Faculty Opinions recommendation of Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.

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.

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

Circulation ◽

10.1161/circ.127.suppl_12.ap249 ◽

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: ∆]]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.

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Sleep-disordered breathing, craniofacial development, and neurodevelopment in premature infants: a 2-year follow-up study

Sleep Medicine ◽

10.1016/j.sleep.2018.10.015 ◽

2019 ◽

Vol 60 ◽

pp. 20-25 ◽

Cited By ~ 3

Author(s):

Yu-Shu Huang ◽

Jen-Fu Hsu ◽

Teresa Paiva ◽

Wei-Chih Chin ◽

I-Chia Chen ◽

...

Keyword(s):

Premature Infants ◽

Sleep Disordered Breathing ◽

Craniofacial Development ◽

Follow Up Study ◽

Disordered Breathing

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215110001635 ◽

2010 ◽

Vol 125 (2) ◽

pp. 193-198 ◽

Cited By ~ 10

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.

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Impact of Tonsillectomy on Obesity in Pediatric Patients With Sleep-Disordered Breathing

OTO Open ◽

10.1177/2473974x211059105 ◽

2021 ◽

Vol 5 (4) ◽

pp. 2473974X2110591

Author(s):

Rohith S. Voora ◽

Daniela Carvalho ◽

Wen Jiang

Keyword(s):

Sleep Disordered Breathing ◽

Weight Status ◽

Pediatric Patients ◽

Case Series ◽

Surgical Indication ◽

Strongly Correlated ◽

Retrospective Case ◽

Academic Center ◽

Disordered Breathing

Objective Both tonsillar hypertrophy and obesity contribute to pediatric sleep-disordered breathing (SDB). Tonsillectomy addresses anatomical obstruction causing SDB; however, it may adversely affect the obesity profile postoperatively. Herein, we investigate posttonsillectomy body mass index (BMI) changes in pediatric patients. Study Design Retrospective case series. Setting Tertiary, pediatric urban academic center. Methods All patients undergoing tonsillectomy from January 1, 2016, to December 31, 2016, were included. Patients’ age, sex, surgical indication, and preoperative BMI were recorded. Postoperative BMI data were collected between March 1, 2016, and December 31, 2017. Statistical analysis was performed using a generalized regression model, using BMI percentile-for-age weight status. Results A total of 1153 patients were included (50% female), with age ranging from 2.0 to 19.5 years (mean [SD], 7.6 [4.0]). The majority (87.8%) had tonsillectomy for SDB. Of the cohort, 560 (48.6%) had available follow-up BMI data. The BMI percentile on the day of the surgery had a median of 65.8, and the BMI percentile on follow-up had a median of 76.4. The median time to follow-up was 197 days with a range of 50 to 605 days. Higher postoperative BMI percentile strongly correlated to higher preoperative BMI percentile ( P < .001), as well as younger age ( P < .001), male sex ( P = .0005), and SDB as a surgical indication ( P = .003). Conclusion We observed a significant increase in BMI percentile following tonsillectomy, which accounted for a significantly higher proportion of the cohort being classified as overweight or obese postoperatively. These findings necessitate greater preoperative counseling, closer follow-up, and adjunctive measures for obesity management in pediatric patients undergoing tonsillectomy.

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