Distinguished Research - Sleep Apnea & Sleep Disordered Breathing

    The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy:  A systematic review and mata-analysis

    • Date: February 19, 2018
    • Source: American Journal of Obstetrics and Gynecology
    • Summary: Researchers performed a systematic review and meta-analysis to ascertain if pregnant women diagnosed with sleep-disordered breathing are more likely to have adverse intrapartum and perinatal outcomes compared to controls. They noticed increased risks of adverse intrapartum and perinatal outcomes in association with maternal sleep-disordered breathing. 

    Studies find tonsillectomies offer only modest benefits

    • Date: January 26, 2018
    • Source: Vanderbilt
    • Summary: Removing tonsils modestly reduced throat infections in the short term in children with moderate obstructive sleep-disordered breathing or recurrent throat infections, according to a systematic review conducted by the Vanderbilt Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ).

    Sleep-Disordered Breathing in Children with Recurrent Wheeze/Asthma: A Single Centre Study

    • Date: November 14, 2017
    • Source: Children
    • Abstract: The relationship between asthma and sleep-disordered breathing is bidirectional due to common risk factors that promote airway inflammation. Obstructive sleep-disordered breathing and recurrent wheeze/asthma are conditions that involve the upper and the lower respiratory system, respectively. The aim of the present study was to investigate the sleep disordered breathing in children with recurrent wheeze/asthma. This was a retrospective study concerning children older than 2 years who underwent—between January 2014 and November 2016—an in-laboratory overnight polygraphic study. We match the children between those who do or do not have recurrent wheeze/asthma disease. We examined the clinical records of 137 children. We excluded eight patients because of neurological and genetic conditions. Children with recurrent wheeze/asthma (N = 28) were younger (p = 0.002) and leaner (p = 0.013) compared to non-affected children (N = 98). Children with wheeze/asthma and unaffected ones had a similar obstructive apnea-hypopnea index (p = 0.733) and oxygen desaturation index (p = 0.535). The logistic regression analysis, in which the condition of wheeze/asthma (yes/no) was a dependent variable, while demographic (age, sex, body mass index (BMI) Z-score) and polygraphic results during sleep (obstructive apnea-hypopnea index, central apnea index, peripheral oxygen saturation (SpO2), and snoring) were covariates, showed that children with wheeze/asthma had higher central apnea index (Exp(B) = 2.212; Wald 6.845; p = 0.009). In conclusion, children with recurrent wheeze/asthma showed an increased number of central sleep apneas than unaffected children. This finding may suggest a dysfunction of the breathing control in the central nervous system during sleep. Systemic or central inflammation could be the cause.

    Interupted sleep may lead to Alzheimer's, new studies show

    • Date: July 18, 2017
    • Source: The Washington Post
    • Summary:  Three studies by researchers at Wheaton College in Illinois found significant connections between breathing disorders that interrupt sleep and the accumulation of biomarkers for Alzheimer’s disease.  People with sleep-disordered breathing experience repeated episodes of hypopnea (under-breathing) and apnea (not breathing) during sleep. It occurs when the upper airway closes fully or partially while efforts to breathe continue, and it can wake a person 50 or 60 times a night, interrupting the stages of sleep necessary for a restful night. 

    Obstructive sleep-disordered breathing, enuresis, and combined disorders in children: chance or related association?

    Interupted sleep may lead to Alzheimer's, new studies show

    • Date: Feb 3, 2017
    • Source: Swiss Med Weekly via pubmed.gov
    • Summary:  Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterised by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides.... Resolution of enuresis after medical or surgical treatment for obstructive sleep-disordered breathing has been emphasized. Consequently, symptoms such as snoring, sleep apneas and restless sleep should be sought for all children with enuresis. Confirmed obstructive sleep-disordered breathing should be treated promptly; subsequently, the persistence of enuresis requires treatment following the standard protocol.

    Sleep Disordered Breathing (SBD) Tied to Risk for Behavioral, Emotional Problems

    • Date: November 28, 2016
    • Source: PsychCentral
    • Summary: Young children with sleep-disordered breathing (SDB) are more likely to develop behavioral problems including hyperactivity and aggressiveness, as well as emotional and friendship difficulties, according to researchers at Albert Einstein College of Medicine of Yeshiva University. The study, the largest and most comprehensive of its kind, evaluated and followed more than 11,000 children for over six years. “This is the strongest evidence to date that snoring, mouth breathing, and apnea (abnormally long pauses in breathing during sleep) can have serious behavioral and social - emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics and gynecology and women’s health at Einstein. “Parents and pediatricians alike should be paying closer attention to sleep - disordered breathing in young children, perhaps as early as the first year of life

    Unraveling pediatric airway disorders

    • Date: December 22, 2014
    • Source: Dental Economics
    • Summary:  Airway trauma, brain damage, or death. Six months ago I found myself sitting in a presurgical room reading over these risk factors on the informed consent. My son was lying in his bed innocently watching cartoons. My wife and I decided to have an adenoidectomy performed to help facilitate his nasal breathing. At five years old, my son had a vague idea about what was going to happen next. Fortunately, he trusts mom and dad completely and knows it will help him breathe better. As a health-care provider, it is easier to tell the parents the minute risks associated with anesthesia and surgery. As a parent, that decision becomes a whole lot more difficult.

    Sleep difficulties common among toddlers with psychiatric disorders

    • Date: October 23, 2014
    • Source: Science Daily
    • Summary:  Sleep difficulties -- particularly problems with falling asleep -- were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders, a study has found. "This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said one expert.

    Towards Restoration of Continuous Nasal Breathing as the Ultimate Treatment Goal in Pediatric Obstructive Sleep Apnea

    • Date: September 6, 2014
    • Source: Enliven
    • Abstract:  The interaction between oral-facial structural growth and muscle activity starts early in development and continues through childhood. Chronic oral breathing is an important clinical marker of orofacial muscle dysfunction, which may be associated with palatal growth restriction, nasal obstruction, and/ or a primary disorder of muscular or connective tissue dysfunction. It is easily documented objectively during sleep. Treatment of pediatric obstructive-sleep-apnea (OSA) and sleep-disordered-breathing (SBD) means restoration of continuous nasal breathing during wakefulness and sleep; if nasal breathing is not restored, despite short-term improvements after adenotonsillectomy (T&A), continued use of the oral breathing route may be associated with abnormal impacts on airway growth and possibly blunted neuromuscular responsiveness of airway tissues. Elimination of oral breathing, i.e., restoration of nasal breathing during wake and sleep, may be the only valid end point when treating OSA. Preventive measures in at-risk groups, such as premature infants, and usage of myofunctional therapy as part of the treatment of OSA are proposed to be important approaches to treat appropriately SDB and its multiple co-morbidities.

    Disordered Sleep as a cause of Attention Deficit/Hyperactivity Disorder: Recognition and Management

    • Date: September 3, 2014
    • Source: Sage Journals
    • Summary:  Sleep disorders are an underlying cause of attention deficit/hyperactivity disorder (ADHA), but they are underdiagnose in children.

    A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

    • Date: June 20, 2013
    • Source: The New England Journal of Medicine
    • Abstract:  Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.

    Children with sleep apnea have higher risk of behavioral, adaptive and learning problems

    • Date: March 29, 2013
    • Source: AASM
    • Summary:  A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioral problems in children as well as other adaptive and learning problems. 

    Critical role of myofascial reeducation in pediatric sleep-disordered breathing

    • Date: March 23, 2013
    • Source: Elsevier
    • Abstract:  Limited studies suggest that pubertal development may lead to a recurrence of sleep-disordered breathing (SDB) despite previous curative surgery. Our study evaluates the impact of myofunctional reeducation in children with SDB referred for adenotonsillectomy, orthodontia, and myofunctional treatment in three different geographic areas.

    The Risks of Sleep-Disordered Breathing in Children

    • Date: Feburary 11, 2013
    • Source: Sleep Newzzz
    • Summary:  Sleep-disordered breathing in children is disruptive to their nightly rest, which can result in other health problems. Scientists are still working to get a sense of how prevalent the disorder is among children. We’re also still learning about the risk factors that contribute to sleep-disordered breathing in children, as well as the health consequences for kids who suffer from it. Increasingly, it appears that both the risks and the health effects of sleep-disordered breathing are different in children than they are in adults. A new study examines both the prevalence of sleep disordered breathing in children, and the particular risk factors they face.  

    Pediatric Obstructive Sleep Apnea and the Critical Role of Oral-Facial Growth : Evidences

    • Date: January 22, 2013
    • Source: Frontiers in Neurology
    • Abstract: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children. 

    Esophageal Pressures, Polysomnography, and Neurobehaviornal Outcomes of Adenotonsillectomy in Children

    • Date: July 2012
    • Source: Chest Journal
    • Background: Esophageal pressure monitoring during polysomnography in children offers a gold-standard, “preferred” assessment for work of breathing, but is not commonly used in part because prospective data on incremental clinical utility are scarce. We compared a standard pediatric apnea/hypopnea index to quantitative esophageal pressures as predictors of apnea-related neurobehavioral morbidity and treatment response.

    Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years

    • Date: March 2012
    • Source: Pediatrics
    • Objectives: Examine statistical effects of sleep-disordered breathing (SDB) symptom trajectories from 6 months to 7 years on subsequent behavior.

    Current hypopnea scoring criteria underscore pediatricc sleep disordered breathing.

    • Date: June 22, 2011
    • Source: Elsevier
    • Objective:  This is a retrospective study comparing 2007 American Academy of Sleep Medicine (AASM) pediatric scoring criteria and Stanford scoring criteria of pediatric polysomnograms to characterize the impact different scoring systems have upon the diagnosis of sleep disordered breathing in children.

    Sleep Disorders in Children - A National Assessment of Primary Care Pedistrician Practices and Perceptions

    • Date: May 17, 2011
    • Source: Pediatrics
    • Objective: To assess general pediatricians’ screening practices for sleep-related issues and assess their knowledge on common sleep complaints in children, their perceived barriers to screening for sleep issues, and whether they have received training regarding sleep issues.

    Nightime sleep found beneficial to infants' skills

    • Date: December 10, 2010
    • Source: Society for Research in Child Development
    • Summary:  Young children who get most of their sleep at night perform better in executive functioning than children who don't sleep as much at night, a new study finds. The study of 60 Canadian children aged 1, 1-1/2 and 2, examined the children's sleep habits and executive functioning skills, including impulse control and mental flexibility. The researchers found that children who sleep mostly at night did better on executive function tasks, especially those involving impulse control.

    Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities?

    • Date: September 2, 2007
    • Source: Sleep Med Clin.
    • Abstract: The spectrum of sleep disordered breathing (SDB) encompasses habitual snoring at the low end of severity all the way to frank obstructive sleep apnea (OSA), with upper airway resistance syndrome (UARS) and obstructive alveolar hypoventilation being considered as less severe variants of this condition. SDB occurs in children of all ages, from neonates to adolescents, and is characterized by repeated events of increased upper airway resistance as well as with either partial or complete upper airway obstruction during sleep, all of which may result in disruption of normal gas exchange and sleep integrity [1]. SDB was initially described over a century ago [2] and was then rediscovered in children by Guilleminault in 1976 [3]. However, this complex and relatively prevalent disorder is only now being recognized as a major public health problem. During the initial years since the seminal paper by Guilleminault et al [3], it became apparent that the classic clinical syndrome of OSA in children markedly differed from the OSA seen in adults, in particular with respect to gender distribution, clinical manifestations, polysomnographic findings, and treatment approaches [4,5]. However in more recent years, the epidemic of obesity that affects the pediatric population all over the world has led, in our opinion, to the emergence of a phenotypic variant of OSA in children that closely resembles that of adults with the disease. In this paper, we will review the pathophysiological mechanisms of OSA in children, delineate the clinical manifestations associated with the disease, and provide arguments for our novel and hopefully useful proposition that aims to define 2 types of OSA in children. For the sake of convenience, and in analogy with type I and type II diabetes, we propose to divide pediatric OSA as types I and II.

    Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy

    • Date: April 2006
    • Source: Pediatrics - Official Journal of the American Academy of Pediatrics
    • Abstract: Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care.

    Neurobehavioral Morbidity Associates with Disordered Breathing During Sleep in Children:  A Comprehensive Review

    • Date: March 14, 2006
    • Source: Sleep
    • Objective: To comprehensively review research on the association between childhood sleep-disordered breathing (SDB) and neurobehavioral functioning.

    Developmental Changes in Upper Airway Dynamics

    • Date: Feburary 27, 2004
    • Source: American Physiological Society
    • Summary:  Normal children have a less collapsible upper airway in response to subatmospheric pressure administration (PNEG) during sleep than normal adults do, and this upper airway response appears to be modulated by the central ventilatory drive. Children have a greater ventilatory drive than adults. 

    Developmental Changes in Upper Airway Dynamics

    • Date: June 2018
    • Source: Diabetes.co.uk
    • Summary: A study exploring whether treating obstructive sleep apnea helps improve diabetes management is set to start in the US. Sleep apnea, a form of interrupted breathing during sleep, has been associated with decreased blood sugar control in people with diabetes, as well as reduced insulin sensitivity. In this new study, researchers from the West Virginia University (WVU) School of Medicine want to investigate how much treating sleep apnea using a specific treatment may improve self-management and blood sugar levels.

    When Should a Child’s Tonsils Come Out?

    • Date: June 2018
    • Source:  Michigan Health
    • Summary: A Michigan Medicine pediatric specialist explains what tonsillectomy and adenoidectomy entails, from examination to recovery. e