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1.
Sleep Med ; 76: 48-54, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33091726

RESUMO

OBJECTIVES: To evaluate sleep duration in a representative sample of preschoolers and examine the relationships between screen time and use of different electronic media devices with sleep duration and social jetlag. METHODS: 2903 preschoolers were included. Parent-completed questionnaire provided information on socioeconomic status, electronic media use of the children and sleep patterns of both parents and children. Preschoolers were divided according to whether they met the international screen time recommendations for their age. Comparisons between the two groups in various sleep measures and effects of different devices on sleep were evaluated. RESULTS: 40% of preschoolers in our cohort did not achieve the recommended sleep duration. Subjects who adhered to the screen time recommendations were from families of higher socioeconomic status, had longer sleep duration and better sleep habits. Each hour increase on portable electronic device use was associated with 11 (95%CI: -15 to -6) and 6 (95%CI: -10 to -2) minutes less of average daily sleep duration in boys and girls, respectively. Every additional hour of non-portable electronic devices use was associated with 3 min shift in social jetlag in boys. Presence of electronic devices in bedroom and their use at bedtime increased risk of social jetlag in boys with an OR of 1.40 (95%CI: 1.01 to 1.92) and 1.39 (95%CI: 1.00 to 1.95) respectively. CONCLUSION: A significant proportion of preschoolers does not obtain the recommended amount of sleep. Screen time in preschoolers affects not only sleep duration but also leads to circadian discrepancy.

2.
Chest ; 156(1): 120-130, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30922948

RESUMO

BACKGROUND: Understanding the natural history of childhood OSA can help to determine disease prognosis and to guide risk stratification and management strategies. METHODS: To evaluate the natural history of childhood OSA and factors associated with spontaneous remission and persistent and incident OSA from childhood to late adolescence/early adulthood, a longitudinal analysis of a prospective community-based cohort was designed. Subjects from a cohort established for an OSA prevalence study were invited to participate in this 10-year follow-up study. RESULTS: Two hundred and forty-three participants (59% male) took part, and their mean age was 9.8 (SD, ± 1.8) and 20.2 (SD, ± 1.9) years at baseline and follow-up, respectively. The mean follow-up duration was 10.4 (SD, ± 1.1) years. Associations between baseline and follow-up log-transformed obstructive apnea-hypopnea index (OAHI) differed by age; a significant positive association was observed only among participants aged 10 years or older at baseline. Overall polysomnographic remission rate (with OAHI < 1 event/h at follow-up) of childhood OSA was 30%, and 69% had an OAHI < 5 events/h at follow-up. Complete remission of OSA was associated with female sex. Incidence of adolescent/adult OSA with an OAHI ≥ 5 events/h at follow-up was 22%. Male sex and higher baseline BMI z score were associated with incident OSA. CONCLUSIONS: A proportion of children with OSA, particularly female children, had complete resolution during transition to late adolescence or early adulthood. Childhood and adolescent OSA are distinct entities, with the latter more likely to persist into adulthood. Obesity and male sex are consistent key risk factors for incident OSA.


Assuntos
Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Fatores Etários , Criança , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Obesidade/complicações , Polissonografia , Prognóstico , Estudos Prospectivos , Remissão Espontânea , Medição de Risco , Fatores Sexuais , Adulto Jovem
3.
Sleep Med ; 16(3): 358-63, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25650159

RESUMO

BACKGROUND: The use of non-surgical treatment for childhood obstructive sleep apnea (OSA) is gaining popularity, especially in children with mild disease. OBJECTIVE: To test the hypothesis that intranasal corticosteroids reduce disease severity in children with mild OSA. STUDY DESIGN: A randomized, double-blinded, placebo-controlled trial of intranasal mometasone furoate (MF) versus placebo in children aged 6 to 18 years with mild OSA. The primary outcome was the change from baseline obstructive apnea hypopnea index (OAHI), as documented by overnight polysomnography, after four months of treatment. RESULTS: Sixty-two children were recruited but 12 dropped out. This left 24 and 26 children for final analysis in the MF and placebo group, respectively. The OAHI and oxygen desaturation index (ODI) improved significantly in the MF group only. The OAHI decreased from 2.7 ± 0.2 to 1.7 ± 0.3 in the MF group, but increased from 2.5 ± 0.2 to 2.9 ± 0.6 in the placebo group (p = 0.039). The mean changes in ODI in the MF group and placebo group were -0.6 ± 0.5 and +0.7 ± 0.4, respectively (p = 0.037). CONCLUSION: Four months of treatment with intranasal mometasone furoate effectively reduces the severity of mild OSA in children.


Assuntos
Anti-Inflamatórios/administração & dosagem , Furoato de Mometasona/administração & dosagem , Apneia Obstrutiva do Sono/tratamento farmacológico , Tonsila Faríngea/patologia , Administração Intranasal , Adolescente , Criança , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Masculino , Tonsila Palatina/patologia , Polissonografia , Apneia Obstrutiva do Sono/patologia , Resultado do Tratamento
4.
Chest ; 147(1): 132-139, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25275798

RESUMO

BACKGROUND: The association between childhood OSA and endothelial function as measured by flow-mediated dilation (FMD) and its response to OSA treatment are uncertain. The objective of this study was to compare FMD in children with OSA with nonsnoring control subjects and to examine its response to treatment. METHODS: Index cases were children aged 6 to 18 years with habitual snoring and polysomnography (PSG)-confirmed OSA (obstructive apnea hypopnea index [OAHI] > 1 events/h). Each case was paired with an age-, sex-, and BMI-matched nonsnoring control subject recruited from our previous community growth survey. All subjects underwent FMD measurement in the morning after overnight PSG. Adenotonsillectomy (AT) was offered to subjects who satisfied predefined AT operation criteria. All cases underwent repeat PSG and FMD assessment 6 months later. RESULTS: A total of 63 case-control pairs were recruited. The OSA group had a significantly higher OAHI (median, 5.3 events/h [interquartile range (IQR), 2.6-11.7] vs 0.2 events/h [IQR, 0-0.5], P < .001) and lower FMD (mean ± SD, 7.9% ± 1.3% vs 8.3% ± 0.8%; P = .04) than the control group. Thirty-two case subjects underwent AT. A significant reduction in OAHI was documented in the AT group (-8.8 events/h [IQR, -13.7 to -4.7]; P < .001) accompanied by a significant increase in FMD (+0.6% [IQR, 0.4-1.4]; P < .001), which was not observed in subjects who did not undergo AT. CONCLUSIONS: Children with OSA had reduced FMD, which was reversible with treatment.


Assuntos
Adenoidectomia , Endotélio Vascular/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Tonsilectomia , Vasodilatação/fisiologia , Adolescente , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/cirurgia , Ultrassonografia
5.
Chest ; 145(6): 1255-1263, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24384690

RESUMO

BACKGROUND: Childhood OSA is a prevalent condition associated with raised BP as documented in cross-sectional studies. This study aimed to determine whether baseline or change in OSA severity was associated with ambulatory BP at 4-year follow-up. METHODS: Children who participated in our previous OSA prevalence research were invited to undergo a repeat overnight sleep study and 24-h ambulatory BP monitoring in this 4-year follow-up study. BP parameters of subjects with differing baseline OSA severity, that is, obstructive apnea-hypopnea index (OAHI) < 1/h, 1 to 5/h, and > 5/h, were compared. Overweight and normal-weight children were analyzed separately. RESULTS: One hundred eighty-five of 306 subjects (60%) were included in the analysis, of whom 58 were overweight at baseline. Linear increasing trends of wake systolic BP (SBP), wake diastolic BP (DBP), and sleep SBP z scores at follow-up were found across groups of increasing baseline OSA severity in the normal weight but not in the overweight subgroup. After adjusting for BMI z score, baseline OAHI was independently associated with all BP z scores at follow-up but not associated with changes in BP z scores across 4 years. On the other hand, change in OAHI was independently associated with sleep SBP and DBP z scores at follow-up and with changes in sleep SBP and DBP z scores across 4 years. CONCLUSIONS: This study provides longitudinal data as additional proof that childhood OSA is associated with elevated BP independent of obesity.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Monitorização Ambulatorial da Pressão Arterial , Criança , Ritmo Circadiano/fisiologia , Comorbidade , Feminino , Seguimentos , Hong Kong , Humanos , Estudos Longitudinais , Masculino , Obesidade/fisiopatologia , Polissonografia , Estudos Prospectivos , Índice de Gravidade de Doença
7.
Int J Cardiol ; 167(5): 2092-6, 2013 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-22703940

RESUMO

BACKGROUND: Sleep disordered breathing, especially obstructive sleep apnea, is associated with endothelial dysfunction in both adults and children. However, the role of primary snoring (PS) on endothelial function has not been investigated. This study aimed to examine flow-mediated vasodilation (FMD) in both normal weight and overweight children with PS. METHODS: Children aged 6-18 years with habitual snoring were recruited from our sleep disorder clinic. Non-snoring controls were recruited from participants of a community growth survey. All subjects underwent polysomnography and FMD evaluation on the same day. Children with body mass index of greater than the 85th percentile of the local reference were defined as overweight. Subjects were divided into groups of normal weight, overweight, non-snorers and PS for comparisons. RESULTS: Two hundred and one children, of whom 83 were overweight, with a mean ± SD age of 11.3 ± 2.7 years were recruited. Seventy three out of 201 children had PS. Both normal weight (7.9 ± 1.3 vs. 8.5 ± 0.9, p=0.012) and overweight subjects (7.4 ± 1.4 vs. 8.1 ± 1.1, p=0.006) with PS had significantly reduced FMD than the non-snoring controls. Multivariate linear regression model showed that PS was independently associated with reduced FMD in both normal weight (p=0.014) and overweight subgroups (p=0.016) after controlling for obstructive apnea hypopnea index. CONCLUSIONS: PS in children is associated with reduced FMD, independent of obesity.


Assuntos
Artéria Braquial/fisiologia , Polissonografia/métodos , Ronco/diagnóstico , Ronco/fisiopatologia , Vasodilatação/fisiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
8.
Chest ; 143(3): 729-735, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23099418

RESUMO

BACKGROUND: The objective of this study was to examine the natural history of childhood primary snoring (PS) and to identify predictive clinical symptoms and risk factors associated with PS progression to obstructive sleep apnea (OSA). METHODS: Children aged 6 to 13 years old who received a diagnosis of PS in our previous community-based OSA prevalence study were invited to undergo repeat polysomnography (PSG) at 4-year follow-up. Subjects with an obstructive apnea hypopnea index (OAHI) ≥ 1 were classified as having OSA at follow-up. RESULTS: Seventy children (60% boys) with a mean age of 14.7 ± 1.8 years were analyzed in this follow-up study. The mean duration of follow-up was 4.6 ± 0.6 years. At follow-up, 26 subjects (37.1%) progressed to OSA, of whom five (7.1%) had moderate to severe disease (OAHI ≥ 5). Twenty-two (31.4%) remained at PS, and 18 (25.7%) had complete resolution of their snoring with normal PSG. Persistent snoring had a positive predictive value of 47.7% and a negative predictive value of 86.4% for progression from PS to OSA. Multivariate logistic regression analysis showed that persistent overweight/obesity was a significant risk factor for the development of OSA at follow-up, with an OR of 7.95 (95% CI, 1.43-44.09). CONCLUSIONS: More than one-third of school-aged children with PS progressed to OSA over a 4-year period, although only 7.1% developed moderate to severe disease. Weight control may be an important component in the management of PS because obesity was found to be a significant risk factor for PS progression.


Assuntos
Apneia Obstrutiva do Sono/epidemiologia , Ronco/epidemiologia , Adolescente , Criança , Progressão da Doença , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Sobrepeso/epidemiologia , Polissonografia , Valor Preditivo dos Testes , Fatores de Risco , Síndromes da Apneia do Sono
9.
Arch Dis Child ; 97(5): 470-3, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21427123

RESUMO

OBJECTIVE: The authors aimed to examine the prevalence and factors associated with night sweats (NS) in primary school children. STUDY DESIGN: Cross-sectional design. RESULTS: Among 6381 children (median age 9.2 (7.7-10.7) years) with complete information on NS, 3225 were boys (50.5%). 747 children (11.7%) were reported to have weekly NS in the past 12 months. Boys were more likely than girls to have NS (p<0.0001). Children with NS were more likely to have sleep-related symptoms and respiratory and atopic diseases. In addition, they were more likely to be hyperactive and have frequent temper outbursts. Using an ordinal regression model, NS was found to be significantly associated with male gender, younger age, allergic rhinitis, tonsillitis and symptoms suggestive of obstructive sleep apnoea, insomnia and parasomnia. CONCLUSION: NS is prevalent among school-aged children and is associated with the presence of sleep-related symptoms and respiratory and atopic diseases.


Assuntos
Transtornos do Sono-Vigília/epidemiologia , Sudorese/fisiologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/fisiopatologia , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Prevalência , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/fisiopatologia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Transtornos do Sono-Vigília/fisiopatologia
10.
J Pediatr ; 159(2): 238-42.e1, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21397910

RESUMO

OBJECTIVES: To examine the prevalence and correlates of nocturnal enuresis (NE) in primary school children, and to compare the prevalence of NE in children with and those without obstructive sleep apnea (OSA). STUDY DESIGN: Parents of children aged 6-11 years completed a questionnaire eliciting information on sleep-related symptoms, demography, and family and past medical history. Children screened due to high risk for OSA, along with a randomly chosen low-risk group, underwent overnight polysomnography (PSG). RESULTS: A total of 6147 children (3032 girls) were studied. The overall prevalence of NE (≥1 wet night/month) was 4.6% (6.7% of boys and 2.5% of girls). Boys had a significantly greater prevalence across all age groups. In 597 children (215 girls) who underwent PSG, the prevalence of NE was not greater in children with OSA, but was increased with increasing severity of OSA in girls only. Boys with NE had longer deep sleep duration. Sex and sleep-related symptoms were associated with NE. CONCLUSIONS: This community-based study demonstrated a sex-associated prevalence of NE in relation to increasing OSA severity.


Assuntos
Enurese Noturna/epidemiologia , Apneia Obstrutiva do Sono/complicações , Criança , Progressão da Doença , Enurese , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Masculino , Enurese Noturna/etiologia , Enurese Noturna/fisiopatologia , Polissonografia , Prevalência , Fatores de Risco , Sono/fisiologia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Inquéritos e Questionários , Fatores de Tempo
11.
J Clin Psychiatry ; 71(11): 1440-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21114949

RESUMO

OBJECTIVE: Nocturnal sleep disturbances, including insomnia and recurrent nightmares, represent common distressing sleep complaints that might have important prognostic and therapeutic implications in psychiatric patients. The present study aimed at investigating nocturnal sleep disturbances in relation to the risk of suicide attempts in a consecutive cohort of psychiatric outpatients. METHOD: Participants attending a psychiatric outpatient clinic in Hong Kong were recruited into the study with a detailed sleep questionnaire assessment. The questionnaire was distributed between May and June 2006. Relevant clinical information, with a comprehensive clinical history of patients since their attendance at psychiatric services and 1 year after completion of their questionnaires, was reviewed. RESULTS: The final study population consisted of 1,231 psychiatric outpatients with a mean age of 42.5 years (SD = 11.3; range, 18-65). Both frequent insomnia and recurrent nightmares were significantly and independently associated with an increased incidence of suicide attempts 1 year after questionnaire assessment (insomnia: OR = 6.96; 95% CI, 1.21-39.97; recurrent nightmares: OR = 8.17; 95% CI, 1.06-63.13) and an increase in lifetime prevalence of suicide attempts (insomnia: OR = 1.55; 95% CI, 1.06-2.25; recurrent nightmares: OR = 2.43; 95% CI, 1.51-3.91). Comorbid insomnia and nightmares had increased odds of lifetime prevalence (OR = 2.43; 95% CI, 1.53-3.85) and 1-year incidence of suicidal risk (OR = 17.08; 95% CI, 2.64-110.40). Antidepressants, particularly selective serotonin reuptake inhibitors (OR = 1.52; 95% CI, 1.02-2.25), serotonin-norepinephrine reuptake inhibitors (OR = 2.10; 95% CI, 1.15-3.83), heterocyclics (OR = 2.78; 95% CI, 1.21-6.42), and non-benzodiazepine hypnotics (OR = 1.54; 95% CI, 1.02-2.33) were independently associated with recurrent nightmares after adjustment for confounding variables. CONCLUSIONS: Nocturnal sleep disturbances, particularly frequent insomnia and recurrent nightmares, were independently associated with enhanced suicidal risk among psychiatric patients. Future studies are warranted to investigate the underlying pathophysiologic mechanism and interventional responses.


Assuntos
Transtornos do Sono-Vigília/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Idoso , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Distribuição de Qui-Quadrado , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Modelos Logísticos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Terrores Noturnos/complicações , Terrores Noturnos/tratamento farmacológico , Terrores Noturnos/psicologia , Estudos Prospectivos , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos do Sono-Vigília/complicações , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
12.
Thorax ; 65(11): 991-7, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20965935

RESUMO

OBJECTIVE: To determine the prevalence and risk factors of obstructive sleep apnoea syndrome (OSAS) in Chinese children using a two-phase community-based study design. METHODS: Children from 13 primary schools were randomly recruited. A validated OSAS screening questionnaire was completed by their parents. Children at high risk of OSAS and a randomly chosen low-risk group were invited to undergo overnight polysomnographic study and clinical examination. The the sex-specific prevalence rate was measured using different cutoffs (obstructive apnoea hypopnoea index ≥ 1, ≥ 1.5, ≥ 3 and ≥ 5 and obstructive apnoea index ≥ 5) and risk factors associated with OSAS were evaluated with logistic regression. RESULTS: 6447 completed questionnaires were returned (out of 9172 questionnaires; 70.3%). 586 children (9.1%; 405 boys and 181 girls) children belonged to the high-risk group. A total of 619 (410 and 209 from the high and low-risk group, respectively) subjects underwent overnight polysomnagraphy. Depending on the cutoffs, the prevalence rate of childhood OSAS varied from 4.8% to 40.3%. Using the International Criteria of Sleep Disorders version II, the OSAS prevalence for boys and girls was 5.8% and 3.8%, respectively. Male gender, body mass index z-score and increased adenoid and tonsil size were independently associated with OSAS. CONCLUSIONS: The prevalence rate of OSAS in children was contingent on the cutoff used. The inclusion of symptoms as a part of the diagnostic criteria greatly reduced the prevalence. A further prospective and outcome study is needed to define a clinically significant diagnostic cutoff for childhood OSAS.


Assuntos
Apneia Obstrutiva do Sono/epidemiologia , Índice de Massa Corporal , Criança , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Tonsila Palatina/patologia , Polissonografia/métodos , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Fatores Socioeconômicos
15.
Chest ; 138(3): 519-27, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20173057

RESUMO

OBJECTIVE: Our study aimed to determine the prevalence of habitual snoring (HS) in primary school children and to evaluate the diurnal symptoms and conditions that may be associated with it. METHODS: A validated questionnaire completed by parents was used to assess the sleep and daytime behaviors of Chinese children aged 5 to 14 years. Thirteen primary schools in two representative districts were randomly selected. RESULTS: A total of 6,349 out of 9,172 questionnaires (response rate 69.2%) with complete answers were returned. The prevalence rate of HS was 7.2%. Male sex (odds ratio [OR] [95% CI]: 2.5 [1.7-3.6]), BMI z score (OR [95% CI]: 1.4 [1.1-1.6]), maternal HS (OR [95% CI]: 3.4 [2.0-5.7]), paternal HS (OR [95% CI]: 3.8 [2.7-5.5]), allergic rhinitis (OR [95% CI]: 2.9 [2.0-4.2]), asthma (OR [95% CI]: 2.4 [1.2-5.2]), nasosinusitis (OR [95% CI]: 4.0 [1.5-10.6]), and tonsillitis (OR [95% CI]: 3.1 [1.9-5.1]) in the past 12 months were identified to be independent risk factors associated with HS. HS was also associated with daytime, nocturnal, parasomniac, and sleep-related breathing symptoms. HS was demonstrated to be an independent risk factor for parent-reported poor temper (OR [95% CI]: 1.9 [1.4-2.5]), hyperactivity (OR [95%CI]: 1.7 [1.2-2.5]), and poor school performance (OR [95% CI]: 1.7 [1.2-2.5]). CONCLUSIONS: HS was a significant and prevalent problem in primary school children. Male sex, obesity, parental HS, atopic symptoms, and history of upper respiratory infections were significant risk factors. HS was also associated with sleep-disordered breathing symptoms and adverse neurobehavioral outcomes.


Assuntos
Ronco/complicações , Ronco/epidemiologia , Adolescente , Fatores Etários , Criança , Comportamento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Hipercinese , Modelos Logísticos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Ronco/psicologia , Temperamento
16.
Chest ; 137(3): 529-35, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20022971

RESUMO

BACKGROUND: The objective of this study was to evaluate circulating adipokines concentration in children with and without obstructive sleep apnea (OSA) and to determine the effects of treatment of OSA on their plasma concentration. METHODS: Children with habitual snoring and symptoms suggestive of OSA were consecutively recruited. Their parents completed a sleep apnea symptom questionnaire, and the subjects underwent physical examination and an overnight polysomnography (PSG). OSA was diagnosed if they had an obstructive apnea index > 1. Fasting serum adiponectin, leptin, and lipid profiles were taken after overnight PSG. The subjects were divided into groups as obese, nonobese, and with and without OSA for comparison. RESULTS: One hundred forty-one children, of whom 96 were boys, with a median (interquartile range) age of 10.8 (8.5-12.8) years were recruited. Forty-three subjects had OSA. Subjects with OSA did not have significantly different adiponectin and leptin concentrations than those without OSA for both the obese and nonobese groups. Stepwise multiple linear regressions revealed that systolic BP, age, high-density lipoprotein cholesterol, and BMI z-score were independently associated with adiponectin, whereas diastolic BP, triglyceride, height, and BMI z-score were independently associated with leptin concentration. Sixteen children with OSA underwent treatment, and there was reduction in their plasma adiponectin concentration after intervention, but such change became insignificant after controlling for change in the BMI z-score. CONCLUSIONS: BMI rather than OSA was the main determinant of adipokines in children.


Assuntos
Adipocinas/sangue , Pressão Positiva Contínua nas Vias Aéreas/métodos , Glucocorticoides/administração & dosagem , Apneia Obstrutiva do Sono/sangue , Tonsilectomia , Administração Intranasal , Biomarcadores/sangue , Índice de Massa Corporal , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Masculino , Polissonografia , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários , Resultado do Tratamento
17.
J Pediatr ; 155(3): 362-8.e1, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19540515

RESUMO

OBJECTIVES: To compare ambulatory blood pressure (ABP) in nonoverweight, prepubertal children with and without primary snoring (PS), and to investigate whether PS is a part of the dose-response relationship between sleep-disordered breathing (SDB) and BP in children. STUDY DESIGN: This was a cross-sectional community-based study involving 190 children age 6 to 13 years. Each participant underwent an overnight sleep study and ABP monitoring after completing a validated sleep symptoms questionnaire. Individual systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial BP were calculated for wake and sleep periods. Subjects were hypertensive if mean SBP or DBP was > 95th percentile (relative to sex and height) of reference. RESULTS: A total of 56 nonsnoring controls, 46 children with PS, 62 children with an apnea-hypopnea index (AHI) of 1 to 3, and 26 children with an AHI > 3 were identified. The daytime and nighttime BP increased across the severity spectrum of SDB. The dose-response trends for the proportion of subjects with nighttime systolic and diastolic hypertension also were significant. Nighttime DBP was significantly higher in the children with PS compared with controls after adjusting for age, sex, and body mass index. CONCLUSIONS: PS was demonstrated to be an aspect of the dose-response relationship between SDB and BP in children and should not be considered completely benign.


Assuntos
Hipertensão/epidemiologia , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/fisiopatologia , Ronco/epidemiologia , Ronco/fisiopatologia , Adolescente , Fatores Etários , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Comorbidade , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Polissonografia , Índice de Gravidade de Doença , Fatores Sexuais , Síndromes da Apneia do Sono/diagnóstico , Ronco/diagnóstico , Inquéritos e Questionários
18.
Ann Acad Med Singap ; 37(8): 649-54, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18797557

RESUMO

OBJECTIVE: To evaluate serum cytokine concentrations in children with and without obstructive sleep apnoea (OSA) and to investigate the effects of OSA treatment on cytokines. MATERIALS AND METHODS: Consecutive children with habitual snoring and symptoms suggestive of OSA were recruited. They completed a sleep apnoea symptom questionnaire, underwent physical examination and overnight polysomnography (PSG). OSA was diagnosed if obstructive apnoea index (OAI) >1. A blood sample was collected for analysis of IL-6, IL-8, and TNF-alpha after PSG. RESULTS: One hundred forty-two children (97 males) with a median (IQR) age of 11.1 years (9.0-12.8) were recruited. The commonest presenting symptoms were nocturnal mouth breathing, prone sleeping position and poor attention at school. Forty-seven children were found to have OSA and they had higher serum IL-6 [0.1 (0.1-0.4) vs 0.1 (0.1-0.1) pg/mL, P = 0.001] and IL-8 [1.7 (1.0-2.3) vs 1.3 (0.9-1.7) pg/mL, P = 0.029] concentrations compared to their non-OSA counterparts. Multiple regression analysis indicated that OAI was significantly associated with both IL-6 (r = 0.351, P <0.001) and IL-8 (r = 0.266, P = 0.002). Sixteen children underwent treatment and there was significant reduction in mean (SD) serum IL-8 after intervention [pre vs post levels of 1.9 (1.0) vs 1.1 (0.6) pg/mL, P = 0.001] independent of weight loss. CONCLUSION: Children with OSA had elevated levels of pro-inflammatory cytokines that normalised following treatment suggesting that the inflammatory response is potentially reversible. Early detection and intervention may be beneficial.


Assuntos
Citocinas/sangue , Apneia Obstrutiva do Sono/sangue , Criança , Feminino , Humanos , Interleucina-6/sangue , Interleucina-8/sangue , Masculino , Polissonografia , Apneia Obstrutiva do Sono/terapia , Fator de Necrose Tumoral alfa/sangue
19.
Pediatr Pulmonol ; 43(1): 34-40, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18041751

RESUMO

OBJECTIVE: To evaluate C-reactive protein (CRP) concentration in children with OSA and to determine the effects of treatment for OSA on its serum concentration. METHODS: Consecutive children with habitual snoring and symptoms suggestive of OSA were recruited. They completed a sleep apnea symptom questionnaire, underwent physical examination and an overnight polysomnography (PSG). Fasting serum CRP and lipid profile were taken after overnight PSG. OSA was diagnosed if obstructive apnea index (OAI)>1. RESULTS: One hundred forty-one children with a median (IQR) age of 10.8 (8.5-12.8) years were recruited. There were 96 boys and the commonest presenting symptoms were nocturnal mouth breathing, prone sleeping position and poor attention at school. Forty-five children were found to have OSA and those with moderate disease (OAI>5) had significantly higher CRP levels compared to their non-OSA counterparts [1.3 (0.8-3.6) vs. 0.7 (0.2-2.0), P=0.01]. Stepwise linear multiple regression analysis indicated that OAI was independently associated with CRP (beta coefficient=0.013, P=0.001). Sixteen children underwent treatment and there was significant reduction in their serum CRP after intervention [pre vs. post-CRP, 1.3 (0.6-4.1) vs. 0.4 (0.2-1.3), P=0.033]. A significant correlation was also demonstrated between change in CRP and change in OAI (r=0.593, P=0.042) following treatment for OSA. CONCLUSION: Children with OSA may have associated systemic inflammation as reflected by a raised CRP that decreased significantly following treatment.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/terapia , Adenoidectomia , Adolescente , Criança , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Polissonografia , Respiração com Pressão Positiva , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários , Tonsilectomia , Resultado do Tratamento
20.
J Clin Psychiatry ; 69(9): 1374-82, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19193338

RESUMO

OBJECTIVE: Epidemiologic studies from general population and clinical case series suggest association of parasomnias with mental illnesses and psychotropic medications. This cross-sectional study aimed at determining the prevalence rate of sleepwalking, sleep-related eating disorder (SRED), rapid eye movement sleep behavior-like disorder (RSBD-like disorder), and sleep-related injury (SRI) and their associated factors in an adult psychiatric outpatient clinic. METHOD: Subjects aged 18 to 65 years who were attending an outpatient clinic in Hong Kong from May 2006 through June 2006 were included in this cross-sectional study. A 3-phase design was employed, including a structured questionnaire on parasomnias, followed by clinical interviews of both questionnaire-positive and -negative groups, and polysomnography for subjects having active parasomnias in recent 1 year. In addition, the principal psychiatric diagnoses, medical illnesses, and detailed drug history over recent 1 year were retrieved from the computerized records. RESULTS: Twelve hundred thirty-five subjects completed the phase 1 interview. The estimated prevalence of the lifetime diagnoses of sleepwalking, SRED, SRI, sleep violence, and RSBD-like disorder were 8.5%, 4.0%, 21.0%, 3.6%, and 5.8%, respectively, while the 1-year prevalence of these conditions were 2.9%, 2.4%, 8.8%, 2.5%, and 3.8%, respectively. These conditions were associated with depression and a constellation of sleep disturbances. Specific combinations of psychotropics were found to pose risk in particular parasomnias: sedative antidepressants and nonbenzodiazapine hypnotics in sleepwalking, regular zolpidem and antidepressants in SRED, and selective serotonin reuptake inhibitors in RSBD-like disorder. CONCLUSIONS: Sleepwalking, SRED, RSBD-like disorder, and SRI were common and underrecognized among the psychiatric population in this study. Their occurrences were likely contributed by interacting effect of mental illnesses, sleep disturbances, and specific psychotropic medications. Further prospective study is warranted for clarification of the etiology and clinical management of these potentially dangerous and "hidden" parasomnias.


Assuntos
Transtornos Mentais/epidemiologia , Parassonias/epidemiologia , Adolescente , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Comorbidade , Estudos Transversais , Interações Medicamentosas , Feminino , Inquéritos Epidemiológicos , Hong Kong , Humanos , Incidência , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Parassonias/induzido quimicamente , Parassonias/diagnóstico , Parassonias/psicologia , Polissonografia , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Fatores de Risco , Adulto Jovem
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