Advances in Sleep-Disordered Breathing in Children.

Pediatric sleep-disordered breathing disorders are a group of common conditions, from habitual snoring to obstructive sleep apnea (OSA) syndrome, affecting a significant proportion of children. The present article summarizes the current knowledge on diagnosis and treatment of pediatric OSA focusing on therapeutic and surgical advancements in the field in recent years. Advancements in OSA such as biomarkers, improving continuous pressure therapy adherence, novel pharmacotherapies, and advanced surgeries are discussed.

Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California.

STUDY OBJECTIVES: Pediatric obstructive sleep apnea (OSA) is common, however, inclusion of adolescents and especially those of ethnic/racial minorities in research is scarce. We hypothesized that ethnic/racial minority adolescents undergoing polysomnography (PSG) have higher prevalence and more severe OSA compared to those who are non-Hispanic (NH) White. METHODS: Retrospective review of 1,745 adolescents undergoing diagnostic PSG. Demographic characteristics, age, body mass index percentile (BMIp), and PSG parameters were obtained. Descriptive statistics comparing race/ethnicity were analyzed. Linear regression of log-transformed obstructive apnea-hypopnea index (OAHI), and logistic regression of moderate-severe OSA (OAHI ≥ 5 events/h) adjusting for covariates were analyzed. RESULTS: 58.2% adolescents were Hispanic, 24.1% NH-White, 4.3% NH-Asian/Pacific Islander (PI), 4.2% NH-Black/African American (AA), and 6.6% NH-other. Compared to the NH-White group, the Hispanic group had higher OAHI and any level of OSA severity; the Black/AA group had higher moderate-severe and severe OSA, and the NH-Asian group had higher moderate-severe OSA. Multiple linear regression of log-OAHI identified an association with Hispanic ethnicity (ß: 0.25, P-value < .05). Compared to the NH-White group, the Hispanic and the Asian/PI groups were 1.45 (95% CI: 1.10, 1.93) and 1.81 (95% CI: 1.05, 3.10) times more likely to have moderate-severe OSA, respectively, after adjusting for relevant covariates. Stratified analysis by sex identified an association only among males between Hispanic ethnicity (OR: 1.85, 95% CI: 1.27, 2.70) and Asian/PI ethnicity (OR: 2.62, 95% CI: 1.35, 5.11) and moderate-severe OSA, compared to the NH-White group. CONCLUSIONS: Among adolescents undergoing PSG evaluation, we identified OSA racial/ethnic and sex disparities in Hispanic and NH-Asian adolescents. Community level studies with adequate representation of these minority groups are needed to identify factors associated with the reported increased susceptibility.

Characteristics of sleep in children with heavy prenatal alcohol exposure.

BACKGROUND: Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods. METHODS: Participants aged 6-10 years, with and without prenatal alcohol exposure, were included in the study (alcohol-exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24-h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. RESULTS: There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age. CONCLUSIONS: Despite similar 2-week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.