Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

Smith, Connie U.; Isaiah, Amal; Melendres, Maria Cecilia; Mahgerefteh, Joseph; Lasso‐Pirot, Anayansi; Mayo, Shawyntee; Gooding, Holly C.; Zachariah, Justin P.

doi:10.1161/jaha.121.022427

Cited by 53 publications

(27 citation statements)

References 172 publications

(257 reference statements)

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“…Intermittent elevations in systemic blood pressure during sleep have been observed in children with OSA [ 9 ]. Children with moderate to severe OSA were found to have higher nocturnal systolic blood pressure and reduced nocturnal drop of systolic blood pressure at 10-year follow up [ 10 ].…”

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

“…Mean blood pressure variability was noted to be higher during wakefulness and during sleep in children with OSA compared to children with primary snoring [ 10 ]. The nocturnal dipping of the mean blood pressure was smaller in children with OSA compared to those with primary snoring [ 9 ].…”

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

“…Pulmonary hypertension has been reported in children with OSA, although it is rare in noncardiac patients. The overall prevalence of pulmonary hypertension in pediatric OSA patients is low (1.8%) [ 9 ].…”

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

“…These data may be indirect evidence of increased heart rate variability in severe OSA [ 11 ]. Another retrospective cross-sectional study of children below 15 years of age with sleep-disordered breathing (SDB) suggested that heart rate variability was significantly increased in sleep in those with severe OSA compared to those with mild OSA [ 9 ].…”

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

“…QT dispersion and P-wave dispersion have also been studied in pediatric OSA. QT dispersion may be associated with a higher risk for ventricular arrhythmia and has been reported in children with severe OSA [ 9 ]. P-wave dispersion was found more in children with severe OSA in a study of 44 children at 1–12 years of age [ 12 ].…”

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

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You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea

et al. 2022

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Pediatric obstructive sleep apnea (OSA) has been shown to not only affect the quality of sleep, but also overall health in general. Untreated or inadequately treated OSA can lead to long-term sequelae involving cardiovascular, endothelial, metabolic, endocrine, neurocognitive, and psychologicalconsequences. The physiological effects of pediatric OSA eventually become pathological. As the complex effects of pediatric OSA are discovered, they must be identified early so that healthcare providers can be better equipped to treat and even prevent them. Ultimately, adequate management of OSA improves overall quality of life.

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Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

Section: Cardiovascular Diseases and Osamentioning

confidence: 99%

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You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea

et al. 2022

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Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children

Redline,

Cook,

Chervin

et al. 2023

JAMA

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ImportanceThe utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown.ObjectivesTo evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB.Design, Setting, and ParticipantsRandomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months.InterventionParticipants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228).Main Outcomes and MeasuresThe 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes.ResultsOf the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: −3.1 for adenotonsillectomy vs −1.9 for watchful waiting; difference, −0.96 [95% CI, −2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, −0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, −9.02 [97% CI, −15.49 to −2.54] and −6.52 [97% CI, −11.59 to −1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, −11.2% [97% CI, −17.5% to −4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy.ConclusionsIn children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up.Trial RegistrationClinicalTrials.gov Identifier: NCT02562040

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Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA

Sjölander

Borgström

Nerfeldt

et al. 2022

Laryngoscope Investig Oto

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Objectives: To investigate whether the OSA-18 questionnaire and a postoperative patient-reported outcome measure (PROM) question correlated with polysomnography (PSG) data.Methods: A prospective study of otherwise healthy young children with moderate to severe obstructive sleep apnea (OSA) to investigate if the obstructive apneahypopnea index (OAHI) before and 6-12 months after adenotonsil surgery correlated with the OSA-18 total symptom score (TSS) and the sleep disturbance subscale (SDS), as well as a PROM question on symptom improvement with responses on a 4-grade Likert scale.Results: Of 201 children, 173 (86%) had complete data of OAHI and OSA-18 preand postoperatively. The mean age was 3.2 years (SD 1.0) and the mean OAHI was 15.9 (11.3). Significant correlations between changes in the OAHI and OSA-18 were found, both TSS (r = 0.29, p < .001) and SDS (r = 0.53, p < .001). A total of 136 (68%) patients responded to the PROM question, the majority of whose symptoms had disappeared (n = 102) or almost disappeared (n = 30). Four patients had unchanged symptoms, and none had worsening symptoms. A correlation was found between the PROM question and a change in the OAHI (r = 0.36, p < .001), as well as a change in the OSA-18 TSS (r = 0.24, p = .006) and the SDS (r = 0.34, p < .001).The specificity of the PROM question for prediction of a postoperative OAHI < 2 was 82%, and the sensitivity was 38%. Conclusion:Changes in the OAHI significantly correlated with changes in the OSA-18, especially with the sleep disturbance scale, which could be an alternative for evaluation at follow-ups.

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Sleep‐Disordered Breathing and Cardiovascular Disease in Children and Adolescents

Cited by 53 publications

References 172 publications

You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea

You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea

Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children

Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA

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