Pediatric Sleep-disordered Breathing Research Articles

A surface electrode adjacent to vagal nerve stimulator lead can aid in characterizing vagal nerve stimulator-mediated pediatric sleep-disordered breathing: a case series of 7 patients.

The vagal nerve stimulator (VNS) is a nonpharmacological treatment for refractory epilepsy. A side effect of the VNS is sleep-disordered breathing. The purpose of this study was to demonstrate how a surface electrode placed over the VNS lead can help distinguish whether sleep-disordered breathing is due to VNS discharge. Seven pediatric patients (aged 7.7 ± 2.2 years) with a VNS underwent a polysomnogram with an additional surface electrode on the left anterolateral neck to detect VNS discharge. The VNS-associated apnea-hypopnea index was calculated by determining the number of hypopneas and apneas occurring during VNS discharge. We evaluated the veracity of the VNS electrode by comparing signal duration and total number to those expected by programmed settings. We compared these findings to chin electromyogram signal change. Three patients had an obstructive pattern with VNS discharge, and 3 had an increase in respiratory rate without gas exchange abnormalities, including 1 with both patterns; 1 patient experienced no respiratory abnormalities. The mean obstructive apnea-hypopnea index was 8.2 ± 8.3 events/h. The mean VNS-associated apnea-hypopnea index was 4.8 ± 6.2 events/h and accounted for 46.9 ± 30.2% of the total obstructive apnea-hypopnea index. The additional electrode captured a statistically high percentage of expected discharges (94.7 ± 6.5%) compared to chin electromyogram (36.1 ± 35.8%; P < .05). We demonstrated that a surface electrode on the VNS lead can temporally coregister VNS discharges and enabled us to attribute sleep-disordered breathing to VNS stimulation in 4 patients. We propose that this sensor be standard procedure in patients with VNS undergoing polysomnogram. Chan JHM, DelRosso LM, Ruth C, Wrede JE. A surface electrode adjacent to vagal nerve stimulator lead can aid in characterizing vagal nerve stimulator-mediated pediatric sleep-disordered breathing: a case series of 7 patients. J Clin Sleep Med. 2022;18(8):1973-1981.

Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children.

The success of surgical treatment for pediatric sleep-disordered breathing is typically assessed using the mixed and obstructive apnea-hypopnea index (MOAHI). Although an important metric, previous work has shown that snoring and stertor are also associated with sleep disruption. Our aim was to assess the efficacy of surgery using the Sonomat (Sonomedical Pty Ltd), a noncontact sleep assessment system, that accurately records complete and partial upper airway obstruction. Forty children (< 18 years) had a Sonomat study, in their own beds, before and after surgery. As an MOAHI ≥ 1 event/h is considered abnormal, the same threshold was applied to snore/stertor runs. Median (interquartile range) values are reported. Respiratory event-induced movements decreased from 12.0 (8.7-19.0) to 0.5 (0.1-3.2) events/h (P < .01), with no significant change in spontaneous movements: 12.8 (9.8-17.9) to 16.5 (13.7-26.1) events/h (P = .07). The MOAHI decreased from 4.5 (1.9-8.6) to 0.0 (0.0-0.4) events/h (P < .01). Snoring and/or stertor runs decreased from 32.8 (23.4-44.4) to 3.0 (0.2-14.6) events/h (P < .01). Thirty-four children had an MOAHI < 1 event/h following surgery; however, 20 had snore and/or stertor runs ≥ 1 event/h and 11 had snore and/or stertor runs ≥ 5 events/h. Only 14 (35%) children had a postsurgery MOAHI < 1 event/h combined with snoring and/or stertor < 1 runs/h. Although surgery is effective in improving breathing, success rates are overestimated using the MOAHI. Our results indicate that snoring and/or stertor are still present at levels that may disrupt sleep despite a normalization of the MOAHI and that when obstructed breathing was objectively measured, there was a large variation in its response to surgery. Norman MB, Harrison HC, Sullivan CE, Milross MA. Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children. J Clin Sleep Med. 2022;18(6):1649-1656.

Rapid Maxillary Expansion in Pediatric Patients with Sleep-Disordered Breathing: Cephalometric Variations in Upper Airway’s Dimension

Rapid maxillary expansion (RME) is considered an effective treatment in the management of sleep-disordered breathing (SDB) and malocclusions in pediatric patients, not only because it is able to correct the transverse maxillary deficiency, but it also widens the floor of the nasal cavities, leading to a drastic and immediate reduction in air resistance and facilitating a normal nasal breathing pattern. The aim of this study was to evaluate cephalometric changes in the upper airway’s dimensions and facial morphology in pediatric SDB patients treated with RME, comparing data with a no-SDB group treated with RME for malocclusion. In this retrospective study, pre-treatment and post-treatment cephalometric variables were measured on lateral skull radiographs from 20 SDB pediatric patients (nine males and 11 females) aged 6 to 9 years (mean age 7.61 ± 0.6), treated with a rapid maxillary expander, and 20 control patients without SDB (nine males and 11 females) aged 6 to 11 years (mean age 8.4 ± 0.5). In both groups, there were statistically significant changes in the variables indicating the airway’s dimensions and mandibular sagittal position in relation to the cranial base, with a skeletal class II correction in SDB children. Rapid maxillary expansion is associated with an increase in upper-airway dimensions in SDB children, as well as in control healthy subjects, with a possible correction of class II relationship.

Perspectives on paediatric sleep-disordered breathing in the UK: a qualitative study.

There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children. The study comprised in-depth qualitative interviews (n = 22) with parents of children (2-9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically. General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed. Guidelines for the management of paediatric sleep-disordered breathing are needed.

Breastfeeding and sleep-disordered breathing in children: systematic review and proposal of underlying interaction models.

Paediatric sleep breathing disorders represent an emerging paediatric health concern. Despite risk factors are widely discussed in literature, evidences about protective factors are lacking. The aim of this systematic review was to examine the available evidence about the effect of breastfeeding on snoring and obstructive sleep apnea in childhood, and to methodically describe the underlying mechanism of interaction. The study protocol was registered in advance in PROSPERO (CRD42020212529). Electronic search of the literature was performed up to October 10th, 2020 using four databases: PubMed, ScienceDirect, Medline and Scopus. Two authors independently retrieved potentially relevant articles to meet eligibility criteria. PRISMA guidelines were followed. Prospective, retrospective, case-control, cohort, clinical trial and cross-sectional studies investigating the association between breastfeeding and paediatric sleep-disordered breathing were included and data were extracted. No restrictions on language or date of publication were set. Subsequently, a search in the literature was further done to investigate underlying mechanisms of interaction. This review suggests that breastfeeding can effectively protect children and adolescents from sleep-disordered breathing, especially from habitual snoring, by preventing the associated risk factors. Future prospective studies with more efficient design are required.

O006 Early vascular ageing in children with sleep disordered breathing: evidence of vascular hypertrophy and hyperplasia

Abstract Children with sleep disordered breathing (SDB) have evidence of increased blood flow velocity and sympathetic overactivity. Sympathetic overactivity leads to peripheral vasoconstriction, increased vascular resistance and consequently, increases blood flow velocity. Early vascular ageing involves premature arterial thickening and stiffening that leads to changes in vascular function. Both increased blood flow velocity and sympathetic overactivity are promoters of arterial remodelling and hence, early vascular ageing. No studies have directly histologically investigated arterial wall structure in children with SDB and how it relates to vascular function. Thirty-six children scheduled for tonsillectomy underwent polysomnography to determine SDB severity and resting brachial artery blood flow velocity (velocity time integral and peak systolic velocity) using Doppler ultrasound. The dorsal lingual artery (tonsil) was stained using hematoxylin and eosin techniques to examine arterial wall structures. Increased velocity time integral correlated with increased arterial medial thickness (r = 0.50, P&amp;lt;0.01), arterial smooth muscle cells (r =0.43, P&amp;lt;0.05) and arterial smooth muscle layers (r=0.45, P&amp;lt;0.01). These relationships remained significant after controlling for body-mass index (BMI). Increased BMI was associated with increased velocity time integral (r=0.61, P&amp;lt;0.01), arterial medial thickness (r=0.37, P&amp;lt;0.05) and arterial medial area (r=0.36, P&amp;lt;0.05). SpO2nadir (TST/REM) was inversely associated with arterial medial area (r=-0.35; r=-0.38, P&amp;lt;0.05). These results demonstrate that increased blood flow velocity is associated with changes in arterial wall composition in children with SDB. This suggests that paediatric SDB, a treatable disorder, is potentially a modifiable risk factor for early vascular ageing and resultant cardiovascular disease in adulthood.

Impact of Tonsillectomy on Obesity in Pediatric Patients With Sleep-Disordered Breathing.

ObjectiveBoth tonsillar hypertrophy and obesity contribute to pediatric sleep-disordered breathing (SDB). Tonsillectomy addresses anatomical obstruction causing SDB; however, it may adversely affect the obesity profile postoperatively. Herein, we investigate posttonsillectomy body mass index (BMI) changes in pediatric patients.Study DesignRetrospective case series.SettingTertiary, pediatric urban academic center.MethodsAll patients undergoing tonsillectomy from January 1, 2016, to December 31, 2016, were included. Patients’ age, sex, surgical indication, and preoperative BMI were recorded. Postoperative BMI data were collected between March 1, 2016, and December 31, 2017. Statistical analysis was performed using a generalized regression model, using BMI percentile-for-age weight status.ResultsA total of 1153 patients were included (50% female), with age ranging from 2.0 to 19.5 years (mean [SD], 7.6 [4.0]). The majority (87.8%) had tonsillectomy for SDB. Of the cohort, 560 (48.6%) had available follow-up BMI data. The BMI percentile on the day of the surgery had a median of 65.8, and the BMI percentile on follow-up had a median of 76.4. The median time to follow-up was 197 days with a range of 50 to 605 days. Higher postoperative BMI percentile strongly correlated to higher preoperative BMI percentile (P < .001), as well as younger age (P < .001), male sex (P = .0005), and SDB as a surgical indication (P = .003).ConclusionWe observed a significant increase in BMI percentile following tonsillectomy, which accounted for a significantly higher proportion of the cohort being classified as overweight or obese postoperatively. These findings necessitate greater preoperative counseling, closer follow-up, and adjunctive measures for obesity management in pediatric patients undergoing tonsillectomy.

Cognition in pediatric SDB-Yes, no, maybe?

Numerous studies in the past 10 years have reported on the neurocognitive sequalae of pediatric sleep disordered breathing (SDB). Variations in criteria used to define SDB in conjunction with the wide variety of neuropsychological measures selected to evaluate cognitive consequences of SDB have resulted in discrepancies within the literature. This review summarizes the extent literature regarding cognitive effects of pediatric SDB across domains of global intelligence, attention, executive function, memory, language, and visuospatial ability. This review also addresses the proposed etiology underlying neurocognitive consequences of pediatric SDB. The differences in findings across the literature are highlighted and discussed throughout.

Effect of sleep-disturbed breathing on maxillofacial growth and development in school-aged children

ABSTRACT Purpose : In children, snoring and apnoea cause impairments in growth, cognitive function, attention, and school performance. In this study, we aimed to identify the association between craniofacial disharmony and paediatric sleep-disordered breathing. Materials and Methods : Forty-one patients with malocclusion (19 boys; 22 girls; mean age, 10.0 ± 2.1 years) were selected from our hospital. The relationship between maxillofacial morphology, pharyngeal airway form, and nasal respiratory function was examined using cephalometric analysis and skeletal patterns. All patients underwent portable monitoring with an overnight out-of-centre sleep testing protocol that could be performed at home using a portable computerized monitoring system. Results : The respiratory disturbance index was significantly greater in patients with mandibular retrusion than those with malocclusion. Arterial oxygen saturation and nasopharyngeal area were significantly smaller in participants with Class II malocclusion than in those with other types of malocclusion. Moreover, dental cast model analyses confirmed that patients with reduced transverse maxillary dimensions had a higher obstructive sleep apnoea syndrome (OSAS) risk than those with malocclusion. Therefore, patients with mandibular retrusion have a higher OSAS risk than those with other types of malocclusion. Conclusion : Childhood maxillofacial morphology may influence adult OSAS, and early treatment for children with OSAS may help prevent adult OSAS.

Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing.

To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Retrospective cohort study. Tertiary children's hospital. A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance (P < .001) and had a median driving distance of 74.8 vs 16.8 miles (P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

Consequences of paediatric sleep disordered breathing: contributions from Australian and New Zealand investigators

AimsTo highlight the contributions of Australian and New Zealand researchers to the identification of the consequences of paediatric sleep disordered breathing (SDB). MethodsA search was conducted in PubMed using the terms “sleep disordered breathing” “child” and “Australia or New Zealand”. All abstracts were reviewed and those which focused on the consequences of SDB have been included. ResultsAustralasian research into the consequences of SDB has grown exponentially over the last 35 years. SDB has significant adverse consequences for quality of life, behaviour, neurocognition and the cardiovascular system and the Australasian research studies investigating these are summarised. ConclusionsAustralian and New Zealand researchers have played a significant role in understanding the consequences of paediatric SDB and the mechanisms which underpin these. The research conducted “Downunder” has led the world in this field of research and will continue to provide evidence to improve the lives of children not only in Australasia but around the world.

Assessment of Predicting Factors for Pediatric Sleep Disordered Breathing

The aim of this study was to evaluate the association between various predicting tools and Apnea-Hypopnea Index (AHI) to identify children with sleep disordered breathing (SDB). From 5 to 10 years old who came for orthodontic counseling, 61 children, whom had lateral cephalograms, pediatric sleep questionnaire (PSQ) records, and portable sleep monitoring results, were included in this study. A total of 17 measurements (11 distances and 6 angles) were made on lateral cephalograms. The measurements of lateral cephalograms, PSQ scales and portable sleep monitoring results were statistically analyzed. 49 of 61 (80%) patients showed AHI &gt; 1, which suspected to have SDB and their mean AHI was 2.75. In this study, adenoid size (A/N ratio), position of the hyoid bone from mandibular plane, gonial angle, and PSQ scale were related to a higher risk of pediatric SDB. Also, oxygen desaturation index (ODI) and snoring time from sleep monitoring results were statistically significant in children with SDB using Mann-Whitney test (&lt;i&gt;p&lt;/i&gt; ＜ 0.05).&lt;br/&gt;In conclusion, evaluation of hyoid bone position, adenoidal hypertrophy, gonial angle in lateral cephalogram, and PSQ scale was important to screen out potential SDB, especially in children with frequent snoring.

Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center.

Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only 2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.

Long-Term Impact of Adenotonsillectomy on Quality of Life in Thai Children with Sleep-Disordered Breathing

Background: Sleep disordered breathing (SDB) is a spectrum of disorders that is characterized by abnormal respiratory patterns during sleep, with symptoms that include snoring, mouth breathing, and pauses in breathing. No previous study has investigated the long-term impact of adenotonsillectomy on the quality of life in Thai children with SDB. Objective: To investigate the long-term impact of adenotonsillectomy on the quality of life in Thai pediatric patients with SDB as measured by Obstructive Sleep Apnea-18 (OSA-18) questionnaire. Materials and Methods: The present study was retrospectively conducted in Thai pediatric SDB that underwent adenotonsillectomy at Siriraj Hospital between January 1997 and December 2010. Caregivers of the present study children completed the OSA-18 questionnaire pre-operatively and at least 6-months post-operatively. Demographic and pre-operative polysomnography (PSG) data were also collected and analyzed. Pre-operative and post-operative OSA-18 total score and OSA-18 scores for all five domains were compared using paired t-test. Results: Forty-nine children with SDB that underwent adenotonsillectomy were included. There were 30 boys (61.2%) and 19 girls (38.8%), with a mean age of 6.1±2.6 years (range 3.0 to 12.1). Pre-operative PSG was performed in 32 children (65.3%), with a mean apnea-hypopnea index of 12.6±12.4. Mean pre-operative and post-operative total OSA-18 score was 69.8±16.1 and 36.0±12.9, respectively. Mean duration from surgery to completion of the OSA-18 questionnaire after adenotonsillectomy was 12.5±4.6 months (range 6 to 28). Total OSA-18 score and the scores for all five OSA-18 domains were significantly improved after adenotonsillectomy (p&lt;0.001 and &lt;0.001, respectively). Conclusion: Long-term quality of life in Thai children with SDB was improved significantly after adenotonsillectomy, as evidenced by the significant improvement in OSA-18 total score and all OSA-18 domains. Based on these findings, the authors encourage adenotonsillectomy as the first-line treatment for SDB in Thai pediatric population. Keywords: Long-term impact, Adenotonsillectomy, Quality of life, Thai children, Sleep-disordered breathing, SDB

The Efficacy of Posterior Turbinoplasty in Combination with Tonsillectomy and Adenoidectomy in Pediatric Sleep Disordered Breathing Patients

Background and Objectives Tonsillectomy and adenoidectomy (T&amp;A) are effective for the treatment of pediatric sleep disorder breathing. However, in some pediatric patients, there remain unresolved snoring and mouth breathing problems after the operation. This study is aimed at evaluating the efficacy of coblation of hypertrophic posterior turbinate in combination with tonsillectomy and adenoidectomy.Subjects and Method We analyzed data from 50 children aged between 5 to 13 years old who were scheduled to undergo T&amp;A operation from June 2018 to December in 2018. We randomly divided them into two groups. The first group consisted of 25 patients who were scheduled to perform only tonsillectomy and adenoidectomy. The second group was 21 patients who were scheduled to perform posterior turbinoplasty in combination with tonsillectomy and adenoidectomy. We evaluated preoperative and postoperative polysomnogram [Apnea-Hypopnea Index (AHI), O2 saturation], acoustic rhinometry (minimal cross section area, nasal volume), and Korean Obstructive Sleep Apnea-18 Survey (KOSA-18) score.Results After additional turbinoplasty (coblation of hypertrophic posterior turbinate), the rate of snoring and mouth breathing remaining was decreased. There were significant improvements in AHI, oxygen saturation, Visual Analog Scale and Epworth Sleepiness Scale in two groups. Symptoms (snoring and mouth breath) remaining postoperatively was much more decreased in the posterior turbinoplasty combined with T&amp;A group than in the single T&amp;A group in terms of KOSA-18.Conclusion When it comes to pediatric sleep disorder breathing surgery, nasal cavity evaluation is an important factor for patient’s postoperative satisfaction for sleeping and snoring. For pediatric sleep disorder breathing patients with hypertrophic posterior turbinate, who are scheduled to do tonsillectomy and adenoidectomy, an additional coblation of posterior turbinate should be considered.

Impact of AAO-HNS Guideline on Obtaining Polysomnography Prior to Tonsillectomy for Pediatric Sleep-Disordered Breathing.

To assess the impact of the 2011 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline on practice patterns in obtaining preadenotonsillectomy (AT) polysomnography (PSG) for pediatric sleep-disordered breathing (SDB). Retrospective cohort study. Tertiary children's hospital. The study population included all patients referred to our pediatric otolaryngology clinic for consideration of AT for SDB during two 12-month time periods: before (2010-2011) and after (2015-2016) publication of the 2011 AAO-HNS guideline. Demographic, insurance, comorbidity, and Pediatric Sleep Questionnaire (PSQ) variables were assessed for association with pre-AT PSG using bivariate and multivariate logistic regression analysis. A greater percentage of patients underwent pre-AT PSG in 2015-2016 vs 2010-2011 (30% vs 22%, P = .001). On multivariate analysis, presence of neuromuscular disorder was the only predictor associated with pre-AT PSG in 2010 to 2011 (odds ratio [OR], 3.00; 95% CI, 1.10, 8.06; P = .03). Presence of neuromuscular disorder (OR, 2.54; 95% CI, 1.51, 4.29; P < .0001), craniofacial anomaly (OR, 2.32; 95% CI, 1.20, 4.50; P = .013), or Down syndrome (OR, 3.45; 95% CI, 1.54, 7.72; P = .003) was associated with pre-AT PSG in 2015 to 2016. Positive PSQ screen was significantly associated with decreased odds of pre-AT PSG in both time periods. After publication of the 2011 AAO-HNS guideline, there was a significant but modest increase in pre-AT PSG utilization in children with SDB and high-risk comorbidities at our institution, consistent with AAO-HNS guideline recommendations. However, overall guideline adherence remains low and may reflect limitations in PSG testing capacity.

Mean platelet volume levels in children with sleep-disordered breathing: a meta-analysis

BackgroundPediatric sleep-disordered breathing (SDB) correlated with respiratory conditions of snoring and hypopnea. Mean platelet volume (MPV) was an inflammatory marker, related to increased inflammatory condition of pediatric patients. Increase of MPV level may cause failure to thrive or increased upper airway infection rate. The aim of this study was to perform systematic review and meta-analysis to investigate the difference on MPV values for pediatric SDB, and compare the change on MPV after surgery in patients with pediatric SDB.MethodsA systemic review of the studies from PubMed, EMBASE, and Cochrane Library databases was conducted in March 2020, supported by reviewing of published articles for studies comparing MPV in pediatric SDB. Meta-analysis was used to compare the change of MPV in pediatric SDB, and sub-group analysis was also used to compare the MPV decrease after surgeries of adenoidectomy or adenotonsillectomy.ResultsThere were seven studies included in the review. Six of them including 963 subjects showed that a significant increase of MPV was noted in pediatric SDB compared to those in pediatric non-SDB (P < 0.05). Total standardized mean difference (SMD) in MPV between pediatric SDB and non-SDB was 0.51 (95% CI =0.30–0.72, P < 0.05). A significant decrease of MPV was found in pediatric SDB patients who underwent surgery (total SMD = − 0.36; 95% CI = − 0.70– -0.02, P < 0.05). Decreases of MPV after adenoidectomy and adenotonsillectomy were observed, but only the effect of adenotonsillectomy had a statistical significance (total SMD = − 0.72; 95% CI = − 1.18 – -0.26, P < 0.05).ConclusionThe MPV was significantly higher in patients with pediatric SDB, indicating the presence of increased platelet activity in pediatric SDB patients. The level of MPV could be reduced by the two surgeries, especially adenotonsillectomy.

Pediatric sleep-disordered breathing in the orthodontic population: Prevalence of positive risk and associations

Pediatric sleep-disordered breathing (SDB) describes a spectrum of disease ranging from snoring to upper airway resistance syndrome and obstructive sleep apnea (OSA). Anatomical features assessed during orthodontic exams are often associated with symptoms of SDB in children. Hence, we need to determine the prevalence of positive risk for SDB in the pediatric orthodontic population compared with a general pediatric population and understand comorbidities associated with SDB risk among orthodontic patients. Responses from Pediatric Sleep Questionnaires were collected from 390 patients between the ages of 5 and 16years, seeking orthodontic treatment. Prevalence of overall SDB risk, habitual snoring, and sleepiness were determined in the orthodontic population and compared with those previously reported by identical methods in the general pediatric population. Additional health history information was used to assess comorbidities associated with SDB risk in 130 of the patients. At 10.8%, the prevalence of positive SDB risk was found to be significantly higher in the general pediatric orthodontic population than in a healthy pediatric population (5%). The prevalence of snoring and sleepiness in the orthodontic population was 13.3% and 17.9%, respectively. Among the comorbidities, nocturnal enuresis (13.6%), overweight (18.2%), and attention deficit hyperactivity disorder (31.8%) had a higher prevalence in orthodontic patients with higher SDB risk (P<0.05). There is a higher pediatric SDB risk prevalence in the orthodontic population compared with a healthy pediatric population. Orthodontic practitioners should make SDB screening a routine part of their clinical practice.

Diagnosis and Effect of Maxillary Expansion in Pediatric Sleep-Disordered Breathing

이 연구의 ëª©ì ì€ ìˆ˜ë©´í˜¸í¡ìž¥ì• ì¦ìƒì„ 보이며 협착된 ìƒì• ê¶ì„ 가진 7 - 9세 어린이에서 ìƒì• í™•ìž¥ìˆ (semi-rapid maxillary expansion, SRME)을 이용한 ìƒì• ì¸¡ë°©í™•ìž¥ 치료 ì „í›„ ìˆ˜ë©´í˜¸í¡ìž¥ì• ì¦ìƒì˜ 변화와 ê°œì„ ì„ 소아수면설문지, 간이수면검사 및 측방두부규격 ë°©ì‚¬ì„ ì‚¬ì§„ì„ 통해 기도부위의 변화를 비교, ë¶„ì„í•˜ê³ ìž 하는 것이다.대상자는 총 15ëª ìœ¼ë¡œ AHI 1 이상이며 좁은 ìƒì• ê¶ì„ 가진 어린이였다. ëª¨ë“ ëŒ€ìƒìžëŠ” SRME가 ì ìš©ë˜ê¸° ì „ 소아수면설문지, 측방두부규격 ë°©ì‚¬ì„ ì‚¬ì§„ 및 간이수면검사를 시행하였다(T0). SRME가 ì ìš©ë˜ì—ˆê³ , í‰ê· í™•ìž¥ 2개월 후 ìœ ì§€ë‹¨ê³„ 3개월을 시행하였다. 치료 ì¢ ë£Œ 후 소아수면설문지, 측방두부규격 ë°©ì‚¬ì„ ì‚¬ì§„ 및 휴대용 간이수면검사를 시행하였다(T1).총 PSQ scale은 확장 ì „(T0) í‰ê· 0.45에서 확장 후(T1) í‰ê· 0.18로 í†µê³„ì ìœ¼ë¡œ ìœ ì˜í•˜ê²Œ 감소하였다(p = 0.001). 특히 코골이, 호흡 ë¬¸ì œ, ì§‘ì¤‘ë ¥ ì €í•˜ 영역에서 ìœ ì˜í•œ 감소를 보였다(p = 0.001). ì•„ë°ë ¸ì´ë“œ 비대율은 확장 ì „(T0) í‰ê· 0.63에서 확장 후(T1) í‰ê· 0.51로 ìœ ì˜í•˜ê²Œ 감소하였다(p = 0.003). 상기도 폭경 중 구개인두 폭경만이 치료 후(T1) í†µê³„ì ìœ¼ë¡œ ìœ ì˜í•œ 증가를 보였다(p = 0.035). 설골 위치는 치료 ì „í›„ì— í†µê³„í•™ì ìœ¼ë¡œ ìœ ì˜í•œ 차이를 보이지 않았다. 휴대용 간이수면검사 ê²°ê³¼ AHI와 ODI는 치료 후(T1) í†µê³„ì ìœ¼ë¡œ ìœ ì˜í•œ 감소를 ë³´ì˜€ê³ , ìµœì € 산소포화도는 ìœ ì˜í•œ 증가를 보였다. 따라서, ìˆ˜ë©´í˜¸í¡ìž¥ì• ì¦ìƒì€ 치료 후 ì „ë°˜ì ìœ¼ë¡œ ê°œì„ ë˜ì—ˆìŒì„ 알 수 있다.

The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing.

The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assessment for pediatric sleep-disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS-15 in a multi-institutional fashion. Five hundred and thirty children from 13 sites with suspected sleep-disordered breathing were recruited, and the investigators completed the CAS-15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty-seven subjects had a follow-up CAS-15. Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS-15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS-15 and the initial apnea-hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver-operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1. This study establishes the generalizability of the CAS-15 as a useful office tool for the evaluation of pediatric sleep-disordered breathing. 2B Laryngoscope, 130:2256-2262, 2020.