Respiratory-related evoked potentials during sleep in children.

STUDY OBJECTIVES: The respiratory related evoked potential (RREP) has been previously recorded in children and adults during wakefulness and in adults during sleep. However, there have been no data on RREP during sleep in children. We thus examined children during sleep to determine whether early RREP components would be maintained during all sleep DESIGN AND PARTICIPANTS: Twelve healthy, nonsnoring children, aged 5-12 years, screened by polysomnography and found to have no sleep disorders were assessed during stage 2 sleep, slow wave sleep, and REM sleep. Brief occlusions were presented via an occlusion valve at the inspiratory port of a non-rebreathing valve as interruptions of inspiration. EEG responses were averaged and assessed for the presence of early and late RREP components. RESULTS: Robust early components were seen in the majority of subjects in all sleep stages. Late components were also present, although with some apparent differences compared to those previously reported in adults (using the same recording protocol and an almost identical method of stimulus presentation). Specifically, N350 and N550 were less readily differentiated as separate components, and the N550 did not display the clear anterior-posterior amplitude gradient that is ubiquitous in adults. CONCLUSION: Cortical processing of respiratory-related information persists throughout sleep in children. The pattern of activation in the late components appear to reflect differences in the structure of the developing brain prior to the process of dendritic pruning associated with adolescence.

Reliability of scoring arousals in normal children and children with obstructive sleep apnea syndrome.

STUDY OBJECTIVES: Scoring of arousals in children is based on an extension of adult criteria, as defined by the American Sleep Disorders Association (ASDA). By this, a minimum duration of 3 seconds is required. A few recent studies utilized modified criteria for the study of children, with durations as short as 1 second. However, the validity and reliability of scoring these shorter arousals have never been verified. Based on studies in adults, we hypothesized that interscorer agreement for scoring arousals shorter than 3 seconds was poor. DESIGN: Retrospective review of polysomnograms by 2 experienced sleep practitioners who independently scored arousals according to the ASDA 3-second criteria and modified duration criteria of 1 and 2 seconds. SETTING: Academic hospital. PATIENTS OR PARTICIPANTS: 20 polysomnographic studies from children aged 3 to 8 years with mild to severe obstructive sleep apnea syndrome, and 16 polysomnographic studies from normal children. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The intraclass correlation coefficient for scoring ASDA arousals was 0.90 (95% confidence interval: 0.81-0.95), indicating excellent interscorer agreement. The intraclass correlation coefficient for scoring modified 1-second and 2-second arousals were 0.35 (95% confidence interval: 0.02-0.61) and 0.42 (95% confidence interval: 0.12-0.65) respectively, indicating poor to fair interscorer agreement. Furthermore, modified 1-second and 2-second arousals accounted for less than 15% of all arousals scored. CONCLUSIONS: We conclude that there is much poorer interscorer agreement for scoring arousals shorter than 3 seconds, when compared to the standard ASDA criteria. We propose that scoring of arousals in children should follow the standard ASDA criteria.

Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing.

OBJECTIVES: Excessive daytime sleepiness (EDS) is seen less frequently as a presenting complaint in children with sleep-disordered breathing than in adults. Instead, symptoms of hyperactivity are often described. We hypothesized that children with suspected sleep-disordered breathing (S-SDB) were both sleepier and more hyperactive than control subjects. Furthermore, we hypothesized that overnight polysomnographic parameters correlated with sleepiness and hyperactivity. METHODS: A cross-sectional study was conducted at a university-affiliated hospital and a community-based pediatric clinic. A total of 108 patients with S-SDB (mean [standard deviation] age: 7 +/- 4 years) and 72 control subjects (8 +/- 4 years) were recruited. A modified Epworth Sleepiness Scale (ESS) and the Conners Abbreviated Symptom Questionnaire were administered. Polysomnography was performed in patients with S-SDB. RESULTS: Patients with S-SDB had a higher ESS (8.1 +/- 4.9 vs 5.3 +/- 3.9) and a higher Conners score (12.8 +/- 7.6 vs 9.0 +/- 6.2) than control subjects. On the basis of adult criteria, 28% of patients had EDS. There was no difference in the ESS and Conners scores of patients with primary snoring and patients with obstructive sleep apnea. The ESS had weak correlations with polysomnographic parameters. CONCLUSIONS: Although the ESS score of children with S-SDB was within the normal range for adults, these children were sleepier and more hyperactive than control subjects. However, these data should be confirmed by a population-based study.