Risk of sleep-disordered breathing in orthodontic patients: comparison between children and adolescents.

OBJECTIVE: The aim of this study was to assess the risk of sleep-disordered breathing (SDB) in orthodontic patients and to evaluate the influence of sex, age, and orthodontic treatment in a cohort of subjects using the Pediatric Sleep Questionnaire (PSQ) screening tool. METHODS: Parents of 245 patients aged 5-18 years (11.4 ±â€…3.3 years) were invited to participate in the study by answering the PSQ, which has 22 questions about snoring, sleepiness, and behavior. The frequency of high and low risk was calculated for the full sample. Multiple logistic regression was used to assess the association among sex, age, orthodontic treatment, rapid maxillary expansion (RME), and body mass index (BMI) with SDB. A significance level of 5% (P < .05) was adopted in all tests. RESULTS: A high risk of SDB was found in 34.3% of the sample. No sex and BMI difference was found for the risk of SDB. The high risk of SDB was significantly associated with younger ages (OR = 1.889, P = .047), pre-orthodontic treatment phase (OR = 3.754, P = .02), and RME (OR = 4.157, P = .001). LIMITATIONS: Lack of ear, nose and throat-related medical history. CONCLUSION: Children showed a 1.8 higher probability of having a high risk of SDB compared with adolescents. Patients before orthodontic treatment and patients submitted to RME showed a high risk of SDB.

Sleep apnea and sudden death in the non-cardiac population: A systematic review.

INTRODUCTION: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS: This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.

Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study.

STUDY OBJECTIVES: The objective of this study was to discern distinguishing characteristics of sleep-related breathing disorders in individuals with chronic spinal cord injury (CSCI) compared with participants without CSCI. Additionally, the study investigated factors associated with sleep-related breathing disorder severity. METHODS: This is a cross-sectional analysis of 123 individuals without CSCI, 40 tetraplegics, and 48 paraplegics who underwent attended or partially supervised full polysomnography for suspected sleep-related breathing disorders in a rehabilitation center. Polysomnographic, transcutaneous capnography, and clinical data were collected and compared between the groups. RESULTS: Among tetraplegics, apnea-hypopnea index ≥ 30 events/h (67.5%, P = .003), central apnea (17.5%, P = .007), and higher oxygen desaturation index (80.0%, P = .01) prevailed. Sleep-related hypoventilation was present in 15.4% of tetraplegics and 15.8% of paraplegics, compared with 3.2% in participants without CSCI (P = .05). In the group without CSCI and the paraplegic group, snoring and neck circumference were positively correlated with obstructive sleep apnea (OSA) severity. A positive correlation between waist circumference and OSA severity was identified in all groups, and multivariate logistic regression analysis showed that loud snoring and waist circumference had the greatest impact on OSA severity. CONCLUSIONS: Severe OSA and central sleep apnea prevailed in tetraplegic participants. Sleep-related hypoventilation was more common in tetraplegics and paraplegics than in participants without CSCI. Loud snoring and waist circumference had an impact on OSA severity in all groups. We recommend the routine implementation of transcutaneous capnography in individuals with CSCI. We underscore the significance of conducting a comprehensive sleep assessment in the rehabilitation process for individuals with CSCI. CITATION: Souza Bastos P, Amaral TLD, Yehia HC, Tavares A. Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study. J Clin Sleep Med. 2024;20(7):1119-1129.

Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial

BACKGROUND: In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is associated with increased morbidity, mortality, and sleep disruption. We hypothesised that treating sleep-disordered breathing with a peak-flow triggered adaptive servo-ventilation (ASV) device would improve cardiovascular outcomes in patients with heart failure and reduced ejection fraction. METHODS: We conducted a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial of peak-flow triggered ASV in patients aged 18 years or older with heart failure and reduced ejection fraction (left ventricular ejection fraction ≤45%) who were stabilised on optimal medical therapy with co-existing sleep-disordered breathing (apnoea-hypopnoea index [AHI] ≥15 events/h of sleep), with concealed allocation and blinded outcome assessments. The trial was carried out at 49 hospitals in nine countries. Sleep-disordered breathing was stratified into predominantly OSA with an Epworth Sleepiness Scale score of 10 or lower or predominantly CSA. Participants were randomly assigned to standard optimal treatment alone or standard optimal treatment with the addition of ASV (1:1), stratified by study site and sleep apnoea type (ie, CSA or OSA), with permuted blocks of sizes 4 and 6 in random order. Clinical evaluations were performed and Minnesota Living with Heart Failure Questionnaire, Epworth Sleepiness Scale, and New York Heart Association class were assessed at months 1, 3, and 6 following randomisation and every 6 months thereafter to a maximum of 5 years. The primary endpoint was the cumulative incidence of the composite of all-cause mortality, first admission to hospital for a cardiovascular reason, new onset atrial fibrillation or flutter, and delivery of an appropriate cardioverter-defibrillator shock. All-cause mortality was a secondary endpoint. Analysis for the primary outcome was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT01128816) and the International Standard Randomised Controlled Trial Number Register (ISRCTN67500535), and the trial is complete. FINDINGS: The first and last enrolments were Sept 22, 2010, and March 20, 2021. Enrolments terminated prematurely due to COVID-19-related restrictions. 1127 patients were screened, of whom 731 (65%) patients were randomly assigned to receive standard care (n=375; mean AHI 42·8 events per h of sleep [SD 20·9]) or standard care plus ASV (n=356; 43·3 events per h of sleep [20·5]). Follow-up of all patients ended at the latest on June 15, 2021, when the trial was terminated prematurely due to a recall of the ASV device due to potential disintegration of the motor sound-abatement material. Over the course of the trial, 41 (6%) of participants withdrew consent and 34 (5%) were lost to follow-up. In the ASV group, the mean AHI decreased to 2·8-3·7 events per h over the course of the trial, with associated improvements in sleep quality assessed 1 month following randomisation. Over a mean follow-up period of 3·6 years (SD 1·6), ASV had no effect on the primary composite outcome (180 events in the control group vs 166 in the ASV group; hazard ratio [HR] 0·95, 95% CI 0·77-1·18; p=0·67) or the secondary endpoint of all-cause mortality (88 deaths in the control group vs. 76 in the ASV group; 0·89, 0·66-1·21; p=0·47). For patients with OSA, the HR for all-cause mortality was 1·00 (0·68-1·46; p=0·98) and for CSA was 0·74 (0·44-1·23; p=0·25). No safety issue related to ASV use was identified. INTERPRETATION: In patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely.

Respiratory arousal threshold among patients with isolated sleep apnea and with comorbid insomnia (COMISA).

Insomnia and obstructive sleep apnea (OSA) are common sleep disorders and frequently coexist (COMISA). Arousals from sleep may be a common link explaining the frequent comorbidity of both disorders. Respiratory arousal threshold (AT) is a physiologic measurement of the level of respiratory effort to trigger an arousal from sleep. The impact of COMISA on AT is not known. We hypothesized that a low AT is more common among COMISA than among patients with OSA without insomnia. Participants referred for OSA diagnosis underwent a type 3 sleep study and answered the insomnia severity index (ISI) questionnaire and the Epworth sleepiness scale. Participants with an ISI score ≥ 15 were defined as having insomnia. Sleep apnea was defined as an apnea hypopnea index (AHI) ≥ 15 events/h. Low AT was determined using a previously validated score based on 3 polysomnography variables (AHI, nadir SpO2 and the frequency of hypopneas). OSA-only (n = 51) and COMISA (n = 52) participants had similar age (61[52-68] vs 60[53-65] years), body-mass index (31.3[27.7-36.2] vs 32.2[29.5-38.3] kg/m2) and OSA severity (40.2[27.5-60] vs 37.55[27.9-65.2] events/h): all p = NS. OSA-only group had significantly more males than the COMISA group (58% vs 33%, p = 0.013. The proportion of participants with a low AT among OSA-only and COMISA groups was similar (29 vs 33%, p = NS). The similar proportion of low AT among COMISA and patients with OSA suggests that the respiratory arousal threshold may not be related to the increased arousability of insomnia.

Poor sleep quality and erectile dysfunction in students from a Peruvian University: A cross-sectional study.

Objective: We aimed to evaluate the association between sleep quality and erectile dysfunction in young university students. Methods: A cross-sectional survey was conducted in men aged 18-30 years from Universidad Ricardo Palma, Lima, Peru. The survey comprised the International Index of Erectile Function, Pittsburgh Sleep Quality Index, Berlin questionnaire, and questions related to sociodemographic data. Prevalence ratios were estimated with generalized linear models. Results: Of 381 participants, the median age was 23 years. Half of the students (50.9%) had poor sleep quality, of which 72.7% had mild erectile dysfunction and 20.6% mild to moderate dysfunction. Prevalence of erectile dysfunction was significantly higher in students with poor sleep quality than in students with good sleep quality (aPR = 6.48; 95% CI: 4.58-9.17) after adjusting for age, academic year, nutritional status, and sleep apnea. In a subsequent exploratory analysis, sleep apnea was associated with a higher prevalence of erectile dysfunction (aPR = 1.19; 95% CI: 1.01-1.39), while overweight (aPR = 0.85; 95% CI: 0.76-0.95) and obesity (aPR = 0.65; 95% CI: 0.52-0.82) were associated with a lower prevalence of this condition. Conclusion: Poor sleep quality was independently associated with erectile dysfunction in young university students. This finding suggests that male students are at risk for sexual problems due to possible academic demands and relationship issues.

Efficacy of Roncolab mobile application for diagnosing the primary sign of sleep-disordered breathing (snoring) in children.

Sleep-disordered breathing (SDB) is a group of disorders associated with breathing anomalies during sleep. Easily detectable by sound, snoring is one of the most common manifestations and the main sign of SDB. Snoring is characteristic of breathing sound during sleep, without apnea, hypoventilation, or interrupted sleep. It may reduce the percentage of sleep and increase microarousals due to breathing effort or gas exchange. A range of questionnaires have been validated and adapted to the pediatric population to screen for patients who require laboratory testing. The Pediatric Sleep Questionnaire (PSQ) screens for SDB and identifies primary signs such as snoring. RoncoLab is a mobile application that records and measures snoring intensity and frequency. Aim: To compare the RoncoLab app and the PSQ regarding how efficiently they diagnose snoring. Materials and Method: This was an observational, analytical study of 31 children aged 7 to 11 years who visited the pediatric dental clinic at Benemérita Universidad Autónoma de Puebla, Mexico (BUAP). The PSQ was applied to diagnose SDB. Guardians were then instructed on how to download and use the mobile application to record data while the child was sleeping at home. Agreement between RoncoLab and the PSQ was analyzed statistically by Cohen's Kappa index at 95% confidence level. Results: The Kappa index for identification of primary snoring was 0.743 (p<0.05). App sensitivity was 0.92, and specificity 0.82. Conclusion: There is good agreement between PSQ and RoncoLab for diagnosing primary snoring, with acceptable sensitivity and specificity.

Los trastornos respiratorios del sueño (TRS) son un grupo de padecimientos asociados con anormalidades respiratorias del sueño. Una de las manifestaciones más comunes es el ronquido; signo fácil de detectar por el ruido que emite y se considera como el signo principal. Este trastorno es característico del ruido respiratorio durante el sueño, sin apneas, hipoventilación, ni interrupciones del sueño. Este puede ocasionar disminución del porcentaje del sueño y aumentar los microdespertares, esto debido al esfuerzo respiratorio o al intercambio de gases. En la actualidad existen cuestionarios validados y adaptados para la población pediátrica útiles como herramienta clínica para el tamizaje y selección de pacientes que requieran pruebas de laboratorio. El Pediatric Sleep Questionnaire (PSQ) permite el cribado de TRS e identificación de signos primarios como el ronquido. RoncoLab es una aplicación móvil que registra y mide la intensidad y frecuencia del ronquido. Objetivo: Comparar la eficacia del diagnóstico del ronquido por medio del RoncoLab contrastado con el PSQ. Materiales y Método: Estudio observacional, analítico, en el cual se incluyeron 31 niños de 7 a 11 años, que acudieron a la clínica de odontopediatría de la Benemérita Universidad Autónoma de Puebla, México (BUAP) Se aplicó el PSQ a los 31 niños para el diagnóstico de TRS, después se le instruyó al tutor como descargar y utilizar la aplicación móvil para registrar los datos obtenidos en las horas de sueño en casa. El análisis estadístico de concordancia entre los instrumentos diagnósticos se realizó con el Índice Kappa de Cohen a un nivel de confianza del 95. Resultados: El Índice de Kappa para la identificación de los ronquidos primarios fue de 0.743 (p<0.05). La sensibilidad de la aplicación fue de 0.92, mientras la especificidad fue de 0.82. Conclusión: Existe buena concordancia entre el PSQ y el RoncoLab en el diagnóstico de ronquido primario, con sensibilidad y especificidad aceptable.

Sleep disorders in Down syndrome: a systematic review.

BACKGROUND: Sleep disorders are commonly observed in children with Down syndrome (DS) and can lead to significant behavioral and cognitive morbidities in these individuals. OBJECTIVE: To perform a systematic review evaluating sleep disorders in individuals with DS. METHODS: Search strategies were based on combinations of keywords: "Down syndrome"; "trisomy 21"; "sleep disorders"; "dyssomnias"; "sleep apnea"; "obstructive"; "sleeplessness"; "insomnia"; "parasomnias"; and "excessive daytime sleepiness". PubMed and Science Direct were used. Only original studies and retrospective reviews in English published between January 2011 and March 2021 were included. RESULTS: 52 articles were included, most of them involving children and adolescents under 18 years of age. The main sleep disorder associated with DS was obstructive sleep apnea (OSA). Some studies reported the presence of cognitive dysfunction in patients with DS and sleep-disordered breathing, and few have been found about parasomnia, insomnia, and daytime sleepiness in these patients. Movement disorders and unusual postures during sleep may be related to disordered sleep breathing in DS. The main treatment options for OSA are continuous positive airway pressure therapy (CPAP), surgery, and weight control. Computational modeling associated with MRI has been used to plan surgical interventions in these patients. CONCLUSIONS: Individuals with DS are at high risk of developing sleep-related breathing disorders. The main sleep disorder associated with DS was OSA. The presence of sleep-disordered breathing contributes to a worsening of cognitive function in patients with DS.

Associations of Sleep-Related Outcomes with Behavioral and Emotional Functioning in Children with Overweight/Obesity.

OBJECTIVE: To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and device-assessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/obesity. STUDY DESIGN: A total of 109 children with overweight/obesity (mean age, 10.0 ± 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). RESULTS: SDB was positively associated with all clinical scale variables (all ß > 0.197, P ≤ .041) and with lower adaptability and leadership (all ß < -0.226, P < .021). Specifically, the PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat (all ß > 0.196, P ≤ .045) and lower adaptability (ß = -0.246, P = .011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all ß > |0.192|, P ≤ .046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. CONCLUSIONS: Our study suggests that SDB symptoms, but not device-assessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability.

Allergic rhinitis and sleep disorders in children - coexistence and reciprocal interactions.

OBJECTIVE: To review, critically analyze and synthesize knowledge from the international literature regarding the association between allergic rhinitis (AR) and sleep disorders, the impact of AR treatment on children's sleep, and lay the foundation for future research on this topic. SOURCE OF DATA: A literature search using PubMed database including original and review articles, systematic reviews and meta-analyses using keywords related to AR, sleep disorders and sleep-disordered breathing. SYNTHESIS OF DATA: Sleep is fundamental to health, and its assessment and control of conditions that trigger or aggravate disturbances are of the uttermost importance. Allergic rhinitis (AR) is common in children and may interfere with both their quality of life and quality of sleep. It has emerged as one of the most important risk factors for habitual snoring in children and appeared to increase the risk of Obstructive Sleep Apnea (OSA), with AR severity exhibiting a significant and independent association with pediatric OSA severity. However, in some studies, those associations between AR and OSA in children are not very consistent. CONCLUSIONS: A substantial level of controversy exists regarding the interactions between AR and OSA in children. Notwithstanding, identifying and treating AR in clinical settings is probably an important step toward improving symptoms and preventing deterioration of sleep quality in children and may improve the severity of underlying OSA. Considering the high prevalence, morbidity, economic and social implications of both AR and sleep problems, it is crucial that healthcare providers improve their understanding of the relationships between those conditions among children.

Chronic apnea during REM sleep increases arterial pressure and sympathetic modulation in rats.

STUDY OBJECTIVES: Obstructive sleep apnea can induce hypertension. Apneas in REM may be particularly problematic: they are independently associated with hypertension. We examined the role of sleep stage and awakening on acute cardiovascular responses to apnea. In addition, we measured cardiovascular and sympathetic changes induced by chronic sleep apnea in REM sleep. METHODS: We used rats with tracheal balloons and electroencephalogram and electromyogram electrodes to induce obstructive apnea during wakefulness and sleep. We measured the electrocardiogram and arterial pressure by telemetry and breathing effort with a thoracic balloon. RESULTS: Apneas induced during wakefulness caused a pressor response, intense bradycardia, and breathing effort. On termination of apnea, arterial pressure, heart rate, and breathing effort returned to basal levels within 10 s. Responses to apnea were strongly blunted when apneas were made in sleep. Post-apnea changes were also blunted when rats did not awake from apnea. Chronic sleep apnea (15 days of apnea during REM sleep, 8 h/day, 13.8 ± 2 apneas/h, average duration 12 ± 0.7 s) reduced sleep time, increased awake arterial pressure from 111 ± 6 to 118 ± 5 mmHg (p < 0.05) and increased a marker for sympathetic activity. Chronic apnea failed to change spontaneous baroreceptor sensitivity. CONCLUSION: Our results suggest that sleep blunts the diving-like response induced by apnea and that acute post-apnea changes depend on awakening. In addition, our data confirm that 2 weeks of apnea during REM causes sleep disruption and increases blood pressure and sympathetic activity.

Prevalence of sleep-disordered breathing and associations with malocclusion in children.

STUDY OBJECTIVES: This study aimed to determine the prevalence of sleep-disordered breathing (SDB) and its association with malocclusion among children in Recife, Brazil. METHODS: This study included 390 children aged 7 to 8 years. The data comprised the measurement of body mass, orthodontic examination, and parental information required by the Sleep Disturbance Scale for Children. The statistics tools used were Pearson's chi-square test and the Lemeshow test. RESULTS: Positively screened for SDB was found in 33.3% of the children, and the association with overjet was P = .007 (odds ratio [OR], 95%, confidence interval [CI]: 1.93). The association with anterior open bite was P = .008 (OR, 95% CI: 2.03), and the association with posterior crossbite was P = .001 (OR, 95% CI: 2.89). This report was unable to indicate an association between body mass index and SDB. The multivariate logistic regression model revealed that the anterior open bite (P = .002; OR, 95% CI: 2.34) and posterior crossbite (P = .014; OR, 95% CI: 2.79) had an association with positively screened for SDB. CONCLUSIONS: The results of this study indicated that the prevalence of SDB was high and highly associated with malocclusion. Since posterior crossbite and anterior open bite were associated with positively screened for SDB, early diagnosis and intervention may prevent and minimize adverse effects of SDB on individuals lives.

Association of sleep spindle activity and sleepiness in children with sleep-disordered breathing.

STUDY OBJECTIVES: The association of snoring and sleep-disordered breathing (SDB) with daytime sleepiness is well documented; however, the exact mechanisms, and especially the role of sleep microstructure that may account for this association remain incompletely understood. In a cohort of children with SDB, we aimed to compare sleep spindle activity between children with daytime sleepiness versus those without daytime sleepiness. METHODS: Children with SDB who reported daytime sleepiness were recruited and compared with age- and sex-matched SDB controls. Polysomnographic recordings were analyzed evaluating sleep spindle activity. A statistical comparison was carried out in both groups to assess the association between sleepiness and sleep spindle activity. RESULTS: Thirty-three children with SDB (mean age: 7.5 ± 1.7 years) were included, 10 with and 23 without daytime sleepiness. Spindle activity was lower in children with daytime sleepiness compared with those without; in stage N2, median (interquartile range) sleep spindle indexes were 77.5 (37.3) and 116.9 (71.2) (P = .015), respectively. CONCLUSIONS: Spindles were significantly reduced in children with SDB and daytime sleepiness. The exact mechanisms of this association remain unknown and future research is needed in order to establish the exact role of sleep spindle activity on daytime symptoms in children with SDB.

Clinically Asymptomatic Sleep-Disordered Breathing in Infants with Single-Ventricle Physiology.

OBJECTIVES: To assess clinically asymptomatic infants with single-ventricle physiology (SVP) for sleep-disordered breathing (SDB) in the supine and car seat positions using polysomnography. Polysomnography results also were compared with results of a standard Car Seat Challenge to measure the dependability of the standard Car Seat Challenge. STUDY DESIGN: This was an observational study of 15 infants with SVP. Polysomnography data included Obstructive Index, Central Index, Arousal Index, Apnea Hypopnea Index, and sleep efficiency. Polysomnography heart rate and oxygen saturation data were used to compare polysomnography with the standard Car Seat Challenge. RESULTS: Polysomnography demonstrated that all 15 infants had SDB and 14 had obstructive sleep apnea (Obstructive Index ≥1/hour) in both the supine and car seat positions. Infants with SVP had a statistically significant greater median Obstructive Index in the car seat compared with supine position (6.3 vs 4.2; P = .03), and median spontaneous Arousal Index was greater in the supine position compared with the car seat (20.4 vs 15.2; P = .01). Comparison of polysomnography to standard Car Seat Challenge results demonstrated 5 of 15 (33%) of infants with SVP with abnormal Obstructive Index by polysomnography would have passed a standard Car Seat Challenge. CONCLUSIONS: Infants with SVP without clinical symptoms of SDB may be at high risk for SDB that appears worse in the car seat position. The standard Car Seat Challenge is not dependable in the identification of infants with SVP and SDB. Further studies are warranted to further delineate its potential impact of SDB on the clinical outcomes of infants with SVP.

Cerebral Oxygenation During Respiratory Events in Children with Sleep-Disordered Breathing and Associated Disorders.

OBJECTIVES: To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders. STUDY DESIGN: Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO2]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age. RESULTS: There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO2 and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those <7 years old. TOI decreases correlated significantly with SpO2 decreases, duration of event, and age, regardless of the type of event. In a multivariable regression model, predictive factors of TOI decreases were the type of respiratory event, SpO2 decrease, apnea-hypopnea index, and age. CONCLUSIONS: In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.

Association between inflammatory potential of the diet and sleep parameters in sleep apnea patients.

OBJECTIVES: The aim of this study was to analyze the association between the inflammatory potential of diet and sleep parameters in individuals with obstructive sleep apnea (OSA) and to evaluate the sensitivity and specificity of the dietary inflammatory index (DII) at predicting sleep pattern. METHODS: Patients diagnosed with mild to severe OSA were included in the study (N = 296). Sleep pattern was analyzed by polysomnography and subjective sleep parameters. DII scores were calculated from a validated food frequency questionnaire. Receiver operating characteristic curve analysis and generalized linear models were conducted. RESULTS: DII scores were efficient at predicting apnea severity (P < 0.05) and daytime sleepiness (P = 0.02) in age stratification and predicting rapid eye movement latency in obese individuals (P = 0.03). No significant associations were found between DII scores and the majority of sleep parameters. The DII was only associated with daytime sleepiness; patients with a more proinflammatory diet (quintile 4) showed more subjective sleepiness than the group with a more anti-inflammatory diet (quintile 1; P < 0.05). CONCLUSION: Findings from this study indicated that the DII could be sensitive and specific for predicting apnea severity in individuals commonly associated with OSA. Although the DII was not associated with most of the sleep parameters, the few associations found demonstrated the need for more studies that evaluate whether DII is associated with the risk for OSA symptoms.

Intermittent hypoxia, brain glyoxalase-1 and glutathione reductase-1, and anxiety-like behavior in mice

Objective: Sleep apnea has been associated with anxiety, but the mechanisms of the sleep apnea-anxiety relationship are unresolved. Sleep apnea causes oxidative stress, which might enhance anxiety-like behavior in rodents. To clarify the apnea-anxiety connection, we tested the effect of intermittent hypoxia, a model of sleep apnea, on the anxiety behavior of mice. Methods: The rodents were exposed daily to 480 one-minute cycles of intermittent hypoxia to a nadir of 7±1% inspiratory oxygen fraction or to a sham procedure with room air. After 7 days, the mice from both groups were placed in an elevated plus maze and were video recorded for 10 min to allow analysis of latency, frequency, and duration in open and closed arms. Glyoxalase-1 (Glo1) and glutathione reductase-1 (GR1) were measured in the cerebral cortex, hippocampus, and striatum by Western blotting. Results: Compared to controls, the intermittent hypoxia group displayed less anxiety-like behavior, perceived by a statistically significant increase in the number of entries and total time spent in open arms. A higher expression of GR1 in the cortex was also observed. Conclusion: The lack of a clear anxiety response as an outcome of intermittent hypoxia exposure suggests the existence of additional layers in the anxiety mechanism in sleep apnea, possibly represented by sleepiness and irreversible neuronal damage.

Intermittent hypoxia, brain glyoxalase-1 and glutathione reductase-1, and anxiety-like behavior in mice.

OBJECTIVE: Sleep apnea has been associated with anxiety, but the mechanisms of the sleep apnea-anxiety relationship are unresolved. Sleep apnea causes oxidative stress, which might enhance anxiety-like behavior in rodents. To clarify the apnea-anxiety connection, we tested the effect of intermittent hypoxia, a model of sleep apnea, on the anxiety behavior of mice. METHODS: The rodents were exposed daily to 480 one-minute cycles of intermittent hypoxia to a nadir of 7±1% inspiratory oxygen fraction or to a sham procedure with room air. After 7 days, the mice from both groups were placed in an elevated plus maze and were video recorded for 10 min to allow analysis of latency, frequency, and duration in open and closed arms. Glyoxalase-1 (Glo1) and glutathione reductase-1 (GR1) were measured in the cerebral cortex, hippocampus, and striatum by Western blotting. RESULTS: Compared to controls, the intermittent hypoxia group displayed less anxiety-like behavior, perceived by a statistically significant increase in the number of entries and total time spent in open arms. A higher expression of GR1 in the cortex was also observed. CONCLUSION: The lack of a clear anxiety response as an outcome of intermittent hypoxia exposure suggests the existence of additional layers in the anxiety mechanism in sleep apnea, possibly represented by sleepiness and irreversible neuronal damage.