Characteristics of ADHD Symptoms and EEG Theta/Beta Ratio in Children With Sleep Disordered Breathing.

Objectives. This study aimed to explore parent-reported symptoms of attention deficit-hyperactivity disorder (ADHD) and sleep electroencephalogram (EEG) theta/beta ratio (TBR) characteristics in children with sleep disordered breathing (SDB). Methods. The parents of children (aged 6-11 years) with SDB (n = 103) and healthy controls (n = 28) completed the SNAP-IV questionnaire, and children underwent overnight polysomnography. Children with SDB were grouped according to obstructive apnea/hypopnea index: primary snoring, mild, and moderate-severe obstructive sleep apnea (OSA) groups. The TBR in non-rapid eye movement (NREM) periods in three sleep cycles was analyzed. Results. Children with SDB showed worse ADHD symptoms compared with the healthy control. There was no intergroup difference in TBR. The time-related decline in TBR observed in the control, primary snoring and mild OSA groups, which was not observed in the moderate-severe OSA group. Overnight transcutaneous oxygen saturation was negatively associated with the hyperactivity/impulsivity score of ADHD symptom. The global TBR during the NREM period in the first sleep cycle was positively correlated with inattention score. Conclusion. Children with SDB showed more ADHD inattention symptoms than the healthy control. Although we found no difference in TBR among groups, we found significant main effect for NREM period. There existed a relationship between hypoxia, TBR, and scores of ADHD symptoms. Hence, it was speculated that TBR can reflect the nocturnal electrophysiological manifestations in children with SDB, which may be related to daytime ADHD symptoms.

Characteristics of the Attentional Network in Children with Sleep-Disordered Breathing.

Purpose: To explore the characteristics of the attentional network and related factors in children with sleep-disordered breathing (SDB). Patients and Methods: A total 228 children (200 children aged 6-10 years with snoring or mouth breathing, admitted to our hospital from May 2020 to July 2022, and 28 healthy children recruited from the community as the control group) were enrolled. All participants underwent polysomnography (PSG) and completed the ADHD rating scale and child version of the Attention Network Test. According to their SDB history and obstructive apnea hypopnea index (OAHI), the participants were divided into control (n = 28), primary snoring (PS; n = 67) and obstructive sleep apnea (OSA; n = 133) groups. Results: The OSA and PS groups were younger than controls (P < 0.05). The proportion of boys was higher in the OSA than control group (P < 0.05). Body mass index was higher in the OSA than control and PS groups (P < 0.01). Attention deficit and hyperactive impulsivity scores were independently associated with the OAHI (P < 0.001). The efficiency of the alerting network was higher in the OSA than in controls (P = 0.020), but was not correlated with OAHI after adjusting for age, sex and SDB history duration (P > 0.05). Conclusion: Children with OSA have impaired attention, characterized by excessive alerting network activation. However, alerting network efficiency did not change linearly with disease severity. More research is needed to elucidate the neural mechanisms underlying attention deficits in pediatric OSA.

The effect of different intervention on disease outcomes and urinary leukotriene levels in pediatric sleep-disordered breathing.

BACKGROUND: The prognosis in children with sleep-disordered breathing (SDB) undergoing adenotonsillectomy (T&A), medication, and watchful waiting with supportive care, and the changes of urine cysteinyl leukotriene E4 (uLTE4) at pretreatment and post-treatment are not well studied. METHODS: Children aged 3-14 yrs suffering from SDB were enrolled. All children underwent polysomnography (PSG), completed OSA-18 Quality of Life questionnaire and uLTE4 levels were measured pre- and post-T&A, medication and watchful waiting with supportive care about six months later. Children with obstructive sleep apnea who demonstrated a resolution of disease (OAHI<1) were defined as remission. The remission in children with primary snoring (PS) was defined as the absence of snoring at the follow-up. Deterioration was defined as a progression of disease severity, such as PS progressing to OSA, mild OSA progressing to moderate-to-severe OSA, and moderate OSA progressing to severe OSA. All the others were defined as unchanged. RESULTS: A total of 78 children were enrolled. After treatment, 10 (50.0%), 6 (18.2%), and 7 (28.0%) children in T&A, medication, and watchful waiting were in remission respectively. PSG variables and OSA-18 Quality of Life scores were significantly improved in the T&A group and remission population. The levels of uLTE4 were not significantly different pre- and post-treatment in T&A group nor in the remission population. CONCLUSIONS: T&A can significantly reduce PSG variables and improve the Quality of Life in children with moderate to severe OSA. The levels of uLTE4 did not change after T&A nor in the remission population after six-month follow-up.

Autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing.

BACKGROUND: The objective of the study was to assess the relationship between autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing. METHODS: We enrolled habitually snoring children aged 3-14 years for overnight polysomnography (PSG) and high-sensitivity C-reactive protein (hsCRP) measurement. Low-grade inflammation was defined as hsCRP >1.0 mg/L to <10.0 mg/L. An electrocardiogram recording was extracted from PSG. Heart rate variability was analyzed using time and frequency domain methods. RESULTS: In total, 190 children were included, with 61 having primary snoring (PS), 39 mild obstructive sleep apnea (OSA), and 90 moderate-to-severe OSA. The average RR interval displayed a significant decline, whereas the low frequency/high frequency (LF/HF) ratio showed an increasing tendency in children with PS, mild OSA, and moderate-to-severe OSA. Mean RR was mainly influenced by age and the apnea hypopnea index (AHI) (all P < 0.01). AHI was an independent risk factor for the altered LF/HF ratio at all sleep stages except N3 stage (all P < 0.05). In the wake stage, low-grade inflammation was an independent risk factor of altered LF/HF ratio (P = 0.014). CONCLUSIONS: Autonomic nervous function was impaired in children with OSA. The sympathetic-vagal balance was influenced by low-grade inflammation in the wake stage, whereas it was only affected by AHI when falling asleep. IMPACT: We found that autonomic nervous function was impaired in children with OSA. We found that there was a negative correlation between systemic inflammation and autonomic nervous function in children with SDB only at wake stage. A negative association between systemic inflammation and autonomic nervous function was demonstrated in children in this study. Furthermore, altered LF/HF ratio maybe a good indicator of autonomic nervous dysfunction in children as it only correlated with the SDB severity, not with age.

Generation and characterization of iPSC lines (BCH001) from a boy with intron 14 mutation in the ret proto-oncogene (RET) gene.

Congenital central hypoventilation syndrome (CCHS) is characterized by an alteration of the ventilatory response to hypercapnia and hypoxia, and is classically presented in neonates with abnormalities of the autonomic nervous system. Here, we generated human induced pluripotent stem cell (iPSC) lines from peripheral blood mononuclear cells (PBMCs) isolated from a male patient clinically diagnosed with CCHS. These iPSC lines carry a heterozygous RET mutation (c.2608-125C > T), express pluripotency markers, have the capacity to differentiate into the normal teratoma tissue, retain the RET mutation and display the normal karyotype, which will also provide a useful resource to study the pathogenesis of CCHS.