Association of body anthropometry and obstructive sleep apnea in children: Variations observed in Hispanic children.

Objectives: Obesity is a risk factor for obstructive sleep apnea (OSA) in children. Childhood obesity rates vary amongst different ethnic groups. Here the interaction of Hispanic ethnicity and obesity on OSA risk was evaluated. Methods: Retrospective cross-sectional analysis of consecutive children undergoing polysomnography and anthropometry using bioelectrical impedance from 2017 to 2020. Demographics obtained from the medical chart. Children who had also undergone cardiometabolic testing were identified and the relationship of cardiometabolic markers with OSA and anthropometry was assessed. Results: Data from 1217 children revealed Hispanic children were more likely to have moderate-severe OSA (36.0%) compared to Non-Hispanic children (26.5%), p < 0.001. Hispanic children had greater Body mass index (BMI), BMI percentile and percent body fat, p < 0.0001. In children that underwent cardiometabolic testing, Hispanic children had significantly greater serum alanine aminotransferase levels (ALT) levels. Following adjustment of age and sex, Hispanic ethnicity was not found to moderate the association of anthropometry with OSA, anthropometry with cardiometabolic markers, and OSA with cardiometabolic markers. Conclusions: OSA was more likely in Hispanic children; this relationship was likely driven by obesity status rather than ethnicity. Among children undergoing cardiometabolic testing, Hispanic children were observed to have greater ALT concentrations however ethnicity did not impact the association of anthropometry and ALT or other cardiometabolic markers.

Evaluation of sleep medicine fellowship program websites.

STUDY OBJECTIVES: Sleep fellowship program websites likely serve as a preliminary source of information for prospective fellows. Arguably, applicants have likely become even more reliant on program websites during the COVID-19 pandemic due to travel restrictions and social-distancing measures limiting in-person interviews. In this study, we evaluated the content and comprehensiveness of sleep medicine fellowship websites to identify areas of improvement. METHODS: A list of sleep medicine fellowship programs in the United States participating in the 2021 match cycle was compiled using the Electronic Residency Application Service (ERAS) and Fellowship and Residency Electronic Interactive database (FREIDA) websites. Twenty-two prespecified content criteria related to education, recruitment, and compensation were used to evaluate each program website. Sleep programs' website comprehensiveness were compared based on US location, type, matching status, core specialty, and size of programs. RESULTS: Seventy-eight US sleep fellowship program websites were evaluated. Most program websites had a working hyperlink on ERAS or FREIDA. There was considerable variability in content reported across program websites, with a mean of 56.8% of content items reported per program. There was a greater educational website content comprehensiveness for internal medicine compared with other specialty-based sleep programs. There was no difference in sleep programs' website comprehensiveness based on US location, type, matching status, or size of programs. CONCLUSIONS: Website content comprehensiveness among sleep fellowship programs is variable. There is opportunity for all sleep fellowship programs to improve their websites to better inform prospective trainees. CITATION: Shenoy S, Akberzie W, Landeo-Gutierrez JS, Leon Guerrero CR, Karroum EG. Evaluation of sleep medicine fellowship program websites. J Clin Sleep Med. 2023;19(6):1083-1088.

Lower respiratory tract infections in early life are associated with obstructive sleep apnea diagnosis during childhood in a large birth cohort.

STUDY OBJECTIVES: Several birth cohorts have defined the pivotal role of early lower respiratory tract infections (LRTI) in the inception of pediatric respiratory conditions. However, the association between early LRTI and the development of obstructive sleep apnea (OSA) in children has not been established. METHODS: To investigate whether early LRTIs increase the risk of pediatric OSA, we analyzed clinical data in children followed during the first 5 years in the Boston Birth Cohort (n = 3114). Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariates were used to evaluate the risk of OSA by the age of 5 years between children with LRTI during the first 2 years of life in comparison to those without LRTI during this period. RESULTS: Early life LRTI increased the risk of pediatric OSA independently of other pertinent covariates and risk factors (hazard ratio, 1.53; 95% CI, 1.15 to 2.05). Importantly, the association between LRTI and pediatric OSA was limited to LRTIs occurring during the first 2 years of life. Complementarily to this finding, we observed that children who had severe respiratory syncytial virus bronchiolitis during infancy had two times higher odds of OSA at 5 years in comparison with children without this exposure (odds ratio, 2.09; 95% CI, 1.12 to 3.88). CONCLUSIONS: Children with severe LRTIs in early life have significantly increased risk of developing OSA during the first 5 years of life. Our results offer a new paradigm for investigating novel mechanisms and interventions targeting the early pathogenesis of OSA in the pediatric population.

Defining the patterns of PAP adherence in pediatric obstructive sleep apnea: a clustering analysis using real-world data.

STUDY OBJECTIVES: The implementation of positive airway pressure (PAP) therapy to treat obstructive sleep apnea in children is a complex process. PAP therapy data are highly heterogeneous in pediatrics, and the clinical management cannot be generalized. We hypothesize that pediatric PAP users can be subgrouped via clustering analysis to guide tailored interventions. METHODS: PAP therapy data for 250 children with obstructive sleep apnea were retrospectively examined using unsupervised hierarchical cluster analysis based on (1) PAP tolerance (average hours on days used) and (2) consistency of PAP use (percentage of days used). Clinical features in each cluster were defined, and a tree decision analysis was generated for clinical implementation. RESULTS: We were able to subclassify all 250 children (median age = 11.5 years) into five clusters: A (13.6%), B (29.6%), C (17.6%), D (16.4%), and E (22.8%). The clusters showed significant differences in PAP use patterns (Kruskal-Wallis P value < 1e-16). The most consistent PAP use patterns were seen in clusters A, B, and C. Major differences across clusters included the prevalence of obesity, PAP setting, developmental delay, and adenotonsillectomy. We also identified important differences in mask acceptance, OSA severity, and individual responses to PAP therapy based on objective apnea-hypopnea reductions in PAP downloads. CONCLUSIONS: A simple method to subset PAP use patterns in children can be implemented by analyzing cloud-based PAP therapy data. This novel approach may contribute to optimization of PAP therapy in children of all ages based on real-world evidence at the individual level.

Prevalencia de síndrome de burnout en alumnos del séptimo año de medicina de una universidad privada de Lima, Perú / Prevalence of burnout syndrome in seventh year medical students from a private university of Lima, Peru

El síndrome de burnout (SBO) se ha descrito como una entidad patológica común entre los médicos y que podría originarse durante su formación académica. Objetivo: Determinar la prevalencia y los factores asociados al SBO en alumnos de medicina del séptimo año de la Universidad Peruana Cayetano Heredia (UPCH). Material y Métodos: Se realizó un estudio transversal con los estudiantes de medicina del séptimo año de la UPCH (n=117) durante diciembre del 2010. Se empleó dos encuestas autoadministradas anónimas, una sobre características sociodemográficas y laborales y otra, la escala Maslach Burnout Inventory en su versión Human Services Survey validada en español. Resultados: Se encontró una prevalencia de SBO de 57,2% (n=59). Más de la mitad de la población presentó niveles medio o alto en despersonalización (DP) (68,9% [n=71]) y agotamiento emocional (AE) (67% [n =69]) y aproximadamente un tercio de los estudiantes tuvieron baja realización personal (RP) (35% [n=36]). No se encontró asociación estadísticamente significativa entre las variables sociodemográficas y laborales estudiadas y la presencia de SBO. La presencia de enfermedad mental se asoció a niveles altos de DP y AE, mientras la ausencia de actividades extracurriculares se asoció a elevados puntajes en AE. Conclusiones: El SBO estuvo presente en más de la mitad de los internos de medicina de la UPCH. La presencia de enfermedad mental y ausencia de actividades extracurriculares se asociaron a las dimensiones del SBO.

Burnout syndrome has been described as a common pathology among physicians and that may begin during medical formation. Objective: To establish the prevalence of burnout and its associated factors in seventh year medical students of Universidad Peruana Cayetano Heredia (UPCH). Materials and Methods: A transversal study was preformed with seventh year medical students from UPCH (n =117) during December 2010. Two anonymous self-administered questionnaires were assessed, one of them included sociodemographic and laboral characteristics and the other included the Maslach Burnout Inventory û Human Services Survey version validated in Spanish. Results: The prevalence of burnout was established at 57,2% (n=59). Over one half of the population had middle or high levels on depersonalization (DP) (68,9% [n =71]) and emotional exhaustion (EE) (67% [n = 69]) and about one third of students presented low personal accomplishment (PA) (35% [n =36]). No statistical significance was found between sociodemographic and occupational variables studied and burnout. The presence of mental illness was associated with high levels of DP and EE, while the absence of extracurricular activities was associated with high levels of EE. Conclusions: Burnout is present in more than half of medical interns of UPCH. The presence of mental illness and the absence of extracurricular activities were associated with burnout dimensions.