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Hudson S, Abusido T, Sebastianski M, Castro-Codesal ML, Lewis M, MacLean JE. Long-Term Non-invasive Ventilation in Children With Down Syndrome: A Systematic Review. Front Pediatr 2022; 10:886727. [PMID: 35676906 PMCID: PMC9168004 DOI: 10.3389/fped.2022.886727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Context Children with Down syndrome are at risk for obstructive sleep apnea, which may not be resolved by adenotonsillecotmy, as well as other respiratory disorders that may impact breathing during sleep. Long-term non-invasive ventilation, including continuous and bilevel positive airway pressure delivery, is an alternate treatment strategy. Objective To assess the use and outcomes of long-term non-invasive ventilation in children with Down syndrome including comparison to other children using long-term non-invasive ventilation. Data Sources The search strategy for the scoping review used Medical Subject Headings (MeSH) and free-text terms for "child" and "non-invasive ventilation." MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), and PubMed databases were searched (1990-2021). Study Selection The scoping review results were searched to identify studies including data on at least three children with Down Syndrome using long-term non-invasive ventilation. Data Extraction Study characteristics, subject characteristics, technology type, and outcome measurements were extracted. Results A total of 28 articles included 543 children with Down syndrome using long-term non-invasive ventilation. Children with Down syndrome accounted for 18% of children using long-term non-invasive ventilation. Data on efficacy, feasibility, and adherence in children with Down syndrome are comparable to other children. Children with Down syndrome may have greater difficulty initiating long-term non-invasive ventilation, longer time to establish use, and a higher rate of inability to establish use. Outcome data is limited but suggest favorable impact on cardiac function and attention. Limitations Articles related to long-term non-invasive ventilation use in adolescents and young adults may have been excluded. Conclusions Children with Down syndrome make up a significant portion of the population of children using long-term non-invasive ventilation. While there is more limited data available with respect to the use and outcomes for children with Down syndrome compared to the other children, long-term non-invasive ventilation is an effective and well-tolerated therapy with no clear differences in the use or outcomes for children with Down syndrome. Additional work is needed to understand potential challenges around establishing long-term non-invasive ventilation use in children with Down syndrome. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206533, identifier: CRD206533.
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Affiliation(s)
- Summer Hudson
- MD Program, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tamer Abusido
- Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Pediatric Pulmonology Division, Pediatric Department, King Abdullah Specialized Children's Hospital, Ministry of National Guard Hospital Affairs, Riyadh, Saudi Arabia
| | - Meghan Sebastianski
- Alberta Strategy for Patient Oriented Research (SPOR) Support Unit, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, AB, Canada
| | - Maria L. Castro-Codesal
- Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Melanie Lewis
- Division of General & Community Pediatrics, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women's & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Joanna E. MacLean
- Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women's & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Santos RA, Costa LH, Linhares RC, Pradella-Hallinan M, Coelho FMS, Oliveira GDP. Sleep disorders in Down syndrome: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:424-443. [PMID: 35293557 DOI: 10.1590/0004-282x-anp-2021-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep disorders are commonly observed in children with Down syndrome (DS) and can lead to significant behavioral and cognitive morbidities in these individuals. OBJECTIVE To perform a systematic review evaluating sleep disorders in individuals with DS. METHODS Search strategies were based on combinations of keywords: "Down syndrome"; "trisomy 21"; "sleep disorders"; "dyssomnias"; "sleep apnea"; "obstructive"; "sleeplessness"; "insomnia"; "parasomnias"; and "excessive daytime sleepiness". PubMed and Science Direct were used. Only original studies and retrospective reviews in English published between January 2011 and March 2021 were included. RESULTS 52 articles were included, most of them involving children and adolescents under 18 years of age. The main sleep disorder associated with DS was obstructive sleep apnea (OSA). Some studies reported the presence of cognitive dysfunction in patients with DS and sleep-disordered breathing, and few have been found about parasomnia, insomnia, and daytime sleepiness in these patients. Movement disorders and unusual postures during sleep may be related to disordered sleep breathing in DS. The main treatment options for OSA are continuous positive airway pressure therapy (CPAP), surgery, and weight control. Computational modeling associated with MRI has been used to plan surgical interventions in these patients. CONCLUSIONS Individuals with DS are at high risk of developing sleep-related breathing disorders. The main sleep disorder associated with DS was OSA. The presence of sleep-disordered breathing contributes to a worsening of cognitive function in patients with DS.
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Affiliation(s)
| | | | - Rebeca Coêlho Linhares
- Faculdade de Ciências Humanas, Exatas e de Saúde do Piauí, Instituto de Educação Superior do Vale do Parnaíba, Parnaíba PI, Brazil
| | | | - Fernando Morgadinho Santos Coelho
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Giuliano da Paz Oliveira
- Universidade Federal Delta do Parnaíba, Parnaíba PI, Brazil.,Faculdade de Ciências Humanas, Exatas e de Saúde do Piauí, Instituto de Educação Superior do Vale do Parnaíba, Parnaíba PI, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
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Takahashi T, Sakai N, Iwasaki T, Doyle TC, Mobley WC, Nishino S. Detailed evaluation of the upper airway in the Dp(16)1Yey mouse model of Down syndrome. Sci Rep 2020; 10:21323. [PMID: 33288820 PMCID: PMC7721723 DOI: 10.1038/s41598-020-78278-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
A high prevalence of obstructive sleep apnea (OSA) has been reported in Down syndrome (DS) owing to the coexistence of multiple predisposing factors related to its genetic abnormality, posing a challenge for the management of OSA. We hypothesized that DS mice recapitulate craniofacial abnormalities and upper airway obstruction of human DS and can serve as an experimental platform for OSA research. This study, thus, aimed to quantitatively characterize the upper airway as well as craniofacial abnormalities in Dp(16)1Yey (Dp16) mice. Dp16 mice demonstrated craniofacial hypoplasia, especially in the ventral part of the skull and the mandible, and rostrally positioned hyoid. These changes were accompanied with a shorter length and smaller cross-sectional area of the upper airway, resulting in a significantly reduced upper airway volume in Dp16 mice. Our non-invasive approach, a combination of computational fluid dynamics and high-resolution micro-CT imaging, revealed a higher negative pressure inside the airway of Dp16 mice compared to wild-type littermates, showing the potential risk of upper airway collapse. Our study indicated that Dp16 mice can be a useful model to examine the pathophysiology of increased upper airway collapsibility of DS and to evaluate the efficacy of therapeutic interventions for breathing and sleep anomalies.
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Affiliation(s)
- Tatsunori Takahashi
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Room 2141, Palo Alto, CA, 94304, USA.,Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Noriaki Sakai
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Room 2141, Palo Alto, CA, 94304, USA.
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, Kagoshima, 8908544, Japan
| | - Timothy C Doyle
- The Neuroscience Community Labs, Wu Tsai Neurosciences Institute, Stanford University, 318 Campus Drive, Suite S170, Stanford, CA, 94305, USA
| | - William C Mobley
- Department of Neurosciences, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Seiji Nishino
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Room 2141, Palo Alto, CA, 94304, USA
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Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, Visconti IC, Meccariello G, Cammaroto G, De Vito A, Gobbi R, Bellini C, Firinu E, Pace A, Colizza A, Pelucchi S, Magliulo G. Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3235. [PMID: 31487798 PMCID: PMC6765844 DOI: 10.3390/ijerph16183235] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 12/27/2022]
Abstract
The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management.
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Affiliation(s)
- Giampiero Gulotta
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Giannicola Iannella
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy.
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy.
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, University "Sapienza", 00185 Rome, Italy
| | - Antonio Greco
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | | | | | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Chiara Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Elisabetta Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Annalisa Pace
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Andrea Colizza
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Stefano Pelucchi
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Giuseppe Magliulo
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
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Pierce B, Brietzke S. Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes. JAMA Otolaryngol Head Neck Surg 2019; 145:854-859. [DOI: 10.1001/jamaoto.2019.1842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Bailey Pierce
- Florida Atlantic University College of Medicine, Boca Raton
| | - Scott Brietzke
- Florida Atlantic University College of Medicine, Boca Raton
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Zaffanello M, Antoniazzi F, Tenero L, Nosetti L, Piazza M, Piacentini G. Sleep-disordered breathing in paediatric setting: existing and upcoming of the genetic disorders. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:343. [PMID: 30306082 PMCID: PMC6174189 DOI: 10.21037/atm.2018.07.13] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Childhood obstructive sleep apnea syndrome (OSAS) is characterized by anatomical and functional upper airway abnormalities as pathophysiological determinants, and clinical symptoms are frequently clear. OSAS is widely described in rare genetic disorders, such as achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, and mucopolysaccharidosis. Craniofacial and upper airway involvement is frequently morbid conditions. In children with genetic diseases, the clinical symptoms of OSAS are often slight or absent, and related morbidities are usually more severe and can be observed at any age. The present review is aimed to updating the discoveries regarding OSAS on Achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, Sickle cell disease, or encountered in our clinical practice (Ehlers-Danlos syndrome, Ellis-van Creveld syndrome, Noonan syndrome). Two additional groups of genetic disorders will be focused (mucopolysaccharidoses and osteogenesis imperfecta). The flowing items are covered for each disease: (I) what is the pathophysiology of OSAS? (II) What is the incidence/prevalence of OSAS? (III) What result from the management and prognosis? (IV) What are the recommendations? Considering the worries of OSAS, such as inattention and behavioural problems, daytime sleepiness, failure to thrive, cardiological and metabolic complications, the benefit of a widespread screening and the treatment in children with genetic diseases is undoubtful. The goals of the further efforts can be the inclusion of various genetic diseases into guidelines for the screening of OSAS, updating the shreds of evidence based on the research progression.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Tan HL, Kheirandish-Gozal L, Gozal D. Adenotonsillectomy in Pediatric OSA: Time to Look Elsewhere. CURRENT SLEEP MEDICINE REPORTS 2018. [DOI: 10.1007/s40675-018-0122-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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