Sleep-disordered Breathing Research Articles

Overnight Monitoring Criteria for Children with Obstructive Sleep-Disordered Breathing After Tonsillectomy: Revisited.

Previous studies indicate children who pass an Asleep Room Air Challenge (AsRAC) do not have significant postoperative adverse respiratory events after adenotonsillectomy (T&A). Subsequently, we revised our overnight monitoring (OM) criteria, allowing patients with an obstructive apnea/hypopnea index (OAHI) ≤20 or nonsevere obesity (Class I) to be considered for same-day surgery (SDS) if they passed an AsRAC. Our hypothesis is that our modified OM criteria would not increase the return visits or readmission rates for patients undergoing SDS within 48 h or 15 days of T&A. A retrospective review of all children aged ≥3 and <21 years who underwent T&A at a tertiary children's hospital and its satellite locations was performed from January 2017 to September 2022. Descriptive statistics and outcome measures were compared using a 3% margin noninferiority test before and after the new criteria implementation. Before intervention, 3,266 (58%) T&As were performed as SDS. Afterward, 74% of T&As were performed as SDS (p-value <0.05). There was no difference in the ED revisit rate for SDS within the 3% noninferiority margin. Following intervention, 29% more children with Class I obesity (62% vs. 33%) underwent SDS (p-value <0.001). Afterward, 19% more children with polysomnography underwent SDS (39% vs. 20%), p-value <0.001. After intervention, within 48 h of SDS, six (0.9%) children had revisits for bleeding and seven (1.2%) for vomiting. There were no perioperative respiratory events. Our revised monitoring criteria did not demonstrate an increase in ED visit or readmissions rates within 48 h or 15 days of T&A. Additionally, we found a 29% increase in Class I obese children undergoing SDS T&A. 3 Laryngoscope, 134:5223-5230, 2024.

Genetic QT score as a predictor of sudden cardiac death in participants with sleep-disordered breathing in the UK Biobank.

The goal of this study was to evaluate the association between a polygenic risk score (PRS) for QT prolongation (QTc-PRS), QTc intervals and sudden cardiac death (SCD) in participants enrolled in the UK Biobank with and without sleep-disordered breathing (SDB). The QTc-PRS was calculated using allele copy number and previously reported effect estimates for each single nuclear polymorphism SNP. Competing-risk regression models adjusting for age, sex, BMI, QT prolonging medication, race, and comorbid cardiovascular conditions were used for SCD analyses. 500,584 participants were evaluated (56.5 ±8 years, 54% women, 1.4% diagnosed with sleep apnea). A higher QTc-PRS was independently associated with the increased QTc interval duration (p<0.0001). The mean QTc for the top QTc-PRS quintile was 15 msec longer than the bottom quintile (p<0.001). SDB was found to be an effect modifier in the relationship between QTc-PRS and SCD. The adjusted HR per 5-unit change in QTc-PRS for SCD was 1.64 (95% CI 1.16 - 2.31, p=0.005) among those with SDB and 1.04 (95% CI 0.95 - 1.14, p=0.44) among those without SDB (p for interaction =0.01). Black participants with SDB had significantly elevated adjusted risk of SCD (HR=9.6, 95% CI 1.24 - 74, p=0.03). In the UK Biobank population, the QTc-PRS was associated with SCD among participants with SDB but not among those without SDB, indicating that SDB is a significant modifier of the genetic risk. Black participants with SDB had a particularly high risk of SCD.

Performance of questionnaires to predict sleep-disordered breathing in acute stroke patients.

Sleep-disordered breathing is common in stroke and may negatively affect its outcome. Screening for sleep-disordered breathing in this setting is of interest but poorly studied. We aimed to evaluate the performance of eight obstructive sleep apnea screening questionnaires to predict sleep-disordered breathing in acute stroke or transient ischaemic attack patients, and to assess the impact of stroke/transient ischaemic attack-specific factors on sleep-disordered breathing prediction. We analysed acute stroke/transient ischaemic attack patients (N = 195) from a prospective cohort ("Sleep Deficiency and Stroke Outcome study"). Assessments included anthropometrics, stroke-specific parameters, sleep history, an in-hospital respiratory polygraphy within the first week after stroke, and obstructive sleep apnea screening questionnaires (Berlin Questionnaire, Epworth Sleepiness Scale, STOP-BANG, NoSAS, Sleep Apnea Clinical Score, No-Apnea, Sleep Obstructive apnea score optimized for Stroke, SLEEP-IN). In a binary classification task for respiratory event index ≥ 15 per hr, we evaluated the performance of the above-mentioned questionnaires. We used logistic regression to identify predictors for sleep-disordered breathing in this cohort. The areas under the curve for respiratory event index ≥ 15 per hr were: Berlin Questionnaire 0.60; STOP-BANG 0.72; NoSAS 0.69; No-Apnea 0.69; Sleep Apnea Clinical Score 0.75; Epworth Sleepiness Scale 0.50; Sleep Obstructive apnea score optimized for Stroke 0.58; and SLEEP-IN 0.67. The No-Apnea had the lowest false omission rate (0.13), a sensitivity of 0.97 and a specificity of 0.12. In multiple logistic regression analysis (respiratory event index ≥ 15 per hr), age, neck circumference, National Institutes of Health Stroke Scale at admission, prior stroke, cardioembolic stroke aetiology and observed apneas were associated with sleep-disordered breathing. The logistic regression model performed similar (area under the curve 0.80) to Sleep Apnea Clinical Score (p = 0.402) and STOP-BANG (p = 0.127), but outperformed the other questionnaires. Neither existing questionnaires nor our statistical model are sufficient to accurately diagnose sleep-disordered breathing after stroke, thus requiring sleep study evaluation. The No-Apnea questionnaire may help to identify patients amenable to sleep testing.

The Importance of Genetic Background and Neurotransmission in the Pathogenesis of the Co-Occurrence of Sleep Bruxism and Sleep-Disordered Breathing—Review of a New Perspective

Sleep bruxism (SB) and sleep-disordered breathing (SDB) are two prevalent conditions that significantly impact overall health. Studies suggest that up to 49.7% of individuals with SDB also exhibit symptoms of SB. This review aims to provide a comprehensive analysis of the role of genetic background and neurotransmission in the pathogenesis of the co-occurrence of SB and SDB. It seeks to synthesize current knowledge, highlight gaps in the existing literature, and propose a new perspective that integrates genetic and neurobiological factors. This review shows that both SB and SDB may be influenced by a combination of genetic, neurochemical, and environmental factors that contribute to their shared pathophysiology. The key neurotransmitters—dopamine, serotonin, and GABA—may play a significant role in their co-occurrence by regulating motor activity, sleep architecture, and respiratory control. Understanding genetic and neurochemical mechanisms may allow for more precise diagnostic tools and more personalized treatment approaches regarding SB and SDB. Clinically, there is a need for interdisciplinary collaboration between sleep specialists, dentists, neurologists, and geneticists. There is also a need to conduct large-scale genetic studies, coupled with neuroimaging and neurophysiological research, uncovering additional insights into the shared mechanisms of SB and SDB.

The Effects of High Altitude on Children's Sleep: A Community-Based Study on Preschoolers in the Tibetan Plateau.

Su, Ping, Masako Taniike, Yuko Ohno, and Ikuko Mohri. The effects of high altitude on children's sleep: A community-based study on preschoolers in the Tibetan Plateau. High Alt Med Biol. 00:00-00, 2024. Objective/Background: It has been reported that high altitude affects breathing during sleep in children. To evaluate the symptoms suspected sleep-disordered breathing (SDB) and sleep quality of preschool children living in high altitude of 2,261-3,800 m above sea level (masl) in the Tibetan Plateau, we conducted the community-based survey using a questionnaire. Patients/Methods: Sleep problems were assessed in 3,113 children aged 3-6 years in Qinghai province using the Chinese version of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P-C), focusing on obstructive sleep apnea (OSA) and OSA-related symptoms. The effect of altitude on these scores was analyzed. Results: The subscale scores of OSA, morning symptoms, and daytime excessive sleepiness in the JSQ-P-C were higher in children living in areas above 3,000 masl than in those living below 3,000 masl and in Japanese children. Altitude, but not family income or maternal education level, significantly affected the scores of OSA, morning symptoms, and daytime excessive sleepiness. Conclusions: Living at altitudes higher than 3,000 masl may adversely affect children's sleep quality.

Sleep breathing disorders in adolescents with asthma.

Background. Childhood asthma, a chronic inflammatory disease, is linked to sleep-breathing disorders (SBD). The vulnerability of asthmatic children to SBDs is well-established, yet limited research focuses on adolescents. This study addresses the research gap, exploring the frequency and risk factors of SBD in adolescents with asthma. Methods. A cross-sectional study was conducted among 98 adolescents (12-17 years) with asthma at a Lisbon healthcare facility. Comprehensive assessments, including sociodemographic data, medical history, lung function variables, and validated questionnaires for SBD risk (Pediatric Sleep Questionnaire), rhinitis control, and asthma control (Control of Allergic Rhinitis and Asthma Test and Asthma Control Test), were employed. Results. The study revealed a substantial frequency of SBD symptoms, with 25.5% of adolescents classified as high-risk based on the Pediatric Sleep Questionnaire. Significant associations were identified between high SBD risk and elevated body mass index (BMI), uncontrolled rhinitis, and uncontrolled asthma. Logistic regression analysis confirmed elevated BMI as a robust predictor of SBD risk, indicating a 5.9-fold increase compared to normal-weight counterparts. Conclusions. This study contributes valuable insights into the interplay between asthma and SBD in adolescents. The high prevalence of SBD symptoms, particularly among those with excess weight and uncontrolled respiratory symptoms, underscores the need for targeted preventive strategies. The identified risk factors, notably elevated BMI, provide clinicians with actionable information for intervention, emphasizing the importance of addressing modifiable factors associated with asthma and SBD in this specific population.

Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing.

Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, while the criteria recommended by the American Academy of Sleep Medicine requires either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these two definitions for men and women in a clinical setting. We reviewed polysomnography (PSG) reports for all patients who completed a diagnostic PSG study at one sleep disorders center in 2019. Every PSG was scored using both sets of criteria to determine AHI-4 and AHI-3A. Data from 279 women (64.7%), and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9±27.3, and the mean AHI-3A was 34.7±32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (p=0.001) for women and 21.7% (p=0.006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, while men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition. The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

Oxygen therapy in the obesity hypoventilation syndrome

Obesity hypoventilation syndrome (OHS) is a condition characterized by prevalence of obesity, sleep-disordered breathing, and a daytime hypoventilation caused by hypercapnia (PaCO2≥45 mmHg) with hypoxia (PaO2&lt;70 mm Hg). During global epidemic of obesity and the struggle with many related complications, the aim of this study is to focus on hypoventilation and respiratory alterations, caused by obesity hypoventilation syndrome. The comprehensive literature review was performed using the electronic databases: PubMed, ScienceDirect and Google Scholar. The search was limited to at least 2014. Keywords such as: “obesity hypoventilation syndrome”, “obesity”, “respiratory system”, “oxygen therapy” and various combinations of the above were used. Considering many possible causes of alveolar hypoventilation and obesity related complications, the diagnosis of the OHS in the majority of patients is delayed. Patients burdened with sleep-related breathing disorders, including OHS, are most prone to develop life-threatening pulmonary hypertension or cardiovascular issues. The most proper treatment option for patients with OHS is positive airway pressure. Clinically documented mortality and morbidity in the co-occurrence of OHS and severe obesity were elevated. Hence, in addition to the recommended oxygen therapy in the OHS treatment, patients should be educated and supported by health professionals in their weight loss efforts. Keywords: obesity hypoventilation syndrome, obesity, respiratory system, oxygen therapy.

French consensus on the care pathway for children with suspected or diagnosed type 1 obstructive sleep disorder

Obstructive sleep-disordered breathing (OSDB) is the consequence of an anatomical and/or functional reduction in upper airway size during sleep. Young patients can also be affected. TROS type1 (TROS1 ) is most often found in young, non-obese children with no associated comorbidities, presenting with an otorhinolaryngological (ENT) obstacle, generally an enlargement of lymphoid tissue (tonsils and/or adenoids). The aim of this article was to outline the consensus. A collaborative work, realized on the request of the French Society of Sleep Research and Medicine, to provide recommendations for the management of obstructive sleep apnea syndrome type1 (OSA1 ) in children was published in 2023. This work brought together various experts in pediatric sleep disorders breathings (SDB). A sleep study for OSA1 is not mandatory when at least two nighttime symptoms are noted. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. The ENT specialist is the mainstay of initial care, but works as part of a multidisciplinary team that includes pediatricians, general practitioners, orthodontists and linguo-oro-maxillo-facial rehabilitation specialists. Whatever the treatment, follow-up must be continuous and multidisciplinary; it is essential to ensure the effectiveness of the treatments implemented, the absence of SDB recurrence and the recovery of nasal breathing.

Craniofacial anatomical determinants of pediatric sleep-disordered breathing: A comprehensive review.

This narrative review aims to elucidate the anatomical features of sleep-disordered breathing (SDB) in children. By identifying key structures and intervening proactively, we seek to alter craniofacial growth patterns and improve functional outcomes for SDB children. The literature on pediatric sleep-disordered breathing (PSDB), pediatric obstructive sleep apnea (OSA), anatomical predispositions, and the relationship between skeletal deformity and PSDB was examined using PubMed and Google Scholar databases, covering studies from 2006 to 2024. Forty relevant articles were reviewed, focusing on craniofacial characteristics associated with PSDB. The etiology of PSDB is multifactorial, with adenoid and palatal tonsil enlargement being the most common cause. While adenotonsillectomy is recommended as the primary treatment, residual SDB may result in craniofacial skeletal deformities contributing to upper airway constriction. Typical craniofacial phenotypes of SDB include excessive vertical growth and constriction of the maxilla, a retruded mandible, and posterior rotation, known as a Class II hyperdivergent pattern. Conversely, Class III with an underdeveloped maxilla shows a relatively lower risk for SDB due to reduced nasal cavity and nasopharyngeal airway volumes. Transverse maxillary constriction with a high, deep palatal vault is a significant risk factor. Additionally, nasal obstruction and low tongue posture, with or without a short lingual frenulum, are identified as craniofacial risk factors for SDB development in children. Early diagnosis and intervention are critical in managing PSDB. Dentists, through screening and early treatment, can significantly influence craniofacial growth and health outcomes. A multidisciplinary approach is essential for effective management, improving the quality of life and long-term health of affected children.

Clinical impact of customised positive airway pressure (PAP) therapy interfaces versus usual care in the treatment of patients with sleep-disordered breathing (3DPiPPIn): a randomised controlled trial protocol

IntroductionSleep-disordered breathing affects 1.6 million people in the UK. The recognised treatment is positive airway pressure (PAP) therapy, delivered via a generic conventional interface (mask). PAP therapy improves morbidity, mortality...

A strategic approach of the management of sleep-disordered breathing in multiple system atrophy.

Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by autonomic dysfunction associated with a combination of cerebellar, parkinsonian, or pyramidal signs. Sleep-disordered breathing (SDB) such as stridor, obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in MSA and can impact survival. Several studies have evaluated treatment modalities. However, the optimal strategy often remains unclear in these patients. This review aims to provide an overview of the current evidence on treatment of SDB in MSA. Systematic review of the current literature through combined keyword search in PubMed, Embase, the Cochrane Library and cited references: multiple system atrophy, stridor, sleep apnea syndrome, sleep-disordered breathing, Shy Drager syndrome. Twenty-nine papers were included, with a total of 681 MSA patients with SDB. Treatment modalities are: continuous positive airway pressure (CPAP); tracheostomy; tracheostomy invasive ventilation (TIV); non-invasive positive pressure ventilation (NPPV); adaptive servoventilation (ASV); vocal cord surgery; botulinum toxin injections; oral appliance therapy; cervical spinal cord stimulation; selective serotonin reuptake inhibitors (SSRIs). Conflicting results on survival are found for CPAP therapy. Tracheostomy has a proven survival benefit. Most beneficial outcomes are seen with TIV. CPAP, other types of PAP and tracheostomy can adequately control symptoms of OSA. However, CPAP may exacerbate central sleep apnea. There was a lack of sufficient data regarding ASV or NPPV. Some patients exhibit a floppy epiglottis and require a different approach. In conclusion, due to the complex characteristics of SDB in MSA, an individualized and multidisciplinary approach is mandatory.

Predictors of progression of arterial hypertension in patients with type 2 diabetes

Abstract Background Arterial hypertension (aHT) is a common comorbidity in patients with type 2 diabetes (T2D). The aim of the present analysis was to determine which predictors are associated with the progression of aHT in participants with T2D. Methods We analyzed data from the sleep-disordered breathing (SDB) sub-study of the DIACORE study, a prospective cohort study of participants with T2D. Blood pressure values were determined at baseline and after a mean follow-up of 2.7 years in a standardized manner with three repeated measurements at rest. Arterial hypertension was defined as blood pressure ≥140/80 mm Hg. Progression of aHT was defined as systolic blood pressure ≥140 mm Hg at follow-up with a concomitant increase of at least 10 mm Hg. Results Of 1122 participants (41% female, age 66 ± 9 years, body mass index 30.7 ± 5.3 kg/m2), 925 had pre-existing aHT at baseline. At follow-up, 280 had aHT with additional progression. Multivariate regression analysis revealed that systolic blood pressure at baseline (odds ratio [95% confidence interval]: 0.984 [0.976;0.993]; p &lt; 0.001) and age (OR [95%CI]: 1.024 [1.002;1.047]; p = 0.015) were associated with progression of aHT, independently of known modulators. Neither SDB nor its treatment were associated with progression of aHT. Conclusion In participants with T2D, lower systolic blood pressure at baseline and age but not SDB were associated with progression of aHT.

Cognitive and Behavioral Outcomes of Snoring Among Adolescents

Snoring is central to sleep-disordered breathing (SDB), which arises from nocturnal upper airway resistance. Habitual snoring is associated with cognitive and behavioral problems in young children, but less is known about these associations in adolescents. To assess the longitudinal associations of snoring with cognition and problem behaviors among adolescents. This cohort study was a secondary analysis of the Adolescent Brain Cognitive Development (ABCD) Study dataset (release 5.0), which enrolled 11 875 children and a parent or caregiver from June 1, 2016, to October 15, 2018, at 21 participating US research institutions and followed-up for 5 years. The analysis was performed between December 2023 and April 2024. Parent-reported snoring categorized as none, nonhabitual (<3 nights/week), and habitual (≥3 times/week). Cognition was assessed using 5 measures from the National Institutes of Health Toolbox (NIH-TB), and caregiver-reported problem behaviors were assessed using the Child Behavior Checklist (CBCL), including Total Problems, Internalizing Problems, and Externalizing Problems. Longitudinal associations of snoring with these assessment measures were analyzed using linear mixed-effects models stratified by obesity. Model fits were assessed after including the fixed-effects of age, sex at birth, race, family income, follow-up time, visit type, and the random-effects of site and identification number. The study included data from 11 862 children at year 1 (mean age, 119.0 months [95% CI, 118.8 to 119.1 months]; 6164 male [52.2%]) and 11 198, 10 870, 10 064, and 4668 children at years 2 to 5, respectively. The proportion of habitual snorers decreased from 811 participants (6.8%) in year 1 to 150 participants (3.2%) in year 5. Snoring was not associated with any of the NIH-TB scores. A statistically significant association of snoring was identified with all CBCL scales. The largest-magnitude association was of snoring with the CBCL Total Problems scale among adolescents with obesity (β = 3.18; 95% CI, 2.59-3.77). In this cohort study analyzing associations of snoring with cognitive test scores and problem behaviors based on the ABCD dataset, the prevalence of snoring declined over time; snoring in adolescents was associated with problem behaviors but not cognitive deficits. These findings may aid shared decision-making regarding treatment options such as adenotonsillectomy for adolescents with SDB.

Tertiary pediatric sleep services in Canada: A national survey

BACKGROUND Sleep disordered breathing (SDB) prevalence ranges from 10% to 14% with obstructive sleep apnea prevalence of 1-4% in the general pediatric population. Its diagnosis and management require complex testing with polysomnography and a specialized care team, often at pediatric tertiary care centers. OBJECTIVE The objectives of this study are to describe the composition of pediatric tertiary care sleep clinics across Canada and describe wait times for clinic and diagnostic services across Canada. METHODS A 6-section questionnaire was sent to 16 sleep laboratory directors from tertiary pediatric sleep centers within Canada. Questions related to sleep clinic/laboratory capacity, referral volumes, wait times and the pandemic impact. RESULTS Responses were obtained from 15 of 16 sleep laboratory directors from tertiary pediatric sleep centers within Canada. Some provinces and territories have no sleep physicians. The total number of physicians providing coverage in the sleep clinics ranged from 2 to 15 across the country. Reported volume of patients waiting for their initial assessment was greater than 300 among 5 of the 13 centers (38%) that provided a response. The potential annual number of children in each province/territory per sleep study ranged greatly from 530 to 1,530. Potential annual number of polysomnograms performed ranged from 210 to 2,700 across provinces, allowing approximately 8,110 polysomnograms per year. CONCLUSION Our recent survey demonstrates that despite the continued need for more pediatric sleep resources in Canada there remains a shortage. We estimate that even if only children with SDB were tested with a polysomnogram there are 9.39 times more children with SDB than testing capacity without accounting for incident cases.

Sleep-Disordered Breathing and Cardiac Arrhythmias.

A narrative review was performed, analyzing peer-reviewed articles from databases such as PubMed, EMBASE, Scopus, and Web of Science to examine the mechanistic links between sleep-disordered breathing (SDB), and cardiac arrhythmias, emphasizing intermittent hypoxia, autonomic imbalance, and intrathoracic pressure swings as key pathways. Studies, including the DREAM and CESAAR trials, consistently demonstrate that SDB patients face elevated risks: more than doubling the likelihood of overall arrhythmias (OR 2.24; 95% CI 1.48-3.39), quadrupling the risk of AF (OR 4.02; 95% CI 1.03-15.74), and tripling the risk of non-sustained ventricular tachycardia (NSVT) with higher apnea-hypopnea index (AHI) values. Additionally, SDB doubles the risk of bradyarrhythmia, such as sinus pause, second and third-degree atrioventricular block, and intraventricular conduction delay (OR 2.50; 95% CI 1.58-3.95). According to meta-analytical findings, continuous positive airway pressure (CPAP) therapy is a pivotal intervention, significantly reducing AF recurrence by 42% and lowering VA incidence by 58%. Moreover, CPAP therapy diminishes sinus bradycardia and occurrences of sinus pause and may reduce the necessity for pacemaker implantation. Recognizing SDB as a modifiable risk factor for cardiac arrhythmias highlights the importance of early diagnosis and effective management, primarily through CPAP therapy, to improve cardiovascular outcomes.

Association between hypoxemia and quality of life in patients with heart failure with preserved ejection fraction and sleep-disordered breathing

Association between hypoxemia and quality of life in patients with heart failure with preserved ejection fraction and sleep-disordered breathing

Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry. This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI. Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001). Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

Sleep and Respiratory Parameters After Lung Transplantation in Adult Patients With Cystic Fibrosis.

We aimed to explore the prevalence and predictive factors of sleep-disordered breathing (SDB) in patients with cystic fibrosis (pwCF) after lung transplantation (LTX). We prospectively recruited adult pwCF who underwent LTX in our hospital from 2013 to 2022 and invited them for an attended overnight polysomnography (PSG) 1year after transplantation. The apnea-hypopnea index (AHI) was the primary outcome, and SDB was defined as an AHI≥5. Demographic, anthropometric, cardiometabolic, drug treatment, and pulmonary function variables were compared between pwCF with and without SDB. Multiple regression analysis was used to identify significant predictors of SDB. For a subset of participants who had available PSG before transplantation, sleep parameters were compared pre-post transplantation. Sixty-two pwCF (31 females) were enrolled. Thirty participants had SDB, but only 11 of them had moderate-to-severe SDB (AHI≥15). The average Epworth Sleepiness Scale (ESS) score indicated the absence of excessive daytime sleepiness. Older age (p<0.001), male sex (p<0.001), and smaller thoracic gas volume (p=0.002) significantly predicted higher AHI. Comparison between pre- and post-transplantation polysomnographic data showed a significant increase in the percentage of slow wave sleep (p=0.047), as well as a significant improvement in mean nocturnal oxygen saturation (p=0.007). A statistically significant increase in the AHI was also observed (p=0.047), but its clinical importance is uncertain (p=0.476 for the increase in the ESS score). We may conclude that SDB is prevalent in pwCF after LTX, but its severity is mild. Older male pwCF with greater improvement in lung hyperinflation after transplantation might be at risk for SDB and should be followed for symptoms or signs of sleep apnea.

Treatment of sleep-disordered breathing among children with myelomeningocele.

Studies have shown a high prevalence of sleep-disordered breathing (SDB) among children with myelomeningocele (MMC), but there are few published data on the longitudinal care of these patients. The objective of this study was to determine the effectiveness of standard treatments for SDB in children with MMC. The authors analyzed records from three multidisciplinary spina bifida clinics to identify all patients with both MMC and SDB diagnosed by polysomnography (PSG). The primary outcome of this study was a change in apnea-hypopnea index (AHI; the number of apneic or hypopneic events per hour of sleep) before and after clinically recommended SDB treatments. Clinical and demographic variables were recorded and evaluated for possible association with posttreatment improvement of AHI. Analysis included change in AHI (a continuous variable) and whether SDB improved (defined as an AHI < 2.5 or decrease of AHI by ≥ 50% from baseline). Seventy-one eligible patients (aged 2 days-21 years, 52% male) had an initial AHI > 2.5 and had follow-up PSG after treatment for SDB. The mean AHI decreased from 20.5 (SD 21.6) at baseline to 11.6 (SD 15.7) after treatment (p = 0.0006). Children treated with supplemental oxygen and with continuous positive airway pressure had improvement on PSG (18 of 25 and 12 of 18, respectively). Children treated with adenotonsillectomy were less likely to improve (7 of 19). Forty-one patients (58%) improved from a baseline AHI > 2.5 to an AHI < 2.5 after treatment. Children with MMC and SDB who undergo standard SDB treatments guided by pediatric sleep medicine physicians show improvement in PSG parameters after treatment.