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To determine outcomes following adenotonsillectomy for obstructive sleep apnea (OSA) and the impact of motor and swallowing impairment on respiratory complications in children with Cerebral Palsy (CP). METHODS A retrospective review of children with CP and sleep disordered breathing (SDB) who underwent adenotonsillectomy (2003-2021) was performed. Children with CP were age-matched to children without CP. Motor and swallowing function was assessed using the Gross Motor Functional Classification System (GMFCS) and the Eating and Drinking Ability Classification System (EDACS). The primary outcome was postoperative obstructive apnea-hypopnea index (OAHI). Secondary outcomes were cure rate, complications, and need for additional interventions. RESULTS Ninety-seven children with CP were assessed for SDB, and 74 underwent polysomnography. Moderate or severe OSA was found in 49% (36/74). Adenotonsillectomy was performed in 30% (29/97). All children who underwent adenotonsillectomy experienced an initial reduction in OAHI (31.7/h to 2.9/h, p < 0.0001). Children with CP were less likely to achieve an OAHI<1 compared with children without CP (62.5% vs 81.8%, p = 0.23). Children with CP had more postoperative complications (43.5% vs. 8.7%) and greater odds of respiratory complications compared with children without CP (OR 8.9 95% CI 2.1-37.9). Children with CP and a GMFCS score of 5 and EDACS score between 3 and 5 had more respiratory complications post-adenotonsillectomy compared to those with GMFCS<5 (p = 0.002) and EDACS<3 (p = 0.031). CONCLUSION Children with CP had an improved OAHI initially following adenotonsillectomy but had higher rates of post-adenotonsillectomy complications. Respiratory complications after adenotonsillectomy were more common in children with motor and swallowing impairment. Findings may provide better preoperative planning for caregivers.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Patrick Scheffler
- Phoenix Children's Hospital, Division of Otolaryngology - Head and Neck Surgery, Phoenix, AZ, USA
| | - Chantal Li
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christopher End
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nicole K McKinnon
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jackie Chiang
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Tamura A, Yamaguchi K, Yanagida R, Miyata R, Tohara H. At-Home Orthodontic Treatment for Severe Teeth Arch Malalignment and Severe Obstructive Sleep Apnea Syndrome in a Child with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095333. [PMID: 35564726 PMCID: PMC9099996 DOI: 10.3390/ijerph19095333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/06/2023]
Abstract
Children with cerebral palsy typically have severe teeth arch malalignment, causing swallowing and respiration dysfunction. Malalignment in cerebral palsy, especially in children, worsens dysphagia and respiratory disorders; sometimes, it is also noted with obstructive sleep apnea. However, no study has reported on the improvement in obstructive sleep apnea after at-home orthodontic treatment in children with cerebral palsy. We herein present a pediatric case of cerebral palsy wherein obstructive sleep apnea improved with at-home orthodontic treatment for malalignment. We administered at-home orthodontic treatment to a 15-year-old boy with quadriplegia, due to spastic-type cerebral palsy, having no oral intake, obstructive sleep apnea, and teeth arch malalignment. After treatment, a decline in the severity of sleep apnea was observed. Perioral muscle hypertension and oral intake difficulties cause maxillary protrusion, narrowed teeth arch, and tilting of teeth in children with cerebral palsy. We expanded the oral cavity volume by orthodontic treatment to relieve muscle hypertension and correct the tongue position, thereby remarkably improving obstructive sleep apnea. Our findings suggest that at-home orthodontic treatment for malalignment effectively improves perioral muscle hypertension, glossoptosis, and obstructive sleep apnea.
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Affiliation(s)
- Atsuko Tamura
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
- Correspondence: ; Tel.: +81-3-5803-5587
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
| | - Rie Miyata
- Department of Pediatrics, Tokyo Kita-Medical Center, Tokyo 115-0053, Japan;
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
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Johnson C, Leavitt T, Daram SP, Johnson RF, Mitchell RB. Obstructive Sleep Apnea in Underweight Children. Otolaryngol Head Neck Surg 2021; 167:566-572. [PMID: 34784263 DOI: 10.1177/01945998211058722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA. STUDY DESIGN Case-control study. SETTING University of Texas Southwestern Medical Center and Children's Medical Center of Dallas. METHODS Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P < .05. RESULTS An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA. CONCLUSION Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.
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Affiliation(s)
- Courtney Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Taylor Leavitt
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shiva P Daram
- Department of Otolaryngology-Head and Neck Surgery, University of Texas, Medical Branch, Galveston, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
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Chiang S, Moss R, Meskis MA, Vogel-Farley V, Sullivan JE, Patel AD, Rao VR. Impact of intellectual and developmental disability on quality-of-life priorities in adults with epilepsy. Epilepsy Behav 2021; 123:108282. [PMID: 34509036 PMCID: PMC11161194 DOI: 10.1016/j.yebeh.2021.108282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/29/2021] [Accepted: 08/14/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adults living with intellectual and developmental disability (IDD) and epilepsy (IDD-E) face challenges in addition to those faced by the general population of adults with epilepsy, which may be associated with distinct priorities for improving health-related quality of life (HR-QOL). This study sought to (1) conduct a survey of HR-QOL priorities identified by adults with IDD-E and caregivers, and (2) perform an exploratory cross-sectional comparison to adults with epilepsy who do not have IDD. METHODS This cross-sectional study recruited 65 adults with IDD-E and 134 adults with epilepsy without IDD and caregivers. Using a three-step development process, 256 items from existing quality-of-life scales recommended by the American Academy of Neurology (AAN) were rated by patients/caregivers for their importance as HR-QOL priorities. HR-QOL items identified as critical to the majority of the sample of adults with IDD-E were reported. Health-related quality of life priorities were compared between adults with IDD-E and adults with epilepsy without IDD. RESULTS Health-related quality of life was significantly lower in adults with IDD-E. Health-related quality of life domains identified as critical priorities by adults with IDD-E included seizure burden, anti-seizure medication side effects, seizure unpredictability, and family impact. Priorities for improving HR-QOL differed between adults with and without IDD-E, with concerns about family impact, difficulty finding appropriate living conditions, inadequate assistance, and difficulty transitioning from pediatric-to-adult care valued significantly more among those with IDD-E. SIGNIFICANCE Intellectual and developmental disability is an important determinant of HR-QOL among adults with epilepsy. We report HR-QOL priorities identified by adults with IDD-E and their caregivers. These results may help epilepsy clinicians and researchers develop tailored strategies to address priorities of the patient with IDD-E/caregiver community.
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Affiliation(s)
- Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
| | - Robert Moss
- Seizure Tracker, LLC, Springfield, VA, United States
| | | | | | - Joseph E Sullivan
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Anup D Patel
- Department of Pediatrics and Division of Neurology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Brunton LK, Condliffe EG, Kuntze G, Janzen L, Esau S, Toomey CM, Emery CA. More Than Just Adolescence: Differences in Fatigue Between Youth With Cerebral Palsy and Typically Developing Peers. Ann Rehabil Med 2021; 45:197-203. [PMID: 34126669 PMCID: PMC8273725 DOI: 10.5535/arm.20250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP. METHODS A convenience sample of 36 youth with CP aged 10-18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected. RESULTS Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06-32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96-18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1-14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57-4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93-8.35). CONCLUSION Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities.
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Affiliation(s)
- Laura K Brunton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Gregor Kuntze
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Leticia Janzen
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Shane Esau
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Clodagh M Toomey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Carolyn A Emery
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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End C, Propst EJ, Cushing SL, McKinnon NK, Narang I, Amin R, Chiang J, Al-Saleh S, Matava C, Wolter NE. Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review. Laryngoscope 2021; 132:687-694. [PMID: 34032299 DOI: 10.1002/lary.29625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/24/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Assess the risks and benefits of adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in children with cerebral palsy (CP). STUDY DESIGN Systematic review. METHODS We conducted a systematic review of Medline, Embase, and Cochrane Central Registry from 1946 to 2021. Broad search concepts included cerebral palsy, pediatric, tonsillectomy/adenoidectomy, and sleep. Additional articles were identified by searching reference lists. Studies on the safety and efficacy of AT for OSA management in children with CP were included. RESULTS Fifteen articles met inclusion criteria. Articles were classified into one or more of four themes: intraoperative risk (n = 1), postoperative risk (n = 3), postoperative care requirements (n = 6), and surgical outcomes (n = 7). No intraoperative anesthetic complications were reported. Postoperatively, respiratory complications including pneumonia were common and necessitated additional airway management. Following AT, children with CP required close postoperative observation, experienced increased lengths of stay, and had increased odds of unplanned intensive care unit (ICU) admission. Benefits following AT were improvement in OSA as measured by a reduction in obstructive apnea-hypopnea index (OAHI) as well as improved quality of life in some; however, many patients went on to require tracheostomy due to persistent OSA. CONCLUSIONS Children with CP who undergo AT have a significant risk of developing a postoperative respiratory complication. Realistic counseling of families around increased perioperative risks in this population is imperative and close postoperative monitoring is critical. Many children will obtain a reduction in OAHI, but additional surgical management is often required, including tracheostomy. Further research is needed to determine the best management strategy for OSA in children with CP. Laryngoscope, 2021.
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Affiliation(s)
- Christopher End
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole K McKinnon
- Department of Critical Care Medicine, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jackie Chiang
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, Department of Anesthesia, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Assessments and Interventions for Sleep Disorders in Infants With or at High Risk for Cerebral Palsy: A Systematic Review. Pediatr Neurol 2021; 118:57-71. [PMID: 33541756 DOI: 10.1016/j.pediatrneurol.2020.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) are five times more likely than typically developing children to have sleep problems, resulting in adverse outcomes for both children and their families. The purpose of this systematic review was to gather current evidence regarding assessments and interventions for sleep in children under age 2 years with or at high risk for CP and integrate these findings with parent preferences. METHODS Five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, and PsycINFO) were searched. Included articles were screened using preferred reporting items for systematic reviews and meta-analyses guidelines, and quality of the evidence was reviewed using best evidence tools by two independent reviewers at minimum. An online survey was conducted regarding parent preferences through social media channels. RESULTS Eleven articles met inclusion criteria. Polysomnography emerged as the only high-quality assessment for the population. Three interventions (medical cannabis, surgical interventions, and auditory, tactile, visual, and vestibular stimulations) were identified; however, each only had one study of effectiveness. The quality of evidence for polysomnography was moderate, while the quality and quantity of the evidence regarding interventions was low. Survey respondents indicated that sleep assessments and interventions are highly valued, with caregiver-provided interventions ranked as the most preferable. CONCLUSIONS Further research is needed to validate affordable and feasible sleep assessments compared to polysomnography as the reference standard. In the absence of diagnosis-specific evidence of safety and efficacy of sleep interventions specific to young children with CP, it is conditionally recommended that clinicians follow guidelines for safe sleep interventions for typically developing children.
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11
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The relationship between gross motor function impairment in cerebral palsy and sleeping issues of children and caregivers. Sleep Med 2021; 81:261-267. [PMID: 33743473 DOI: 10.1016/j.sleep.2021.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
AIM To investigate, among children and adolescents with cerebral palsy (CP), the relationship between impairment of the gross motor function and: (i) child sleep disorders; (ii) the need for nocturnal support; and (iii) the quality of sleep of their caregivers. METHODS For children, we considered their scores on the gross motor function measure (GMFM-88) and on the sleep disturbance scale for children (SDSC), besides analyzing qualitative features about their sleep. For caregivers, we considered their scores in the Pittsburgh sleep quality index (PSQI). RESULTS Our sample was comprised of 87 participants with mean age of 11.4 years old (±3.4). We observed correlations between GMFM-88 and disorders of initiating and maintaining sleep (DIMS) (r = -0.22; p = 0.039), sleep-wake transition disorders (SWTD) (r = 0.26; p = 0.017) and disorders of arousal (DA) (r = 0.23; p = 0.033). Children receiving nocturnal support presented lower scores in the GMFM-88 (p = 0.001) and higher scores in the SDSC (p = 0.029). For the caregivers, we found no correlation between GMFM-88 and PSQI. Nonetheless, their PSQI scores correlated with the SDSC scores (r = 0.24; p = 0.027). CONCLUSION Impairment of the gross motor function correlated with DIMS and the need for nocturnal support but might not have an impact on the caregivers' sleep, which in turn correlated with child sleep disorders.
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12
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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13
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Selvadurai S, Voutsas G, Propst EJ, Wolter NE, Narang I. Obstructive sleep apnea in children aged 3 years and younger: Rate and risk factors. Paediatr Child Health 2020; 25:432-438. [PMID: 33173554 PMCID: PMC7606157 DOI: 10.1093/pch/pxz097] [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: 11/07/2018] [Accepted: 06/25/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Undiagnosed and untreated obstructive sleep apnea (OSA) can predispose children to neurobehavioural consequences. However, there is a lack of data identifying rate of, and risk factors for, OSA in very young healthy children. The objective of this study was to determine the rate of OSA and identify risk factors associated with the presence and severity of OSA in children aged 3 years and younger. METHODS This was a retrospective chart review of healthy children between 1 and 3 years old who had a baseline polysomnogram (PSG) between January 2012 and June 2017. Patient demographics, referral history, and PSG data were recorded. RESULTS One hundred and thirteen children were referred for a PSG, of which 66 (58%) were diagnosed with OSA and 47 (42%) did not have OSA. In the OSA group, 13 (20%) were mild and 53 (80%) were moderate-severe. Nasal congestion (P=0.001), adenoid hypertrophy (P=<0.001), and tonsillar hypertrophy (P=0.04) reported at the time of referral were more common in the OSA group compared to the no-OSA group. Binary logistic regression analysis showed that referral from an otolaryngologist (odds ratio=2.6, 95% confidence interval=1.1 to 6.0) were associated with moderate-severe OSA. CONCLUSION A high rate of OSA was found among children aged 3 years and younger. Children referred by an otolaryngologist are more likely to be diagnosed with moderate-severe OSA. Children aged 3 years and younger with symptoms of OSA should be considered high-risk for OSA and be prioritized for early PSG and management.
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Affiliation(s)
- Sarah Selvadurai
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Giorge Voutsas
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - Evan J Propst
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Nikolaus E Wolter
- University of Toronto, Toronto, Ontario
- Department of Otolaryngology- Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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Abstract
Sleep-disordered breathing (SDB) includes disorders of breathing that affect airway patency, which impair children's sleep and lead to negative consequences. Obstructive sleep apnea, hypoventilation and upper airway resistance syndrome are common causes of morbidity and mortality in childhood. These clinical practice guidelines, intended for use by pediatricians and primary care clinicians, provide a clear recommendation for the diagnosis and management of sleep-disordered breathing, focusing on the most serious disorder, obstructive sleep apnea syndrome (OSAS). These clinical guidelines formulate clear recommendations to identify patients with suspected OSAS. Further, the manuscript will highlight the potential consequences of SBD in children, and how to overcome such difficulties, what could be the therapeutic options, a 12 recommendations and what are the future direction for pediatric sleep medicine.
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Affiliation(s)
- Abdullah Al-Shamrani
- Pediatric Respiratory and Sleep Medicine, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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15
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Hulst RY, Voorman JM, Pillen S, Ketelaar M, Visser-Meily JM, Verschuren O. Parental perspectives on care for sleep in children with cerebral palsy: a wake-up call. Disabil Rehabil 2020; 44:458-467. [DOI: 10.1080/09638288.2020.1770873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Raquel Y. Hulst
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Jeanine M. Voorman
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht Utrecht, The Netherland
| | - Sigrid Pillen
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M.A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht Utrecht, The Netherland
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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16
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Louer R, McKinney RC, Abu-Sultaneh S, Lutfi R, Abulebda K. Safety and Efficacy of a Propofol and Ketamine Based Procedural Sedation Protocol in Children with Cerebral Palsy Undergoing Botulinum Toxin A Injections. PM R 2019; 11:1320-1325. [PMID: 30761757 DOI: 10.1002/pmrj.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pediatric patients with cerebral palsy often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. OBJECTIVE To investigate the safety and efficacy of a propofol and ketamine based sedation protocol in pediatric patients with cerebral palsy requiring BoNT-A injections. DESIGN Retrospective chart review. SETTING The sedations took place in a procedural sedation suite at a tertiary children's hospital from February 2013 through September 2017. PATIENTS 164 patients with diagnoses of cerebral palsy undergoing propofol and ketamine based sedation for injections with botulinum toxin A. METHODS An initial bolus of 0.5 mg/kg ketamine followed by a 2 mg/kg bolus of propofol was administered with supplemental boluses of propofol as needed to achieve deep sedation during the intramuscular BoNT-A injections. MAIN OUTCOME MEASUREMENTS Propofol dosages, adverse events, serious adverse events, and sedation time parameters were reviewed. RESULTS 345 sedations were successfully performed on 164 patients. The median total dose of propofol was 4.7 mg/kg (interquartile range [IQR]: 3.5, 6.3). Adverse events were encountered in 10.1% of procedures including hypoxemia responsive to supplemental oxygen (9.6%) and transient apnea (1.4%). The mean procedure time, recovery time, and total sedation time were 10, 11 and 33 minutes, respectively. With regard to patient variables, including age, weight, dose of propofol, sedation time, and Gross Motor Function Classification System classification, there was no association with increased incidence of adverse events. CONCLUSION Our sedation protocol of propofol and ketamine is safe and effective in children with cerebral palsy undergoing procedural sedation for intramuscular injections with BoNT-A. The adverse events encountered appeared to be related to airway and respiratory complications secondary to musculoskeletal deformities, emphasizing the importance of airway monitoring and management in these patients. LEVEL IV.
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Affiliation(s)
- Ryan Louer
- Indiana University School of Medicine, Indianapolis, IN
| | - Renee C McKinney
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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17
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Rodriguez KE, Bibbo J, O'Haire ME. The effects of service dogs on psychosocial health and wellbeing for individuals with physical disabilities or chronic conditions. Disabil Rehabil 2019; 42:1350-1358. [PMID: 30634884 DOI: 10.1080/09638288.2018.1524520] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the effects of service dogs on psychosocial health and indicators of wellbeing among individuals with physical disabilities or chronic conditions.Materials and methods: A total of 154 individuals participated in a cross-sectional survey including 97 placed with a mobility or medical service dog and 57 on the waitlist to receive one. Hierarchical regression evaluated the effect of having a service dog on standardized measures of psychosocial health (Pediatric Quality of Life Inventory) as well as anger, companionship, and sleep disturbance (Patient Reported Outcome Measurement Information System). Among those with a service dog, the Monash Dog-Owner Relationship Scale quantified the human-animal bond.Results: Results indicated that compared to those on the waitlist, individuals with a service dog exhibited significantly better psychosocial health including higher social, emotional, and work/school functioning. There was no significant effect of having a service dog on anger, companionship, or sleep disturbance. Among those with a service dog, emotional closeness, dog-owner interaction, and amount of time since the service dog was placed were weak correlates of outcomes.Conclusions: Findings suggest that service dogs may have measurable effects on specific aspects of psychosocial health for individuals with physical disabilities or chronic conditions.Implications for rehabilitationHealth care providers should recognize that in addition to the functional benefits service dogs are trained to provide, they can also provide their handlers with psychosocial benefits from their assistance and companionship.Results indicate that having a service dog was related to better emotional functioning, social functioning, and work/school functioning. Areas with no significant relationship with having a service dog included social companionship, sleep, and anger.Although findings are from a large and representative sample of mobility and medical service dogs, there may be individual differences in how service dogs affect the psychosocial health of their handlers.
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Affiliation(s)
- Kerri E Rodriguez
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
| | - Jessica Bibbo
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA.,Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH, USA
| | - Marguerite E O'Haire
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
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18
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Relief of Upper Airway Obstruction Using a Cervical Splint for Young Patients with Cerebral Palsy. J Clin Pediatr Dent 2018; 42:295-298. [PMID: 29750629 DOI: 10.17796/1053-4628-42.4.10] [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] [Indexed: 11/17/2022] Open
Abstract
13-year old boy with spastic quadriplegia cerebral palsy visited dental clinic with chief complaints of mouth breathing and malocclusion. His mouth was constantly open at the resting position, with his mandible and tongue displaced downward. He breathed through his mouth, making a constant gurgling sound, a sign of upper airway obstruction. To enhance his mandible position, vertical chin cap was first considered, but it was not sufficient to reduce the gurgling sound or ease breathing. Then, cervical splint was considered, which effectively decreased the gurgling sound by repositioning his mandible to the anterior-superior position. Oxygen saturation was increased when the cervical splint was used. Cervical splint can effectively assist breathing in patients with cerebral palsy, but it should be carefully applied as long-term use can result in unexpected complications. Under instruction by a physician regarding proper usage, a cervical splint can be applied to assist breathing in patients with cerebral palsy.
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19
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Santos JS, Giacheti CM, Dornelas LS, Silva NC, Souza ALDM, Guissoni Campos LM, Pinato L. Day/night melatonin content in cerebral palsy. Neurosci Lett 2018; 686:23-27. [PMID: 30176339 DOI: 10.1016/j.neulet.2018.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022]
Abstract
Changes in the sleep-wake cycle are frequent and may impair quality of life in individuals with cerebral palsy (CP). To investigate if a lack of a day/night variation of melatonin content could be related with sleep disorders (SD), the SD were evaluated with a Sleep Questionnaire and the melatonin content using ELISA in 33 individuals with CP and 24 controls. The indicative of SD were present in 47% of CP group, and the most frequent was the indicative of sleep breathing disorder. The CP group showed higher diurnal and lower nocturnal melatonin content than controls. Individuals with CP that had indicative of SD showed lower nocturnal content of melatonin than those without SD. These results showed that the lack of the day/night variation of melatonin was related to SD in individuals with CP.
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Affiliation(s)
- Janaina S Santos
- Specialized Center for Rehabilitation, Sorri - Bauru-SP, Brazil; São Paulo State University-UNESP, Marília, SP, Brazil
| | | | - Lilian S Dornelas
- Specialized Center for Rehabilitation, Sorri - Bauru-SP, Brazil; São Paulo State University-UNESP, Marília, SP, Brazil
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20
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Abel F, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Tan HL, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50:50/6/1700985. [PMID: 29217599 DOI: 10.1183/13993003.00985-2017] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Abstract
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
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Affiliation(s)
- Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Francois Abel
- Dept of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Paediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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21
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Galán C, Sánchez S, Franco L, Bravo R, Rivero M, Rodríguez AB, Barriga C. Tryptophan-enriched antioxidant cereals improve sleep in children with autistic spectrum and attention deficit hyperactivity disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.37212/jcnos.334393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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A pilot study comparing custom contoured and planar support surfaces for pressure ulcer risk over the heels for night time postural management using interface pressure mapping and discomfort scores. J Tissue Viability 2017; 26:189-195. [PMID: 28454679 DOI: 10.1016/j.jtv.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 11/20/2022]
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Abstract
Sleep breathing issues in children have been described for some considerable time and it is well established that children with neurodisability such as cerebral palsy are at increased risk of sleep disturbances [1, 2] when compared to the general population. However, there are concerns that awareness amongst clinicians remains patchy, and that many children with neurodisability have sleep breathing problems that remain undiagnosed and untreated. This case study illustrates that these issues remain challenging, highlighting the multifactorial approach required when dealing with sleep in this patient subgroup. Despite the known correlation between neurodisability and sleep disordered breathing, cases are still missedhttp://ow.ly/2pNS305Kll3
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Affiliation(s)
- Andrew Morley
- Royal Hospital for Children, Sleep Department, Glasgow, UK
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Hoque R, Bliwise DL. Snoring resolution with vagus nerve stimulator activation. Sleep Med 2017; 30:17-18. [DOI: 10.1016/j.sleep.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/24/2016] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
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Joosten KF, Larramona H, Miano S, Van Waardenburg D, Kaditis AG, Vandenbussche N, Ersu R. How do we recognize the child with OSAS? Pediatr Pulmonol 2017; 52:260-271. [PMID: 27865065 DOI: 10.1002/ppul.23639] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/12/2016] [Accepted: 10/30/2016] [Indexed: 12/29/2022]
Abstract
Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Koen F Joosten
- Erasmus MC, Pediatric Intensive Care, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Department of Pediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Dick Van Waardenburg
- Pediatric Intensive Care Unit, Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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Durr ML, Meyer AK, Kezirian EJ, Mamlouk MD, Frieden IJ, Rosbe KW. Sleep-disordered breathing in pediatric head and neck vascular malformations. Laryngoscope 2017; 127:2159-2164. [DOI: 10.1002/lary.26468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/21/2016] [Accepted: 11/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Megan L. Durr
- Department of Otolaryngology-Head and Neck Surgery; Kaiser Permanente Medical Center; Oakland California U.S.A
| | - Anna K. Meyer
- Department of Otolaryngology Head and Neck Surgery; Univerisity of California San Francisco; San Francisco California U.S.A
| | - Eric J. Kezirian
- Department of Otolaryngology-Head and Neck Surgery; University of Southern California Caruso; Los Angeles California U.S.A
| | - Mark D. Mamlouk
- Department of Radiology; Kaiser Permanente Medical Center; Santa Clara California U.S.A
| | - Ilona J. Frieden
- Departments of Dermatology and Pediatrics; Univerisity of California San Francisco; San Francisco California U.S.A
| | - Kristina W. Rosbe
- Department of Otolaryngology Head and Neck Surgery; Univerisity of California San Francisco; San Francisco California U.S.A
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Long Y, Tan J, Nie Y, Lu Y, Mei X, Tu C. Hyperbaric oxygen therapy is safe and effective for the treatment of sleep disorders in children with cerebral palsy. Neurol Res 2017; 39:239-247. [PMID: 28079475 DOI: 10.1080/01616412.2016.1275454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Ying Long
- Department of Hyperbaric Oxygen Treatment, Shenzhen People’s Hospital, Shenzhen, P. R. China
| | - Jiewen Tan
- Department of Hyperbaric Oxygen Treatment, Sun Yat-Sen, Memorial Hospital, Sun Yat-Sen University, Guangzhou, P. R. China
- Xinhua College, Sun Yat-sen University, Guangzhou, P. R. China
| | - Yulin Nie
- Department of Hyperbaric Oxygen Treatment, 2nd Hospital of Longgang District, Shenzhen, China
| | - Yu Lu
- Department of Hyperbaric Oxygen Treatment, Shenzhen People’s Hospital, Shenzhen, P. R. China
| | - Xiufang Mei
- Department of Hyperbaric Oxygen Treatment, Shenzhen People’s Hospital, Shenzhen, P. R. China
| | - Chaoqun Tu
- Department of Hyperbaric Oxygen Treatment, Shenzhen People’s Hospital, Shenzhen, P. R. China
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Abstract
Key points Educational aims Children with neurocognitive impairment often present with chronic or recurrent respiratory problemshttp://ow.ly/uqiG306pE9B
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Affiliation(s)
- Marijke Proesmans
- Dept of Pediatric Pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium
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Garcia J, Wical B, Wical W, Schaffer L, Wical T, Wendorf H, Roiko S. Obstructive sleep apnea in children with cerebral palsy and epilepsy. Dev Med Child Neurol 2016; 58:1057-62. [PMID: 26991829 DOI: 10.1111/dmcn.13091] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 11/28/2022]
Abstract
AIM To examine the risk of obstructive sleep apnea (OSA) in children with cerebral palsy (CP) and/or epilepsy. METHOD This cross-sectional study employs the Pediatric Sleep Questionnaire (PSQ), the Gross Motor Function Classification System (GMFCS), and chart review to identify symptoms of OSA in children presenting to a multi-specialty pediatric healthcare institution. RESULTS Two-hundred and fifteen patients were grouped into those with epilepsy (n=54), CP (n=18), both (n=55), and neither (comparison group, n=88). The comparison group comprised children with developmental disabilities but not children with typical development. Significantly increased PSQ scores (indicating increased risk of OSA) were found among children with CP (58%) and CP with epilepsy (67%) than among the comparison group (27%; p<0.001 and p<0.0001 respectively). Children with both CP and epilepsy had a greater number of increased PSQ scores compared with CP alone (p<0.05). Increased PSQ scores were observed with increasing CP severity as measured using the GMFCS. The PSQ identified more children at risk of OSA (46%) than did the medical record review for symptoms of OSA (8.2%, p<0.001). INTERPRETATION Children with CP of greater severity or comorbid epilepsy are at increased risk of OSA. This study supports the routine questionnaire-based assessment for OSA as a regular part of the care of all children with CP, especially in those with more severe CP and those with epilepsy.
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Affiliation(s)
- John Garcia
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Beverly Wical
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - William Wical
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Leah Schaffer
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Thomas Wical
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Heather Wendorf
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Samuel Roiko
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
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Crowe TK, Clark L, Quails C. The Impact of Child Characteristics on Mothers' Sleep Patterns. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153944929601600101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The sleep patterns of 45 mothers of children with moderate to severe multiple disabilities, 45 mothers of children with Down syndrome, and 45 mothers of typically developing children were compared by means of a 7-day diary. The children ranged in age from 6 months to 5 years. The Caregiver's Activity and Recording of Events (CARE) Inventory was completed by each subject to record mothers' activities in half-hour segments throughout a 24-hour day. Activities were coded into nine categories including rest/sleep. The three groups of mothers were compared on total hours of rest/sleep per day, number of sleep interruptions, reason for sleep interruptions, influences of siblings of target children, and number of times the father attended to the target child during the night as perceived by the mother. Surprisingly, the results indicated that mothers of children with multiple disabilities reported more sleep than did mothers in the other two groups. There were no significant differences found among the groups in the following: amount of weekly daytime sleep; frequency and duration of child-related interruptions per week; number of nights of uninterrupted sleep per week; maximum number of sleep interruptions in one night; and mothers' perception of fathers' nighttime assistance. The data indicated that many mothers in all three groups experienced numerous weekly sleep interruptions, particularly mothers of infants 6 to 12 months of age. Professionals working with mothers of young children must consider the effects of shortened and interrupted sleep patterns on the day time functioning and health of mothers and the effect on the well-being of the entire family.
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Choi JY, Rha DW, Park ES. Change in Pulmonary Function after Incentive Spirometer Exercise in Children with Spastic Cerebral Palsy: A Randomized Controlled Study. Yonsei Med J 2016; 57:769-75. [PMID: 26996580 PMCID: PMC4800370 DOI: 10.3349/ymj.2016.57.3.769] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/23/2015] [Accepted: 09/03/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effect of incentive spirometer exercise (ISE) on pulmonary function and maximal phonation time (MPT) in children with spastic cerebral palsy (CP). MATERIALS AND METHODS Fifty children with CP were randomly assigned to two groups: the experimental group and the control group. Both groups underwent comprehensive rehabilitation therapy. The experimental group underwent additional ISE. The forced vital capacity (FVC), forced expiratory volume at one second (FEV₁), FEV₁/FVC ratio, peak expiratory flow (PEF), and MPT were assessed as outcome measures before and after 4 weeks of training. RESULTS There were significant improvements in FVC, FEV₁, PEF, and MPT in the experimental group, but not in the control group. In addition, the improvements in FVC, FEV₁, and MPT were significantly greater in the experimental group than in the control group. CONCLUSION The results of this randomized controlled study support the use of ISE for enhancing pulmonary function and breath control for speech production in children with CP.
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Affiliation(s)
- Ja Young Choi
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-wook Rha
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Sook Park
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
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32
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Drug-induced sleep endoscopy in children with Prader-Willi syndrome. Sleep Breath 2016; 20:1029-34. [DOI: 10.1007/s11325-016-1338-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/02/2016] [Accepted: 03/28/2016] [Indexed: 11/27/2022]
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McCabe SM, Blackmore AM, Abbiss CR, Langdon K, Elliott C. Sleep concerns in children and young people with cerebral palsy in their home setting. J Paediatr Child Health 2015; 51:1188-94. [PMID: 26045018 DOI: 10.1111/jpc.12933] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
Abstract
AIMS The aims were to identify in-home concerns about sleep in children and young people with cerebral palsy (CP) across age and Gross Motor Function Classification Scale (GMFCS) levels. METHODS This was a retrospective review of clinical notes of 154 children and young people with CP, aged 1-18 years (M = 7.8; standard deviation = 5.4) who received a home-based sleep service. Reported concerns were synthesised, for analysis according to age groups (1-5, 6-13, 14-18) and GMFCS levels. RESULTS Sixteen factors of concern were derived from the home-based assessment reports. Most children and young people had multiple factors of concern. These varied across age groups and GMFCS levels. Body position was of concern across all age groups, for over 90% at GMFCS levels IV and V, and for 10% at GMFCS level I. Settling routines were of concern for more than 90% at GMFCS levels I and II, but for less than 50% at GMFCS levels IV and V. Settling routines were of concern to over 65% of those under 6 years but less than 25% of those over 14 years. Conversely, pain and pressure care concerned less than 10% of children under 6, and more than 35% of those over 14 years. CONCLUSIONS Concerns about sleep vary across ages and GMFCS levels of children and young people with CP. Concerns relate to impairment of body structure and function, activity, environment, and personal supports. Multi-disciplinary, home-based assessment and interventions are recommended to address these concerns.
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Affiliation(s)
- Susan M McCabe
- School of Exercise and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Ability Centre, Perth, Western Australia, Australia
| | | | - Chris R Abbiss
- School of Exercise and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Catherine Elliott
- Faculty of Health Sciences, Curtin University of Technology, Perth, Western Australia, Australia.,Child and Adolescent Health Services, Perth, Western Australia, Australia
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2015; 47:69-94. [PMID: 26541535 DOI: 10.1183/13993003.00385-2015] [Citation(s) in RCA: 460] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).
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Affiliation(s)
- Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Pediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Devinsky O, Asato M, Camfield P, Geller E, Kanner AM, Keller S, Kerr M, Kossoff EH, Lau H, Kothare S, Singh BK, Wirrell E. Delivery of epilepsy care to adults with intellectual and developmental disabilities. Neurology 2015; 85:1512-21. [PMID: 26423430 PMCID: PMC4631073 DOI: 10.1212/wnl.0000000000002060] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/28/2015] [Indexed: 11/15/2022] Open
Abstract
Epilepsy is common in people with intellectual and developmental disabilities (IDD). In adulthood, patients with IDD and epilepsy (IDD-E) have neurologic, psychiatric, medical, and social challenges compounded by fragmented and limited care. With increasing neurologic disability, there is a higher frequency of epilepsy, especially symptomatic generalized and treatment-resistant epilepsies. The causes of IDD-E are increasingly recognized to be genetic based on chromosomal microarray analysis to identify copy number variants, gene panels (epilepsy, autism spectrum disorder, intellectual disability), and whole-exome sequencing. A specific genetic diagnosis may guide care by pointing to comorbid disorders and best therapy. Therapy to control seizures should be individualized, with drug selection based on seizure types, epilepsy syndrome, concomitant medications, and comorbid disorders. There are limited comparative antiepileptic drug data in the IDD-E population. Vagus nerve and responsive neural stimulation therapies and resective surgery should be considered. Among the many comorbid disorders that affect patients with IDD-E, psychiatric and sleep disorders are common but often unrecognized and typically not treated. Transition from holistic and coordinated pediatric to adult care is often a vulnerable period. Communication among adult health care providers is complex but essential to ensure best care when these patients are seen in outpatient, emergency room, and inpatient settings. We propose specific recommendations for minimum care standards for people with IDD-E.
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Affiliation(s)
- Orrin Devinsky
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN.
| | - Miya Asato
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Peter Camfield
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Eric Geller
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Andres M Kanner
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Seth Keller
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Michael Kerr
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Eric H Kossoff
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Heather Lau
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Sanjeev Kothare
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Baldev K Singh
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Elaine Wirrell
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
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Proesmans M, Vreys M, Huenaerts E, Haest E, Coremans S, Vermeulen F, Feys H. Respiratory morbidity in children with profound intellectual and multiple disability. Pediatr Pulmonol 2015; 50:1033-8. [PMID: 25327770 DOI: 10.1002/ppul.23114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/11/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND 'Profound intellectual and multiple disability' (PIMD) is defined as a profound cognitive disability with severe sensory and motor impairments. The aim of this study was to evaluate the respiratory morbidity in children with PIMD and investigate possible risk factors. METHODS In 10 specialized facilities for daily care of patients with PIMD, children underwent a standardized clinical assessment evaluating respiratory and motor function. Additional medical information was obtained. RESULTS One hundred and twenty seven children aged 2-21 years were tested (median age 12 years; IQR 8-16). 72% had epilepsy, 42% were gastrostomy fed. The median number of lower airway infection per years was four (IQR 1-4). While 68% of patient had no hospital admissions for respiratory disease, 12% of patients were admitted three times or more. Chronic antibiotic therapy was prescribed to nine patients (7%), and 19 patients (15%) were chronically treated with mucolytics, inhaled corticosteroids and/or bronchodilators. Chest physiotherapy was given daily to 26 patients (22%). Gastroesophageal reflux, swallowing problem and aspiration increased the risk for hospital admissions. Additionally risk factors were the severity of disability, axial hypotonia, presence of epilepsy, scoliosis, limited shoulder movement, paradoxical breathing and absence of a spontaneous cough reflex. CONCLUSION The overall respiratory morbidity in our sample of children with PIMD was lower than anticipated. While a subgroup of children are prone to recurrent severe airway problems, the majority of children did not experience severe airway infections.
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Affiliation(s)
- M Proesmans
- Department of pediatric pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Vreys
- Department of pediatric pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - E Huenaerts
- Department of pediatric pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - E Haest
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - S Coremans
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - F Vermeulen
- Department of pediatric pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - H Feys
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Abstract
There is a close relationship between sleep and childhood neurodevelopmental/neurodegenerative disorders. Understanding the sleep issues may provide greater insight into pathophysiology and treatment of these disorders.
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Atmawidjaja RW, Wong SW, Yang WW, Ong LC. Sleep disturbances in Malaysian children with cerebral palsy. Dev Med Child Neurol 2014; 56:681-5. [PMID: 24528212 DOI: 10.1111/dmcn.12399] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
Abstract
AIM The aim of the study was to compare the frequency and type of sleep disturbances in a group of Malaysian children aged 4 to 18 years with cerebral palsy (CP) with their nearest-age, able-bodied siblings and to identify factors associated with sleep disturbances. METHOD The study was a case-control study of 109 children with CP (61 males, 48 females; mean age 9 y, SD 3 y 11 mo, range 4-18 y) and their healthy siblings (56 males, 53 females; mean age 10 y, SD 3 y 9 mo, range 4-18 y). The Sleep Disturbances Scale for Children (SDSC) questionnaire was completed by the main caregiver. In children with CP, multiple regression analysis was be used to determine factors related to higher Total SDSC sleep scores. RESULTS Ninety-seven children (89%) had spastic CP, 10 (9%) had dyskinetic CP, and two (2%) had mixed CP. Based on the Gross Motor Function Classification System (GMFSC), 34 patients (31%) were at GMFSC level I or II, 10 patients (9%) at level III, and 65 patients (60%) at level IV or V. Children with CP scored significantly higher than their siblings on Total SDSC and four SDSC subscale scores - difficulty in initiating and maintaining sleep, sleep breathing disorders, sleep-wake transition disorders, and sleep hyperhidrosis. Caregiver sleep duration of less than 7 hours (p=0.02) and caregiver sleep latency of more than 30 minutes (p=0.03) were significantly associated with higher Total SDSC scores. Co-sleeping was not a significant factor. INTERPRETATION Sleep disturbances are more common in children with CP than in their siblings. Attention should be given to caregiver sleep when evaluating sleep disturbances in children with CP as this factor was shown to be associated with higher Total SDSC scores.
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Affiliation(s)
- Raymond Warouw Atmawidjaja
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Carotenuto M, Parisi P, Esposito M, Cortese S, Elia M. Sleep alterations in children with refractory epileptic encephalopathies: a polysomnographic study. Epilepsy Behav 2014; 35:50-3. [PMID: 24802904 DOI: 10.1016/j.yebeh.2014.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
Data on the relationship between sleep disturbances and refractory epileptic encephalopathies (EEs) are scarce. Our aim was to assess, by means of nocturnal polysomnography, if children with EEs present with objective alterations in sleep organization. Twenty-three children with EEs (12 males; mean age: 8.7±1.4years) and 40 healthy controls (22 males; mean age: 8.8±1.1years) underwent an overnight full polysomnography (PSG). Relative to controls, children with EEs showed a significant reduction in all PSG parameters related to sleep duration time in bed (TIB-min p<0.001), total sleep time (TST-min p<0.001), and sleep percentage (SPT-min p<0.001), as well as significantly higher REM latency (FRL-min p<0.001), rate in stage shifting (p=0.005), and number of awakenings/hour (p=0.002). Relative to controls, children with EEs also showed significant differences in respiratory parameters (AHI/h p<0.001, ODI/h p<0.001, SpO2% p<0.001, SpO2 nadir% p<0.001) and a higher rate of periodic limb movements (PLMs% p<0.001). Our findings suggest that sleep evaluation could be considered mandatory in children with refractory epileptic encephalopathy in order to improve the clinical management and the therapeutic strategies.
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Affiliation(s)
- Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - Pasquale Parisi
- Child Neurology, Pediatric Headache & Sleep Disorders Centre, Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza University", Via Di Grottarossa 1035-1039, 00189 Rome, Italy.
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - Samuele Cortese
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
| | - Maurizio Elia
- Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggiero 73, 94018 Troina (EN), Italy.
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Sleep disorders in children with cerebral palsy: neurodevelopmental and behavioral correlates. Sleep Med 2014; 15:213-8. [DOI: 10.1016/j.sleep.2013.08.793] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 11/22/2022]
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Sato H, Ikura D, Tsunoda M. Assessing head and trunk symmetry during sleep using tri-axial accelerometers. Disabil Rehabil Assist Technol 2013; 10:113-7. [PMID: 24274623 DOI: 10.3109/17483107.2013.860634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Using two types of small, lightweight tri-axial accelerometers, we obtained evidence for the effectiveness of an approach for assessing head-trunk symmetrical or asymmetrical positions during sleep. First, we assessed the accuracy of our monitoring system in five healthy young adults (age range, 22-24 years). The participants wore acceleration monitors on the sternum and forehead; then spent 5 min in six different positions. Once accuracy was confirmed, we assessed head-trunk symmetry during night-time sleep in 10 healthy children (age range, 3-13 years) and 10 young adults (age range, 21-26 years) in their home environments. All participants wore the monitors during one night's sleep in their homes. After computing head-trunk positions using the orientation data obtained by the accelerometers, head and trunk symmetry were evaluated. The head and trunk positions were correctly detected: the positional data from the trunk had 99% agreement, and the data from the head had 96% agreement. Both the young adults and children were observed to spend time with the head-trunk in asymmetric positions; however, the subjects changed position frequently so the asymmetrical postures were mobile. We concluded that the proposed monitoring system is a reliable and valid approach for assessing head-trunk symmetry during sleep at home. Implications for Rehabilitation We propose a head and trunk symmetry monitoring system using accelerometers. The proposed system could accurately identify head and trunk position. Asymmetrical positioning was seen in healthy participants but it was not immobile.
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Affiliation(s)
- Haruhiko Sato
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences , Sagamihara , Japan
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Kontorinis G, Thevasagayam MS, Bateman ND. Airway obstruction in children with cerebral palsy: need for tracheostomy? Int J Pediatr Otorhinolaryngol 2013; 77:1647-50. [PMID: 23947996 DOI: 10.1016/j.ijporl.2013.07.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/02/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the progress of the airway obstruction over time in children with cerebral palsy (CP) and the timing of any interventions. METHODS The medical notes of patients with CP younger than 16 years admitted with airway obstruction to a tertiary referral Pediatric Otolaryngology Center from 2006 to 2012 were retrospectively reviewed. The gender, age of referral, co-morbidities, type of surgical intervention and age this was performed and the time interval between sequential surgeries were documented. RESULTS Fifteen children with CP and airway obstruction were admitted, eight boys and seven girls with an average age of referral 8 years (range 3-13.3 years). Adenotonsillectomy was performed in 11/15 patients at a mean age of 9.1 years (range 4.5-14 years). Tracheostomy was performed in 8/15 children at an average age of 11.6 years (range 7.5-15 years). Seven out of 11 patients having undergone adenotonsillectomy, required tracheostomy after an average time interval of 1.9 years (range 0.5-3.5 years). Tracheostomy was performed in 80% of referred patients with CP older than 10 years, while surgical intervention was uncommon in children younger than 5 years. There was a statistically significant correlation between the age of the children and the performance of a tracheostomy (Pearson's correlation coefficient 0.68, p = 0.005). CONCLUSIONS The severity of the airway obstruction in children with CP tends to increase with age. We postulate that this increase results from worsening hypotonia of pharyngeal musculature. Children with CP and severe upper airway obstruction are likely to require tracheostomy as they grow older.
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Affiliation(s)
- Georgios Kontorinis
- Department of Otolaryngology, Sheffield Children's Hospital, Sheffield, United Kingdom.
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Sato H, Iwasaki T, Yokoyama M, Inoue T. Monitoring of body position and motion in children with severe cerebral palsy for 24 hours. Disabil Rehabil 2013; 36:1156-60. [DOI: 10.3109/09638288.2013.833308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Elsayed RM, Hasanein BM, Sayyah HE, El-Auoty MM, Tharwat N, Belal TM. Sleep assessment of children with cerebral palsy: Using validated sleep questionnaire. Ann Indian Acad Neurol 2013; 16:62-5. [PMID: 23661965 PMCID: PMC3644784 DOI: 10.4103/0972-2327.107708] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/01/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022] Open
Abstract
Background: On the basis of clinical experience, it seems that sleep disturbances are common in children with cerebral palsy (CP); however, there is a lack of research and objective data to support this observation. Aim of Work: Our aim was to assess sleep of children with cerebral palsy, using validated sleep questionnaire. Subjects and Methods: one hundred children with diagnosis of CP were investigated via sleep questionnaires, with their ages from 2-12 years. The 100 children with CP were divided into two groups, pre-school group (52 children had a mean age 2.35 ± 1.04 years) and school ages group (48 children had a mean age 10.21 ± 3.75 years). Results: We found high incidence of sleep problem in both pre-school and school age groups. We found that pre-school children have more prevalence of early insomnia (46.2%, P value 0.028) and sleep bruxism (50%, P value 0.000), while school group suffer more sleep disordered breathing (SDB) (50%, P value 0.001), more nightmares (50%, P value 0.001), more sleep talking (12.5% P value 0.049), and more excessive daytime sleepiness (EDS) (62.5%, P value 0.001). Conclusion: Results of our study indicate that CP children have high incidence of sleep problem in both pre-school and school age groups.
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Affiliation(s)
- Riad M Elsayed
- Department of Pediatrics, Pediatric Neurology Unit, Mansoura University, Egypt
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Galland BC, Elder DE, Taylor BJ. Interventions with a sleep outcome for children with cerebral palsy or a post-traumatic brain injury: A systematic review. Sleep Med Rev 2012; 16:561-73. [DOI: 10.1016/j.smrv.2012.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 01/05/2012] [Accepted: 01/30/2012] [Indexed: 11/27/2022]
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Verma SK, Maheshwari S, Sharma NK, Prabhat KC. Role of oral health professional in pediatric obstructive sleep apnea. Natl J Maxillofac Surg 2012; 1:35-40. [PMID: 22442548 PMCID: PMC3304178 DOI: 10.4103/0975-5950.69162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sleep disordered breathing (SDB) in children is common. The impact of SDB on the growth and development of child may have detrimental effects on health, neuropsychological development, quality of life, and economic potential; therefore, SDB in children should be recognized as a public health problem as in the adult population. The coexistence of obesity and obstructive sleep apnea (OSA) not only appears to yield increased morbidity rates and poorer responses to therapy, but also is altogether associated with a distinct and recognizable clinical phenotype. Therapeutic options have somewhat expanded since the initial treatment approaches were conducted, to include not only surgical extraction of hypertrophic adenoids and tonsils, but also nonsurgical alternatives such as continuous positive air pressure, anti-inflammatory agents and oral appliances (OAs). Now, American academy of sleep medicine (AAOSM) has recommended OAs for OSA, hence the therapeutic interventions that are directed at the site of airway obstruction in the maxillofacial region are within the scope of dentistry. Among the physicians treating the children, dentists are more likely to identify adenotonsillar hypertrophy. Hence, the dentist can play an important role in identifying and treating those cases with OAs, who refuse the surgery, or those with structural abnormality in which myofunctional appliances are beneficial.
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Affiliation(s)
- Sanjeev Kumar Verma
- Department of Orthodontics and Dental Anatomy, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, India
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Wayte S, McCaughey E, Holley S, Annaz D, Hill CM. Sleep problems in children with cerebral palsy and their relationship with maternal sleep and depression. Acta Paediatr 2012; 101:618-23. [PMID: 22536813 DOI: 10.1111/j.1651-2227.2012.02603.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare sleep problems in children with cerebral palsy to typically developing children. To study the relationship between sleep problems in children with cerebral palsy and maternal sleep quality and depression. METHODS Fifty-seven children with cerebral palsy aged 4-12 years were identified from a UK disability database. Maternal sleep disturbance and mood were assessed using the Pittsburgh Sleep Quality Index and the Major Depression Inventory. Child sleep problems, assessed with the Children's Sleep Habits Questionnaire, but not maternal variables, were compared to 102 typically developing children. RESULTS Forty children (70%) were recruited with a mean age of 7.8 (SD 2.4). Sleep anxiety, night wakings, parasomnias and sleep-disordered breathing sub-scales indicated significantly more difficulties than in typically developing children. 40% of mothers of children with cerebral palsy had poor sleep quality of whom 44% had depressed mood. Child and maternal sleep disturbance were significantly correlated. Maternal sleep quality predicted 50% of the variance in maternal depression. CONCLUSIONS Children with cerebral palsy have more sleep problems than typically developing peers. Their mothers also have disturbed sleep that correlates with maternal depression. Childhood sleep problems can be treated and should be identified in routine clinical practice.
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Affiliation(s)
- Sarah Wayte
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, UK
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Tietze AL, Blankenburg M, Hechler T, Michel E, Koh M, Schlüter B, Zernikow B. Sleep disturbances in children with multiple disabilities. Sleep Med Rev 2012; 16:117-27. [DOI: 10.1016/j.smrv.2011.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
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Ikeda T, Nagai T, Kato-Nishimura K, Mohri I, Taniike M. Sleep problems in physically disabled children and burden on caregivers. Brain Dev 2012; 34:223-9. [PMID: 21602006 DOI: 10.1016/j.braindev.2011.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 04/22/2011] [Accepted: 04/24/2011] [Indexed: 10/18/2022]
Abstract
AIM The present study was implemented to investigate relationships between sleep problems in physically disabled children and sleep quality and perceived burden of caregivers. METHODS Subjects comprised 100 caregivers of disabled children, including 96 mothers, 2 fathers and 2 grandmothers. Questionnaires included demographic data for children and caregivers, sleep problems of children, and sleep quality (Pittsburgh sleep quality index (PSQI)) and perceived burden on caregivers (Japanese version of the Zarit Burden Interview (J-ZBI)). The sleep problems of children were evaluated according to the following five categories: "Problems initiating and maintaining sleep"; "Problems with sleep-related breathing"; "Problems with excessive somnolence"; "Problems with circadian rhythm"; and "Problems with sleep-related movement". RESULTS The children comprised 66 boys and 34 girls (age range, 1-17 years). Of these, 65 children could not sit up and 35 could. A total of 88 children were found to have one or more categories of sleep problems. The most common sleep problem was "Problems initiating and maintaining sleep" (64.8%), followed by "Problems with sleep-related movement" (59.1%). J-ZBI was significantly higher in caregivers of children with "Problems initiating and maintaining sleep". PSQI scores were significantly higher in caregivers of children with "Problems with sleep-related breathing" and "Problems with circadian rhythm". A significant correlation was identified between perceived J-ZBI and PSQI of the caregiver. CONCLUSIONS Increased focus on the sleep problems of disabled children is needed, particularly in relation to the sleep quality and perceived burden of caregivers.
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Affiliation(s)
- Tomomi Ikeda
- Department of Nursing, Faculty of Health Science, Hyogo University, Kakogawa, Hyogo, Japan.
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