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Yoshioka Y, Matsune S, Sekine K, Ishida M, Wakayama N, Yamaguchi S, Okubo K. Improvements in blood IGF-1 and skeletal age following adenotonsillectomy for growth delay in children with obstructive sleep apnea. Auris Nasus Larynx 2024; 51:236-241. [PMID: 37813729 DOI: 10.1016/j.anl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/14/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE In children with obstructive sleep apnea (OSA) who underwent adenotonsillectomy (AT), we measured body height and weight using standard deviation (SD) scores, insulin-like growth factor 1 (IGF-1), and skeletal age using carpal radiography. We then compared these values before and after surgery with the aim of investigating postoperative improvements in growth hormone (GH) deficiency. METHODS Subjects comprised 35 children between 2 and 9 years of age (21 boys, 14 girls; mean age, 5.85 ± 1.75 years). Respiratory event index (REI), 3 % oxygen desaturation index (3 % ODI), height SD score, body mass index (BMI) percentile, blood IGF-1 level, and skeletal age from carpal radiographs were measured before surgery and both 3 and 12 months after surgery, and compared. RESULTS Height SD score improved significantly from preoperatively (-0.44 ± 1.13) to both 3 months postoperatively (-0.22 ± 1.14) and 12 months postoperatively (-0.13 ± 0.94). However, no significant improvement in height SD score was seen from 3 months to 12 months after AT. BMI percentile improved significantly from preoperatively (35.6 ± 26.7) to both 3 months postoperatively (44.7 ± 26.5) and 12 months postoperatively (49.1 ± 22.15), with significant improvement also seen from 3 months to 12 months after AT. SD score for IGF-1 showed significant improvement from before (-0.57 ± 1.00) to 12 months after surgery (-0.12 ± 0.89). No significant improvement in the difference between skeletal and chronological ages was seen from before to after surgery, but the number of patients for whom skeletal age normalized from before to after surgery increased significantly (74.3 % vs. 94.3 %), and the number with advanced or delayed skeletal age decreased significantly (25.7 % vs. 5.7 %) CONCLUSION: Early improvements can be obtained with surgical treatment in children with OSA who have short height and poor weight gain due to GH deficiency.
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Affiliation(s)
- Yuma Yoshioka
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan.
| | - Shoji Matsune
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Kuwon Sekine
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Mariko Ishida
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Nozomu Wakayama
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Satoshi Yamaguchi
- Department of Otolaryngology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
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DeJarnette K, Frederick RM, Harris AJ, Bashir A, Wood J, Sheyn A. Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2022; 162:111256. [PMID: 35994833 DOI: 10.1016/j.ijporl.2022.111256] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 06/18/2022] [Accepted: 07/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Obstructive Sleep Apnea (OSA) affects 1-4% of the pediatric population in the U.S. Drug-Induced Sleep Endoscopy (DISE) is widely used to localize the level(s) of obstruction. The VOTE classification system is used to grade obstructions found at the velum, oropharynx, base of tongue, and epiglottis and has been validated in adults. This study aims to determine if the VOTE score has any predictive value in pediatric OSA postoperative outcomes. METHODS A retrospective chart review of 129 patients from January 7, 2016 to 05/30/2020 was performed. Included patients were between the ages of 2 and 17, undergoing DISE, and if they had preoperative and postoperative polysomnography (PSG) data. Excluded patients did not meet one of the above or had other comorbidities contributing to their sleep apnea. 53 patients were included. RESULTS Pearson's Correlation tests compared intraoperative VOTE score to postoperative BMI, AHI, and O2 nadir and their relationships. We found a weakly positive correlation between the VOTE and postoperative AHI with a coefficient of 0.35 and a p-value of 0.01. We found a relationship between postoperative O2 nadir and AHI, with a coefficient of -0.627 and a p-value <0.0001. Finally, a paired, two-tailed t-test compared the mean change between preoperative and postoperative BMIs (+1.6), oAHIs (-23.5), and O2 nadirs (+14), all with p-value <0.0001. CONCLUSION We demonstrated a correlation between VOTE and improved postoperative AHI and a relationship between improved postoperative AHI and postoperative O2 nadir. The validity of VOTE may be proven with larger sample size. Alternatively, a different scoring system may be required for pediatric OSA.
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Affiliation(s)
- Kaci DeJarnette
- University of Tennessee Health Science Center College of Medicine, 910 Madison Ave Ste. 1031, Memphis, TN, 38163, USA
| | - Robert M Frederick
- University of Tennessee Health Science Center College of Medicine, 910 Madison Ave Ste. 1031, Memphis, TN, 38163, USA
| | - Atia J Harris
- Division of Pulmonology and Sleep Medicine, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA
| | - Ahsan Bashir
- Division of Pulmonology and Sleep Medicine, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA
| | - Joshua Wood
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA; University of Tennessee Health Science Center Department of Otolaryngology, 910 Madison Ave Ste. 430, Memphis, TN, 38163, USA
| | - Anthony Sheyn
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, 848 Adams Avenue Memphis, TN, 38103, USA; University of Tennessee Health Science Center Department of Otolaryngology, 910 Madison Ave Ste. 430, Memphis, TN, 38163, USA.
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Jurado MJ, Sampol G, Quintana M, Romero O, Cambrodí R, Ferré A, Sampol J. Nasal cannula use during polysomnography in children aged under three with suspected sleep apnea. Sleep Med 2022; 99:41-48. [PMID: 35947888 DOI: 10.1016/j.sleep.2022.07.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Early diagnosis of obstructive sleep apnea (OSA) in children is important. The use of a nasal cannula as an airflow sensor during polysomnography has not been evaluated in younger children. The study aims to evaluate the use of nasal cannula in detecting respiratory events in children under three with suspected OSA during daytime nap studies. METHODS A total of 185 patients were prospectively included. Respiratory events were scored using nasal cannula alone, thermistor alone, and both methods simultaneously as the airflow sensor. Agreement and diagnostic accuracy were assessed. RESULTS One hundred and seventy-two children were finally analyzed and 110 (64.0%) presented OSA. Total sleep time with an uninterpretable signal was longer with the nasal cannula than with the thermistor (17.8% vs 1.9%; p < 0.001), and was associated with poor sensor tolerance and adenotonsillar hypertrophy. In the estimation of the apnea-hypopnea index, the nasal cannula showed lower agreement than the thermistor with the joint use of the two sensors (intraclass correlation coefficient: 0.79 vs 0.996 with thermistor). Compared with the thermistor, the nasal cannula presented lower sensitivity for detecting OSA (82.7% vs 95.5%) and a lower negative predictive value (76.5% vs 92.4%). Overall, fewer children were diagnosed with severe OSA with the nasal cannula (19.8% vs 30.8% with the thermistor, and 32.6% with both). CONCLUSIONS In children under the age of three, the ability of the nasal cannula to detect obstructive events was relatively low. Therefore, other non-invasive measurements for identifying respiratory events during sleep may be of additional value.
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Affiliation(s)
- María José Jurado
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Gabriel Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Odile Romero
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Roser Cambrodí
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Alex Ferré
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Júlia Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
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Bertrán K, Sans Capdevila O, Nascimiento A, Ortez C, Natera D, Iranzo de Riquer A. Sleep breathing disorders in pediatric patients with spinal muscular atrophy 2. Sleep Med 2021; 89:85-89. [PMID: 34923450 DOI: 10.1016/j.sleep.2021.11.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 11/13/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The study is aimed to analyze both sleep architecture and prevalence of sleep-disordered breathing (SDB), in a group of patients with type 2 spinal muscular atrophy (SMA), considering motor dysfunction, and compare them with age-matched controls. METHODS Eighteen SMA type 2 patients (nine males median age 9.5 (4-17) years) and eighteen controls (fourteen males, median age 8,5 (1-16) years) underwent nocturnal polysomnography. SMA type 2 patients were evaluated with motor scales; Hammersmith Functional Motor Scale Expanded (HFMSE), Revised upper limb model (ULMR) and Egen Klassification Scale Version 2 (EK2). Parents/tutors completed two pediatric sleep questionnaires (respiratory subscale from Chervin Pediatric Sleep Questionnaire and Bruni's Sleep Disturbance Scale for Children). RESULTS When compared with controls, SMA type 2 patients showed no significant differences in age (9.72 ± 4.2 vs 8.22 ± 3.9 (p = 0.28), gender 9 (9 men (50%) vs 14 (77,8%) (p = 0.083) and nutritional status; Body Mass Index (BMI) (16.4 (12.2-34.8) vs 17.6 (4.4-24.2) (p = 0.83). Apnea Hypopnea Index (AHI) was statistically higher in SMA type 2 patients (6.7 ± 6.2 vs 0.4 ± 0.3) (p < 0.001). The SpO2 mean values in cases were (96% ± 1.4) vs (97.5% ± 1.2) (p = 0.007). TcPCO2 median value (41,5 mmHg; (range 34-47.2) in the SMA type-2 patients within normal reference values. Only one motor scale; Hammersmith Functional Motor Scale Expanded (HFMSE) showed a negative correlation with AHI (r = -0.132). CONCLUSIONS Patients affected by SMA type 2 presented significantly higher apnea-hypopnea indices than controls; differences in sleep architecture identified include: decreased total sleep time, increased percentage of stage N1 of NREM sleep as well as increased sleep fragmentation seen in the SMA type 2 group, due to respiratory related arousals. We would like to point out that validated pediatric sleep questionnaires in general population, may not be useful tools when screening for SDB in these patients. This should be taken into consideration in clinical practice and in the elaboration of future clinical guidelines for these patients.
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Affiliation(s)
- Katalina Bertrán
- Sleep Unit, Department of Neurology, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Oscar Sans Capdevila
- Sleep Unit, Department of Neurology, Sant Joan de Deu Hospital, Barcelona, Spain.
| | - Andrés Nascimiento
- Neuromuscular Unit, Department of Neurology, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Carlos Ortez
- Neuromuscular Unit, Department of Neurology, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Daniel Natera
- Neuromuscular Unit, Department of Neurology, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Alex Iranzo de Riquer
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain
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Dmowska J, Larson SR, Gillespie MB, Sheyn A. Effect of drug induced sleep endoscopy on intraoperative decision making in pediatric sleep surgery. Int J Pediatr Otorhinolaryngol 2020; 130:109810. [PMID: 31835120 DOI: 10.1016/j.ijporl.2019.109810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/03/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To demonstrate the effect of drug induced sleep endoscopy (DISE) on intra-operative decision making during pediatric sleep surgery for obstructive sleep apnea (OSA). METHODS A retrospective chart review was performed on pediatric (3-17 years) patients with moderate-to-severe OSA (7.2-71.8) who underwent drug induced sleep endoscopy at the time of initial sleep surgery. The characteristics evaluated included age, race, gender, site of obstruction, type of surgical intervention, pre- and post-operative apnea and hypopnea index. Of the 26 patients that were identified, 18 had both a pre- and post-operative polysomnograms result. RESULTS All patients underwent DISE immediately prior to surgical treatment. The mean pre-operative AHI for the 18 patients with post-operative polysomnogram results was 21.3 (7.2-71.8). The mean post-operative AHI for the 18 patients was 7.6 (0.7-25.1). There was a significant difference between pre- and post-operative AHI (p < 0.001). Of the 26 patients, the most common area of collapse was the soft palate, occurring in 17/26 (65.4%) patients. Base of tongue involvement was found to be present in 11/26 (42.3%) patients, and the epiglottis was involved in 4/26 (15.4%). Evidence of multilevel collapse was observed in 6/26 (23.1%) patients. Patients observed to have palatal collapse underwent a pharyngoplasty (20/26; 76.9%) at the time of adenotonsillectomy. Three (11.5%) patients underwent a tongue reduction. CONCLUSION This study provides additional evidence that DISE can affect intra-operative decision making, with the potential for improved post-operative outcomes. A randomized controlled study is needed to determine if these outcomes are better than what can be achieved without DISE.
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Affiliation(s)
- Julia Dmowska
- Department of Otolaryngology, The University of Tennessee Health Science Center, 910 Madison Ave. Memphis, TN, 38163, USA.
| | - Stephen Reed Larson
- Department of Otolaryngology, The University of Tennessee Health Science Center, 910 Madison Ave. Memphis, TN, 38163, USA
| | - M Boyd Gillespie
- Department of Otolaryngology, The University of Tennessee Health Science Center, 910 Madison Ave. Memphis, TN, 38163, USA
| | - Anthony Sheyn
- Department of Otolaryngology, The University of Tennessee Health Science Center, 910 Madison Ave. Memphis, TN, 38163, USA
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Marianayagam NJ, Shalom NB, Zarchi O, Michowiz S, Margalit N, Rajz G. Conservative management for pediatric patients with chiari 1 anomaly: A retrospective study. Clin Neurol Neurosurg 2019; 189:105615. [PMID: 31786431 DOI: 10.1016/j.clineuro.2019.105615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/08/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To better understand the natural history of non-surgical management of chiari 1 anomaly. PATIENTS AND METHODS After obtaining approval of the institutional review board, medical records and radiological exams of patients treated for CM1 at our institution between the years 2010 and 2016 were reviewed. Twenty-nine patients total were included in our study. RESULTS The average age of our patient population was 8.5 years old at the time of diagnosis. The average tonsillar herniation on first MRI was 9.4 mm (+/- 4.6) and the average tonsillar herniation on second MRI was 10.4 mm (+/- 4.8). The average follow up time of our sample of patients was 26 months. Of the 29 patients in our study 9 (31 %) had symptomatic presentation. Interestingly, four of our patients (13.8 %) presented with epilepsy. CONCLUSIONS Our findings support the previous work that nonoperative management is best in asymptomatic or mildly symptomatic chiari patients.
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Affiliation(s)
| | | | - Omer Zarchi
- Neurophysiology Unit, Rabin Medical Center, Petah Tiqva, Israel
| | - Shalom Michowiz
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Nevo Margalit
- Department of Neurosurgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gustavo Rajz
- Department of Neurosurgery, Shaare Zedek Medical Center, Jerusalem, Israel
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Socarras MA, Landau BP, Durr ML. Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after adenotonsillectomy: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 121:179-87. [PMID: 30925395 DOI: 10.1016/j.ijporl.2019.02.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of upper airway surgery for children with persistent obstructive sleep apnea after adenotonsillectomy and to assess sleep study outcomes when Drug Induced Sleep Endoscopy, Cine MRI, or other imaging procedure is performed to assist in identifying the location of obstruction and planning surgery. METHODS Systematic review and meta-analysis was performed. Inclusion criteria was English-language studies with original data including pediatric patients with persistent OSA after T&A. Exclusion criteria included case reports and lack of pre and post-operative sleep study data. Data Sources were PubMed, Cochrane Central, and Embase from 2000 to 2018. PRISMA standards were followed for the selection and review of articles. The Newcastle-Ottawa Quality Assessment scale was used to score the quality of evidence of the studies. All manuscripts were reviewed independently by two investigators. Primary outcome measures were apnea-hypopnea index and minimum oxygen saturation. Data was pooled using a random-effects model. RESULTS Of the 1902 abstracts identified, 11 studies (214 patients) met inclusion criteria for systematic review, 5 with Drug Induced Sleep Endoscopy as the diagnostic technique, 4 with Cine MRI, and 2 with MRI/CT. All studies were case series. Most subjects had syndromic comorbidities and/or obesity. Ten studies (198 patients) were included in the meta-analysis. Overall, there was a change in apnea hypopnea index of -6.51 (95% CI, -8.17 to - 4.85; p < 0.001) and an increase in minimum oxygen saturation by 3.24% (95% CI, 1.49%-4.98%; p < 0.001) following surgical intervention. Both Drug Induced Sleep Endoscopy and Cine MRI directed surgeries resulted in significant improvement in sleep study parameters. The two techniques could not be directly compared due to significant differences in co-morbidity rates between patients. CONCLUSIONS Surgery for pediatric persistent obstructive sleep apnea improves apnea hypopnea index and minimum oxygen saturation but does not resolve the disease. This is true when both Drug Induced Sleep Endoscopy and Cine MRI findings were used to direct surgery.
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Garde A, Hoppenbrouwer X, Dehkordi P, Zhou G, Rollinson AU, Wensley D, Dumont GA, Ansermino JM. Pediatric pulse oximetry-based OSA screening at different thresholds of the apnea-hypopnea index with an expression of uncertainty for inconclusive classifications. Sleep Med 2018; 60:45-52. [PMID: 31288931 DOI: 10.1016/j.sleep.2018.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 06/29/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessments of pediatric obstructive sleep apnea (OSA) are underutilized across Canada due to a lack of resources. Polysomnography (PSG) measures OSA severity through the average number of apnea/hypopnea events per hour (AHI), but is resource intensive and requires a specialized sleep laboratory, which results in long waitlists and delays in OSA detection. Prompt diagnosis and treatment of OSA are crucial for children, as untreated OSA is linked to behavioral deficits, growth failure, and negative cardiovascular consequences. We aim to assess the performance of a portable pediatric OSA screening tool at different AHI cut-offs using overnight smartphone-based pulse oximetry. MATERIAL AND METHODS Following ethics approval and informed consent, children referred to British Columbia Children's Hospital for overnight PSG were recruited for two studies including 160 and 75 children, respectively. An additional smartphone-based pulse oximeter sensor was used in both studies to record overnight pulse oximetry [SpO2 and photoplethysmogram (PPG)] alongside the PSG. Features characterizing SpO2 dynamics and heart rate variability from pulse peak intervals of the PPG signal were derived from pulse oximetry recordings. Three multivariate logistic regression screening models, targeted at three different levels of OSA severity (AHI ≥ 1, 5, and 10), were developed using stepwise-selection of features using the Bayesian information criterion (BIC). The "Gray Zone" approach was also implemented for different tolerance values to allow for more precise detection of children with inconclusive classification results. RESULTS The optimal diagnostic tolerance values defining the "Gray Zone" borders (15, 10, and 5, respectively) were selected to develop the final models to screen for children at AHI cut-offs of 1, 5, and 10. The final models evaluated through cross-validation showed good accuracy (75%, 82% and 89%), sensitivity (80%, 85% and 82%) and specificity (65%, 79% and 91%) values for detecting children with AHI ≥ 1, AHI ≥ 5 and AHI ≥ 10. The percentage of children classified as inconclusive was 28%, 38% and 16% for models detecting AHI ≥ 1, AHI ≥ 5, and AHI ≥ 10, respectively. CONCLUSIONS The proposed pulse oximetry-based OSA screening tool at different AHI cut-offs may assist clinicians in identifying children at different OSA severity levels. Using this tool at home prior to PSG can help with optimizing the limited resources for PSG screening. Further validation with larger and more heterogeneous datasets is required before introducing in clinical practice.
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Affiliation(s)
- Ainara Garde
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands; The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Xenia Hoppenbrouwer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands
| | - Parastoo Dehkordi
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- Center for Outcomes Research & Evaluation, School of Medicine, Yale University, New Haven, United States
| | - Aryannah Umedaly Rollinson
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wensley
- Division of Critical Care, The University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Guy A Dumont
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Lam DJ, Weaver EM, Macarthur CJ, Milczuk HA, O'Neill E, Smith TL, Nguyen T, Shea SA. Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale. Laryngoscope 2016; 126:1492-8. [PMID: 26775080 DOI: 10.1002/lary.25842] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/15/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Assess the reliability of a Sleep Endoscopy Rating Scale (SERS) and its relationship with pediatric obstructive sleep apnea (OSA) severity. STUDY DESIGN Retrospective case series of pediatric patients who underwent drug-induced sleep endoscopy (DISE) at the time of surgery for OSA from January 1, 2013 to May 1, 2014. METHODS Three blinded otolaryngologists scored obstruction on DISE recordings as absent (0), partial (+1), or complete (+2) at six anatomic levels: nasal airway, nasopharynx, velopharynx, oropharynx, hypopharynx, and arytenoids. Ratings were summed for a SERS total score (range, 0-12). Reliability was calculated using a κ statistic with linear weighting. SERS ratings and obstructive apnea-hypopnea index (OAHI) were compared using Spearman correlation. A receiver operating characteristic (ROC) analysis determined the ability of the SERS total score to predict severe OSA (OAHI >10). RESULTS Thirty-nine patients were included (mean age, 8.3 ± 5.1 years; 36% obese; mean OAHI, 19.1 ± 23.7). Intrarater and inter-rater reliability was substantial-to-excellent (κ = 0.61-0.83) and fair-to-substantial (κ = 0.33-0.76), respectively. Ratings correlated best with OAHI for the oropharynx (r = 0.54, P = .02), hypopharynx (r = 0.48, P = .04), and SERS total score (r = 0.75, P = .002). In ROC analysis, a SERS total score ≥6 demonstrated sensitivity/specificity of 81.8%/87.5%, respectively, and correctly classified 84% of patients. CONCLUSIONS The SERS can be applied reliably in children undergoing DISE for OSA. Ratings of the oropharynx, hypopharynx, and SERS total score demonstrated significant correlation with OSA severity. A SERS total score ≥6 was an accurate predictor of severe OSA. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1492-1498, 2016.
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Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Edward M Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Carol J Macarthur
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Henry A Milczuk
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Eleni O'Neill
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, U.S.A
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Suri JC, Sen MK, Venkatachalam VP, Bhool S, Sharma R, Elias M, Adhikari T. Outcome of adenotonsillectomy for children with sleep apnea. Sleep Med 2015; 16:1181-6. [PMID: 26429742 DOI: 10.1016/j.sleep.2015.02.539] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 10/31/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of obstructive sleep apnea syndrome is about 1%-4.9% in children aged 2-18 years. This is a prospective study carried out to evaluate the role of adenotonsillectomy (AT) in pediatric sleep apnea. METHODS Fifty children aged less than 15 years presenting with the chief complaints of snoring, mouth breathing, recurrent upper respiratory infections, and adenotonsillar hypertrophy were included in the study. Physical examination included body mass index (BMI) z-score, orodental and nasal examination, modified Mallampati scoring; whole-night level I polysomnography was conducted and repeated after three to six months of AT. RESULTS The mean preoperative BMI z-score was -0.76, which improved significantly to -0.15 (p < 0.001) after AT. A negative correlation was seen between respiratory distress index (RDI) and pre surgery BMI z-score. As per pre-operative RDI, OSA was classified mild in 6.7% children (31.1% as per apnea-hypopnea index [AHI]), moderate in 35.6% (31.1% as per AHI), and severe in 57.8% (37.8% as per AHI). The average RDI value reduced significantly from 16.2 ± 10.7 to 6.46 ± 4.8 (p < 0.001) and AHI from 8.5 (SD ± 5.7) to 1.3 (SD ± 1) post-operatively. Only 6.7% children could be cured with surgery, of whom none belonged to moderate or severe category. Multivariate analysis shows that initial severity of disease, modified Mallampati scores III and IV, high-arched palate, and age above eight years were associated with significant residual disease after AT. CONCLUSION AT was associated with a statistically significant change in RDI and AHI. However, complete resolution of OSA could be seen in a small percentage of patients with a mild degree of disease.
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Affiliation(s)
- Jagdish Chander Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjang Hospital, New Delhi, India.
| | - Manas K Sen
- Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjang Hospital, New Delhi, India
| | | | - Shikha Bhool
- Department of ENT, VMMC & Safdarjang Hospital, New Delhi, India
| | - Rahul Sharma
- Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjang Hospital, New Delhi, India
| | - Mir Elias
- Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjang Hospital, New Delhi, India
| | - Tulsi Adhikari
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
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Kheirandish-Gozal L, Yoder K, Kulkarni R, Gozal D, Decety J. Preliminary functional MRI neural correlates of executive functioning and empathy in children with obstructive sleep apnea. Sleep 2014; 37:587-92. [PMID: 24587582 DOI: 10.5665/sleep.3504] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 11/03/2022] Open
Abstract
BACKGROUND Pediatric obstructive sleep apnea (OSA) is associated with neurocognitive deficits. However, the neural substrates underlying such deficits remain unknown. METHODS To examine executive control and emotional processing in OSA, 10 children age 7 to 11 y with polysomnographically diagnosed OSA and 7 age- and sex-matched controls underwent a color-word Stroop task and an empathy task consisting of dynamic visual scenarios depicting interpersonal harm or neutral actions in a magnetic resonance imaging (MRI) scanner. Functional MRI data were processed using MATLAB 7.12 with SPM8 for region of interest (ROI) analyses, and a general linear model was used with regressors for each trial type in each task. RESULTS For the Stroop task, accuracy was similar in the two groups, with no differences in the effect of incongruency on success rates. OSA showed greater neural activity than controls in eight ROI clusters for incongruent versus congruent trials (P < 0.001). Within the a priori ROIs, the anterior cingulate cortex was significantly different between groups (P < 0.05). For perceiving harm versus neutral actions, ROI analysis revealed a significant correlation between apnea-hypopnea index and left amygdala activity in harm versus neutral actions (r = -0.71, P < 0.05). CONCLUSIONS These results provide the first functional MRI evidence that cognitive and empathetic processing is influenced by obstructive sleep apnea (OSA) in children. Children with OSA show greater neural recruitment of regions implicated in cognitive control, conflict monitoring, and attentional allocation in order to perform at the same level as children without OSA. When viewing empathy-eliciting scenarios, the severity of OSA predicted less sensitivity to harm in the left amygdala.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Keith Yoder
- Department of Psychology, Social Sciences Division, The University of Chicago, Chicago, IL
| | - Richa Kulkarni
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Jean Decety
- Department of Psychology, Social Sciences Division, The University of Chicago, Chicago, IL
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