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Maski KP, Amos LB, Carter JC, Koch EE, Kazmi U, Rosen CL. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in children: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med 2024; 20:631-641. [PMID: 38149645 PMCID: PMC10985297 DOI: 10.5664/jcsm.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 12/28/2023]
Abstract
The American Academy of Sleep Medicine commissioned a task force of clinical experts in pediatric sleep medicine to review published literature on performing the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test for diagnosis and management of central disorders of hypersomnolence among children and adolescents. This paper follows a format similar to that of the paper "Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine" that was published in 2021. Since there is insufficient evidence to specify a recommended protocol for the Maintenance of Wakefulness Test in children and adolescents, this paper focuses only on the MSLT protocol. This protocol paper provides guidance to health care providers who order, sleep specialists who interpret, and technical staff who administer the MSLT to pediatric patients. Similar to the adult protocol paper, this document provides guidance based on pediatric expert consensus and evidence-based data when available. Topics include patient preparation, evaluation of medication and substance use, sleep needs before testing, scheduling considerations, optimal test conditions for youth, and documentation. Specific changes recommended for pediatric MSLT protocols include (1) provision of a minimum of 7 hours of sleep (with a minimum 8-hour recording time) on polysomnography the night before the MSLT, ideally meeting age-based needs; (2) use of clinical judgment to guide the need for sleep-disordered breathing treatments before polysomnography-MSLT testing; and (3) shared patient-health care provider decision-making regarding modifications in the protocol for children and adolescents with neurodevelopmental/neurological disorders, young age, and/or delayed sleep phase. CITATION Maski KP, Amos LB, Carter JC, Koch EE, Kazmi U, Rosen CL. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in children: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med. 2024;20(4):631-641.
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Affiliation(s)
- Kiran P. Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Louella B. Amos
- Pediatric Pulmonology and Sleep Medicine, Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John C. Carter
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ellen E. Koch
- American Academy of Sleep Medicine, Darien, Illinois
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, Illinois
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- American Academy of Sleep Medicine, Darien, Illinois
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Gueye-Ndiaye S, Tully M, Amin R, Baldassari CM, Chervin RD, Cole M, Ibrahim S, Kirkham EM, Mitchell RB, Naqvi K, Ross K, Rueschman M, Tapia IE, Williamson AA, Wei Z, Rosen CL, Wang R, Redline S. Neighborhood Disadvantage, Quality of Life, and Symptom Burden in Children with Mild Sleep-disordered Breathing. Ann Am Thorac Soc 2024; 21:604-611. [PMID: 38241286 PMCID: PMC10995551 DOI: 10.1513/annalsats.202307-653oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024] Open
Abstract
Rationale: Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied.Objectives: To evaluate associations between ND with SDB symptom burden and QOL.Methods: Cross-sectional analyses were performed on 453 children, ages 3-12.9 years, with mild SDB (habitual snoring and apnea-hypopnea index < 3/h) enrolled in the PATS (Pediatric Adenotonsillectomy Trial for Snoring) multicenter study. The primary exposure, neighborhood disadvantage, was characterized by the Child Opportunity Index (COI) (range, 0-100), in which lower values (specifically COI ⩽ 40) signify less advantageous neighborhoods. The primary outcomes were QOL assessed by the obstructive sleep apnea (OSA)-18 questionnaire (range, 18-126) and SDB symptom burden assessed by the Pediatric Sleep Questionnaire-Sleep-related Breathing Disorder (PSQ-SRBD) scale (range, 0-1). The primary model was adjusted for age, sex, race, ethnicity, maternal education, recruitment site, and season. In addition, we explored the role of body mass index (BMI) percentile, environmental tobacco smoke (ETS), and asthma in these associations.Results: The sample included 453 children (16% Hispanic, 26% Black or African American, 52% White, and 6% other). COI mean (standard deviation [SD]) was 50.3 (29.4), and 37% (n = 169) of participants lived in disadvantaged neighborhoods. Poor SDB-related QOL (OSA-18 ⩾ 60) and high symptom burden (PSQ-SRBD ⩾ 0.33) were found in 30% (n = 134) and 75% (n = 341) of participants, respectively. In adjusted models, a COI increase by 1 SD (i.e., more advantageous neighborhood) was associated with an improvement in OSA-18 score by 2.5 points (95% confidence interval [CI], -4.34 to -0.62) and in PSQ-SRBD score by 0.03 points (95% CI, -0.05 to -0.01). These associations remained significant after adjusting for BMI percentile, ETS, or asthma; however, associations between COI and SDB-related QOL attenuated by 23% and 10% after adjusting for ETS or asthma, respectively.Conclusions: Neighborhood disadvantage was associated with poorer SDB-related QOL and greater SDB symptoms. Associations were partially attenuated after considering the effects of ETS or asthma. The findings support efforts to reduce ETS and neighborhood-level asthma-related risk factors and identify other neighborhood-level factors that contribute to SDB symptom burden as strategies to address sleep-health disparities.Clinical trial registered with www.clinicaltrials.gov (NCT02562040).
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meg Tully
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raouf Amin
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia
- Department of Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, Virginia
| | | | - Melissa Cole
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sally Ibrahim
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | | | - Ron B. Mitchell
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kamal Naqvi
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kristie Ross
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | - Michael Rueschman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariel A. Williamson
- The Ballmer Institute for Children’s Behavioral Health, University of Oregon, Eugene, Oregon
| | - Zhuoran Wei
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Rui Wang
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Redline S, Cook K, Chervin RD, Ishman S, Baldassari CM, Mitchell RB, Tapia IE, Amin R, Hassan F, Ibrahim S, Ross K, Elden LM, Kirkham EM, Zopf D, Shah J, Otteson T, Naqvi K, Owens J, Young L, Furth S, Connolly H, Clark CAC, Bakker JP, Garetz S, Radcliffe J, Taylor HG, Rosen CL, Wang R. Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial. JAMA 2023; 330:2084-2095. [PMID: 38051326 PMCID: PMC10698619 DOI: 10.1001/jama.2023.22114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023]
Abstract
Importance The utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown. Objectives To evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB. Design, Setting, and Participants Randomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months. Intervention Participants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228). Main Outcomes and Measures The 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes. Results Of the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: -3.1 for adenotonsillectomy vs -1.9 for watchful waiting; difference, -0.96 [95% CI, -2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, -0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, -9.02 [97% CI, -15.49 to -2.54] and -6.52 [97% CI, -11.59 to -1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, -11.2% [97% CI, -17.5% to -4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy. Conclusions In children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT02562040.
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Affiliation(s)
- Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn Cook
- Program in Statistical and Data Sciences, Smith College, Northampton, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Ronald D. Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor
| | - Stacey Ishman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk
| | - Ron B. Mitchell
- Departments of Otolaryngology-Head and Neck Surgery and Neurology Sleep Disorders Center, UT Southwestern Medical Center, Children’s Medical Center, Dallas
| | - Ignacio E. Tapia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raouf Amin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Fauziya Hassan
- Sleep Disorders Center and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
| | - Sally Ibrahim
- Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Kristie Ross
- Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Lisa M. Elden
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erin M. Kirkham
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - David Zopf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jay Shah
- Department of Otolaryngology, University Hospitals Rainbow Babies
- University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Todd Otteson
- Department of Otolaryngology, University Hospitals Rainbow Babies
- University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Kamal Naqvi
- Department of Pediatrics, UT Southwestern Medical Center, Dallas
| | - Judith Owens
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Young
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan Furth
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Heidi Connolly
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Caron A. C. Clark
- Department of Educational Psychology, University of Nebraska-Lincoln
| | - Jessie P. Bakker
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Garetz
- Department of Otolaryngology–Head and Neck Surgery and Department of Neurology-Sleep Disorders Center, University of Michigan, Ann Arbor
| | - Jerilynn Radcliffe
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University, Columbus
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, Ohio
| | - Rui Wang
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Robinson KA, Wei Z, Radcliffe J, Taylor HG, Baldassari CM, Chervin RD, Ishman S, Mitchell RB, Tapia IE, Garetz S, Hassan F, Ibrahim S, Elden LM, Ievers-Landis CE, Williamson AA, Hjelm M, Kirkham E, Tham A, Naqvi K, Rueschman M, Rosen CL, Wang R, Redline S. Associations of actigraphy measures of sleep duration and continuity with executive function, vigilance, and fine motor control in children with snoring and mild sleep-disordered breathing. J Clin Sleep Med 2023; 19:1595-1603. [PMID: 37185231 PMCID: PMC10476043 DOI: 10.5664/jcsm.10620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
STUDY OBJECTIVES Children with snoring and mild sleep-disordered breathing may be at increased risk for neurocognitive deficits despite few obstructive events. We hypothesized that actigraphy-based sleep duration and continuity associate with neurobehavioral functioning and explored whether these associations vary by demographic and socioeconomic factors. METHODS 298 children enrolled in the Pediatric Adenotonsillectomy Trial, ages 3 to 12.9 years, 47.3% from racial or ethnic minority groups, with habitual snoring and an apnea-hypopnea index < 3 were studied with actigraphy (mean 7.5 ± 1.4 days) and completed a computerized vigilance task (Go-No-Go) and a test of fine motor control (9-Hole Pegboard). Caregivers completed the Behavior Rating Inventory of Executive Function. Regression analyses evaluated associations between sleep exposures (24-hour and nocturnal sleep duration, sleep fragmentation index, sleep efficiency) with the Behavior Rating Inventory of Executive Function Global Executive Composite index, pegboard completion time (fine motor control), and vigilance (d prime on the Go-No-Go), adjusting for demographic factors and study design measures. RESULTS Longer sleep duration, higher sleep efficiency, and lower sleep fragmentation were associated with better executive function; each additional hour of sleep over 24 hours associated with more than a 3-point improvement in executive function (P = .002). Longer nocturnal sleep (P = .02) and less sleep fragmentation (P = .001) were associated with better fine motor control. Stronger associations were observed for boys and children less than 6 years old. CONCLUSIONS Sleep quantity and continuity are associated with neurocognitive functioning in children with mild sleep-disordered breathing, supporting efforts to target these sleep health parameters as part of interventions for reducing neurobehavioral morbidity. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Pediatric Adenotonsillectomy for Snoring (PATS); URL: https://clinicaltrials.gov/ct2/show/NCT02562040; Identifier: NCT02562040. CITATION Robinson KA, Wei Z, Radcliffe J, et al. Associations of actigraphy measures of sleep duration and continuity with executive function, vigilance, and fine motor control in children with snoring and mild sleep-disordered breathing. J Clin Sleep Med. 2023;19(9):1595-1603.
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Affiliation(s)
- Keith A. Robinson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zhuoran Wei
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jerilynn Radcliffe
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk, VA
| | - Ronald D. Chervin
- Department of Neurology and Sleep Disorders Centers, University of Michigan, Ann Arbor, Michigan
| | - Stacey Ishman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ron B. Mitchell
- Departments of Otolaryngology-Head and Neck Surgery and Neurology Sleep Disorders Center, Utah Southwestern Medical Center, Children’s Medical Center, Dallas, Texas
| | - Ignacio E. Tapia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Garetz
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Fauziya Hassan
- Department of Neurology and Sleep Disorders Centers, University of Michigan, Ann Arbor, Michigan
| | - Sally Ibrahim
- Department of Pediatrics, Rainbow Babies and Children’s of University Hospitals Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Lisa M. Elden
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn E. Ievers-Landis
- Department of Pediatrics, Rainbow Babies and Children’s of University Hospitals Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Ariel A. Williamson
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Hjelm
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Erin Kirkham
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Addy Tham
- Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk, VA
| | - Kamal Naqvi
- Department of Pediatrics, Utah Southwestern Medical Center, Dallas, Texas
| | - Michael Rueschman
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol L. Rosen
- Department of Pediatrics, Rainbow Babies and Children’s of University Hospitals Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Rui Wang
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute and Harvard Medical School, Boston, Massachusetts
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Das AM, Chang JL, Berneking M, Hartenbaum NP, Rosekind M, Ramar K, Malhotra RK, Carden KA, Martin JL, Abbasi-Feinberg F, Nisha Aurora R, Kapur VK, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV, Trotti LM, Gurubhagavatula I. Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2022; 18:2467-2470. [PMID: 34534065 PMCID: PMC9516580 DOI: 10.5664/jcsm.9670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022]
Abstract
Obstructive sleep apnea (OSA) may lead to serious health, safety, and financial implications-including sleepiness-related crashes and incidents-in workers who perform safety-sensitive functions in the transportation industry. Evidence and expert consensus support its identification and treatment in high-risk commercial operators. An Advanced Notice of Proposed Rulemaking regarding the diagnosis and treatment of OSA in commercial truck and rail operators was issued by the Federal Motor Carrier Safety Administration and Federal Railroad Administration, but it was later withdrawn. This reversal has led to questions about whether efforts to identify and treat OSA are warranted. In the absence of clear directives, we urge key stakeholders, including clinicians and patients, to engage in a collaborative approach to address OSA by following, at a minimum, the 2016 guidelines issued by a Medical Review Board of the Federal Motor Carrier Safety Administration, alone or in combination with 2006 guidance by a joint task force. The current standard of care demands action to mitigate the serious health and safety risks of OSA. CITATION Das AM, Chang JL, Berneking M, et al. Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2022;18(10):2467-2470.
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Affiliation(s)
- Aneesa M. Das
- Division of Pulmonary, Critical Care and Sleep, The Ohio State University, Columbus, Ohio
| | - Judy L. Chang
- San Jose Military Entrance Processing Station, Mountain View, California
| | | | | | - Mark Rosekind
- Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Raman K. Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Kelly A. Carden
- Saint Thomas Medical Partners–Sleep Specialists, Nashville, Tennessee
| | - Jennifer L. Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
| | | | - R. Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vishesh K. Kapur
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Eric J. Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Anita V. Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Lynn Marie Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Lecendreux M, Plazzi G, Dauvilliers Y, Rosen CL, Ruoff C, Black J, Parvataneni R, Guinta D, Wang YG, Mignot E. Long-term safety and maintenance of efficacy of sodium oxybate in the treatment of narcolepsy with cataplexy in pediatric patients. J Clin Sleep Med 2022; 18:2217-2227. [PMID: 35689598 PMCID: PMC9435339 DOI: 10.5664/jcsm.10090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Evaluate long-term efficacy and safety of sodium oxybate (SXB) in children and adolescents (aged 7-16 years) with narcolepsy with cataplexy. METHODS A double-blind randomized withdrawal study was conducted. Prior to randomization, SXB-naive participants were titrated to an efficacious and tolerable dose of SXB; participants taking SXB entered on their established dose. Following a 2-week stable-dose period and 2-week, double-blind, randomized withdrawal period, participants entered an open-label period (OLP; ≤ 47 weeks). Efficacy measures during the OLP included number of weekly cataplexy attacks, cataplexy-free days, and Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). Safety outcomes included treatment-emergent adverse events; assessments of depression, anxiety, and suicidality; and polysomnography. RESULTS Of 106 enrolled participants, 95 entered and 85 completed the OLP. In SXB-naive participants and participants previously taking SXB, efficacy of SXB established prior to the double-blind, randomized withdrawal period was maintained throughout the OLP for number of weekly cataplexy attacks (median [quartile 1, quartile 3] change from the stable-dose period to end of the OLP: 0.0 [-2.5, 4.9] and 0.0 [-3.4, 2.6], respectively) and ESS-CHAD scores (0.0 [-3.0, 2.5] and 1.0 [-3.0, 3.0], respectively). The median (quartile 1, quartile 3) number of cataplexy-free days per week was 2.3 (0.0, 6.0) in OLP week 1 and 3.8 (0.5, 5.5) in week 48. Treatment-emergent adverse events (≥ 5%) were enuresis, nausea, vomiting, headache, decreased weight, decreased appetite, nasopharyngitis, upper respiratory tract infection, and dizziness. CONCLUSIONS SXB demonstrated long-term maintenance of efficacy in pediatric narcolepsy with cataplexy, with a safety profile consistent with that observed in adults. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A Multicenter Study of the Efficacy and Safety of Xyrem with an Open-Label Pharmacokinetic Evaluation and Safety Extension in Pediatric Subjects with Narcolepsy with Cataplexy; URL: https://clinicaltrials.gov/ct2/show/NCT02221869; Identifier: NCT02221869. CITATION Lecendreux M, Plazzi G, Dauvilliers Y, et al. Long-term safety and maintenance of efficacy of sodium oxybate in the treatment of narcolepsy with cataplexy in pediatric patients. J Clin Sleep Med. 2022;18(9):2217-2227.
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Affiliation(s)
- Michel Lecendreux
- AP-HP, Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (CNR Narcolepsie-Hypersomnie), Paris, France
- INSERM CIC1426, Paris, France
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France
- University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chad Ruoff
- Stanford Sleep Medicine Center, Redwood City, California
- Division of Pulmonary Medicine, Center for Sleep Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Jed Black
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
- Jazz Pharmaceuticals, Palo Alto, California
| | | | | | | | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
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7
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Amos L, Afolabi-Brown O, Gault D, Lloyd R, Prero MY, Rosen CL, Malhotra RK, Martin JL, Ramar K, Rowley JA, Abbasi-Feinberg F, Aurora RN, Kapur VK, Kazmi U, Kuhlmann D, Olson EJ, Shelgikar AV, Thomas SM, Trotti LM. Age and weight considerations for the use of continuous positive airway pressure therapy in pediatric populations: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2022; 18:2041-2043. [PMID: 35638127 PMCID: PMC9340596 DOI: 10.5664/jcsm.10098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This position statement provides guidance for age and weight considerations for using continuous positive airway pressure (CPAP) therapy in pediatric populations. The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in pediatric sleep medicine to review the medical literature and develop a position statement based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statement. It is the position of the AASM that CPAP can be safe and effective for the treatment of obstructive sleep apnea (OSA) for pediatric patients, even in children of younger ages and lower weights, when managed by a clinician with expertise in evaluating and treating pediatric OSA. The clinician must make the ultimate judgment regarding any specific care in light of the individual circumstances presented by the patient, accessible treatment options, patient/parental preference, and resources.
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Affiliation(s)
- Louella Amos
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Dominic Gault
- Division of Pediatric Sleep Medicine, Prisma Health, Greenville, South Carolina
| | | | - Moshe Y Prero
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raman K Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vishesh K Kapur
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, IL
| | - David Kuhlmann
- Sleep Medicine, Bothwell Regional Health Center, Sedalia, Missouri
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anita V Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | | | - Lynn Marie Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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8
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Yu PK, Radcliffe J, Gerry Taylor H, Amin RS, Baldassari CM, Boswick T, Chervin RD, Elden LM, Furth SL, Garetz SL, George A, Ishman SL, Kirkham EM, Liu C, Mitchell RB, Kamal Naqvi S, Rosen CL, Ross KR, Shah JR, Tapia IE, Young LR, Zopf DA, Wang R, Redline S. Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea. Sleep 2022; 45:zsac035. [PMID: 35554583 PMCID: PMC9113015 DOI: 10.1093/sleep/zsac035] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea. METHODS Children 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis. RESULTS The sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing. CONCLUSIONS Abnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention. TRIAL REGISTRATION Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.
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Affiliation(s)
- Phoebe K Yu
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA
| | - Jerilynn Radcliffe
- Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Gerry Taylor
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | - Raouf S Amin
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Cristina M Baldassari
- Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA
| | - Thomas Boswick
- Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA
| | - Ronald D Chervin
- University of Michigan, Department of Neurology, Ann Arbor, MI, USA
| | - Lisa M Elden
- Children’s Hospital of Philadelphia, Division of Otolaryngology, Philadelphia, PA, USA
| | - Susan L Furth
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - Susan L Garetz
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Alisha George
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Stacey L Ishman
- University of Cincinnati College of Medicine, Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Division of Otolaryngology – Head & Neck Surgery, Cincinnati, OH, USA
| | - Erin M Kirkham
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Christopher Liu
- University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA
| | - Ron B Mitchell
- University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA
- University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA
| | - S Kamal Naqvi
- University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA
| | - Carol L Rosen
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | - Kristie R Ross
- University Hospitals Rainbow Babies & Children’s Hospital, Department of Pediatrics, Cleveland, OH, USA
| | - Jay R Shah
- University Hospitals Rainbow Babies & Children’s Hospital, Department of Otolaryngology, Cleveland, OH, USA
| | - Ignacio E Tapia
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - Lisa R Young
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - David A Zopf
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Rui Wang
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
| | - Susan Redline
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
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9
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Rosen CL. Sleep-Disordered Breathing (SDB) in Pediatric Populations. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Pascoe M, Bena J, Andrews ND, Auckley D, Benca R, Billings ME, Kapur VK, Iber C, Zee PC, Redline S, Rosen CL, Foldvary-Schaefer N. Dose response relationship between positive airway pressure therapy and excessive daytime sleepiness: the HomePAP study. J Clin Sleep Med 2021; 18:1027-1034. [PMID: 34870587 DOI: 10.5664/jcsm.9792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Clinical benefits of PAP therapy for OSA are assumed to require adherent PAP usage, as defined by CMS as ≥ 4 hours of use ≥ 70% of nights. However, this is based on early data and does not necessarily capture improvements at subthreshold adherence. We explored dose-response relationships between PAP adherence measures and EDS from the HomePAP RCT. METHODS Participants ≥18 years with apnea hypopnea index ≥ 15 and baseline sleepiness (Epworth Sleepiness Scale (ESS) ≥ 12) received PAP therapy. Data were collected at baseline, 1-month, and 3-months follow-up. Regression models and receiver operating characteristic curves evaluated PAP measures as predictors of ESS change and normalization (ESS < 10). RESULTS In 119 participants (age 49.4 ± 12.6 years, 66.4% male, 72.3% white), > 50% were PAP non-adherent per CMS criteria at 3 months. Percent of nights with PAP use ≥ 4 hours predicted ESS change (p = 0.023), but not when controlling for AHI. Percent of nights with ≥ 4 hours and average PAP use provided the best discrimination for predicting ESS normalization; each 10% increase in PAP use ≥ 4 hours increased the odds of ESS normalization by 22% (p = 0.007); those using PAP ≥ 4 hours had nearly 3-fold greater odds of ESS normalization (p = 0.025). At least 4 hours and 70% of nights provided the best balance between specificity (0.50) and sensitivity (0.73). CONCLUSIONS Although sub-adherent PAP usage may still confer some benefit for OSA patients, adherence to current criteria confers the highest likelihood for ESS change and normalization. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP); Identifier: NCT00642486; URL: http://clinicaltrials.gov/show/NCT00642486.
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Affiliation(s)
- Maeve Pascoe
- Cleveland Clinic Sleep Disorders Center, Cleveland, OH
| | - James Bena
- Cleveland Clinic Sleep Disorders Center, Cleveland, OH
| | | | - Dennis Auckley
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland OH
| | - Ruth Benca
- University of California Irvine, Irvine, CA
| | | | - Vishesh K Kapur
- Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Phyllis C Zee
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Carol L Rosen
- Case Western Reserve University School of Medicine, Cleveland, OH
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11
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Ramar K, Malhotra RK, Carden KA, Martin JL, Abbasi-Feinberg F, Aurora RN, Kapur VK, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV, Trotti LM. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2021; 17:2115-2119. [PMID: 34170250 PMCID: PMC8494094 DOI: 10.5664/jcsm.9476] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022]
Abstract
CITATION Sleep is a biological necessity, and insufficient sleep and untreated sleep disorders are detrimental for health, well-being, and public safety. Healthy People 2030 includes several sleep-related objectives with the goal to improve health, productivity, well-being, quality of life, and safety by helping people get enough sleep. In addition to adequate sleep duration, healthy sleep requires good quality, appropriate timing, regularity, and the absence of sleep disorders. It is the position of the American Academy of Sleep Medicine (AASM) that sleep is essential to health. There is a significant need for greater emphasis on sleep health in education, clinical practice, inpatient and long-term care, public health promotion, and the workplace. More sleep and circadian research is needed to further elucidate the importance of sleep for public health and the contributions of insufficient sleep to health disparities. CITATION Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2021;17(10):2115-2119.
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Affiliation(s)
- Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Raman K. Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Kelly A. Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Jennifer L. Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
| | | | - R. Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vishesh K. Kapur
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Eric J. Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Anita V. Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Lynn Marie Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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12
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Ji Y, Chalacheva P, Rosen CL, DeBaun MR, Coates TD, Khoo MCK. Identifying elevated risk for future pain crises in sickle-cell disease using photoplethysmogram patterns measured during sleep: A machine learning approach. Front Digit Health 2021; 3. [PMID: 34396363 PMCID: PMC8360353 DOI: 10.3389/fdgth.2021.714741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transient increases in peripheral vasoconstriction frequently occur in obstructive sleep apnea and periodic leg movement disorder, both of which are common in sickle cell disease (SCD). These events reduce microvascular blood flow and increase the likelihood of triggering painful vaso-occlusive crises (VOC) that are the hallmark of SCD. We recently reported a significant association between the magnitude of vasoconstriction, inferred from the finger photoplethysmogram (PPG) during sleep, and the frequency of future VOC in 212 children with SCD. In this study, we present an improved predictive model of VOC frequency by employing a two-level stacking machine learning (ML) model that incorporates detailed features extracted from the PPG signals in the same database. The first level contains seven different base ML algorithms predicting each subject's pain category based on the input PPG characteristics and other clinical information, while the second level is a meta model which uses the inputs to the first-level model along with the outputs of the base models to produce the final prediction. Model performance in predicting future VOC was significantly higher than in predicting VOC prior to each sleep study (F1-score of 0.43 vs. 0.35, p-value <0.0001), consistent with our hypothesis of a causal relationship between vasoconstriction and future pain incidence, rather than past pain leading to greater propensity for vasoconstriction. The model also performed much better than our previous conventional statistical model (F1 = 0.33), as well as all other algorithms that used only the base-models for predicting VOC without the second tier meta model. The modest F1 score of the present predictive model was due in part to the relatively small database with substantial imbalance (176:36) between low-pain and high-pain subjects, as well as other factors not captured by the sleep data alone. This report represents the first attempt ever to use non-invasive finger PPG measurements during sleep and a ML-based approach to predict increased propensity for VOC crises in SCD. The promising results suggest the future possibility of embedding an improved version of this model in a low-cost wearable system to assist clinicians in managing long-term therapy for SCD patients.
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Affiliation(s)
- Yunhua Ji
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | | | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, OH
| | - Michael R DeBaun
- Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Thomas D Coates
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
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13
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Rishi MA, Ahmed O, Barrantes Perez JH, Berneking M, Dombrowsky J, Flynn-Evans EE, Santiago V, Sullivan SS, Upender R, Yuen K, Abbasi-Feinberg F, Aurora RN, Carden KA, Kirsch DB, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Ramar K, Rosen CL, Rowley JA, Shelgikar AV, Gurubhagavatula I. Daylight saving time: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2021; 16:1781-1784. [PMID: 32844740 DOI: 10.5664/jcsm.8780] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
None The last several years have seen intense debate about the issue of transitioning between standard and daylight saving time. In the United States, the annual advance to daylight saving time in spring, and fall back to standard time in autumn, is required by law (although some exceptions are allowed under the statute). An abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks, including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. Although chronic effects of remaining in daylight saving time year-round have not been well studied, daylight saving time is less aligned with human circadian biology-which, due to the impacts of the delayed natural light/dark cycle on human activity, could result in circadian misalignment, which has been associated in some studies with increased cardiovascular disease risk, metabolic syndrome and other health risks. It is, therefore, the position of the American Academy of Sleep Medicine that these seasonal time changes should be abolished in favor of a fixed, national, year-round standard time.
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Affiliation(s)
- Muhammad Adeel Rishi
- Department of Pulmonology, Critical Care and Sleep Medicine, Mayo Clinic, Eau Claire, Wisconsin
| | - Omer Ahmed
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | | | | | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, California
| | - Vicente Santiago
- Sleep Medicine, The Permanente Medical Group, Manteca, California
| | - Shannon S Sullivan
- Department of Pediatrics, Division of Pulmonary, Asthma & Sleep Medicine, Stanford University School of Medicine, Palo Alto, California.,Eval Research Institute, Palo Alto, California
| | - Raghu Upender
- Department of Neurology, Division of Sleep Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Kin Yuen
- Sleep Disorders Center, UCSF Health, San Francisco, California
| | | | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | | | | | - Raman K Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | | | - Anita V Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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14
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Goldstein CA, Berry RB, Kent DT, Kristo DA, Seixas AA, Redline S, Westover MB, Abbasi-Feinberg F, Aurora RN, Carden KA, Kirsch DB, Malhotra RK, Martin JL, Olson EJ, Ramar K, Rosen CL, Rowley JA, Shelgikar AV. Artificial intelligence in sleep medicine: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2021; 16:605-607. [PMID: 32022674 DOI: 10.5664/jcsm.8288] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
None Sleep medicine is well positioned to benefit from advances that use big data to create artificially intelligent computer programs. One obvious initial application in the sleep disorders center is the assisted (or enhanced) scoring of sleep and associated events during polysomnography (PSG). This position statement outlines the potential opportunities and limitations of integrating artificial intelligence (AI) into the practice of sleep medicine. Additionally, although the most apparent and immediate application of AI in our field is the assisted scoring of PSG, we propose potential clinical use cases that transcend the sleep laboratory and are expected to deepen our understanding of sleep disorders, improve patient-centered sleep care, augment day-to-day clinical operations, and increase our knowledge of the role of sleep in health at a population level.
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Affiliation(s)
- Cathy A Goldstein
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Richard B Berry
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - David T Kent
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Azizi A Seixas
- Department of Population Health, Department of Psychiatry, NYU Langone Health, New York, New York
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - M Brandon Westover
- Neurology Department, Massachusetts General Hospital, Boston, Massachusetts
| | | | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | | | - Raman K Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V Shelgikar
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan
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15
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Chalacheva P, Ji Y, Rosen CL, DeBaun MR, Khoo MCK, Coates TD. Nocturnal peripheral vasoconstriction predicts the frequency of severe acute pain episodes in children with sickle cell disease. Am J Hematol 2021; 96:60-68. [PMID: 33027545 DOI: 10.1002/ajh.26014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 01/27/2023]
Abstract
The basic model of SCD physiology states that vaso-occlusion occurs when hemoglobin S-containing red blood cells (RBC) undergo sickling before they escape the capillary into a larger vessel. We have shown that mental stress, pain and cold, and events reported by patients to trigger SCD vaso-occlusive crisis (VOC), cause rapid and significant decrease in blood flow, reducing the likelihood that RBC could transit the microvasculature before sickling occurs. However, the critical link between decrease in microvascular blood flow and the incidence of future sickle VOC has never been established experimentally in humans. Using data from centrally adjudicated, overnight polysomnograms (PSG), previously collected in a prospective multi-center cohort sleep study, we analyzed the beat-to-beat amplitudes of vasoconstriction reported by the fingertip photoplethysmogram in 212 children and adolescents with SCD and developed an algorithm that detects vasoconstriction events and quantifies the magnitude (Mvasoc ), duration, and frequency of vasoconstriction that reflect the individual's inherent peripheral vasoreactivity. The propensity to vasoconstrict, quantified by median Mvasoc , predicted the incidence rate of post-PSG severe acute vaso-occlusive pain events (P = .006) after accounting for age and hemoglobin. Indices of sleep-disordered breathing contributed to median Mvasoc but did not predict future pain rate. Median Mvasoc was not associated with vaso-occlusive pain events that occurred prior to each PSG. These results show that SCD individuals with high inherent propensity to vasoconstrict have more frequent severe acute pain events. Our empirical findings are consistent with the fundamental SCD hypothesis that decreased microvascular flow promotes microvascular occlusion.
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Affiliation(s)
| | - Yunhua Ji
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Carol L. Rosen
- Department of Pediatrics, Division of Pediatric Pulmonary Allergy/Immunology and Sleep, University Hospitals‐Cleveland Medical Center, Rainbow Babies and Children's Hospitals Cleveland Ohio
| | - Michael R. DeBaun
- Division of Hematology‐Oncology, Department of Pediatrics Vanderbilt University School of Medicine Nashville Tennessee
| | - Michael C. K. Khoo
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Thomas D. Coates
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Department of Pediatrics University of Southern California Keck School of Medicine Los Angeles California
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16
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Rosen CL, Aurora RN, Kapur VK, Ramos AR, Rowley JA, Troester MM, Zak RS. Supporting American Academy of Neurology's new clinical practice guideline on evaluation and management of insomnia in children with autism. J Clin Sleep Med 2020; 16:989-990. [PMID: 32125270 DOI: 10.5664/jcsm.8426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals-Cleveland Medical Center, Cleveland, Ohio
| | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vishesh K Kapur
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Alberto R Ramos
- Department of Neurology, University of Miami, Miami, Florida
| | | | | | - Rochelle S Zak
- Sleep Disorders Center, University of California, San Francisco, California
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17
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Dauvilliers Y, Lammers GJ, Lecendreux M, Plazzi G, Maski K, Kansagra S, Mignot E, Menno D, Wang Y, Rosen CL. 0950 Effects of Sodium Oxybate (SXB) on Body Mass Index (BMI) in Pediatric Patients With Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Obesity is a common comorbidity of pediatric narcolepsy. SXB is a standard of care for cataplexy and excessive daytime sleepiness in narcolepsy. BMI decreases have been observed with SXB treatment. We examined BMI changes by BMI percentile category at study entry in pediatric participants.
Methods
Participants were aged 7-17 years with narcolepsy with cataplexy. SXB-naive participants were titrated to an optimal SXB dose, then entered a 2-week stable-dose period; participants taking SXB at study entry entered a 3-week stable-dose period. After a 2-week, placebo-controlled, double-blind, randomized-withdrawal period, all participants entered an open-label safety period (total study duration: ≤1 year). Weight categories were defined using BMI percentiles at study entry based on growth charts from the Centers for Disease Control. BMI percentile was categorized as: underweight (<5%ile), normal (≥5%ile to <85%ile), overweight (≥85%ile to<95%ile), obese (≥95%ile).
Results
Among SXB-naive participants, median (Q1, Q3) BMI percentile decreased with SXB treatment in participants who were categorized as normal-weight and overweight/obese at baseline (normal-weight, n=16: 76.5 [57.8, 82.4] at baseline, 35.0 [20.5, 62.6] at week 52; overweight/obese, n=35: 97.6 [93.6, 99.1] at baseline, 86.7 [72.5, 97.9] at week 52). Of participants who were normal-weight at baseline, 15/16 remained normal-weight at week 52. Of participants who were overweight at baseline, 9/10 were normal-weight at week 52. Of participants who were obese at baseline, 7/25 were normal-weight, 3/25 were overweight, and 15/25 remained obese at week 52. Among participants taking SXB at study entry, BMI percentile decreased, but to a lesser degree. Decreased weight or weight loss was reported as an adverse event in 13 participants (11 SXB-naive; 1 participant withdrew). Four participants became underweight during the study but returned to normal-weight by study end.
Conclusion
Decreases in BMI percentile and category were observed with SXB treatment in pediatric participants with narcolepsy.
Support
Jazz Pharmaceuticals
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Affiliation(s)
- Y Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, FRANCE
| | - G J Lammers
- Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, NETHERLANDS
| | - M Lecendreux
- Centre Pédiatrique des Pathologies du Sommeil, Hôpital Robert Debré, Paris, FRANCE
| | - G Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITALY
| | - K Maski
- Department of Neurology, Boston Children’s Hospital, Boston, MA
| | - S Kansagra
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - E Mignot
- Stanford Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - D Menno
- Jazz Pharmaceuticals, Inc., Philadelphia, PA
| | - Y Wang
- Jazz Pharmaceuticals, Inc., Palo Alto, CA
| | - C L Rosen
- Division of Pediatric Pulmonology and Sleep Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies & Children’s Hospital, Cleveland, OH
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18
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Chen C, Rosen CL, Ruoff C, Boyce LH, Parvataneni R, Zomorodi K, Brantley S, Sale M, Plazzi G. Population and Noncompartmental Pharmacokinetics of Sodium Oxybate Support Weight-Based Dosing in Children and Adolescents With Narcolepsy With Cataplexy. Clin Transl Sci 2020; 13:932-940. [PMID: 32216084 PMCID: PMC7485950 DOI: 10.1111/cts.12780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/09/2020] [Indexed: 11/29/2022] Open
Abstract
The pharmacokinetics (PKs) of sodium oxybate (SXB) was evaluated in a subset of participants from a study of SXB treatment in children (aged 7–11 years; n = 11) and adolescents (aged 12–17 years; n = 18) with narcolepsy with cataplexy. PK evaluation was conducted over 2 nights during the period when participants received a stable nightly SXB dose. The SXB dose on night 1 was half of night 2 and was administered in two equally divided doses: dose 1 was administered > 2 hours after the evening meal, and dose 2 was administered ≥ 4 hours after dose 1. Noncompartmental PK analysis demonstrated higher plasma concentrations post‐dose 2 vs. post‐dose 1, higher than dose‐proportional increases in area under the concentration‐time curve from 0 to 4 hours (AUC0–4h) after dose 1, indicating nonlinear clearance, and better correlation between exposure and mg/kg than exposure and gram dose. To confirm the noncompartmental findings, identify factors affecting SXB PK, and compare with prior results in adults, a population PK (PopPK) model was established combining PK data from the current study with prior data from adults (132 healthy volunteers and 13 with narcolepsy). A two‐compartment PopPK model with first‐order absorption and nonlinear clearance from the central compartment described the data well. PopPK identified weight as the main intrinsic factor and food as the main extrinsic factor affecting SXB PK, and predicts similar PK profiles on a mg/kg basis across ages. These results, along with previously reported efficacy and safety outcomes, support weight‐based SXB dose initiation in pediatric patients.
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Affiliation(s)
- Cuiping Chen
- Jazz Pharmaceuticals, Palo Alto, California, USA
| | - Carol L Rosen
- Division of Pediatric Pulmonology and Sleep Medicine, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Chad Ruoff
- Stanford University Sleep Medicine Center, Redwood City, California, USA
| | - Leslie H Boyce
- Raleigh Neurology Associates, Raleigh, North Carolina, USA
| | | | | | | | - Mark Sale
- Nuventra Pharma Sciences, Durham, North Carolina, USA
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCSS, Istituto delle Scienze Neurologiche, Bologna, Italy
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19
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Wang R, Bakker JP, Chervin RD, Garetz SL, Hassan F, Ishman SL, Mitchell RB, Morrical MG, Naqvi SK, Radcliffe J, Riggan EI, Rosen CL, Ross K, Rueschman M, Tapia IE, Taylor HG, Zopf DA, Redline S. Pediatric Adenotonsillectomy Trial for Snoring (PATS): protocol for a randomised controlled trial to evaluate the effect of adenotonsillectomy in treating mild obstructive sleep-disordered breathing. BMJ Open 2020; 10:e033889. [PMID: 32179560 PMCID: PMC7073822 DOI: 10.1136/bmjopen-2019-033889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/22/2019] [Accepted: 02/03/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Mild obstructive sleep-disordered breathing (oSDB), characterised by habitual snoring without frequent apnoeas and hypopnoeas on polysomnography, is prevalent in children and commonly treated with adenotonsillectomy (AT). However, the absence of high-level evidence addressing the role of AT in improving health and behavioural outcomes has contributed to significant geographical variations in care and potential for surgery to be both overused and underused. METHODS AND ANALYSIS The Pediatric Adenotonsillectomy Trial for Snoring (PATS) is a single-blinded, multicentre randomised controlled trial designed to evaluate the effect of AT in treating mild oSDB. Four hundred sixty eligible children, aged 3.0-12.9 years old, will be randomised to either early adenotonsillectomy or to watchful waiting with supportive care (WWSC) with a 1:1 ratio. The study's coprimary endpoints are (1) change from baseline in executive behaviour relating to self-regulation and organisation skills as measured by the Behavioural Rating Inventory of Executive Function (BRIEF) Global Composite Score (GEC); and (2) change from baseline in vigilance as measured on the Go-No-Go (GNG) signal detection parameter (d-prime). A mixed effects model will be used to compare changes in the BRIEF GEC score and GNG score at 6 and 12 months from baseline between the AT arm and the WWSC arm. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board (IRB) at Children's Hospital of Philadelphia (CHOP) on 3 October 2014 (14-0 11 214). The approval of CHOP as the central IRB of record was granted on 29 February 2016. The results will be published in peer-reviewed journals and presented at academic conferences. The data collected from the PATS study will be deposited in a repository (National Sleep Research Resource, sleepdata.org) after completion of the study to maximise use by the scientific community. TRIAL REGISTRATION NUMBER NCT02562040; Pre-results.
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Affiliation(s)
- Rui Wang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessie P Bakker
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan L Garetz
- Sleep Disorders Center and Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Fauziya Hassan
- Sleep Disorders Center and Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stacey L Ishman
- Divisions of Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ron B Mitchell
- Department of Otolaryngology, Head and Neck Surgery, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| | - Michael G Morrical
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Syed K Naqvi
- Department of Otolaryngology, Head and Neck Surgery, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| | - Jerilynn Radcliffe
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Emily I Riggan
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Carol L Rosen
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kristie Ross
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Rueschman
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ignacio E Tapia
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - H Gerry Taylor
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - David A Zopf
- Sleep Disorders Center and Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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20
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Kancherla BS, Upender R, Collen JF, Rishi MA, Sullivan SS, Ahmed O, Berneking M, Flynn-Evans EE, Peters BR, Abbasi-Feinberg F, Aurora RN, Carden KA, Kirsch DB, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Ramar K, Rosen CL, Rowley JA, Shelgikar AV, Gurubhagavatula I. Sleep, fatigue and burnout among physicians: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2020; 16:803-805. [PMID: 32108570 DOI: 10.5664/jcsm.8408] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
None Physician burnout is a serious and growing threat to the medical profession and may undermine efforts to maintain a sufficient physician workforce to care for the growing and aging patient population in the United States. Burnout involves a host of complex underlying associations and potential for risk. While prevalence is unknown, recent estimates of physician burnout are quite high, approaching 50% or more, with midcareer physicians at highest risk. Sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of burnout. Maladaptive attitudes regarding sleep and endurance also may increase the risk for sleep deprivation among attending physicians. While duty-hour restrictions have been instituted to protect sleep opportunity among trainees, virtually no such effort has been made for attending physicians who have completed their training or practicing physicians in nonacademic settings. It is the position of the American Academy of Sleep Medicine that a critical need exists to evaluate the roles of sleep disruption, sleep deprivation, and circadian misalignment in physician well-being and burnout. Such evaluation may pave the way for the development of effective countermeasures that promote healthy sleep, with the goal of reducing burnout and its negative impacts such as a shrinking physician workforce, poor physician health and functional outcomes, lower quality of care, and compromised patient safety.
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Affiliation(s)
- Binal S Kancherla
- Department of Pediatrics, Division of Pediatric Pulmonology, Texas Children's Hospital - Baylor College of Medicine, Houston, Texas
| | - Raghu Upender
- Department of Neurology, Division of Sleep Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Jacob F Collen
- Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Muhammad Adeel Rishi
- Department of Pulmonology, Critical Care and Sleep Medicine, Mayo Clinic, Eau Claire, Wisconsin
| | | | - Omer Ahmed
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, California
| | - Brandon R Peters
- Sleep Disorders Center, Virginia Mason Medical Center, Seattle, Washington
| | | | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | | | | | - Raman K Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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21
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Rosen IM, Aurora RN, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Abbasi-Feinberg F, Kristo DA, Martin JL, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV. Chronic Opioid Therapy and Sleep: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2019; 15:1671-1673. [PMID: 31739858 PMCID: PMC6853382 DOI: 10.5664/jcsm.8062] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/23/2023]
Abstract
None There is a complex relationship among opioids, sleep and daytime function. Patients and medical providers should be aware that chronic opioid therapy can alter sleep architecture and sleep quality as well as contribute to daytime sleepiness. It is also important for medical providers to be cognizant of other adverse effects of chronic opioid use including the impact on respiratory function during sleep. Opioids are associated with several types of sleep-disordered breathing, including sleep-related hypoventilation, central sleep apnea (CSA), and obstructive sleep apnea (OSA). Appropriate screening, diagnostic testing, and treatment of opioid-associated sleep-disordered breathing can improve patients' health and quality of life. Collaboration among medical providers is encouraged to provide high quality, patient-centered care for people who are treated with chronic opioid therapy.
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Affiliation(s)
- Ilene M. Rosen
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R. Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Kelly A. Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Raman K. Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jennifer L. Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J. Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V. Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - American Academy of Sleep Medicine Board of Directors
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Sleep Medicine, Atrium Health, Charlotte, North Carolina
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Millennium Physician Group, Fort Myers, Florida
- University of Pittsburgh, Pittsburgh, Pennsylvania
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
- Wayne State University, Detroit, Michigan
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
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22
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Hodges E, Marcus CL, Kim JY, Xanthopoulos M, Shults J, Giordani B, Beebe DW, Rosen CL, Chervin RD, Mitchell RB, Katz ES, Gozal D, Redline S, Elden L, Arens R, Moore R, Taylor HG, Radcliffe J, Thomas NH. Depressive symptomatology in school-aged children with obstructive sleep apnea syndrome: incidence, demographic factors, and changes following a randomized controlled trial of adenotonsillectomy. Sleep 2019; 41:5096052. [PMID: 30212861 DOI: 10.1093/sleep/zsy180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Depressive symptoms following adenotonsillectomy (AT) relative to controls were examined in children with obstructive sleep apnea syndrome (OSAS). Methods The Childhood Adenotonsillectomy Trial (CHAT) multisite study examined the impact of AT in 453 children aged 5 to 9.9 years with polysomnographic evidence of OSAS without prolonged desaturation, randomized to early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). One hundred seventy-six children (eAT n = 83; WWSC n = 93) with complete evaluations for depressive symptomatology between baseline and after a 7-month intervention period were included in this secondary analysis. Results Exact binomial test assessed proportion of depressive symptomatology relative to norms, while effects of AT and OSAS resolution were assessed through linear quantile mixed-models. Treatment group assignment did not significantly impact depression symptoms, although self-reported depression symptoms improved over time (p < 0.001). Resolution of OSAS symptoms demonstrated a small interaction effect in an unexpected direction, with more improvement in parent ratings of anxious/depressed symptoms for children without resolution (p = 0.030). Black children reported more severe depressive symptoms (p = 0.026) and parents of overweight/obese children reported more withdrawn/depressed symptoms (p = 0.004). Desaturation nadir during sleep was associated with self-report depressed (r = -0.17, p = 0.028), parent-reported anxious/depressed (r = -0.15, p = 0.049), and withdrawn/depressed (r = -0.24, p = 0.002) symptoms. Conclusions Increased risk for depressed and withdrawn/depressed symptoms was detected among children with OSAS, and different demographic variables contributed to risk in self-reported and parent-reported depression symptoms. Arterial oxygen desaturation nadir during sleep was strongly associated with depressed symptoms. However, despite improvements in child-reported depressed symptoms over time, changes were unrelated to either treatment group or OSAS resolution status. Trials Registration Childhood Adenotonsillectomy Study for Children with OSAS (CHAT), https://clinicaltrials.gov/show/NCT00560859, NCT00560859.
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Affiliation(s)
- Elise Hodges
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Carole L Marcus
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA.,Sleep Center and Center for Human Phenomic Science, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ji Young Kim
- Sleep Center and Center for Human Phenomic Science, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melissa Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justine Shults
- Center for Human Phenomic Science, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bruno Giordani
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Dean W Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Carol L Rosen
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ronald D Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Ron B Mitchell
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern and Children's Medical Center Dallas, Dallas, TX
| | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA
| | - David Gozal
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Lisa Elden
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York City, NY
| | - Renee Moore
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - H Gerry Taylor
- Center for Behavioral Health, Nationwide Children's Hospital Research Institute, Columbus, OH.,Department of Pediatrics, Ohio State University, Columbus, OH
| | - Jerilynn Radcliffe
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA.,Center for Human Phenomic Science, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Nina H Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA.,Center for Human Phenomic Science, The Children's Hospital of Philadelphia, Philadelphia, PA
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23
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Ruhl AP, Sadreameli SC, Allen JL, Bennett DP, Campbell AD, Coates TD, Diallo DA, Field JJ, Fiorino EK, Gladwin MT, Glassberg JA, Gordeuk VR, Graham LM, Greenough A, Howard J, Kato GJ, Knight-Madden J, Kopp BT, Koumbourlis AC, Lanzkron SM, Liem RI, Machado RF, Mehari A, Morris CR, Ogunlesi FO, Rosen CL, Smith-Whitley K, Tauber D, Terry N, Thein SL, Vichinsky E, Weir NA, Cohen RT. Identifying Clinical and Research Priorities in Sickle Cell Lung Disease. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2019; 16:e17-e32. [PMID: 31469310 PMCID: PMC6812163 DOI: 10.1513/annalsats.201906-433st] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Pulmonary complications of sickle cell disease (SCD) are diverse and encompass acute and chronic disease. The understanding of the natural history of pulmonary complications of SCD is limited, no specific therapies exist, and these complications are a primary cause of morbidity and mortality.Methods: We gathered a multidisciplinary group of pediatric and adult hematologists, pulmonologists, and emergency medicine physicians with expertise in SCD-related lung disease along with an SCD patient advocate for an American Thoracic Society-sponsored workshop to review the literature and identify key unanswered clinical and research questions. Participants were divided into four subcommittees on the basis of expertise: 1) acute chest syndrome, 2) lower airways disease and pulmonary function, 3) sleep-disordered breathing and hypoxia, and 4) pulmonary vascular complications of SCD. Before the workshop, a comprehensive literature review of each subtopic was conducted. Clinically important questions were developed after literature review and were finalized by group discussion and consensus.Results: Current knowledge is based on small, predominantly observational studies, few multicenter longitudinal studies, and even fewer high-quality interventional trials specifically targeting the pulmonary complications of SCD. Each subcommittee identified the three or four most important unanswered questions in their topic area for researchers to direct the next steps of clinical investigation.Conclusions: Important and clinically relevant questions regarding sickle cell lung disease remain unanswered. High-quality, multicenter, longitudinal studies and randomized clinical trials designed and implemented by teams of multidisciplinary clinician-investigators are needed to improve the care of individuals with SCD.
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24
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Ayache M, Rosen CL, Chiang A, Little JA, Strohl KP. Overnight oxygen desaturation index in sickle cell disease: prediction of sleep apnea. Sleep Med 2019; 64:12-14. [PMID: 31655319 DOI: 10.1016/j.sleep.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mirna Ayache
- Division of Pulmonary, Critical Care and Sleep Medicine, Metrohealth Medical Center, United States.
| | - Carol L Rosen
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States; Division of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children's Hospital, United States
| | - Ambrose Chiang
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States
| | - Jane A Little
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes Veterans Affair Medical Center, United States
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25
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Mignot E, Rosen CL, Menno D, Wang G, Profant J, Dauvilliers Y. 0766 Evaluation Of Cataplexy-free Days In Children/Adolescents With Narcolepsy With Cataplexy Treated With Sodium Oxybate. Sleep 2019. [DOI: 10.1093/sleep/zsz067.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Palo Alto, CA, USA
| | - Carol L Rosen
- Division of Pediatric Pulmonology and Sleep Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies & Children’s Hospital, Cleveland, OH, USA
| | - Diane Menno
- Jazz Pharmaceuticals Inc., Palo Alto, CA, USA
| | - Grace Wang
- Jazz Pharmaceuticals Inc., Palo Alto, CA, USA
| | | | - Yves Dauvilliers
- Unité du Sommeil, CHRU Gui de Chauliac, INSERM U1061, Montpellier, France
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26
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Rosen IM, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Aurora RN, Kristo DA, Martin JL, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV. Clinical Use of a Home Sleep Apnea Test: An Updated American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2018; 14:2075-2077. [PMID: 30518456 DOI: 10.5664/jcsm.7540] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 01/09/2023]
Abstract
ABSTRACT The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. It is the position of the American Academy of Sleep Medicine (AASM) that only a medical provider can diagnose medical conditions such as OSA and primary snoring. Throughout this statement, the term "medical provider" refers to a licensed physician and any other health care professional who is licensed to practice medicine in accordance with state licensing laws and regulations. A home sleep apnea test (HSAT) is an alternative to polysomnography for the diagnosis of OSA in uncomplicated adults presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. It is also the position of the AASM that: the need for, and appropriateness of, an HSAT must be based on the patient's medical history and a face-to-face examination by a medical provider, either in person or via telemedicine; an HSAT is a medical assessment that must be ordered by a medical provider to diagnose OSA or evaluate treatment efficacy; an HSAT should not be used for general screening of asymptomatic populations; diagnosis, assessment of treatment efficacy, and treatment decisions must not be based solely on automatically scored HSAT data, which could lead to sub-optimal care that jeopardizes patient health and safety; and the raw data from the HSAT device must be reviewed and interpreted by a physician who is either board-certified in sleep medicine or overseen by a board-certified sleep medicine physician.
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Affiliation(s)
- Ilene M Rosen
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas B Kirsch
- Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | | | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | | | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
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27
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Willen SM, Rodeghier M, Rosen CL, DeBaun MR. Sleep disordered breathing does not predict acute severe pain episodes in children with sickle cell anemia. Am J Hematol 2018; 93:478-485. [PMID: 29266432 DOI: 10.1002/ajh.25013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/09/2022]
Abstract
Conflicting evidence has suggested that low mean nocturnal hemoglobin oxygen saturation (SpO2 ) predicts future hospital days for acute severe pain in children with sickle cell anemia (SCA). In an unselected multicenter prospective cohort study, we tested the hypothesis that either low mean nocturnal SpO2 or high obstructive apnea-hypopnea index (OAHI; the number of obstructive apneas and hypopneas with ≥ 3% desaturation or arousal per hour of sleep) or high oxygen desaturation index (ODI; number of ≥ 3% desaturation from baseline saturation per hour of sleep) is associated with increased incidence rates of pain. A total of 140 children with SCA with a median age of 10.8 years (interquartile range 7.2) were followed for a median of 4.9 years (interquartile range 1.8). Overnight polysomnography evaluations at baseline health exam were measured and adjudicated centrally. Multivariable models created in two steps were included. First, all plausible covariates were included in a screening model. Subsequently, covariates meeting level of statistical significance of P < .20 were included in the final model. Contrary to our hypothesis, higher (but not lower) mean nocturnal SpO2 was associated with higher rates of pain episodes (Incidence rate ratio (IRR) 1.10, 95% CI [1.03-1.18], P = .004). Higher log OAHI did not pass screening criteria. Higher log ODI was not significantly associated with higher rates of pain episodes (IRR 0.93, 95% CI [0.82-1.06], P = .28). Neither low nocturnal SpO2, higher OAHI, nor higher ODI were associated with clinically relevant increased incidence rates of acute severe pain episodes.
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Affiliation(s)
- Shaina M. Willen
- Department of Pediatrics, Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | | | - Carol L. Rosen
- Department of Pediatrics, Division of Pediatric Pulmonary, Allergy/Immunology and Sleep; University Hospitals-Cleveland Medical Center, Rainbow Babies and Children's Hospitals; Cleveland Ohio
| | - Michael R. DeBaun
- Department of Pediatrics, Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
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28
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Malhotra RK, Kirsch DB, Kristo DA, Olson EJ, Aurora RN, Carden KA, Chervin RD, Martin JL, Ramar K, Rosen CL, Rowley JA, Rosen IM. Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2018; 14:1245-1247. [PMID: 29991439 DOI: 10.5664/jcsm.7234] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/07/2018] [Indexed: 11/13/2022]
Abstract
ABSTRACT The diagnostic criteria for obstructive sleep apnea (OSA) in adults, as defined in the International Classification of Sleep Disorders, Third Edition, requires an increased frequency of obstructive respiratory events demonstrated by in-laboratory, attended polysomnography (PSG) or a home sleep apnea test (HSAT). However, there are currently two hypopnea scoring criteria in The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (AASM Scoring Manual). This dichotomy results in differences among laboratory reports, patient treatments and payer policies. Confusion occurs regarding recognizing and scoring "arousal-based respiratory events" during OSA testing. "Arousal-based scoring" recognizes hypopneas associated with electroencephalography-based arousals, with or without significant oxygen desaturation, when calculating an apnea-hypopnea index (AHI), or it includes respiratory effort-related arousals (RERAs), in addition to hypopneas and apneas, when calculating a respiratory disturbance index (RDI). Respiratory events associated with arousals, even without oxygen desaturation, cause significant, and potentially dangerous, sleep apnea symptoms. During PSG, arousal-based respiratory scoring should be performed in the clinical evaluation of patients with suspected OSA, especially in those patients with symptoms of excessive daytime sleepiness, fatigue, insomnia, or other neurocognitive symptoms. Therefore, it is the position of the AASM that the RECOMMENDED AASM Scoring Manual scoring criteria for hypopneas, which includes diminished airflow accompanied by either an arousal or ≥ 3% oxygen desaturation, should be used to calculate the AHI. If the ACCEPTABLE AASM Scoring Manual criteria for scoring hypopneas, which includes only diminished airflow plus ≥ 4% oxygen desaturation (and does not allow for arousal-based scoring alone), must be utilized due to payer policy requirements, then hypopneas as defined by the RECOMMENDED AASM Scoring Manual criteria should also be scored. Alternatively, the AASM Scoring Manual includes an option to report an RDI which also provides an assessment of the sleep-disordered breathing that results in arousal from sleep. Furthermore, given the inability of most HSAT devices to capture arousals, a PSG should be performed in any patient with an increased risk for OSA whose HSAT is negative. If the PSG yields an AHI of 5 or more events/h, or if the RDI is greater than or equal to 5 events/h, then treatment of symptomatic patients is recommended to improve quality of life, limit neurocognitive symptoms, and reduce accident risk.
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Affiliation(s)
| | - Douglas B Kirsch
- Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina
| | | | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Ronald D Chervin
- University of Michigan Sleep Disorders Center, Ann Arbor, Michigan
| | - Jennifer L Martin
- Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Ilene M Rosen
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Plazzi G, Ruoff C, Lecendreux M, Dauvilliers Y, Rosen CL, Black J, Parvataneni R, Guinta D, Wang YG, Mignot E. Treatment of paediatric narcolepsy with sodium oxybate: a double-blind, placebo-controlled, randomised-withdrawal multicentre study and open-label investigation. The Lancet Child & Adolescent Health 2018; 2:483-494. [DOI: 10.1016/s2352-4642(18)30133-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 10/16/2022]
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30
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Khosla S, Deak MC, Gault D, Goldstein CA, Hwang D, Kwon Y, O'Hearn D, Schutte-Rodin S, Yurcheshen M, Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA. Consumer Sleep Technology: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2018; 14:877-880. [PMID: 29734997 DOI: 10.5664/jcsm.7128] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/13/2022]
Abstract
ABSTRACT Consumer sleep technologies (CSTs) are widespread applications and devices that purport to measure and even improve sleep. Sleep clinicians may frequently encounter CST in practice and, despite lack of validation against gold standard polysomnography, familiarity with these devices has become a patient expectation. This American Academy of Sleep Medicine position statement details the disadvantages and potential benefits of CSTs and provides guidance when approaching patient-generated health data from CSTs in a clinical setting. Given the lack of validation and United States Food and Drug Administration (FDA) clearance, CSTs cannot be utilized for the diagnosis and/or treatment of sleep disorders at this time. However, CSTs may be utilized to enhance the patient-clinician interaction when presented in the context of an appropriate clinical evaluation. The ubiquitous nature of CSTs may further sleep research and practice. However, future validation, access to raw data and algorithms, and FDA oversight are needed.
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Affiliation(s)
- Seema Khosla
- North Dakota Center for Sleep, Fargo, North Dakota
| | | | - Dominic Gault
- Greenville Health System, University of South Carolina, Greenville, South Carolina
| | | | - Dennis Hwang
- Southern California Permanente Medical Group, Kaiser Permanente Fontana Sleep Disorders Center, Fontana, California
| | - Younghoon Kwon
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Daniel O'Hearn
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sharon Schutte-Rodin
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Yurcheshen
- UR Medicine Sleep Center, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ilene M Rosen
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas B Kirsch
- Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina
| | - Ronald D Chervin
- University of Michigan Sleep Disorders Center, Ann Arbor, Michigan
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | | | - Raman K Malhotra
- Washington University Sleep Center, Washington University, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Health System, North Hills, California.,David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
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31
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Rosen CL, Ruoff C, Boyce LH, Chen C, Wang Y, Parvataneni R, Zomorodi K, Plazzi G. 0837 Pharmacokinetics of Sodium Oxybate in Children and Adolescents with Narcolepsy with Cataplexy. Sleep 2018. [DOI: 10.1093/sleep/zsy061.836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C L Rosen
- Division of Pediatric Pulmonology and Sleep Medicine, Rainbow Babies & Children’s Hospital, Cleveland, OH
| | - C Ruoff
- Stanford University Sleep Medicine Center, Redwood City, CA
| | - L H Boyce
- Raleigh Neurology Associates, Raleigh, NC
| | - C Chen
- Jazz Pharmaceuticals, Palo Alto, CA
| | - Y Wang
- Jazz Pharmaceuticals, Palo Alto, CA
| | | | | | - G Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITALY
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32
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Hodges E, Marcus CL, Kim J, Xanthopoulos M, Shults J, Giordani B, Beebe DW, Rosen CL, Chervin RD, Mitchell RB, Katz ES, Gozal D, Redline S, Radcliffe J, Thomas NH. 0754 Depressive Symptomatology in School-Aged Children with Obstructive Sleep Apnea Syndrome: Incidence, Demographic Factors, and Changes Following a Randomized Controlled Trial of Adenotonsillectomy. Sleep 2018. [DOI: 10.1093/sleep/zsy061.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Hodges
- Department of Psychiatry and Psychology, University of Michigan, Ann Arbor, MI
| | - C L Marcus
- Sleep Center, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - J Kim
- Sleep Center Biostatistical and Informatics Core, Center for Human Phenomic Science, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - M Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - J Shults
- Biostatistical and Informatics Core, Center for Human Phenomic Science, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - B Giordani
- Department of Psychiatry and Psychology, University of Michigan, Ann Arbor, MI
| | - D W Beebe
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - C L Rosen
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Boston, MA
| | - R D Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - R B Mitchell
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern and Children’s Medical Center Dallas, Dallas, TX
| | - E S Katz
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA
| | - D Gozal
- Department of Pediatrics, The University of Chicago, Chicago, IL
| | - S Redline
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - J Radcliffe
- Department of Pediatrics, Children’s Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - N H Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Behavioral Neuroscience Core, Center for Human Phenomic Science, The Children’s Hospital of Philadelphia, Philadelphia, PA
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Mong LE, Rosen CL. 1157 The Sabbath Sleep-in: an adolescent female with delayed sleep phase disorder, hypersomnolence, and a problematic multiple sleep latency test. Sleep 2018. [DOI: 10.1093/sleep/zsy063.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura E Mong
- Sleep Medicine Fellow, University Hospitals Cleveland Medical Center
| | - Carol L Rosen
- Medical Director, Pediatric Sleep Center Pediatric Pulmonology and Sleep Medicine Rainbow Babies and Children’s Hospital Professor of Pediatrics Case Western Reserve University
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34
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Ramar K, Rosen IM, Kirsch DB, Chervin RD, Carden KA, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA. Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2018; 14:679-681. [PMID: 29609727 DOI: 10.5664/jcsm.7070] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/13/2022]
Abstract
ABSTRACT The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have differential effects, with variable efficacy and side effects in the treatment of OSA. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety. OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs, and patients with OSA should discuss their treatment options with a licensed medical provider at an accredited sleep facility. Further research is needed to understand the functionality of medical cannabis extracts before recommending them as a treatment for OSA.
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Affiliation(s)
- Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ilene M Rosen
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas B Kirsch
- Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina
| | - Ronald D Chervin
- University of Michigan Sleep Disorders Center, Ann Arbor, Michigan
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - R Nisha Aurora
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Jennifer L Martin
- Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
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35
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Berneking M, Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA, Gurubhagavatula I. The Risk of Fatigue and Sleepiness in the Ridesharing Industry: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2018; 14:683-685. [PMID: 29609728 DOI: 10.5664/jcsm.7072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/13/2022]
Abstract
ABSTRACT The ridesharing-or ride-hailing-industry has grown exponentially in recent years, transforming quickly into a fee-for-service, unregulated taxi industry. While riders are experiencing the benefits of convenience and affordability, two key regulatory and safety issues deserve consideration. First, individuals who work as drivers in the ridesharing industry are often employed in a primary job, and they work as drivers during their "off" time. Such a schedule may lead to driving after extended periods of wakefulness or during nights, both of which are factors that increase the risk of drowsy driving accidents. Second, these drivers are often employed as "independent contractors," and therefore they are not screened for medical problems that can reduce alertness, such as obstructive sleep apnea. Some ridesharing companies now require a rest period after an extended driving shift. This measure is encouraging, but it is insufficient to impact driving safety appreciably, particularly since many of these drivers are already working extended hours and tend to drive at non-traditional times when sleepiness may peak. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that fatigue and sleepiness are inherent safety risks in the ridesharing industry. The AASM calls on ridesharing companies, government officials, medical professionals, and law enforcement officers to work together to address this public safety risk. A collaborative effort is necessary to understand and track the scope of the problem, provide relevant education, and mitigate the risk through thoughtful regulation and effective fatigue risk management systems.
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Affiliation(s)
| | - Ilene M Rosen
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas B Kirsch
- Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina
| | - Ronald D Chervin
- University of Michigan Sleep Disorders Center, Ann Arbor, Michigan
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - R Nisha Aurora
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Jennifer L Martin
- Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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36
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Willen SM, Rodeghier M, Strunk RC, Bacharier LB, Rosen CL, Kirkham FJ, DeBaun MR, Cohen RT. Aeroallergen sensitization predicts acute chest syndrome in children with sickle cell anaemia. Br J Haematol 2018; 180:571-577. [PMID: 29363738 DOI: 10.1111/bjh.15076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/21/2017] [Indexed: 12/15/2022]
Abstract
Asthma is associated with higher rates of acute chest syndrome (ACS) and vaso-occlusive pain episodes among children with sickle cell anaemia (SCA). Aeroallergen sensitization is a risk factor for asthma. We hypothesized that aeroallergen sensitization is associated with an increased incidence of hospitalizations for ACS and pain. Participants in a multicentre, longitudinal cohort study, aged 4-18 years with SCA, underwent skin prick testing to ten aeroallergens. ACS and pain episodes were collected from birth until the end of the follow-up period. The number of positive skin tests were tested for associations with prospective rates of ACS and pain. Multivariable models demonstrated additive effects of having positive skin tests on future rates of ACS (incidence rate ratio (IRR) for each positive test 1·23, 95% confidence interval [CI] 1·11-1·36, P < 0·001). Aeroallergen sensitization was not associated with future pain (IRR 1·14, 95%CI 0·97-1·33, P = 0·11). Our study demonstrated that children with SCA and aeroallergen sensitization are at increased risk for future ACS. Future research is needed to determine whether identification of specific sensitizations and allergen avoidance and treatment reduce the risk of ACS for children with SCA.
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Affiliation(s)
- Shaina M Willen
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Robert C Strunk
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Leonard B Bacharier
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Carol L Rosen
- Department of Pediatrics, Division of Pediatric Pulmonary, Allergy/Immunology and Sleep, University Hospitals-Cleveland Medical Center, Rainbow Babies and Children's Hospitals, Cleveland, OH, USA
| | - Fenella J Kirkham
- Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Michael R DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robyn T Cohen
- Department of Pediatrics, Division of Pediatric Pulmonary & Allergy, Boston University School of Medicine, Boston, MA, USA
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37
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Affiliation(s)
- Lourdes M. DelRosso
- Sleep Disorders Center, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
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38
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Willen SM, Rodeghier M, Strunk RC, Rosen CL, Kirkham FJ, Field JJ, DeBaun MR, Cohen RT. Airway Hyperresponsiveness Does Not Predict Morbidity in Children with Sickle Cell Anemia. Am J Respir Crit Care Med 2017; 195:1533-1534. [PMID: 28569575 DOI: 10.1164/rccm.201610-1970le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shaina M Willen
- 1 Vanderbilt University School of Medicine Nashville, Tennessee.,2 Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee
| | | | - Robert C Strunk
- 4 Washington University School of Medicine St Louis, Missouri
| | - Carol L Rosen
- 5 University Hospitals-Cleveland Medical Center Cleveland, Ohio
| | | | | | - Michael R DeBaun
- 1 Vanderbilt University School of Medicine Nashville, Tennessee.,2 Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee
| | - Robyn T Cohen
- 8 Boston University School of Medicine Boston, Massachusetts
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39
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Thomas NH, Xanthopoulos MS, Kim JY, Shults J, Escobar E, Giordani B, Hodges E, Chervin RD, Paruthi S, Rosen CL, Taylor GH, Arens R, Katz ES, Beebe DW, Redline S, Radcliffe J, Marcus CL. Effects of Adenotonsillectomy on Parent-Reported Behavior in Children With Obstructive Sleep Apnea. Sleep 2017; 40:2982587. [PMID: 28199697 DOI: 10.1093/sleep/zsx018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives The childhood obstructive sleep apnea syndrome (OSAS) is associated with behavioral abnormalities. Studies on the effects of OSAS treatment on behavior are conflicting, with few studies using a randomized design. Further, studies may be confounded by the inclusion of behavioral outcome measures directly related to sleep. The objective of this study was to determine the effect of adenotonsillectomy on behavior in children with OSAS. We hypothesized that surgery would improve behavioral ratings, even when sleep symptom items were excluded from the analysis. Methods This was a secondary analysis of Child Behavior Checklist (CBCL) data, with and without exclusion of sleep-specific items, from the Childhood Adenotonsillectomy Trial (CHAT). CBCL was completed by caregivers of 380 children (7.0+1.4 [range 5-9] years) with OSAS randomized to early adenotonsillectomy (eAT) versus 7 months of watchful waiting with supportive care (WWSC). Results There was a high prevalence of behavioral problems at baseline; 16.6% of children had a Total Problems score in the clinically abnormal range. At follow-up, there were significant improvements in Total Problems (p < .001), Internalizing Behaviors (p = .04), Somatic Complaints (p = .01), and Thought Problems (p = .01) in eAT vs. WWSC participants. When specific sleep-related question items were removed from the analysis, eAT showed an overall improvement in Total (p = .02) and Other (p = .01) problems. Black children had less improvement in behavior following eAT than white children, but this difference attenuated when sleep-related items were excluded. Conclusions This large, randomized trial showed that adenotonsillectomy for OSAS improved parent-rated behavioral problems, even when sleep-specific behavioral issues were excluded from the analysis.
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Affiliation(s)
| | - Melissa S Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences.,Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ji Young Kim
- Biostatistical and Informatics Cores of the Clinical and Translational Research Center and
| | - Justine Shults
- Biostatistical and Informatics Cores of the Clinical and Translational Research Center and
| | - Emma Escobar
- Biostatistical and Informatics Cores of the Clinical and Translational Research Center and
| | - Bruno Giordani
- Department of Psychiatry and Psychology, University of Michigan
| | - Elise Hodges
- Department of Psychiatry and Psychology, University of Michigan
| | - Ronald D Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan
| | | | - Carol L Rosen
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine
| | - Gerry H Taylor
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine
| | - Raanan Arens
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital
| | - Dean W Beebe
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Jerilynn Radcliffe
- Neurobehavioral and.,Children's Hospital of Philadelphia, University of Pennsylvania
| | - Carole L Marcus
- Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA.,Children's Hospital of Philadelphia, University of Pennsylvania
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40
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Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA. Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2017; 13:1205-1207. [PMID: 28942762 DOI: 10.5664/jcsm.6774] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. It is the position of the American Academy of Sleep Medicine (AASM) that only a physician can diagnose medical conditions such as OSA and primary snoring. Throughout this statement, the term "physician" refers to a medical provider who is licensed to practice medicine. A home sleep apnea test (HSAT) is an alternative to polysomnography for the diagnosis of OSA in uncomplicated adults presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. It is also the position of the AASM that: the need for, and appropriateness of, an HSAT must be based on the patient's medical history and a face-to-face examination by a physician, either in person or via telemedicine; an HSAT is a medical assessment that must be ordered by a physician to diagnose OSA or evaluate treatment efficacy; an HSAT should not be used for general screening of asymptomatic populations; diagnosis, assessment of treatment efficacy, and treatment decisions must not be based solely on automatically scored HSAT data, which could lead to sub-optimal care that jeopardizes patient health and safety; and the raw data from the HSAT device must be reviewed and interpreted by a physician who is either board-certified in sleep medicine or overseen by a board-certified sleep medicine physician.
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Affiliation(s)
- Ilene M Rosen
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas B Kirsch
- Carolinas Healthcare Medical Group Sleep Services, Charlotte, North Carolina
| | - Ronald D Chervin
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Kelly A Carden
- Saint Thomas Medical Partners -Sleep Specialists, Nashville, Tennessee
| | - Kannan Ramar
- Division of Pulmonary/Sleep/Critical Care, Mayo Clinic, Rochester, Minnesota
| | - R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | | | - Raman K Malhotra
- SLUCare Sleep Disorders Center.,Department of Neurology, Saint Louis University, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Health System, North Hills, California and David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary/Sleep/Critical Care, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
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Jesudoss R, Otteson TD, Strohl KP, Rosen CL. 1243 Revision Adenoidectomy in the Management of Residual OSA Post-Adenotonsillectomy in a Child. Sleep 2017. [DOI: 10.1093/sleepj/zsx052.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Pediatric Sleep Duration Consensus Statement: A Step Forward. J Clin Sleep Med 2016; 12:1705-1706. [PMID: 27855732 DOI: 10.5664/jcsm.6368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/13/2022]
Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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43
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med 2016; 12:1549-1561. [PMID: 27707447 DOI: 10.5664/jcsm.6288] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 12/13/2022]
Abstract
ABSTRACT Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. COMMENTARY A commentary on this article apears in this issue on page 1439.
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Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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44
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Paruthi S, Buchanan P, Weng J, Chervin RD, Mitchell RB, Dore-Stites D, Sadhwani A, Katz ES, Bent J, Rosen CL, Redline S, Marcus CL. Effect of Adenotonsillectomy on Parent-Reported Sleepiness in Children with Obstructive Sleep Apnea. Sleep 2016; 39:2005-2012. [PMID: 27568804 DOI: 10.5665/sleep.6232] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/13/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To describe parental reports of sleepiness and sleep duration in children with polysomnography (PSG)-confirmed obstructive sleep apnea (OSA) randomized to early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC) in the ChildHood Adenotonsillectomy Trial (CHAT). We hypothesized children with OSA would have a larger improvement in sleepiness 6 mo following eAT compared to WWSC. METHODS Parents of children aged 5.0-9.9 y completed the Epworth Sleepiness Scale modified for children (mESS) and the Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS). PSG was performed at baseline and at 7-mo endpoint. Children underwent early adenotonsillectomy or WWSC. RESULTS The mESS and PSQ-SS classified 24% and 53% of the sample as excessively sleepy, respectively. At baseline, mean mESS score was 7.4 ± 5.0 (SD) and mean PSQ-SS score was 0.44 ± 0.30. Sleepiness scores were higher in African American children; children with shorter sleep duration; older children; and overweight children. At endpoint, mean mESS score decreased by 2.0 ± 4.2 in the eAT group versus 0.3 ± 4.0 in the WWSC group (P < 0.0001); mean PSQ-SS score decreased 0.29 ± 0.40 in eAT versus 0.08 ± 0.40 in the WWSC group (P < 0.0001). Despite higher baseline sleepiness, African American children experienced similar improvement with adenotonsillectomy than other children. Improvement in sleepiness was weakly associated with improved apnea-hypopnea index or oxygen desaturation indices, but not with change in other polysomnographic measures. CONCLUSIONS Sleepiness assessed by parent report was prevalent; improved more after eAT than after WWSC; and was not strongly predicted by sleep disturbances identified by PSG. CLINICAL TRIAL REGISTRATION Childhood Adenotonsillectomy Study for Children with OSA (CHAT). ClinicalTrials.gov Identifier #NCT00560859.
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Affiliation(s)
- Shalini Paruthi
- Department of Pediatrics, Saint Louis University, St. Louis, MO
| | - Paula Buchanan
- Saint Louis University Center for Outcomes Research, St. Louis, MO
| | - Jia Weng
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ronald D Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Ronald B Mitchell
- Department of Otolaryngology, University of Texas Southwestern, Dallas, Texas
| | - Dawn Dore-Stites
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI
| | | | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA
| | - John Bent
- Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Carol L Rosen
- Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Carole L Marcus
- Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA
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45
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Cohen RT, Rodeghier M, Kirkham FJ, Rosen CL, Kirkby J, DeBaun MR, Strunk RC. Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia. J Allergy Clin Immunol 2016; 138:1338-1343.e4. [PMID: 27521278 DOI: 10.1016/j.jaci.2016.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The significance of fractional exhaled nitric oxide (Feno) levels in children with sickle cell anemia (SCA) is unclear, but increased levels can be associated with features of asthma and thus increased morbidity. OBJECTIVES We sought to determine factors associated with Feno and whether Feno levels are associated with increased rates of acute chest syndrome (ACS) and pain. METHODS All participants had SCA, were part of the prospective observational Sleep and Asthma Cohort study, and had the following assessments: Feno levels, spirometry, blood samples analyzed for hemoglobin, white blood cell counts, eosinophil counts and total serum IgE levels, questionnaires about child medical and family history, and review of medical records. RESULTS The analytic sample included 131 children with SCA (median age, 11.2 years; age range, 6-18 years) followed for a mean of 16.2 years, including a mean of 5.1 years after baseline Feno data measurements. In multivariable analyses higher Feno levels were associated with ln(IgE) levels (P < .001) and the highest quartile of peripheral eosinophil counts (P = .03) but not wheezing symptoms, baseline spirometric indices, or response to bronchodilator. Multivariable analyses identified that the incident rate of ACS was associated with ln(Feno) levels (P = .03), as well as male sex (P = .025), wheezing causing shortness of breath (P = .002), and ACS at less than 4 years of age (P < .001). Feno levels were not associated with future pain episodes. CONCLUSIONS Steady-state Feno levels were not associated with an asthma diagnosis, wheezing symptoms, lung function measures, or prior sickle cell morbidity but were associated with markers of atopy and increased risk of future ACS events.
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Affiliation(s)
- Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass.
| | | | - Fenella J Kirkham
- Neurosciences Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane Kirkby
- Portex Respiratory Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Robert C Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
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46
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Taylor HG, Bowen SR, Beebe DW, Hodges E, Amin R, Arens R, Chervin RD, Garetz SL, Katz ES, Moore RH, Morales KH, Muzumdar H, Paruthi S, Rosen CL, Sadhwani A, Thomas NH, Ware J, Marcus CL, Ellenberg SS, Redline S, Giordani B. Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea. Pediatrics 2016; 138:peds.2015-4458. [PMID: 27464674 PMCID: PMC4960728 DOI: 10.1542/peds.2015-4458] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial. METHODS Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures. RESULTS Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d, 0.20-0.24). As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures. CONCLUSIONS Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest.
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Affiliation(s)
- H. Gerry Taylor
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Susan R. Bowen
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Dean W. Beebe
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Raouf Amin
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Raanan Arens
- Department of Pediatrics, Children’s Hospital at Montefiore and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ronald D. Chervin
- Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Susan L. Garetz
- Department of Otolaryngology–Head and Neck Surgery and Sleep Disorders Center, University of Michigan Health Center, Ann Arbor, Michigan
| | - Eliot S. Katz
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Reneé H. Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Knashawn H. Morales
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hiren Muzumdar
- Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shalini Paruthi
- Department of Pediatrics, Cardinal Glennon Children’s Medical Center, Saint Louis University, St Louis, Missouri
| | - Carol L. Rosen
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anjali Sadhwani
- Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Nina Hattiangadi Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Neuropsychology and Assessment Group, and
| | - Janice Ware
- Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Carole L. Marcus
- Department of Pediatrics, Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susan S. Ellenberg
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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47
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Cohen RT, Strunk RC, Rodeghier M, Rosen CL, Kirkham FJ, Kirkby J, DeBaun MR. Pattern of Lung Function Is Not Associated with Prior or Future Morbidity in Children with Sickle Cell Anemia. Ann Am Thorac Soc 2016; 13:1314-23. [PMID: 27300316 PMCID: PMC5021073 DOI: 10.1513/annalsats.201510-706oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/15/2016] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Patient factors associated with development of abnormal lung function in children with sickle cell anemia (SCA) have not been fully characterized. OBJECTIVES To characterize lung function abnormalities among children with SCA and to determine whether these steady-state lung function results were associated with morbidity before or after testing among children with SCA. METHODS This study was part of the prospective National Institutes of Health-funded Sleep and Asthma Cohort Study. Children with HbSS or Hb Sβ(o) (SCA) were enrolled without regard for sickle cell-related comorbidities or diagnosis of asthma. Lung function was measured by spirometry and plethysmography on the same day, when free of acute disease. Standardized asthma symptom questionnaires and review of the medical records were also performed. MEASUREMENTS AND MAIN RESULTS A total of 149 children aged 6 to 19 years completed lung function testing, of whom 139 participants had retrospective morbidity data from birth to the test date, and 136 participants were followed prospectively for a median of 4.3 years from the test date. At baseline, percentages with normal, obstructive, restrictive, nonspecific, and mixed lung function patterns were 70, 16, 7, 6, and 1, respectively. Neither retrospective rates of pain nor acute chest syndrome was associated with lung function patterns. Furthermore, baseline lung function pattern was not predictive of future pain or acute chest syndrome episodes. CONCLUSIONS The majority of children with SCA have lung function that is within the normal range. Abnormal lung function patterns were not associated with prior vasoocclusive pain or acute chest syndrome episodes, and baseline lung function patterns did not predict future vasoocclusive pain or chest syndrome episodes.
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Affiliation(s)
- Robyn T. Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Robert C. Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Jane Kirkby
- Respiratory, Critical Care, and Anaesthesia Section of IIIP, University College London, Institute of Child Health, London, United Kingdom; and
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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48
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Puri P, Ross KR, Mehra R, Spilsbury JC, Li H, Levers-Landis CE, Rosen CL. Pediatric Positive Airway Pressure Adherence in Obstructive Sleep Apnea Enhanced by Family Member Positive Airway Pressure Usage. J Clin Sleep Med 2016; 12:959-63. [PMID: 27092699 DOI: 10.5664/jcsm.5924] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/07/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Adherence to positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) remains a challenge in children. We hypothesized that the presence of another family member on PAP therapy (parent, sibling, other family member) would be associated with better adherence in the child. METHODS We conducted a retrospective chart review to identify children < 18 years of age who had a new diagnosis of OSA between Jan 2011 and May 2013. Outcomes were objective PAP adherence at 1 week, 1 month, and 3 months. Potential predictors included family member on PAP therapy, patient demographics, and clinical characteristics. Group differences between children with and without a family member on PAP therapy were determined using χ(2) test and Wilcoxon two-sample test. PAP adherence measures at each time point and patterns of change across time between the two groups were examined using mixed-effects models. RESULTS The final analytic sample included 56 children: age 13.2 ± 3.7 years, 60% male, 67% African American, 65% obese, and 32% with developmental disabilities. The mean obstructive apnea-hypopnea index was 25.2 ± 28.7, and 19 (33%) had a family member on PAP therapy. Overall PAP adherence was 2.8 ± 2.4 h/night at 3 months. At month 3, the group with a family member on PAP therapy had significantly greater average nightly PAP use on all nights (3.6 ± 0.6 vs. 2.3 ± 0.39) and on nights used (4.8 ± 0.6 vs. 3.8 ± 0.40); (p value = 0.04). CONCLUSIONS Overall PAP adherence was low, but having a family member on PAP therapy as a "role model" was associated with better adherence. COMMENTARY A commentary on this article appears in this issue on page 941.
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Affiliation(s)
- Pooja Puri
- Department of Pediatrics, Division of Pulmonology, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kristie R Ross
- Department of Pediatrics, Division of Pulmonology, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Reena Mehra
- Sleep Center, Neurologic Institute, Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - James C Spilsbury
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine Cleveland, Cleveland, OH
| | - Hong Li
- Center for Clinical Investigation, Statistical Science Core, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Carolyn E Levers-Landis
- Department of Pediatrics, Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Carol L Rosen
- Department of Pediatrics, Division of Pulmonology, Allergy and Sleep Medicine, Rainbow Babies and Children's Hospital - University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
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49
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016; 12:785-6. [PMID: 27250809 DOI: 10.5664/jcsm.5866] [Citation(s) in RCA: 742] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.
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Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics, Elk Grove Village, IL
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Carol L Rosen
- Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Matthew M Troester
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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50
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Chervin RD, Ellenberg SS, Hou X, Marcus CL, Garetz SL, Katz ES, Hodges EK, Mitchell RB, Jones DT, Arens R, Amin R, Redline S, Rosen CL. Prognosis for Spontaneous Resolution of OSA in Children. Chest 2016; 148:1204-1213. [PMID: 25811889 DOI: 10.1378/chest.14-2873] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment. METHODS The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline. RESULTS After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors. CONCLUSIONS Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Ronald D Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI.
| | - Susan S Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Xiaoling Hou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carole L Marcus
- Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Susan L Garetz
- Department of Otolaryngology/Head and Neck Surgery and Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA
| | - Elise K Hodges
- Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Ron B Mitchell
- Department of Otolaryngology and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dwight T Jones
- Department of Otolaryngology/Head & Neck Surgery, University of Nebraska College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx NY
| | - Raouf Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Carol L Rosen
- Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
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