RESUMO
OBJECTIVE: To investigate the amount of time spent in periodic breathing and its consequences in infants born preterm before and after hospital discharge. METHODS: Infants born preterm between 28-32 weeks of gestational age were studied during daytime sleep in the supine position at 32-36 weeks of postmenstrual age (PMA), 36-40 weeks of PMA, and 3 months and 6 months of corrected age. The percentage of total sleep time spent in periodic breathing (% total sleep time periodic breathing) was calculated and infants were grouped into below and above the median (8.5% total sleep time periodic breathing) at 32-36 weeks and compared with 36-40 weeks, 3 and 6 months. RESULTS: Percent total sleep time periodic breathing was not different between 32-36 weeks of PMA (8.5%; 1.5, 15.0) (median, IQR) and 36-40 weeks of PMA (6.6%; 0.9, 15.1) but decreased at 3 (0.4%; 0.0, 2.0) and 6 months of corrected age 0% (0.0, 1.1). Infants who spent above the median % total sleep time periodic breathing at 32-36 weeks of PMA spent more % total sleep time periodic breathing at 36-40 weeks of PMA (18.1%; 7.7, 23.9 vs 2.1%; 0.6, 6.4) and 6 months of corrected age 0.9% (0.0, 3.3) vs 0.0% (0.0, 0.0). CONCLUSIONS: Percentage sleep time spent in periodic breathing did not decrease as infants born preterm approached term corrected age, when they were to be discharged home. High amounts of periodic breathing at 32-36 weeks of PMA was associated with high amounts of periodic breathing at term corrected age (36-40 weeks of PMA), and persistence of periodic breathing at 6 months of corrected age.
Assuntos
Recém-Nascido Prematuro , Alta do Paciente , Recém-Nascido , Humanos , Lactente , Sono , Idade Gestacional , HospitaisRESUMO
BACKGROUND: To assess if the effects of sleep disordered breathing (SDB) on heart rate (HR) and HR variability, as a measure of autonomic control, were more severe in a group of children born preterm compared with a group of children born at term referred to our sleep laboratory for assessment of SDB. STUDY DESIGN: Children (3-12 years of age) referred for polysomnographic assessment of SDB were recruited; 50 born preterm (<37 weeks of gestation) and 50 at term, matched for age and SDB severity. The mean HR and HR variability using power spectral analysis were calculated for each child for wake and sleep, and stages N1, N2, N3, and rapid eye movement sleep. RESULTS: Ex-preterm children were born between 23 and 35 weeks of gestational age (29.3 ± 3.6; mean ± SEM). There were no differences in the demographic, sleep, or respiratory characteristics between the groups. High-frequency power (reflecting parasympathetic activity) was greater in the ex-preterm children in both N2 and N3 (P < .05 for both) and total power was greater in N3 (P < .05). When the children were divided by SDB severity, these effects were most marked in those preterm born children with moderate to severe disease. CONCLUSIONS: Preterm born children matched for age and SDB severity with children born at term showed no differences in sleep characteristics; however, they did exhibit increased parasympathetic tone during non-rapid eye movement sleep.
Assuntos
Sistema Nervoso Autônomo , Doenças Cardiovasculares/fisiopatologia , Recém-Nascido Prematuro , Síndromes da Apneia do Sono/fisiopatologia , Sono , Pressão Sanguínea , Sistema Cardiovascular/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Frequência Cardíaca , Humanos , Recém-Nascido , Masculino , Polissonografia , Estudos Retrospectivos , Sono REMRESUMO
OBJECTIVE: To measure sleep patterns and quality, objectively and subjectively, in clinically stable children with cystic fibrosis (CF) and healthy control children, and to examine the relationship between sleep quality and disease severity. STUDY DESIGN: Clinically stable children with CF and healthy control children (7-18 years of age) were recruited. Sleep patterns and quality were measured at home with actigraphy (14 days). Overnight peripheral capillary oxygen saturation was measured via the use of pulse oximetry. Daytime sleepiness was evaluated by the Pediatric Daytime Sleepiness Scale (PDSS) and subjective sleep quality by the Sleep Disturbance Scale for Children and Obstructive Sleep Apnea-18. RESULTS: A total of 87 children with CF and 55 control children were recruited with no differences in age or sex. Children with CF had significantly lower total sleep time and sleep efficiency than control children due to frequent awakenings and more wake after sleep onset. In children with CF, forced expiratory volume in 1 second and overnight peripheral capillary oxygen saturation nadir correlated positively with total sleep time and sleep efficiency and negatively with frequency of awakenings and wake after sleep onset. Patients with CF had significantly greater Sleep Disturbance Scale for Children (45 vs 35; P < .001), Obstructive Sleep Apnea-18 (35 vs 24; P < .001), and PDSS scores (14 vs 11; P < .001). There was a negative correlation between PDSS and forced expiratory volume in 1 second (r = -0.23; P < .05). CONCLUSIONS: Even in periods of clinical stability, children with CF get less sleep than their peers due to more time in wakefulness during the night rather than less time spent in bed. Objective measures of sleep disturbance and subjective daytime sleepiness were related to disease severity. In contrast, parents of children with CF report high levels of sleep disturbance unrelated to disease severity.
Assuntos
Fibrose Cística/complicações , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Actigrafia/métodos , Adolescente , Distribuição por Idade , Austrália , Estudos de Casos e Controles , Criança , Fibrose Cística/diagnóstico , Feminino , Volume Expiratório Forçado , Humanos , Incidência , Masculino , Oximetria/métodos , Polissonografia/métodos , Prognóstico , Troca Gasosa Pulmonar , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Transtornos do Sono-Vigília/diagnóstico , Estatísticas não Paramétricas , Centros de Atenção TerciáriaRESUMO
STUDY OBJECTIVES: The obstructive sleep apnea syndrome (OSAS) is more prevalent in ex-preterm children compared to the general pediatric population. However, it is unknown whether OSAS in ex-preterm children is associated with specific perinatal risk factors. This multicenter cohort study aimed to determine perinatal factors associated with OSAS at school age. METHODS: 197 ex-preterm (500-1,250 g) children aged 5-12 y who participated as neonates in a double-blind, randomized clinical trial of caffeine versus placebo (Caffeine for Apnea of Prematurity) underwent comprehensive ambulatory polysomnography. A negative binomial regression model was used to identify perinatal risk factors associated with OSAS. RESULTS: 19 children had OSAS (9.6%). Chorioamnionitis and multiple gestation were positively associated with OSAS with P values of 0.014 and 0.03, respectively. Maternal white race (P = 0.047) and maternal age (P = 0.002) were negatively associated with OSAS. Other risk factors, such as birth weight, Apgar score at 5 min, antenatal corticosteroids, delivery route, and sex were not significant. CONCLUSIONS: OSAS is very frequent, and is associated with chorioamnionitis and multiple gestation in ex-preterm children. Those born to older white mothers appear to be protected. We speculate that the former may be due to systemic inflammation and the latter to a higher socio-economic status. COMMENTARY: A commentary on this article appears in this issue on page 721.
Assuntos
Recém-Nascido Prematuro , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Índice de Apgar , Peso ao Nascer , Cafeína/administração & dosagem , Cafeína/efeitos adversos , Criança , Pré-Escolar , Corioamnionite , Estudos de Coortes , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Idade Materna , Polissonografia , Gravidez , Complicações na Gravidez , Gravidez Múltipla , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Classe Social , População BrancaRESUMO
OBJECTIVE: To determine whether sustained resolution of sleep disordered breathing (SDB) in young children, either because of treatment or spontaneous recovery, predicted long-term improvements in quality of life, family functioning, and parental stress. STUDY DESIGN: Children diagnosed with primary snoring (n = 16), mild obstructive sleep apnea (OSA, n = 11), moderate-severe (MS) OSA (n = 8), and healthy nonsnoring controls (n = 25) at ages 3-5 years underwent repeat polysomnography at 6-8 years. Parents completed quality of life and parental stress questionnaires at both time points. Resolution of SDB was determined as obstructive apnea hypopnea index (OAHI) ≤1 event/hour, or absence of snoring during polysomnography or on parent report. Linear mixed-model analyses determined the effects of resolution on psychosocial morbidity. OAHI was used to determine the predictive value of changes in SDB severity on psychosocial outcomes. RESULTS: Fifty percent of primary snoring, 45% mild OSA, and 63% MS OSA resolved, of which 67% received treatment. Children originally diagnosed with SDB continued to show significant psychosocial impairments compared with nonsnoring controls, irrespective of resolution. A reduction in OAHI predicted improvements in physical symptoms, school functioning, family worry and family relationships, and stress related to a difficult child. CONCLUSIONS: Treatment was more likely to result in resolution of SDB if original symptoms were MS. Children originally diagnosed with SDB, irrespective of resolution, continued to experience psychosocial dysfunction suggesting additional interventions are required.
Assuntos
Pais/psicologia , Qualidade de Vida/psicologia , Síndromes da Apneia do Sono/psicologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Polissonografia , Índice de Gravidade de Doença , Sono , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/fisiopatologia , Ronco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To compare symptoms of obstructive sleep apnea (OSA) and polysomnography (PSG) results in children with Down syndrome and typically developing children. STUDY DESIGN: A total of 49 children with Down syndrome referred for PSG between 2008 and 2012 were matched with typically developing children of the same sex, age, and OSA severity who had undergone PSG in the same year. A parent completed a sleep symptom questionnaire for each child. Sleep quality and measures of gas exchange were compared between the matched groups. RESULTS: The 98 children (46 females, 52 males) had mean age of 6.2 years (range, 0.3-16.9 years). Fourteen children had primary snoring, and 34 had OSA (9 mild, 7 moderate, and 19 severe). Children with Down syndrome had more severe OSA compared with 278 typically developing children referred in 2012. Symptom scores were not different between the matched groups. Those with Down syndrome had a higher average pCO2 during sleep (P = .03) and worse McGill oximetry scores. CONCLUSION: Compared with closely matched typically developing children with OSA of comparable severity, children with Down syndrome had a similar symptom profile and slightly worse gas exchange. Referred children with Down syndrome had more severe OSA than referred typically developing children, suggesting a relative reluctance by parents or doctors to investigate symptoms of OSA in children with Down syndrome. These findings highlight the need for formal screening tools for OSA in children with Down syndrome to improve detection of the condition in this high-risk group.
Assuntos
Síndrome de Down/complicações , Programas de Rastreamento/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Polissonografia , Apneia Obstrutiva do Sono/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine predictors of continuous airway pressure (CPAP) adherence in children. STUDY DESIGN: Analysis of CPAP usage data for children between 2004 and 2008. RESULTS: During the study period, 32 children were prescribed CPAP; 2 failed to accept the mask, and 30 (mean ± SD age 9.1 ± 5.3 years) were included in further analysis. In the first 2 to 3 months of treatment, average (± SD) CPAP use was 4.7 ± 2.7 hours/night. Hours of use were not affected by age, sex, baseline obstructive apnea-hypopnea index, intellectual disability, or socioeconomic status (P > .05). Of the children, 10 (33%) used CPAP for one hour or more on more than 6 nights per week and were defined as consistent users. Consistent users treated with CPAP for significantly longer on nights of use than intermittent users (7.2 ± 2.0 hours vs 4.7 ± 2.4 hours, P = .008). The hours of use differed between the two groups after the second night of treatment (P < .05), and this difference persisted for the first 3 months of therapy. CONCLUSIONS: Children who attempted to use CPAP at least 6 nights a week were treated with CPAP for a longer time on the nights of use. Usage in the first week of treatment predicted longer term use over 2 to 3 months. Monitoring adherence in the first week of treatment and intervening in cases of low adherence may improve long-term CPAP use.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Apneia Obstrutiva do Sono/terapia , Fatores Etários , Criança , Feminino , Humanos , Deficiência Intelectual , Masculino , Índice de Gravidade de Doença , Fatores Sexuais , Classe SocialRESUMO
OBJECTIVE: To obtain parental perspectives on changes in sleep, breathing, quality of life (QOL), and neurobehavioral measures after adenotonsillectomy. STUDY DESIGN: This retrospective cohort study comprised otherwise healthy children evaluated for obstructive sleep apnea syndrome (OSAS) from 1993 to 2001. We compared those children who underwent adenotonsillectomy with those children who did not. The parents of 473 children (292 boys) 2 years of age and older were sent questionnaires to evaluate QOL and clinical and behavioral changes. For 94 children 3 years of age and older, behavioral changes were evaluated using the Conners' Parent Rating Scale-Revised (CPRS-R) for three different periods: pre-operatively/pre-polysomnography, postoperatively/postpolysomnography, and recently. RESULTS: One hundred and sixty-six questionnaires were returned (35%), 138 of which were complete with written consent provided. Compared with parents of unoperated children, parents of children who had adenotonsillectomy were more likely to report improvements in sleep, breathing, and QOL but not improvements in concentration, school performance, and intellectual or developmental progress. Both short and long term, there were no significant effects of adenotonsillectomy on any of the CPRS-R behavior subscales. CONCLUSION: From a parental perspective, adenotonsillectomy frequently improves sleep, breathing, and QOL but does not often improve neurobehavioral outcomes.