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Iannuccelli C, Lucchino B, Gioia C, Dolcini G, Rabasco J, Venditto T, Ioppolo F, Santilli V, Conti F, Di Franco M. Gender influence on clinical manifestations, depressive symptoms and brain-derived neurotrophic factor (BDNF) serum levels in patients affected by fibromyalgia. Clin Rheumatol 2022; 41:2171-2178. [PMID: 35344113 PMCID: PMC9187562 DOI: 10.1007/s10067-022-06133-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION OBJECTIVES: Fibromyalgia (FM) is a common rheumatic disorder characterized by chronic, widespread pain associated with several not painful symptoms. The contribution of gender to the manifestation of the disease may influence the higher prevalence of FM among women. In spite of this, how patients' gender influences the clinical manifestation of FM is still not well understood. The frequent association with neuropsychiatric symptoms raised the attention on the role of neurotrophins, including the brain-derived neurotrophic factor (BDNF) as potential biomarkers of the condition. Aims of the study were to evaluate the influence of gender on clinical manifestations and to investigate BDNF serum levels as a potential biomarker of FM. METHODS We consecutively enrolled 201 adult patients of both sexes diagnosed with FM. For each patient, we collected clinical and clinimetric data and, in a subgroup of 40 patients, we measured serum BDNF levels. BDNF levels have been measured also in 40 matched healthy controls (HC). RESULTS Several symptoms were significantly higher in women compared with men, including pain, fatigue, memory problems, tenderness, balance problems and sensitivity to environmental stimuli. On the contrary, men reported a significant higher frequency of coexisting depressive symptoms. BDNF levels were significantly lower in FM patients compared with HC, discriminating with good accuracy the condition. CONCLUSION Gender influences FM clinical manifestations, with a higher prevalence of pain, fatigue and other common FM symptoms among women while higher frequency of neuropsychiatric symptoms among men. BDNF offers promises as a potential biomarker of the disease. Key Points • Gender-related differences in the clinical manifestations of FM may contribute to the higher prevalence of FM among females. Indeed, women show higher levels of pain and symptoms traditionally associated to FM, which are evaluated to establish the diagnosis according to the clinical criteria. • The new insights into the pathogenesis of the disease raised the attention on the role of brain mediators in FM. Among these, BNDF shows potential as a diagnostic biomarker.
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Affiliation(s)
- Cristina Iannuccelli
- Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Bruno Lucchino
- Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Chiara Gioia
- Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Giulio Dolcini
- Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Jole Rabasco
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Teresa Venditto
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Ioppolo
- Unit of Physical Medicine and Rehabilitation, Umberto I Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Unit of Physical Medicine and Rehabilitation, Umberto I Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Manuela Di Franco
- Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy.
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Bai AV, Rabasco J, Ceccatelli V, Floridia S, Sbardella S, Petrignani C, Agostini F, Paoloni M. Suggestions for changes in professional procedures and adaptation to COVID-19: new models of care in the rehabilitation setting. Ann Ig 2021; 33:299-304. [PMID: 33739361 DOI: 10.7416/ai.2021.2434] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstracts The COVID-19 (COrona Virus Disease 2019), due to the SARS-COV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) has been an unprecedented global challenge for the healthcare systems (1).
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Affiliation(s)
- A V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - J Rabasco
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - V Ceccatelli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - S Floridia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - S Sbardella
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - C Petrignani
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - F Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
| | - M Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy
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Rabasco J, Vigo A, Vitelli O, Noce S, Pietropaoli N, Evangelisti M, Pia Villa M. Apparent life-threatening events could be a wake-up call for sleep disordered breathing. Pediatr Pulmonol 2016; 51:1403-1408. [PMID: 27163733 DOI: 10.1002/ppul.23468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/31/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life. MATERIALS AND METHODS We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR). RESULTS In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05). CONCLUSIONS Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jole Rabasco
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Alessandro Vigo
- Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy
| | - Ottavio Vitelli
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Silvia Noce
- Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy
| | - Nicoletta Pietropaoli
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Melania Evangelisti
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Maria Pia Villa
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
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Evangelisti M, Shafiek H, Rabasco J, Forlani M, Montesano M, Barreto M, Verhulst S, Villa MP. Oximetry in obese children with sleep-disordered breathing. Sleep Med 2016; 27-28:86-91. [PMID: 27938925 DOI: 10.1016/j.sleep.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Obesity is an important risk factor for obstructive sleep apnea syndrome (OSAS), and obese children with OSAS have frequently shown oxygen desaturations when compared with normal-weight children. The aim of our study was to investigate the oximetry characteristics in children with obesity and sleep-disordered breathing (SDB). METHODS Children referred for suspected OSAS were enrolled in the study. All children underwent sleep clinical record (SCR), pulse oximetry, and polysomnography (PSG). RESULTS A total of 248 children with SDB were recruited (128 obese and 120 normal-weight children). Obese children showed higher oxygen desaturation index (ODI) and lower nadir oxygen saturation (nadir SaO2) compared to non-obese children (p < 0.05). ODI and nadir SaO2 correlated with obesity (p < 0.05). The SCR evaluation showed that deep bite and overjet were more common among obese children (p < 0.05), whereas habitual nasal obstruction and arched palate were more common among non-obese children (p < 0.05). Furthermore, skeletal malocclusion and tonsillar hypertrophy were significant risk factors in obese children associated with severe desaturation (p < 0.05). CONCLUSION Obese children with SDB have a more significant oxygen desaturation; adeno-tonsillar hypertrophy is not the only important risk factor for its development but also the presence of malocclusions.
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Affiliation(s)
- Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Hanaa Shafiek
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jole Rabasco
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Martina Forlani
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marilisa Montesano
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mario Barreto
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Stijn Verhulst
- Department of Pediatric Pulmonology, Cystic Fibrosis Clinic and Pediatric Sleep Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
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Villa MP, Pietropaoli N, Supino MC, Vitelli O, Rabasco J, Evangelisti M, Del Pozzo M, Kaditis AG. Diagnosis of Pediatric Obstructive Sleep Apnea Syndrome in Settings With Limited Resources. JAMA Otolaryngol Head Neck Surg 2016; 141:990-6. [PMID: 26540025 DOI: 10.1001/jamaoto.2015.2354] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although polysomnographic (PSG) testing is the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children, the number of pediatric sleep laboratories is limited. Developing new screening methods for identifying OSAS may reduce the need for PSG testing. OBJECTIVE To evaluate the combined use of the sleep clinical record (SCR) and nocturnal oximetry testing for predicting PSG results in children with clinically suspected OSAS. DESIGN, SETTING, AND PARTICIPANTS Prospective study over 10 months. A cohort of 268 consecutive children (mean [SD], age 6 [3] years) referred for clinically suspected OSAS was studied at a pediatric sleep center at a university hospital. Children with disorders other than adenotonsillar hypertrophy or obesity were excluded. MAIN OUTCOMES AND MEASURES Mild OSAS (obstructive apnea-hypopnea index [AHI], 1-5 episodes/h) and moderate-to-severe OSAS (AHI, >5 episodes/h) were the main outcome measures. Sleep clinical record scores greater than or equal to6.5 were considered positive, as were McGill oximetry scores (MOS) greater than 1, and these positive scores were the main explanatory variables in our study. Each participant was evaluated by the SCR, followed by pulse oximetry test the first night and PSG test in the sleep laboratory the second night. RESULTS Of the total participants, 236 (88.1%) were diagnosed with OSAS, 236 (88.1%) had a positive SCR score, and 50 (18.7%) had a positive MOS. Participants with positive SCR scores had significantly increased risk of an AHI greater than or equal to 1 (adjusted odds ratio [AOR], 9.3; 95% CI, 3.7-23.2; P < .001). Children with an MOS greater than 1 were significantly more likely to have an AHI greater than 5 episodes/h than children with an MOS equal to 1 (AOR, 26.5; 95% CI, 7.8-89.2; P < .001). A positive SCR score had satisfactory sensitivity (91.9%) and positive predictive value (91.9%) but limited specificity (40.6%) and negative predictive value (40.6%) for OSAS. An MOS greater than 1 had excellent specificity (97.4%) and positive predictive value (94%) but low sensitivity (39.2%) and fair negative predictive value (60.8%) for moderate-to-severe OSAS among children with a positive SCR score. The combination of SCR scores and MOS correctly predicted primary snoring, mild OSAS, or moderate-to-severe OSAS in 154 of 268 (57.4%) participants. CONCLUSIONS AND RELEVANCE The combined use of the SCR score and nocturnal oximetry results has moderate success in predicting sleep-disordered breathing severity when PSG testing is not an option.
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Affiliation(s)
- Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Nicoletta Pietropaoli
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Ottavio Vitelli
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Jole Rabasco
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marco Del Pozzo
- Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Villa MP, Shafiek H, Evangelisti M, Rabasco J, Cecili M, Montesano M, Barreto M. Sleep clinical record: what differences in school and preschool children? ERJ Open Res 2016; 2:00049-2015. [PMID: 27730168 PMCID: PMC5005151 DOI: 10.1183/23120541.00049-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/03/2015] [Accepted: 12/29/2015] [Indexed: 11/24/2022] Open
Abstract
The sleep clinical record (SCR) may be a valid method for detecting children with obstructive sleep apnoea (OSA). This study aimed to evaluate whether there were differences in SCR depending on age and to identify the possible risk factors for OSA development. We enrolled children with sleep disordered breathing between 2013 and 2015, and divided them according to age into preschool- and school-age groups. All patients underwent SCR and polysomnography. OSA was detected in 81.1% and 83.6% of preschool- and school-age groups, respectively. Obesity, malocclusions, nasal septal deviation and inferior turbinate hypertrophy were significantly more prevalent in school-age children (p<0.05); however, only tonsillar hypertrophy had significant hazard ratio (2.3) for OSA development. Saddle nose, nasal hypotonia, oral breathing and tonsillar hypertrophy were significantly more prevalent for development of OSA in preschoolers (p<0.03). The SCR score was significantly higher among preschool children than in school-age children (8.4±2.22 versus 7.9±2.6; p=0.044). Further, SCR score >6.5 had a sensitivity of 74% in predicting OSA in preschool children with positive predictive value of 86% (p=0.0001). Our study confirms the validity of the SCR as a screening tool for patient candidates for a PSG study for suspected OSA, in both school and preschool children. The differences in sleep clinical record between school and preschool children suspected to have OSAhttp://ow.ly/X778Q
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Affiliation(s)
- Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Hanaa Shafiek
- Dept of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Jole Rabasco
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Manuela Cecili
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marilisa Montesano
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mario Barreto
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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Vitelli O, Del Pozzo M, Baccari G, Rabasco J, Pietropaoli N, Barreto M, Villa MP. Autonomic imbalance during apneic episodes in pediatric obstructive sleep apnea. Clin Neurophysiol 2016; 127:551-555. [DOI: 10.1016/j.clinph.2015.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/18/2015] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
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Villa MP, Sujanska A, Vitelli O, Evangelisti M, Rabasco J, Pietropaoli N, Banovcin P, Kheirandish-Gozal L, Gozal D. Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment. Sleep Breath 2015; 20:321-9. [PMID: 26564170 DOI: 10.1007/s11325-015-1287-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 03/11/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of our study was to evaluate the utility of the sleep clinical record (SCR) in the follow-up of children with obstructive sleep apnea (OSA) after treatment. METHODS SCR was completed and overnight polysomnography (PSG) was performed in all enrolled children (T0), with SCR considered positive for scores ≥6.5, as previously validated. Patients underwent adenotonsillectomy (T&A), rapid maxillary expansion (RME), and medical therapy according to severity of OSA and clinical features. Six months after completing therapy, the second overnight PSG and SCR (T1) were performed. RESULTS For all subjects, both Apnea-Hypopnea Index (AHI) and total SCR score decreased significantly (<0.005) from T0 to T1. For SCR items, clinical examination (item 1) and reported sleep respiratory symptoms (item 2) ameliorated significantly (<0.005). However, hyperactivity or inattention (item 3) decreased significantly (<0.005) after treatment only in T&A group, while no differences in AHI and SCR scores occurred in the medically treated group. At T1, SCR was positive in 95.6 % of children with AHI ≥1, with a concordance of 100 % in the T&A and RME groups, resulting in a positive predictive value of 100 %. A poor concordance (38.3 % in T&A group and 53.4 % in RME group) was found when SCR < 6.5. Children with SCR ≥ 6.5 at T1 showed higher AHI compared to patients with SCR < 6.5 (5.7 ± 5.9 ev/h vs 1.78 ± 1.76 ev/h; p < 0.005). CONCLUSIONS SCR emerges as a potentially useful instrument for follow-up of children with OSA after treatment.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Anna Sujanska
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Melania Evangelisti
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Peter Banovcin
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA
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Šujanská A, Ďurdík P, Rabasco J, Vitelli O, Pietropaoli N, Villa MP. SURGICAL AND NON-SURGICAL THERAPY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN CHILDREN. Acta Medica (Hradec Kralove) 2015; 57:135-41. [PMID: 25938896 DOI: 10.14712/18059694.2015.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Interventions of paediatric obstructive sleep apnea syndrome are complex, varied and multidisciplinary. The goal of the treatment is to restore optimal breathing during the night and to relieve associated symptoms. Evidence suggests that the surgical intervention with removal of the tonsils and adenoids will lead to significant improvements in the most incomplicated cases, as recently reported from a meta-analysis. However, post-operative persistence of this syndrome in paediatric population is more frequent than expected, which supports the idea of the complexity of this syndrome. Adenotomy alone may not be sufficient in children with OSAS, because it does not address oropharyngeal obstruction secondary to tonsillar hyperplasia. Continuous positive airway pressure can effectively treat this syndrome in selected groups of children, improving both nocturnal and daytime symptoms, but poor adherence is a limiting factor. For this reason, CPAP is not recommended as first-line therapy for OSAS when adenotonsillectomy is an option. It is now being investigated the incorporation of nonsurgical approaches for milder forms and for residual OSAS after surgical intervention. Althought adeno-tonsillar hypertrophy is the most common for OSAS in children; obesity is emerging as an equally important etiological factor. Therefore an intensive weight reduction program and adequate sleep hygiene are also important lifestyle changes that may be very effective in mitigating the symptoms of this syndrome. Pharmacological therapy (leukotriene antagonists, topical nasal steroids) is usually use for mild forms of OSAS and in children with associated allergic diseases. Special orthodontic treatment and oropharyngeal exercises are a relatively new and promising alternative therapeutic modality used in selected groups of children with OSAS.
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Affiliation(s)
- Anna Šujanská
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava, Martin, Slovak Republic
| | - Peter Ďurdík
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava, Martin, Slovak Republic.
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Villa MP, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M, Marino A, Malagola C. Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med 2015; 16:709-16. [PMID: 25934539 DOI: 10.1016/j.sleep.2014.11.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/19/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives of this study were to confirm the efficacy of rapid maxillary expansion in children with moderate adenotonsillar hypertrophy in a larger sample and to evaluate retrospectively its long-term benefits in a group of children who underwent orthodontic treatment 10 years ago. METHODS After general clinical examination and overnight polysomnography, all eligible children underwent cephalometric evaluation and started 12 months of therapy with rapid maxillary expansion. A new polysomnography was performed at the end of treatment (T1). Fourteen children underwent clinical evaluation and Brouilette questionnaire, 10 years after the end of treatment (T2). RESULTS Forty patients were eligible for recruitment. At T1, 34/40 (85%) patients showed a decrease of apnea-hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined responders. Only 6/40 (15%) showed a decrease <20% of AHI at T1 and were defined as non-responders (ΔAHI -53.47% ± 61.57%). Moreover, 57.5% of patients presented residual OSA (AHI > 1 ev/h) after treatment. Disease duration was significantly lower (2.5 ± 1.4 years vs 4.8 ± 1.9 years, p <0.005) and age at disease onset was higher in responder patients compared to non-responders (3.8 ± 1.5 years vs 2.3 ± 1.9 years, p <0.05). Cephalometric variables showed an increase of cranial base angle in non-responder patients (p <0.05). Fourteen children (mean age 17.0 ± 1.9 years) who ended orthodontic treatment 10 years previously showed improvement of Brouilette score. CONCLUSION Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
| | - Alessandra Rizzoli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Manuela Cecili
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Alessandra Marino
- Orthodontic Clinic Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Caterina Malagola
- Orthodontic Clinic Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
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Vitelli O, Tabarrini A, Miano S, Rabasco J, Pietropaoli N, Forlani M, Parisi P, Villa MP. Impact of obesity on cognitive outcome in children with sleep-disordered breathing. Sleep Med 2015; 16:625-30. [PMID: 25862118 DOI: 10.1016/j.sleep.2014.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of obesity on cognitive impairment, in children with obstructive sleep apnoea (OSA), children with OSA and obesity, and in normal controls. METHODS Thirty-six children with OSA (group 1), 38 children with OSA and obesity (group 2) and 58 normal controls (group 3) were studied. The Total intelligence quotient (T-IQ), Verbal IQ (V-IQ) and the Performance IQ (P-IQ) scores were obtained using the Wechsler Intelligence Scale for Children - Third Edition Revised. All participants' parents filled out the questionnaire containing the attention deficit and hyperactive disorder rating scale to investigate symptoms of hyperactivity and attention deficit. Obese and non-obese children with sleep-disordered breathing (SDB) underwent polysomnography. RESULTS T-QI and P-QI scores were significantly lower in group 2 with higher performance impairment at the subtest compared to other groups. In obese children, V-IQ was significantly correlated with age of onset (r = 0.335, p = 0.05) and duration of SDB (r = -0.362, p = 0.02), while P-IQ and T-IQ were correlated with body mass index (BMI) percentile (r = -0.341, p = 0.03) and respiratory disturbance index (RDI) (r = -0.321, p = 0.05), respectively. RDI and BMI negatively influenced T-IQ in obese children with OSA. No correlation was found between sleep parameters and IQ scores or subtest scores in all groups. CONCLUSIONS Obese children with OSA showed higher cognitive impairment. Obesity has an additive and synergic action with that exerted by OSA, speeding up the onset of complications.
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Affiliation(s)
- Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Alessandra Tabarrini
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Switzerland
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Martina Forlani
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Pasquale Parisi
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome.
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Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, Pietropaoli N, Martella S. Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath 2014; 19:281-9. [PMID: 24859614 DOI: 10.1007/s11325-014-1011-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/30/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study evaluated the efficacy of oropharyngeal exercises in children with symptoms of obstructive sleep apnea syndrome (OSA) after adenotonsillectomy. METHODS Polysomnographic recordings were performed before adenotonsillectomy and 6 months after surgery. Patients with residual OSA (apnea-Hypopnea Index, AHI > 1 and persistence of respiratory symptoms) after adenotonsillectomy were randomized either to a group treated with oropharyngeal exercises (group 1) or to a control group (group 2). A morphofunctional evaluation with Glatzel and Rosenthal tests was performed before and after 2 months of exercises. All the subjects were re-evaluated after exercise through polysomnography and clinical evaluation. The improvement in OSA was defined by ΔAHI: (AHI at T1 - AHI at T2)/AHI at T1 × 100. RESULTS Group 1 was composed of 14 subjects (mean age, 6.01 ± 1.55) while group 2 was composed of 13 subjects (mean age, 5.76 ± 0.82). The AHI was 16.79 ± 9.34 before adenotonsillectomy and 4.72 ± 3.04 after surgery (p < 0.001). The ΔAHI was significantly higher in group 1 (58.01 %; range from 40.51 to 75.51 %) than in group 2 (6.96 %; range from -23.04 to 36.96 %). Morphofunctional evaluation demonstrated a reduction in oral breathing (p = 0.002), positive Glatzel test (p < 0.05), positive Rosenthal test (p < 0.05), and increased labial seal (p < 0.001), and lip tone (p < 0.05). CONCLUSIONS Oropharyngeal exercises may be considered as complementary therapy to adenotonsillectomy to effectively treat pediatric OSA.
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Affiliation(s)
- Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Via Grottarossa 1035/1039, 00189, Rome, Italy,
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Miano S, Tabarrini A, Vitelli O, Mazzotta A, Del Pozzo M, Rabasco J, Barreto M, Parisi P, Ferretti A, Villa MP. The cooccurrence of interictal discharges and seizures in pediatric sleep-disordered breathing. Epilepsy Behav 2013; 29:508-12. [PMID: 24128933 DOI: 10.1016/j.yebeh.2013.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/01/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022]
Abstract
Studies in the literature data have shown that the prevalence of obstructive sleep apnea (OSA) in children with epilepsy is high and that treatment for OSA leads to a reduction in the number of seizures; by contrast, few studies have demonstrated an increased prevalence of interictal epileptiform discharges (IEDs) or epilepsy in children with sleep-disordered breathing (SDB). The aim of the present study was to confirm the high prevalence of IEDs or epilepsy in a large sample of children with SDB and to collect follow-up data. Children were recruited prospectively and underwent their first video-polysomnography (video-PSG) for SDB in a teaching hospital sleep center. Of the 298 children who fulfilled the diagnostic criteria for sleep-disordered breathing, 48 (16.1%) children were found to have IEDs, three of these 48 children were also found to have nocturnal seizures (two females diagnosed with rolandic epilepsy and a male diagnosed with frontal lobe epilepsy). Only 11 subjects underwent a second video-PSG after 6months; at the second video-PSG, the IEDs had disappeared in six subjects, who also displayed a reduced AHI and an increased mean overnight saturation. Thirty-eight of the 250 children without IEDs underwent a second video-PSG after 6months. Of these 250 children, four, who did not display any improvement in the respiratory parameters and were found to experience numerous stereotyped movements during sleep, were diagnosed with nocturnal frontal lobe epilepsy. Our study confirms the high prevalence of IEDs in children with SDB. Follow-up data indicate that they may recede over time, accompanied by an improvement of sleep respiratory parameters.
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Affiliation(s)
- Silvia Miano
- Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
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Miano S, Donfrancesco R, Parisi P, Rabasco J, Mazzotta AR, Tabarrini A, Vitelli O, Villa MP. Case reports of sleep phenotypes of ADHD: from hypothesis to clinical practice. J Atten Disord 2013; 17:565-73. [PMID: 24022016 DOI: 10.1177/1087054713497254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Five sleep ADHD phenotypes have been hypothesized: (a) the hypo-arousal state of the "primary" form of ADHD, (b) the sleep phase advanced disorder, (c) sleep disordered breathing (SDB), (d) restless legs syndrome and/or periodic limb movements disorder (PLMD), and (e) epilepsy. METHOD Five case reports are presented; each child but one underwent video-polysomnography. RESULTS The first case report is an example of ADHD and SDB, with improvement of hypersomnolence after resolution of sleep apnea. The second case shows the impact of delayed sleep onset latency in the pathogenesis of ADHD, and the efficacy of melatonin. The third case report describes the association with PLMD, with amelioration after iron supplementation. The other two cases are examples of ADHD and epilepsy, with clinical improvement after antiepileptic treatment was started. CONCLUSION A diagnostic and therapeutic algorithm should be designed to find the best first-line treatment for ADHD and sleep problems/epilepsy.
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