Night-to-night variability in respiratory parameters in children and adolescents examined for obstructive sleep apnea.

INTRODUCTION: The diagnosis of obstructive sleep apnea (OSA) is routinely based on just a single night's sleep examination. The night-to-night variability in children and adolescents has previously been investigated using type 4 sleep monitors or PSG. However, there is a lack of studies investigating the night-to-night variability when using type 3 sleep monitors. Therefore, the main purpose was to investigate the night-to-night variability in respiratory parameters in children and adolescents using a portable type 3 monitor. Furthermore, the purpose was to investigate the clinical relevance of night-to-night variability. METHODS: The study population was recruited from an ongoing research project concerning the effect of weight loss in children and adolescents with OSA and overweight/obesity. The inclusion criterion was the successful recording of two consecutive nights of sleep. Sleep examinations were recorded at home using the Nox T3 device and then blindly scored by the same registered polysomnographic technologist. To compare the respiratory parameters measured each night, a paired t-test or a Wilcoxon signed-rank test was used. The apnea-hypopnea index (AHI) was further described graphically with a scatter plot and a Bland-Altman plot. The presence and severity of OSA were described in tables. RESULTS: A total of 30 children and adolescents with a median age of 14.8 years were included. When comparing respiratory parameters between nights, all p-values derived from paired t-tests and Wilcoxon signed-rank tests were >0.05. When considering the graphical depictions of AHI, it was evident that for some participants AHI measurements varied widely from night to night. Regarding the presence of OSA, 27% of participants changed diagnostic category between nights and 40% of those with a normal AHI on the first night had OSA on the second night. Regarding OSA severity, 50% of participants changed severity category between nights. CONCLUSIONS: AHI measurements varied widely between nights in some children and adolescents leading to frequent changes in both diagnosis and severity of OSA from night to night. We therefore suggest the presence of a clinically relevant night-to-night variability which should be taken into account when diagnosing pediatric OSA.

Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea.

OBJECTIVES: To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. METHODS: This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. RESULTS: A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). CONCLUSION: We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.

Impact of weight-loss management on children and adolescents with obesity and obstructive sleep apnea.

OBJECTIVES: To evaluate the impact of weight-loss management on obstructive sleep apnea (OSA) in children and adolescents with obesity. We hypothesized that a reduction in the degree of obesity was associated with a reduction in the apnea-hypopnea index (AHI). METHODS: OSA (AHI ≥2) was investigated using a type 3 portable sleep device (Nox T3) in children and adolescents aged 7-18 years with overweight or obesity (body mass index standard deviation score (BMI SDS) > 1.28) at enrollment in a chronic care multidisciplinary overweight- and obesity treatment clinic. Individuals with OSA were included prospectively and longitudinally. A follow-up sleep examination was performed after 6 and 12 months from baseline accompanied by anthropometric measurements. RESULTS: At baseline, 62 children with OSA were included (median age = 13.4 years, median BMI SDS = 3.16). A total of 55 out of 62 children (89%) attended the first follow-up, and 29 out of 34 children (85%) with residual OSA attended the second follow-up. By the end of the study, the AHI was normalized in 27 out of 62 children (44%). In a multiple linear regression analysis, the decrease in BMI SDS was associated with the decrease in AHI upon the first follow-up (p = 0.02) independently of sex; age; baseline puberty stage; baseline tonsillar hypertrophy; baseline AHI; baseline BMI SDS; and time to follow-up. There was no association between change in BMI SDS and change in AHI from the first to the second follow-up (p = 0.81). CONCLUSIONS: OSA improved during obesity treatment, and the reduction in BMI SDS was significantly associated with the reduction in AHI after approximately six months of treatment. This indicates that obesity treatment should be considered among the first-line treatments of OSA in children and adolescents affected by overweight or obesity.

Obstructive sleep apnea in children and adolescents with and without obesity.

PURPOSE: To investigate the prevalence of obstructive sleep apnea (OSA) in children referred for obesity treatment, and to compare the prevalence with that of a normal-weight group. Moreover, we examined the association between Body Mass Index Standard Deviation Score (BMI SDS) and the Apnea-Hypopnea Index (AHI). METHODS: This cross-sectional study included 139 children aged 7-18 years with overweight/obesity (BMI SDS >1.28) recruited from an obesity treatment clinic. The normal-weight group consisted of 33 children (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor (Nox T3). OSA was defined as AHI ≥ 2. Height and weight were measured and the tonsillar size was clinically estimated using the Brodsky scale. RESULTS: The OSA prevalence was 44.6% in children with overweight/obesity compared with 9.1% in the normal-weight group (p = 0.0002), and the relative risk of OSA was 4.9 (95% CI 1.6-14.7). In a logistic regression, a one-unit increase in the BMI SDS increased the odds of having OSA by a factor of 1.92 independent of age, sex, tonsillar hypertrophy, and asthma (95% CI 1.33-2.76, p = 0.0005). A generalized linear regression adjusted for the same variables revealed an association between BMI SDS and AHI (a one-unit increase in the BMI SDS equaled an average increase in the AHI of 35% (95% CI 19-53%, p < 0.0001)). CONCLUSIONS: In this study, children with overweight/obesity had a significantly higher prevalence of OSA compared with a normal-weight group. Increased BMI SDS was associated with increased AHI.

Validation of the Danish STOP-Bang obstructive sleep apnoea questionnaire in a public sleep clinic.

INTRODUCTION: Obstructive sleep apnoea is common; a prevalence of 1-5% was previously reported. However, only few cases are diagnosed and receive treatment. The aim of this study was to validate the Danish translated version of the STOP-Bang screening tool for obstructive sleep apnoea (OSA) in a public sleep clinic. 
 METHODS: A study population of 208 patients who were referred to a public sleep clinic on suspicion of OSA were assessed with the STOP-Bang questionnaire and at-home cardiorespiratory monitoring in order to assess the quality of the questionnaire as an OSA screening tool. 
RESULTS: In the study population, 73% were males, and 51% of the population had an Apnoea-Hypopnoea Index (AHI) ≥ 15. The STOP-Bang screening tool had a sensitivity of 0.98 for detection of OSA with AHI ≥ 15 and a corresponding specificity of 0.09. Hence, the questionnaire is able to detect almost all patients suffering from OSA. However, using the tool will cause many healthy subjects to be falsely classified as having OSA. 
 CONCLUSIONS: The Danish version of the STOP-Bang screening tool does not seem useful for OSA screening of patients in a sleep clinic setup, but it may be useful in primary care. 
 FUNDING: The Zealand Research Foundation. 
 TRIAL REGISTRATION: not relevant.

Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment - A systematic review.

OBJECTIVES: To systematically review and discuss the outcome of treating obstructive sleep apnea (OSA) in obese children and adolescents. METHODS: In February 2016 Pub Med was searched using a predetermined string to retrieve all relevant articles. The search identified 518 publications. In total 16 articles were included for review using the selected inclusion and exclusion criteria. The PRISMA guidelines was used. RESULTS: OSA was significantly more likely to persist in obese children after adenotonsillectomy. The prevalence of persistent OSA ranged from 33 to 76% in obese children and from 15 to 37% in non-obese children depending on the definition of OSA, the degree of obesity and the age of the study population. The few studies that investigated the effect of weight loss found that OSA improved significantly after intervention and that the prevalence of persistent OSA varied between 10 and 38%. Positive airway pressure was effective for treating OSA, but the mean nightly use was <4 h in two out of three available studies. CONCLUSION: Obese children benefit less from adenotonsillectomy than normal-weight children. Weight loss improve OSA significantly, but more research is needed to clarify the role of weight loss as treatment for OSA. Positive airway pressure is effective for treating OSA; however, adherence is a challenge.

Effectiveness of propanolol for treatment of infantile haemangioma.

INTRODUCTION: Infantile haemangiomas (IH) are the most common benign tumours in children. They are characterised by rapid growth during the first year of life followed by spontaneous regression during childhood. Indications for treatment are functional impairment, bleeding/ulceration, rapid growth and severe aesthetic risk. Recently, systemic treatment with propranolol has become the first-line therapy. The objective of this study was to assess the efficacy of propranolol in the treatment of IH and to investigate whether treatment with a low dose of 1 mg/kg/day was sufficient. MATERIAL AND METHODS: This study was retrospective and based on a review of children treated for IH with propranolol from the 2010-2012 period at Rigshospitalet. RESULTS: Overall, propranolol was effective in all but one child (97%). The majority of the children (84%) were treated with an initial dose of 1 mg/kg/day, which was considered sufficient in most cases (71%). Children who started treatment before five months of age had a significantly better response than children who started treatment at a later age. No relation was found between location of IH and the effect of treatment. There were only few and mild side effects. CONCLUSION: Propranolol is effective in the treatment of IH and it has only few and mild side effects. In most cases, a low dose of 1 mg/kg/day was sufficient. Early initiation of treatment is recommended as the response to treatment was better in younger children and because early initiation helps prevent large residual changes. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.