Sleep Breathing Research Articles

Risk of sleep problems in a clinical sample of children who stutter

PurposePrevious studies have shown increased prevalence of sleep problems among people who stutter. However, there is a lack of knowledge about what these sleep problems may specifically be. MethodFifty children who stutter (CWS) from 6;0 to 12;9 years of age and 50 age- and gender-matched controls participated in this study. Parents did not report coexisting conditions, excepting stuttering and/or sleep problems. Sleep problems were investigated using a standardized questionnaire answered by parents. The questionnaire shows cut-off scores to identify the risk of sleep problems as a whole and on each one of the six subscales (i.e., disorders of initiating and maintaining sleep; sleep breathing disorders; disorders of arousal; sleep-wake transition disorders; disorders of excessive somnolence; and sleep hyperhidrosis). Scores above the cut-off are suggestive of sleep problems. ResultsTwenty-one CWS scored higher than the cut-off on the sleep questionnaire compared to only two controls (p < 0.00001). Specifically, CWS scored higher than controls in disorders of initiating and maintaining sleep, sleep-wake transition disorders (especially jerking, sleep talking, and bruxism), and disorders of excessive somnolence (p < 0.0083, corrected for multiple comparisons). DiscussionCompared to controls, CWS are at greater risk for sleep problems, which are not consequences of coexisting disorders. Present findings confirm and expand current knowledge about sleep problems in CWS. Directionality possibilities and clinical implications are discussed.

Multiple Allergic Rhinitis Single Nucleotide Polymorphism Variants are Associated with Sleep-Breathing Parameters in Men with Obstructive Sleep Apnea: A Large-Scale Study.

Sleep-disordered breathing is more prevalent in individuals with allergic rhinitis (AR) than in those without AR. In addition to increased risk for sleep-disordered breathing, AR is associated with greater severity of obstructive sleep apnea (OSA) symptoms. The aim of this research study was to evaluate the association of multiple single nucleotide polymorphism (SNP) variations in AR with sleep- and breathing-related parameters in men with OSA. Men who had complained of snoring were consecutively enrolled in the Shanghai Sleep Health Study of Shanghai Sixth People's Hospital from 2007 to 2018. After rigorous screening, 5322 men were included in the analysis. Anthropometric, fasting biochemical, and polysomnographic parameters, along with 27 AR-associated SNPs were analyzed. The associations between AR-related genetic polymorphisms and OSA were determined via linear, binary, and multinomial logistic regression analyses. Rs12509403 had significantly positive associations with most sleep-breathing parameters. While the risk for OSA was increased by rs12509403, it was decreased by rs7717955 [odds ratio (OR) = 1.341, 95% confidence interval [CI] = 1.039-1.732, P = 0.024; OR = 0.829, 95% CI = 0.715-0.961, P = 0.013, respectively]. A graded increase in the risk of being in the highest quartile (Q4) vs the reference category (Q1) for sleep breathing indicators, especially REM-AHI and NREM-AHI, was identified by rs12509403 (OR = 1.496, 95% CI = 1.175-1.904, P = 0.001; OR = 1.471, 95% CI = 1.151-1.879, P < 0.001, respectively). The association of multiple AR SNPs with OSA-related hypoxia and sleep indices provides a genetic explanation for the higher AR susceptibility of OSA patients. Understanding the AR-related genetic underpinnings of OSA may lead to more personalized treatment approaches.

Changes the level of differentiating growth factor - GDF 15 in patients with sleep apnea syndrome after aPAP-therapy: pilot study

Comparative assessment of the level of differentiating growth factor 15 (GDF 15 ) against the background of a 6-month course of respiratory support in the mode of automatic positive pressure in the airways therapy (aPAP therapy) in patients with obstructive sleep apnea syndrome (OSA). 59 men participated in the study, the average age was 51.9±2.4 years. The main group (MG1) consisted of 30 patients with a verified diagnosis of moderate OSA. 29 men of comparable age and body weight made up the control group (CG) without an objectively confirmed diagnosis of OSA. After the stage of introduction into the study, the type of respiratory support with individual pressure settings was selected for patients with MG1. After 6 months of aPAP therapy with high compliance (at least 85%), the same patients who made up MG2 after treatment underwent repeated polysomnography (PSG) and the GDF 15 content was evaluated. Methods: questionnaire, examination, polysomnography, enzyme immunoassay of blood serum to determine the content of GDF 15. A 6-month course of aPAP therapy with a high degree of compliance significantly improved the sleep structure and breathing pattern: the representation of NREM 3 increased from 79.2±15.6 to 102.6±21.6 minutes and the REM phase from 56.9± 13.6 to 115.6±26.8. Episodes of apnea were eliminated - apnea-hypopnea index decreased from 21.1 [17.3; 39.1] to 2.5 [1.8; 4.6] and the average values of SaO2 increased from 85.9% to 91.5%. At the same time, a statistically significant excess of GDF 15 was revealed in MG1 - 20.4 [14.16; 31.71] and MG2 - 17.2 [13.63; 24.44]) in comparison with CG - 13.65 [10.7; 17.09]. Despite the lack of statistical significance, a change in the level of GDF 15 was revealed in the form of a decrease in its concentration after a 6-month course of aPAP therapy. A 6-month course of aPAP therapy made it possible to eliminate intermittent nocturnal hypoxia and improve sleep structure in patients with OSA, as well as reduce the content of GDF 15 protein in blood serum in patients with OSA. However, the tendency to decrease the content of this protein, despite the lack of statistical reliability, confirms the effectiveness of OSA therapy and the possibility of preventing early and pathological aging from the standpoint of somnology and molecular biogerontology.

Neurogenesis, A Potential Target for Intermittent Hypoxia Leading to Cognitive Decline.

As a sleep breathing disorder, characterized by intermittent hypoxia (IH) and Obstructive sleep apnea (OSA), is believed to decrease the cognitive function of patients. Many factors are thought to be responsible for cognitive decline in OSA patients. Neurogenesis, a process by which neural stem cells (NSCs) differentiate into new neurons in the brain, is a major determinant affecting cognitive function. However, there is no clear relationship between IH or OSA and neurogenesis. In recent years, increasing numbers of studies on IH and neurogenesis are documented. Therefore, this review summarizes the effects of IH on neurogenesis; then discusses the influencing factors that may cause these effects and the potential signaling pathways that may exist. Finally, based on this impact, we discuss potential methods and future directions for improving cognition.

Sleep habits and orofacial myofunctional self-assessment of children at risk for sleep breathing disorders.

To identify orofacial myofunctional complaints and sleep-disordered breathing and correlate them with sleep habits in childhood. The study included 71 parents/guardians of public school children aged 6 to 11 years. They answered a form with semi-structured medical history questions and the Nordic Orofacial Test-Screening - interview, the Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, and the Children's Sleep Habits Questionnaire - all of them in their Portuguese/Brazilian versions in an online format. Statistical analyses used Spearman's correlation, setting the significance level at 5%. There were 29 female children (40.8%) and 42 male ones (59.2%), with a mean age of 8.52 years. The study found orofacial myofunctional complaints related to breathing functions (35.2%), chewing and swallowing (32.4%), and deleterious habits (33.8%). All children were at a low risk of sleep-disordered breathing. As for sleep habits, 23 children (32.39%) had a lower total score, whereas 48 children (67.61%) exceeded 41 points. There was a correlation between the risk of sleep-disordered breathing in children with complaints of orofacial myofunctional disorders and poor sleep quality/habits.

앙상블 머신러닝 모델을 활용한 치매 예측

As we become an aging society, there is a growing concern about geriatric diseases. Among them, senile dementia, which disrupts daily life, is best detected at an early stage because there is no cure, even with technological advances. However, many preliminary studies to predict dementia require continuous imaging data, such as MRI and retinal imaging data, and are expensive. These methods have the disadvantage that they cannot be applied to all people, so this study aims to develop low-cost predictive dementia detection. Therefore, the purpose of this study is to identify the main variables that most influenced the presence of dementia using deep learning prediction models such as XGBsoot and lightGBM by utilizing various activity data such as exercise duration, high-intensity activity duration, and metabolic rate, and sleep data such as deep sleep duration and breathing rate per minute to determine sleep quality. The analysis showed that the best dementia prediction performance was achieved when both activity and sleep data were considered simultaneously, and the most important variable in the XGBoost model was the “activity_score_move_every_hour” and the “sleep_hr_everage” in lightGBM.

Sleep problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder: A comparative study and effects on communication skills.

Sleep disturbances are highly prevalent among children with neurodevelopmental disorders, like Autism Spectrum Disorder (ASD) and Attention-Deficit/Hiperactivity Disorder (ADHD). The first objective of this study is to examine the differences in sleep problems between a group of children with ASD without intellectual disabilities, a group with ADHD and a typically developing (TD) group. A second objective is aimed at analyzing the effects of sleep problems and symptom severity on their communication skills. Participants were 122 children between 7 and 12 years old distributed in three groups: 32 TD children, 47 children with ASD and 43 children with ADHD, matched on age and intelligence. Parents completed different questionnaires that measured sleep disturbances and communication skills. Findings show significant differences between the clinical groups and the TD group in most types of sleep disorders. Moreover, the group with ADHD showed significantly more sleep breathing disorders and hyperhidrosis in comparison with ASD and TD, as well as more total sleep problems. In contrast to ASD, the predictive power of sleep problems on communication difficulties was greater in the group with ADHD. The results of the mediation analysis indicate that in both groups, sleep problems partially mediate the relationship between symptoms and communication. This investigation highlights the need of considering sleep disorders when assessing communication skills in ASD and ADHD, given its indirect influence in this domain. Understanding the sleep dysfunctions of both conditions and their repercussions is crucial to develop adjusted interventions.

Sleep breathing disorder frequency, risk factors, and treatment among adults with cystic fibrosis

BackgroundOur understanding of the epidemiology of sleep breathing disorders among adults with cystic fibrosis (CF) is limited. Our purpose was to describe the frequency, risk factors and treatment of sleep breathing disorders among adults with CF. MethodsThis was a retrospective analysis of linked data from laboratory-based diagnostic polysomnography (PSG) undertaken at St. Michael's Hospital (Toronto, Canada) and the Canadian CF Registry. Adults (≥19 years old) with CF that underwent a diagnostic PSG at St. Michael's Hospital between 2002 and 2021 were included. Sleep breathing disorder frequency, risk factors, and treatment were described, using descriptive statistics and logistic regression. ResultsThere were 42 patients included (33.3 % women and median age at diagnostic PSG was 34.7 years). Obstructive sleep apnea [OSA] was the most commonly observed sleep breathing disorder (found in 64.3 %), followed by sustained nocturnal hypoxemia (16.7 %), and sleep hypoventilation (9.5 %). Only 41 % of individuals with an elevated total apnea-hypopnea index were receiving positive airway pressure [PAP] therapy. Corticosteroid use (either oral or inhaled) was the only factor with a significant positive association with presence of any sleep breathing disorder (odds ratio 5.00, 95 % confidence interval 1.28-22.78). ConclusionsAmong adults with CF, OSA occurs more commonly than previously appreciated and the majority of sleep breathing disorders were not being treated with PAP or supplemental oxygen. Management of sleep breathing disorders among adults with CF reflects a potentially important care gap, but further research is needed to determine the health impacts of treating sleep breathing disorders in CF.

Longitudinally assessed maternal sleep position, measures of breathing during sleep, and fetal growth in high-risk pregnancies.

Subjective recall of supine sleep during pregnancy has been linked to increased risk of stillbirth, but longitudinal, objective data are lacking. We aimed to examine how sleep position and breathing parameters change throughout pregnancy, and investigated associations between maternal supine sleep, assessed objectively in early and late gestation, and fetal growth velocity in high-risk women. Women with singleton pregnancies and body mass index (BMI) ≥27 kg/m2 underwent level-III sleep apnea testing. Sleep position was assessed by accelerometry. We derived percentiles of estimated fetal weight and birthweight using FetalGPSR software, then calculated growth velocity as change in percentile/week between the second-trimester anatomy scan and birth. In total, 446 women were included, with N = 126 in the longitudinal sleep pattern analysis and N = 83 in the fetal growth analysis. Sleep-onset position and predominant sleep position were significantly correlated in both early (p = 0.001) and late (p < 0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. Between early and late pregnancy there was a reduction in predominant supine sleepers (51.6% to 30.2%). Percent of sleep spent supine and oxygen desaturation index, in the third trimester, were significantly associated after BMI adjustment (B = 0.018, p = 0.04). Models did not suggest significant effects of early or late pregnancy supine sleep on growth velocity (p > 0.05). Going-to-bed position predicts predominant supine sleep in less than half of women with overweight and obesity. Time spent supine throughout pregnancy correlates with measures of sleep-disordered breathing. Maternal sleep position patterns did not affect fetal growth velocity in this high-risk population, but the study was not powered to detect differences.

Association of sleep-related factors with nocturia

Purpose:Sleep-related factors, such as snoring or sleep duration may be causes for or consequence of nocturia. The purpose of this study was to evaluate the associations between sleep-related factors and nocturia in the absence of sleep disorders. Materials and Methods:Using the National Health and Nutrition Examination Survey (NHANES) database from 2005/06 to 2017/18, we analyzed respondents who completed the kidney conditions and sleep disorders questionnaires. Respondents who reported a physician-diagnosed sleep disorder, did not provide an answer to this sleep disorder question, or had other conditions impacting nocturia were excluded. After sample weighing, the prevalence of nocturia for responses to sleep-related factors (hours of sleep, work schedule, snoring, snorting or stopping breathing, and sleepiness) was analyzed using chi-square analysis and the association of sleep-related factors to nocturia, accounting for age, gender, race, and BMI, was determined using univariate and multivariate regression. Results:From the 2005/06–2017/18 NHANES database, 23,895 respondents (11,672 males and 12,223 females; mean age, SD = 45.2, 20.1 years) were included. For sleep-related factors, greatest nocturia prevalence was seen in those sleeping <6 h (38.4%) or >8 h (38.0%), snoring ≥5 nights per week (33.4%), snorting or stopping breathing ≥5 nights per week (38.7%), and feeling sleepy 16–30 times per month (44.7%). Work schedule differences (morning, evening/night, rotating) showed no differences in nocturia prevalence (21.1–22.5%) or significant odds of nocturia. On univariate analysis, nocturia was associated with age (OR = 1.035, p < 0.001), BMI (OR = 1.038, p < 0.001), sleeping <6 h (OR = 1.603, p < 0.001) or >8 h (OR = 1.673, p < 0.001), snoring ≥5 nights per week (OR = 1.192, p = 0.004), snorting or stopping breathing 3–4 nights (OR = 1.425, p < 0.001) to ≥5 nights per week (OR = 1.528, p < 0.001), and feeling sleepy 5–15 times (OR = 1.579, p < 0.001) to 16–30 times per month (OR = 1.970, p < 0.001). On multivariate analysis, only age (OR = 1.035, p < 0.001), BMI (OR = 1.032, p < 0.001), and sleepiness (OR = 1.169, p < 0.001) showed an association with nocturia. Conclusion:While most sleep-related factors showed increasing prevalence of nocturia at their extremes, only sleepiness showed an association to nocturia on multivariate analysis. Further examination of sleep issues related to nocturia elucidating causality are warranted.

Sleep breathing patterns and neurocognitive function in a diverse Hispanic/Latino cohort

AbstractBackgroundSleep disorders are common in patients with Alzheimer’s Disease (AD). Obstructive sleep apnea (OSA), characterized by intermittent cessation of breathing and hypoxemia, has been associated with increased risk of AD and worse cognitive function. However, the interacting effects of neurocognitive function with sleep breathing patterns, independent of the apnea‐hypopnea index, (a measure of OSA severity) have not been carefully studied. We use a novel approach to analyzing home sleep apnea data to examine breathing patterns and their relationships with neurocognitive function.MethodThe Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective multicenter study of diverse Latinos. Around 16,000 diverse Hispanic/Latinos were recruited from four major metropolitan cities. Participants used an ARES unirecorder device for a single night of unsupervised at home recording. We used python package “bycycle” to cannula data (sampled at 10Hz). Bycycle uses a time domain approach to parameterizing rhythmic time‐series data. We extracted breathing rate (breaths per minute), breathing variability (interquartile range of breathing rate) and time spent in inhalation phase (percent time). Participants ages ≥45 (unweighted n = 5,957) were tested in their preferred language using a brief battery including: B‐SEVLT (3‐trials sum) and Delayed Recall (memory), World Fluency (verbal fluency), and Digit Symbol Substitution (executive function). Covariates used in our models are described in Table 1. All presented estimates were weighted for appropriate generalization to the HCHS/SOL target population.ResultIn unadjusted models, all breathing measures were negatively associated with cognitive function, but only breathing rate remained significant after full covariate adjustment (Figure 1). We found significant interactions between breathing rate and sex, as well as age for verbal fluency models. Being female and older age were associated with steeper slopes of cognitive under‐performance for both breathing rate and breathing variability (Figure 2).ConclusionThese results suggest that breathing patterns outside apneas‐hypopneas may be as critical in understanding sleep related changes and cognitive function in an aging population. Given cessation of breathing during an apnea‐hypopnea event, breathing variability may add more precision to account for varying oxygen demands. Further studies should examine whether breathing instability is also associated with cognitive decline, impairment, and dementia.

Awareness and Sources of Knowledge about Obstructive Sleep Apnea: A Cross Sectional Survey Study

Obstructive sleep apnea (OSA) is a multifactorial sleep breathing disorder, seriously impacting quality of life and involving approximately 1 billion of the world’s population. It is characterized by episodes of total cessation of breathing or decreases in airflow during sleep. Available data suggest that most cases of OSA remain undiagnosed even in developed countries. This is due to a lack of widespread knowledge about this pathology and the medical morbidities and mortality it brings about, among both laypeople and physicians. Moreover, despite receiving indications about the need to undergo specific evaluations for OSA signs and symptoms, sometimes patients do not pay sufficient attention to the problem. This is probably due to a lack of correct information on these issues. The present investigation analyzed the level of knowledge about OSA pathology and the sources through which a group of OSA patients gained information on their condition. A survey of 92 patients diagnosed with OSA (mean age 60.55 ± 10.10) and referred to the Unit of Orthodontics and Dental Sleep Medicine of the University of Bologna was conducted by means of a questionnaire investigating sociodemographic characteristics, the level of general knowledge on OSA pathology and its possible medical consequences. Despite about two third (67.38%) of the population demonstrating extensive knowledge, remarkably, a group of subjects (20.65%) had poor awareness of the OSA condition. A statistically significant correlation emerged between the level of knowledge about OSA and the level of education (p = 0.002). A great effort should be made to improve the quality of information and the communication modalities for OSA to enable a fully appropriate awareness of the condition among patients.

Wavelet transform and deep learning-based obstructive sleep apnea detection from single-lead ECG signals.

Sleep apnea is a common sleep disorder. Traditional testing and diagnosis heavily rely on the expertise of physicians, as well as analysis and statistical interpretation of extensive sleep testing data, resulting in time-consuming and labor-intensive processes. To address the problems of complex feature extraction, data imbalance, and low model capacity, we proposed an automatic sleep apnea classification model (CA-EfficientNet) based on the wavelet transform, a lightweight neural network, and a coordinated attention mechanism. The signal is converted into a time-frequency image by wavelet transform and put into the proposed model for classification. The effects of input time window, wavelet transform type and data balancing on the classification performance are considered, and a cost-sensitive algorithm is introduced to more accurately distinguish between normal and abnormal breathing events. PhysioNet apnea ECG database was used for training and evaluation. The 3-min Frequency B-Spline wavelets transform of ECG signal was carried out, and Dice Loss was used to train the classification model of sleep breathing. The classification accuracy was 93.44%, sensitivity was 88.9%, specificity was 96.2% and most indexes were better than other related work.

The objective assessment of sleep in cluster headache: State of the art and future directions.

Several lines of evidence suggest that cluster headache is related to chronobiology and sleep. Nevertheless, the nature of such a relationship is unclear. In this view, the objective evaluation of sleep in cluster headache has strong theoretical and clinical relevance. Here, we provide an in-depth narrative review of the literature on objective sleep assessment in cluster headache. We found that only a small number of studies (N = 12) focused on this topic. The key research aims were directed to assess: (a) the relationship between cluster headache and sleep breathing disorders; (b) the temporal relationship between sleep stages/events and cluster headache attacks; (c) sleep macrostructure in patients with cluster headache. No studies considered sleep microstructure. The reviewed studies are heterogeneous, conducted by a few research groups, and often characterised by relevant methodological flaws. Results are substantially inconclusive considering the main hypothesis. We outline several methodological points that should be considered for future research, and suggest that evaluating sleep microstructure, local sleep electrophysiology and actigraphic measures may strongly increase knowledge on the relationship between sleep and cluster headache.

Obstructive sleep apnea syndrome in the continuum of uncontrolled hypertension

Aim. To assess frequency and severity of sleep breathing disorders in patients with uncontrolled hypertension among patients referred to a sleep laboratory.Materials and methods. 113 patients aged 18-80 years with arterial hypertension (AH) were included. All patients underwent sleep cardiorespiratory monitoring, general clinical and laboratory diagnostics. Uncontrolled hypertension was defined as systolic blood pressure (BP) &gt;140 mm Hg, or diastolic BP &gt;90 mm Hg. in case of permanent antihypertensive therapy (AHT) taking.Results. Among all patients with uncontrolled hypertension (Group 1; n=42, 37,2%), 95,2% had obstructive sleep apnea syndrome (OSA). Compared with the controlled hypertension group (Group 2), AHI and ODI were higher in Group 1 (AHI 28,0 events/hour [14,8; 51,8] vs. 17,5 events/hour [8,7; 39,0], p=0,03; ODI 25,3 events/hour [14,4; 50,6] versus 17,1 events/hour [8,5; 37,0], p=0,04). In addition, these parameters turned out to be markers of uncontrolled hypertension (AHI &gt;19,9 events/hour, AUC=0,62, p=0,03; OR 3,23, 95%; CI 1,7-6,1, p=0,00; ODI &gt;19,5 events/hour, AUC=0,62, p=0,03; OR 3,07, 95% CI 1,7-5,7, p=0,01). The level of systolic BP &gt;146 mm Hg. turned out to be a marker of the moderate or severe OSA (AUC=0,66, p=0,00; OR 4,45, 95% CI 1,811,2, p=0,00).Conclusion. High incidence of moderate or severe OSA in patients with uncontrolled hypertension emphasizes the importance of sleep breathing disorders examining in these patients. Timely diagnostics and treatment of OSA probably will allow to provide better BP levels control and thus will lead to reducing of cardiovascular risk.

Cognitive Functions in Patients with Moderate-to-Severe Obstructive Sleep Apnea Syndrome with Emphasis on Executive Functions and Decision-Making.

Patients with obstructive sleep apnea syndrome (OSAS) have cognitive dysfunction in many aspects, however, these patients' decision-making function remains unclear. In this study, the Game of Dice Task (GDT) was used to investigate the function of decision making in patients with OSAS. 30 participants with moderate to severe OSAS and 27 participants with no or mild OSAS diagnosed by sleep breathing monitor were selected from June 2021 to March 2022. Risky decision making was tested through the GDT with known risk probability. General demographic information and background cognitive functions, such as the overall cognitive functioning and executive functioning, were tested to establish baseline data. There were no significant differences in gender, age, and years of education between the two groups. During the GDT, the moderate to severe OSAS group opted for the safety option at a statistically significant lower rate when compared to the no or mild OSAS group (7.53 ± 4.43 vs. 10.26 ± 4.26, p = 0.022). The moderate to severe OSAS group utilized the higher risk option than the group with no or mild OSAS (10.47 ± 4.43 vs. 7.74 ± 4.26, p = 0.022). The utilization rate of negative feedback in the moderate and severe OSAS group was lower than that in the no or mild OSAS group (7.50, 52.50 vs. 28.57, 100.00, p = 0.001). At the end of the GDT, the moderate and severe OSAS group was more likely to have negative total assets than the patients with no or mild OSAS (-1846.67 ± 2587.20 vs. 300.00 ± 1509.97, p < 0.001). Multiple linear regression analysis shows that there is a negative correlation between the selection of risk options and negative feedback utilization in the GDT. Patients with moderate and severe OSAS displayed impaired decision-making throughout the study. Impaired decision-making is related to executive processes and may be caused by diminished prefrontal cortex functioning. However, the functions of memory, attention, language, abstraction, and orientation are relatively retained.

605 Description of sleep breathing disorder prevalence, risk factors, and treatment in adults with cystic fibrosis

605 Description of sleep breathing disorder prevalence, risk factors, and treatment in adults with cystic fibrosis

Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study.

Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. 4 Laryngoscope, 134:1970-1977, 2024.

“It Affects Everything about Me”: Sleep Problems among Children with Cerebral Palsy and Their Caregivers in Ile-Ife—A Mixed-Methods Study

AbstractSleep problems are common in children with cerebral palsy (CWCP). However, the effect of sleep problems in CWCP on caregivers has not been well studied. We aimed to describe the sleep problems in CWCP and their caregivers, and explore the effect of the children's sleep on the caregivers' sleep. This cross-sectional, mixed-methods research was conducted at a pediatric neurology clinic in Ile-Ife, Nigeria. The Sleep Disturbance Scale for Children (SDSC) and Pittsburgh Sleep Quality Index (PSQI) were used for assessing sleep problems of the children and their caregivers, respectively. We held three focused group discussions (FGDs) involving 18 caregivers using a pretested FGD guide. We analyzed the quantitative data using Stata-15 software, while qualitative data were transcribed and managed using ATLAS.ti Software. We studied 71 CWCP–caregiver dyads and 69 age- and sex-matched controls. There was a male preponderance for CWCP (M:F = 1.09:1) and female preponderance for caregivers (89.5%). Sleep disturbances (SDSC &gt; 40) occurred in 34% of CP children and poor sleep quality was seen in 39% of caregivers. When compared with age- and sex-matched typically developing peers, there was a statistically significant higher sleep disturbance in CWCP (p = 0.009). Sleep difficulties in the CWCP comprise sleep–wake transition disorders (45.0%), difficulty initiating sleep (43.3%), and sleep breathing disorders (37.5%). Caregivers experienced short sleep duration. One mother said: “It affects my sleep, health, and work. It affects everything about me.” Sleep problems in CWCP affect the well-being of their caregivers. Interventions targeted at both the children and their caregivers are needed.

A retrospective evaluation of patients with sleep breathing disorders in single center, Edirne province.

Our aim was to investigate the characteristics of patients with preliminary diagnosis of sleep breathing disorder studied in Edirne province, to identify the risk factors and comorbid conditions, to determine the diagnostic distribution of our sleep patients by analyzing the results of polysomnography and PAP titration, and to understand their problems related to treatment compliance and device use. Our study retrospectively evaluated the results of 956 patients who had sleep-related complaints in our region and underwent full nocturnal polysomnography and PAP titration with a preliminary diagnosis of sleep breathing disorder. A total of 956 patients were enrolled in the study, of whom 641 (67.1%) were males and 315 (32.9%) were females. Of our patients, 49.7% had severe obstructive sleep apnea (OSA), 18.2% had moderate OSA, 17.9% had mild OSA, 11.4% had REM-dependent OSA, and 8.4% had positionsupine-dependent OSA. Hypertension was the most common comorbid condition in 44% of our patients, and diabetes mellitus in 25%. It was determined that 228 (57.9%) of 394 patients who were recommended to use the PAP device received the device, and 71.5% of these patients could use the device in a compatible manner. Patients with appropriate symptoms can be diagnosed with a high probability of OSA in our region. The fact that a substantial group of patients diagnosed with OSA and recommended to use the PAP device did not receive the device or the proportion of those who could not use the device was high is one of the notable findings of the study.