Comparison of Clinical Symptoms and Severity of Sleep Disordered Breathing in Children with and without Cleft Lip and/or Palate

Objective To determine whether the clinical presentation or severity of sleep disordered breathing differs between children with or without a history of cleft lip and/or palate (CL/P) presenting for sleep assessment. Design Retrospective chart review. Setting Tertiary care pediatric hospital cleft clinic, sleep clinic. Patients Children > 6 months of age presenting to the cleft clinic with sleep concerns and children without CL/P presenting to the sleep clinic in the same 2-year period. Main Outcomes Measures Clinical symptoms and overnight polysomnography (PSG) results. Results A total of 168 children (55 from cleft clinic, 113 from sleep clinic) were identified. Age at clinical review (6.6 ± 4.1 years versus 6.8 ± 4.0 years, P = ns), sex distribution (64.6% versus 58.4%, P = ns), and the presence of syndromes or significant medical conditions (12% versus 16%, P = ns) were similar between groups. Snoring was the reason for referral in 59% of children with CL/P and 69% of non-CL/P children ( P = ns). The only presenting feature that differentiated between the groups was a lower incidence of tonsillar enlargement in children with CL/P (33% versus 79%, chi-square 30.4, P < 0.001). Sleep study results showed similar apnea-hypopnea indices (6.2 ± 6.9 versus 7.9 ± 7.1 events/hr, P = ns) with more central apnea in children with CL/P (1.5 ± 1.5 versus 1.0 ± 1.0 events/hr, P = 0.017). Conclusions Snoring and obstructive sleep apnea are common in CL/P with less tonsillar enlargement than non-CL/P children. Children with CL/P have similar OSA severity compared to non-cleft children but more central apnea which may indicate differences in the control of breathing.

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The spectrum of sleep-disordered breathing symptoms and respiratory events in infants with cleft lip and/or palate

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302104 ◽

2012 ◽

Vol 97 (12) ◽

pp. 1058-1063 ◽

Cited By ~ 44

Author(s):

Joanna E MacLean ◽

David Fitzsimons ◽

Dominic A Fitzgerald ◽

Karen A Waters

Keyword(s):

Sleep Disordered Breathing ◽

Cleft Lip ◽

Tertiary Care ◽

Newborn Infants ◽

Clinical History ◽

Study Data ◽

Sleep Study ◽

Paediatric Hospital ◽

Respiratory Events ◽

Disordered Breathing

ObjectiveTo determine the prevalence of sleep-disordered breathing (SDB) symptoms and respiratory events during sleep in infants with cleft lip and/or palate (CL/P).DesignProspective observational study.SettingCleft palate clinic, tertiary care paediatric hospital, before palate surgery.PatientsConsecutive newborn infants with CL/P.Main outcome measuresDemographics, clinical history, sleep symptoms, facial measurement and polysomnography (PSG; sleep study) data.ResultsFifty infants completed PSG at 2.7±2.3 months; 56% were male, and 30% had a clinical diagnosis of Pierre Robin sequence (PRS) or a syndrome. The majority of infants (75%) were reported to snore frequently or constantly, while 74% were reported to have heavy or loud breathing during sleep. The frequency of parent-reported difficulty with breathing during sleep was 10% for infants with isolated CL/P, 33% for those with syndrome, and 43% for PRS (χ2 16.1, p<0.05). All infants had an Obstructive–Mixed Apnoea–Hypopnoea Index (OMAHI) >1 event/h, and 75% had an OMAHI >3 events/h. Infants with PRS had higher OMAHI (34.3±5.1) than infants with isolated CL/P (7.6±1.2) or infants with syndromes (15.6±5.7, F stat, p<0.001). Multivariate analysis showed that PRS was associated with higher OMAHI (B 0.53±0.22, p=0.022), but the majority of the variance for SDB was unexplained (constant B 1.31±0.55, p=0.024).ConclusionsThe results highlight that infants across the spectrum of CL/P have a high risk of SDB symptoms and obstructive respiratory events before palate surgery. Clinicians should enquire about symptoms of SDB and consider investigation with polysomnography in all infants with CL/P.

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Prevalence and Patterns of Sleep-Disordered Breathing in Indian Heart Failure Population

Pulmonary Medicine ◽

10.1155/2021/9978906 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Sajit Kishan ◽

Mugula Sudhakar Rao ◽

Padmakumar Ramachandran ◽

Tom Devasia ◽

Jyothi Samanth

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Systolic Function ◽

Left Ventricular ◽

Sleep Study ◽

Coronary Syndrome ◽

Obstructive Sleep ◽

Study Results ◽

Disordered Breathing

Background. Sleep-disordered breathing (SDB) is a common yet a largely underdiagnosed entity in developing countries. It is one treatable condition that is known to adversely affect the mortality and morbidity in heart failure (HF). This study is one of the first attempts aimed at studying SDB in chronic HF patients from an Indian subcontinent. Objectives. The aim of this study was to study the prevalence, type, and characteristics of SDB in chronic HF patients and their association with HF severity and left ventricular (LV) systolic function and also to determine the relevance of SDB symptoms and screening questionnaires such as the Epworth Sleepiness Scale (ESS), Berlins questionnaire, and STOP-BANG score in predicting SDB in chronic HF patients. Methods. We enrolled 103 chronic heart failure patients aged more than 18 years. Patients with a history of SDB and recent acute coronary syndrome within 3 months were excluded. Relevant clinical data, anthropometric measures, echocardiographic parameters, and sleep apnea questionnaires were collected, and all patients underwent the overnight type 3 sleep study. Results. The overall prevalence of SDB in our study was high at 81.55% (84/103), with a predominant type of SDB being obstructive sleep apnea (59.2%). The occurrence of SDB was significantly associated with the male gender ( p = 0.002 ) and higher body mass index (BMI) values ( p = 0.01 ). SDB symptoms and questionnaires like ESS, STOP-BANG, and Berlins also did not have a significant association with the occurrence of SDB in HF patients. Conclusions. Our study showed a high prevalence of occult SDB predominantly OSA, in chronic HF patients. We advocate routine screening for occult SDB in HF patients.

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569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽

10.1093/sleep/zsab072.567 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A224-A225

Author(s):

Fayruz Araji ◽

Cephas Mujuruki ◽

Brian Ku ◽

Elisa Basora-Rovira ◽

Anna Wani

Keyword(s):

Sleep Apnea ◽

Primary Care Physicians ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Sleep Study ◽

Surgical Interventions ◽

Screening Guidelines ◽

Obstructive Sleep ◽

Children’S Sleep ◽

Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

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Recognition of Sleep-disordered Breathing in Children

PEDIATRICS ◽

10.1542/peds.98.5.871 ◽

1996 ◽

Vol 98 (5) ◽

pp. 871-882 ◽

Cited By ~ 4

Author(s):

Christian Guilleminault ◽

Rafael Pelayo ◽

Damien Leger ◽

Alex Clerk ◽

Robert C. Z. Bocian

Keyword(s):

Gold Standard ◽

Sleep Disordered Breathing ◽

Clinical Symptoms ◽

Upper Airway ◽

Esophageal Pressure ◽

Respiratory Events ◽

Obstructive Sleep ◽

Abnormal Breathing ◽

Polygraphic Recording ◽

Disordered Breathing

Objective. To determine whether upper airway resistance syndrome (UARS) can be recognized and distinguished from obstructive sleep apnea syndrome (OSAS) in prepubertal children based on clinical evaluations, and, in a subgroup of the population, to compare the efficacy of esophageal pressure (Pes) monitoring to that of transcutaneous carbon dioxide pressure (tcPco2) and expired carbon dioxide (CO2) measurements in identifying UARS in children. Study Design. A retrospective study was performed on children, 12 years and younger, seen at our clinic since 1985. Children with diagnoses of sleep-disordered breathing were drawn from our database and sorted by age and initial symptoms. Clinical findings, based on interviews and questionnaires, an orocraniofacial scale, and nocturnal polygraphic recordings were tabulated and compared. If the results of the first polygraphic recording were inconclusive, a second night's recording was performed with the addition of Pes monitoring. In addition, simultaneous measurements of tcPco2 and endtidal CO2 with sampling through a catheter were performed on this second night in 76 children. These 76 recordings were used as our gold standard, because they were the most comprehensive. For this group, 1848 apneic events and 7040 abnormal respiratory events were identified based on airflow, thoracoabdominal effort, and Pes recordings. We then analyzed the simultaneously measured tcPCo2 and expired CO2 levels to ascertain their ability to identify these same events. Results. The first night of polygraphic recording was inconclusive enough to warrant a second recording in 316 of 411 children. Children were identified as having either UARS (n = 259), OSAS (n = 83), or other sleep disorders (n = 69). Children with small triangular chins, retroposition of the mandible, steep mandibular plane, high hard palate, long oval-shaped face, or long soft palate were highly likely to have sleep-disordered breathing of some type. If large tonsils were associated with these features, OSAS was much more frequently noted than UARS. In the 76 gold standard children, Pes, tcPco2, and expired CO2 measurements were in agreement for 1512 of the 1848 apneas and hypopneas that were analyzed. Of the 7040 upper airway resistance events, only 2314 events were consonant in all three measures. tcPco2 identified only 33% of the increased respiratory events identified by Pes; expired CO2 identified only 53% of the same events. Conclusions. UARS is a subtle form of sleep-disordered breathing that leads to significant clinical symptoms and day and nighttime disturbances. When clinical symptoms suggest abnormal breathing during sleep but obstructive sleep apneas are not found, physicians may, mistakenly, assume an absence of breathing-related sleep problems. Symptoms and orocraniofacial information were not useful in distinguishing UARS from OSAS but were useful in distinguishing sleep-disordered breathing (UARS and OSAS) from other sleep disorders. The analysis of esophageal pressure patterns during sleep was the most revealing of the three techniques used for recognizing abnormal breathing patterns during sleep.

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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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OR10-01 Mild Maternal Sleep Disordered Breathing in Pregnant Women Affects Growth Patterns of Head Circumference and Adiposity During the First Three Years of Life

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.415 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Avivit Brener ◽

Yael Lebenthal ◽

Sigal Levy ◽

Galit Levi Dunietz ◽

Orna Sever ◽

...

Keyword(s):

Pregnant Women ◽

Head Circumference ◽

Sleep Disordered Breathing ◽

Growth Patterns ◽

Distinctive Pattern ◽

Third Trimester ◽

Sleep Study ◽

The Third ◽

Study Results ◽

Disordered Breathing

Abstract Background The intrauterine environment affects growth and adiposity acquisition from the fetal period until adulthood. Mild sleep disordered breathing (SDB) during pregnancy is a common underdiagnosed medical condition in healthy women. We aimed to investigate the interaction between maternal isolated SDB during the third trimester of pregnancy and the offspring’s growth and adiposity during the first three years of life. Methods Healthy pregnant women in the third trimester of an uncomplicated singleton pregnancy who were followed at the low-risk obstetric surveillance clinic of our hospital were recruited between 4/2013 and 5/2016. They were followed from enrollment until their offspring was three years old. During their third trimester of pregnancy, they underwent an ambulatory overnight sleep study by means of a validated sleep technology [SDB defined as apnea hypopnea index (AHI) ≥5]. Fasting blood samples were drawn on the following morning for glucose, insulin, HbA1c, lipid profile and C-reactive protein (CRP) levels. The offspring’s growth (length, weight and head circumference) and adiposity (subscapular and triceps skinfolds) parameters were measured at birth, 1 and 4 months, and 1, 2, and 3 years of age. Growth parameters were presented as standard deviation scores using the CDC growth charts. A general linear model was used to evaluate the interaction between maternal SDB and her offspring’s growth and adiposity measurements, after controlling for gestational week at delivery and maternal and paternal body mass index (BMI). Results Fourteen of 58 women (24.1%) were diagnosed with SDB (AHI range 5.3–14.7). They had a significantly higher mean BMI during the third trimester of pregnancy (30.1 ± 3.9 vs 27.2 ± 3.5, P = 0.011), elevated CRP levels, and decreased HDL-cholesterol levels (6.39 ± 2.29 mg/L vs 4.28 ± 2.15 mg/L, P = 0.003 and 67 ± 14 mg/dl vs 82 ± 19 mg/dl, P = 0.009, respectively) compared to women with normal sleep study results. Offspring of mothers with SDB had a smaller mean head circumference SDS at birth (-0.95 ± 0.70 vs -0.30 ± 0.71, P = 0.004), with a distinctive pattern of catchup growth by the end of the first year of life (P = 0.018). They also had increased mean adiposity at birth measured by triceps and subscapular skinfolds (6.8 ± 1.8 mm vs 5.4 ± 1.2 mm, P =0.002 and 5.8 ± 1.3 mm vs 5.0 ± 1.0 mm, P =0.019, respectively), with a distinctive pattern of increased triceps thickness at age 3 years (P = 0.001). There was no significant difference in offspring length or weight between groups. Conclusions Our findings suggest that isolated maternal SDB during pregnancy affected longitudinal head circumference growth and adiposity acquisition in the fetus and during the first three years of life.

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Sleep Disordered Breathing in Children with Mitochondrial Disease

Pulmonary Medicine ◽

10.1155/2014/467576 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ricardo A. Mosquera ◽

Mary Kay Koenig ◽

Rahmat B. Adejumo ◽

Justyna Chevallier ◽

S. Shahrukh Hashmi ◽

...

Keyword(s):

Mitochondrial Disease ◽

Sleep Disordered Breathing ◽

Chart Review ◽

Muscle Tone ◽

Retrospective Chart Review ◽

Overweight Status ◽

Obstructive Sleep ◽

The Common ◽

Review Study ◽

Disordered Breathing

A retrospective chart review study was performed to determine the presence of sleep disordered breathing (SDB) in children with primary mitochondrial disease (MD). The symptoms, sleep-related breathing, and movement abnormalities are described for 18 subjects (ages 1.5 to 18 years, 61% male) with MD who underwent polysomnography in our pediatric sleep center from 2007 to 2012. Of the 18 subjects with MD, the common indications for polysomnography were excessive somnolence or fatigue (61%,N= 11), snoring (44%,N= 8), and sleep movement complaints (17%,N= 3). Polysomnographic measurements showed SDB in 56% (N= 10) (obstructive sleep apnea in 60% (N= 6), hypoxemia in 40% (N= 4), and sleep hypoventilation in 20% (N= 2)). There was a significant association between decreased muscle tone and SDB (P: 0.043) as well as obese and overweight status with SDB (P=0.036). SDB is common in subjects with MD. Early detection of SDB, utilizing polysomnography, should be considered to assist in identification of MD patients who may benefit from sleep-related interventions.

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ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

European Respiratory Journal ◽

10.1183/13993003.00985-2017 ◽

2017 ◽

Vol 50 (6) ◽

pp. 1700985 ◽

Cited By ~ 29

Author(s):

Athanasios G. Kaditis ◽

Maria Luz Alonso Alvarez ◽

An Boudewyns ◽

Francois Abel ◽

Emmanouel I. Alexopoulos ◽

...

Keyword(s):

Airway Obstruction ◽

Sleep Disordered Breathing ◽

Objective Assessment ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Sleep Study ◽

Mandibular Hypoplasia ◽

Obstructive Sleep ◽

Obstructive Sleep Disordered Breathing ◽

Disordered Breathing

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1–23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g.snoring) and/or conditions predisposing to SDB (e.g.mandibular hypoplasia) as well as children with SDB and complex conditions (e.g.Down syndrome, Prader–Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g.supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1–23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.

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The Utility of a Portable Sleep Monitor to Diagnose Sleep-Disordered Breathing in a Pediatric Population

Canadian Respiratory Journal ◽

10.1155/2014/271061 ◽

2014 ◽

Vol 21 (1) ◽

pp. 31-35 ◽

Cited By ~ 15

Author(s):

Colin Massicotte ◽

Suhail Al-Saleh ◽

Manisha Witmans ◽

Indra Narang

Keyword(s):

Sleep Disordered Breathing ◽

Pediatric Population ◽

Apnea Hypopnea Index ◽

Strongly Correlated ◽

Sleep Study ◽

Obstructive Sleep ◽

Abnormal Breathing ◽

Delays In Diagnosis ◽

Pearson Correlations ◽

Disordered Breathing

BACKGROUND: Central and/or obstructive sleep-disordered breathing (SDB) in children represents a spectrum of abnormal breathing during sleep. SDB is diagnosed using the gold standard, overnight polysomnography (PSG). The limited availability and access to PSG prevents its widespread use, resulting in significant delays in diagnosis and treatment of SDB. As such, portable sleep monitors are urgently needed.OBJECTIVE: To evaluate the utility of a commercially available portable sleep study monitor (PSS-AL) (ApneaLink, ResMed, USA) to diagnose SDB in children.METHODS: Children referred to a pediatric sleep facility were simultaneously monitored using the PSS-AL monitor and overnight PSG. The apnea-hypopnea index (AHI) was calculated using the manual and autoscoring function of the PSS-AL, and PSG. Sensitivity and specificity were compared with the manually scored PSS-AL and PSG. Pearson correlations and Bland-Altman plots were constructed.RESULTS: Thirty-five children (13 female) completed the study. The median age was 11.0 years and the median body mass index z-score was 0.67 (range −2.3 to 3.8). SDB was diagnosed in 17 of 35 (49%) subjects using PSG. The AHI obtained by manually scored PSS-AL strongly correlated with the AHI obtained using PSG (r=0.89; P<0.001). Using the manually scored PSS-AL, a cut-off of AHI of >5 events/h had a sensitivity of 94% and a specificity of 61% to detect any SDB diagnosed by PSG.CONCLUSIONS: Although PSG is still recommended for the diagnosis of SDB, the ApneaLink sleep monitor has a role for triaging children referred for evaluation of SDB, but has limited ability to determine the nature of the SDB.

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