Sleep breathing disorders in pediatric patients with spinal muscular atrophy 2.

OBJECTIVES: The study is aimed to analyze both sleep architecture and prevalence of sleep-disordered breathing (SDB), in a group of patients with type 2 spinal muscular atrophy (SMA), considering motor dysfunction, and compare them with age-matched controls. METHODS: Eighteen SMA type 2 patients (nine males median age 9.5 (4-17) years) and eighteen controls (fourteen males, median age 8,5 (1-16) years) underwent nocturnal polysomnography. SMA type 2 patients were evaluated with motor scales; Hammersmith Functional Motor Scale Expanded (HFMSE), Revised upper limb model (ULMR) and Egen Klassification Scale Version 2 (EK2). Parents/tutors completed two pediatric sleep questionnaires (respiratory subscale from Chervin Pediatric Sleep Questionnaire and Bruni's Sleep Disturbance Scale for Children). RESULTS: When compared with controls, SMA type 2 patients showed no significant differences in age (9.72 ± 4.2 vs 8.22 ± 3.9 (p = 0.28), gender 9 (9 men (50%) vs 14 (77,8%) (p = 0.083) and nutritional status; Body Mass Index (BMI) (16.4 (12.2-34.8) vs 17.6 (4.4-24.2) (p = 0.83). Apnea Hypopnea Index (AHI) was statistically higher in SMA type 2 patients (6.7 ± 6.2 vs 0.4 ± 0.3) (p < 0.001). The SpO2 mean values in cases were (96% ± 1.4) vs (97.5% ± 1.2) (p = 0.007). TcPCO2 median value (41,5 mmHg; (range 34-47.2) in the SMA type-2 patients within normal reference values. Only one motor scale; Hammersmith Functional Motor Scale Expanded (HFMSE) showed a negative correlation with AHI (r = -0.132). CONCLUSIONS: Patients affected by SMA type 2 presented significantly higher apnea-hypopnea indices than controls; differences in sleep architecture identified include: decreased total sleep time, increased percentage of stage N1 of NREM sleep as well as increased sleep fragmentation seen in the SMA type 2 group, due to respiratory related arousals. We would like to point out that validated pediatric sleep questionnaires in general population, may not be useful tools when screening for SDB in these patients. This should be taken into consideration in clinical practice and in the elaboration of future clinical guidelines for these patients.

Sleep quality in children with atopic dermatitis during flares and after treatment.

BACKGROUND: Little is known on sleep quality of children with atopic dermtitis (AD) during flares and how treatment impacts their sleep. The purpose of this study is to evaluate variations in sleep quality of children with AD during flares and its response to intensified treatment. MATERIAL AND METHODS: Prospective case-crossover study in 10 children with moderate-severe AD. At baseline, AD severity was assessed using SCORAD and patients were prescribed intensified AD therapy. All subjects were monitored by actigraphy during 14 days and returned for SCORAD assessment. RESULTS: Subjects' age was 5.6 ± 5.3 years; 50% were female. Sleep duration was decreased in all subjects and awakenings were increased in 90%. Parental perception of sleep significantly differed from actigraphy results: parents estimated less sleep duration and less awakenings. Nocturnal sleep efficiency at baseline was reduced in 50%. After intensified treatment, median SCORAD decreased from 58.5 to 31.3 (p=0.005), with significant improvement in sleep loss and pruritus visual analogue scales. Despite improvement of SCORAD and parental perception of sleep loss and pruritus, objective sleep duration and efficiency measured by actigraphy did not vary significantly after intensified treatment. Change in SCORAD, sleep loss and pruritus scales did not correlate significantly with change in sleep duration, efficiency or other actigraphic sleep quality measurements. CONCLUSIONS: Children with moderate-severe AD have sleep quality abnormalities, with decreased sleep duration, low sleep efficiency and increased awakenings. Improvement in AD severity upon intensified AD treatment was associated with improved parental perception of sleep loss, but not of objective sleep quality assessed by actigraphy.

Recomendación de experto: apneas respiratorias y parámetros de sueño en el recién nacido y lactantes menores de 3 meses / Expert consensus: management of respiratory apneas and sleep parameters in newborn and infants under 3 months

El diagnóstico de apneas en lactantes menores de tres meses constituye un gran desafío y es un área en pleno desarrollo. Es por esto, que diferentes especialistas en sueño, pertenecientes a dos Sociedades Científicas de Chile: la Comisión de Sueño, de la Sociedad Chilena de Neumología Pediátrica (SOCHINEP) y el Grupo de Trabajo Trastornos del Sueño en Pediatría de la Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA), se han puesto de acuerdo en proponer un consenso básico sobre los parámetros de sueño y del manejo de las apneas en los menores de 3 meses de vida. El objetivo, es que podamos contribuir al manejo de estos pacientes, con un lenguaje y manejo similar, y valores de referencia apropiados para ese grupo etario, respaldado con las últimas investigaciones al respecto.

Sleep apnea diagnosis in infants younger than 3 months has been a major challenge for modern medicine. Using current literature, experts from the Chilean Society of Pediatric Pulmonology Sleep Commission, and the Chilean Society of Psychiatry and Neurology for Children and Adolescents, have produced a national state-of-the-art consensus. The main goal of this statement is to unify our language in this matter, based on the latest evidence.

Nocturnal Oximetry-based Evaluation of Habitually Snoring Children.

RATIONALE: The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea-hypopnea syndrome (OSA) are not objectively diagnosed by nocturnal polysomnography because of access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could potentially provide a reliable and convenient diagnostic approach for pediatric OSA. METHODS: Deidentified nSpO2 recordings from a total of 4,191 children originating from 13 pediatric sleep laboratories around the world were prospectively evaluated after developing and validating an automated neural network algorithm using an initial set of single-channel nSpO2 recordings from 589 patients referred for suspected OSA. MEASUREMENTS AND MAIN RESULTS: The automatically estimated apnea-hypopnea index (AHI) showed high agreement with AHI from conventional polysomnography (intraclass correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the widely used AHI cutoff points of 1, 5, and 10 events/h revealed an incremental diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and 0.913 area under the receiver operating characteristic curve, respectively). CONCLUSIONS: Neural network-based automated analyses of nSpO2 recordings provide accurate identification of OSA severity among habitually snoring children with a high pretest probability of OSA. Thus, nocturnal oximetry may enable a simple and effective diagnostic alternative to nocturnal polysomnography, leading to more timely interventions and potentially improved outcomes.

Diagnostic accuracy of the Spanish version of the Pediatric Sleep Questionnaire for screening of obstructive sleep apnea in habitually snoring children.

OBJECTIVES: We aimed to determine the diagnostic test accuracy of the Spanish version of the respiratory symptoms scale of the Pediatric Sleep Questionnaire (PSQ) in habitually snoring children for identifying obstructive sleep apnea (OSA). METHODS: Habitually snoring children referred for polysomnography (PSG) were recruited. Parents answered the PSQ prior to PSG. Based on an apnea-hypopnea index (AHI) >1.0 in PSG, children were divided into OSA and primary snorers. Correlations to PSG indices and diagnostic test accuracy measures were calculated. RESULTS: Of the 83 (n = 53 males, mean age 9.5 ± 3.6 years) habitually snoring children included, 35 had OSA. The previously validated PSQ cutoff value of 0.33 showed a specificity of 0.72 and sensitivity of 0.78. The PSQ score correlated significantly with the AHI rs = 0.313 (p-value = 0.004). Six items of the PSQ were significantly different between cases and controls. A subscale constructed on these six PSQ items concerning respiratory symptoms showed a good sensitivity (0.886) and an excellent negative likelihood ratio (0.261). PSQ was able to identify 89% of the children with OSA correctly. CONCLUSIONS: This version of the PSQ was able to identify children with OSA, separating them from those with primary snoring. The use of this simple, standardized questionnaire tool seems to be helpful and may improve clinical decision making in habitually snoring children.