1
|
Yanney M, Rowbotham N, Ng C, Zulkifli M, Shehata A, Chidambaram A, Tsirevelou P, Fergie N, Thakkar P, Crookes E, Dean R, Prayle A. Prospective evaluation of the impact of multi-channel studies on treatment outcomes in children with sleep disordered breathing. Sleep Med X 2024; 7:100111. [PMID: 38800098 PMCID: PMC11127274 DOI: 10.1016/j.sleepx.2024.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 05/29/2024] Open
Abstract
There are significant variations in practice regarding the use of sleep studies in children with symptoms of sleep disordered breathing (SDB) prior to adenotonsillectomy. Current UK guidance recommends the selective use of sleep studies to confirm a diagnosis of obstructive sleep apnoea (OSA) when there is diagnostic uncertainty, in children with comorbidities, or to assess perioperative risk when severe OSA is suspected. We have developed a novel paediatric sleep service over the past decade based on the routine use of multi-channel sleep studies (MCSS) before adenotonsillectomy. We present the results of a prospective evaluation assessing the impact of our service on treatment outcomes. We conducted a prospective service evaluation of 49 children with SDB seen between July 2021 and August 2022. We used medical records and a sleep study database to determine treatment outcomes. Otolaryngologists completed a questionnaire before each multi-channel sleep study to help evaluate the impact of sleep study findings on surgical decision making. Questionnaire responses before MCSS showed that clinicians thought 66 % of children were 'likely', 'very likely' or 'definitely' would require surgery but only 54 % of children underwent surgery following their sleep study. We estimate that the use of MCSS was associated with a 21 % reduction in children undergoing surgery in this small sample. We conclude that our use of MCSS facilitates conservative management, allowing a significant reduction in the number of children with SDB undergoing surgery, but further validation of MCSS against polysomnography is required.
Collapse
Affiliation(s)
- Michael Yanney
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Nicola Rowbotham
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christabella Ng
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Muhammad Zulkifli
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Ahmed Shehata
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Alagappan Chidambaram
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Paraskevi Tsirevelou
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Neil Fergie
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Pathik Thakkar
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Emma Crookes
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Roy Dean
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Andrew Prayle
- Nottingham Biomedical Research Centre and School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
2
|
Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [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: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
Collapse
Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
3
|
Fitzgerald DA, MacLean J, Fauroux B. Assessment of obstructive sleep apnoea in children: What are the challenges we face? Paediatr Respir Rev 2024:S1526-0542(24)00027-7. [PMID: 38616458 DOI: 10.1016/j.prrv.2024.04.002] [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: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
There is an increasing demand for the assessment of sleep-disordered breathing in children of all ages to prevent the deleterious neurocognitive and behaviour consequences of the under-diagnosis and under-treatment of obstructive sleep apnoea [OSA]. OSA can be considered in three broad categories based on predominating contributory features: OSA type 1 [enlarged tonsils and adenoids], type II [Obesity] and type III [craniofacial abnormalities, syndromal, storage diseases and neuromuscular conditions]. The reality is that sleep questionnaires or calculations of body mass index in isolation are poorly predictive of OSA in individuals. Globally, the access to testing in tertiary referral centres is comprehensively overwhelmed by the demand and financial cost. This has prompted the need for better awareness and focussed history taking, matched with simpler tools with acceptable accuracy used in the setting of likely OSA. Consequently, we present key indications for polysomnography and present scalable, existing alternatives for assessment of OSA in the hospital or home setting, using polygraphy, oximetry or contactless sleep monitoring.
Collapse
Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia.
| | - Joanna MacLean
- Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Brigitte Fauroux
- Pediatric Non-invasive Ventilation and Sleep Unit AP-HP, Necker Enfants Malades University Hospital, 149 rue de Sèvres, 75015 Paris, France; Paris Cité University, EA 7330 VIFASOM, Paris, France
| |
Collapse
|
4
|
Yoshioka Y, Matsune S, Sekine K, Ishida M, Wakayama N, Yamaguchi S, Okubo K. Improvements in blood IGF-1 and skeletal age following adenotonsillectomy for growth delay in children with obstructive sleep apnea. Auris Nasus Larynx 2024; 51:236-241. [PMID: 37813729 DOI: 10.1016/j.anl.2023.09.002] [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: 12/30/2022] [Revised: 06/14/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE In children with obstructive sleep apnea (OSA) who underwent adenotonsillectomy (AT), we measured body height and weight using standard deviation (SD) scores, insulin-like growth factor 1 (IGF-1), and skeletal age using carpal radiography. We then compared these values before and after surgery with the aim of investigating postoperative improvements in growth hormone (GH) deficiency. METHODS Subjects comprised 35 children between 2 and 9 years of age (21 boys, 14 girls; mean age, 5.85 ± 1.75 years). Respiratory event index (REI), 3 % oxygen desaturation index (3 % ODI), height SD score, body mass index (BMI) percentile, blood IGF-1 level, and skeletal age from carpal radiographs were measured before surgery and both 3 and 12 months after surgery, and compared. RESULTS Height SD score improved significantly from preoperatively (-0.44 ± 1.13) to both 3 months postoperatively (-0.22 ± 1.14) and 12 months postoperatively (-0.13 ± 0.94). However, no significant improvement in height SD score was seen from 3 months to 12 months after AT. BMI percentile improved significantly from preoperatively (35.6 ± 26.7) to both 3 months postoperatively (44.7 ± 26.5) and 12 months postoperatively (49.1 ± 22.15), with significant improvement also seen from 3 months to 12 months after AT. SD score for IGF-1 showed significant improvement from before (-0.57 ± 1.00) to 12 months after surgery (-0.12 ± 0.89). No significant improvement in the difference between skeletal and chronological ages was seen from before to after surgery, but the number of patients for whom skeletal age normalized from before to after surgery increased significantly (74.3 % vs. 94.3 %), and the number with advanced or delayed skeletal age decreased significantly (25.7 % vs. 5.7 %) CONCLUSION: Early improvements can be obtained with surgical treatment in children with OSA who have short height and poor weight gain due to GH deficiency.
Collapse
Affiliation(s)
- Yuma Yoshioka
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan.
| | - Shoji Matsune
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Kuwon Sekine
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Mariko Ishida
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Nozomu Wakayama
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Satoshi Yamaguchi
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
5
|
Brennan MP, Webber AM, Patel CV, Chin WA, Butz SF, Rajan N. Care of the Pediatric Patient for Ambulatory Tonsillectomy With or Without Adenoidectomy: The Society for Ambulatory Anesthesia Position Statement. Anesth Analg 2024:00000539-990000000-00799. [PMID: 38517763 DOI: 10.1213/ane.0000000000006645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The landscape of ambulatory surgery is changing, and tonsillectomy with or without adenoidectomy is one of the most common pediatric surgical procedures performed nationally. The number of children undergoing tonsillectomy on an ambulatory basis continues to increase. The 2 most common indications for tonsillectomy are recurrent throat infections and obstructive sleep-disordered breathing. The most frequent early complications after tonsillectomy are hemorrhage and ventilatory compromise. In areas lacking a dedicated children's hospital, these cases are managed by a nonpediatric specialized anesthesiologist and general otolaryngology surgeon. In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities. This statement identifies children that are more likely to experience complications and to require additional dedicated provider time that is not conducive to the rapid pace and staffing ratios of many freestanding ambulatory centers with mixed adult and pediatric practices. The aim is to provide health care professionals with practical criteria and suggestions based on the best available evidence. When high-quality evidence is unavailable, we relied on group consensus from pediatric ambulatory specialists in the SAMBA Pediatric Committee. Consensus recommendations were presented to the Pediatric Committee of SAMBA.
Collapse
Affiliation(s)
- Marjorie P Brennan
- From the Department of Anesthesiology, Pain and Perioperative Medicine, The George Washington University School of Medicine, Children's National Hospital, Washington, DC
| | - Audra M Webber
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Chhaya V Patel
- Department of Anesthesiology and Pediatrics, Emory School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wanda A Chin
- Department of Anesthesiology and Perioperative Medicine, New York University Grossman School of Medicine, NYU Lagone Health, New York, New York
| | - Steven F Butz
- Department of Anesthesiology, Medical College of Wisconsin, Children's Wisconsin Surgicenter
| | - Niraja Rajan
- Department of Anesthesiology, Penn State Milton S Hershey Medical Center, Hershey Outpatient Surgery Center, Hershey, Pennsylvania
| |
Collapse
|
6
|
Selby A, Buchan E, Davies M, Hill CM, Kingshott RN, Langley RJ, McGovern J, Presslie C, Senior E, Shinde SS, Yuen HM, Samuels M, Evans HJ. Role of overnight oximetry in assessing the severity of obstructive sleep apnoea in typically developing children: a multicentre study. Arch Dis Child 2024; 109:308-313. [PMID: 38253431 DOI: 10.1136/archdischild-2023-326191] [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: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Cardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is, however, cheaper and more accessible. This study evaluated the ability of NPO indices to predict OSA in typically developing (TD) children. METHODS Indices from simultaneous NPO and CRP recordings were compared in TD children (aged 1-16 years) referred to evaluate OSA in three tertiary centres. OSA was defined as an obstructive apnoea-hypopnoea index (OAHI) ≥1 event/hour. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices including ODI3 (3% Oxygen Desaturation Index, ODI4 (4% Oxygen Desaturation Index), delta 12 s index and minimum oxygen saturation. Two-by-two tables were generated to determine the sensitivities and specificities of whole number cut-off values for predicting OAHIs ≥1, 5 and 10 events/hour. RESULTS Recordings from 322 TD children, 197 male (61.2%), median age 4.9 years (range 1.1-15.6), were reviewed. OAHI was ≥1/hour in 144 (44.7%), ≥5/hour in 61 (18.9%) and ≥10/hour in 28 (8.7%) cases. ODI3 and ODI4 had the best diagnostic accuracy. ODI3 ≥7/hour and ODI4 ≥4/hour predicted OSA in TD children with sensitivities/specificities of 57.6%/85.4% and 46.2%/91.6%, respectively. ODI3 ≥8/hour was the best predictor of OAHI ≥5/hour (sensitivity 82.0%, specificity 84.3%). CONCLUSION Raised ODI3 and ODI4 predict OSA in TD children with high specificity but variable sensitivity. NPO may be an alternative to diagnose moderate-severe OSA if access to CRP is limited. Low sensitivities to detect mild OSA mean that confirmatory CRP is needed if NPO is normal.
Collapse
Affiliation(s)
- Anna Selby
- Faculty of Medicine, University of Southampton, Southampton, UK
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elise Buchan
- Respiratory and Sleep Physiology, Royal Hospital for Children, Glasgow, UK
| | - Matthew Davies
- Respiratory Sleep Unit, Great Ormond Street Hospital for Children, London, UK
| | - Catherine M Hill
- Faculty of Medicine, University of Southampton, Southampton, UK
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ruth N Kingshott
- Department of Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ross J Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Julia McGovern
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Callum Presslie
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Emily Senior
- Paediatric Sleep and Respiratory Medicine Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Ho Ming Yuen
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin Samuels
- Paediatric Respiratory and Sleep Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Hazel J Evans
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
7
|
Wilson A, Hartnett C, Kilner D, Davies K, Slee N, Chawla J, Iyer K, Kevat A. Real-world utility of overnight oximetry for the screening of obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2024; 178:111892. [PMID: 38387157 DOI: 10.1016/j.ijporl.2024.111892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common problem in children and can result in developmental and cognitive complications if untreated. The gold-standard tool for diagnosis is polysomnography (PSG); however, it is an expensive and time-consuming test to undertake. Overnight oximetry has been suggested as a faster and cheaper initial test in comparison to PSG as it can be performed at home using limited, reusable equipment. AIM This retrospective case control study aims to evaluate the effectiveness of a home oximetry service (implemented in response to extended waiting times for routine PSG) in reducing the time between patient referral and treatment. METHODS Patients undergoing diagnostic sleep evaluation for suspected OSA who utilized the Queensland Children's Hospital screening home oximetry service in the first year since its inception in 2021 (n = 163) were compared to a historical group of patients who underwent PSG in 2018 (n = 311). Parameters compared between the two groups included time from sleep physician review to sleep test, ENT review, and definitive treatment in the form of adenotonsillectomy surgery (or CPAP initiation for those who had already undergone surgery). RESULTS The time from sleep physician review and request of the sleep-related study to ENT surgical treatment was significantly reduced (187 days for the HITH oximetry group vs 359 days for the comparable PSG group; p-value <0.05), and time from sleep study request to the report of results was significantly lower for patients in the oximetry group compared to those in the PSG group (11 days vs 105 days; p-value <0.05). CONCLUSION These results suggest that for children referred to a tertiary sleep center for possible obstructive sleep disordered breathing, a home oximetry service can be effective in assisting sleep evaluation and reducing the time to OSA treatment.
Collapse
Affiliation(s)
- Alice Wilson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Chloe Hartnett
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - David Kilner
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - Kate Davies
- Department of General Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - Nicola Slee
- Department of Otolaryngology Head and Neck Surgery, Queensland Children's Hospital, Brisbane, Australia.
| | - Jasneek Chawla
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| | - Kartik Iyer
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Ajay Kevat
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.
| |
Collapse
|
8
|
Katherine Sylvia R, Gideon David P, Gillian Michelle N, Haytham K. The impact of intranasal corticosteroids in a prospective cohort of children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2024; 178:111899. [PMID: 38402717 DOI: 10.1016/j.ijporl.2024.111899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Sleep disordered breathing (SDB) is common in children and the most common reason for adenotonsillectomy. This large observational cohort study from a specialist outpatient clinic describes the impact of intranasal steroids (INS) on symptom improvement and the need for surgery. METHOD Observational cohort study of 568 children assessing the impact of INS using the OSA-5 questionnaire with clinical and surgical outcome measures. RESULTS The mean OSA-5 score at first visit was 7.78. Symptoms were persistent for a median 9 months (range 2-72). 51% underwent a trial of INS with 56% reporting symptomatic improvement. The mean score decreased from 8.2 to 5.5 (p < 0.0001) in those prescribed INS. They had a significantly higher symptom load (p < 0.01), turbinate size (p < 0.005) and history of atopy (p < 0.01) than the non-trial group. The rate of surgery in the non-trial group was 56% compared with 38% in those who had INS (p < 0.001). With increasing symptom burden, the reported improvement with INS and comparative reduction in surgery increased. Baseline OSA-5 scores were predictive of rates of surgery. Atopic status or age did not influence response to INS. CONCLUSION The mean score at first visit and the median duration of symptoms indicated significant persistent symptoms in this cohort. The use of INS improved symptoms of SDB in 56%. The need for surgery in the group that received INS was 38% compared with 56% in those not trialling INS, despite the non-trial group having significantly less symptoms and signs. Symptomatic improvement was not influenced by age or atopic status.
Collapse
Affiliation(s)
- Rowe Katherine Sylvia
- Department of General Medicine, Royal Children's Hospital, Flemington Rd Parkville, 3052, Australia.
| | - Pinczower Gideon David
- Department of General Medicine, Royal Children's Hospital, Flemington Rd Parkville, 3052, Australia.
| | - Nixon Gillian Michelle
- Paediatric Sleep Physician, Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Kubba Haytham
- Otolaryngologist, Department of Otolaryngology, Royal Children's Hospital, Flemington Rd Parkville, 3052, Australia; Royal Hospital for Children, 1345 Govan Road Glasgow, G51 4TF, UK, Scotland, UK.
| |
Collapse
|
9
|
Springford LR, Griffiths M, Bajaj Y. Management of paediatric sleep-disordered breathing. Br J Hosp Med (Lond) 2024; 85:1-6. [PMID: 38416524 DOI: 10.12968/hmed.2023.0275] [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] [Indexed: 02/29/2024]
Abstract
Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.
Collapse
Affiliation(s)
- Laurie R Springford
- Department of Ear, Nose, Throat and Head and Neck Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Yogesh Bajaj
- Department of Ear, Nose, Throat and Head and Neck Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
10
|
Radwan ES, Maher A, Montasser MA. Effect of functional appliances on sleep-disordered breathing in Class II division 1 malocclusion children: Randomized controlled trial. Orthod Craniofac Res 2024; 27:126-138. [PMID: 37522361 DOI: 10.1111/ocr.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/27/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES A randomized controlled trial was undertaken to investigate the orthopaedic effect of functional appliances on the pharyngeal airway space and nocturnal breathing of children with skeletal class II due to mandibular retrusion. MATERIALS AND METHODS Forty patients were randomized into a 1:1 ratio study (Twin block) group and a control (fixed appliance) group. Each group included equal numbers of boys and girls. Diagnosis with sleep-disordered breathing was not an inclusion criterion. The duration of the trial was 12 months (T0 - T12). Eligibility criteria included skeletal Class II division 1 malocclusion with mandibular retrognathism, SNA ≥82, SNB ≤78, ANB ≥4, overjet ≥6 mm, and patients in circumpubertal stage CVM2 and CVM3. The main outcomes were pharyngeal airway volume, oxygen desaturation index (ODI), and maximum expiratory pressure (MEP), while the secondary outcomes were skeletal and dental changes of the maxilla and mandible. Randomization was accomplished with random blocks of 20 patients with allocation concealed in sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for data analysis of radiographic measurements and data extracted from the pulse oximeter. RESULTS The mean age of the patients was 10 ± 1.5 and 10 ± 1.2 at (T0) for the Twin Block and the control groups, respectively. The changes in the oropharyngeal (2.66 cc and 0.056; P = .03) and nasopharyngeal (1.3 cc and 0.84; P = .053) airway volumes for the Twin block and control groups, respectively, were significantly different for the oropharynx. There was a significant decrease in ODI by [median -3.55 (-5.05 to 0.50); P ≤ .001] and a significant increase [median 45 (0.0-110); P ≤ .001] in MEP for the Twin block group. A significant inverse correlation (r = -.589; P = .006) could be found between the total volume of the oropharynx and ODI. No serious harm was observed. CONCLUSIONS The Twin block group showed significant change in oropharyngeal airway volume and improvement of nocturnal breathing. REGISTRATION This trial was registered at https://www. CLINICALTRIALS gov, registration number NCT04255511.
Collapse
Affiliation(s)
- E S Radwan
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - A Maher
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - M A Montasser
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| |
Collapse
|
11
|
Barroso-García V, Fernández-Poyatos M, Sahelices B, Álvarez D, Gozal D, Hornero R, Gutiérrez-Tobal GC. Prediction of the Sleep Apnea Severity Using 2D-Convolutional Neural Networks and Respiratory Effort Signals. Diagnostics (Basel) 2023; 13:3187. [PMID: 37892008 PMCID: PMC10605440 DOI: 10.3390/diagnostics13203187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
The high prevalence of sleep apnea and the limitations of polysomnography have prompted the investigation of strategies aimed at automated diagnosis using a restricted number of physiological measures. This study aimed to demonstrate that thoracic (THO) and abdominal (ABD) movement signals are useful for accurately estimating the severity of sleep apnea, even if central respiratory events are present. Thus, we developed 2D-convolutional neural networks (CNNs) jointly using THO and ABD to automatically estimate sleep apnea severity and evaluate the central event contribution. Our proposal achieved an intraclass correlation coefficient (ICC) = 0.75 and a root mean square error (RMSE) = 10.33 events/h when estimating the apnea-hypopnea index, and ICC = 0.83 and RMSE = 0.95 events/h when estimating the central apnea index. The CNN obtained accuracies of 94.98%, 79.82%, and 81.60% for 5, 15, and 30 events/h when evaluating the complete apnea hypopnea index. The model improved when the nature of the events was central: 98.72% and 99.74% accuracy for 5 and 15 events/h. Hence, the information extracted from these signals using CNNs could be a powerful tool to diagnose sleep apnea, especially in subjects with a high density of central apnea events.
Collapse
Affiliation(s)
- Verónica Barroso-García
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (M.F.-P.); (D.Á.); (R.H.); (G.C.G.-T.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - Marta Fernández-Poyatos
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (M.F.-P.); (D.Á.); (R.H.); (G.C.G.-T.)
| | - Benjamín Sahelices
- Electronic Devices and Materials Characterization Group, Department of Computer Science, University of Valladolid, 47011 Valladolid, Spain;
| | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (M.F.-P.); (D.Á.); (R.H.); (G.C.G.-T.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - David Gozal
- Office of The Dean, Joan C. Edwards School of Medicine, Marshall University, 1600 Medical Center Drive, Huntington, WV 25701, USA;
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (M.F.-P.); (D.Á.); (R.H.); (G.C.G.-T.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - Gonzalo C. Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (M.F.-P.); (D.Á.); (R.H.); (G.C.G.-T.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| |
Collapse
|
12
|
Ramamurthy MB, Jayaprakash S. Introduction to Pediatric Sleep Medicine. Indian J Pediatr 2023; 90:927-933. [PMID: 37378884 DOI: 10.1007/s12098-023-04697-4] [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: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Sleep is a key component of life to maintain our health, performance, safety and quality of life. In fact, sleep has been implicated in the optimal functioning of all organ systems - brain, heart, lung, metabolism, immune function, and hormonal balance too. One of the most common reasons for poor-quality sleep in children is a group of conditions termed sleep disordered breathing (SDB). Obstructive sleep apnea (OSA) is the most severe form of SDB. A good history and clinical examination is likely to reveal features of SDB including snoring, restless sleep, morning sleepiness, irritability or exhibit signs of hyperactivity. Examination may also reveal evidence of underlying pathology e.g., Craniofacial abnormalities, obesity and neuromuscular disorders that creates higher risk of developing SDB. Further investigation using polysomnography (PSG) is considered a gold-standard assessment of SDB and allows for scoring using Obstructive Apnoea-Hypopnea scale. Adenotonsillectomy is used as the first-line management in patients who otherwise have normal anatomy. Parents often approach their pediatricians with concerns regarding their child's sleeping habits and given the significant role sleep has on child development, it is essential that doctors are equipped to provide good care and advice for this population. This article aims to summarise presentation of SDB and common risk factors, investigations and management options to aid clinicians in managing SDB.
Collapse
Affiliation(s)
- Mahesh Babu Ramamurthy
- Department of Pediatrics, KTP-National University Children's Medical Institute, National University Hospital, Singapore, Singapore.
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | |
Collapse
|
13
|
Borrelli M, Corcione A, Cimbalo C, Annunziata A, Basilicata S, Fiorentino G, Santamaria F. Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1331. [PMID: 37628330 PMCID: PMC10452996 DOI: 10.3390/children10081331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.
Collapse
Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Chiara Cimbalo
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Anna Annunziata
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Simona Basilicata
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Giuseppe Fiorentino
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| |
Collapse
|
14
|
Omer KA, Mlauzi R, Basera W, McGuire J, Meyer H, Lawrenson J, Peer S, Singh Y, Zampoli M. Low incidence of pulmonary hypertension in children with suspected obstructive sleep apnea: A prospective observational study. Int J Pediatr Otorhinolaryngol 2023; 171:111648. [PMID: 37419069 DOI: 10.1016/j.ijporl.2023.111648] [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: 05/11/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Pulmonary hypertension (PH) secondary to obstructive sleep apnea (OSA) is an uncommon but serious perioperative risk factor in children undergoing surgery for adenotonsillar hypertrophy. Routine pre-operative echocardiography is commonly requested if severe OSA is suspected. We investigated the incidence of PH in children with suspected OSA and explored the association between PH and OSA severity. METHODS A prospective study of children aged 1-13 years with suspected OSA admitted for overnight oximetry (OO) and echocardiography at a pediatric referral hospital in Cape Town, South Africa from 2018 to 2019. OSA severity was defined by McGill Oximetry Score (MOS): MOS 1-2 (mild-moderate) and MOS 3-4 (severe). PH was defined as mean pulmonary arterial pressure (mPAP) ≥20 mmHg estimated on echocardiographic criteria. Children with congenital heart disease, underlying cardio-respiratory or genetic disorders, and severe obesity were excluded. RESULTS One hundred and seventy children median age 3.8 years (IQR 2.7-6.4) were enrolled and 103 (60%) were female. Twenty-two (14%) had a BMIz >1.0 and 99 (59%) had tonsillar enlargement grade 3/4. One hundred and twenty-two (71%) and 48 (28%) children had mild-moderate and severe OSA, respectively. Echocardiographic assessment for PH was successful in 160 (94%) children of which eight (5%) had PH with mPAP 20.8 mmHg (SD 0.9): six with mild-moderate OSA and two with severe OSA. No significant difference in mPAP and other echocardiographic indices was observed in children with mild-moderate (16.1 mmHg; SD 2.4) and severe OSA (15.7 mmHg; SD 2.1). Similarly, no clinical and OSA severity differences were observed in children with and without PH. CONCLUSION PH is uncommon in children with uncomplicated OSA and there is no association of PH with severity of OSA measured by OO. Routine echocardiographic screening for PH in children with clinical symptoms of OSA without co-morbidity is unwarranted.
Collapse
Affiliation(s)
- Khadar A Omer
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Raphael Mlauzi
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town. Burden of Disease Research Unit, South African Medical Research Council, South Africa
| | - Jessica McGuire
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Heidi Meyer
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa
| | - John Lawrenson
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town. Department of Paediatrics and Child Health, Stellenbosch University, South Africa
| | - Shazia Peer
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Yanita Singh
- Paediatric Cardiology Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Department of Paediatrics and Child Health, University of Cape Town, South Africa.
| |
Collapse
|
15
|
Solano-Pérez E, Coso C, Castillo-García M, Romero-Peralta S, Lopez-Monzoni S, Laviña E, Cano-Pumarega I, Sánchez-de-la-Torre M, García-Río F, Mediano O. Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed. Biomedicines 2023; 11:1708. [PMID: 37371803 DOI: 10.3390/biomedicines11061708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. OSA has relevant consequences in the pediatric population, mainly in the metabolic, cardiovascular (CV), and neurological spheres. However, contrary to adults, advances in diagnostic and therapeutic management have been scarce in the last few years despite the increasing scientific evidence of the deleterious consequences of pediatric OSA. The problem of underdiagnosis and the lack of response to treatment in some groups make an update to the management of OSA in children necessary. Probably, the heterogeneity of OSA is not well represented by the classical clinical presentation and severity parameters (apnea/hypopnea index (AHI)), and new strategies are required. A specific and consensus definition should be established. Additionally, the role of simplified methods in the diagnosis algorithm should be considered. Finally, the search for new biomarkers for risk stratification is needed in this population. In conclusion, new paradigms based on personalized medicine should be implemented in this population.
Collapse
Affiliation(s)
- Esther Solano-Pérez
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Carlota Coso
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - María Castillo-García
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - Sofía Romero-Peralta
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - Sonia Lopez-Monzoni
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Eduardo Laviña
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Sleep Unit, Pneumology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, 25198 Lleida, Spain
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, 25002 Lleida, Spain
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Respiratory Diseases Group, Respiratory Service, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
- Pneumology Department, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Olga Mediano
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain
| |
Collapse
|
16
|
Teplitzky TB, Zauher AJ, Isaiah A. Alternatives to Polysomnography for the Diagnosis of Pediatric Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:diagnostics13111956. [PMID: 37296808 DOI: 10.3390/diagnostics13111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed. The goal of this review is to evaluate and discuss alternatives for evaluating pediatric SDB. To date, wearable devices, single-channel recordings, and home-based PSG have not been validated as suitable replacements for PSG. However, they may play a role in risk stratification or as screening tools for pediatric OSA. Further studies are needed to determine if the combined use of these metrics could predict OSA.
Collapse
Affiliation(s)
- Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Audrey J Zauher
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| |
Collapse
|
17
|
Mesolella M, Allosso S, Coronella V, Massimilla EA, Mansi N, Motta G, Salerno G, Motta G. Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS. J Pers Med 2023; 13:jpm13050806. [PMID: 37240976 DOI: 10.3390/jpm13050806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The objective of our study was to compare our experience of intracapsular tonsillotomy performed with the help of a microdebrider usually used for adenoidectomy with results obtained from extracapsular surgery through dissection and from adenoidectomy in cases of people affected with OSAS, linked to adeno-tonsil hypertrophy, observed and treated in the last 5 years. METHODS 3127 children with adenotonsillar hyperplasia and OSAS-related clinical symptoms (aged between 3 and 12 years) underwent tonsillectomy and/or adenoidectomy. A total of 1069 patients (Group A) underwent intracapsular tonsillotomy, while 2058 patients (Group B) underwent extracapsular tonsillectomy, from January 2014 to June 2018. The parameters considered in order to evaluate the effectiveness of the two different surgery techniques taken into consideration were as follows: the presence of possible postoperative complications, represented mainly by pain and perioperative bleeding; the level of postoperative respiratory obstruction compared with the original obstruction through night pulse oximetry, performed 6 months before and after the surgery; tonsillar hypertrophy relapse in Group A and/or the presence of residues in Group B with clinical evaluation performed 1 month, 6 months, and 1 year after the surgery; and postoperative life quality, evaluated through submitting to parents the same survey proposed before the surgery 1 month, 6 months, and 1 year after the surgery. RESULTS Regardless of the technique used (extracapsular tonsillectomy or intracapsular tonsillotomy), there was a clear improvement in both the obstructive respiratory symptomatology and quality of life in both patient groups, as highlighted by the pulse oximetry and the OSA-18 survey submitted later. CONCLUSIONS Intracapsular tonsillotomy surgery has improved in terms of a reduction in postoperative bleeding cases and pain reduction, with an earlier return to patients' usual lifestyle. Lastly, using a microdebrider with the intracapsular technique seems to be particularly effective in removing most of the tonsillar lymphatic tissue, leaving only a thin border of pericapsular lymphoid tissue and preventing lymphoid tissue regrowth during one year of follow-up.
Collapse
Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | - Valentina Coronella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | | | - Nicola Mansi
- Otorhinolaryngology Unit, AORN Santobono-Pausilipon, 80112 Naples, Italy
| | - Giovanni Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80138 Napoli, Italy
| | - Grazia Salerno
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80138 Napoli, Italy
| |
Collapse
|
18
|
Ishman SL, Maturo S, Schwartz S, McKenna M, Baldassari CM, Bergeron M, Chernobilsky B, Ehsan Z, Gagnon L, Liu YCC, Smith DF, Stanley J, Zalzal H, Dhepyasuwan N. Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy. Otolaryngol Head Neck Surg 2023; 168:115-130. [PMID: 36757810 PMCID: PMC10105630 DOI: 10.1002/ohn.159] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/03/2022] [Accepted: 08/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. METHODS An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. RESULTS After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug-induced sleep endoscopy, surgical management, and postoperative care. CONCLUSION The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.
Collapse
Affiliation(s)
- Stacey L. Ishman
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephen Maturo
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Seth Schwartz
- Virginia Mason Medical Center, Seattle, Washington, USA
| | - Margo McKenna
- University of Rochester Medical Center/Golisano Children’s Hospital, Rochester, New York, USA
| | - Cristina M. Baldassari
- Eastern Virginia Medical School/Children’s Hospital of the King’s Daughter, Norfolk, Virginia, USA
| | - Mathieu Bergeron
- Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | | | - Zarmina Ehsan
- University of Missouri—Kansas City, Kansas City, Missouri, USA
| | - Lisa Gagnon
- Yale University/Connecticut Pediatric Otolaryngology, New Haven, Connecticut, USA
| | - Yi-Chun Carol Liu
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - David F. Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey Stanley
- University of Michigan Health/Michigan Medicine, Ann Arbor, Michigan, USA
| | - Habib Zalzal
- Children’s National Health System, Washington, District of Columbia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
19
|
Polytarchou A, Ohler A, Moudaki A, Koltsida G, Kanaka-Gantenbein C, Kheirandish-Gozal L, Gozal D, Kaditis AG. Nocturnal oximetry parameters as predictors of sleep apnea severity in resource-limited settings. J Sleep Res 2023; 32:e13638. [PMID: 35624085 DOI: 10.1111/jsr.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/03/2023]
Abstract
Nocturnal oximetry is an alternative modality for evaluating obstructive sleep apnea syndrome (OSAS) severity when polysomnography is not available. The Oxygen Desaturation (≥3%) Index (ODI3) and McGill Oximetry Score (MOS) are used as predictors of moderate-to-severe OSAS (apnea-hypopnea index-AHI >5 episodes/h), an indication for adenotonsillectomy. We hypothesised that ODI3 is a better predictive parameter for AHI >5 episodes/h than the MOS. All polysomnograms performed in otherwise healthy, snoring children with tonsillar hypertrophy in a tertiary hospital (November 2014 to May 2019) were analysed. The ODI3 and MOS were derived from the oximetry channel of each polysomnogram. Logistic regression was applied to assess associations of ODI3 or MOS (predictors) with an AHI >5 episodes/h (primary outcome). Receiver operating characteristic (ROC) curves and areas under ROC curves were used to compare the ODI3 and MOS as predictors of moderate-to-severe OSAS. The optimal cut-off value for each oximetry parameter was determined using Youden's index. Polysomnograms of 112 children (median [interquartile range] age 6.1 [3.9-9.1] years; 35.7% overweight) were analysed. Moderate-to-severe OSAS prevalence was 49.1%. The ODI3 and MOS were significant predictors of moderate-to-severe OSAS after adjustment for overweight, sex, and age (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.19-1.51); and OR 4.10, 95% CI 2.06-8.15, respectively; p < 0.001 for both). Area under the ROC curve was higher for the ODI3 than for MOS (0.903 [95% CI 0.842-0.964] versus 0.745 [95% CI 0.668-0.821]; p < 0.001). Optimal cut-off values for the ODI3 and MOS were ≥4.3 episodes/h and ≥2, respectively. The ODI3 emerges as preferable or at least a complementary oximetry parameter to MOS for detecting moderate-to-severe OSAS in snoring children when polysomnography is not available.
Collapse
Affiliation(s)
- Anastasia Polytarchou
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | - Adrienne Ohler
- Child Health Research Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aggeliki Moudaki
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | - Georgia Koltsida
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | - Leila Kheirandish-Gozal
- Child Health Research Institute, University of Missouri School of Medicine, Columbia, Missouri, USA.,Division of Pediatric Pulmonology and Pediatric Sleep Center, Department of Child Health, University of Missouri School of Medicine and MUHC Children's Hospital, Columbia, Missouri, USA
| | - David Gozal
- Child Health Research Institute, University of Missouri School of Medicine, Columbia, Missouri, USA.,Division of Pediatric Pulmonology and Pediatric Sleep Center, Department of Child Health, University of Missouri School of Medicine and MUHC Children's Hospital, Columbia, Missouri, USA
| | - Athanasios G Kaditis
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece.,Child Health Research Institute, University of Missouri School of Medicine, Columbia, Missouri, USA.,Division of Pediatric Pulmonology and Pediatric Sleep Center, Department of Child Health, University of Missouri School of Medicine and MUHC Children's Hospital, Columbia, Missouri, USA
| |
Collapse
|
20
|
Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020244. [PMID: 36832373 PMCID: PMC9954808 DOI: 10.3390/children10020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4-10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children's Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4-11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.
Collapse
|
21
|
Demonstration of Accuracy and Feasibility of Remotely Delivered Oximetry: A Blinded, Controlled, Real-World Study of Regional/Rural Children with Obstructive Sleep Apnoea. Healthcare (Basel) 2023; 11:healthcare11020278. [PMID: 36673646 PMCID: PMC9859066 DOI: 10.3390/healthcare11020278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
Objectives: Evaluate diagnostic accuracy and feasibility of a mail-out home oximetry kit. Design: Patients were referred for both the tertiary/quaternary-centre hospital-delivered oximetry (HDO) and for the mail-out remotely-delivered oximetry (RDO). Quantitative and qualitative data were collected. The COVID-19 pandemic began during this study; therefore, necessary methodological adjustments were implemented. Setting: Patients were first evaluated in Swan Hill, Victoria. RDO kits were sent to home addresses. For the HDO, patients travelled to the Melbourne city area, received the kit, stayed overnight, and returned the kit the following morning. Participants: All consecutive paediatric patients (aged 2−18), diagnosed by a specialist in Swan Hill with obstructive sleep apnoea (OSA) on history/examination, and booked for tonsillectomy +/− adenoidectomy, were recruited. Main outcome measures: Diagnostic accuracy (i.e., comparison of RDO to HDO results) and test delivery time (i.e., days from consent signature to oximetry delivery) were recorded. Patient travel distances for HDO collection were calculated using home/delivery address postcodes and Google® Maps data. Qualitative data were collected with two digital follow-up surveys. Results: All 32 patients that had both the HDO and RDO had identical oximetry results. The HDO mean delivery time was 87.7 days, while the RDO mean delivery time was 23.6 days (p value: <0.001). Qualitatively, 3/28 preferred the HDO, while 25/28 preferred the RDO (n = 28). Conclusions: The remote option is as accurate as the hospital option, strongly preferred by patients, more rapidly completed, and also an ideal investigation delivery method during certain emergencies, such as the COVID-19 pandemic.
Collapse
|
22
|
Evaluation of Genetic Diversity in Dog Breeds Using Pedigree and Molecular Analysis: A Review. DIVERSITY 2022. [DOI: 10.3390/d14121054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Domestic dogs are important for many economic and social reasons, and they have become a well-known model species for human disease. According to research, dog breeds exhibit significant levels of inbreeding and genetic diversity loss, decreasing the population’s ability to adapt in certain conditions, and indicating the need of conservation strategies. Before the development of molecular markers, pedigree information was used for genetic diversity management. In recent years, genomic tools are frequently applied for accurate estimation of genetic diversity and improved genetic conservation due to incomplete pedigrees and pedigree errors. The most frequently used molecular markers include PCR-based microsatellite markers (STRs) and DNA sequencing-based single-nucleotide polymorphism markers (SNP). The aim of this review was to highlight genetic diversity studies on dog breeds conducted using pedigree and molecular markers, as well as the importance of genetic diversity conservation in increasing the adaptability and survival of dog breed populations.
Collapse
|
23
|
Ezeugwu VE, Adamko D, van Eeden C, Dubeau A, Turvey SE, Moraes TJ, Simons E, Subbarao P, Wishart DS, Mandhane PJ. Development of a predictive algorithm to identify pre-school children at risk for behavior changes associated with sleep-related breathing disorders. Sleep Med 2022; 100:472-478. [PMID: 36252416 DOI: 10.1016/j.sleep.2022.09.015] [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: 06/24/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES Children with late-onset (2-5 years) or persistent (3 months-5 years) sleep-related breathing disorder (SRBD) have an increased risk of behavior problems compared to children with no or early-onset SRBD. We sought to determine whether a combination of urine metabolites and sleep questionnaires could identify children at risk for SRBD-associated behavior problems. METHODS Urine and data were analyzed from the Edmonton site of the CHILD birth cohort study. We measured urine metabolites (random, mid-stream) at age three-years among a sub-cohort of participants (n = 165). Random Forest with a Boruta wrapper was used to identify important metabolites (creatinine-corrected, z-scores) for late/persistent SRBD versus no/early SRBD (reference). An algorithm was subsequently generated to predict late/persistent SRBD in children with a history of snoring using a metabolite composite score (z-scores < or ≥ 0) plus the SDBeasy score defined as [age (yrs.) of most recent positive SRBD]2 - [age (yrs.) first reported ever snoring]2. RESULTS Of the 165 children with SRBD data, 40 participants had late/persistent SRBD. Seven urinary metabolites in addition to the SDBeasy score were confirmed as important for late/persistent SRBD (AUC = 0.87). Among children with an ever-snoring history and a metabolite composite score ≥0, those with SDBeasy score ≥3 were over 13-fold more likely to have late/persistent SRBD (OR 13.7; 95%CI: 3.0, 62.1; p = 0.001). This algorithm has a Sensitivity of 69.6%, Specificity of 85.7% and a positive likelihood ratio (+LR) of 4.9. CONCLUSIONS We developed a predictive algorithm using a combination of questionnaires and urine metabolites at age three-years to identify children with late/persistent SRBD by five-years of age.
Collapse
Affiliation(s)
- Victor E Ezeugwu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Darryl Adamko
- Department of Pediatrics, University of Saskatchewan, Saskatoon SK, Canada
| | | | - Aimee Dubeau
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elinor Simons
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David S Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | | |
Collapse
|
24
|
House M, Klein S, Parham D, Hysinger EB, Brady JM. Frequent hypoxemia found in infants with bronchopulmonary dysplasia after weaning home oxygen. Pediatr Pulmonol 2022; 57:2638-2645. [PMID: 35832023 DOI: 10.1002/ppul.26076] [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: 05/17/2021] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Parental reports and brief clinical examinations are the primary information used to assist clinicians in weaning home supplemental oxygen in infants with bronchopulmonary dysplasia (BPD). Recorded nocturnal oximetry provides an objective assessment of hypoxemia; however, it is unknown if it identifies clinically undetected hypoxemia in the home setting. Our objective was to determine if nocturnal oximetry can identify unreported hypoxemia in infants with BPD who appear ready to wean from supplemental oxygen. STUDY DESIGN We conducted a retrospective chart review of infants born <32 weeks gestation with BPD who were discharged to home receiving supplemental oxygen and completed recorded nocturnal oximetry in room air during an 18-month period. Abnormal oximetry was defined as >5 min with SpO2 < 90% and/or an oxyhemoglobin desaturation index (ODI4) >5. Comparative analysis of patients with normal and abnormal overnight oximetry was performed using Fisher Exact and Wilcoxon signed-rank test. RESULTS Thirty-five former premature infants completed nocturnal oximetry at 5.8 (3.4-8.3) months corrected age. Nocturnal oximetry was abnormal as defined in 67% of the cohort (n = 21). Five percent of patients were hypoxemic, 52% had frequent desaturation events, and 43% had both. No significant differences existed in neonatal characteristics between patients with normal and abnormal studies. CONCLUSIONS Nocturnal oximetry was abnormal in the majority of infants with BPD who were otherwise clinically ready to wean from oxygen support, suggesting that recorded home oximetry could be a feasible and useful tool to evaluate for otherwise clinically unapparent nocturnal hypoxemia in patients with BPD.
Collapse
Affiliation(s)
- Melissa House
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sarah Klein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Danielle Parham
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Erik B Hysinger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Brady
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
25
|
Key S, Chia C, Nixon G, Paddle P. Cost-minimisation analysis of polysomnography and pulse oximetry in a risk stratification protocol for paediatric adenotonsillectomy. ANZ J Surg 2022; 92:2292-2298. [PMID: 35719108 DOI: 10.1111/ans.17858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe obstructive sleep apnoea (OSA) is associated with increased risk of respiratory compromise in the post-operative period following adenotonsillectomy (AT). This study analyses the economic cost of polysomnography or overnight oximetry as part of pre-operative risk stratification in paediatric AT, supplementing previously published research demonstrating the efficacy of this protocol in predicting respiratory complications. METHODS This cost-minimisation analysis examines costs associated with pre-operative overnight oximetry and polysomnography in triaging paediatric patients older than 2 years old, with no major comorbidities except for OSA, undergoing AT for OSA (n = 1801) to either a secondary or quaternary Australian hospital. Decision analysis modelling via probability trees were utilized to estimate pre- and peri-operative costs. A third hypothetical 'no investigation' model based upon conducting all AT at a secondary hospital was performed. Costs are derived from the financial year 2020-2021, censored at discharge. RESULTS The total cost per patient of AT including pre-operative investigations of oximetry and polysomnography, and associated inpatient costs, were AUD4181.34 and 5013.99 respectively. This is more expensive compared to a hypothetical no-investigation model (AUD3958.98). CONCLUSION Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre-operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low-risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri-operative risk stratification for paediatric AT from a financial perspective.
Collapse
Affiliation(s)
- Seraphina Key
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Clemente Chia
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gillian Nixon
- Melbourne Children's Sleep Centre, Monash Health, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Paul Paddle
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Faculty Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Feasibility of split night polysomnography in children to diagnose and treat sleep related breathing disorders. Sleep Med 2022; 96:107-112. [DOI: 10.1016/j.sleep.2022.05.011] [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: 03/17/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
|
27
|
Rahman AE, Ameen S, Hossain AT, Jabeen S, Majid T, AFM AU, Tanwi TS, Banik G, Shaikh MZH, Islam MJ, Ashrafee S, Alam HMS, Saberin A, ANM EK, Ahmed S, Khan M, Ahmed A, Rahman QSU, Chisti MJ, Cunningham S, Islam MS, Dockrell DH, Nair H, El Arifeen S, Campbell H. Success and time implications of SpO 2 measurement through pulse oximetry among hospitalised children in rural Bangladesh: Variability by various device-, provider- and patient-related factors. J Glob Health 2022; 12:04036. [PMID: 35493782 PMCID: PMC9041243 DOI: 10.7189/jogh.12.04036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Hypoxaemia is one of the strongest predictors of mortality among children with pneumonia. It can be identified through pulse oximetry instantaneously, which is a non-invasive procedure but can be influenced by factors related to the specific measuring device, health provider and patient. Following WHO's global recommendation in 2014, Bangladesh decided to introduce pulse oximetry in paediatric outpatient services, ie, the Integrated Management of Childhood Illness (IMCI) services in 2019. A national committee updated the existing IMCI implementation package and decided to test it by assessing the pulse oximetry performance of different types of assessors in real-life inpatient settings. Methods We adopted an observational design and conducted a technology assessment among children admitted to a rural district hospital. Eleven nurses and seven paramedics received one-day training on pulse oximetry as assessors. Each assessor performed at least 30 pulse oximetry measurements on children with two types of handheld devices. The primary outcome of interest was obtaining a successful measurement of SpO2, defined as observing a stable (±1%) reading for at least 10 seconds. Performance time, ie, time taken to obtain a successful measurement of SpO2 was considered the secondary outcome of interest. In addition, we used Generalized Estimating Equation to assess the effect of different factors on the pulse oximetry performance. Results The assessors obtained successful measurements of SpO2 in all attempts (n = 1478) except one. The median time taken was 30 (interquartile range (IQR) = 22-42) seconds, and within 60 seconds, 92% of attempts were successful. The odds of obtaining a successful measurement within 60 seconds were 7.3 (95% confidence interval (CI) = 3.7-14.2) times higher with a Masimo device than a Lifebox device. Similarly, assessors aged >25 years were 4.8 (95% CI = 1.2, 18.6) times more likely to obtain a successful measurement within 60 seconds. The odds of obtaining a successful measurement was 2.6 (95% CI = 1.6, 4.2) times higher among children aged 12-59 months compared to 2-11 months. Conclusions Our study indicated that assessors could achieve the necessary skills to perform pulse oximetry successfully in real-life inpatient settings through a short training module, with some effect of device-, provider- and patient-related factors. The National IMCI Programme of Bangladesh can use these findings for finalising the national IMCI training modules and implementation package incorporating the recommendation of using pulse oximetry for childhood pneumonia assessment.
Collapse
Affiliation(s)
- Ahmed Ehsanur Rahman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh,Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sabrina Jabeen
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Tamanna Majid
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Azim Uddin AFM
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Tania Sultana Tanwi
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | - Md Ziaul Haque Shaikh
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Md Jahurul Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Husam Muhammad Shah Alam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh
| | | | | | | | - Anisuddin Ahmed
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Steve Cunningham
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Bangladesh
| | - David H Dockrell
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh
| | - Harish Nair
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh
| | - Shams El Arifeen
- Maternal and Child Health Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Harry Campbell
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh
| |
Collapse
|
28
|
Abstract
Pediatric obstructive sleep apnea (OSA) is a common entity that can cause both daytime and nighttime issues. Children with symptoms should be screened for OSA. If possible, polysomnography should be performed to evaluate symptomatic children. Depending on the severity, first-line options for treatment of pediatric OSA may include observation, weight loss, medication, or surgery. Even after adenotonsillectomy, about 20% of children will have persistent OSA. Sleep endoscopy and cine MRI are tools that may be used to identify sites of obstruction, which in turn can help in the selection of site-specific treatment.
Collapse
Affiliation(s)
- Pakkay Ngai
- Division of Pediatric Pulmonology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN 3rd Floor, Hackensack, NJ 07601, USA
| | - Michael Chee
- Division of Pediatric Otolaryngology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN PC-311, Hackensack, NJ 07601, USA.
| |
Collapse
|
29
|
Masaracchia M, Lee M, Dalesio N. Obesity in childhood. BJA Educ 2022; 22:168-175. [PMID: 35496648 PMCID: PMC9039480 DOI: 10.1016/j.bjae.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
|
30
|
Marpole R, Ohn M, O'Dea CA, von Ungern-Sternberg BS. Clinical utility of preoperative pulmonary function testing in pediatrics. Paediatr Anaesth 2022; 32:191-201. [PMID: 34875135 DOI: 10.1111/pan.14356] [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: 10/26/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
Perioperative respiratory adverse events pose a significant risk in pediatric anesthesia, and identifying these risks is vital. Traditionally, this is assessed using history and examination. However, the perioperative risk is multifactorial, and children with complex medical backgrounds such as chronic lung disease or obesity may benefit from additional objective preoperative pulmonary function tests. This article summarizes the utility of available pulmonary function assessment tools as preoperative tests in improving post-anesthetic outcomes. Currently, there is no evidence to support or discourage any pulmonary function assessment as a routine preoperative test for children undergoing anesthesia. In addition, there is uncertainty about which patients with the known or suspected respiratory disease require preoperative pulmonary function tests, what time period prior to surgery these are required, and whether spirometry or more sophisticated tests are indicated. Therefore, the need for any test should be based on information obtained from the history and examination, the child's age, and the complexity of the surgery.
Collapse
Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Paediatrics, School of Medical, University of Western Australia, Crawley, WA, Australia
| | - Mon Ohn
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Paediatrics, School of Medical, University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
| | - Christopher A O'Dea
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medical, University of Western Australia, Crawley, WA, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
| |
Collapse
|
31
|
Makhout S, Boudewyns A, Van Hoorenbeeck K, Verhulst S, Van Eyck A. Nocturnal pulse oximetry as a possible screening method for obstructive sleep apnea in infants with laryngomalacia. Sleep Med 2022; 90:91-95. [DOI: 10.1016/j.sleep.2022.01.010] [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: 11/25/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
|
32
|
Damian A, Gozal D. Pediatric Obstructive Sleep Apnea: What’s in a Name? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:63-78. [PMID: 36217079 DOI: 10.1007/978-3-031-06413-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea is a highly prevalent disease across the lifespan and imposes substantial morbidities, some of which may become irreversible if the condition is not diagnosed and treated in a timely fashion. Here, we focus on the clinical and epidemiological characteristics of pediatric obstructive sleep apnea, describe some of the elements that by virtue of their presence facilitate the emergence of disrupted sleep and breathing and its downstream consequences, and also discuss the potential approaches to diagnosis in at-risk children.
Collapse
Affiliation(s)
- Allan Damian
- Departments of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
| |
Collapse
|
33
|
Mlauzi R, McGuire J, Zampoli M, Takuva S, Lawrenson J, Singh Y, Peer S. Clinical correlations to distinguish severe from milder forms of obstructive sleep apnoea syndrome using overnight oximetry for prioritising adenotonsillectomy in a limited-resource setting. Int J Pediatr Otorhinolaryngol 2022; 152:110988. [PMID: 34871949 DOI: 10.1016/j.ijporl.2021.110988] [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: 02/15/2021] [Revised: 05/14/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In resource-poor settings with limited surgical services, it is essential to identify and prioritise children with severe and very severe obstructive sleep apnoea syndrome (OSAS) to expedite surgery. McGill's Oximetry Score (MOS) has been validated against polysomnography for OSAS and is affordable and easy to use. AIMS The aim of this study was to assess the correlation of tonsillar size and clinical symptoms with MOS grade 3 or 4, to identify who requires overnight oximetry and who to prioritise for adenotonsillectomy. METHODS Children with suspected OSAS were recruited from the otolaryngology clinic at the Red Cross War Memorial Children's Hospital. Demographics, symptom screening scores (SSS), patient characteristics, overnight oximetry (OO), echocardiography and MOS scores (graded 1-4) were recorded. Multivariate modified-Poisson regression models were used to examine correlations of patient characteristics 'with grade 3 or 4 MOS. RESULTS One-hundred-and-three children were analysed, 38% were female, and median (IQR) age was 3.8 (2.5-5.3) years. Increased tonsil size was associated with a 60% increased risk of grade 3 or 4 MOS, risk ratio (RR) 1.59, 95% CI 1.10-2.29 (p = 0.014). Children with witnessed apnoeic events during sleep had 1.3 times increased risk of MOS Grade 3 or 4, RR 1.31, 95% CI (p = 0.033). A significant correlation was shown with grade 3 or 4 MOS, RR 1.15, 95% CI 1.03-1.27 (p = 0.010) by combining tonsillar size with the following symptoms: apnoeic events; struggling to breathe during sleep and needing to stimulate the child to breathe. CONCLUSION Identifying children with suspected OSAS who require overnight oximetry can be performed using a simple 3-question screening tool: witnessed apnoeic events, struggling to breathe and the need to shake them awake to breathe. This is more precise with an additional clinical finding of grade 3 or 4 tonsils. These children should have surgery expedited. Any child with a MOS 3 or 4 score on OO needs to have expedited surgery.
Collapse
Affiliation(s)
- Raphael Mlauzi
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Jessica McGuire
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Department of Paediatrics and Child Health, Division of Paediatric Pulmonology, University of Cape Town, Cape Town, South Africa
| | - Simbarashe Takuva
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - John Lawrenson
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, University of Cape Town, Cape Town, South Africa
| | - Yanita Singh
- Department of Paediatrics and Child Health, Division of Paediatric Cardiology, University of Cape Town, Cape Town, South Africa
| | - Shazia Peer
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| |
Collapse
|
34
|
Álvarez D, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Moreno F, Del Campo F, Hornero R. Oximetry Indices in the Management of Sleep Apnea: From Overnight Minimum Saturation to the Novel Hypoxemia Measures. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:219-239. [PMID: 36217087 DOI: 10.1007/978-3-031-06413-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea (OSA) is a multidimensional disease often underdiagnosed due to the complexity and unavailability of its standard diagnostic method: the polysomnography. Among the alternative abbreviated tests searching for a compromise between simplicity and accurateness, oximetry is probably the most popular. The blood oxygen saturation (SpO2) signal is characterized by a near-constant profile in healthy subjects breathing normally, while marked drops (desaturations) are linked to respiratory events. Parameterization of the desaturations has led to a great number of indices of severity assessment commonly used to assist in OSA diagnosis. In this chapter, the main methodologies used to characterize the overnight oximetry profile are reviewed, from visual inspection and simple statistics to complex measures involving signal processing and pattern recognition techniques. We focus on the individual performance of each approach, but also on the complementarity among the great amount of indices existing in the state of the art, looking for the most relevant oximetric feature subset. Finally, a quick overview of SpO2-based deep learning applications for OSA management is carried out, where the raw oximetry signal is analyzed without previous parameterization. Our research allows us to conclude that all the methodologies (conventional, time, frequency, nonlinear, and hypoxemia-based) demonstrate high ability to provide relevant oximetric indices, but only a reduced set provide non-redundant complementary information leading to a significant performance increase. Finally, although oximetry is a robust tool, greater standardization and prospective validation of the measures derived from complex signal processing techniques are still needed to homogenize interpretation and increase generalizability.
Collapse
Affiliation(s)
- Daniel Álvarez
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain.
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain.
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Fernando Moreno
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Félix Del Campo
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group (GIB), University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| |
Collapse
|
35
|
Gozal D. Diagnostic approaches to respiratory abnormalities in craniofacial syndromes. Semin Fetal Neonatal Med 2021; 26:101292. [PMID: 34556443 DOI: 10.1016/j.siny.2021.101292] [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: 11/16/2022]
Abstract
Craniofacial syndromes are a complex cluster of genetic conditions characterized by embryonic perturbations in the developmental trajectory of the upper airway and related structures. The presence of reduced airway size and maladaptive neuromuscular responses, particularly during sleep, leads to significant alterations in sleep architecture and overall detrimental gas exchange abnormalities that can be life-threatening. The common need for multi-stage therapeutic interventions for these craniofacial problems requires careful titration of anatomy and function, and the latter is currently evaluated by overnight polysomnography in sleep laboratories. The cost, inconvenience, and scarcity of pediatric sleep laboratories preclude the frequent evaluations that could optimize the overall process of treatment and corresponding outcomes. Here, we critically examine reductionist approaches to polysomnography in children to establish the parallel approximation of such techniques to infant with craniofacial disorders. The need for prospective longitudinal multicenter studies with side-by-side comparisons aimed at identifying an optimal diagnostic and long-term monitoring paradigm for these potentially life-threatening conditions is emphasized.
Collapse
Affiliation(s)
- David Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA.
| |
Collapse
|
36
|
Thavagnanam S, H'ng SY, Nathan AM, Eg KP, Chinna K, Hajar Bte Turbirin S, Anne de Bruyne J. WRISTOX 2 is a reliable tool to diagnose obstructive sleep apnoea syndrome. Int J Pediatr Otorhinolaryngol 2021; 151:110930. [PMID: 34571207 DOI: 10.1016/j.ijporl.2021.110930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/10/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Overnight pulse oximetry is an alternative to polysomnography (PSG) in diagnosing obstructive sleep apnoea syndrome, but its sensitivity is reported to be low. AIMS To determine the (a) diagnostic accuracy, interobserver reliability and reliable oxygen desaturation index of 4% (ODI4) score at diagnosing obstructive sleep apnoea syndrome in children and (b) correlation between the apnoea hypopnoea index (AHI) with ODI4 and oxygen nadir between both PSG and oximetry. METHODS This cross-sectional study included children aged 1-18 years old, undergoing a fully attended overnight PSG for suspected obstructive sleep apnoea syndrome. The Nonin 3150 WristOx2 ™ [Fig. 2] was worn simultaneously during the PSG. Poor oximetry recordings were excluded. Pulse oximetry was scored using the McGill Oximetry Score (MOS) whereby a score of 2-4 was positive for OSAS. Specificity, sensitivity, positive predictive values (PPV), negative predictive values (NPV) and interobserver reliability of the WristOx2 were calculated. RESULTS One hundred and sixty-two children with a mean (SD) age of 9.3 (±3.5) years (range 2 years 6 months old - 17 years old) were included after excluding 18 children (poor oximetry data [n = 16] and incomplete PSG [n = 2]). Interobserver agreement of the WristOx2 was 0.8763 (95% CI:0.80, 0.95). WristOx2 had a sensitivity 50%, specificity 96.7%, PPV 96% and NPV 53% at diagnosing OSAS. ODI4 ≥ 2 events/hour in oximetry had a sensitivity of 97.6% and negative predictive value of 85.7% at diagnosing OSA. CONCLUSION Overnight pulse oximetry with the Nonin 3150 WristOx2 ™ is an accurate and reliable tool in diagnosing significant OSAS in children.
Collapse
Affiliation(s)
- Surendran Thavagnanam
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia; Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia; Department of Paediatrics, Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1BB, United Kingdom
| | - Shih Ying H'ng
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Anna Marie Nathan
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia; Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia; Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Faculty of Medicine and Department of Social and Preventive, Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia; School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Malaysia
| | | | - Jessie Anne de Bruyne
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia; Faculty of Medicine and Department of Social and Preventive, Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
37
|
Kajiyama T, Komori M, Hiyama M, Kobayashi T, Hyodo M. Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea. Auris Nasus Larynx 2021; 49:625-633. [PMID: 34840035 DOI: 10.1016/j.anl.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly. METHODS Our prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments. RESULTS The respective proportions of patients who improved to obstructive AHI (O-AHI) < 1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaO2 improved significantly between before and after medical treatment in both O-AHI < 1/h and O-AHI ≥ 1/h patients (respectively p < 0.0001, p = 0.0009). The lowest nadir SaO2 before medical treatment was 74% in patients in whom O-AHI was normalized after medical treatments. CONCLUSION Medical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO2 of less than 74% by medical treatment.
Collapse
Affiliation(s)
- Taihei Kajiyama
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan.
| | - Mariko Hiyama
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Taisuke Kobayashi
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| |
Collapse
|
38
|
Moin Anwer HM, Albagieh HN, Kalladka M, Chiang HK, Malik S, McLaren SW, Khan J. The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea. Saudi Dent J 2021; 33:424-433. [PMID: 34803282 PMCID: PMC8589585 DOI: 10.1016/j.sdentj.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. Material and methods A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. Results Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.
Collapse
Affiliation(s)
- Hafiz M Moin Anwer
- Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
| | - Hamad N Albagieh
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mythili Kalladka
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Harmeet K Chiang
- Virginia Commonwealth University, 521 N. 11th Street, Richmond, VA 23298, USA
| | - Shaima Malik
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Sean W McLaren
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Junad Khan
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| |
Collapse
|
39
|
Chuanprasitkul C, Veeravigrom M, Sunkonkit K, Tansrirattanawong S, Sritippayawan S. Incidence / predictors of pediatric obstructive sleep apnea with normal oximetry. Pediatr Int 2021; 63:1376-1380. [PMID: 33606330 DOI: 10.1111/ped.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The polysomnogram (PSG) is the "gold standard" for diagnosing obstructive sleep apnea (OSA). However, nocturnal oximetry is a practical screening tool for children with adenotonsillar hypertrophy (ATH). This study aimed to investigate the incidence of, and predictive factors for, OSA in children with ATH and normal / inconclusive overnight oximetry. METHODS The prospective study enrolled children aged 3-15 years with ATH and normal / inconclusive overnight oximetry. All participants underwent full-night PSG. To evaluate the predictors of OSA, we used logistic regression analysis, including sex, history of allergic rhinitis, body mass index z-score, neck circumference-height ratio, and polysomnographic parameters (obstructive apnea-hypopnea index (OAHI), nadir oxygen saturation (SpO2), peak end-tidal CO2 , and arousal index). RESULTS The participants were 189 children; 167 (88%) were diagnosed with OSA by PSG. A history of allergic rhinitis (P = 0.033), and the PSG findings for nadir SpO2 (P = 0.027) and arousal index (P = <0.001) predicted the diagnosis of OSA. We divided patients with OSA into two groups (mild versus moderate to severe OSA). Patients with OAHI ≥5/h were defined as having moderate-to-severe OSA. No clinical factors significantly predicted OAHI ≥5. Of the 189 participants, 58 children (31%) were diagnosed with severe OSA (OAHI ≥10). The only PSG factor that predicted severe OSA was the arousal index (P < 0.001). CONCLUSIONS The observed incidence of OSA in children aged 3-15 years with ATH and normal/inconclusive overnight oximetry was very high. A history of allergic rhinitis may help to triage the patients. The arousal index was a predictor of pediatric OSA.
Collapse
Affiliation(s)
| | - Montida Veeravigrom
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Section of Neurology and Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital/ The Thai Red Cross Society, Bangkok, Thailand
| | - Kanokkarn Sunkonkit
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakanya Tansrirattanawong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suchada Sritippayawan
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
40
|
Stražišar BG. Sleep Measurement in Children-Are We on the Right Track? Sleep Med Clin 2021; 16:649-660. [PMID: 34711388 DOI: 10.1016/j.jsmc.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sleep plays a critical role in the development of healthy children. Detecting sleep and sleep disorders and the effectiveness of interventions for improving sleep in children require valid sleep measures. Assessment of sleep in children, in particular infants and young children, can be a quite challenging task. Many subjective and objective methods are available to evaluate various aspects of sleep in childhood, each with their strengths and limitations. None can, however, replace the importance of thorough clinical interview with detailed history and clinical examination by a sleep specialist.
Collapse
Affiliation(s)
- Barbara Gnidovec Stražišar
- Pediatric Department, Centre for Pediatric Sleep Disorders, General Hospital Celje, Oblakova ulica 5, Celje 3000, Slovenia; College of Nursing in Celje, Celje, Slovenia; Medical Faculty, University of Maribor, Maribor, Slovenia.
| |
Collapse
|
41
|
Comparison of polysomnography, sleep apnea screening test and cardiopulmonary coupling in the diagnosis of pediatric obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 2021; 149:110867. [PMID: 34385038 DOI: 10.1016/j.ijporl.2021.110867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/08/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study aims to investigate into the correlation between clinical characteristics of pediatric obstructive sleep apnea (OSA) and the results of polysomnography (PSG), sleep apnea screening test (SAST) and cardiopulmonary coupling (CPC) respectively and compare their diagnostic values for pediatric OSA patients. METHODS We recruited 239 pediatric OSA patients aged between 2 and 12 from Jan 1, 2017 to Jun 30, 2018. All the patients received PSG, SAST and CPC simultaneously and the results of these three different tests were compared and analyzed together with their clinical features. The relationship between the size of adenoid/tonsil and the severity of OSA was also analyzed. RESULTS No statistically significant differences were noted between SAST and PSG in the oxygen desaturation index (ODI3) and lowest oxygen saturation (LsO2) respectively. No significant statistical difference was noted in the proportion of rapid eye movement sleep between CPC and PSG. The apnea-hypopnea index (AHI) from CPC was significantly lower than that from PSG. In the severe OSA group, no significant statistical difference was noted in AHI between these two tests. However, AHI from CPC was significantly lower than that from PSG in other groups. No statistically significant difference was noted in AHI and ODI3 among different groups graded by the size of adenoid or tonsil, suggesting that the size of adenoid/tonsil may not be highly related to the severity of OSA. CONCLUSION SAST is an acceptable fast screening tool in the assessments of blood oxygen desaturation and further pediatric OSA screening. CPC is capable to screen severe pediatric OSA, but its results should be interpreted with caution for pediatric patients with non-severe OSA. The size of adenoid/tonsil may not be highly related to the severity of OSA.
Collapse
|
42
|
Adenotonsillectomy for the Treatment of Obstructive Sleep Apnoea in Extreme Paediatric Obesity. The Journal of Laryngology & Otology 2021; 136:1071-1076. [PMID: 34593058 DOI: 10.1017/s0022215121002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
43
|
[Diagnostic criteria for obstructive sleep apnea syndrome in adolescent]. Rev Mal Respir 2021; 38:829-839. [PMID: 34565640 DOI: 10.1016/j.rmr.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/13/2021] [Indexed: 11/20/2022]
Abstract
The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.
Collapse
|
44
|
Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020). Pediatr Investig 2021; 5:167-187. [PMID: 34589673 PMCID: PMC8458722 DOI: 10.1002/ped4.12284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
|
45
|
Gozal D, Ismail M, Brockmann PE. Alternatives to surgery in children with mild OSA. World J Otorhinolaryngol Head Neck Surg 2021; 7:228-235. [PMID: 34430830 PMCID: PMC8356096 DOI: 10.1016/j.wjorl.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Precision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient. In this context, the treatment approach to mild obstructive sleep apnea (OSA) is fraught with substantial debate as to what is mild OSA, and as to what constitutes appropriate treatment. As such, it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA, and then examine the circumstances under which treatment is indicated, and if so, whether and when anti-inflammatory therapy (AIT), rapid maxillary expansion (RME), and/or myofunctional therapy (MFT) may be indicated.
Collapse
Affiliation(s)
- David Gozal
- Department of Child Health and Child Health Research Institute, and MU Women and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, USA
| | - Mahmoud Ismail
- Department of Neurology and Sleep Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
46
|
Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020). World J Otorhinolaryngol Head Neck Surg 2021; 7:201-220. [PMID: 34430828 PMCID: PMC8356108 DOI: 10.1016/j.wjorl.2021.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
|
47
|
Vaquerizo-Villar F, Alvarez D, Kheirandish-Gozal L, Gutierrez-Tobal GC, Barroso-Garcia V, Santamaria-Vazquez E, Campo FD, Gozal D, Hornero R. A Convolutional Neural Network Architecture to Enhance Oximetry Ability to Diagnose Pediatric Obstructive Sleep Apnea. IEEE J Biomed Health Inform 2021; 25:2906-2916. [PMID: 33406046 PMCID: PMC8460136 DOI: 10.1109/jbhi.2020.3048901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aims at assessing the usefulness of deep learning to enhance the diagnostic ability of oximetry in the context of automated detection of pediatric obstructive sleep apnea (OSA). A total of 3196 blood oxygen saturation (SpO2) signals from children were used for this purpose. A convolutional neural network (CNN) architecture was trained using 20-min SpO2 segments from the training set (859 subjects) to estimate the number of apneic events. CNN hyperparameters were tuned using Bayesian optimization in the validation set (1402 subjects). This model was applied to three test sets composed of 312, 392, and 231 subjects from three independent databases, in which the apnea-hypopnea index (AHI) estimated for each subject (AHICNN) was obtained by aggregating the output of the CNN for each 20-min SpO2 segment. AHICNN outperformed the 3% oxygen desaturation index (ODI3), a clinical approach, as well as the AHI estimated by a conventional feature-engineering approach based on multi-layer perceptron (AHIMLP). Specifically, AHICNN reached higher four-class Cohen's kappa in the three test databases than ODI3 (0.515 vs 0.417, 0.422 vs 0.372, and 0.423 vs 0.369) and AHIMLP (0.515 vs 0.377, 0.422 vs 0.381, and 0.423 vs 0.306). In addition, our proposal outperformed state-of-the-art studies, particularly for the AHI severity cutoffs of 5 e/h and 10 e/h. This suggests that the information automatically learned from the SpO2 signal by deep-learning techniques helps to enhance the diagnostic ability of oximetry in the context of pediatric OSA.
Collapse
|
48
|
Systemic corticosteroids could be used as bridge treatment in children with obstructive sleep apnea syndrome waiting for surgery. Sleep Breath 2021; 26:879-885. [PMID: 34302609 DOI: 10.1007/s11325-021-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Local and systemic inflammatory markers and pro-inflammatory cytokines are increased in children with obstructive sleep apnea syndrome (OSAS). Therefore, systemic or topical anti-inflammatory agents are used to treat this syndrome. We evaluated the treatment with systemic corticosteroids in children with severe OSAS and adenotonsillar hypertrophy before surgery. METHODS This was an unblinded open label study. Children with severe OSAS (diagnosed through polysomnography, obstructive apnea-hypopnea index [AHI] > 10 eV/h) were recruited. Exclusion criteria included age < 3 years, history of acute or chronic cardiorespiratory or neuromuscular or metabolic disease; major craniofacial abnormalities; and chromosomal syndromes and epilepsy. Computer-generated random numbers were used for simple randomization of subjects. All children were treated with intranasal beclomethasone spray, and 15 children additionally received oral betamethasone and 0.1 mg/kg per day for 7 days. Sleep clinical record (SCR) and pulsoximetry were performed before and after 7 days in all children. RESULTS Among 28 children with severe OSAS mean age was 4.5 ± 1.8 years, AHI 20.4 ± 1.8 eV/h). In children treated with intranasal and oral corticosteroids, mean (95.3 ± 1.1 vs 97.0 ± 0.8%, p = 0.0001) and minimum oxygen saturation (78.8 ± 6.3 vs 89.2 ± 4.2, p = 0.001) improved, and the SCR score (12.6 ± 1.2 vs 8.3 ± 1.1, p = 0.0001) was reduced. Children treated only with intranasal beclomethasone spray showed no differences in outcome measures before and after treatments. When we considered the oximetry measures, after corticosteroid treatment, we obtained statistical differences between the 2 groups (p < 0.01). CONCLUSIONS These results seem to suggest that a short course of oral betamethasone could be useful to treat children with severe OSAS and adenotonsillar hypertrophy waiting for surgery.
Collapse
|
49
|
Screening Severe Obstructive Sleep Apnea in Children with Snoring. Diagnostics (Basel) 2021; 11:diagnostics11071168. [PMID: 34206981 PMCID: PMC8304319 DOI: 10.3390/diagnostics11071168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022] Open
Abstract
Efficient screening for severe obstructive sleep apnea (OSA) is important for children with snoring before time-consuming standard polysomnography. This retrospective cross-sectional study aimed to compare clinical variables, home snoring sound analysis, and home sleep pulse oximetry on their predictive performance in screening severe OSA among children who habitually snored. Study 1 included 9 (23%) girls and 30 (77%) boys (median age of 9 years). Using univariate logistic regression models, 3% oxygen desaturation index (ODI3) ≥ 6.0 events/h, adenoidal-nasopharyngeal ratio (ANR) ≥ 0.78, tonsil size = 4, and snoring sound energy of 801–1000 Hz ≥ 22.0 dB significantly predicted severe OSA in descending order of odds ratio. Multivariate analysis showed that ODI3 ≥ 6.0 events/h independently predicted severe pediatric OSA. Among several predictive models, the combination of ODI3, tonsil size, and ANR more optimally screened for severe OSA with a sensitivity of 91% and a specificity of 94%. In Study 2 (27 (27%) girls and 73 (73%) boys; median age, 7 years), this model was externally validated to predict severe OSA with an accuracy of 76%. Our results suggested that home sleep pulse oximetry, combined with ANR, can screen for severe OSA more optimally than ANR and tonsil size among children with snoring.
Collapse
|
50
|
Ong JWY, Williams D, Gavlak JC, Liddle N, Lowe P, Evans HJ. Observational study to define reference ranges for the 3% oxygen desaturation index during sleep in healthy children under 12 years using oximetry motion-resistant technology. Arch Dis Child 2021; 106:583-586. [PMID: 33082136 DOI: 10.1136/archdischild-2020-320066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To define reference ranges for the 3% oxygen desaturation index (DI3) in healthy children under 12 years old during sleep. DESIGN Observational. SETTING Home. SUBJECTS Healthy children aged 6 months to 12 years of age. INTERVENTION Nocturnal pulse oximetry at home. Parents documented sleep times. Visi-Download software (Stowood Scientific) analysed data with artefact and wake periods removed. MAIN OUTCOME MEASURES The following oximetry parameters used in the assessment of sleep-disordered breathing conditions were measured: 3% (DI3) and 4% (DI4) oxygen desaturation indices-the number of times per hour where the oxygen saturation falls by at least 3% or 4% from baseline, mean saturations (SAT50), minimum saturations (SATmin), delta index 12 s (DI12s), and percentage time with saturations below 92% and 90%. RESULTS Seventy-nine children underwent nocturnal home pulse oximetry, from which there were 66 studies suitable for analysis. The median values for DI3 and DI4 were 2.58 (95% CI 1.96 to 3.10) and 0.92 (95% CI 0.73 to 1.15), respectively. The 95th and 97.5th centiles for DI3 were 6.43 and 7.06, respectively, which inform our cut-off value for normality. The mean values for SAT50 and SATmin were 97.57% (95% CI 97.38% to 97.76%) and 91.09% (95% CI 90.32% to 91.86%), respectively. CONCLUSION In children aged 6 months to 12 years, we define normality of the 3% oxygen desaturation index as <7 using standalone, motion-resistant pulse oximeters with short averaging times.
Collapse
Affiliation(s)
- Jonathan Wen Yi Ong
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Daniel Williams
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Johanna C Gavlak
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Natasha Liddle
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Paula Lowe
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Hazel J Evans
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| |
Collapse
|