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1.
Bharat Bhushan Stephen Sheldon Edward Wang James W. Schroeder Jr. 《American journal of otolaryngology》2014
Objective
To determine if clinical indicators can predict the presence of moderate to severe Obstructive Sleep Apnea (OSA) after Adenotonsillectomy (T&A) in children.Study Design
Retrospective study.Setting
Urban Tertiary Care Pediatric Hospital.Methods
Parents of children (< 18 yrs.) with OSA completed a 55-item questionnaire based on their child’s symptoms at the time of preoperative polysomnography and then again at the follow up polysomnography completed 3 to 6 months after T&A.Main outcome measures
55 item questionnaire, polysomnography variables.Results
97 children were included (59 Male and 38 Female). The mean preoperative apnea hypopnea index (AHI) was 30.5 ± 31.6/h and the mean postoperative AHI was 4.4 ± 6.0/h. After T&A, all 97 children had reduction in AHI, and 35 (36.1%) no longer had OSA (AHI < 1/h). The total symptom scores decreased from 15.8 ± 9.4 to 11.3 ± 8.7 after T&A (p < .0001). Fourteen symptoms highly predictive of moderate to severe OSA were identified in the univariate analysis (p < 0.1). Using a cut-point of 4, this 14-item subscale illustrated an overall predictability of 72.2% (73.7% sensitivity and 70.0% specificity) for identifying children with moderate to severe OSA.Conclusion
A cluster of 14 clinical sleep symptoms are highly predictive of moderate to severe OSA and can serve as clinical predictor for the presence of moderate to severe OSA after T&A. 相似文献2.
Chia-Hsuan Lee Kun-Tai Kang Wen-Chin Weng Pei-Lin Lee Wei-Chung Hsu 《International journal of pediatric otorhinolaryngology》2014
Objective
To study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity.Materials and methods
Children aged 2–18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI < 1), mild obstructive sleep apnea (OSA) (5 > AHI ≥1), and moderate-to-severe OSA (AHI ≥ 5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model.Results
In total, 144 children were enrolled (mean age, 7.0 ± 3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥6 years vs. <6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P = 0.004; mild OSA vs. moderate-to-severe OSA, P = 0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring.Conclusions
Children with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity. 相似文献3.
Vasileios A. Lachanas George K. Mousailidis Charalampos E. Skoulakis Nikolaos Papandreou Sotirios Exarchos Emmanouel I. Alexopoulos John G. Bizakis 《International journal of pediatric otorhinolaryngology》2014
Objective
OSD-6 is a disease specific questionnaire for pediatric obstructive sleep apnea (OSA). The aims of this study were to validate OSD-6 in Greek language and correlate OSD-6 with polysomnography results.Study design
Prospective study.Setting
Tertiary referral center.Subjects and methods
OSD-6 questionnaire was translated to Greek and back to English. A prospective study was conducted on children undergoing overnight polysomnography due to snoring and disrupted sleep. Test–retest evaluation was carried out. Internal consistency and test–retest reliability were evaluated. Validity was assessed by exploring correlations between OSD-6 scores and apnea–hypopnea index (AHI), and by comparing total scores of OSA and non-OSA groups. Responsiveness was assessed by comparing preoperative to postoperative total scores in OSA children who underwent adenotonsillectomy.Results
Test–retest evaluation of 91 subjects showed good internal consistency (Cronbach’s alpha 0.860 for test and 0.873 for retest) and reliability (Pearson’s correlation coefficients between test and retest scores: 0.751–0.546; p < 0.01). Total and domains’ OSD-6 scores and AHI were significantly correlated (Spearman’s correlation coefficients: 0.277–0.630; p < 0.01), while children with OSA had higher total OSD-6 score than those without OSA (median (interquartile range): 16 (11) vs. 10 (7), respectively; p < 0.01), indicating good validity. Postoperative OSD-6 scores were significantly lower than preoperative (2.84 ± 3.21 vs. 15.42 ± 6.48, respectively; p < 0.001), suggesting good responsiveness.Conclusion
The Greek version of the OSD-6 questionnaire proved to be a valid instrument with satisfactory internal consistency, reliability, validity and responsiveness. Furthermore, in our study OSD-6 was significantly correlated to polysomnography results. 相似文献4.
Marit Erna Austeng Britt Øverland Kari Jorunn Kværner Els-Marie Andersson Stefan Axelsson Michael Abdelnoor Harriet Akre 《International journal of pediatric otorhinolaryngology》2014
Objective
We aimed to assess the prevalence of obstructive sleep apnea (OSA) in 8 year old school children with Down syndrome (DS). While the prevalence in otherwise healthy children is below 5%, the prevalence estimates in children with DS are uncertain (30–80%). OSA directly affects cognitive development and school performance.Study design
Population based cross sectional study in a limited geographical area.Methods
Polysomnography (PSG) with video and audio recordings was performed in 8-year-old children with DS in a pediatric sleep unit according to the guidelines of American Academy of Sleep Medicine. Twenty-nine of all 32 children with DS within a restricted area comprising >50% of the Norwegian population and 54% of the children with DS born in Norway in 2002 were enrolled.Results
This study reports an apnea hypopnea index AHI > 1.5 in 28 of 29 children and an obstructive apnea index (OAI) > 1 in 24 of 29 children. 19 children (66%) had an AHI > 5 and 17 children (59%) had an OAI > 5 which indicated moderate to severe OSA. No correlation was found between OSA and obesity or gender.Conclusion
The high prevalence of disease found in these previously undiagnosed 8-year-old children underlines the importance of performing OSA diagnostics in children with DS throughout childhood. These findings suggest that the prevalence of OSA remains high up to early school years. In contrast to earlier publications, this current study has the advantage of being population based, the study is performed on children of a narrow age band to estimate prevalence of disease and the diagnostic gold standard of PSG is applied. 相似文献5.
Katherine E. Baguley Alan T. Cheng Chenda Castro Natalie Wainbergas Karen A. Waters 《International journal of pediatric otorhinolaryngology》2014
Objective
This study explored the perioperative course of 100 children with polysomnogram (PSG) proven mild to moderate OSA to evaluate if day stay adenotonsillectomy is safe.Methods
A retrospective chart review of patients who had undergone tonsillectomy with or without adenoidectomy following an overnight PSG at The Children's Hospital at Westmead Sleep Laboratory. 263 records were reviewed. Patients with apnoea hypopnea index (AHI) ≥1 and <15/h and/or a final sleep study report of mild to moderate OSA were included. Exclusion criteria were age <3 years, weight <10 kg, or any significant co-morbidities or other surgery that would preclude day stay surgery. Demographic, PSG and post-operative data was analyzed.Results
No major respiratory complications occurred. No patient required an unplanned medical review for respiratory concerns, or admission to a high care facility. Eleven children left recovery with oxygen prescribed. One child had a desaturation to 88% in recovery, and one child had laryngospasm. The nine other children required oxygen to maintain saturation >90%.Supplemental oxygen was prescribed to 7 patients on the ward. Of these, three patients received supplemental oxygen beyond 6 h. The other 97 patients had an uncomplicated post-operative course and would have been suitable for day-stay surgery. Increasing severity of OSA grade on pre-operative PSG was significantly associated with post-operative supplemental oxygen use (p = 0.003; Cochrane-Armitage test for trend).Conclusions
Children who are otherwise well with mild to moderate OSA have a sufficiently low risk of respiratory complications following adenotonsillectomy to permit day-stay surgery in the setting of appropriate facilities with careful post-operative monitoring for the first 6 h to identify a small sub-group who require overnight observations. 相似文献6.
Pablo E. Brockmann Jose Luis PerezAna Moya 《International journal of pediatric otorhinolaryngology》2013
Objective
To investigate the technical feasibility of unattended polysomnography (HPSG) for diagnosis of obstructive sleep apnea (OSA) in children.Methods
A single-night HPSG was performed on children referred to the pediatric respiratory laboratory. Non-interpretable HPSGs were defined as: recordings with (i) loss of ≥2 of the following channels: nasal flow, or thoraco-abdominal belts, or (ii) HPSG with less than 4 h of artifact-free recording time or (iii) less than 4 h SpO2 signal.Results
Of n = 101 included HPSGs, n = 75 were ambulatory and n = 26 in hospitalized subjects. Median (minimum–maximum) age was 2.8 (0–15.4) years. Interpretable and technically acceptable recordings were obtained in 94 subjects (93%). Only 7 recordings (4 at home versus 3 in hospitalized subjects, p-value = 0.254) were classified as non-interpretable and had to be repeated. Artifact-free recording time was 461 (23–766) min. Complete artifact-free pulse oximetry signal was obtained in 14% of the included subjects. Neither age, gender, AHI, nor place of performance was significantly associated with the interpretability of recordings.Discussion
HPSG showed a high rate of interpretability and technical acceptance. The high technical feasibility obtained by HPSG may help to improve simple screening tests for OSA in children. 相似文献7.
Hyo Yeol KimHun-Jong Dhong Jae-Kwon LeeSeung-Kyu Chung Soo-Chan Jung 《Auris, nasus, larynx》2011,38(2):228-232
Objectives
To assess whether obstructive sleep apnea syndrome (OSAS) affects sleep architecture and quality in East Asian children, and also to assess the effects of body position during sleep on respiratory disturbance during sleep.Materials and methods
We enrolled 50 consecutive East Asian children with habitual snoring between 2007 and 2009. Nineteen children had OSAS (apnea-hypopnea index, AHI ≥ 5; OSAS group) and 31 children were simple snorers (control group). They underwent polysomnography and physical examination of their nasal and oral cavities with a roentgenogram of the nasopharynx. Sleep architecture and other polysomnographic variables were compared between the OSAS and control groups. The effect of body position during sleep on respiratory disturbance was examined, and also in relation to obesity and adeno-tonsillar size.Results
There was a decrease in total sleep time and in sleep efficiency, as well as increased arousal and heart rate (P < 0.05) in the OSAS group. Sub-analysis of AHI according to sleep posture showed that AHI is higher when the patient is in the supine position than in the non-supine position (P = 0.032). The presence of OSAS and kissing tonsils were contributing factors to the positional difference in AHI (P < 0.05). Obesity and adenoid hypertrophy did not affect the positional difference of AHI.Conclusions
OSAS may have a greater influence on the sleep architecture of East Asian children, and East Asian children may have a higher AHI when sleeping in the supine position. Tonsillar hypertrophy and the presence of OSAS are possible contributing factors for positional difference of AHI in East Asian children. 相似文献8.
Shyam Sudhakar Sudarsan Vijaya Krishnan ParamasivanSenthil Vadivu Arumugam Sathiya MuraliMohan Kameswaran 《International journal of pediatric otorhinolaryngology》2014
Introduction
Obstructive Sleep Apnea (OSA) is a common medical problem in adults that is becoming increasingly recognized in children. It occurs in the pediatric age group, from newborns to teens. More recently, many specialists have estimated OSA prevalence to be between 5 and 6%. However, in syndromic children, the prevalence of OSA can be from 50 to 100%, having a significant effect on their Quality-of-Life. As they are a challenging population for management, it is essential to evaluate them thoroughly before planning appropriate intervention.Objective
To compare the efficacy of Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) in syndromic children [Down syndrome (DS) and Mucopolysaccharidoses (MPS)] with Obstructive Sleep Apnea (OSA).Materials and methods
In a prospective, randomized, cohort comparative study, 124 syndromic children (DS and MPS) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society, Chennai. A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C) and Quality-of-Life (QOL) tool OSA-18. The children with positive PSG who consented for the study (n = 80) were randomly distributed to two groups, T&A group & CPAP group. The children were followed up with repeat PSG, clinical evaluation, ESS-C and Quality-of-Life (QOL) tool OSA-18 for a period of 1 year.Observation and results
Follow-up was available for 73 syndromic children. Both the groups, T&A group and CPAP group, showed statistically significant (p < 0.05) improvement in Apnea-Hypoapnea Index (AHI), ESS-C, QOL from the intervention. In our study, T&A showed equal outcome compared to CPAP. The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year.Conclusion
On average, T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children. 相似文献9.
Burhanettin Gönüldaş Taner Yılmaz H. Serap Sivri K. Şafak Güçer Kamer Kılınç G. Aydan Genç Mustafa Kılıç Turgay Coşkun 《International journal of pediatric otorhinolaryngology》2014
Objective
The aim of this study is to evaluate otolaryngologic problems (upper airway obstruction, obstructive sleep apnea, restriction of mouth opening, middle ear effusion, hearing and breathing problems) and their treatments on mucopolysaccharidoses (MPS) patients and to investigate accumulation of glucosaminoglycans (GAG) in the upper airway biochemically and pathologically.Methods
76 MPS patients were evaluated. Forty-two MPS patients underwent polysomnography (PSG) for obstructive sleep apnea (OSA). Pre- and postoperative PSG results of 18 patients were compared. The success and complications of treatments for OSA in MPS were evaluated. Biochemical and histopathological accumulation of GAG in tonsil and adenoid tissue and middle ear effusion were analyzed and compared with the control group.Results
Forty patients out of 42 tested with PSG had OSA (95%). Adenoid grade, Mallampati grade, restricted mouth opening, rate of difficult intubation were significantly different among MPS subtypes. MPS types III and IV had significantly lower Mallampati scores; type VI had significantly worse mouth opening; and type III had significantly better mouth opening and higher rate of easy intubation when compared to other MPS types. There was no significant difference between MPS subtypes according to tonsil grade, adenoid grade, rate of otitis media with effusion and OSA severity. Statistically significant difference was found between GAG accumulation in adenoid tissue and middle ear effusion of MPS and control group (p < 0.05). However, GAG accumulation in tonsil was not significantly different between MPS and control group. There was a statistically significant improvement in postop Apnea–Hypopnea Index (AHI) compared to preop AHI (p < 0.05).Conclusions
Most MPS patients have airway obstruction and OSA due to adenotonsillar hypertrophy. Most of these children benefit from adenotonsillectomy, after which OSA significantly improves. They experience high recurrence rate after adenoidectomy; though this is not clinically problematic. They also suffer from conductive hearing loss due to OME, which has to be treated with ventilation tube insertion. However, such operations are usually complicated by difficult endotracheal intubation and restricted mouth opening. Sometimes tracheotomy may be necessary. Tracheotomy is also highly complicated in MPS patients. Significant accumulation of GAG in middle ear fluid and adenoid tissue is present; however, GAG appears not to accumulate in tonsillar tissue. 相似文献10.
Christopher T. Wootten Sivakumar ChinnaduraiSteven L. Goudy 《International journal of pediatric otorhinolaryngology》2014
Objectives
In this study we determine the subjective and objective outcomes of pediatric patients with refractory OSA undergoing drug-induced sleep endoscopy (DISE)-directed surgical treatment.Methods
31 consecutive children with OSA following TA underwent DISE. 26 completed DISE-directed operative management of the level(s) of ongoing upper airway obstruction. Pre- and postoperative OSA were assessed through a detailed history (of nighttime symptoms (NS) and daytime symptoms (DS)), physical examination, and polysomnography.Results
Age ranged 5–18 years (mean 9.7 ± 3.4). Fourteen of 26 had trisomy 21 (51%). Operations were performed in the following frequencies: lingual tonsillectomy (LT) (22), midline posterior glossectomy (MPG) (16), revision adenoidectomy (11), inferior turbinate submucosal resection (7), uvulopalatoplasty (2), and supraglottoplasty (2). Overall, 92% reported subjective improvement. NS improved from 5.8 ± 2.9 preoperatively to 2.1 ± 2.5 postoperatively (p < 0.05), while DS improved from 2.1 ± 1.3 preoperatively to 0.6 ± 1.1 postoperatively (p < 0.05). Seventeen patients completed preoperative polysomnography, while only 11 of them also completed postoperative polysomnography. Mean OAHI fell from 7.0 (±5.8) events/hr to 3.6 (±1.8) events/hr (t-test, p = 0.09).Conclusions
Individualized, multilevel, DISE-directed operative therapy was associated with substantial improvement in subjective measures of sleep. 相似文献11.
Hill CA Litvak A Canapari C Cummings B Collins C Keamy DG Ferris TG Hartnick CJ 《International journal of pediatric otorhinolaryngology》2011,75(11):1385-1390
Objective
A pilot study to identify risk factors predicting post-operative complications in children with severe OSA undergoing adenotonsillectomy.Methods
Retrospective review in a tertiary care academic institution. Two-stage least squares regression analysis and instrumental variable analysis to allow for modeling of pre- and peri-operative risk factors as having significance in predicting post-operative morbidity.Results
Eighty-three children (mean age 4.88 ± 3.09 years) with apnea-hypopnea index (AHI) ≥10 who were observed overnight following adenotonsillectomy were evaluated for rates of major (increased level of care, CPAP/BiPAP use, pulmonary edema and reintubation) and minor (oxygen saturation <90%) airway complications as well as total observation costs. Major and minor complications occurred in 4.8% and 19.3% of children, respectively. Age <2 years (p < 0.01), AHI >24 (p < 0.05), intra-operative laryngospasm requiring treatment (p < 0.05), oxygen saturations <90% on room air in PACU (p < 0.05) and PACU stay >100 min (p < 0.01) independently predicted post-operative complications. Children with any one of these factors experienced a 38% complication rate versus 4% in all others.Conclusions
This pilot study identified pre- and peri-operative risk factors that collectively can be investigated as predictors of post-operative airway complications in a prospective study. By identifying preliminary results comparing the complication rates between those children with and without these risk factors, we will be able to calculate the sample size for a future prospective validation study. Such a study is necessary to understand the safety and potential significant cost savings of observing children without risk factors on the pediatric floor and not in an ICU setting. A best practice algorithm can be created for children with severe OSA only after completing this prospective study. 相似文献12.
Anna Borgström Pia NerfeldtDanielle Friberg 《International journal of pediatric otorhinolaryngology》2013
Objective
To evaluate the diagnostic value of the quality-of-life instrument OSA-18 by comparing it with objective data from polysomnography in children with sleep-disordered breathing.Study Design
Cross-sectional.Patients and Methods
Full-night polysomnographic data were obtained from 225 subjects, 139 boys and 86 girls, median age 4.5 years (1–12) in our sleep laboratory. Their caregivers answered the OSA-18 quality-of-life instrument (range 18–126). The polysomnographic parameter, the apnea-hypopnea index (AHI) was compared with the total symptom score (TSS) and with the subscale of sleep disturbance (SD) from the OSA-18 questionnaire. Receiver operating characteristic (ROC) curves were created to test the predictive value of OSA-18.Results
With the TSS of the OSA-18 at ≥60, compared with AHI levels of >1 and ≥5, the sensitivity was 55.2% and 59.3% respectively, and the specificity 40.9% and 48.4%, respectively. With the TSS > 80 and AHI levels of ≥5 and ≥10, the sensitivity was 24.6% and 32.1%, respectively. For the subscale of SD, the majority of the subjects showed poor correlation with the AHI values. The ROC area under the curve for different levels of the AHI (>1, ≥5, and ≥10) was 0.49, 0.57, and 0.56, respectively.Conclusions
The OSA-18 questionnaire showed poor validity in detecting and predicting pediatric OSA. The majority of the children with severe OSA would not be correctly diagnosed if the OSA-18 were used as a dominant diagnostic tool. 相似文献13.
Yuki Hara Akiko Noda Seiko Miyata Hironao Otake Yoshinari Yasuda Masato Okuda Yasuo Koike Seiichi Nakata Tsutomu Nakashima 《American journal of otolaryngology》2013
Purpose
Although the number of apnea–hypopnea episodes per hour apnea-hypopnea index (AHI) is typically used to evaluate sleep-disordered breathing (SDB) in adults, it does not provide an accurate characterization of SDB in children. We investigated differences in SDB patterns in children and adults to evaluate SDB severity in children.Materials and methods
Fifteen adults (mean age, 45.3 ± 8.4 years) and 15 children (mean age, 6.7 ± 3.9 years) with adenotonsillar hypertrophy underwent standard polysomnography. The change of oxygen saturation (ΔSpO2) was defined as the difference between baseline SpO2 during stable nighttime breathing and the lowest SpO2 accompanied by an apnea–hypopnea event. The number of apnea-hypopnea episodes was determined using two different criteria to define an episode (criterion 1: cessation of airflow for at least 10 s; criterion 2: cessation of airflow for at least two consecutive breaths).Results
Mean ΔSpO2 accompanied by obstructive apneas lasting ≤ 10 s was significantly greater in children than in adults, although there was no significant difference in the duration of apnea–hypopnea episodes. The slope of the regression line between ΔSpO2 and apnea-hypopnea duration in children was greater than in adults (P < 0.005). AHI in children was higher when calculated using criterion 2 compared to criterion 1 (10.9 ± 9.4 vs. 6.5 ± 4.9/h, P = 0.003).Conclusions
ΔSpO2 is a good indicator of SDB severity in children, and should therefore be considered in the diagnosis and treatment of pediatric SDB along with AHI. 相似文献14.
Andrea De Giacomo Francesco Craig Alessandra D’Elia Francesca Giagnotti Emilia Matera Nicola Quaranta 《International journal of pediatric otorhinolaryngology》2013
Objective
The aim of this study is to examine cognitive skills, adaptive behavior, social and emotional skills in deaf children with cochlear implant (CI) compared to normal hearing children.Methods
The study included twenty children affected by profound hearing loss implanted with a CI compared to 20 healthy children matched to chronological age and gender.Results
Results of this study indicated that 55% of children with CI showed a score in the normal range of nonverbal intelligence (IQ > 84), 40% in the borderline range (71 < IQ < 84) and 5% were in mild range (50 < IQ < 70). No significant differences were found after comparison with normal hearing children. Children with CI reported more abnormalities in emotional symptoms (p = .018) and peer problems (p = .037) than children with normal hearing. Age of CI was negatively correlated with IQ (p = .002), positively correlated with emotional symptoms (p = .04) and with peer problems (p = .02).Conclusions
CI has a positive effect on the lives of deaf children, especially if it is implanted in much earlier ages. 相似文献15.
Jolanta Wasilewska Maciej KaczmarskiKatarzyna Debkowska 《International journal of pediatric otorhinolaryngology》2011,75(5):657-663
Objective
The mechanism of persisting obstructive sleep apnea (OSA) after adenotonsillectomy is not fully explained. The purpose of this study was to evaluate factors associated with residual OSA. The primary outcome measures were metabolic tests and polysomnographic respiratory indices in children with residual disease compared with children who were diagnosed with OSA but were untreated. Secondary outcome measures were acid gastroesophageal reflux indices recorded parallel to the sleep study.Methods
In the one-year study consecutive series of patients with sleep disordered breathing hospitalized in a tertiary pediatric center were evaluated. Following the study protocol a sleep interview, physical examination, metabolic blood tests (serum leptin and the homeostasis model assessment index for insulin resistance, HOMA-IR) and an overnight polysomnography with pH-metry recording were performed. Children diagnosed with OSA were analyzed in two groups: I - residual OSA (after surgery), II - non-residual OSA (newly diagnosed). Logistic regression analysis was applied to obtain significant risk factors for prediction of OSA.Results
Fifty-seven children (mean age ± SE, 6.9 ± 0.5 years; 66.7% boys) met the inclusion criteria and were enrolled in the study as residual (n = 19) or non-residual OSA (n = 38). The groups differed significantly in mean oxygen saturation, SpO2 (94.3% vs. 96.2%; p = 0.018 respectively), in the Apnea Hypopnea Index, (20.6/h vs. 9.1/h; p < 0.03), the number of respiratory arousals with desaturation (2.2/h vs. 0.8/h; p < 0.03); mean intraluminal esophageal pH (5.36 vs. 5.86; p = 0.007) and the Reflux Index (9.61% vs. 4.35%; p = 0.003). The groups did not differ in total sleep time, tonsil size, BMI z-score and blood metabolic indices. Logistic regression analysis showed that residual OSA was significantly predicted by two polygraphic findings: the obstructive hypopnea index (OR 1.15; 95% CI 1.02-1.28; p = 0.014) and by the Reflux Index (OR 1.01; 95% CI 1.00-1.34; p = 0.042).Conclusions
1. Obstructive hypopneas, rather than obstructive apneas, persist after adenotonsillar surgery resulting in residual OSA. 2. Children with residual OSA are at higher risk of acid gastroesophageal reflux and should be evaluated for gastroesophageal reflux disease. 相似文献16.
Andrea Canale Federico DagnaElena Favero Michelangelo LacillaCarla Montuschi Roberto Albera 《International journal of pediatric otorhinolaryngology》2014
Objective
To assess the role of the efferent auditory system by inhibition of contralateral otoacoustic emission in dyslexic children with auditory processing disorders.Methods
The study sample was 34 children: 17 with dyslexia and 17 age-matched controls. Sensitive speech tests (low-pass filtered, time-compressed, distorted and dichotic) were performed to assess coexisting auditory processing disorder. Distortion-product otoacoustic emission (DPOAE) values were measured in basal condition and with contralateral broadband noise signal delivered via an earphone transducer at 60 dB SPL.Results
The lower scores at sensitive speech testing confirmed the association of an auditory processing disorder in the dyslexic children. DPOAE values were significantly attenuated by contralateral inhibition only in the control group (p = 0.001; dyslexics, p = 0.19); attenuation was not significant at any frequency in the dyslexic group.Conclusions
The differences in DPOAE attenuation between the groups, although not statistically significant, suggest alterations in the auditory efferent system in the dyslexic population. These alterations may affect language perception. If confirmed in further studies with larger samples, these results could provide insight into a possible pathophysiological background of dyslexia. 相似文献17.
Courtney B. Shires Sandra L. Anold Robert A. Schoumacher George W. Dehoff Sreekrishna K. Donepudi Rose Mary Stocks 《International journal of pediatric otorhinolaryngology》2010,74(7):768-772
Objective
Our objective was to determine if higher body mass index (BMI) increases the likelihood of, obstructive sleep apnea (OSA) in pediatric Down syndrome (DS) patients.Methods
We performed a, retrospective chart review of 63 DS patients evaluated by overnight polysomnography from December 1995 to February 2005. Patients aged less than 2 years were excluded. Remaining patients were grouped, according to presence (n = 19) or absence (n = 33) of OSA based on apnea hypopnea index (AHI). OSA, and non-OSA DS groups were age matched while blinded to patient attributes other than age and OSA, status. Patients without appropriate age matches were excluded. We recorded various patient information, including age, sex, height, weight, number of apneas, number of hypopneas, respiratory distress index (RDI), apnea-hypopnea index (AHI), lowest oxygen saturation during sleep, mean oxygen saturation, number of arousals per hour, and mean time spent in REM sleep. We calculated BMI using the, standard kg/m2 formula and converted this into a Z-score.Results
Fifty-two DS patients were analyzed with average age of 9.3 ± 4.5 years (10.2 ± 4.2 in 33 OSA patients, 7.8 ± 4.3 in 19 non-OSA patients). There were 28 males and 24 females. The OSA group mean BMI Z-score was 2.09 ± 0.94, and the non-OSA group Z-score was 1.4 ± 1.40. The Z-scores for BMI were statistically significant between OSA and non-OSA patients with p = 0.03 by t-test.Conclusions
When age and sex adjusted, BMI has a statistically significant association with the presence of OSA in Down syndrome patients. The incidence of OSA also increases with increasing age in this population. 相似文献18.
Travis D. Reeves Christopher M. DiscoloDavid R. White 《International journal of pediatric otorhinolaryngology》2013
Objective
To determine the dimensions of the nasal cavity in infants with congenital pyriform aperture stenosis (CPAS).Study design
The nasal cavities of seven children with CPAS were identified and were compared to the nasal cavities of 13 neonates (<30 days old) who had received CT scans for other indications.Methods
The width of the nasal cavities was measured at the pyriform aperture, choana, and at two standardized points along the lateral nasal wall (LW-1 and LW-2) between the pyriform aperture and choana.Results
Comparison between neonates with and without CPAS demonstrates significant narrowing of the nasal cavity (not just the pyriform aperture) in infants with CPAS. Significantly smaller nasal width was noted at pyriform aperture, LW-1, and LW-2 (p < 0.01, p < 0.01, p = 0.02). No significant narrowing was seen at the choana.Conclusion
These findings suggest that CPAS is associated with narrowing of the anterior 75% of the nasal cavity. This has implications for surgical management because simple pyriform aperture ostectomy may not be sufficient to relieve symptoms of obstruction. 相似文献19.
Hiroto Moriwaki Yuichi Inoue Kazuyoshi Namba Yuji Suto Shintaro Chiba Hiroshi Moriyama 《Auris, nasus, larynx》2009
Objectives
In order to assess the relationship between upper airway obstruction pattern and the clinical characteristics of obstructive sleep apnea syndrome (OSAS), we evaluated dynamic changes in the pharyngeal airway of patients with the disorder by using ultrafast dynamic magnetic resonance imaging (MRI).Methods
MRI while asleep was performed on 31 patients with OSAS (29 men, 2 women; mean age, 46.6 ± 8.2 years; mean body mass index, 26.7 ± 4.9 kg/m2; mean AHI, 40.6 ± 21.7 episodes/h). Relationships between obstruction pattern focusing on differences between single-site obstruction (SO) and multiple-site obstructions (MO) and titrated value of nasal CPAP in addition to respiratory variables were investigated.Results
The velopharynx (VP) was the main obstructive site among most of the cases with SO (17 of 18 cases), and all of the cases with MO (n = 13) showed obstruction at and below the VP. AHI was significantly higher in cases with MO than in those with SO (P < 0.01). As for SaO2 variables, minimum value during sleep was significantly lower and total time with SaO2 £90% was longer in cases with MO than in those with SO (P < 0.05 each). Titrated value of n-CPAP was also significantly higher in cases with MO than in cases with SO (P < 0.05).Conclusions
Our results strongly suggest that formation of MO manifested on ultrafast dynamic MRI could be related to increased severity of the disorder. Considering the higher titrable value of CPAP, MO could be brought about by high pharyngeal pressure. 相似文献20.
Andrew Walls Matthew Pierce Hongkun Wang Ashley Steehler Matthew Steehler Earl H. Harley Jr. 《International journal of pediatric otorhinolaryngology》2014