Search

Myrtha E Reyna-Vargas,1 Arpita Parmar,2 Diana L Lefebvre,3 Meghan B Azad,4– 6 Allan B Becker,4,5 Stuart E Turvey,7 Theo J Moraes,1 Wendy Lou,8 Padmaja Subbarao,1,8 Malcolm R Sears,3 Piushkumar J Mandhane,9 Indra Narang1,10 1Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada; 2Sculich School of Medicine and Dentistry, Western University, London, ON, Canada; 3Department of Medicine, McMaster University, Hamilton, ON, Canada; 4Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; 5Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children’s Hospital, Winnipeg, MB, Canada; 6Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada; 7Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada; 8Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 9Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; 10Faculty of Medicine, University of Toronto, Toronto, ON, CanadaCorrespondence: Indra Narang, The Hospital for Sick Children, 555 University Ave-Hill Wing Room #4534, Toronto, ON, M5G 1X8, Canada, Email indra.narang@sickkids.caIntroduction: Decreased sleep duration and increased screen time as early as preschool age may contribute to overweight and obesity. The effects of bedtime together with nocturnal sleep duration remain unclear with a paucity of data evaluating these associations longitudinally. We aim to evaluate the independent and joint effects of sleep duration, sleep bedtime, and screen time at 3 years of age on BMI status, particularly overweight and obesity by age 5 years.Methods: Data from 2185 participants of the CHILD Cohort Study were analyzed longitudinally using generalized estimating equations (GEE). Models included changes in overweight/obesity status from 3 to 5 years of age as outcome, and nocturnal sleep duration, bedtime, and daily screen time at 3 years of age as explanatory variables. The joint effects of nocturnal sleep time and excess screen time, late bedtime on overweight/obesity were subsequently analyzed.Results: The median nocturnal sleep time at 3 and 5 years of age was 11.0 hours/night [IQR 10.5, 11.5]. A total of 14.5% children went to bed after 9PM at 3 years and 7.2% at 5 years. Median screen time was 1.0 hr/day [IQR 1.0, 2.0] at both ages. Longitudinal analyses showed that sleeping less than 10.5 hours at age 3 years was associated with 46% greater odds of overweight/obesity by age 5 years (OR 1.46, 95% CI 1.07, 2.00). The risk was higher when coupled with late bedtime after 9pm (OR 1.60, 95% CI 1.12, 2.31). Children with both short nocturnal sleep duration and excess screen time (> 1hr/day) had twice the associated risk of overweight/obesity by age 5 years (OR 1.96, 95% CI 1.34, 2.88).Conclusion: Nocturnal sleep duration and screen time are modifiable risk factors in young children, which may have important implications for obesity prevention as early as infancy.Keywords: Nocturnal sleep, bedtime, BMI

Kanokkarn Sunkonkit,1,2,&ast; Sarah Selvadurai,3,&ast; Giorge Voutsas,3 David Benzon,3 Adele Baker,1 Melissa Trinh,1 Indra Narang1,3 1Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada; 2Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Translational Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada&ast;These authors contributed equally to this workCorrespondence: Indra Narang, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada, Tel +1-416-813-6346, Fax +1-416-813-6246, Email indra.narang@sickkids.caPurpose: Positive airway pressure (PAP) therapy is an effective treatment prescribed to children with sleep disordered breathing (SDB); however, PAP adherence remains challenging. Given that COVID-19 pandemic continues to impact sleep and daily life, the aim of this study was to evaluate longitudinal trajectory of PAP usage in children during the COVID-19 pandemic.Patients and Methods: This was a retrospective study. Children aged 1– 18 years with SDB prescribed PAP at The Hospital for Sick Children (Toronto, Canada) were evaluated for PAP adherence. Demographics, medical history and PAP adherence data during four consecutive 3-month time periods from December 2019 to December 2020 were collected. These four time periods included i) prior to COVID-19 lockdown, ii) during the first three months of lockdown, iii) summer and iv) return to school period. Percentage of days where PAP was used for ≥ 4 hours and average nightly usage of PAP were primary outcomes.Results: A total of 149 children (61.7% male, mean (±SD) age=12.8 ± 4.1 years, BMI (±SD) z-score=1.45± 1.43) were enrolled. Compared to prior to lockdown, the median (IQR) of percentage of PAP usage ≥ 4 hours and average nightly usage of PAP declined significantly during the summer and return to school periods (p< 0.001 for all). By the end of the return to school period, only 69/149 (46%) showed sustained PAP usage and 80/149 (54%) had decreased PAP usage. Obesity was a risk factor for a decline in PAP usage after returning to school (β=− 15.36, p=0.03).Conclusion: Compared to COVID-19 pre-pandemic PAP usage, there was a significant decline in PAP usage across COVID-19 pandemic. There is critical under usage of PAP in children diagnosed with SDB, resulting in an urgent need to address barriers to mitigate poor adherence to PAP long-term. Targeted strategies are required to optimize PAP adherence in children with SDB.Keywords: COVID-19 pandemic, sleep disordered breathing, longitudinal, positive airway pressure adherence, children

Indra Narang,1,2,&ast; Tetyana Kendzerska,3,4,&ast; Austin Heffernan,5 Uzair Malik,6 Carolina G Carvalho,7 Clodagh M Ryan8,9 1Department of Pediatrics, University of Toronto, Toronto, Canada; 2The Hospital for Sick Children, Toronto, Canada; 3Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; 4The Ottawa Hospital Research Institute, Ottawa, Canada; 5UBC, Faculty of Medicine, Vancouver, Canada; 6RCSI University of Medicine and Health Sciences, Dublin, Ireland; 7University Health Network; 8Department of Medicine, University of Toronto, Toronto, Canada; 9Sleep Research laboratory, KITE-UHN&ast;These authors contributed equally to this workCorrespondence: Clodagh M Ryan, 9N-967 Toronto General Hospital, 585 University Ave., Toronto, Ontario, M5G 2N2, Canada, Email clodagh.ryan@uhn.caBackground: There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses.Research Question: Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA?Study Design and Methods: Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders.Results: Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17– 18), median BMI was 30.3 (IQR: 24.0– 37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8– 30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3– 8.0) vs 2.6 hours/day (0.0– 6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of − 1.14; 95% CI − 2.27 to − 0.01.Interpretation: Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.Keywords: CPAP adherence, transition care, obstructive sleep apnea, young adults, CPAP compliance

Dear Editor, During the COVID-19 pandemic, with the greater need for donning personal protective equipment (PPE) and frequent handwashing, we have noted increasing reports in the UK and abroad of high rates of irritant dermatitis in frontline healthcare workers (HCWs). Workers with a previous history of acne or rosacea appeared especially prone to an exacerbation: 36 of 65 (55%) with previous facial skin problems had acne or rosacea vs. 20 of 100 (20%) with no such history [ SP 2 sp (1 + 1 degree of freedom, 234) = 21-9994; I P i < 0-001]. Predominantly patient-facing roles and past history of atopic eczema or acne are prevalent in HCWs requesting dermatology assessment, respirator wear is associated with facial pressure injury, and all mask wear may exacerbate or precipitate acne. [Extracted from the article]