Are sleep studies worth doing?

AIMS: To evaluate a sleep study service for children suspected of having sleep related upper airway obstruction (SRUAO). DESIGN: Prospective survey. SETTING: Paediatric and ear, nose, and throat clinics of the Royal Free Hampstead NHS Trust. SUBJECTS: Consecutively referred children with SRUAO symptoms. MAIN OUTCOME MEASURES: Sleep study data, referring clinician's impression, and completed symptom questionnaires. RESULTS: A total of 120 children (aged 6 months to 15.5 years) were studied. Study scores showed that 24 were classified as normal, 42 as mild, 33 as moderate, and 21 as severe SRUAO. In the 106 cases with matching data between clinician's impression and study score, 71 had good agreement, 18 were underestimated by the clinician, and 17 were over estimated. No cases reported as moderate or severe sleep apnoea by the study were referred by the clinician as normal. There were no important associations between parental symptom scores and sleep study scores. CONCLUSION: In children with suspected SRUAO, sleep studies do contribute to assessing the need for operation, the likelihood of postoperative respiratory failure, or as a baseline or outcome measure in intervention studies.     

What's new in paediatric sleep?

The major recent advance in our understanding of paediatric sleep is the publication of reference values for sleep in children aged 3.2-8.6 years. These data show developmental changes reflecting a subtle process of the maturation of the central nervous system with regard to sleep in childhood. In infants, a significant negative correlation has been observed between a snore-associated arousal index and an infant development scale, underlining that snoring is less innocent than has been suggested. A link between obstructive sleep apnoea (OSA) and airway inflammation has been demonstrated, with children with OSA having significantly higher expression of the leukotriene (LT) 1 and 2 receptors and higher concentrations of LT C4/D4/E4 and LT B4 in adenotonsillar tissues than children with recurrent rhinitis who have no OSA. This explains the efficacy of treatment for OSA with montelukast, a LT receptor antagonist, alone or in combination with corticosteroids. By using peripheral arterial tonometry, a noninvasive technique that allows the moment-to-moment measurement of sympathetic tone, persistent waking-associated autonomic nervous system dysfunction has been demonstrated in young children with sleep-disordered breathing (SDB). As such, SDB in childhood may represent a cardiovascular risk factor in adulthood.     

Are sleep problems under-recognised in general practice?

AIMS: To evaluate the frequency of sleep problems in Australian children aged 4.5-16.5 years, and to determine whether the frequency of sleep problems on questionnaire predicts the reporting of sleep problems at consultation. METHODS: Parents of 361 children (aged 4.5-16.5 years) attending their general practitioner for "sick" visits were asked to assess their child's sleep over the previous six months using the Sleep Disturbance Scale for Children, from which six sleep "disorder" factors and a total sleep problem score were obtained. RESULTS: The percentage of children with a total sleep problem score indicative of clinical significance (T score >70 or >95th centile) was 24.6% (89/361). Despite this high frequency, parents only addressed sleep problems in 4.1% (13/317) of cases and reported that GPs discussed sleep problems in 7.9% (25/317) of cases. Of the 79 children who reported total sleep problem T scores in the clinical range, only 13.9% (11/79) discussed sleep with their general practitioner within the previous 12 months. Regression analyses revealed an age related decrease in problems with sleep-wake transition and sleep related obstructive breathing; sleep hyperhydrosis, initiating and maintaining sleep, and excessive daytime sleepiness did not significantly decrease with age. No significant gender differences were observed. CONCLUSIONS: Results suggest that chronic sleep problems in Australian children are significantly under-reported by parents during general practice consultations despite a relatively high frequency across all age groups. Given the impact on children and families, there is a need for increased awareness of children's sleep problems in the community and for these to be more actively addressed at consultation.     

What's new in paediatric sleep in 2007?

In young children, sleep problems are associated with poorer mental and psychological health in their parents, although no clear causal relationship has been established to date. The increase in the number of children presenting with sleep problems puts increasing demand on polysomnography (PSG), which represents the gold standard for the diagnosis of sleep-disordered breathing (SDB). However, PSG is expensive and very time and labour intensive. Screening tools have therefore been developed to identify children at risk for SDB and obstructive sleep apnoea (OSA). Most interestingly, position during sleep influences motor development in infants, with the supine position being associated with significant delays in motor development and the acquisition of motor milestones. The majority of publications have dealt with the neurocognitive consequences of SDB and OSA, and more precisely, individual susceptibility for these adverse effects, involving the level of systemic inflammation as well as the polymorphisms of some genes with a neuroprotective role.     

Does short sleep duration favor abdominal adiposity in children?

The main aim of this cross-sectional study was to determine whether the increased body mass index (BMI) characterizing short-duration sleeping children is related to an increased predisposition to abdominal adiposity. A total of 422 children (211 boys and 211 girls) involved in the "Québec en Forme" Project were tested for body weight, height, waist circumference, and sleep duration. As there was no gender interaction with the other factors, a partial regression of waist circumference on hours of sleep was performed for both genders combined, adjusting for age, sex, BMI, parental obesity, parental education, total annual family income, frequency of taking breakfast, watching television, playing videogames, computer use, and frequency of practicing sports activities outside of school. Sleep duration had an independent effect on waist circumference, with the correlation between these variables remaining significant after adjustment for BMI and the several other covariates (r=- 0.17, p<0.001). In conclusion, these results suggest that short sleep duration favors abdominal adiposity in children. This finding is of particular concern since abdominal obesity is an important feature of the metabolic syndrome.     

Cross-sectional study on the sleep status and risk factors for sleep problems in infants and young children in Jilin Province北大核心CSCD

目的 了解吉林省婴幼儿睡眠状况及睡眠问题发生的危险因素。 方法 选取吉林省8个地级市和1个自治州的1 080例0~3岁的健康婴幼儿作为研究对象。采用自制调查问卷收集研究对象的一般资料,采用简明婴幼儿睡眠问卷了解婴幼儿睡眠情况,并应用多因素logistic回归分析探讨睡眠问题发生的危险因素。 结果 婴幼儿睡眠问题的总检出率为38.24%（413/1 080）。4~11月龄、12~24月龄、25~36月龄组睡眠总时长均高于推荐睡眠总时长（P<0.05）。多因素logistic回归分析显示,足月出生、主要监护人文化程度较高、白天活动强度较大是婴幼儿睡眠问题的保护因素（P<0.05）,而服用维生素D频次较低、夜间喂养频繁和母亲打鼾是睡眠问题发生的危险因素（P<0.05）。 结论 吉林省4月龄以上婴幼儿睡眠总时长均高于推荐睡眠总时长,但睡眠问题发生率较高。睡眠问题的发生与多种因素有关;加强对早产儿的随访,对主要监护人进行婴幼儿睡眠知识宣教,坚持规律地补充维生素D,有利于减少婴幼儿睡眠问题的发生。     

Diagnostic techniques for obstructive sleep apnoea: is polysomnography necessary?

Obstructive sleep apnoea (OSA) is a common condition of childhood with significant associated morbidity. The comprehensive evaluation of children who present with suggestive symptoms involves the overnight recording and assessment of both sleep and respiration by polysomnography in a sleep laboratory. These studies require resources and facilities that are not widely available and thus simpler, more available and less expensive alternatives have been sought. This review discusses the available alternatives to polysomnography for the evaluation of the child with suspected obstructive sleep apnoea.     

Can parents predict the severity of childhood obstructive sleep apnoea?

OBJECTIVE: To determine whether parents' observations can be used to predict the severity of the obstructive sleep apnoea syndrome (OSAS) in children. STUDY DESIGN: Sixty-five children with OSAS diagnosed by overnight polysomnography were consecutively recruited and classified as having severe or non-severe OSAS according to the obstructive apnoea index (OAI) and the oxygen saturation measured by pulse oximetry (SpO2) nadir. Parents were asked to complete a questionnaire about the child's breathing difficulties at night. RESULTS: Twenty-eight patients were classified as severe OSAS and 37 as non-severe OSAS. There were no differences between the two groups with respect to age, sex or body mass index. Male to female ratio was 5:1. Parents of children with severe OSAS more frequently reported observed cyanosis (35 vs 8%; p=0.02); obstructive apnoea (60 vs 35%; p = 0.04); snoring extremely loudly (52 vs 22%; p = 0.01); shaking the child (64 vs 35%; p = 0.02); watching the child during sleep and being afraid of apnoea (85 vs 60%; p = 0.03). However, neither any single nor combinations of observations showed high values for both sensitivity and specificity. CONCLUSIONS: Although some parents' observations are more frequently reported in children with severe OSAS, neither any single nor combinations of observations accurately predict the severity of OSAS. Polysomnography is still needed to determine the severity of obstruction.     

Does sleep promote recovery after bone marrow transplantation?--A hypothesis

Bone marrow transplantation is increasingly being used for treatment of patients with malignant and hematologic disorders. The process requires 4-6 wk of waiting for recovery from conditioning regimens and for engraftment. Patients undergo intensive monitoring and supportive care, yet their requirements for deep uninterrupted sleep often go unrecognized. We suggest that deep sleep may promote recovery and stem cell proliferation through production of growth hormone and melatonin, and through other mechanisms. Growth hormone production occurs primarily during deep, rapid-eye-movement (REM) sleep. Growth hormone promotes nutritional recovery, mucosal healing, cellular uptake of amino acids, and promotes proliferation of bone marrow cell lines in animal models. Melatonin is also secreted during nighttime and during sleep. Melatonin increases immune response, inhibits tumor growth, counteracts stress-induced immunosuppression, protects against viral infections, stimulates GM-CSF, salivary IgA, antioxidant properties and enhances sleep. In our preliminary studies, we have found that most patients undergoing bone marrow transplantation complain of sleep disturbances related to laminar air flow noise-beepers, and lights. We recommend several simple methods of enhancing sleep and for more research in the pathophysiology of sleep and bone marrow transplantation.     

Allergic rhinitis and sleep disorders in children – coexistence and reciprocal interactions

ObjectiveTo 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 dataA 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 dataSleep 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.ConclusionsA 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.