Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

2021 ◽  
pp. 019459982199338
Author(s):  
Flora Yan ◽  
Dylan A. Levy ◽  
Chun-Che Wen ◽  
Cathy L. Melvin ◽  
Marvella E. Ford ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Sleep Disordered Breathing ◽  
Healthy Children ◽  
Loss To Follow Up ◽  
Cox Regression Analysis ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

Impact of Adenotonsillectomy on Homework Performance in Children With Obstructive Sleep-Disordered Breathing

2021 ◽  
pp. 000348942110625
Author(s):  
Derek Wu ◽  
Vivienne H. Au ◽  
Billy Yang ◽  
Sylvia J. Horne ◽  
Jeremy Weedon ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Control Group ◽  
Clinical Criteria ◽  
Control Subjects ◽  
Obstructive Sleep ◽  
And Control ◽  
The Impact ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Objective: As a first line treatment for pediatric obstructive sleep-disordered breathing (SDB), adenotonsillectomy (AT) has been shown to confer physiologic and neurocognitive benefits to a child. However, there is a scarcity of data on how homework performance is affected postoperatively. Our objective was to evaluate the impact of AT on homework performance in children with SDB. Methods: Children in grades 1 to 8 undergoing AT for SDB based on clinical criteria with or without preoperative polysomnography along with a control group of children undergoing surgery unrelated to the treatment of SDB were recruited. The primary outcome of interest was the differential change in homework performance between the study group and control at follow-up as measured by the validated Homework Performance Questionnaire (HPQ-P). Adjustments were made for demographics and Pediatric Sleep Questionnaire (PSQ) scores. Results: 116 AT and 47 control subjects were recruited, and follow-up data was obtained in 99 AT and 35 control subjects. There were no significant differences between the general (total) HPQ-P scores and subscale scores between the AT and control subjects at entry and there were no significant differences in the change scores (follow-up minus initial scores) between the groups. Regression modeling also demonstrated that there were no group (AT vs control) by time interactions that predicted differential improvements in the HPQ-P ( P > .10 for each model) although initial PSQ score was a significant predictor of lower HPQ-P scores for all models. Conclusions: Children with SDB experienced improvement in HPQ-P scores postoperatively, but the degree of change was not significant when compared to controls. Further studies incorporating additional educational metrics are encouraged to assess the true scholastic impact of AT in children with SDB.

scholarly journals Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing

2018 ◽  
Vol 159 (2) ◽  
pp. 371-378 ◽  
Author(s):  
Vandra C. Harris ◽  
Anne R. Links ◽  
Julia M. Kim ◽  
Jonathan Walsh ◽  
David E. Tunkel ◽  
...  
Keyword(s):  
Primary Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Loss To Follow Up ◽  
Obstructive Sleep Apnea Severity ◽  
Obstructive Sleep ◽  
Lost To Follow Up ◽  
Disordered Breathing

Objective To evaluate follow-up and timing of sleep-disordered breathing diagnosis and treatment in urban children referred from primary care. Study Design Retrospective longitudinal cohort analysis. Setting Tertiary health system. Subjects and Methods Pediatric outpatients with sleep-disordered breathing, referred from primary care for subspecialty appointment or polysomnography in 2014, followed for 2 years. Timing of polysomnography or subspecialty appointments, loss to follow-up, and sleep-disordered breathing severity were main outcomes. Chi-square and t-test identified differences in children referred for polysomnography, surgery, and loss to follow-up. Logistic regression identified predictors of loss to follow-up. Days to polysomnography or surgery were evaluated using the Kaplan-Meier estimator, with Cox regression comparing estimates by polysomnography receipt and disease severity. Results Of 216 children, 188 (87%) had public insurance. Half (109 [50%]) were lost to follow-up after primary care referral. More children were lost to follow-up when referred for polysomnography (50 [76%]) compared with subspecialty evaluation (35 [32%]; P < .001). Children referred to both polysomnography and subspecialty were more likely to be lost to follow-up (odds ratio = 2.73, 95% confidence interval = 1.29-5.78; P = .009). For children who obtained polysomnography, an asymmetric distribution of obstructive sleep apnea severity was not observed ( P = .152). Median time to polysomnography and surgery was 75 and 226 days, respectively. Obstructive sleep apnea severity did not influence time to surgery ( P = .410). Conclusion In this urban population, half of the children referred for sleep-disordered breathing evaluation are lost to follow-up from primary care. Obstructive sleep apnea severity did not predict follow-up or timeliness of treatment. These findings suggest social determinants may pose barriers to care in addition to the clinical burden of sleep-disordered breathing.

Hemorrhage from cerebral cavernous malformations

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. e89-e96 ◽  
Author(s):  
Bixia Chen ◽  
Annika Herten ◽  
Dino Saban ◽  
Steffen Rauscher ◽  
Alexander Radbruch ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cox Regression ◽  
Binary Logistic Regression Analysis ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Cox Regression Analysis ◽  
Mode Of Presentation ◽  
The Impact

ObjectiveTo determine the role of associated developmental venous anomalies (DVAs) in intracranial hemorrhage (ICH) caused by cerebral cavernous malformations (CCMs).MethodsWe analyzed patient registry data of 1,219 patients with cavernous malformations treated in our institution between 2003 and 2018. Patients with spinal and familial CCM and patients without complete MRI data were excluded. The impact of various variables on ICH as a mode of presentation was assessed with multivariate binary logistic regression analysis. Kaplan Meier/Cox regression analysis was performed to analyze cumulative 5-year-risk for (re)hemorrhage and to identify baseline predictors of this outcome.ResultsSeven hundred thirty-one patients with CCM were included. Multivariate logistic regression confirmed a statistically significant negative correlation with DVA (odds ratio [OR] 0.635 [95% confidence interval (CI) 0.459–0.878]) and positive correlation with brainstem localization (OR 6.277 [95% CI 4.287–9.191]) with ICH as the mode of presentation. Among 731 patients, 76 experienced (re)hemorrhage during 2,338 person-years of follow-up. Overall cumulative 5-year risk was 24.1% (95% CI 21.1%–27.5%). Cox regression analysis revealed initial presentation with ICH (hazard ratio [HR] 8.0 [95% CI 3.549–18.122]) and brainstem localization (HR 2.9 [95% CI 1.756–4.765]) as independent baseline predictors of (re)hemorrhage. Presence of DVA added no independent prognostic information (HR 1.1 [95% CI 0.717–1.885]).ConclusionPatients with CCM with associated DVA are at lower risk to present with ICH. During untreated 5-year follow-up, they showed equal (re)hemorrhage risk compared to patients with CCM without DVA.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

NLRP3 is a Novel Prognostic Biomarker and Correlates With Immune Infiltrates in Lung Adenocarcinoma and Skin Cutaneous Melanoma

2021 ◽  
Author(s):  
Chenxi Yuan ◽  
Qingwei Wang ◽  
Xueting Dai ◽  
Yipeng Song ◽  
Jinming Yu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Lung Adenocarcinoma ◽  
Immune Cells ◽  
Cutaneous Melanoma ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Potential Biomarker ◽  
The Impact ◽  
Nlrp3 Expression

Abstract Background: Lung adenocarcinoma (LUAD) and skin cutaneous melanoma (SKCM) are common tumors around the world. However, the prognosis in advanced patients is poor. Because NLRP3 was not extensively studied in cancers, so that we aimed to identify the impact of NLRP3 on LUAD and SKCM through bioinformatics analyses. Methods: TCGA and TIMER database were utilized in this study. We compared the expression of NLRP3 in different cancers and evaluated its influence on survival of LUAD and SKCM patients. The correlations between clinical information and NLRP3 expression were analyzed using logistic regression. Clinicopathologic characteristics associated with overall survival in were analyzed by Cox regression. In addition, we explored the correlation between NLRP3 and immune infiltrates. GSEA and co-expressed gene with NLRP3 were also done in this study. Results: NLRP3 expressed disparately in tumor tissues and normal tissues. Cox regression analysis indicated that up-regulated NLRP3 was an independent prognostic factor for good prognosis in LUAD and SKCM. Logistic regression analysis showed increased NLRP3 expression was significantly correlated with favorable clinicopathologic parameters such as no lymph node invasion and no distant metastasis. Specifically, a positive correlation between increased NLRP3 expression and immune infiltrating level of various immune cells was observed. Conclusion: Together with all these findings, increased NLRP3 expression correlates with favorable prognosis and increased proportion of immune cells in LUAD and SKCM. These conclusions indicate that NLRP3 can serve as a potential biomarker for evaluating prognosis and immune infiltration level.

Abstract P249: Incident Sleep-Disordered Breathing is Associated with Obesity: Penn State Child Cohort

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Edward O Bixler ◽  
Alexandros N Vgontzas ◽  
Duanping Liao ◽  
Susan Calhoun ◽  
Julio Fernandez-Mendoza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Sleep Disordered Breathing ◽  
Population Sample ◽  
Population Based ◽  
Penn State ◽  
Potential Risk Factors ◽  
State Child ◽  
Disordered Breathing

Objectives: To study the epidemiology of sleep-disordered breathing (SDB) in adolescents, which has received little attention. Methods: The Penn State Child Cohort (PSCC) is a representative general population sample of 700 children aged 5-12 years. Our preliminary results are based on an average 8 year follow up of the initial 300 prospective subjects (~43%) from this ongoing cohort study. A logistic regression was used to assess the association between potential risk factors and incident SDB. Results: The mean age at the 8-year follow up examination was 17.2 ± 0.1 years, with an average BMI percentile of 66.6 ± 1.6 and 56.5% boys. At baseline 1.5% of this subsample had SDB, defined by Apnea Hypopnia Index (AHI > 5 /hour). Surprisingly, there was no persistence of SDB. Eight-year incident SDB was 10.5%. The average AHI in those with incident SDB was 12.7 with a maximum of 92.4. Incident SDB was similar for girls (7.8%) and boys (12.7%). Those with SDB were older than those without (18.7 vs 17.0 years, P<0.001) and girls with SDB were older than boys with SDB (20.0 vs 18.0 years, P=0.002). Those with incident SDB tended to have a greater change in BMI percentile (8.2 vs 1.8, P = 0.143) during the follow up and slightly higher minority representation (25.8% vs 21.9%, P=0.655). A logistic regression model identified three variables that were associated with incident SDB, controlling for baseline AHI: age (OR = 1.5 (1.3, 1.9) P<0.001), male (OR= 2.5 (1.11,10.00) P=0.021), and [[Unable to Display Character: &#8710;]]BMIPCT (OR=1.2(1.02, 1.5) P=0.032). Conclusion: In this population based sample of adolescents, the 8-year incidence of SDB was high (10.5%), whereas childhood SDB did not persist into adolescence. Further, the results indicate that risk factors for incident SDB in adolescents are age, male and the development of obesity.

Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy

2010 ◽  
Vol 125 (2) ◽  
pp. 193-198 ◽  
Author(s):  
S M Powell ◽  
M Tremlett ◽  
D A Bosman
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Life Assessment ◽  
Effect Sizes ◽  
Obstructive Sleep ◽  
Disordered Breathing

AbstractObjective:To assess the quality of life of UK children with sleep-disordered breathing undergoing adenotonsillectomy, by using the Obstructive Sleep Apnoea 18 questionnaire and determining score changes and effect sizes.Design:Prospective, longitudinal study.Setting:The otolaryngology department of a university teaching hospital in Northern England.Participants:Twenty-eight children for whom adenotonsillectomy was planned as treatment for sleep-disordered breathing, and who had either a clinical history consistent with obstructive sleep apnoea or a polysomnographic diagnosis.Main outcome measure:The Obstructive Sleep Apnoea 18 questionnaire, a previously validated, disease-specific quality of life assessment tool; changes in questionnaire scores and effect sizes were assessed.Methods:The Obstructive Sleep Apnoea 18 questionnaire was administered to each child's parent pre-operatively, then again at the follow-up appointment. Questionnaire scores ranged from 1 to 7. Score changes were analysed using the paired t-test; effect sizes were calculated using 95 per cent confidence intervals.Results:Complete data were obtained for 22 children (mean age, 61 months). Ten had undergone pre-operative polysomnography. Twenty-one children underwent adenotonsillectomy (one underwent tonsillectomy). Median follow up was eight weeks (interquartile range, six to 11 weeks). Following surgery, the overall mean score improvement was 2.6 (p < 0.0001) and the mean effect size 2.4 (95 per cent confidence interval 1.9 to 2.8). There were significant improvements in each of the individual questionnaire domains, i.e. sleep disturbance (mean score change 3.9, p < 0.0001), physical suffering (2.2, p < 0.0001), emotional distress (2.0, p = 0.0001), daytime problems (1.8, p = 0.0001) and caregiver concerns (2.6, p < 0.0001).Conclusion:In these children with sleep-disordered breathing treated by adenotonsillectomy, Obstructive Sleep Apnoea 18 questionnaire results indicated significantly improved mean score changes and effect sizes across all questionnaire domains, comparing pre- and post-operative data.

scholarly journals The impact of chronic rhinosinusitis on sleep-disordered breathing

2016 ◽  
Vol 54 (1) ◽  
pp. 75-79
Author(s):  
Rong-San Jiang ◽  
Kai-Li Liang ◽  
Chung-Han Hsin ◽  
Mao-Chang Sun
Keyword(s):  
Sleep Quality ◽  
Chronic Rhinosinusitis ◽  
Nasal Obstruction ◽  
Sleep Disordered Breathing ◽  
Sleep Problems ◽  
Sleep Apnea Syndrome ◽  
Sinus Surgery ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Background: The nose plays an important role in sleep quality. Very little is known about sleep problems in patients with chronic rhinosinusitis (CRS). The aim of this study was to investigate the impact of CRS on sleep-disordered breathing. Methodology: CRS patients who underwent functional endoscopic sinus surgery were collected between July 2010 and May 2015. Before surgery, they filled 20-item Sino-Nasal Outcome Test and Epworth Sleepiness Scale questionnaires, were asked about the severity of nasal obstruction, and received acoustic rhinometry, smell test, an endoscopic examination, sinus computed tomography, and a one-night polysomnography. Sleep quality was evaluated in these patients and was correlated with the severity of rhinosinusitis. Results: One hundred and thirty-nine CRS patients were enrolled in the study. Among them, 38.1% complained of daytime sleepiness, and this sleep problem was correlated with the symptom of nasal obstruction. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 64.7% of the patients, but there was no correlation with the severity of rhinosinusitis. Nasal polyps did not worsen sleep problems in the CRS patients. Conclusions: This study showed that CRS patents had a high prevalence of OSAS, and worse OSAS in CRS patients was not correlated with the severity of rhinosinusitis.

The impact of patient-related factors on the occurrence of febrile neutropenia in breast cancer patients receiving (neo-)adjuvant chemotherapy with 5-fluorouracil, epirubicin, and cyclofosfamide (FEC) x6 or FEC x3 followed by docetaxel (D) x3.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1078-1078
Author(s):  
Christof Vulsteke ◽  
Alena Pfeil ◽  
Barbara Brouwers ◽  
Matthias Schwenkglenks ◽  
Robert Paridaens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Febrile Neutropenia ◽  
Serum Creatinine ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Related Factors ◽  
The Impact

1078 Background: Recently we described the impact of genetic variability on severe toxicity in breast cancer patients receiving (neo-) adjuvant FEC chemotherapy (Annals of Oncology 2013, In Press). We now further assessed the impact of a wide range of patient-related factors on FEC toxicity in routine clinical setting. Methods: Patients with early breast cancer receiving (neo-)adjuvant 6 cycles FEC or sequential 3 cycles of FEC and 3 cycles D were retrospectively evaluated through electronic chart review for febrile neutropenia (primary endpoint; CTC 3.0). Age at diagnosis, body mass index, body surface area, number of cycles received, germline genetic polymorphisms, and baseline biochemical variables (white blood cell count, absolute neutrophil count, platelets, aspartate aminotransferase, alanine aminotransferase, total bilirubin and creatinine) were available for most patients (missing data <10%). All patients had follow up for progression free survival (PFS) and overall survival (OS). Multivariate logistic regression analysis was performed including univariate associates of outcome with a p-value <0.25. Results: We identified 1,031 patients treated between 2000-2010 with 6x FEC (n=488) or 3x FEC followed by 3x D (n=543). 174 (16.9%) patients developed febrile neutropenia during FEC. After logistic regression analysis febrile neutropenia was found to be significantly associated with carriers of the rs45511401 variant T-allele in the MRP1 gene found in 12% of patients (p= 0.03, OR1.99, CI 1.07-3.71) and with increasing serum creatinine values (p=0.05 OR 4.58/CI 0.99-20.98); all other investigated patient-related parameters were not retained by the model. At a mean follow up of 5.2 years, the occurrence of febrile neutropenia was not correlated with PFS and OS. Conclusions: In this study, only the baseline level of serum creatinine and germline genetic polymorphisms in the MRP-1 gene were predictive for the occurrence of febrile neutropenia in patients receiving FEC chemotherapy. The occurrence of febrile neutropenia did not seem to impact on outcome.

Impact of Tonsillectomy on the Life Quality of Parents to Children With Obstructive Sleep-Disordered Breathing

2021 ◽  
pp. 019459982110641
Author(s):  
Yair Heskiau Shteinberg ◽  
Netanel Eisenbach ◽  
Maayan Gruber ◽  
Ohad Ronen
Keyword(s):  
Sleep Disordered Breathing ◽  
Life Quality ◽  
Control Group ◽  
Healthy Children ◽  
Academic Center ◽  
Obstructive Sleep ◽  
Before And After ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Objective Parents of children with any chronic illness may experience increased anxiety and reduced health-related quality of life (QoL). Our objective was to evaluate the change in parental QoL before vs after tonsillectomy. Our hypothesis was that pediatric tonsil surgery with or without adenoidectomy would improve parental QoL. Study Design A prospective cohort study. Setting An otolaryngology department in a tertiary academic center. Methods We enrolled parents of 79 children <5 years old. Adenotonsillectomy due to an obstructive airway indication was performed in 45 children. A group of 34 parents to healthy children served as a control group. Initially, we validated a modified version of the PAR-ENT-QoL questionnaire; then, we analyzed QoL parameters among parents of children with obstructive sleep-disordered breathing before and after surgical treatment. Results We found significant differences between the QoL score before and after surgery ( P = .003). The QoL score after surgery significantly improved and was even lower than that of the control group ( P < .001). Conclusions These results highlight the importance of timely diagnosis and treatment of children with obstructive sleep-disordered breathing, as this condition may affect not only the children themselves but also their caregivers.

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