Screening for sleep-disordered breathing with Pediatric Sleep Questionnaire in children with underlying conditions.

The Pediatric Sleep Questionnaire described by Chervin et al. (Sleep Medicine, 2000, 1, 21-32) was originally validated for children with obstructive sleep apnoea syndrome but without other disorders. The aim of our study was to check the applicability of this questionnaire in children with underlying chronic medical conditions. Children aged 2-18 years who underwent a diagnostic sleep study at Great Ormond Street Hospital were recruited over a 10-month period. The Pediatric Sleep Questionnaire completed by their parents and cardiorespiratory polygraphy were scored. Sensitivities and specificities of the Pediatric Sleep Questionnaire were calculated using a Pediatric Sleep Questionnaire score of 0.33 as being indicative of sleep-disordered breathing. A total of 561 patients were reviewed. Neuromuscular disorders (n = 108), craniofacial anomalies (n = 58) and the obstructive sleep apnea syndrome control group (n = 155) were best represented. The sensitivity for patients with isolated obstructive sleep apnoea syndrome was 76.5% when using an apnoea-hypopnoea index ≥ 5, but this was much lower when looking at specific sub-groups such as neuromuscular patients (25%) or patients with Trisomy 21 (36.7%). Sensitivities remained unchanged for patients with obstructive sleep apnoea syndrome (77.3%) when an apnoea-hypopnoea index of ≥ 1 was used, but improved for neuromuscular disorders sub-groups (36.7%) and Trisomy 21 (84%). In conclusion, the Pediatric Sleep Questionnaire is not a good screening tool for obstructive sleep apnoea syndrome in children with complex underlying disorders when a cut-off apnoea-hypopnoea index of ≥ 5 is used, and it cannot replace cardiorespiratory polygraphy recording.

Home (Level 2) polysomnography is feasible in children with suspected sleep disorders.

AIM: To audit the feasibility and patient experience of home polysomnography (sleep study) for the investigation of a sleep disorder in children. METHODS: The signal quality and outcomes of a Level 2 (home) polysomnography in young people undergoing investigation between September 2020 and January 2021 in a single centre was reviewed. A successful home polysomnogram was defined as a study with ≥6 h of sleep and all channels (EEG, thoraco-abdominal bands, calculated airflow, and pulse oximetry) present for at least 90% of the study time. Feedback from the guardian and young person was collected following the study using a questionnaire. RESULTS: Fifty-five patients, aged 4 months to 18 years, were included. A successful polysomnogram, on the first attempt, was achieved for 48/55 (87%) subjects. There were no differences in success when accounting for neurodevelopmental conditions, OSA severity or age. The majority (76%) of guardians felt that their child slept the same or better than normal and only 12% found having the study conducted at home difficult. Following the study, only 8% would have preferred a hospital sleep study in retrospect. CONCLUSIONS: Home polysomnography produced a technically adequate study for the majority of subjects. Most families also found the experience of having a home sleep study to be positive. These data support the use of home sleep studies as an alternative to an in-patient sleep study, in appropriate circumstances, for young people undergoing investigation of a sleep disorder.

The effect of technique change on knee loads during sidestep cutting.

PURPOSE: To identify the effect of modifying sidestep cutting technique on knee loads and predict what impact such change would have on the risk of noncontact anterior cruciate ligament injury. METHODS: A force platform and motion-analysis system were used to record ground-reaction forces and track the trajectories of markers on 15 healthy males performing sidestep cutting tasks using their normal technique and nine different imposed techniques. A kinematic and inverse dynamic model was used to calculate the three-dimensional knee postures and moments. RESULTS: The imposed techniques of foot wide and torso leaning in the opposite direction to the cut resulted in increased peak valgus moments experienced in weight acceptance. Higher peak internal rotation moments were found for the foot wide and torso rotation in the opposite direction to the cut techniques. The foot rotated in technique resulted in lower mean flexion/extension moments, whereas the foot wide condition resulted in higher mean flexion/extension moments. The flexed knee, torso rotated in the opposite direction to the cut and torso leaning in the same direction as the cut techniques had significantly more knee flexion at heel strike. CONCLUSION: Sidestep cutting technique had a significant effect on loads experienced at the knee. The techniques that produced higher valgus and internal rotation moments at the knee, such as foot wide, torso leaning in the opposite direction to the cut and torso rotating in the opposite direction to the cut, may place an athlete at higher risk of injury because these knee loads have been shown to increase the strain on the anterior cruciate ligament. Training athletes to avoid such body positions may result in a reduced risk of noncontact anterior cruciate ligament injures.