Symptoms Of Sleep-disordered Breathing Research Articles

0877 Impact of Sleep-Disordered Breathing on Quality of Life in Pediatric Cystic Fibrosis

Abstract Introduction The frequency of sleep-disordered breathing (SDB) may be high among children with cystic fibrosis (CF), a life-shortening, genetic disease that affects 1/3400 Caucasian live-births. Yet, the potential impact of SDB on their quality of life has not been well-studied. Methods The Pediatric Sleep Questionnaire Sleep-Related Breathing Disorders (PSQ-SRBD) Scale, a well-validated SDB screening tool, and two validated quality-of-life questionnaires, the Pediatric Quality of Life Inventory (PedsQL™) and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were administered to children 6-17 years of age with CF consecutively during a 2-week period during routine pulmonary clinic visits. Results Twenty-two children with CF and their parents completed the questionnaires. Mean age of the participants was 11.6±3.8(sd) years. Mean body mass index (BMI) percentile was 54.8±27.1%. Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was 86.6±22.5%. Five subjects (23%) showed high risk for SDB (PSQ-SRBD Scores > 0.33). Seven additional subjects had PSQ-SRBD Scores of 0.3. Mean BMI percentile was higher among subjects with vs. without positive PSQ-SRBD Scores (66% vs. 42% respectively, p=0.03). The groups did not differ with regards to FEV1. Pearson/Spearman correlation identified negative associations between PSQ-SRBD Scores and functioning in multiple parent PedsQL domains: physical (R=-0.45, p=0.03), social (R=-0.53, p=0.01), school (R=-0.56, p=0.008); two child PedsQL domains: physical (R=-0.41, p=0.06), school (R=-0.41, p=0.06); multiple parent CFQ-R domains: physical (R=-0.44, p=0.08), respiratory (R=-0.45, p=0.07), emotional (R=-0.54, p=0.02), school (R=-0.70, p=0.002); and one child CFQ-R domain: physical (R=-0.51, p=0.01). None of these domains were associated with FEV1. Conclusion Children with CF may have SDB symptoms independent of the extent of lung dysfunction. Although the current cross-sectional data cannot prove a causal effect, they raise the possibility that the SDB itself may have adverse impact on physical, emotional, social, and school functioning. Support NIH Training Grant (F32HL145915)

Feto-placental Dopplers are not altered in women with obstructive sleep apnoea symptoms.

Snoring, gasping or choking during sleep are common symptoms of sleep-disordered breathing and are associated with multiple adverse maternal and obstetric outcomes. The mechanisms responsible remain unknown; however, placental dysfunction is suspected. The aim of this study was to investigate feto-placental and fetal cardiac function in women with pregnancies complicated by obstructive sleep apnoea symptoms. This was a prospective observational cohort study at a large tertiary obstetric hospital in Australia. Women were asked to complete a questionnaire relating to the presence and severity of obstructive sleep apnoea symptoms. They also underwent an ultrasound scan where Doppler indices of various feto-placental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. A total of 255 women were included in the final analysis. Of these, 36.1% (92/255) of women reported no obstructive sleep apnoea symptoms; 63.9% (163/255) reported they experienced some form of obstructive sleep apnoea symptoms that included any frequency of snoring or choking/gasping, while 42.0% (107/255) complained of severe obstructive sleep apnoea symptoms (snoring ≥3 times a week or choking/gasping). There were no significant differences in feto-placental Dopplers or fetal cardiac function parameters in women with obstructive sleep apnoea symptoms. There were also no differences in regional cerebral blood flow between groups, or any correlation with severity of symptoms. Our data challenge the current perspective that adverse perinatal outcomes in women with obstructive sleep apnoea symptoms are related primarily to placental dysfunction and fetal compromise.

Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing.

Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p -values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

Pediatric sleep-disordered breathing in the orthodontic population: Prevalence of positive risk and associations

Pediatric sleep-disordered breathing (SDB) describes a spectrum of disease ranging from snoring to upper airway resistance syndrome and obstructive sleep apnea (OSA). Anatomical features assessed during orthodontic exams are often associated with symptoms of SDB in children. Hence, we need to determine the prevalence of positive risk for SDB in the pediatric orthodontic population compared with a general pediatric population and understand comorbidities associated with SDB risk among orthodontic patients. Responses from Pediatric Sleep Questionnaires were collected from 390 patients between the ages of 5 and 16years, seeking orthodontic treatment. Prevalence of overall SDB risk, habitual snoring, and sleepiness were determined in the orthodontic population and compared with those previously reported by identical methods in the general pediatric population. Additional health history information was used to assess comorbidities associated with SDB risk in 130 of the patients. At 10.8%, the prevalence of positive SDB risk was found to be significantly higher in the general pediatric orthodontic population than in a healthy pediatric population (5%). The prevalence of snoring and sleepiness in the orthodontic population was 13.3% and 17.9%, respectively. Among the comorbidities, nocturnal enuresis (13.6%), overweight (18.2%), and attention deficit hyperactivity disorder (31.8%) had a higher prevalence in orthodontic patients with higher SDB risk (P<0.05). There is a higher pediatric SDB risk prevalence in the orthodontic population compared with a healthy pediatric population. Orthodontic practitioners should make SDB screening a routine part of their clinical practice.

Associations between symptoms of sleep-disordered breathing and maternal sleep patterns with late stillbirth: Findings from an individual participant data meta-analysis.

Sleep-disordered breathing (SDB) affects up to one third of women during late pregnancy and is associated with adverse pregnancy outcomes, including hypertension, diabetes, impaired fetal growth, and preterm birth. However, it is unclear if SDB is associated with late stillbirth (≥28 weeks' gestation). The aim of this study was to investigate the relationship between self-reported symptoms of SDB and late stillbirth. Data were obtained from five case-control studies (cases 851, controls 2257) from New Zealand (2 studies), Australia, the United Kingdom, and an international study. This was a secondary analysis of an individual participant data meta-analysis that investigated maternal going-to-sleep position and late stillbirth, with a one-stage approach stratified by study and site. Inclusion criteria: singleton, non-anomalous pregnancy, ≥28 weeks' gestation. Sleep data ('any' snoring, habitual snoring ≥3 nights per week, the Berlin Questionnaire [BQ], sleep quality, sleep duration, restless sleep, daytime sleepiness, and daytime naps) were collected by self-report for the month before stillbirth. Multivariable analysis adjusted for known major risk factors for stillbirth, including maternal age, body mass index (BMI kg/m2), ethnicity, parity, education, marital status, pre-existing hypertension and diabetes, smoking, recreational drug use, baby birthweight centile, fetal movement, supine going-to-sleep position, getting up to use the toilet, measures of SDB and maternal sleep patterns significant in univariable analysis (habitual snoring, the BQ, sleep duration, restless sleep, and daytime naps). Registration number: PROSPERO, CRD42017047703. In the last month, a positive BQ (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02-2.04), sleep duration >9 hours (aOR 1.82, 95% CI 1.14-2.90), daily daytime naps (aOR 1.52, 95% CI 1.02-2.28) and restless sleep greater than average (aOR 0.62, 95% CI 0.44-0.88) were independently related to the odds of late stillbirth. 'Any' snoring, habitual snoring, sleep quality, daytime sleepiness, and a positive BQ excluding the BMI criterion, were not associated. A positive BQ, long sleep duration >9 hours, and daily daytime naps last month were associated with increased odds of late stillbirth, while sleep that is more restless than average was associated with reduced odds. Pregnant women may be reassured that the commonly reported restless sleep of late pregnancy may be physiological and associated with a reduced risk of late stillbirth.

Partial resection of hypertrophic torus tubarius for recurred snoring: Case series.

Sleep-disordered breathing symptoms may recur in some children after successful adenoidectomy. A potential etiology that warrants consideration is torus tubarius hypertrophy (TTH) as well as residual or recurrent adenoid hypertrophy. Here, we report our experience and the treatment outcomes with microscopic coblator-assisted partial resection of TTH.Seven children who had undergone coblator-assisted partial resection of TTH under microscopy from April 2000 through January 2017 were retrospectively reviewed. The patient age at the time of initial adenotonsillectomy and the interval between the first operation and partial resection of TTH were identified. Lateral cephalometry and scores on the Korean version of the obstructive sleep apnea-18 (KOSA-18) questionnaire were reviewed.The median age at the time of the first operation was 3.0 years and the average time interval between the first operation and subsequent tubal tonsillectomy was 44.0 months. The average width between the torus tubarius was 2.1 mm preoperatively. Symptoms of sleep-disordered breathing were relieved in all patients after operation. Preoperative and postoperative KOSA-18 scores were 73.5 and 35.5, respectively (P = .024). On polysomnography, the preoperative and postoperative apnea-hypopnea index scores were 22.9 and 4.7, respectively (P = .068). The patients were followed up for an average of 1.3 years. One patient developed a recurrence of symptoms and underwent a revision operation. Complications such as bleeding and nasopharyngeal stenosis were not observed.Otorhinolaryngologists should keep TTH in mind as one of the differential diagnoses for recurrent upper airway obstruction symptoms after adenoidectomy. Microscopic coblator-assisted partial resection of TTH is likely to be safe and effective.

Clinically Asymptomatic Sleep-Disordered Breathing in Infants with Single-Ventricle Physiology

To assess clinically asymptomatic infants with single-ventricle physiology (SVP) for sleep-disordered breathing (SDB) in the supine and car seat positions using polysomnography. Polysomnography results also were compared with results of a standard Car Seat Challenge to measure the dependability of the standard Car Seat Challenge. This was an observational study of 15 infants with SVP. Polysomnography data included Obstructive Index, Central Index, Arousal Index, Apnea Hypopnea Index, and sleep efficiency. Polysomnography heart rate and oxygen saturation data were used to compare polysomnography with the standard Car Seat Challenge. Polysomnography demonstrated that all 15 infants had SDB and 14 had obstructive sleep apnea (Obstructive Index ≥1/hour) in both the supine and car seat positions. Infants with SVP had a statistically significant greater median Obstructive Index in the car seat compared with supine position (6.3 vs 4.2; P=.03), and median spontaneous Arousal Index was greater in the supine position compared with the car seat (20.4 vs 15.2; P=.01). Comparison of polysomnography to standard Car Seat Challenge results demonstrated 5 of 15 (33%) of infants with SVP with abnormal Obstructive Index by polysomnography would have passed a standard Car Seat Challenge. Infants with SVP without clinical symptoms of SDB may be at high risk for SDB that appears worse in the car seat position. The standard Car Seat Challenge is not dependable in the identification of infants with SVP and SDB. Further studies are warranted to further delineate its potential impact of SDB on the clinical outcomes of infants with SVP.

Prevalence of Sleep-disordered Breathing and its Association with Obesity among Saudi Schoolchildren

Epidemiological studies of sleep disturbances are essential to promote awareness among families and educational officials and deliver appropriate treatment at a very early timing. The aim of this population-based study was to determine the frequency of sleep-disordered breathing (SDB) symptoms and its association with obesity among schoolchildren in West Saudi Arabia. This cross-sectional study comprised 2,000 schoolchildren aged 6-12 years. Sleep-disordered breathing symptoms were assessed with Arabic version of Pediatric Sleep Questionnaire (PSQ). Overweight/obesity was evaluated using body mass index (BMI) and their association with SDB was tested using a regression analysis model. Overall, 23% of children were at high risk of SDB. Prevalence of habitual snoring was 15.9% and sleep apnea 4%. Boys were at higher risk of SDB than girls (p = 0.026), while age had no effect (p = 0.254). High-risk SDB had a strong association with sleep symptoms compared to low-risk SDB (p < 0.05). Sleep-disordered breathing increased significantly in overweight and obese children (p = 0.017 and p < 0.001, respectively). Around 23% Saudi schoolchildren are at risk of SDB. Related symptoms were strongly associated with high risk of SDB. Overweight and obesity had a strong and progressive association with SDB. The results will help in identifying children at high risk of developing SDB and plan for early intervention to avoid the progression of SDB later in life.

Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy.

Sleep disordered breathing (SDB) is a common, yet under-recognized and undertreated condition in pregnancy. Sleep disordered breathing is associated with pregnancy complications including preeclampsia, gestational diabetes, preterm birth, as well as severe maternal morbidity and mortality. The identification of risk factors for SDB in pregnancy may improve screening, diagnosis, and treatment of SDB prior to the onset of pregnancy complications. The goal of this study was to determine whether fetal sex increases risk of SDB in pregnancy. A cohort of singleton (N = 991) pregnant women were recruited within 24 to 48 hours of delivery and answered questions regarding SDB symptoms by questionnaire. Women who reported frequent loud snoring at least 3 times a week were considered to have SDB. Hospital records were reviewed to extract information on fetal sex and pregnancy complications including preeclampsia, pregnancy-induced hypertension, gestational diabetes, preterm delivery, and low birth weight. Women carrying male fetuses were significantly more likely to have SDB (β = .37, P = .01, OR: 1.45 [95% CI: 1.09–1.94]). Fetal sex was associated with increased risk of hypertensive disorders of pregnancy (defined as preeclampsia and/or pregnancy-induced hypertension) among women with SDB in pregnancy (β = .41, P = .02, OR: 1.51[95%CI:1.08–2.11]).Fetal sex did not increase risk of preterm birth, low birth weight, or gestational diabetes among women with SDB in pregnancy. Women carrying male fetuses were approximately 1.5 times more likely to report SDB in pregnancy compared to women carrying female fetuses, and women with pregnancy-onset SDB carrying male fetuses were 1.5 times more likely to have hypertensive disorders of pregnancy compared to women with SDB carrying female fetuses. Confirmation of fetal sex as a risk factor may, with other risk factors, play a role in identifying women at highest risk of SDB complications in pregnancy.

Can pregnant women accurately report snoring? A pilot study

Sleep-Disordered Breathing (SDB) has been associated with possible negative outcomes, such as preeclampsia and foetal growth restriction. SDB screening tools have been developed for use within general populations. These included the use of self-reports and objective measurements. Seventeen pregnant women within their 34th to 37th week of pregnancy were recruited. Participants undertook an overnight study within their home and SDB symptoms were monitored using the Watch-PAT 200 and an infra-red video camera. The women were administered an online questionnaire comprised of the Multivariable Apnea Risk Index (MAP Index) and the Basic Nordic Sleep Questionnaire (BNSQ). More than half of our participants (n = 10) were identified as snorers while much fewer (n = 4) met the current cut off for diagnosis of mild SDB. Investigation of concordance and predictive value of self-report measures compared to standard video-scoring and Watch-PAT 200 determined SDB indicators suggests that self-reports may not provide an accurate assessment of SBD symptoms in late pregnancy. Self-report in this study, resulted in an underestimation of the number of participants who experienced SDB symptoms. This was a pilot study, with a small sample size. However, our study lends weight to others that found poor predictive value of common scales to detect SDB in pregnancy. Future study is therefore needed to validate screening tools, which may need to be a combination of measures.

Patient-reported outcome measure for obstructive sleep apnea: Symptoms, Tiredness, Alertness, Mood and Psychosocial questionnaire: Preliminary results.

Obstructive sleep apnea (OSA) is a common chronic condition that has a significant impact on the biopsychosocial aspects of the patient's life. There is currently no psychometrically validated patient-reported outcome measure to assess the impact of this condition on the health-related quality of life. We designed a novel instrument based on common patient statements, prioritized by patient preference. Sixty-three patients with OSA and 33 participants with no symptoms of sleep-disordered breathing were asked to complete a 20-item initial questionnaire. The acceptability, reliability and validity of the instrument were assessed using known psychometric techniques. The instrument had strong acceptability and was completed within 180s with no missing data. Five items were removed as they had a high ceiling factor. A further three items were removed as they did not represent the central construct uniquely. The final 12-item instrument had high internal consistency (Cronbach's alpha 0.91), strong test-retest reliability (p=.83) and high discriminant validity when comparing mean total scores of controls (6.88; 95% confidence interval [CI], 4.67-9.08) and those with OSA (31.39; 95% CI, 27.94-34.84) (p<.001). Further studies are planned to help validate this instrument for clinical use.

Obstructive Sleep Apnea in Pregnancy

Obstructive sleep apnea (OSA) is often undiagnosed and undertreated in women, particularly in women who are pregnant, as the physiologic changes of pregnancy overlap with symptoms of OSA and sleep-disordered breathing, including excessive sleepiness, tiredness, headaches, and gastroesophageal reflux. Pregnant women with sleep apnea have a higher chance of developing high blood pressure, preeclampsia, and gestational diabetes, as well as having a higher chance of premature birth. Treatment with continuous positive airway pressure can effectively reduce blood pressure within a single night, generally by reducing circulating stress hormone levels. Women who have had prior pregnancies with complications should be evaluated for OSA, preferably prior to or in early subsequent pregnancies to reduce maternal-fetal complications. [ Psychiatr Ann. 2019;49(12):524–528.]

Is nurse-led telephone follow-up for post-operative obstructive sleep apnoea patients effective? A prospective observational study at a paediatric tertiary centre

ObjectivesTo assess the effectiveness and patient satisfaction of a nurse-led telephone follow-up service in children following surgery for sleep disordered breathing (SDB)/obstructive sleep apnoea (OSA) in a tertiary paediatric hospital. DesignProspective observational uncontrolled study. ParticipantsChildren under the age of 16 undergoing adenoid and/or tonsil surgery between June 2015 and June 2018 for SDB or OSA. Parents were contacted by telephone six weeks post-operatively by an ENT nurse specialist. The T-14 questionnaire was utilised to assess post-operative outcomes. Parents were subsequently asked to evaluate their experience of this nurse-led telephone consultation service between June 2016 and April 2017. Results535 patients were included with an average post-operative T-14 score of 2.13 (95% CI 1.7–2.5). 430 patients were discharged following the nurse-led telephone consultation with a mean post-operative T-14 score 1.0 (95% CI 0.8–1.2). 105 patients were subsequently reviewed in clinic with an average T-14 score of 6.88 (95% CI 5.25–8.51). 36 (6.7%) patients had ongoing symptoms of SDB or OSA. 55 parents were invited to provide an evaluation of the nurse-led telephone FU clinic, which showed a 100% satisfaction rate with the service. ConclusionA nurse-led telephone follow-up service is efficient and safe with high levels of parental satisfaction. It reduces unnecessary follow-up of uncomplicated patients whilst providing a robust safety net for those with ongoing problems.

Parent report of children's sleep disordered breathing symptoms and limited academic progress in reading, writing, and math

ObjectivesTo estimate via questionnaire within a population sample of New Zealand (NZ) children aged 6-to-10 years, the prevalence of sleep disordered breathing (SDB) and those struggling academically, and to identify individual and shared risk factors (health and demographic) for parent-reported SDB symptoms and academic difficulties. MethodsIn this cross-sectional study, parents/caregivers of children were recruited through schools and social media to complete an online questionnaire covering health and demographic factors, their children's SDB symptoms (Pediatric Sleep Questionnaire; PSQ) and parental ratings of academic performance based on teacher feedback relative to expected progress in the national curriculum (well below/below/at/above) in reading, writing, and math. ResultsA total of 1205 children (53% male) aged (mean) eight years two months were included, comprising 79.4% NZ European/other and 15.0% Māori. The survey-weighted prevalence of SDB (based on the PSQ) was 17.5%. This was higher amongst those with academic difficulties rated ‘below/well below’ expected progress for reading, writing and math (estimated at 24.0%, 31.0% and 27.5% respectively), with increased odds (adjusted odds ratios) for poor progress of 1.9 (95% CI: 1.2, 3.0), 1.8 (95% CI: 1.2, 2.7) and 2.4 (95% CI: 1.6, 3.7) respectively. There were no shared risk factors common to both SDB and academic difficulties identified from multivariate analyses. ConclusionsThe findings suggest that children with parent-reported SDB symptoms may be at high risk for poor progress in reading, writing, and math. Future research could examine whether treatment of SDB reduces barriers to learning and offsets educational risk.

Snoring and incident chronic kidney disease: a community-based prospective cohort study

ObjectivesPrevious studies have shown that symptoms of sleep-disordered breathing are associated with metabolic derangements and vascular disease development. However, the relationship between snoring and renal function is not well investigated....

Self-Reported Daytime Sleepiness and Sleep-Disordered Breathing in Patients With Atrial Fibrillation: SNOozE-AF

BackgroundAtrial fibrillation (AF) management guidelines recommend screening for symptoms of sleep-disordered breathing (SDB). We aimed to assess the role of self-reported daytime sleepiness in detection of patients with SDB and AF. MethodsA total of 442 consecutive ambulatory patients with AF who were considered candidates for rhythm control and underwent polysomnography comprised the study population. The utility of daytime sleepiness (quantified by the Epworth Sleepiness Scale [ESS]) to predict any (apnea-hypopnea index [AHI] ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB on polysomnography was tested. ResultsMean age was 60 ± 11 years and 69% patients were men. SDB was present in two-thirds of the population with 33% having moderate-to-severe SDB. Daytime sleepiness was low (median ESS = 8/24) and the ESS poorly predicted SDB, regardless of the degree of SDB tested (area under the curve: 0.48-0.56). Excessive daytime sleepiness (ESS ≥ 11) was present in 11.9% of the SDB population and had a negative predictive value of 43.1% and a positive predictive value of 67.5% to detect moderate-to-severe SDB. Male gender (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.8, P = 0.001), obesity (OR: 3.5, 95% CI: 2.3-5.5, P < 0.001), diabetes (OR: 2.3, 95% CI: 1.2-4.4, P = 0.08), and stroke (OR: 4.6, 95% CI: 1.7-12.3, P = 0.002) were independently associated with an increased likelihood of moderate-to-severe SDB. ConclusionsIn an ambulatory AF population, SDB was common but most patients reported low daytime sleepiness levels. Clinical features, rather than daytime sleepiness, were predictive of patients with moderate-to-severe SDB. Lack of excessive daytime sleepiness should not preclude patients from being investigated for the potential presence of concomitant SDB.

Assessing the need for adenotonsillectomy for sleep-disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study.

To assess whether children with sleep-disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention. Children with snoring and tonsillar hypertrophy (4 to 10-years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3-month follow-up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep-related breathing disorder scale (PSQ-SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ-SRBD <0.33 (low-risk for apnea-hypopnea index ≥5/h) if they had score ≥0.33 at baseline. Sixty-eight children were assigned to the AT and 72 to the control group and two-thirds of them had PSQ-SRBD ≥0.33. The AT group experienced significantly larger improvement between follow-up and baseline than controls (between-group difference [95% CI] for PSQ-SRBD: -0.31 [-0.35 to -0.27]; and mESS: -2.76 [-3.63 to -1.90]; P < .001 for both). Children with baseline PSQ-SRBD ≥0.33 in the AT group had an eight-times higher probability of achieving PSQ-SRBD <0.33 at follow-up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92-17.54]; P < .001). Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ-SRBD score ≥0.33 show measurable clinical benefit postoperatively.

Sleep-disordered breathing and neurobehavioral symptoms in children in a Southeast Nigerian city

Introduction: Sleep-related breathing difficulties can lead to neurobehavioral symptoms in children. They can be assessed through validated screening questionnaires. Objective: This study aims to determine the prevalence of sleep-disordered breathing (SDB) among children, as well as neurobehavioral symptoms and associated risk factors. Materials and Methods: Descriptive cross-sectional study was conducted using the pediatric sleep questionnaire to assess sleep habits such as snoring and sleep apnea; neurobehavioral symptoms such as easy distractibility and disruptive behavior. The sample size of the study was 400 participants consecutively enrolled from consenting households in the enumeration areas in Enugu, Southeast Nigeria. Percentage prevalence of neurobehavioral symptoms was calculated, and SDB scores assigned with the determining cutoff score of &gt;0.33. Analyses for an association of SDB score with socio-economic class (SEC), age, and gender, were performed using relevant statistics. Results: Of the 338 children aged between 2 and 18 years, 47% (158) were males. Children between 2 and 5 years represented 30% (101), while 59% (110) and 11% (46) were children 5–10 years and &gt;10 years, respectively. The mean age of all participants was 6.4±3.1 years, 10% (34) belonged to SEC one while 49% (164) and 41% (139) belonged to middle and lower classes, respectively. At least one of SDB symptoms was present in 73% (248) of participants, but the SDB criteria score was met by 45 participants giving a prevalence of 13.3%. The most prevalent neurobehavioral symptoms were bed wetting in 56.8% (192), easy distractibility in 50.9% (167), and excessive day time sleepiness in 41.3% (139) cases. SDB was more likely in children with up to seven neurobehavioral symptoms, with an odds ratio of 8.27 (CI 3.48–19.66). Conclusions: SDB prevalence rate was found to be high in the present estimated pediatric population. The presence of seven or more neurobehavioral symptoms was associated with SDB and was predominant in children aged between 5 and 10 years.

An Epworth Sleep Score ≥11 is associated with emergency operative birth and poor neonatal composite outcome at term.

During pregnancy, the Epworth Sleepiness Scale can be used as a surrogate marker for maternal sleep-disordered breathing, a condition that is becoming increasingly prevalent in obstetric populations and is associated with a multitude of pregnancy complications. The aim of this observational study was to investigate the relationship between the Epworth Sleepiness Scale score and indication and mode of delivery during pregnancy. The Epworth Sleepiness Scale was completed by 178 women at Mater Mothers' Hospital, Brisbane, Australia. Women with a score ≥11 were less likely to achieve a spontaneous vaginal delivery (aOR 0.43, 95% CI 0.21-0.88, P=0.02), and were more likely to have an instrumental (aOR 2.81, 95% CI 1.30-6.08, P=0.01) or any operative birth (instrumental and caesarean section aOR 2.32, 95% CI 1.14-4.71, P=0.02). These women were also more likely to have an operative birth for intrapartum fetal compromise (aOR 2.62, 95% CI 1.21-5.69, P=0.015), as well as an infant with poor neonatal outcomes (aOR 2.77, 95% CI 1.09-7.03, P=0.03). These results show that symptoms of sleep-disordered breathing are associated with emergency operative birth, particularly when the indication for operative birth was intrapartum fetal compromise.

Respiratory Care of Patients With Neuromuscular Disease.

Neuromuscular diseases are a heterogeneous group of neurologic diseases that affect a number of neural structures including the motor nerves, neuromuscular junctions, or the muscles themselves. Although many of the diseases are rare, the total number of individuals who present to a pulmonologist or respiratory care provider is significant. Approaches to care include regular and careful clinical follow-up of symptoms of sleep-disordered breathing, daytime hypoventilation, as well as cough and swallowing effectiveness. Noninvasive support with nocturnal mask ventilation and a pressure support device can be extraordinarily helpful and delay daytime ventilatory failure. When daytime ventilatory failure develops, other noninvasive methods are available for portable assistance. Support of cough function with manual assistance, a resuscitator bag, and/or mechanical insufflation-exsufflation can help prevent and treat infection. Referral for swallowing evaluation and treatment is very important for those with impaired bulbar function. This comprehensive respiratory care approach to individuals with neuromuscular disease and respiratory system involvement is essential to maintaining the health and longevity of these individuals.