Risk Factors For Sleep-disordered Breathing Research Articles

Clinical Practice Guideline on Management of Sleep Disorders in the Elderly.

Clinical Practice Guideline on Management of Sleep Disorders in the Elderly.

Association between air pollution and sleep disordered breathing in children

BACKGROUND AND OBJECTIVE Similar to other respiratory diseases, sleep disordered breathing (SDB) may be exacerbated by air contaminants. Air pollution may have an impact on incidence and severity of SDB in children. The aims of this study were to examine potential associations between the exposure to different air pollutants and SDB symptoms in children. METHODS In this cross-sectional study, parents from first grade children of elementary schools throughout Chile were included. Data about clinical and family-related SDB risk factors, and the pediatric sleep questionnaire (PSQ) were obtained. Air pollution and meteorological data were obtained from the Chilean online air quality database. RESULTS A total of 564 children (44.9% males) aged (median) 6 years (5-9 year) were included. Prevalence of SDB based on PSQ was 17.7%. When examining air pollutants and conditions, only higher humidity (β = 0.005, 95%CI 0.001-0.009, P = 0.011) was significantly associated with higher PSQ scores after adjusting for demographic and household variables. Higher ozone (O3 ) levels (OR = 1.693, 95%CI 1.409-2.035, P 3 nights/week, following adjustment (OR = 0.865, 95%CI 0.751-0.997, P < 0.05). CONCLUSION Sleep respiratory symptoms (wheezing and snoring) are significantly associated with air pollutants such as O3 and SO2 . In addition, meteorological conditions such as humidity and low temperatures may be also associated with SDB-related symptoms.

Examination of Risk for Sleep-Disordered Breathing Among College Football Players

Professional football linemen are at risk for sleep-disordered breathing (SDB) compared with other types of athletes. It is currently unknown whether college football linemen display a similar risk profile. (1)To determine for the first time whether college football linemen show risk for SDB and (2)test the hypothesis that SDB risk is higher in college football linemen compared with an athletic comparison group. Descriptive laboratory study. The Health Risk Assessment Laboratory. Male football linemen (n = 21) and track (n = 19) Division I athletes between the ages of 18 and 22 years. Participants completed the Multivariable Apnea Prediction Index and Epworth Sleepiness Scale surveys, validated measures of symptoms of sleep apnea and daytime sleepiness, respectively. Neck and waist circumferences, blood pressure, Modified Mallampati Index (MMPI), and tonsil size were determined, followed by body composition assessment using dual-energy X-ray absorptiometry. Scores from surveys, anthropometric data, MMPI, and body composition. Survey data demonstrated a deficiency in sleep quality and efficiency, coinciding with increased self-reported symptoms of apnea (Multivariable Apnea Prediction Index = 0.78) in college linemen relative to track athletes. Neck circumference (44.36 cm), waist circumference (107.07cm), body mass index (35.87 kg/m2), and percent body fat (29.20%), all of which exceeded the clinical predictors of risk for obstructive sleep apnea, were significantly greater in linemen compared with track athletes. Multivariable Apnea Prediction variables were significantly correlated with MMPI, neck circumference, percent body fat, body mass index, and systolic blood pressure (r ≥ .31, P < .05), indicating that college football linemen are at increased risk for SDB. Risk factors for SDB recognized in professional football linemen are also present at the college level. Screening may minimize present or future risk for SDB, as well as the downstream risk of SDB-associated metabolic and cardiovascular disease.

0867 SLEEP DISORDERED BREATHING IS HIGHLY PREVALENT AMONG NEWBORNS WITH MYELOMENINGOCELE

Children with myelomeningocele are at risk for sleep-disordered breathing (SDB), possibly due to comorbid hydrocephalus and Chiari II malformations. Yet, objective assessments of their sleep in the newborn period have not been published. The goal of this study was to compare SDB in newborns with and without myelomeningocele, in the absence of obvious additional risk factors for SDB. Twenty newborns with myelomeningocele (12 male; mean gestational age 38 ± 2.6 weeks) who had undergone fetal (n=5) or postnatal (n=15) surgical repair were monitored with 12-hour attended polysomnography during the neonatal hospital admission at mean postnatal age of 8 ± 7.8 days. These newborns’ sleep measures were compared to those of (postmenstrual) age-matched subjects admitted to the newborn ICU for non-neurologic concerns. Every newborn with myelomeningocele had SDB. The mean apnea hypopnea index (AHI) (32.4 ± 21.8) for these subjects was significantly higher than that of the comparison group (18.8+11.0) (conditional logistic regression, p=0.035, OR 1.11, 95% CI 1.01–1.23, per 1 point increase in AHI). AHI was highest during active sleep for both myelomeningocele (48.9 ± 26.8) and comparison (29.8 ± 18.9) newborns. The mean oxygen saturation of subjects with myelomeningocele (94.1 ± 3.1) was slightly lower than that of comparison subjects (96.4 ± 2.2) (p = 0.05, OR = 0.68, 95% CI 0.46–0.99). Time spent in specific sleep wake stages was not different between groups. SDB is ubiquitous among newborn infants with myelomeningocele. As treatment of SDB has long-term benefit for behavior and general health among older children, screening and treating sleep apnea in newborns with myelomeningocele may provide a new, worthwhile opportunity to optimize health at the very start of life. This work was supported by a grant from the American Sleep Medicine Foundation and the University of Michigan Barwick Scholar Award.

Épidémiologie, populations à risque et phénotypes cliniques du syndrome d’apnées du sommeil

Recent epidemiological studies show that the prevalence of sleep-disordered breathing seems to be higher than previously estimated in the middle to older aged general population with approximatively 49% of men and 23% of women being affected. This higher than expected prevalence of sleep-disordered breathing seems to be due to the high sensitivity of current recording techniques and to the new and more inclusive definition of respiratory events (hypopnea definition in particular). Male sex, age, and truncal obesity (large neck girth, high waist to hip ratio) are the main risk factors for sleep-disordered breathing. Among sleep-disordered breathing patients, different phenotypes can be observed according to the underlying pathophysiologic mechanism of their condition: purely anatomical impairment, central breathing control instability (high "loop gain"), low arousal threshold, or sleep-associated pharyngeal muscles dysfunction. A better phenotyping of the patients could help directing the treatment to the specific cause of their disorder.

A narrative review: The effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients.

Opioids increase the risk for sleep disordered breathing (SDB), but there are few studies examining the prevalence and risk factors for SDB, specifically central sleep apnea (CSA), and obstructive sleep apnea (OSA) in chronic pain patients on opioids as well as methadone maintained patients (MMPs). A literature review was conducted in which SDB was confirmed by polysomnography (PSG) in chronic pain patients on opioids as well as patients with a diagnosis of an opioid use disorder or opioid dependence on methadone maintenance treatment (MMT). About 22 reports were included. Six were with MMPs, and 16 were with chronic pain patients on opioids. Among MMPs, the prevalence of SDB ranged from 42.3% to 70%; 0-60% had CSA and 10-35.2% had OSA. In chronic pain patients on opioids, the prevalence of SDB ranged from 71% to 100%; 17-80% had CSA and 20-39% had OSA. In MMPs, studies found a positive association between BMI, weight gain, duration of MMT, non-Caucasian race and the number of obstructive apneas, as well as blood methadone concentrations and the number of central apneas. In chronic pain patients on opioids, older age, higher BMI, male gender, and higher opioid doses predicted more obstructive apneas; older age, lower BMI, male gender, higher pain levels, higher benzodiazepine doses, and higher opioid doses predicted more central apneas. CSA and OSA are common in MMPs and chronic pain patients on opioids. Among chronic pain patients, higher opioid doses appear to be a risk factor for CSA, and to a lesser extent OSA. Therefore, it is important for providers to screen these patient populations for SDB. (Am J Addict 2016;25:452-465).

The Effect of Adenotonsillectomy on Growth in Prepubertal Children

Adenotonsillar hypertrophy (ATH) is the most common cause of obstructive sleep apnea syndrome in children,1 and the prevalence of obstructive sleep apnea syndrome (OSAS) were at least 1–3% in children.2 Sleep disordered breathing (SDB) is often associated with loud snoring, daytime sleepiness, and daytime mouth breathing. Complications of SDB may include failure to thrive, nocturnal enuresis, sweating during sleep, reduced neurocognition, behavioral problem, and school performances.3-5 Several possible mechanisms for failure to thrive have been assessed. Interruption of the insulin-like growth factor-I axis secondary to abnormal nocturnal growth hormone secretion,6 low caloric intake caused by poor appetite and dysphagia,7 recurrent tonsillitis,8 and high energy expenditure as a consequence of increased work of breathing during sleep9 had been proposed as causes. Also many studies had suggested and proved that growth failures were improved after adenotonsillectomy in children with ATH.10-12 On the other hand, obesity could be one of the risk factor for SDB in children.13 There were few studies about the effect of adenotonsillectomy in obesity children, instead it was reported that children who undergo adenotonsillectomy could be at risk to develop overweight in the years after surgery.14 The effect of SDB and adenotonsillectomy on children might be different according to the growth status, but little is known in this aspect. Received: June 8, 2016 Revised: June 17, 2016 Accepted: June 20, 2016

Sleep disordered breathing at the extremes of age: the elderly.

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

Natural history of sleep disordered breathing in prepubertal children transitioning to adolescence.

Because there is a lack of agreed upon diagnostic criteria, it is critical to understand the natural history of obstructive sleep apnoea (OSA) in children in order to establish treatment strategies based on objective data.The Penn State Child Cohort is a representative, general-population sample of 700 elementary school children at baseline, of whom 421 were reassessed 8 years later, during adolescence.The remission of childhood apnoea-hypopnoea index (AHI) ≥2 events per h in adolescence was 52.9%. Using the higher threshold of AHI ≥5 events per h, remission was 100.0%, with 50.0% partially remitting to AHI 2- <5 events per h and the other half remitting to AHI <2 events per h. The incidence of adolescent AHI ≥2 events per h in those with childhood AHI <2 events per h was 36.5%, while the incidence of AHI ≥5 events per h in those with childhood AHI <5 events per h was 10.6%. This longitudinal study confirms that prepubertal OSA tends to resolve naturally during the transition to adolescence, and that primary snoring and mild sleep disordered breathing (SDB) do not appear to be strongly associated with progression to more severe SDB.The key risk factors for SDB in adolescence are similar to those found in middle-aged adults (i.e. male sex, older age and obesity). Moreover, consistent with recent studies in adults, this study includes the novel cross-sectional finding that visceral fat is associated with SDB as early as adolescence.

Sleep-disordered breathing syndrome in acute ischemic stroke

To evaluate the prevalence, structure and risk factors of sleep-disordered breathing in patients with acute ischemic stroke. This prospective study included 54 acute ischemic stroke patients aged 66 [57; 72] years, 32 men, 22 women. The diagnosis was confirmed by MRI. The neurological state was assessed with the NIHSS and modified Rankin Scale (mRS). To verify the SDB, cardiorespiratory monitoring was performed on 2-5 day from stroke onset. Total number of SDB episodes, apnea/hypopnea index (AHI), the index of hypoxemia (IH) were registered. SDB was detected in 50 (92%) patients, including 44 (88%) with predominantly obstructive apneas (OA), 6 (12%) patients with central apnea (CA). It was found that the severity of respiratory disorders did not depend on the severity of the neurological state but is associated with a variety of somatic, hemodynamic and metabolic disorders (increased BMI, smoking, diabetes mellitus,atrial fibrillation - AF). Cardioembolic stroke (СES) was accompanied by a more pronounced SDB and can be considered as a marker of respiratory disorders during sleep, especially in patients with AF. Involvement of the insula in the brain infarct zone is a significant factor in the development of SDB and increase of central apnea (CA). Multiple small deep (lacunar) infarcts of the brain, including asymptomatic infarcts, visualized by MRI also indicate a high risk of obstructive SDB.

Prevalence and Predictors of Sleep-Disordered Breathing in Patients With Stable Chronic Heart Failure: The SchlaHF Registry

ObjectivesThis prospective study investigated the prevalence of sleep-disordered breathing (SDB) and its predictors in patients with stable chronic heart failure (HF). BackgroundSDB is increasingly recognized as being important in patients with HF. MethodsThe multicenter SchlaHF (Sleep-Disordered Breathing in Heart Failure) registry provides demographic and clinical data on chronic, stable, symptomatic patients with HF (New York Heart Association functional class ≥II; left ventricular rejection fraction ≤45%). Moderate-to-severe SDB (apnea-hypopnea index ≥15/h) was determined by a 2-channel screening device (ApneaLink, ResMed, Sydney, Australia). ResultsData from 6,876 patients were analyzed. The prevalence of moderate-to-severe SDB was 46%, with a significant sex difference: 36% in women (n = 1,448) versus 49% in men (n = 5,428). Prevalence of SDB rose with increasing age (31%, 39%, 45%, 52%, and 59% in those age ≤50, >50 to 60, >60 to 70, >70 to 80, and >80 years, respectively). Risk factors for SDB were body mass index (per 5 units; odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.22 to 1.36), left ventricular rejection fraction (per 5% decrement from 45%; OR: 1.10; 95% CI: 1.06 to 1.14), age (per 10-year difference to 60 years; OR: 1.41; 95% CI: 1.34 to 1.49), atrial fibrillation (OR: 1.19; 95% CI: 1.06 to 1.34), and male sex (OR: 1.90; 95% CI: 1.67 to 2.17). ConclusionsSchlaHF registry data demonstrate a high prevalence of SDB in a representative population of stable patients with chronic HF receiving contemporary medical management. Male sex, age, body mass index, and the severity of both symptoms and left ventricular dysfunction were clinical predictors for prevalent SDB. (Prevalence, Clinical Characteristics and Type of Sleep-disordered Breathing in Patients With Chronic, Symptomatic, Systolic Heart Failure; NCT01500759)

Sleep disordered breathing in pregnancy.

Key pointsSleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy.SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain.Educational aimsTo highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population.To inform readers about risk factors for SDB in pregnancy.To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.To introduce current management options for SDB in pregnancy, including medical and behavioural approaches.Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.

Cross-sectional Association between Walking Pace and Sleep-disordered Breathing.

Sleep-disordered breathing is an important comorbidity for several diseases, including stroke. Initial screening tools comprise simple yes/no questions about known risk factors for sleep-disordered breathing, e.g., obesity, sex. But walking speed has not been investigated in this context. We examined the cross-sectional association between walking pace and sleep-disordered breathing in the population-level Multi-Ethnic Study of Atherosclerosis. A sample of 2912 men and 3213 women (46-87 years) reported perceived walking pace outside their homes. A walking pace<0.89 m/s was deemed "slow", with ≥ 0.89 m/s considered "average/brisk" according to validated thresholds. Sample prevalences were: sleep apnoea (3.5%), self-reported apnoeas (8.4%), loud snoring (20.5%), daytime tiredness (22.2%) and slow-walking pace (26.9%). The 95% CI risk differences (multivariable-adjusted) for slow vs. faster walking pace were; sleep apnoea (0.4-2.5%), self-reported apnoeas (0.1-3.8%), loud snoring (1.2-8.3%), and daytime tiredness (3.0-7.8%). Risk differences were similar between sexes. The multivariable-adjusted risk ratio indicated that slower walkers had 1.5 (95% CI: 1.0 to 2.1) times the risk of sleep apnoea vs. faster walkers. In conclusion, a slower walking speed was associated with a greater prevalence of sleep-disordered breathing, independently from other common screening factors. Therefore, a simple walking speed question may help consolidate screening for this disorder.

Home sleep study for patients with myasthenia gravis

The objective of the study was to examine predictors for sleep-disordered breathing (SDB) in patients with myasthenia gravis (MG) using Watch-PAT. We prospectively studied 58 consecutive patients with MG without respiratory symptoms for a full-night Watch-PAT with concomitant recording of the MG score and acetylcholine receptor antibody concentration and analyzed potential risk factors of SDB. Twenty-four patients (41%) had definitive SDB, which was mild in 12 patients, moderate in six, and severe in six. Assessing risk factors with multivariate models, we found four significant predictors (BMI, age, male gender, and use of azathioprine); BMI was the most powerful predictor. The severity and prevalence of sleep-disordered breathing had no significant association with MG score, myasthenia stage, or seropositivity of acetylcholine receptor antibody. The prevalence of SDB in myasthenic patients with mild and moderate weakness was high when using the Watch-PAT. Both myasthenia-specific factors (use of azathioprine) and general predictors in terms of BMI, age, and male gender predisposed the development of SDB in patients with myasthenia gravis. Careful screening of patients with myasthenia gravis at risk of SDB using Watch-PAT might improve the quality of sleep and cardiovascular health through proper treatment of underlying SDB.

Sleep-disordered breathing in high-altitude Peruvian communities

Abstract Background Sleep-disordered breathing (SDB) is a highly prevalent disorder with major consequences for cardiopulmonary health, public safety, use of health-care, and mortality. Hypoxia is a known risk factor for SDB, yet the prevalence and effect of SDB in high-altitude settings remain largely unknown. Methods The CRONICAS Cohort Study is a longitudinal study of non-communicable diseases in an age-stratified and sex-stratified random sample of more than 3000 Peruvian adults (≥35 years), including more than 1000 individuals residing at high altitude. Participants were surveyed for sociodemographics, anthropometry, spirometry, and metabolic and inflammatory biomarkers beginning in September, 2010. We recruited a convenience sample of 127 participants living at high altitute (3825 m) for home-based nocturnal physiological recordings including respiratory effort, air flow, oxyhaemoglobin saturation, and actigraphy. We estimated the prevalence of SDB and examined its associations with traditional risk factors and non-communicable diseases. Findings Our sample was middle-aged (mean 57·2 years [SD 12·2]), 55·1% were men, and the mean body-mass index (BMI) was 27·3 kg/m 2 (SD 4·1). Most participants were urban residents (112 of 127, 88·2%). We identified several nocturnal respiratory phenotypes, including obstructive sleep apnoea (48 of 127, 37·8%), central sleep apnoea (21, 16·5%), mixed sleep apnoea (three, 2·4%), and substantial isolated oxyhaemoglobin desaturation during sleep (two, 1·6%), wakefulness (two, 1·6%), and normal nocturnal breathing (51, 40·2%). The overall prevalence of SDB was 56·7% (72 of 127). SDB was significantly associated with older age (p=0·042, test for trend in odds), male sex (OR 2·29, 95% CI 1·05–4·99, p=0·023), and rural residence (5·84, 1·22 −55·04, p=0·013). SDB was not significantly associated with BMI, chronic obstructive pulmonary disease, hypertension, cardiovascular disease, diabetes, or depression. Interpretation We noted a high prevalence of SDB in the high-altitude sample, encompassing several distinct phenotypes. SDB was associated with age, male sex, and rural residence, but not BMI or chronic diseases. This pilot study shows the feasibility of home-based nocturnal recordings in this setting, and will guide further investigation in larger representative samples. Funding National Heart, Lung and Blood Institute, National Institutes of Health (HHSN268200900033C); Johns Hopkins University School of Medicine Dean's Funding; University of Chicago Pritzker School of Medicine Global Health Scholarship; University of Chicago Pritzker School of Medicine Scholarship; and Discovery Innovation Fund.

The Prevalence of and Risk Factors for Sleep-Disordered Breathing in an Elderly Korean Population

Background: There are just a few epidemiological studies on sleep-disordered breathing (SDB) in the elderly, and the results are inconsistent. Study Objectives: We sought to investigate the prevalence of and risk factors for SDB in a representative elderly population with the use of attended nocturnal polysomnography (NPSG). Methods: Among 6,959 individuals aged ≥60 years living in Yongin City, Korea, 696 subjects were selected using random sampling. All the subjects were invited to visit a hospital for NPSG, and SDB was defined as an apnea-hypopnea index ≥15. Results: Of the 696 participants investigated, 348 participants completed the sleep study and clinical evaluation. SDB was observed in 127 of the 348 participants, and the prevalence of SDB was 36.5% (52.6% in males and 26.3% in females). A body mass index ≥25 was associated with SDB in both male and female subjects, particularly in males, whereas snoring was independently associated with SDB in female participants only. In male participants, SDB was a significant risk factor for hypertension (p = 0.025). Conclusions: SDB was found to be common among elderly Koreans, and it was more prevalent and severe in male than in female subjects. Health consequences of SDB in the elderly need to be further explored.

Is sleep-disordered breathing associated with miscarriages? An emerging hypothesis

Sleep-disordered breathing (SDB) is a common disorder that has numerous medical consequences including cardiovascular morbidity. The clinical presentation in women is frequently vague, leading to its under-recognition in this population. Sleep is known to influence several female hormonal cycles including estrogen, progesterone, prolactin, luteinizing hormone (LH), and follicle stimulating hormone (FSH); consequently, sleep disruption may have adverse effects on female health including pregnancy. Miscarriage, defined as the loss of a pregnancy in the first trimester, occurs in one in four pregnancies; in up to half of cases, the cause may be unknown. Risk factors for miscarriage include increased age, increased weight, and a history of polycystic ovarian syndrome, all of which are also risk factors for SDB. Since SDB is frequently accompanied by sleep fragmentation and intermittent hypoxemia, we speculate that these factors may contribute to miscarriage risk. If this is the case, then treatment of SDB may be a possible intervention for subsequent pregnancies.

Sleep-disordered breathing in adults with down syndrome: a cross cultural comparison

Individuals with Down syndrome (DS) are at increased risk of sleep disordered breathing (SDB). Anatomical characteristics of DS, such as mid-facial hypoplasia, small jaw and obesity, are also risk factors for SDB, and may differ with ethnicity. Untreated SDB can lead to adverse cardiac outcomes and impaired cognitive function, thus early diagnosis and treatment may be important in DS. To date, no systematic population survey or cultural comparison has been made in DS individuals. This study aims to compare prevalence of SDB among adults aged >16 years with DS in two diverse cultures: Japan and Scotland. Questionnaires including physical profile, traditional or pictorial Epworth Sleepiness Scale (ESS) and witnessed signs of SDB (e.g. apnoeic episodes and snoring) were sent to adults aged >16 years with DS and their caregivers in Japan (J) and Scotland (S). 705 questionnaires were valid for analysis (J: 461; S: 244). Standard statistical analysis was undertaken. Similar gender distributions (male/female J: 259/202 vs. S: 139/105) and ESS (J: 6 ± 5 vs. S: 7 ± 5) were observed among Japanese and Scottish responders. Adults with DS in Scotland were older and had higher BMI than those in Japan (J: 24 ± 8 vs. S: 32 ± 11 years; J: 24.0 ± 4.1 vs. S: 29.6 ± 7.4 kg/m 2 ). In Japan, 80% of responders snored and 30% had witnessed apnoeas. Similarly, in Scotland, 74% snored and 24% had witnessed apnoeas. In Japan, snorers had significantly higher BMI (OR 1.1, 95%Cl 1.0–1.2, p < 0.01) and ESS (OR 1.2, 95%Cl 1.1–1.3, p < 0.001), and tended to be younger (OR 1.0 95%Cl 0.9–1.0, p = 0.06). Similar associations were found in Scotland, with snorers being younger (OR 1.0, 95%Cl 0.9–1.0, p < 0.05) and having significantly higher ESS (OR 1.3, 95%Cl 1.0–1.4, p < 0.01). In Japan, witnessed apnoeas were significantly associated with higher ESS (OR 1.2, 95%Cl 1.1–1.2, p < 0.001). Prevalence of symptoms of SDB was high among adults with DS in both countries. The DS population in Scotland was significantly more obese. These results imply that the anatomical characteristics of DS might overshadow the racial and anatomical differences in terms of causing SDB, although further research is required. Appropriate evaluation and treatment should be offered if symptoms of SDB are observed, regardless of ethnicity, in adults with DS. Both studies are ongoing. We sincerely appreciate Donna Fairley, RN, for helpful effort. Hiroyuki Sawatari and Elizabeth A Hill were joint 1st author. Renata L Riha and Shin-ich Ando were Joint supervisors.

Allergy as a risk factor for sleep disordered breathing

Allergy is strongly associated with poor sleep quality, being sleep disruption and sleep disordered breathing (SDB) the most common alterations, both in asthma and allergic rhinitis (AR). Nasal obstruction and congestion are a risk factor for SDB and for its persistence after adenotonsillectomy (AT). This study aims to describe and characterize the population with respiratory allergic disease (rhinitis and asthma) referred to specialized sleep clinic for snoring and/or breathing pauses and its follow-up. Retrospective descriptive study, reviewing the clinical files of patients referred to our sleep clinic for SDB who had a history of asthma and/or AR from January 2008 to December 2012. Allergy was considered present if reported by the parents in child past medical history. Allergic patients represent 15.8% (n = 58) out of the total of the children referred for SDB. Descriptive and comparative (non-parametric tests) statistics were done. All the 68 children files were reviewed. Male gender predominates (42; 72.4%) and the median age at first observation was 9 (3; 16) years. Most children had a regular growth (56; 96.6%). Regarding respiratory allergic disease, 15 (25.9%) children had rhinitis, 27 (46.6%) had asthma, 16 (27.6%) had both. Fourteen (24.1%) had been previously submitted to TA. Family history of atopy was frequent (24; 41.4%), as well as family history of snoring (28; 48.3%). Most children were under allergy medication (47; 80.0%) on first observation. Of the 50 (86.2%) children who underwent polysomnography, 17 (29.3%) had a fragmented sleep, with multiple arousals; the median apnea-hypopnea index (AHI) was 0.42/h (0.00; 3.00), and the median desaturation index (DSI) was 1.42/h (0.00;7.80). Forty (69.0%) children were referred to Ear, Nose and Throat clinic, being 18 (45.0%) of them submitted to TA. In half of these (9; 50.0%) snoring had persisted, with no difference between children with asthma or rhinitis ( p -value = 0.143). Five (7.4%) children were referred to an orthodontics specialist and 1 needed CPAP. Our review shows that allergic disease is frequent in children with SDB, even if it is not severe. In these children, snoring persists after TA in a large number of patients, being necessary to consider other therapeutic options and prolonged follow-up. Allergy should be accessed as a risk-factor in the management of sleep-disordered breathing in children.

We need to pay special attention on sleep postures and heart diseases in down syndrome with sleep disordered breathing

Down syndrome (DS) is known to be often (30–50%) comorbid with sleep disordered breathing (SDB) for their facial anatomical deformation, muscular hypotonia. Daytime sleepiness resulted from SDB may relate to impaired cognitive function even in general public. In DS, congenital heart diseases (CHD) are also highly complicated (30–60%). Such CHD and SDB may cause a vicious cycle and early intervention to SDB in DS would contribute to their better intellectual and physical development. We reported that some of the DS slept in unusual postures. Thus, we studied the mutual relation among them in DS. We recruited 90 caregivers of the DS in Fukuoka. The questionnaires for the DS contained demographic descriptions including CHD, sleeping postures, Epworth sleepiness scale (ESS), and SDB symptoms (easiness of getting to sleep, snoring, arousal, witnessed apneic episodes, nocturnal urination, nap, hardness of awakening). We calculated individual Caup index (0–5 yo), Rhorer index (6–13 yo), and BMI (14-yo) for judging obesity. We analyzed the relation between SDB symptoms and these items using chi-square test. Seventy of 90 DS (34 men, 18 ± 10 yo) responded to the survey. Thirty-seven DS (53%, 15 men, 15 ± 9 yo) had CHD. Symptoms of SDB were as follows: “easiness of getting to sleep” in 90%, “snore” in 75%, “nocturnal arousal” in 52%, “witnessed apneic episodes” in 40%, “night urination” in 19%, “nap” in 41%, “hard to awaken” in 15%. There was significantly higher proportion of obese DS in “hard to awaken” than in “easy to awaken” (78% vs. 33%, P < 0.05), and tendency of higher proportion of unusual sleep postures in “easy to awaken” than “hard to awaken” (67% vs. 33%, P < 0.1). Furthermore, higher ESS was in “nocturnal arousal” and “night urination” than in “no arousal” and “no night urination” (38% and 55% vs. 4% and 13%, P < 0.01, respectively). Finally, there were tendencies of higher comorbidity of CHD in those with SDB symptoms. Preventing obesity seems to be useful to improve SDB also in DS. The complication of CHD in the DS with SDB suggested formation of the vicious cycle. The unusual sleeping postures in the DS seem to be self-defending behaviors to protect from SDB. In conclusion, we need not only to take general care of SDB like reducing weight but also to give attention to specific risk factors of SDB in DS. Our deepest appreciation goes to the members of the Fukuoka branch of Japan Down Syndrome Society.