Aims: To determine the prevalence of sleep-disordered breathing (SDB) in a clinical sample of overweight and obese children and adolescents, and to examine the contribution of fat distribution. Methods: Consecutive subjects without chronic lung disease, neuromuscular disease, laryngomalacia, or any genetic or craniofacial syndrome were recruited. All underwent measurements of neck and waist circumference, waist-to-hip ratio, % fat mass and polysomnography. Obstructive apnoea index >1 or obstructive apnoea-hypopnoea index (OAHI) >2, further classified as mild (2(OAHI,5) or moderate-tosevere (OAHI>5), were used as diagnostic criteria for obstructive sleep apnoea (OSA). Central sleep apnoea was diagnosed when central apnoeas/hypopnoeas >10 s were present accompanied by .1 age-specific bradytachycardia and/or .1 desaturation ,89%. Subjects with desaturation (85% after central events of any duration were also diagnosed with central sleep apnoea. Primary snoring was diagnosed when: snoring was detected by microphone and normal obstructive indices and saturation. Results: 27 overweight and 64 obese subjects were included (40 boys; mean (standard deviation (SD)) age 11.2 (2.6) years). Among the obese children, 53% were normal, 11% had primary snoring, 11% had mild OSA, 8% had moderate-to-severe OSA and 17% had central sleep apnoea. Half of the patients with central sleep apnoea had desaturation ,85%. Only enlarged tonsils were predictive of moderate-to-severe OSA. On the other hand, higher levels of abdominal obesity and fat mass were associated with central sleep apnoea. Conclusion: SDB is very common in this clinical sample of overweight children. OSA is not associated with abdominal obesity. On the contrary, higher levels of abdominal obesity and fat mass are associated with central sleep apnoea.

No abstract

Our data are in agreement with other non-European studies, designed to establish normal values in children.

Aims: To assess the presence of a first night effect (FNE) in children and adolescents and to examine if a single night polysomnography (PSG) is sufficient for diagnosing obstructive sleep apnoea syndrome (OSAS). Methods: Prospective case study of 70 patients (group 1: 2-6 years, n = 22; group 2: 7-12 years, n = 32; group 3: 13-17 years, n = 16) referred for OSAS. Diagnostic criteria for OSAS: one or more of the following: (1) obstructive apnoea index (OAI) >1; (2) obstructive apnoea hypopnoea index (oAHI) >2; (3) SaO 2 (89% in association with obstruction. Results: In all age groups, but mainly in the oldest children, REMS increased during the second night, mainly at the expense of stage 2 sleep. The first night PSG correctly identified OSAS in 86%, 91%, and 100% of the children for groups 1, 2, and 3 respectively. This represents 9% false negatives for OSAS when only the first night PSG was used. All cases missed had mild OSAS, except for one with oAHI .5 on night 2. There were also seven patients with OSAS on night 1 but with a normal PSG on night 2: all had oAHI ,5. Conclusion: There is a FNE in children and adolescents. A single night PSG is sufficient for diagnosing OSAS, but in cases with a suggestive history and examination and with a negative first night, a second night study might be advisable. N ight-to-night variation in sleep quality has been observed in adult patients who underwent polysomnography (PSG) on two or more consecutive nights. An important factor in this variability is the so-called ''first night effect'' (FNE), which is mainly characterised by less total sleep time (TST) and less REM sleep, with more intermittent awake time, lower sleep efficiency, and a longer REMS latency (REML) during the first night.1 This reduced sleep quality is probably due to multiple factors: discomfort caused by electrodes, limitation of movements, and the unfamiliar environment of the sleep laboratory. 2In adults, the FNE is widely studied in normal subjects and in various pathological conditions. 3-13 In children, there are studies evaluating the FNE for sleep parameters using home PSG, [14][15][16] but only a few recent studies have examined the FNE in a hospital setting. Scholle et al studied the FNE for sleep and respiratory variables in 131 children and adolescents with suspected sleep disordered breathing (SDB). 17 The authors found more REM sleep and less wakefulness on the second night in their three age groups (2-6 years, 7-12 years, and 13-17 years). Additionally, they found a significant increase of the sleep efficiency in the 7-12 and 13-17 year olds and, finally, a higher percentage of stage 4 sleep on the second night in the latter group. Scholle et al found no FNE for apnoea hypopnoea index (AHI) and mean oxygen saturation (SaO 2 ). The authors did not assess the presence of obstructive sleep apnoea syndrome (OSAS) on either of the two nights. More recently, Li et al also studied the FNE in 44 obese children and in a normal weight control group (n = 43). 18 In all subjects, sleep efficiency imp...

No abstract