Sleep Studies for Clinical Indications during the First Year of Life: Infants Are Not Small Children

Kaditis, Athanasios G.; Gozal, David

doi:10.3390/children9040523

Cited by 12 publications

(13 citation statements)

References 47 publications

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“…Hence, the ODI3 is a strong alternative or at least complementary oximetry parameter to the MOS for detecting moderate‐to‐severe OSAS when PSG is not an option. Findings of the present study are valid for children aged >1 year, as interpretative rules and reference values not only for nocturnal oximetry but also for PSG in infants are a matter of discussion (Kaditis & Gozal, 2022).…”

Section: Discussionsupporting

confidence: 54%

Nocturnal oximetry parameters as predictors of sleep apnea severity in resource‐limited settings

Polytarchou

Ohler

Moudaki

et al. 2022

Journal of Sleep Research

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Nocturnal oximetry is an alternative modality for evaluating obstructive sleep apnea syndrome (OSAS) severity when polysomnography is not available. The Oxygen Desaturation (≥3%) Index (ODI3) and McGill Oximetry Score (MOS) are used as predictors of moderate-to-severe OSAS (apnea-hypopnea index-AHI >5 episodes/h), an indication for adenotonsillectomy. We hypothesised that ODI3 is a better predictive parameter for AHI >5 episodes/h than the MOS. All polysomnograms performed in otherwise healthy, snoring children with tonsillar hypertrophy in a tertiary hospital (November 2014 to May 2019) were analysed. The ODI3 and MOS were derived from the oximetry channel of each polysomnogram. Logistic regression was applied to assess associations of ODI3 or MOS (predictors) with an AHI >5 episodes/h (primary outcome). Receiver operating characteristic (ROC) curves and areas under ROC curves were used to compare the ODI3 and MOS as predictors of moderate-tosevere OSAS. The optimal cut-off value for each oximetry parameter was determined using Youden's index. Polysomnograms of 112 children (median [interquartile range] age 6.1 [3.9-9.1] years; 35.7% overweight) were analysed. Moderate-to-severe OSAS prevalence was 49.1%. The ODI3 and MOS were significant predictors of moderate-to-severe OSAS after adjustment for overweight, sex, and age (odds ratio[OR] 1.34, 95% confidence interval [CI] 1.19-1.51); and OR 4.10, 95% CI 2.06-8.15, respectively; p < 0.001 for both). Area under the ROC curve was higher for the ODI3 than for MOS (0.903 [95% CI 0.842-0.964] versus 0.745 [95% CI 0.668-0.821]; p < 0.001). Optimal cut-off values for the ODI3 and MOS were ≥4.3 episodes/h and ≥2, respectively. The ODI3 emerges as preferable or at least a complementary oximetry parameter to MOS for detecting moderate-to-severe OSAS in snoring children when polysomnography is not available.

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Section: Discussionsupporting

confidence: 54%

Nocturnal oximetry parameters as predictors of sleep apnea severity in resource‐limited settings

Polytarchou

Ohler

Moudaki

et al. 2022

Journal of Sleep Research

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“…28 This also may be a result of a paucity of normative data for OSA and CSA in infants which also may be contributing to the variability in clinical practice. 33 Similar to our study, Flores-Fenton et al reported the main type of SDB in a cohort of infants with bronchopulmonary dysplasia was CSA with similar respiratory support management as in our study. 32 There are some notable limitations to our cohort.…”

Section: Discussionsupporting

confidence: 92%

“…The different types of SDB and interventions compared to our study might be a result of the different underlying diseases or CCCs of patients given that the Kim et al study had more infants with craniofacial anomalies and upper airway anomalies compared to our study 28 . This also may be a result of a paucity of normative data for OSA and CSA in infants which also may be contributing to the variability in clinical practice 33 . Similar to our study, Flores‐Fenton et al reported the main type of SDB in a cohort of infants with bronchopulmonary dysplasia was CSA with similar respiratory support management as in our study 32 …”

Section: Discussionmentioning

confidence: 70%

Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center

Sunkonkit

Alzaid

Xiao

et al. 2023

Pediatric Pulmonology

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BackgroundPolysomnography (PSG) is the gold standard for the diagnosis of pediatric sleep‐disordered breathing (SDB). However, the literature characterizing the indications for inpatient PSGs and the impact on clinical decision‐making is limited.ObjectiveTo determine the indications, results, and outcomes for children undergoing inpatient PSGs at our institution.MethodsWe performed a retrospective review of children aged 0–18 years who underwent inpatient diagnostic PSGs between July 2018 and July 2021 at SickKids, Toronto, Canada. Baseline characteristics, indications, and management were reviewed and characterized by descriptive statistics.ResultsEighty‐eight inpatient PSGs were performed in 75 children (male 62.7%). Median (interquartile range) age and body mass index z‐score were 1.5 (0.2, 10.8) years and 0.27 (−1.58, 2.66), respectively. The most common indication for inpatient PSG was initiation and titration of ventilation (n = 34/75, 45.3%). Of the 75 children, 48 (64%) had multiple complex chronic conditions (CCCs). Sixty children (80%) underwent a baseline PSG for either the entire night or a portion of the night. Of these studies, 54 (90%) had clinically significant SDB of which isolated obstructive sleep apnea (OSA; 17/60, 28.3%) was the most common. The following management was undertaken for the 54 patients with SDB; respiratory technology (88.9%), surgical intervention (31.5%), positional therapy (1.9%), intranasal steroids (3.7%), and no further intervention (5.6%), respectively.ConclusionsOur study highlights that inpatient PSG was an important diagnostic tool resulting in directed medical and surgical management. Future multicenter studies are needed to compare indications for inpatient PSGs across institutions to develop evidence‐based clinical practice guidelines.

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“…The clinical significance of OSA in our study sample is unclear as available normative data suggests higher OAHI values may be within normal limits for infant. 21 Similarly to a group of children with SMA1 treated with nusinersen, 11 we also report an increased AHI in REM sleep compared to non-REM sleep (p = 0.003) (E-Figure S1). The predominance of obstructive hypopneas in REM sleep is suggestive of underlying neuromuscular weakness as the etiology of OSA.…”

Section: Discussionsupporting

confidence: 60%

“…Notably, the use of a single classification system for OSA severity across infants and children may lead to over‐diagnosis of OSA in infants. The clinical significance of OSA in our study sample is unclear as available normative data suggests higher OAHI values may be within normal limits for infant 21 . Similarly to a group of children with SMA1 treated with nusinersen, 11 we also report an increased AHI in REM sleep compared to non‐REM sleep ( p = 0.003) (E‐Figure ).…”

Section: Discussionmentioning

confidence: 58%

Respiratory characteristics in children with spinal muscular atrophy type 1 receiving nusinersen

Xiao

Chiang

Castro‐Codesal

et al. 2022

Pediatric Pulmonology

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Background: Spinal muscular atrophy type 1 (SMA1) is a neuromuscular disorder with a natural history of chronic respiratory failure and death during infancy without ventilation. Recently, disease-modifying therapies such as nusinersen have improved disease trajectory. However, objective data on the trajectory of polysomnography outcomes, the relationship between motor scores and respiratory parameters, respiratory technology dependence and healthcare utilization in children with SMA1 remain to be elucidated. Methods: This was a retrospective observational study of children with SMA1 receiving nusinersen between October 2016 and February 2021 at two tertiary care hospitals in Canada. Baseline polysomnography data, motor scores, respiratory technology, and unanticipated healthcare utilization were examined. Results: Eleven children (five females, two SMN2 copies each) were included. Median (interquartile range [IQR]) age at diagnosis was 3.6 (2.8-5.0) months and age at diagnostic polysomnogram following nusinersen initiation was 9.4 (5.3-14.0) months. Nusinersen was initiated at a median (IQR) age of 5.4 (3.4-7.6) months and 8/11 children had respiratory symptoms at that time. Diagnostic polysomnography data showed a median (IQR) central apnea-hypopnea index (AHI) of 4.1 (1.8-10.0) and obstructive AHI of 2.2 (0-8.0) events/h. We observed an inverse relationship between motor scores and central apnea-hypopnea indices. All children required ventilatory support at the end of the study period. Conclusion: This study showed abnormal polysomnography parameters and need for ventilation despite nusinersen suggesting ongoing need for regular monitoring with polysomnography. Understanding the respiratory disease trajectory of children

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Sleep Studies for Clinical Indications during the First Year of Life: Infants Are Not Small Children

Abstract: In a previous issue of Children, Guyon et al [...]

Cited by 12 publications

References 47 publications

Nocturnal oximetry parameters as predictors of sleep apnea severity in resource‐limited settings

Nocturnal oximetry parameters as predictors of sleep apnea severity in resource‐limited settings

Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center

Respiratory characteristics in children with spinal muscular atrophy type 1 receiving nusinersen

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