Risk For Sleep-disordered Breathing Research Articles

Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans.

The incidence of sleep-disordered breathing (SDB) increases in chronic lung diseases. Our aim was to evaluate SDB and sleep quality in children with postinfectious bronchiolitis obliterans (BO) and assess associated risk factors. We hypothesized that children with BO are at increased risk for SDB and have impaired sleep quality. We also hypothesized that severity of SDB and impairment of sleep quality is related to the severity of lung disease. Sleep Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI) questionnaires; spirometry, impulse oscillometry (IOS), and overnight polysomnography (PSG) were performed. Twenty-one patients (14 male, median age: 8.3 years) were enrolled. Five patients (25%) had a PSQ score of >0.33, predictive of a SDB. Ten patients (48%) had poor sleep quality. Four patients (19%) had an OAHI of >1/hr. Nineteen patients (90%) had a high desaturation index. Four patients (19%) had a mean oxygen saturation of <93%. Median central apnea time was 7.5 (IQR: 6.9-9.1) seconds. Central apnea index of the patients correlated positively with R5, R10, R15, R20, Z5, and negatively with X10 and X15 at IOS. There was a positive correlation between the lowest oxygen saturation and FVC, FEV1 , X5, X10, X15, X20 while there was a negative correlation between lowest saturation and the central apnea index at PSG, R5, R10, and Z5 at IOS. Mean oxygen saturation during PSG correlated positively with FVC, FEV1, FEF(25-75), X5, X10, X15, X20 results. The risk of nocturnal hypoxia is increased in patients with BO and correlated to the severity of lung disease determined by pulmonary function tests. Although BO patients have a shorter duration of central apneas, they are more prone to desaturate.

Parental poverty and occupation as risk factors for pediatric sleep-disordered breathing

Objectives/BackgroundPrevious studies have found associations between pediatric sleep-disordered breathing (SDB) and socioeconomic status (SES), as well as a neighborhood-related disadvantage. This study analyzes the association among familial SES, parental occupation, and SDB in Swedish offspring. MethodsA nationwide dataset was constructed by linking Swedish census data to hospital discharge register data on all first hospitalizations of children and adolescents aged 0–18 years during the study period 1997–2007. The outcome was SDB, defined as diagnostic codes for obstructive sleep apnea (OSA), adenotonsillar hypertrophy, or tonsillar hypertrophy. Familial SES was defined as family income and maternal education. The odds ratio (OR) was calculated with a 95% confidence interval (CI). Results34,933 of three million children had a first hospital diagnosis of SDB. The OR was significantly increased in offspring in families with a low income (1.79) and maternal education (1.21). Significantly increased ORs were found in 14 of 38 maternal (37%) and 13 of 48 paternal (27%) occupations, and six of them involved both parents: drivers, welders, and workers in mechanics and iron metalware, chemical processing, and manufacture of food and glass. A significantly decreased OR was found in 12 (25%) of the paternal occupations, e.g., scientists, physicians, teachers, artists, administrators, and farmers, as well as in maternal occupations, such as artists and farmers, with offspring aged 0–6 years. ConclusionThis study indicates that low familial SES and parental occupations associated with a low educational level increased, whereas academic parental occupations and farmers decreased the risk of SDB in offspring.

Craniofacial changes and symptoms of sleep-disordered breathing in healthy children

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB.

Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Con

Sleep-disordered breathing (SDB) is one of the most common comorbidities in people with congestive heart failure (CHF). Although SDB has major cardiometabolic consequences, the attributable risk of SDB in asymptomatic CHF patients remains unclear. Whether early intervention using positive airway pressure would improve the prognosis in CHF patients is uncertain. As yet, there is insufficient evidence that routine polysomnography screening is cost-effective for asymptomatic CHF patients. Careful clinical risk evaluation and thoughtful use of limited-channel home sleep testing should be considered before the application of routine polysomnography in all CHF patients.

Lateral facial profile may reveal the risk for sleep disordered breathing in children—The PANIC-study

Objective. To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs. Materials and methods. The present study sample consisted of 382 children 6–8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile. Results. The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000–0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951–0.992. Conclusion. In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study

Sleep-disordered breathing is associated with major morbidity and mortality. However, its prevalence has mainly been selectively studied in populations at risk for sleep-disordered breathing or cardiovascular diseases. Taking into account improvements in recording techniques and new criteria used to define respiratory events, we aimed to assess the prevalence of sleep-disordered breathing and associated clinical features in a large population-based sample. Between Sept 1, 2009, and June 30, 2013, we did a population-based study (HypnoLaus) in Lausanne, Switzerland. We invited a cohort of 3043 consecutive participants of the CoLaus/PsyCoLaus study to take part. Polysomnography data from 2121 people were included in the final analysis. 1024 (48%) participants were men, with a median age of 57 years (IQR 49-68, range 40-85) and mean body-mass index (BMI) of 25·6 kg/m(2) (SD 4·1). Participants underwent complete polysomnographic recordings at home and had extensive phenotyping for diabetes, hypertension, metabolic syndrome, and depression. The primary outcome was prevalence of sleep-disordered breathing, assessed by the apnoea-hypopnoea index. The median apnoea-hypopnoea index was 6·9 events per h (IQR 2·7-14·1) in women and 14·9 per h (7·2-27·1) in men. The prevalence of moderate-to-severe sleep-disordered breathing (≥15 events per h) was 23·4% (95% CI 20·9-26·0) in women and 49·7% (46·6-52·8) in men. After multivariable adjustment, the upper quartile for the apnoea-hypopnoea index (>20·6 events per h) was associated independently with the presence of hypertension (odds ratio 1·60, 95% CI 1·14-2·26; p=0·0292 for trend across severity quartiles), diabetes (2·00, 1·05-3·99; p=0·0467), metabolic syndrome (2·80, 1·86-4·29; p<0·0001), and depression (1·92, 1·01-3·64; p=0·0292). The high prevalence of sleep-disordered breathing recorded in our population-based sample might be attributable to the increased sensitivity of current recording techniques and scoring criteria. These results suggest that sleep-disordered breathing is highly prevalent, with important public health outcomes, and that the definition of the disorder should be revised. Faculty of Biology and Medicine of Lausanne, Lausanne University Hospital, Swiss National Science Foundation, Leenaards Foundation, GlaxoSmithKline, Ligue Pulmonaire Vaudoise.

Sleep disordered breathing risk in childhood cancer survivors: an exploratory study.

Sleep disordered breathing (SDB) is emerging as a significant health condition for children. The purpose of this study is to evaluate SDB symptoms in childhood cancer survivors and identify associations with quality of life (QOL) and psychological symptoms. A sample of 62 survivors aged 8-18 years were recruited during routine survivorship visits. All subjects and their parents completed questionnaires to evaluate sleep, QOL and psychological symptoms; scales included were: Pediatric Sleep Questionnaire, Sleep Disordered Breathing Subscale (PSQ-SDBS), Pediatric Quality of Life Inventory (PedsQL) and Depression Anxiety Stress Scale (DASS-21). Continuous data were used for all scales and a threshold score of >0.33 on the PSA-SDBS was used to identify risk of SDB. The relationships between measures of sleep and independent variables were examined using Pearson correlations and multiple linear regression models for significant associations. Of the 62 subjects enrolled, underlying diagnoses included 29 leukemias, 30 solid tumors and 3 non-malignant diseases. Nineteen percent of subjects were identified as having SDB risk on the PSQ-SDBS. The lowest mean PedsQL subscale score for parent and child ratings were school QOL; Parent mean 73(±SD 19) and Child mean 71(±SD 20). The severity of SDB per the PSQ was significantly associated with reduced total and school QOL which remained significant after adjusting for stress. Symptoms suggestive of SDB are common in childhood cancer survivors with negative implications for overall quality of life and school performance.

Sleep disorders in menopause: results from an Italian Multicentric Study.

Menopause in the female life cycle is a special period due to important hormonal, physical and psychological changes. Sleep disruption represents a common complaint for midlife and menopausal women, related to primary sleep disorders, including insomnia, sleep disordered breathing, restless legs syndrome (RLS), mood and anxiety disorder, other medical illness, hormonal-related vasomotor symptoms, and aging per se. Aims of our study were to evaluate the prevalence of sleep disorders in a sample of pre and post menopausal women, and to investigate the relationship between sleep and other medical disorders, and life habits. Among workers in the six participant centers, we enrolled 334 women, aged between 40 and 60 years, that completed a questionnaire that included screening on menarche, menstrual cycle, fertility, parity, menopause, life habits, personal medical and sleep history and related treatment, and self-administered scales for sleep quality (PSQI), excessive daytime sleepiness [Epworth Sleepiness Scale (ESS)], mood disorder [Beck Depression Inventory (BDI)], Berlin Questionnaire for sleep disordered breathing (SDB), IRLS diagnostic interview and Rating Scale. Menopausal and perimenopausal women showed an increased prevalence of poor sleep, high risk of SDB, and mood disorder; menopausal women also reported increased RLS severity. Mood disorder had a significant impact on night sleep measures and excessive daytime sleepiness, as well as on RLS severity, and had a greater prevalence in hypertensive women. Sleep disturbances are frequent in menopausal women. Their aetiology is unclear, but probably multifactorial, and many factors contribute to the sleep disruption. Our data suggest the importance of correctly investigate and address sleep problems associated with menopause, through sleep history, and a sleep study could be obtained if clinically warranted. Pharmacological and behavioural treatment strategies should then be aimed at improving sleep and life quality in perimenopausal and menopausal women.

Prevalence of sleep-disordered breathing in patients with Beckwith-Wiedemann syndrome.

Patients with Beckwith-Wiedemann syndrome (BWS), a genetic disorder characterized by macroglossia, abdominal wall malformations, and gigantism, are at risk for sleep-disordered breathing (SDB). SDB is defined by abnormal breathing that is exacerbated during sleep and is a spectrum ranging from apnea of prematurity to obstructive sleep apnea (OSA). The aim of this study is to determine the prevalence of SDB in children with BWS, and to document clinical characteristics and method(s) of treatment. This is a retrospective cohort study of children with BWS seen at Boston Children's Hospital between 1979 and 2010. Clinical features, presence, type, treatment, and outcomes of SDB were documented. The prevalence of SDB in the 118 patients with BWS was 48% (n = 57). This included 16 subjects who had airway obstruction limited to the neonatal period (26%), 26 subjects with snoring or other obstructive symptoms not diagnosed by polysomnography (46%), and 15 patients with OSA confirmed by polysomnography (28%). Macroglossia was not a significant predictor of SDB, although adenotonsillar hypertrophy was (P < 0.001). Laryngomalacia, feeding problems, and gastroesophageal reflux also predicted a higher risk for SDB (P < 0.018). OSA was most commonly treated with partial glossectomy and/or adenotonsillectomy. The prevalence of SDB in this cohort of patients with BWS was 48%. The etiology of SDB in these patients is multifactorial and may not be solely the result of a large tongue. Further information as to the site(s) of airway obstruction in patients with BWS will help guide treatment strategies.

Antenatal depression: an artefact of sleep disturbance?

Research indicates that poor sleep quality is linked to and may precede depressive symptomatology in pregnancy, complicating screening for either condition. Pregnancy onset may also contribute to the development of sleep-disordered breathing (SDB). For the first time, the link between SDB and depression was examined in pregnancy. A total of 189 pregnant women completed the Edinburgh Postnatal Depression Scale (EPDS), Pittsburgh Sleep Quality Index (PSQI) for sleep quality and the Berlin Questionnaire for SDB. Women were also asked what they felt was the cause of their symptoms. PSQI-assessed poor sleep quality and self-perceived depression were strongly associated with EPDS scores of probable depression (X (2) 13.39; p < 0.001). Berlin-assessed risk of SDB was also associated with probable depression (X (2) 9.20 p < 0.01), though this was attenuated following multivariate analysis. There was a significant relationship between total PSQI score and the tendency for participants to attribute 'sleep-related causes' to their low mood (X (2) 20.78; p < 0.001). This study confirms the link between PSQI-assessed poor sleep quality and depressive symptoms in pregnancy, suggesting the two questionnaires assess the same or overlapping conditions. Although there was a relationship between probable depression and high risk SDB, the effect was attenuated after accounting for other depression risk factors, including body mass index (BMI).

Risk for Sleep-Disordered Breathing in Adults after Atrial Switch Repairs for d-Looped Transposition of the Great Arteries

Although sleep-disordered breathing has been extensively studied in patients with left-ventricular dysfunction, little is known of its prevalence in adults with congenital heart disease. Patients with d-looped transposition of the great arteries (d-TGA) who have undergone atrial switch procedures often develop progressive heart failure. The objective of this study was to determine the prevalence of patients at risk for sleep-disordered breathing in adults with d-TGA and atrial switch procedures compared with a control population. Thirty-two patients with d-TGA (66 % males, median age 31) were compared with 32 healthy controls. Baseline demographics and clinical characteristics were documented. The snoring, tiredness during daytime, observed apnea, and high blood pressure (STOP) questionnaire was used to identify subjects at risk for obstructive sleep apnea (OSA). There was no difference in baseline demographics between subjects and controls. For the STOP questionnaire, 14 subjects with d-TGA had scores predictive of OSA compared with three in the control group (44 vs. 9 %, p = 0.0038). There was no difference in functional status between d-TGA patients with or without OSA. There is a greater prevalence of risk for sleep disordered breathing in adults with d-TGA compared with controls. Further prospective investigation with sleep studies will be valuable to confirm these findings.

Sleep-disordered Breathing in Hispanic/Latino Individuals of Diverse Backgrounds. The Hispanic Community Health Study/Study of Latinos

Hispanic/Latino populations have a high prevalence of cardiovascular risk factors and may be at risk for sleep-disordered breathing (SDB). An understanding of SDB among these populations is needed given evidence that SDB increases cardiovascular risk. To quantify SDB prevalence in the U.S. Hispanic/Latino population and its association with symptoms, risk factors, diabetes, and hypertension; and to explore variation by sex and Hispanic/Latino background. Cross-sectional analysis from the baseline examination of the Hispanic Community Health Study/Study of Latinos. The apnea-hypopnea index (AHI) was derived from standardized sleep tests; diabetes and hypertension were based on measurement and history. The sample of 14,440 individuals had an age-adjusted prevalence of minimal SDB (AHI ≥ 5), moderate SDB (AHI ≥ 15), and severe SDB (AHI ≥ 30) of 25.8, 9.8, and 3.9%, respectively. Only 1.3% of participants reported a sleep apnea diagnosis. Moderate SDB was associated with being male (adjusted odds ratio, 2.7; 95% confidence interval, 2.3-3.1), obese (16.8; 11.6-24.4), and older. SDB was associated with an increased adjusted odds of impaired glucose tolerance (1.7; 1.3-2.1), diabetes (2.3; 1.8-2.9), and hypertension. The association with hypertension varied across background groups with the strongest associations among individuals of Puerto Rican and Central American background. SDB is prevalent in U.S. Latinos but rarely associated with a clinical diagnosis. Associations with diabetes and hypertension suggest a large burden of disease may be attributed to untreated SDB, supporting the development and evaluation of culturally relevant detection and treatment approaches.

Abstract W P129: Association Between Acute Stroke Location and Sleep-Disordered Breathing

BACKGROUND: A high prevalence of sleep-disordered breathing (SDB) has been demonstrated among stroke patients. The literature about the relationship between SDB and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of obstructive sleep apnea (OSA) (apnea hypopnea index [AHI] ≥ 5 events/hour) and sleep apnea severity (defined by AHI). METHODS: Data were obtained from 236 patients participating in an ongoing randomized controlled trial (NCT01446913) that is evaluating the effectiveness of a strategy of diagnosing and treating SDB among patients with acute ischemic strokes and transient ischemic attacks. As part of this trial, all intervention patients receive polysomnography. Demographics, pre-stroke disability, comorbidities, National Institutes of Health Stroke Scale, clinical and laboratory parameters, and Epworth Sleepiness Scale are also recorded. Stroke location was classified by brain imaging (MRI or CT) reports as follows: lobe (frontal, parietal, temporal, insular, occipital), subcortical (thalamus, basal ganglia, internal capsule, corona radiata, corpus callosum), brainstem (midbrain, pons, medulla), cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for SDB presence and negative binomial regression for AHI. RESULTS: Among 94 patients with complete polysomnography and stroke location data, 72 (77%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence of SDB or its severity. Similarly, in multivariable modeling accounting for baseline characteristics that were associated with SDB (e.g., neck circumference), stroke location was not associated with SDB presence. CONCLUSIONS: These results confirm that SDB is present in the majority of stroke patients and suggest that stroke location cannot be used to identify a group with higher risk of SDB. Given this high overall prevalence, strong consideration should be given to providing polysomnography for all ischemic stroke patients.

Prevalence and predictors of sleep disordered breathing in patients undergoing chronic ambulatory intermittent hemodialysis

Sleep disordered breathing (SDB) is a common finding in chronic hemodialysis (CHD) patients. Two recent American studies investigated the prevalence of SDB in patients with different degree of chronic kidney disease and reported a prevalence of 26–57%. The purpose of this study is to evaluate the prevalence of SDB and to evaluate the predictive value of Berlin questionnaire, hemodialysis frequency and duration, and biometric parameters in a large group of European patients undergoing CHD. All the patients attending six CHD centers in the western part of Switzerland were screened. Eligible patients completed the Berlin questionnaire, a validated 11 items form used to evaluate the risk of obstructive sleep apnea and the Epworth Sleepiness Scale (ESS). All patients underwent a home nocturnal polygraphy (PG) using Apnea Link Plus system recording nasal pressure, oxygen saturation, thoracic movements and heart rate. Respiratory events were scored according to the AASM 99 criteria. Apnea-hypopnea index (AHI) was calculated by dividing the total number of apnea and hypopnea during the night by the recording time. Among 166 screening patients, 98 were included and 71 completed the study (50 men, mean age 61.8 ± 15.4, neck circumference 40.6 ± 4.6 cm, BMI 25.7 ± 4.8 kg/m2). Mean AHI was 23.9 ± 20.4/h (18% obstructive apnea, 8.5% central apnea, 2.4% mixed apnea). Among these 71 patients, 31% had severe SDB (AHI ⩾ 30/h), 23.9% had moderate SDB (AHI 15–30/h), 31% had mild SDB (AHI 5–15/h) and 14.1% were normal (AHI < 5/h). Berlin’s questionnaire showed a high risk of SDB in 62.5% of the patients with a sensitivity of 65%, a specificity of 39%, a positive predictive value of 58% and a negative predictive value of 47%. According to ESS, 18.5% of the patients had significant sleepiness (>10/24). Using a logistic regression model including age, sex, BMI, neck circumference, Berlin questionnaire, ESS, smoking, alcohol, number/week and duration of CHD session, the only independent predictor was neck circumference with odds ratio of 1.59 (p = 0.023). The prevalence of SDB in the CHD population is higher than expected. Berlin questionnaire is not useful to screen for SDB in CHD patients but neck circumference seems to be an independant predictor of SDB in this population. Supported by the Leenaards Foundation, Ligue Pulmonaire Vaudoise, Swiss National Foundation for Research, GSK.

Association between clinical signs and symptoms related to sleep-disordered breathing in mouth breathers school children

Introduction Sleep-disordered breathing (SDB) is one of the causes of morbidity in children. The symptoms of SDB in children are varied and difficult to diagnose, especially in mouth breathing children (MB). The aim of this study was to associate the clinical signs of the MB and the self-perception of their symptoms related to SDB, focusing on nasal, sleep and masticatory problems. Materials and methods From a previous study, a sample of 73 pre-selected MB derived from elementary schools, aged 7–14 years old, was reevaluated about the presence of anatomical and functional facial and dental occlusion changes, the temporomandibular joint (TMJ) and posture alterations and breathing pattern abnormalities. Concomitantly, a questionnaire about symptoms of SDB was applied to the MB. This instrument contains 16 questions about TMJ, nasal and sleep problems. From 42 clinical variables reevaluated, 19 were selected by the Binomial test where the cutoff point was the average of the variables’ prevalence. Afterwards, we used the logistic regression through Backward method and the Wald test to verify the association between these clinical variables and the 16 questions from the questionnaire. Results For TMJ symptoms the clinical variables were significant to: lack of lip closure, Class II malocclusion, deviation from interocclusal position, overbite, forward head position and palatine tonsil hypertrophy. For the nasal symptoms the clinical variables were significant to: turbinate hypertrophy and deviation from interocclusal position. Lastly, for the sleep symptoms the clinical variables were significant to: turbinate hypertrophy, palatine tonsils hypertrophy, deviation from interocclusal position, lack of lip seal, obstructive Mallampati index (III and IV), and protrusion deviation. Most significant finds were those related to the sleep symptoms: mouth breathing and obstructive Mallampati index were related to complaints of snoring, waking up during the night and sleeping were related with the mouth open; mouth breathing and palatine tonsils hypertrophy were related to complaints of sleep problems and daytime sleepiness. Conclusion This study showed that craniofacial, upper airway and postural abnormalities are associated with an increased risk of SDB in mouth breathers children. Acknowledgements Management of Vitoria City, ES, Brazil.

Screening for sleep-disordered breathing in the general population: predictive performance of four questionnaires

Background : Several questionnaires have been used to screen for sleep-disordered breathing (SDB). Most of them have been validated in selected clinical populations, and little is known about their predictive performance in the general population. To investigate the accuracy of four questionnaires used for SDB screening in the general population: the Berlin Questionnaire (BQ), the Epworth Sleepiness Scale (ESS), the STOP-Bang (SB) and the adjusted-neck circumference (neck+). 2115 subjects (50.4% women, 58.4 ± 11.0 years old, BMI 26.2 ± 4.4 kg/m 2 ) participating in an ongoing population-based sleep cohort study (HypnoLaus, Lausanne, Switzerland) underwent complete polysomnographic recordings at home. Respiratory events were scored according to the AASM 2013 criteria. Prevalence of SDB was determined for apnea–hypopnea index (AHI) thresholds of ⩾15 and ⩾30. Interviewers administered the BQ and the ESS and calculated SB and neck+. SB includes the following items: snoring, daytime Tiredness, Observed apnea, high blood Pressure, Body-mass index ⩾35 kg/m 2 , Age ⩾ 50 yr, Neck girth ⩾ 40 cm, and male Gender. Neck + is obtained by measuring the neck girth in cm and adding 3 cm for the presence of snoring, 3 cm for observed apnea and 4 cm for high blood pressure. Subjects were considered at increased risk for SDB if BQ is positive in ⩾2 categories, ESS score ⩾11, SB score ⩾3 and neck+ ⩾43 cm. Assessment of questionnaire included their sensitivity, specificity, positive-predicted value (PPV) and negative-predicted value (NPV). Prevalence of SDB with AHI thresholds of ⩾15 and ⩾30 were respectively 36.4% and 15.0%. Percentages of positive BQ was 25.3%, ESS:13.4%, SB: 41.3% and neck+:29.0%. For an AHI ⩾ 15, sensitivity, specificity, PPV and NPV were respectively: BQ (39.4%, 82.7%, 56.6% and 70.5%), ESS (13.5%, 86.7%, 35.8% and 64.5%), SB (67.3%, 72.8%, 57.3% and 80.4%) and neck+ (52.3%, 83.8%, 64.0% and 76.1%). For an AHI ⩾ 30, sensitivity, specificity, PPV and NPV were respectively: BQ (48.7%, 78.8%, 28.8% and 89.7%), ESS (13.1, 86.6%, 14.2% and 85.4%), SB (81.7%, 65.6%, 28.7% and 95.5%) and neck+ (69.8%, 77.9%, 34.6% and 93.9%). Our population-based study suggests that questionnaires such as BQ, ESS, SB and neck+ could be used to rule out severe SDB considering their strong NPV. However they do not seem suitable to screen for moderate to severe SDB in the general population. Funding : Ligue pulmonaire vaudoise, Fondation Leenaards, Fond national Suisse and GSK.

Snoring, sleepiness, inattention, and hyperactivity in preschool and kindergarten children with a repaired cleft palate

School-age children with repaired cleft palate appear to be at high risk for symptoms of sleep-disordered breathing (SDB). In addition, they are also at risk of neurobehavioral morbidity. In typically developing school-age children, SDB symptoms such as snoring are robustly associated with behavioral problems. However, it is currently unknown whether underlying SDB may play a role in neurobehavioral morbidity in young children with a repaired cleft palate. Therefore, the main goal of this study was to investigate the association between cleft palate repair, SDB symptoms, and behavioral problems in children attending preschool and kindergarten. Children aged 2–6 years old with non- syndromic repaired cleft palate were recruited from a Craniofacial Anomalies Clinic. All parents completed the sleep- related breathing disturbance subscale (SRBD) from the Pediatric Sleep Questionnaire, a validated scale for SDB risk. A score on this scale of >=0.33 indicates high risk for SDB. The 4-item snoring and sleepiness scale scores were also calculated. In addition, parents completed the Early Conners ¯ Childhood Assessment which addresses adaptive behavior, development, and cognitive function in children below 6 years of age. A T- score on the Conners questionnaire of 65 (>=1.5 SD above the mean) was considered elevated. Of 36 children thus far, mean age was 4.9iÀ1.3 years and 53% were boys. Overall, 14% of children screened positive for SDB. Positive responses to the snoring and sleepiness subscales were reported in 17% and 8% of children respectively. Inattention/hyperactivity was identified in 25% of children, Defiant/Aggressive Behaviors in 17% and Poor Social Functioning in 11%. There were no correlations between the SRBD scale nor the snoring subscale scores and any behavioral domain. However, the sleepiness score was positively correlated with inattention/hyperactivity ( r = 0.33, p = 0.05). Children with an elevated T-score for inattention/hyperactivity, compared to those without, had a higher SRBD score (0.26 vs. 0.13; p = 0.036) and a higher sleepiness score (0.31 vs. 0.05; p = 0.004). There were no differences in snoring scores (0.28 vs. 0.19; p = 0.50). Inattentive/hyperactive behaviors are common in preschool and kindergarten children with a repaired cleft palate. Although children with poor daytime behavior were more likely to screen positive for SDB, the relationship with behavior was driven by daytime sleepiness rather than snoring. Dr. Moraleda-Cibrian is supported in part by Fundacio Universitaria Agusti Pedro i Pons.

Sleep-disordered-breathing in Ehlers–Danlos syndrome (a genetic model of obstructive sleep apnea)

Investigation of presence of sleep-disordered-breathing (SDB) and its cause in Ehlers–Danlos-(ED) Syndrome patients. ED is a genetic disorder characterized by cartilaginous defects including the nasal-maxillary cartilages. Retrospective series of 34 ED patients presenting to a sleep medicine clinic with complaints of fatigue and poor sleep, evaluated using clinical history, physical examination, polysomnography (PSG) and in a subgroup with anterior rhinometry. Prospective clinical investigation of 9 ED patients followed in a specialized medical ED clinic. All sleep clinic patients had SDB on PSG. SDB included sleep-apnea and hypopnea but also flow limitation; there was an inverse relationship between age of subjects and amount of flow limitation versus apnea–hypopnea during sleep but clinical complaints were similar independent of abnormal polysomnographic finding. Of the subgroup of patients on whom nasal rhinometry was obtained, increased nasal resistance was noted relative to normative values. Nasal CPAP importantly improved symptoms of patients. ED patients in medical clinic presented symptoms and clinical signs of SDB but were never referred for evaluation of SDB. In ED patients, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. ED patients are at particular risk for SDB due to genetically related cartilage defects causing these patients to develop facial structures known to cause SDB. ED may be a genetic model for obstructive sleep apnea because of abnormalities of oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.

Abstract 9955: Echocardiographic Markers of Right Ventricular Function, Body-Mass Index, and Sleep Apnea in the Wisconsin Sleep Cohort

Background: Sleep-disordered breathing (SDB) is associated with increased cardiovascular disease risk and adverse cardiac remodeling due to increased sympathetic activity, oxidative stress and intermittent hypoxia. We characterized echocardiographic markers of right ventricular (RV) function in a large cohort with SDB. Methods: Between 2009 and 2012, transthoracic echocardiography was performed in a population-based cohort study evaluating the association of SDB and cardiovascular disease risk. Overnight polysomnography was performed ~1 month prior. SDB was characterized by the apnea-hypopnea index (AHI, events/hour). Participants on continuous positive airway pressure were excluded. RV systolic function was assessed from apical views and described by RV fractional area change (RVFAC), RV free wall strain (%) and strain rate (s -1 ), Tricuspid Annular Plane Systolic Excursion (TAPSE, mm), and qualitatively by an experienced echocardiographer. Associations between echocardiographic markers and AHI were adjusted for covariates in multivariable linear and logistic regression models. Results: The 352 subjects were mean (standard deviation) 64.6 (7.3) years old (49% female). They had a body-mass index (BMI) of 30.5 (6.4) kg/m 2 , systolic blood pressure (SBP) of 127 (13.6) mmHg, and ejection fraction of 61.4 (5.8) %. 52% had hypertension. Mean AHI was 5.8 (7.8) events/hour; 7.7% had moderate-severe SDB (AHI ≥15 events/hour). After adjustment for age, sex, BMI, smoking status, lung disease, SBP and use of antihypertensive medications, subjects with higher AHI had lower global RV strain rate (β=-0.12 s -1 /events/hour, p=0.03) and TAPSE (β=-0.07 mm/events/hour, p=0.03). Increased AHI was a significant predictor of visually assessed RV systolic dysfunction, but only in models that did not include BMI (OR=1.04; 95% confidence interval 1.01 -1.08 events/hour; p=0.015). RVFAC (p=0.20) and RV free wall global strain (p=0.21) were not associated with AHI. Conclusion: SDB is associated with RV dysfunction independent of its associations with obesity and hypertension. Quantification of RV global strain rate and TAPSE permit more objective assessment of RV function and are less sensitive to the confounding effects of BMI.

Sleep-Disordered Breathing in Ehlers-Danlos Syndrome: A Genetic Model of OSA

Objectives The objective of this study was to investigate the presence of sleep-disordered breathing (SDB) in patients with Ehlers-Danlos syndrome. Ehlers-Danlos syndrome is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages. Methods A retrospective series of 34 patients with Ehlers-Danlos syndrome and complaints of fatigue and poor sleep were evaluated by clinical history, physical examination, polysomnography (PSG), and, in some cases, anterior rhinomanometry. Additionally, a prospective clinical investigation of nine patients with Ehlers-Danlos syndrome was performed in a specialized Ehlers-Danlos syndrome clinic. Results All patients with Ehlers-Danlos syndrome evaluated had SDB on PSG. In addition to apneas and hypopneas, SDB included flow limitation. With increasing age, flow limitation decreased in favor of apnea and hypopnea events, but clinical complaints were similar independent of the type of PSG finding. In the subgroup of patients who underwent nasal rhinomanometry, increased nasal resistance was increased relative to normative values. Nasal CPAP improved symptoms. Patients with Ehlers-Danlos syndrome presenting to the medical clinic had symptoms and clinical signs of SDB, but they were never referred for evaluation of SDB. Conclusions In patients with Ehlers-Danlos syndrome, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. These patients are at particular risk for SDB because of genetically related cartilage defects that lead to the development of facial structures known to cause SDB. Ehlers-Danlos syndrome may be a genetic model for OSA because of abnormalities in oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation. The objective of this study was to investigate the presence of sleep-disordered breathing (SDB) in patients with Ehlers-Danlos syndrome. Ehlers-Danlos syndrome is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages. A retrospective series of 34 patients with Ehlers-Danlos syndrome and complaints of fatigue and poor sleep were evaluated by clinical history, physical examination, polysomnography (PSG), and, in some cases, anterior rhinomanometry. Additionally, a prospective clinical investigation of nine patients with Ehlers-Danlos syndrome was performed in a specialized Ehlers-Danlos syndrome clinic. All patients with Ehlers-Danlos syndrome evaluated had SDB on PSG. In addition to apneas and hypopneas, SDB included flow limitation. With increasing age, flow limitation decreased in favor of apnea and hypopnea events, but clinical complaints were similar independent of the type of PSG finding. In the subgroup of patients who underwent nasal rhinomanometry, increased nasal resistance was increased relative to normative values. Nasal CPAP improved symptoms. Patients with Ehlers-Danlos syndrome presenting to the medical clinic had symptoms and clinical signs of SDB, but they were never referred for evaluation of SDB. In patients with Ehlers-Danlos syndrome, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. These patients are at particular risk for SDB because of genetically related cartilage defects that lead to the development of facial structures known to cause SDB. Ehlers-Danlos syndrome may be a genetic model for OSA because of abnormalities in oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.