Risk For Sleep-disordered Breathing Research Articles

Orofacial dysfunction screening examinations in children with sleep-disordered breathing symptoms

Orofacial myofunctional disorders (OMD) and sleep-disordered breathing (SDB) may present as comorbidities. Orofacial characteristics might serve as a clinical marker of SDB, allowing early identification and management of OMD and improving treatment outcomes for sleep disorders. The study aims to characterize OMD in children with SDB symptoms and to investigate possible relationships between the presence of various components of OMD and symptoms of SDB. A cross-sectional study of healthy children aged 6–8 from primary schools was conducted in central Vietnam in 2019. SDB symptoms were collected using the parental Pediatric Sleep Questionnaire, Snoring Severity Scale, Epworth Daytime Sleepiness Scale, and lip-taping nasal breathing assessment. Orofacial myofunctional evaluation included assessment of tongue mobility, as well as of lip and tongue strength using the Iowa Oral Performance Instrument, and of orofacial characteristics by the protocol of Orofacial Myofunctional Evaluation with Scores. Statistical analysis was used to investigate the relationship between OMD components and SDB symptoms. 487 healthy children were evaluated, of whom 46.2% were female. There were 7.6% of children at high risk of SDB. Children with habitual snoring (10.3%) had an increased incidence of restricted tongue mobility and decreased lip and tongue strength. Abnormal breathing patterns (22.4%) demonstrated lower posterior tongue mobility and lower muscle strength. Daytime sleepiness symptoms were associated with changes in muscle strength, facial appearance, and impaired orofacial function. Lower strengths of lip and tongue or improper nasal breathing were more likely to be present in children with reported sleep apnea (6.6%). Neurobehavioral symptoms of inattention and hyperactivity were linked to anomalous appearance/posture, increases in tongue mobility and oral strength. This study demonstrates a prevalence of orofacial myofunctional anomalies in children exhibiting SDB symptoms. Children with prominent SDB symptoms should be considered as candidates for further orofacial myofunctional assessment.

Identifying gaps in clinical evaluation and treatment of sleep-disordered breathing in women veterans.

Sleep-disordered breathing (SDB) is a common sleep disorder in veterans; however, limited research exists in women veterans. We sought to estimate patterns of care in terms of evaluation, diagnosis, and treatment among women veterans with factors associated with elevated SDB risk. Within one VA healthcare system, women identified through electronic health record data as having one or more factors (e.g., age >50 years, hypertension) associated with SDB, completed telephone screening in preparation for an SDB treatment study and answered questions about prior care related to SDB diagnosis and treatment. Of 319 women, 111 (35%) reported having completed a diagnostic sleep study in the past, of whom 48 (43%) were diagnosed with SDB. Women who completed a diagnostic study were more likely to have hypertension or obesity. Those who were diagnosed with SDB based on the sleepstudy were more likely to have hypertension, diabetes, or be ≥50 years old. Of the 40 women who received treatment, 37 (93%) received positive airway pressure therapy. Only 9 (24%) had used positive airway pressure therapy in the prior week. Few women received other treatments such as oral appliances or surgery. Findings support the need for increased attention to identification and management of SDB in women veterans, especially those with conditions associated with elevated SDB risk.

The association of multidimensional sleep health with adiposity in heart failure with preserved ejection fraction

BackgroundThere are bi-directional relationships between sleep disturbances and obesity, both of which are prevalent in patients with heart failure with preserved ejection fraction (HFpEF). However, little is known about the sleep-obesity association in HFpEF. ObjectivesTo determine associations of multidimensional sleep health, night movement, sleep fragmentation, and sleep-disordered breathing (SDB) risk with overall and regional adiposity in HFpEF patients. MethodsMen and women with HFpEF (n = 49) were assessed via 14-day actigraphy, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale to derive multidimensional sleep health. SDB risk was assessed via Berlin Questionnaire. Body composition was measured using anthropometry; MRI quantification of epicardial, abdominal, liver, and thigh adipose tissue was performed in a subsample (n = 22). Spearman correlation (rs) and linear regression analyses (β coefficient) were used to estimate bivariate and age-adjusted associations. ResultsMultidimensional sleep health was inversely associated with BMI (rs = -0.50, p < .001; unadjusted: β = -4.00, 95%CI: -5.87, -2.13; age-adjusted: β = -2.48, 95%CI: -4.65, -0.30), thigh subcutaneous adipose tissue (rs = -0.50, p = .018; unadjusted: β = -36.95, 95%CI: -67.31, -6.59), and thigh intermuscular fat (age-adjusted: β = -0.24, 95%CI: -0.48, -0.01). Night movement and sleep fragmentation were associated with greater intermuscular thigh and lower liver fat. High SDB risk was associated with a higher visceral-to-subcutaneous ratio of abdominal adiposity and lower thigh adiposity. ConclusionsAdverse multidimensional sleep health is associated with higher adiposity measures in HFpEF patients. Further studies are needed to determine whether intervening on sleep could ameliorate excess adiposity or whether weight loss could improve sleep quality in HFpEF.

Sleep Disordered Breathing in Children

Sleep disordered breathing (SDB) is a disease characterized by repeated hypopnea and apnea during sleep due to complete or partial obstruction of upper airway. The prevalence of pediatric SDB is approximately 12 - 15%, and the most common age group is preschool children aged 3 - 5 years. Children show more varied presentations, from snoring and frequent arousals to enuresis and hyperactivity. The main cause of pediatric SDB is obstruction of the upper airway related to enlarged tonsils and adenoids. If SDB is left untreated, it can cause complications such as learning difficulties, cognitive impairment, behavioral problems, cardiovascular disease, metabolic syndrome, and poor growth. Pediatric dentists are in a special position to identify children at risk for SDB. Pediatric dentists recognize clinical features related to SDB, and they should screen for SDB by using the pediatric sleep questionnaire (PSQ), lateral cephalometry radiograph, and portable sleep monitoring test and refer to sleep specialists. As a therapeutic approach, maxillary arch expansion treatment, mandible advancement device, and lingual frenectomy can be performed. Pediatric dentists should recognize that prolonged mouth breathing, lower tongue posture, and ankyloglossia can cause abnormal facial skeletal growth patterns and sleep problems. Pediatric dentists should be able to prevent these problems through early intervention.

Sleep-disordered breathing in children seeking orthodontic care-an Australian perspective.

The prevalence of sleep-disordered breathing in children is underestimated due to impediments in detection and diagnosis. Consequently, delayed management may affect the quality of life and the growth and development of a child. Due to their patient demographic, orthodontists are optimally positioned to identify those at risk of sleep-disordered breathing and make referrals for investigation and management. This study aims to determine the prevalence of children at risk of sleep-disordered breathing in an Australian orthodontic population. A 1-year retrospective study was conducted in an urban Western Australian private orthodontic practice with two branches in similar socioeconomic demographics. The responses of new patients to a modified paediatric sleep questionnaire and standard medical history form were recorded. In 1209 patients (4-18 years), 7.3% were at risk of sleep-disordered breathing. An association between sex and the potential risk of sleep-disordered breathing was found with 11% of males at risk of sleep-disordered breathing compared to 7% of females (P= 0.012). The relatively high prevalence of children at risk of sleep-disordered breathing presenting for orthodontic care presents an opportunity to identify at-risk individuals through routine use of the paediatric sleep questionnaire. This would facilitate early referral for diagnosis and management of sleep-disordered breathing.

Racial and ethnic differences in sleep-disordered breathing and sleep duration among stroke patients

ObjectiveWe sought to characterize racial and ethnic differences in pre- and post-stroke sleep-disordered breathing (SDB) and pre-stroke sleep duration. MethodsWithin the Brain Attack Surveillance in Corpus Christi cohort of patients with ischemic stroke (8/26/2010-1/31/2020), pre-stroke SDB risk was assessed retrospectively using the Berlin Questionnaire. Post-stroke SDB was defined by prospective collection of the respiratory event index (REI) using the ApneaLink Plus performed shortly after stroke. Pre-stroke sleep duration was self-reported. We used separate regression models to evaluate the association between race/ethnicity and each outcome (pre-stroke SDB, post-stroke SDB, and pre-stroke sleep duration), without and with adjustment for potential confounders. ResultsThere was no difference in pre-stroke risk of SDB between Black and non-Hispanic white (NHW) participants (odds ratio (OR) 1.07, 95% CI 0.77-1.49), whereas MA (Mexican American), compared to NHW, participants had a higher risk of SDB before adjusting for demographic and clinical variables (OR 1.26, 95% CI 1.08-1.47). Post-stroke SDB risk was higher in MA (estimate 1.16, 95% CI 1.06-1.28) but lower in Black (estimate 0.79, 95% CI 0.65-0.96) compared to NHW participants; although, only the ethnic difference remained after adjustment. MA and Black participants had shorter sleep duration than NHW participants (OR 0.83, 95% CI 0.72-0.96 for MA; OR 0.67, 95% CI 0.49-0.91 for Black participants) before but not after adjustment. ConclusionsRacial/ethnic differences appear likely to exist in pre- and post-stroke SDB and pre-stroke sleep duration. Such differences might contribute to racial/ethnic disparities in stroke incidence and outcomes.

Comorbid insomnia and sleep apnea in children: a preliminary explorative study.

Insomnia and sleep-disordered breathing (SDB) are prevalent sleep disorders. These disorders can therefore be concurrently present - comorbid insomnia and sleep apnea (COMISA). The prevalence of COMISA in the paediatric age range is unclear. As such, phenotypic constructs should help better define this comorbid condition if it exists in children and improve both diagnostic sensitivity and ultimately clinical care outcomes. We aimed to evaluate the frequency of insomnia in children and adolescents referred for evaluation of sleep symptoms suggestive of SDB in one initial (Cohort#1) and verify such findings in an independent cohort (Cohort#2) using a retrospective cross-sectional approach in patients aged 9-19 years presenting at a sleep centre to be evaluated for symptoms of SDB. Cohort #1 comprised 50 consecutive children (58% males; mean [SD] age 13.6[3.3]years; median [interquartile range, IQR] Epworth Sleepiness Scale score 10[6-12]) who were evaluated using validated SDB and insomnia questionnaires. Cohort#2 was extracted from electronic medical records and included 384 polysomnographically evaluated children (mean [SD] age 12.9[3.6]years; mean [SD] body mass index z score 1.27[0.28]; median Epworth Sleepiness Scale score 9.7[4-17]). In Cohort #1, 56% were at high risk of SDB, 36% had insomnia alone, and 18% were at high risk of COMISA. The prevalence of COMISA in Cohort #2 was 16%, 72% had SDB alone, and 12% had insomnia alone. In both cohorts, COMISA manifested as increased propensity for sleepiness and fatigue during both waking and daytime. Thus, the presence of COMISA is frequent in the paediatric age range and accompanied by a more prominent symptomatic phenotype.

Association of orofacial dysfunction and sleep disordered breathing among Indian primary school children

IntroductionSleep-disordered breathing (SDB) ranges from partial obstruction of the upper airway resulting in snoring to total upper airway obstruction leading to obstructive sleep apnea. The impairment in the dynamics of the stomatognathic system is termed as orofacial dysfunction. This study investigates the prevalence of orofacial dysfunction and sleep-disordered breathing in primary school children and identifies their correlation. MethodsA total of 560 forms were distributed to 8 primary schools in Belagavi city. Among them, 482 parents responded (86% response rate), which included 239 boys (49.58%) and 243 girls (50.41%). All the participants were screened for orofacial dysfunction using Nordic Orofacial Dysfunction Test-screening (NOT-S) and sleep-disordered breathing using the Pediatric Sleep Questionnaire (PSQ). ResultA positive direct correlation of sleep-disordered breathing with orofacial dysfunction (r = 0.47; p ≤ 0.001) was noted. A total of 41(8.58%) children were found to be at risk of sleep-disordered breathing with a score less than or equal to eight, based on (PSQ) Pediatric Sleep Questionnaire, and 156 (32.6%) children showed symptoms of orofacial dysfunction based on Nordic Orofacial Test–Screening (NOT-S). ConclusionThe study demonstrates that around 32.6% of children had orofacial dysfunction symptoms, and 8.58% of children were at risk for sleep-disordered breathing, girls having a greater risk as compared to boys. There was a positive correlation between orofacial dysfunction and sleep-disordered breathing among children aged 6–12 years.

A Study on Factors Related to Sleep Disordered Breathing in Children

The aim of this study was to investigate the risk factors associated with sleep disordered breathing (SDB) by comparing intraoral factors, body mass index (BMI), and medical history with pediatric sleep questionnaire (PSQ) findings.Seven hundred eighty-seven subjects aged between 7 to 11 years old were included. Their caregivers were asked to complete questionnaires. Oral manifestations including Angle’s classification, overjet, and Brodsky tonsil grade were examined. Children with PSQ scores of more than 0.33 points were classified into the SDB high-risk group.Among the 787 subjects, 34 (4.3%) were classified into the SDB high-risk group. Children with allergic rhinitis, atopic dermatitis, excessive overjet, or large tonsil size had a significantly higher risk for SDB versus those without. Also, there was a significant difference in SDB risk according to BMI status. Gender, gestational age, breastfeeding, and Angle’s classification were not associated with SDB.Children at high risk for SDB were predisposed to tonsillar hypertrophy, allergic rhinitis, obesity, and atopic dermatitis. Children with these factors could be candidates for early intervention to prevent the progression of SDB.

Sleep disordered breathing and oral health-related quality of life in children with different skeletal malocclusions

ABSTRACT Objective To evaluate the relationship among different skeletal malocclusion patterns, sleep-disordered breathing (SDB) and children’s oral health-related quality of life (OHRQoL). Methods Two hundred-five patients were divided into three groups, considering skeletal malocclusion. Parents completed the Pediatric Sleep Questionnaire (PSQ) on behalf of the patients, who completed the 14-question version of the Oral Health Impact Profile (OHIP-14). Results SDB was observed in 10.7% of children. The overall prevalence of snoring, difficulty breathing during sleeping, mouth breathing, and dry mouth on awakening was 8.78%, 7.31%, 36.09%, and 37.07%, respectively. However, there was no significant difference in OHIP-14 parameters among the skeletal groups. A positive correlation was found between OHIP-14 and PSQ and was significant in Class I and III. Conclusion Although there was no significant difference, SDB risk and sleep quality were found as most to least problematic, in the following sequential order: Class II > Class III > Class I.

0523 Prevalence And Severity Of Sleep Disordered Breathing In Asthmatic Children

Abstract Introduction Children with severe and poorly controlled asthma have a higher predisposition for sleep disordered breathing (SDB). It can lead to cardiovascular, neurocognitive, and behavioral problems. Variable data exists currently whether demographic factors like age, sex, obesity, adeno-tonsillar hypertrophy tend to increase the risk of SDB in asthmatics. Our objective was to evaluate the risk factors and prevalence of SDB in asthmatics as compared to non - asthmatics and describe the polysomnographic parameters in asthmatics with SDB. Methods Asthmatic and non - asthmatic children aged 5 – 15 years, were recruited in this case – control study. Parameters like age, gender, body mass index, adeno-tonsillar hypertrophy, and the history of snoring were compared. All participants completed the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ) and prevalence of risk of SDB (defined as SDBS - PSQ ≥ 0.33) was calculated. A subset of asthmatics with risk of SDB underwent polysomnography, and subjects were classified into no, mild, moderate, and severe SDB [based on apnea-hypopnea index (AHI) ≤1, 1-5, 5-10, and ≥10, respectively]. Results 120 children, with 60 asthmatics were included. Amongst asthmatic group, 61.7% were male and mean age was 9.51 ± 2.50 years. Risk of SDB was significantly higher in asthmatics compared to non - asthmatics (18.33% vs 1.67%, p = 0.001; with mean SDBS-PSQ score 0.14 ± 0.17 vs 0.05 ± 0.08, p = 0.001). History of snoring was reported in 25% of asthmatic children versus 11.7% in non – asthmatics (p&amp;gt; 0.05). Other parameters were similar in both the groups (p&amp;gt; 0.05). Of the 11 asthmatics with risk of SDB, 10 underwent polysomnography. 9 patients (15% of asthmatics) were diagnosed with SDB, with a mean AHI of 4.21 ± 3.28, mean total sleep time of 279.23 ± 57.69 minutes and mean arousal index of 10.23 ± 8.67. In this subset, 60% had mild SDB. Conclusion Prevalence of SDB is higher in asthmatics, compared to general population. SDBS-PSQ is a useful screening tool for diagnosing SDB and should be incorporated in the daily practice, the gold standard being polysomnography. Further studies would help in a better understanding of SDB spectrum in children. Support (If Any) Nil

0520 Effect Of Sleep Disordered Breathing On Control And Severity Of Asthma On Pediatric Population

Abstract Introduction Pediatric sleep disordered breathing (SDB) can co-exist with asthma, affecting its control and severity, adding to the overall health care burden. Our aim was to determine the association of SDB with control and severity of asthma, and to evaluate any concomitant risk factors associated with both. Methods Based on the Sleep-Related Breathing Disorder scale extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ), children (5 – 15 years) with persistent asthma were classified as: with SDB (SDBS-PSQ ≥ 0.33) and without SDB, in a cross – sectional study. Characteristics like age, gender, body mass index and spirometry were compared. Control of asthma was categorized into well-controlled, not-well, and poorly controlled using childhood – asthma control test (c-ACT ≥20, 12-19 and ≤12, respectively). Correlation between SDBS-PSQ and c-ACT was analysed. Correlation of risk factors like adeno-tonsillar hypertrophy, gastroesophageal reflux disease, obesity and allergic rhinitis (AR) with presence of SDB in asthma was also assessed. Results Among sixty asthmatics, mild, moderate, and severe persistent asthma was observed in 26.67%, 40% and 33.33%, respectively. 18.33% asthmatics had risk for SDB (mean SDBS-PSQ of 0.45 ± 0.11 vs 0.07 ± 0.07 in those without SDB, p&amp;lt;0.001). Baseline and spirometric characteristics were similar in both groups. Asthmatics with SDB had higher rates of severe persistent (63.6% vs 26.5%, p = 0.018) and uncontrolled asthma (100% vs 30.6%, p&amp;lt;0.001), and a lower mean c–ACT score (14.45 ± 3.20 vs 20.04 ± 4.56, p&amp;lt;0.001) compared to asthmatics without SDB. Amongst asthmatics with SDB, mean SDBS-PSQ score was higher in not-well and poorly controlled asthmatics (0.41 ± 0.07 vs 0.12 ± 0.08, p &amp;lt;0.001 and 0.58 ± 0.08 vs 0.01 ± 0.07, p&amp;lt;0.001; respectively), compared to those without SDB. Negative correlation was confirmed between c-ACT and SDBS-PSQ scores (p&amp;lt;0.001, r2 = 0.36). Only AR was associated with SDB (p = 0.001, correlation coefficient &amp;lt;0.001). Conclusion Control and severity of asthma is adversely affected by SDB, independent of other risk factors. AR can increase the risk of SDB in asthmatic children, further affecting the control. Therefore, children with severe and difficult-to-control asthma should be screened for SDB using objective questionnaires like SDBS-PSQ. Support (If Any) Nil

0701 STOP-BANG Score, Age, and Body Mass Index Predict Severity of Sleep Disordered Breathing in Women Veterans

Abstract Introduction Despite increasing evidence that sleep disordered breathing (SDB) is common in women veterans, little is known of how to screen for SDB in this population. Some evidence suggests there are sex-related differences in SDB presentation, where women may be more likely to present with fatigue or depression, compared to men who may present with daytime sleepiness. The goal of this study was to evaluate whether commonly used measures predict SDB in women veterans. Methods Women veterans (N=179) without treated SDB, but with 1 or more SDB risk factors (identified from electronic medical records) completed baseline assessment as part of an ongoing controlled trial of treatment for SDB. Measures included: age, body mass index (BMI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FSS), Insomnia Severity Index (ISI), Patient-Health Questionnaire 9-item (PHQ-9), STOP-BANG score, and apnea-hypopnea index (AHI via WatchPAT home sleep apnea testing). Descriptive statistics and bivariate correlations testing the relationship between AHI and other measures were performed. Results Mean age was 49.8 [±13.8] years and BMI 29.6 [±6.0] kg/m2. Mean ESS was 8.1, FFS 13.9, ISI 14.0, PHQ-9 7.1, and STOP-BANG score 2.7. Mean AHI was 15.4 [±13.2], where higher AHI correlated with higher BMI (r=0.3, p&amp;lt;0.001), higher STOP-BANG score (r=0.4, p&amp;lt;0.001) and older age (r=0.4, p&amp;lt;0.001). Conclusion These findings support the use of the STOP-BANG score to predict SDB severity in women veterans with risk factors for SDB. Age and BMI may be particularly important predictors of SDB in this population. Sleepiness, depression, insomnia, and fatigue questionnaires were not related to SDB severity. Further work is needed to understand the role of patient-reported symptoms in those at-risk for SDB and to inform guidelines for the recognition of SDB in this important and understudied population. Support (If Any) VA HSR&amp;D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&amp;D COIN; VAGLAHS GRECC.

Oral cavity morphology among children at risk of sleep disordered breathing.

The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB). The study included children 3-17years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum. A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group. The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.

Sleep-disordered breathing as a risk factor for unnecessary pacemaker implantation.

Sleep-disordered breathing (SDB) is a risk factor for bradyarrhythmia, which is reversible with positive airway pressure therapy. The study aims to evaluate the occurrence and number of severe sinus bradycardia and advanced atrioventricular block (AVB) in patients with cardiovascular diseases and SDB risk factors. The analysis covered 207 patients with cardiovascular diseases aged 59.4 (standard deviation [SD], 10.49) years, including 177 men (85.51%), hospitalized in the Department of Electro-cardiology and the Day Stay Cardiac Rehabilitation Ward Upper-Silesian Medical Centre in Katowice, Poland. The inclusion criterion was a high risk of SDB, in particular obstructive sleep apnea (OSA), in one of the following questionnaires: the Four-Variable Screening Tool, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale. Both level-3 portable sleep tests and electrocardiogram Holter recordings were made simultaneously. SDB was confirmed in 175 (84.5%) patients, including severe in 74 (35.7%), moderate in 42 (20.3%), and mild in 59 (28.5%) participants. The dominant type of SDB was OSA, which was found in 158 (76.3%) participants. The severe SDB was a predictor of third-degree AVB (odds ratio [OR], 11.61; 95% confidence interval [CI], 1.37-98.60), second-degree AVB type 2 (Mobitz) (OR, 4.51; 95% CI, 1.17-18.08), pauses above 3 seconds (OR, 10.26; 95% CI, 2.18-48.40), and sinus bradycardia below 40 bpm (OR, 3.00; 95% CI, 1.36-6.60) during sleep. SDB, with particular emphasis on OSA, is a risk factor for sinus bradycardia and advanced AVB during sleep, which may lead to a hasty qualification for pacemaker implantation. The severity of SDB determines the frequency and number of bradyarrhythmic episodes.

Sleep-disordered breathing in children and adolescents seeking paediatric dental care in Dubai, UAE.

This study aimed to evaluate the severity of high-risk SDB in children and adolescents seeking paediatric dental care. Sleep-disordered breathing (SDB) has many untoward consequences that may interfere with children's health and is associated with several risk factors. In this cross-sectional study, the convenience sample included 65 healthy children and adolescents aged 7-16. High-risk SDB breathing was assessed using the Paediatric-Sleep-Questionnaire consisting of 22 questions. High-risk was defined as a positive response to 33% or more of the questions. The clinical examination included: tonsils' size, Body-Mass Index, orthodontic examination, and enamel defects. In this sample of 65 children with a mean age of 9.75 (± 2.60) years; 36 (55.4%) were boys, and 29 (44.6%) were girls. Overall, 12.3% of children in the sample were at high-risk of SDB, and this was significantly associated with tonsils' size (P = 0.001), Body-Mass Index (P = 0.03), Class-II molar relationship (P = 0.03), and posterior crossbite/s (P = 0.02). This study suggested that approximately 12% of the sample studied were potentially at risk of SDB. Tonsils' size, Body-Mass Index, Class-II molar relationship, and posterior crossbite/s were positively associated with the risk of SDB. Therefore, the importance of investigating the risk for sleep-disordered breathing should not be disregarded.

Sleep-Disordered Breathing Risk with Comorbid Insomnia Is Associated with Mild Cognitive Impairment

Introduction: Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). To test the hypothesis that SDB with comorbid insomnia is associated with greater odds of MCI than either sleep disorder independently, we used ADNI data to evaluate cross-sectional associations between SDB risk with comorbid insomnia status and MCI. Methods: Participants with normal cognition or MCI were included. Insomnia was defined by self-report. SDB risk was assessed by modified STOP-BANG. Logistic regression models evaluated associations between four sleep disorder subgroups (low risk for SDB alone, low risk for SDB with insomnia, high risk for SDB alone, and high risk for SDB with insomnia) and MCI. Models adjusted for age, sex, BMI, APOE4 genotype, race, ethnicity, education, marital status, hypertension, cardiovascular disease, stroke, alcohol abuse, and smoking. Results: The sample (n = 1391) had a mean age of 73.5 ± 7.0 years, 44.9% were female, 72.0% were at low risk for SDB alone, 13.8% at low risk for SDB with insomnia, 10.1% at high risk for SDB alone, and 4.1% at high risk for SDB with insomnia. Only high risk for SDB with comorbid insomnia was associated with higher odds of MCI (OR 3.22, 95% CI 1.57–6.60). Conclusion: Studies are needed to evaluate SDB with comorbid insomnia as a modifiable risk factor for MCI.

Central Sleep Apnea Is Associated with an Abnormal P-Wave Terminal Force in Lead V1 in Patients with Acute Myocardial Infarction Independent from Ventricular Function.

Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease. We have recently shown that an elevation of the electrocardiographic (ECG) parameter P wave terminal force in lead V1 (PTFV1) is linked to atrial proarrhythmic activity by stimulation of reactive oxygen species (ROS)-dependent pathways. Since SDB leads to increased ROS generation, we aimed to investigate the relationship between SDB-related hypoxia and PTFV1 in patients with first-time acute myocardial infarction (AMI). We examined 56 patients with first-time AMI. PTFV1 was analyzed in 12-lead ECGs and defined as abnormal when ≥4000 µV*ms. Polysomnography (PSG) to assess SDB was performed within 3–5 days after AMI. SDB was defined by an apnea-hypopnea-index (AHI) >15/h. The multivariable regression analysis showed a significant association between SDB-related hypoxia and the magnitude of PTFV1 independent from other relevant clinical co-factors. Interestingly, this association was mainly driven by central but not obstructive apnea events. Additionally, abnormal PTFV1 was associated with SDB severity (as measured by AHI, B 21.495; CI [10.872 to 32.118]; p < 0.001), suggesting that ECG may help identify patients suitable for SDB screening. Hypoxia as a consequence of central sleep apnea may result in atrial electrical remodeling measured by abnormal PTFV1 in patients with first-time AMI independent of ventricular function. The PTFV1 may be used as a clinical marker for increased SDB risk in cardiovascular patients.

Detection of Sleep-Disordered Breathing in Patients with Spinal Cord Injury Using a Smartphone.

Patients with spinal cord injury (SCI) have an increased risk of sleep-disordered breathing (SDB), which can lead to serious comorbidities and impact patients’ recovery and quality of life. However, sleep tests are rarely performed on SCI patients, given their multiple health needs and the cost and complexity of diagnostic equipment. The objective of this study was to use a novel smartphone system as a simple non-invasive tool to monitor SDB in SCI patients. We recorded pulse oximetry, acoustic, and accelerometer data using a smartphone during overnight tests in 19 SCI patients and 19 able-bodied controls. Then, we analyzed these signals with automatic algorithms to detect desaturation, apnea, and hypopnea events and monitor sleep position. The apnea–hypopnea index (AHI) was significantly higher in SCI patients than controls (25 ± 15 vs. 9 ± 7, p < 0.001). We found that 63% of SCI patients had moderate-to-severe SDB (AHI ≥ 15) in contrast to 21% of control subjects. Most SCI patients slept predominantly in supine position, but an increased occurrence of events in supine position was only observed for eight patients. This study highlights the problem of SDB in SCI and provides simple cost-effective sleep monitoring tools to facilitate the detection, understanding, and management of SDB in SCI patients.

Sleep-disordered breathing and risk of the breast cancer: A meta-analysis of cohort studies.

Sleep-disordered breathing (SDB) has been related to a higher risk of breast cancer whereas the results of previous studies are inconsistent. We, therefore, performed a meta-analysis to evaluate the association between SDB and subsequent risk of breast cancer in women. Cohort studies that investigated the temporal relationship between SDB and breast cancer incidence were obtained via search of PubMed, Embase and Web of Science from inception to 30 January 2021. Only studies with multivariate analyses were included. A fixed or a randomised effect model was applied according to the heterogeneity. Eight cohort studies with 1398113 women were included. Pooled results with a randomised-effect model showed that compared with women without SDB at baseline, women with SDB had a significantly increased risk of breast cancer (risk ratio [RR]: 1.36, 95% confidence interval [CI]: 1.08 to 1.71, P=.01) with significant heterogeneity (P for Cochrane's Q test<.001, I2 =95%). Subgroup analyses showed that SDB seemed to confer a more remarkably increased risk of breast cancer in elderly women (RR: 3.00, 95% CI: 1.33 to 6.76, P=.008) than that in non-elderly women (RR: 1.15, 95% CI: 1.02 to 1.29, P=.02; P for subgroup difference=.04). However, the association was not significantly affected by country of the study, study design, diagnostic strategy for SDB or adjustment of obesity (P for subgroup analyses all>.05). SDB may be an independent risk factor for breast cancer in women, particularly in elderly females.