Obstructive sleep disorders in Down syndrome’s children with and without lower airway anomalies

(1) Background: Obstructive sleep apnea (OSA) and lower airway anomalies are both highly prevalent in children with Down syndrome (DS). However, little is known on the interaction between both. We aim to investigate the co-occurrence of OSA (defined as obstructive apnea/hypopnea index (oAHI) ≥ 2/h) and lower airway anomalies in children with DS and explore their impact on OSA severity and treatment outcome. (2) Methods: Retrospective analysis of data from airway endoscopy and polysomnography (PSG) in a cohort of children with DS. (3) Results: Data on both lower airway evaluation and PSG were available for 70 patients with DS. Our study population was relatively young (mean age 3.5 years), not obese and presented with severe OSA (mean oAHI 13.1/h). Airway anomalies were found in 49/70 children (70%), most frequently laryngomalacia, tracheomalacia or a combined airway malformation. In the remaining 21 cases (30%), endoscopy was normal. A comparison between both groups showed a similar distribution of gender, age and BMI z-scores. The prevalence of OSA was not significantly higher in DS patients with airway anomalies (89.6% vs 71.4%, p = 0.078). Additionally, OSA severity or treatment choice (conservative, upper airway surgery or CPAP) were not significantly different. Follow-up data (available for 49/70 patients) showed a significant improvement of OSA in both groups. There is a not significant tendency to more patients with persistent OSA among those with lower airway anomalies (34.3% vs 7.1%, p = 0.075). (4) Conclusions: We found no significant differences in OSA severity, treatment choice or outcome between children with DS with and without lower airway anomalies. Further studies should investigate the role of DISE-directed treatment and compare the outcome of different treatment modalities in larger patient groups.

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Vitamin D and Sleep Regulation: Is there a Role for Vitamin D?

Current Pharmaceutical Design ◽

10.2174/1381612826666200310145935 ◽

2020 ◽

Vol 26 (21) ◽

pp. 2492-2496 ◽

Cited By ~ 1

Author(s):

Fiammetta Romano ◽

Giovanna Muscogiuri ◽

Elea Di Benedetto ◽

Volha V. Zhukouskaya ◽

Luigi Barrea ◽

...

Keyword(s):

Vitamin D ◽

Sleep Disorders ◽

Vitamin D Deficiency ◽

Sleep Apnea Syndrome ◽

Regulatory Mechanisms ◽

Sleep Regulation ◽

Vitamin D Receptors ◽

Obstructive Sleep ◽

The Impact

Background: Vitamin D exerts multiple pleiotropic effects beyond its role in calcium-phosphate metabolism. Growing evidence suggests an association between hypovitaminosis D and sleep disorders, thus increasing the interest in the role of this vitamin in the regulatory mechanisms of the sleep-wake cycle. Objective: The study aimed to explore and summarize the current knowledge about the role of vitamin D in sleep regulation and the impact of vitamin D deficiency on sleep disorders. Methods: The main regulatory mechanisms of vitamin D on sleep are explained in this study. The literature was scanned to identify clinical trials and correlation studies showing an association between vitamin D deficiency and sleep disorders. Results: Vitamin D receptors and the enzymes that control their activation and degradation are expressed in several areas of the brain involved in sleep regulation. Vitamin D is also involved in the pathways of production of Melatonin, the hormone involved in the regulation of human circadian rhythms and sleep. Furthermore, vitamin D can affect sleep indirectly through non-specific pain disorders, correlated with alterations in sleep quality, such as restless legs syndrome and obstructive sleep apnea syndrome. Conclusions: : Vitamin D has both a direct and an indirect role in the regulation of sleep. Although vitamin D deficiency has been associated to sleep disorders, there is still scant evidence to concretely support the role of vitamin D supplementation in the prevention or treatment of sleep disturbances; indeed, more intervention studies are needed to better clarify these aspects.

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611 Sleep Disorders in a Longitudinal Community Cohort of Children with Down Syndrome

SLEEP ◽

10.1093/sleep/zsab072.609 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A240-A240

Author(s):

Nisha Patel ◽

Timothy Morgenthaler ◽

Julie Baughn

Keyword(s):

Down Syndrome ◽

Sleep Disorders ◽

Screening Tools ◽

Treatment Needs ◽

Cross Sectional Survey ◽

Periodic Limb Movement Disorder ◽

Cross Sectional ◽

Children With Down Syndrome ◽

Obstructive Sleep ◽

Respiratory Sleep Disorders

Abstract Introduction Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS. Methods A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded. Results 94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis. Conclusion Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs. Support (if any):

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Uncovering Common Sleep Disorders and Their Impacts on Occupational Performance

Workplace Health & Safety ◽

10.1177/2165079917702911 ◽

2017 ◽

Vol 65 (5) ◽

pp. 232-232

Author(s):

Sylvia R. Judd

Keyword(s):

Sleep Disorders ◽

Hormonal Regulation ◽

The Body ◽

Screening Tools ◽

Occupational Performance ◽

Obstructive Sleep ◽

Occupational Health Nurse ◽

Inadequate Sleep ◽

Simple Screening ◽

Healthy Immune System

Sleep is an active process; the body undergoes restoration and regeneration. Adequate sleep is essential to health and cognitive function. Sleep is critical for cell repair, a healthy immune system, and hormonal regulation, and aids in the process of learning, memory, and emotion. Inadequate sleep can lead to multiple chronic health and mental conditions over time. The occupational health nurse can be instrumental in screening for two of the most common sleep disorders, insomnia and obstructive sleep apnea, by asking workers key questions and using simple screening tools.

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Integrative Sleep Medicine

10.1093/med/9780190885403.001.0001 ◽

2021 ◽

Keyword(s):

Circadian Rhythm ◽

Sleep Disorders ◽

Health Care Providers ◽

Sleep Disturbances ◽

Well Being ◽

Sleep Medicine ◽

Whole Body ◽

Care Providers ◽

Obstructive Sleep ◽

The Many

Sleep is one of the key underpinnings of human health, yet sleep disturbances and impaired sleep are rampant in modern life. Healthy sleep is a whole-body process impacted by circadian rhythm, daily activities, and emotional well-being, among others. When properly aligned, these work in concert to produce restorative and refreshing sleep. When not in balance, however, sleep disorders result. Yet too often, the approach to treatment of sleep disorders is compartmentalized, failing to recognize all of the complex interactions that are involved. This text offers a comprehensive approach to sleep and sleep disorders by delineating the many factors that interplay into healthy sleep. Health care providers can learn how to better manage their patients with sleep disorders by integrating complementary and conventional approaches. Using an evidence-based approach throughout, this book describes the basics of normal sleep then delves into the foundations of integrative sleep medicine, including the circadian rhythm, mind/body-sleep connection, light, dreaming, the gastrointestinal system, and botanicals/supplements. Specific sleep issues and disorders are then addressed from an integrative perspective, including insomnia, obstructive sleep apnea, sleep related movement disorders, and parasomnias.

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Inter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders

Sleep And Breathing ◽

10.1007/s11325-016-1356-6 ◽

2016 ◽

Vol 20 (4) ◽

pp. 1263-1268

Author(s):

Danilo Anunciatto Sguillar ◽

Tatiana de Aguiar Vidigal ◽

João Paulo Mangussi ◽

Lia Bittencourt ◽

Luiz Carlos Gregório ◽

...

Keyword(s):

Physical Examination ◽

Sleep Disorders ◽

Obstructive Sleep ◽

Examiner Agreement

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The efficiency of obesity treatment in patients with insomnia and obstructive sleep apnea syndrome

Obesity and metabolism ◽

10.14341/omet2016225-32 ◽

2015 ◽

Vol 13 (2) ◽

pp. 25-32

Author(s):

Natal'ya V. Strueva ◽

Galina A. Mel'nichenko ◽

Mikhail G. Poluektov ◽

Larisa V. Savel'eva

Keyword(s):

Weight Loss ◽

Obstructive Sleep Apnea ◽

Body Weight ◽

Sleep Apnea ◽

Sleep Disorders ◽

Sleep Apnea Syndrome ◽

Obese Patients ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

Clinically Significant

The aim of this study was to investigate the relationship between the dynamics of body weight and sleep disorders in the treatment of obesity.Materials and methods. The study included 200 obese patients: 83 men and 117 women.Results. Complaints about problems sleeping (snoring, hypersomnia, insomnia, etc.) were present in 78% of obese patients. 89 patients were under the observation of an endocrinologist for 7 ± 1 months, they were divided into three matched by age, sex and BMI groups: patients with obstructive sleep apnea syndrome (OSAS) (n = 42), the second – with the syndrome of insomnia (n = 19), the third (control group) – patients without sleep disorders (n = 24). After treatment of obesity the weight loss in patients with insomnia syndrome was -2.5 [-4; 0]kg, in patients with OSAS -7 [-18; -2] kg, in patients without sleep disorders -6.5 [-12; -2.25] kg. Clinically significant weight reduction was reached in 25 (59.5%) patients with OSAS; 3 (16%) – with insomnia syndrome; 15 (62.5%) – without sleep disorders.Conclusion. Thus, the insomnia syndrome essentially influences the obesity treatment results – most of patients with this sleep disorder (81.2%) do not achieve clinically significant weight loss. The presence and severity of breathing disorders during sleep do not prevent weight loss. However, with the regular use of CPAP-therapy in patients with OSAS has a tendency of greater reduction of body weight.

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Sleep disorders in migraine

Medical Council ◽

10.21518/2079-701x-2021-2-111-120 ◽

2021 ◽

pp. 111-120

Author(s):

N. V. Vashchenko ◽

A. I. Kozhev ◽

Ju. E. Azimovа

Keyword(s):

Combination Therapy ◽

Sleep Disorders ◽

Sleep Disturbances ◽

Mutual Influence ◽

Integrated Approach ◽

Epidemiological Studies ◽

Exact Nature ◽

Obstructive Sleep ◽

Underlying Mechanisms

Migraine and sleep disorders are common in the general population, may be associated with each other and often significantly reduce patients’ quality of life. Clinicians and epidemiological studies have long acknowledged a link between these conditions. However, the exact nature of this relationship, its underlying mechanisms and patterns are complex and not fully understood. This publication brings together the latest data on the relationship between migraine and sleep disorders: the biochemical and functional-anatomical background, the mutual influence of these conditions on each other and the typical sleep disturbances in migraine patients (such as insomnia, obstructive sleep apnea, parasomnia, snoring, excessive daytime sleepiness). The paper discusses the hypotheses of pathogenetic relationships based on the studies of the central nervous system’s anatomical and physiological features in people with migraine and sleep disorders. The available data should encourage physicians to evaluate sleep quality in migraineurs and use combination therapy systematically. The therapy of insomnia is reviewed: both nonpharmacological and pharmacological therapies are discussed; the advantages of an integrated approach are discussed, and a brief overview of each group of medications is offered.Lastly, a case study of a patient with chronic migraine and insomnia treated with Doxylamine in combination therapy is presented. Treatment with Doxylamine significantly reduced the incidence of insomnia, probably thereby positively influencing the course of migraine as well.

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Unwanted Overtures by Night, Remorse by Day

Sleep Disorders ◽

10.1093/med/9780190671099.003.0028 ◽

2019 ◽

pp. 514-525

Author(s):

Muna Irfan ◽

Michel J. Howell

Keyword(s):

Obstructive Sleep Apnea ◽

Sexual Behavior ◽

Sleep Apnea ◽

Sleep Disorders ◽

Eye Movement ◽

Management Strategies ◽

Current Understanding ◽

Obstructive Sleep ◽

Epilepsy Treatment ◽

The Subject

Sexual behavior in sleep has only recently been recognized as a variant of non–rapid-eye-movement (NREM) arousal parasomnias. This chapter discusses a case of sexsomnia precipitated by obstructive sleep apnea, the ensuing impact on the subject and his bed partner, and evaluation and management strategies. Sexsomnia is suspected to be highly underreported and carries significant physical, psychosocial, and forensic ramifications. Polysomnography with expanded electroencephalography can help identify concurrent sleep disorders and exclude other etiologies such as epilepsy. Treatment of comorbid sleep disorders such as obstructive sleep apnea and sleep deprivation is highly effective in controlling the abnormal sexual behavior. There is a pressing need for research and expansion of current understanding to develop a standardized approach to evaluation and management of sexsomnia.

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Tormented Sunrises

Sleep Disorders ◽

10.1093/med/9780190671099.003.0022 ◽

2019 ◽

pp. 418-434

Author(s):

Maha Alattar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

General Population ◽

Sleep Disorders ◽

Headache Disorders ◽

Distinct Subset ◽

Obstructive Sleep ◽

High Prevalence ◽

The Relationship

This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.

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