Increased incidence of pediatric narcolepsy following the 2009 H1N1 pandemic: a report from the pediatric working group of the sleep research network.

This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6  ±â€… 3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p  <  .0001) occurred over the 1998-2016 period, peaking in 2010, reflecting a 1.6-fold increase in narcolepsy incidence. In addition, there was significant seasonal variation in narcolepsy incident cases, with increased cases in spring (p  <  .05). Cross-correlation analysis demonstrated a significant correlation between monthly H1N1 infection and monthly narcolepsy incident cases (p  =  .397, p  <  .0001) with a lag time of 8 months. We conclude that there is a significant increase in pediatric narcolepsy incidence after the 2009 H1N1 pandemic in the United States. However, the magnitude of increase is lower than reported in European countries and in China. The temporal correlation between monthly H1N1 infection and monthly narcolepsy incidence, suggests that H1N1 infection may be a contributing factor to the increased pediatric narcolepsy incidence after the 2009 H1N1 pandemics.

Night of Kentucky blues: the case of the hypoxic child in the sleep laboratory.

CITATION: Sleep-disordered breathing is an increasingly identified condition in the pediatric population, resulting in an increasing number of direct-to-lab referrals for polysomnography (PSG). We present a unique case of a pediatric patient who demonstrated continuous hypoxemia during PSG. A 6-year-old Black female presented for PSG via direct referral with obstructive sleep apnea as a concern. At the onset of the PSG, oxygen saturation of 85% while awake and at rest was noted. The oxygen saturation did not improve despite troubleshooting, probe and patient repositioning, or probe replacement. The PSG demonstrated an average sleep oxygen saturation of 81%, with oxygen saturation nadir of 73% and apnea-hypopnea index = 6.1 events/h, consistent with mild obstructive sleep apnea with persistent desaturation. Hemoglobin electrophoresis was consistent with hemoglobin Louisville. This case illustrates that communication between the sleep medicine physician and the community physician after a direct to lab referral is crucial to avoid concern and confusion. CITATION: Sendon C, Carosella C, Melendres C. Night of Kentucky blues: the case of the hypoxic child in the sleep laboratory. J Clin Sleep Med. 2021;17(10):2125-2128.