Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy

OBJECTIVE: To investigate the relative contribution of various risk factors to the surgical outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. STUDY DESIGN: Children (n = 110; mean age, 6.4 +/- 3.9 years) underwent two polysomnographic evaluations before and after adenotonsillectomy. In addition, 22 control children were studied. History for allergy and family history of sleep-disordered breathing was taken before each polysomnographic evaluation. RESULTS: Significant changes in sleep stage percentages and sleep fragmentation were found in the postsurgery study compared with the presurgery study; 25% of the children had apnea/hypopnea index (AHI) 1 and <5, and 29% had AHI >/=5 in the postsurgery study. The frequency of subjects with AHI 相似文献   

Long-term sleep disturbances in children: A cause of neuronal loss

Short-term sleep loss is known to cause temporary difficulties in cognition, behaviour and health but the effects of persistent sleep deprivation on brain development have received little or no attention. Yet, severe sleep disorders that last for years are common in children especially when they have neurodevelopmental disabilities. There is increasing evidence that chronic sleep loss can lead to neuronal and cognitive loss in children although this is generally unrecognized by the medical profession and the public. Without the restorative functions of sleep due to total sleep deprivation, death is inevitable within a few weeks. Chronic sleep disturbances at any age deprive children of healthy environmental exposure which is a prerequisite for cognitive growth more so during critical developmental periods. Sleep loss adversely effects pineal melatonin production which causes disturbance of circadian physiology of cells, organs, neurochemicals, neuroprotective and other metabolic functions. Through various mechanisms sleep loss causes widespread deterioration of neuronal functions, memory and learning, gene expression, neurogenesis and numerous other changes which cause decline in cognition, behaviour and health. When these changes are long-standing, excessive cellular stress develops which may result in widespread neuronal loss. In this review, for the first time, recent research advances obtained from various fields of sleep medicine are integrated in order to show that untreated chronic sleep disorders may lead to impaired brain development, neuronal damage and permanent loss of developmental potentials. Further research is urgently needed because these findings have major implications for the treatment of sleep disorders.     

上海市松江区学龄前儿童睡眠状况和睡眠问题的横断面调查

目的调查学龄前儿童的睡眠情况，分析不同特征学龄前儿童的常见睡眠问题。方法在普遍动员、自愿参与的原则下，以上海市松江区幼儿园作为问卷调查现场，以《儿童家族社会环境与睡眠健康问卷》作为调查工具，以年龄和性别分层分析。睡眠问题包括睡眠不足，就寝延迟，睡眠中发生每周＞2次的以下情况：害怕就寝、打鼾、白天嗜睡、磨牙、夜惊、梦魇、入睡困难和梦游。先对幼儿园保健老师集中统一培训，保健老师再对幼儿园班主任进行培训。问卷填写人为幼儿父或母或抚养人且近１年与幼儿一起生活。当场发放问卷、填写和回收。结果2018年5~6月22所幼儿园参与问卷调查，向儿童家长发放问卷8 624份，有效问卷8 586份，男孩4 595名(53.5%)，女孩3 991名； 3~岁占17.8%、4~岁占34.1%、5~岁占32.0%、6~岁占16.1%。平均晚上就寝时间为21∶43，平均晨醒时间为7∶01，随年龄增长，白天、夜间和全天睡眠时间总量在减少，晚上就寝时间点延迟，平均晨醒时间点提前，差异有统计学意义（P＜0.01）。不同性别学龄前儿童白天、夜间、全天睡眠总量和就寝时间，差异均无统计学意义（P＞0.05）。睡眠不足的发生率为12.2%，就寝延迟的发生率为75.7%。随年龄增长，睡眠不足和就寝延迟的发生率逐渐增加，差异有统计意义(P＜0.05)。害怕就寝72.4%，打鼾62.5%，白天嗜睡51.2%，磨牙50.4%，夜惊49.2%，梦魇41.2%，入睡困难33.4%，梦游4.4%。打鼾和磨牙的发生率男童高于女童（P＜0.05），夜惊、梦魇、入睡困难和梦游的发生率女童高于男童（P＜0.05）。结论上海市松江区学龄前儿童睡眠时间不足，就寝延迟，睡眠问题发生率高，应引起社会及家长的重视。     

上海市松江区学龄前儿童睡眠状况和睡眠问题的横断面调查

目的调查学龄前儿童的睡眠情况,分析不同特征学龄前儿童的常见睡眠问题。方法在普遍动员、自愿参与的原则下,以上海市松江区幼儿园作为问卷调查现场,以《儿童家族社会环境与睡眠健康问卷》作为调查工具,以年龄和性别分层分析。睡眠问题包括睡眠不足,就寝延迟,睡眠中发生每周＞2次的以下情况：害怕就寝、打鼾、白天嗜睡、磨牙、夜惊、梦魇、入睡困难和梦游。先对幼儿园保健老师集中统一培训,保健老师再对幼儿园班主任进行培训。问卷填写人为幼儿父或母或抚养人且近１年与幼儿一起生活。当场发放问卷、填写和回收。结果2018年5~6月22所幼儿园参与问卷调查,向儿童家长发放问卷8 624份,有效问卷8 586份,男孩4 595名(53.5%),女孩3 991名; 3~岁占17.8%、4~岁占34.1%、5~岁占32.0%、6~岁占16.1%。平均晚上就寝时间为21∶43,平均晨醒时间为7∶01,随年龄增长,白天、夜间和全天睡眠时间总量在减少,晚上就寝时间点延迟,平均晨醒时间点提前,差异有统计学意义（P＜0.01）。不同性别学龄前儿童白天、夜间、全天睡眠总量和就寝时间,差异均无统计学意义（P＞0.05）。睡眠不足的发生率为12.2%,就寝延迟的发生率为75.7%。随年龄增长,睡眠不足和就寝延迟的发生率逐渐增加,差异有统计意义(P＜0.05)。害怕就寝72.4%,打鼾62.5%,白天嗜睡51.2%,磨牙50.4%,夜惊49.2%,梦魇41.2%,入睡困难33.4%,梦游4.4%。打鼾和磨牙的发生率男童高于女童（P＜0.05）,夜惊、梦魇、入睡困难和梦游的发生率女童高于男童（P＜0.05）。结论上海市松江区学龄前儿童睡眠时间不足,就寝延迟,睡眠问题发生率高,应引起社会及家长的重视。     

Short-term prospective study of sleep disturbances in 5-8-year-old children

The course and psychological correlates of disturbed sleep during middle childhood were investigated using parents' responses to questionnaires. Five specified sleep disturbances were explored in 614 5-8-y-old children, at baseline and at follow-up, 14 +/- 3 mo later. Difficulties falling asleep, in 6.2% of the children at baseline, persisted in 47.4% of the cases at follow-up; night-waking, in 18.6% at baseline, persisted in 45.5%; snoring, in 9.4% at baseline, persisted in 60%; nightmares, in 4.4% at baseline, persisted in 29.6%, and bedwetting, in 6% at baseline, persisted in 46%. Moreover, children with difficulties falling asleep at baseline frequently displayed bedtime resistance and shorter sleep at follow-up, while night-waking at baseline was related to co-sleeping at follow-up. Snoring at baseline was associated with a trend towards restless sleep at follow-up. Nightmares at baseline were related to several other sleep complaints as well as to behavioural difficulties during daytime at follow-up. Bedwetting at baseline was associated with tendencies towards hyperactivity at follow-up. Separate analyses of cases of persisting sleep disturbances showed that persisting difficulties falling asleep were associated with a need to remedy sleep problems, while persisting nightmares were strongly related to reports suggesting behavioural and emotional problems. Conclusion: During middle childhood, difficulties falling asleep, night-waking, snoring, nightmares or bedwetting commonly persist over the course of a year. Persistent nightmares frequently indicate significant psychological problems in affected children.     

Persistence of occurrence of injury: can injuries of preschool children predict injuries of school-aged children?

Data regarding 10,394 children from the 1970 British birth cohort were used to assess the consistency of injuries reported by parents as occurring between birth and 5 years of age and injuries reported between 5 and 10 years of age. Children with three or more separate injury events reported between birth and 5 years of age were 5.9 times more likely to have three or more injuries reported between 5 and 10 years of age than children without early injuries (95% confidence interval = 4.4 to 8.0). Children with one or more injuries resulting in hospitalization before 5 years of age were 2.5 times as likely to have one or more admissions to the hospital for injuries after 5 years of age than children with no early hospitalizations for injuries (95% confidence interval = 2.0 to 3.3). Stepwise regression was used to identify other predictors of injury. The number of injuries before 5 years of age were the best predictors of injuries reported between 5 and 10 years of age, followed by male sex, aggressive child behavior, young maternal age, many older, and few younger siblings. The findings of this study are consistent with two other large studies that relied on medical records rather than parental report and that focused on more severe injuries. Children with several of the identified risk factors can be predicted to have high rates of accidental injuries and may benefit from focused intervention.     

Symptoms of sleep disturbances among children at two general pediatric clinics

OBJECTIVE: We assessed the frequency of childhood sleep problems at 2 general pediatric clinics.Study design: Parents of 1038 unselected children (554 boys) aged 2.0 to 13.9 years completed a validated Pediatric Sleep Questionnaire while waiting for appointments. RESULTS: Habitual snoring was reported in 176 (17%) of the children. Criterion scores suggestive of sleep-disordered breathing were found in 115 (11%) of the children, in 29% of children at the clinic for neurologic indications, and in 21% of children at the clinic for noninfectious respiratory indications. Insomnia (ie, unrefreshing sleep or difficulty with sleep onset, sleep maintenance, or early morning awakening from sleep) was reported in 430 (41%) of the children; > or =2 symptoms were present in 191 (18%) of the children. Excessive daytime sleepiness was suggested in 148 (14%) of the children, and 390 (38%) had symptoms of sleep terrors, sleepwalking, or nocturnal bruxism. CONCLUSIONS: Sleep problems such as sleep-disordered breathing, insomnia, excessive sleepiness, and parasomnias are frequent among children seen at general pediatric practices.     

学龄前期和学龄期儿童阻塞性睡眠呼吸暂停综合征的比较研究

2001年3月—2004年2月,我们对60例学龄前期和学龄期儿童阻塞性睡眠呼吸暂停综合征（obstmctive sleepapnea syndrome,OSAS）的睡眠结构和睡眠呼吸障碍在不同睡眠阶段的表现进行了分析,旨在阐明阻塞性睡眠呼吸暂停综合征对不同年龄阶段儿童睡眠的影响及睡眠呼吸特征。     

Appendicitis in preschool children

Appendicitis in preschool children, although uncommon, is associated with a high perforation rate and increased morbidity. Of 132 preschool children treated for appendicitis over a 5-year period, 63 (47.7%) had perforations and 29 (22.0%) had an appendiceal mass. Although classic symptoms were present in the majority of the patients, atypical symptoms were found in many children and included diarrhoea (35), cough/sore throat (15), dysuria (4), headache (2), and earache (2). A diagnosis other than appendicitis was suspected by attending medical practitioners in 53 (40%) patients, leading to delay in management. Mean duration of symptoms before admission was as follows: acute appendicitis 38.9 h, perforation 52.6 h, and appendix mass 81.7 h. Ten (7.6%) patients developed postoperative complications that included wound infection in 5, intra-abdominal abscess in 4, and adhesive intestinal obstruction in 1. A high index of suspicion of appendicitis is necessary in preschool children in view of the atypical presentation and high incidence of advanced appendicitis and morbidity.