0914 Sleep Disordered Breathing In Pediatric Patients Before And After Intrathecal Baclofen Therapy

Abstract Introduction Refractory spasticity in children is treated with intrathecal baclofen (ITB), which may worsen both central and obstructive breathing events. Sleep disordered breathing (SDB) is seldom investigated prior and/or subsequent to placement of ITB and there are currently no standardized protocols. This study aims to compare occurrence of SDB pre/post ITB placement. Methods Retrospective chart review revealed 104 patients started on ITB therapy from 2009-2019 and those who had pre and/or post ITB polysomnograms (PSG) were included. Medical history and PSG parameters were extracted. Comparison of paired results will occur using the Wilcoxon Signed Rank Sum Tests once collection is complete. Results Thirty-seven patients were identified having pre and/or post ITB PSGs. Results in mean ± SD show: age was 11 ± 4 years and 65% were male. Twenty-five pre ITB PSG had an oAHI of 4 ± 5 with 22/25 (88%) having SDB. There were 15/25 (60%) with mild OSA (oAHI >1 but < 5) and 7/25 (28%) with moderate-severe OSA (oAHI > 5/hr). CAI was 1 ± 2 and oxygen saturation nadir was 88 ± 9 %. Sixteen post ITB PSG had an oAHI of 8 ± 13 with 100% having SDB. There were 11/16 (69%) with mild OSA and 5/16 (31%) with moderate-severe OSA. CAI was 3 ± 7 and oxygen saturation nadir was 84 ± 8 %. Ten patients were initiated on non-invasive ventilation, one on supplemental oxygen and two had adenotonsillectomy. Conclusion Initial data shows high occurrence of SDB in patients pre and post ITB placement leading to medical or surgical intervention in 35%. Post ITB PSGs showed worsened oAHI and CAI and lower oxygen saturation nadir. Possible mechanisms include depression of central respiratory drive and decreased pulmonary reserves. This study may help stratify and address risks of ITB for those with refractory spasticity and SDB. Support None

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Comparison of the State of Sleep in Patients with Sleep-disordered Breathing Before and After Surgical Treatment

Acta Oto-Laryngologica ◽

10.1080/0365523031000054 ◽

2003 ◽

Vol 123 (0) ◽

pp. 51-55

Author(s):

Munenori Hayakawa ◽

Tadao Nishimura ◽

Kenji Suzuki ◽

Natsuki Morishima ◽

Nobuhiro Shibata ◽

...

Keyword(s):

Surgical Treatment ◽

Sleep Disordered Breathing ◽

The State ◽

Before And After ◽

Disordered Breathing

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0897 Sleep Disordered Breathing In Pediatric Patients With Turner Syndrome

SLEEP ◽

10.1093/sleep/zsaa056.893 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A341-A342

Author(s):

Y A Yu ◽

B V Vaughn

Keyword(s):

Sleep Apnea ◽

Turner Syndrome ◽

Sleep Disordered Breathing ◽

Pediatric Patients ◽

Genetic Disorder ◽

Case Series ◽

Growth Failure ◽

Retrospective Chart Review ◽

Upper Airway Resistance Syndrome ◽

Disordered Breathing

Abstract Introduction Turner syndrome (TS) is a common genetic disorder that affects phenotypic females with partial or complete absence of one X chromosome. It typically presents with characteristic facial appearance, neck webbing, lymphedema, linear growth failure, and ovarian insufficiency. TS is also associated with other disorders, though sleep related disorders are not commonly reported. We present a case series of pediatric patients diagnosed with TS and assess their risk for sleep disordered breathing. Methods This study utilized retrospective chart review of the electronic medical record at the University of North Carolina at Chapel Hill from April 2014 to January 2019. Only pediatric patients under the age of 18 years who had previously undergone polysomnography and carrying the diagnosis of Turner syndrome were included in this study. Polysomnography results were reviewed. Results Retrospective chart analysis yielded ten (10) patients who qualified for inclusion. The mean age was 8.3 years (age range 1-15 years). Nine (9) patients were found to have sleep disordered breathing ranging from upper airway resistance syndrome to moderate sleep apnea (AHI range 1.2 to 6.2). Six (6) patients were found to have elevated periodic limb movement indices (PLM index range 5.1 to 30). Parasomnias and hypoventilation were not seen. Conclusion Our case series illustrates that sleep disordered breathing may be more common in TS than previously realized. Eklund et al. found that females with TS had more retrognathic mandibles and maxillas, shorter mandibles, and larger cranial base angles. These findings may indicate elevated risk of sleep apnea. Further studies are needed to define the overall risk of sleep disordered breathing in TS. Support None.

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417 Transgender Hormone Therapy and Sleep-Disordered Breathing

SLEEP ◽

10.1093/sleep/zsab072.416 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A165-A165

Author(s):

Ronald Gavidia ◽

Galit Levi Dunietz ◽

Lisa Matlen ◽

Shelley Hershner ◽

Daphna Stroumsa ◽

...

Keyword(s):

Linear Regression ◽

Regression Models ◽

Sleep Disordered Breathing ◽

Hormone Replacement ◽

Apnea Hypopnea Index ◽

Linear Regression Models ◽

Sleep Complaints ◽

Human Respiration ◽

Lower Oxygen ◽

Disordered Breathing

Abstract Introduction Sex hormones may affect human respiration during wakefulness and sleep. Testosterone has been associated with increased obstructive respiratory events contributing to sleep-disordered breathing (SDB) in men, whereas a protective effect against SDB has been attributed to estrogen in women. These associations, primarily observed in cisgender populations, have been rarely examined in transgender individuals on hormone replacement therapy (HRT). The present study investigated associations between HRT and SDB in transgender adults. Methods A chart review of medical records from transgender patients was conducted in a large academic sleep medicine center. Individuals were included if they were at least 18 years old, had one or more sleep complaints, and SDB testing results available. Participants were then stratified by affirmed gender (transmasculine and transfeminine) and by HRT status. We used descriptive statistics procedures to examine differences between gender and HRT groups. Associations between HRT and the apnea-hypopnea index (AHI) were estimated with age-adjusted linear regression models. Results Of the 194 individuals identified, 89 satisfied the inclusion criteria. Nearly half of participants were transmasculine (52%). The mean age was 38±13 years, and mean body mass index was 34.7±9.0 Kg/m2. Approximately 60% of participants were on HRT at the time of SDB evaluation. Transmasculine people who were prescribed testosterone had a significantly increased AHI and lower oxygen nadir in comparison to transmasculine individuals not on testosterone (AHI 36.8±37.8/hour vs.15.3±16.6/hour, p=0.01; oxygen nadir 83.4±8.3% vs. 89.1±2.4%, p=0.001). In contrast, differences between transfeminine people with and without feminizing HRT (androgen blocker + estrogen) were not statistically significant (AHI 21.4±27.7/hour vs. 27.7±26.0/hour, p=0.45; oxygen nadir 86.5±6.7% vs. 84.1±7.7%, p=0.29). Linear regression models adjusted for age found an association between HRT and AHI for transmasculine (β=16.7, 95% CI 2.7, 30.8), but not for transfeminine participants (β=-2.5, 95% CI -17.9, 12.9). Conclusion These findings suggest differential associations between HRT and AHI among transgender individuals, with transmasculine on testosterone having a significant increase in AHI. Prospective studies with large sample sizes are warranted to evaluate these associations. Support (if any) Dr. Gavidia’s work was supported by an NIH/NINDS T32-NS007222 grant

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574 Sleep-disordered breathing symptoms in children who co-sleep: Are caregivers better reporters?

SLEEP ◽

10.1093/sleep/zsab072.572 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A226-A227

Author(s):

Nimra Alvi ◽

Allison Clarke ◽

Pallavi Patwari

Keyword(s):

Sleep Disordered Breathing ◽

Chart Review ◽

Retrospective Chart Review ◽

Caregiver Distress ◽

Inclusion Criteria ◽

Demographic Information ◽

Older Children ◽

Obstructive Sleep ◽

Morbid Conditions ◽

Disordered Breathing

Abstract Introduction Medical consensus advises against co-sleeping for infants to protect against SIDS, but co-sleeping in older children is often dismissed if not associated with caregiver distress. While some families may choose to co-sleep due to cultural, circumstantial, or psychosocial factors, this choice can also be due to medical concerns warranting greater caregiver attention. We aimed to explore characteristics of co-sleeping children referred for sleep disordered breathing and hypothesized that children with polysomnogram confirmed obstructive sleep apnea (OSA) would have higher caregiver-reported sleep disordered breathing symptoms as compared to children without confirmed OSA. Methods Caregivers who accompanied their child for polysomnogram were asked to complete a questionnaire that included sleep-related symptoms of sleep-disordered breathing (snoring, apnea, gasping/choking), restlessness, and parasomnias. Inclusion criteria are age >1.0 years and <18 years, baseline study for sleep disordered breathing, and completed questionnaire. Retrospective chart review included demographic information, BMI, co-morbid conditions, and polysomnogram results. The cohort was divided into 2 groups based on polysomnogram confirmed diagnosis of “snoring” or “OSA”. Results Of 75 co-sleeping children, 27 (36%) had a diagnosis of snoring and 48 (64%) of OSA. The cohort was similar in age, gender, and insurance type for snoring and OSA groups (Average 5.7 +/- 2.6 yrs and 5.4 +/- 2.9 yrs, respectively; 41% and 35% female, respectively; 44% and 50% Medicaid, respectively). Notable differences in the snoring and OSA groups were found with BMI z-score (1.6 +/- 4.6 and 1.0 +/- 1.5, respectively) and absence of co-morbid conditions (44% and 63%, respectively). Regarding reported symptoms, the snoring-group compared to OSA-group had lower report of gasping/choking (19% vs 29%), bedwetting (7% vs 13%), and nightmares (7% vs 15%); and had higher report of movement (74% vs 60%), kicking (48% vs 31%), and startle/jump (30% vs 19%). Conclusion Although we predicted that co-sleeping would be associated with increased caregiver vigilance, witnessed sleep-disordered-breathing symptoms was only higher for report of gasping/choking and did not differ significantly for report of snoring and apnea in children with and without OSA. Interestingly, co-sleeping in children without OSA appeared to be more strongly related to report of sleep disruption in the form of restless sleep. Support (if any):

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Abstract WP357: Prevalence of Pre- and Post-intracerebral Hemorrhage Sleep-disordered Breathing

Stroke ◽

10.1161/str.48.suppl_1.wp357 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Richard V Scheer ◽

Lynda D Lisabeth ◽

Chengwei Li ◽

Erin Case ◽

Ronald D Chervin ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Mexican American ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Portable Monitor ◽

Before And After ◽

Disordered Breathing

Background: Sleep-disordered breathing (SDB) is an independent risk factor for stroke. The reported prevalence of SDB after stroke ranges from 60 to >70%, while the pre-stroke prevalence of SDB is less well described. Moreover, much of these data are derived from ischemic stroke or mixed ischemic stroke and intracerebral hemorrhage (ICH) cohorts. Studies that assess the prevalence of SDB before and after ICH are lacking, with only one prior study (n=32) that reported a post-ICH SDB prevalence of 78%. We report herein the results of a second, larger, prospective study that assessed the prevalence of pre- and post-ICH. Methods: Participants enrolled in the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) project, with ICH from 2010-2015 were screened for SDB with the well validated ApneaLink Plus portable monitor (SDB defined as apnea-hypopnea index (AHI) ≥10). The Berlin questionnaire was administered, with reference to the pre-ICH state, to assess for possible pre-stroke SDB. Results: Of the 60 ICH participants screened, the median age was 63 years (interquartile range (IQR): 55.5, 74.5). Twenty-one (35%) were female, 54 (90%) were Mexican American, and 53 (88%) had a history of hypertension. The median Glasgow Coma Scale score was 15.0 (IQR: 15.0, 15.0) and the median NIHSS was 5.5 (IQR: 1.5, 8.0). Post-ICH, the median AHI was 9.5 (IQR: 5.5, 19.0); almost half (46.7%) met criteria for SDB. Thirty-four participants (56.7%) screened as high risk for SDB pre-ICH. Conclusion: Sleep-disordered breathing was highly prevalent after ICH, and also likely common before ICH, in this mostly Mexican American, community-based sample. If SDB increases risk for ICH, the findings suggest a potential new treatment target to prevent ICH and recurrent ICH.

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