Descriptive analysis of central sleep apnea in childhood at a single center.

UNLABELLED: Data on central sleep apnea (CSA) and its significance in children are limited. Our objectives were to describe the polysomnogram (PSG) characteristics and clinical features of children with significant CSA at a single pediatric sleep center. STUDY DESIGN AND METHODS: A retrospective chart review of children diagnosed with CSA on a PSG, from January 2007 to December 2008, was performed. All the PSG's were performed in the pediatric sleep laboratory at The Hospital for Sick Children in Toronto, Canada. All children diagnosed with significant CSA with a PSG was eligible for inclusion. Each PSG was conducted and scored according to the American Academy of Sleep Medicine standard. Significant CSA was defined as a central apnea index (CAI) of >5 events/hr. Outcome for each patient was defined by the percentage change in the CAI at follow up. RESULTS: 52/969 (5.4%) patients had a CAI > 5/hr on a baseline PSG. Of the 25/52 (13 males) patients who met inclusion criteria, the median age was 19 months (range 3-156 months) and their median BMI z score was +0.27 (range -2.95 to 3.02). The median CAI was 11 events/hr (range 6-198/hr). The mean oxygen saturations ranged from 92.8% to 98.5%, with a median of 97%. Six (24%) patients had associated sleep-related hypoventilation and none of the patients had periodic breathing. The commonest identifiable risk factor for CSA in the study population was a neurological disorder. CONCLUSIONS: This study confirms that CSA is an important finding in a significant number of young children referred for an evaluation for suspected sleep related disordered breathing. Any child diagnosed with CSA warrants full clinical assessment, including neuro-imaging. Future research should aim to evaluate the long term outcome of significant CSA.

No decrease in annual risk of tuberculosis infection in endemic area in Cape Town, South Africa.

OBJECTIVE: To estimate the change in annual risk of tuberculosis infection (ARTI) in two neighbouring urban communities of Cape Town, South Africa with an HIV prevalence of approximately 2%, and to compare ARTI with notification rates and treatment outcomes in the tuberculosis (TB) programme. METHODS: In 1998-1999 and 2005, tuberculin skin test surveys were conducted to measure the prevalence of Mycobacterium tuberculosis infection and to calculate the ARTI. All 6 to 9-year-old children from all primary schools were included in the survey. Notification rates and treatment outcomes were obtained from the TB register. RESULTS: A total of 2067 children participated in the survey from 1998 to 1999 and a total of 1954 in 2005. Based on a tuberculin skin test cut-off point of 10 mm, the ARTI was 3.7% (3.4-4.0%) in the 1998-1999 survey and 4.1% (3.8-4.5%) in 2005. The notification rate for pulmonary TB increased significantly from 646 per 100 000 in 1998 to 784 per 100,000 in 2002. In Ravensmead, there was no significant change in ARTI [first survey: 3.5% (3.1-3.9%), second survey: 3.2% (2.9-3.6%)], but in Uitsig the ARTI increased significantly from 4.1% (3.6-4.6%) to 5.8% (5.2-6.5%). The difference in ARTI between the two areas was associated with differences in reported case rates and the proportion of previously treated cases. CONCLUSION: Tuberculosis transmission remains very high in these two communities and control measures to date have failed. Additional measures to control TB are needed.