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Summary: Sleep‐disordered breathing is common among children with spinal muscular atrophy, but has been hardly studied among adult subjects. Little is known about sleep quality in spinal muscular atrophy. The aims of this study were to evaluate occurrence and characteristics of sleep‐disordered breathing and subjective sleep quality among adolescent and adult patients with spinal muscular atrophy type 2 or 3. Twenty patients aged 33.9 ± 15.2 years were studied. They underwent nocturnal cardiorespiratory monitoring, lung and muscular function evaluation, and were administered the Pittsburgh Sleep Quality Index questionnaire. Nineteen patients showed sleep‐disordered breathing, with obstructive events in seven subjects and non‐obstructive events in the remaining 12. In the latter group, 10 patients showed pseudo‐obstructive hypopneas. Patients with non‐obstructive sleep‐disordered breathing were younger (p = 0.042), had a lower body mass index (p = 0.0001), were more often affected by spinal muscular atrophy type 2 (p = 0.001), and showed worse impairment of respiratory function than patients with obstructive sleep‐disordered breathing. Ten patients were classified as poor sleepers and 10 patients good sleepers. In the whole sample, sniff nasal inspiratory pressure proved to be the only independent predictor of sleep quality (p = 0.009). In conclusion, sleep‐disordered breathing is common even among adult patients with spinal muscular atrophy type 2 and 3, and may show either obstructive or different types on non‐obstructive features. A worse respiratory muscle function is associated to non‐obstructive sleep‐disordered breathing and poorer sleep quality. Sleep quality should receive greater attention especially in patients with spinal muscular atrophy type 2, who have a poorer respiratory muscle function, as it could affect their quality of life. [ABSTRACT FROM AUTHOR]

Total sleep time (TST) misperception has been reported in obstructive sleep apnea (OSA). However, previous findings on predictors were inconsistent and predominantly relied on single-night polysomnography, which may alter patients' sleep perception. We leveraged advances in wearable sleep staging to investigate predictors of TST misperception in OSA over multiple nights in the home environment. The study included 141 patients with OSA, 75 without insomnia symptoms (OSA group), and 66 with insomnia symptoms (OSA-I group). Objective TST was measured using a previously validated wrist-worn photoplethysmography and accelerometry device. Self-reported TST was assessed using a digital sleep diary. TST misperception was quantified with the misperception index (MI), calculated as (objective − self-reported TST)/objective TST. MI values differed significantly between the OSA (median = −0.02, IQR = [−0.06, 0.02]) and the OSA-I group (0.05, [−0.02, 0.13], p < 0.001). Multilevel modeling revealed that the presence of insomnia symptoms (β = 0.070, p < 0.001) and lower daily reported sleep quality (β = −0.229, p < 0.001) were predictive of higher MI (TST underestimation), while a higher apnea–hypopnea index (AHI) was predictive of lower MI (TST overestimation; β = −0.001, p = 0.006). Thus, insomnia symptoms and AHI are associated with TST misperception in OSA patients, but in opposite directions. This association extends over multiple nights in the home environment. [ABSTRACT FROM AUTHOR]

Objectives: Individuals with obstructive sleep apnea (OSA) suffer from a multitude of concurrent morbidities including cardiovascular disease (CVD). Limited data exists comparing long term cardiovascular disease (CVD) clinical outcomes for patients treated with surgical intervention versus continuous positive airway pressure (CPAP). The purpose of this study was to compare CVD outcomes at multiple time points comparing those treated with sleep surgery versus CPAP alone. Methods: A research database was used to assess outcomes: death, myocardial infarction, atrial fibrillation, heart failure, essential hypertension, and pulmonary hypertension at 5, 8, and 20 years for patients with OSA treated with surgical interventions (upper airway stimulation [UAS], uvulopalatopharyngoplasty [UPPP], and tonsillectomy) or CPAP alone. Subjects were identified using ICD and CPT codes and analyses were conducted with and without propensity score matching for age, sex, race, BMI, myocardial infarction (MI), essential hypertension, pulmonary hypertension, atrial fibrillation, and heart failure. Results: All surgical interventions demonstrated benefit over CPAP alone at most time points for most surgical interventions. At 8 years, for all sleep surgeries (UAS or UPPP or tonsillectomy) (n = 6627) versus treatment with CPAP alone (n = 6627), matched subjects demonstrated decreased risk (odds ratios) and superior survival (hazard ratios and log ranks tests) for death (OR = 0.49 [0.39, 0.62] P ≤.0001, HR = 0.29 [0.23, 0.37], χ2 = 109.58 P ≤.0001), myocardial infarction (OR = 0.67 [0.54, 0.84] P =.0005*, HR = 0.48 [0.38, 0.60], χ2 = 42.40 P ≤.0001), atrial fibrillation (OR = 0.70 [0.59, 0.83] P ≤.0001, HR = 0.54 [0.45, 0.64], χ2 = 51.53 P ≤.0001), heart failure (OR = 0.55 [0.47, 0.64] P ≤.0001, HR = 0.41 [0.35, 0.47], χ2 = 137.416 P ≤.0001), essential hypertension (OR = 0.88 [0.82, 0.94] P =.0002, HR = 0.78 [0.74, 0.82], χ2 = 76.38 P ≤.0001), and pulmonary hypertension (OR = 0.51 [0.40, 0.65] P ≤.0001, HR = 0.38 [0.29, 0.48], χ2 = 60.67 P ≤.0001) where P ≤.00037 indicated statistical significance*. Conclusion: This investigation suggests surgical management of obstructive sleep apnea may contribute to the mitigation of long-term clinical CVD morbidity. [ABSTRACT FROM AUTHOR]

Objective: Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars. Methods: A cross‐sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017‐March 2020 data on participants, aged 18–65 years (n = 4742). Variables of interest included self‐reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test. Results: There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants. Conclusion: Concerns of the impact of first premolar extractions on SDB were not supported with this study. [ABSTRACT FROM AUTHOR]

Purposes: To evaluate whether mandibular advancement device therapy is recommended in patients affected by obstructive sleep apnea. Methods: In order to predict oral appliances therapy response, drug induced sleep endoscopy with cardio-respiratory polygraphy and mandibular advancement device simulator was carried out. Patients in which upper airway obstruction was resolved on all levels and AHI was normalized (< 5/h), were referred for oral appliance therapy. At 5 months follow up, a cardio-respiratory polygraphy with MAD was performed. Results: 36 patients who have evidence of resolution of UA collapse and AHI below 5 events per hour, were referred for MAD therapy. At follow up, the mean AHI decreased from 29.1 ± 13.1 to 3.3/h ± 1.9 (p < 0.001). All the patients were responders. Conclusion: Combining the evaluation of drug induced sleep endoscopy and cardio-respiratory polygraphy data simultaneously during mandibular protrusion, has the potential to be a useful tool for prediction of MAD therapy response. [ABSTRACT FROM AUTHOR]

Objective: Obstructive sleep apnea is common in children with Down syndrome (DS). Tonsillectomy is recommended as the first‐line approach in treating children with obstructive sleep apnea (OSA), however, there is limited data on the long‐term outcomes in children with DS who undergo tonsillectomy. In this retrospective study, we examined the long‐term polysomnographic and symptomatic outcomes in children with DS who underwent tonsillectomy with or without an adenoidectomy (T&A). We hypothesize that the success of T&A to treat OSA in children with DS will diminish with time. Study Design: A retrospective chart review of children with DS who underwent T&A between 2009 and 2015 was conducted. Inclusion criteria were children with at least 1 postoperative polysomnogram (PSG) within 6 months of T&A with an obstructive apnea/hypopnea index (OAHI) < 5. Outcomes were determined by subsequent clinic visits and postoperative polysomnograms: OAHI ≥ 5, snoring reported during clinic visit and time to reoccurrence. Setting: Childrens Hospital Colorado. Results: Of the 57 children with mild OSA at 1st (initial) PSG, 13/40 (33%) children had OAHI ≥ 5 at the 2nd postoperative PSG. Of the 18 patients who underwent a 3rd PSG, 4 (22%) progressed to moderate/severe OSA. A total of 17 patients out of the original 57 (30%) progressed to moderate/severe OSA with the median time for the additional post‐op PSG's being 2.3 years. Conclusion: Children with DS who have at most mild OSA (OAHI < 5) following a T&A are at risk for progressing to at least moderate OSA within 2 years after their T&A. A surveillance PSG 2 years following surgery will identify these children. [ABSTRACT FROM AUTHOR]

Myofunctional therapy is a specialized treatment aimed at correcting orofacial myofunctional disorders (OMDs), addressing muscle dysfunction and improper oral habits. Myofunctional therapy (MT) has emerged as a critical intervention in pediatric dentistry, particularly in addressing sleep disordered breathing (SDB) and non-nutritive sucking habits (NNSH), and their impact on growth and development. This article reviews the role of myofunctional therapy in pediatric dentistry, focusing on its mechanisms, benefits, and the interdisciplinary approach required for optimal oral health and function in children. [ABSTRACT FROM AUTHOR]

Objective: Children with cleft lip and/or palate (CL/P) are at increased risk for Sleep Disordered Breathing (SDB), particularly Obstructive Sleep Apnea (OSA). At our institution, routine screening for SDB is performed using the Chevrin Pediatric Sleep Questionnaire (PSQ). This analysis is a practice audit looking at the outcomes of screening children with CL/P. Design/Setting/Patients/Participants: A single-center, retrospective analysis was done of all non-syndromic patients with CL/P over the age of 36 months over a 4-year period. Children with known OSA were eliminated from analysis. Main Outcome Measures: Univariate logistic regression was used to assess predictors for SDB (PSQ score > 8) amongst various patient, disease, and treatment characteristics. Outcomes of those screened were tracked. Results: Of the 239 patients in the study cohort, 43 (18%) had positive PSQs. These subjects were more likely to have class III dental occlusion with maxillary retrusion (OR = 2.65, 95% CI: 1.2–5.8, p = 0.02). There were no differences amongst age, type of cleft, Veau classification, BMI, or history of pharyngeal surgery. One third of the group did not complete recommended testing. Twenty-five subjects with positive sleep screening underwent subsequent polysomnography and 21 (84%) had OSA. Conclusion: Routine screening reveals a significant proportion of patients with CL/P with symptoms suggestive of OSA. While several patients did not complete confirmatory testing, those who completed a PSG had a high rate of identification of OSA. After excluding children with known OSA, patients with SDB are also likely to have class III dental occlusion and maxillary retrusion. [ABSTRACT FROM AUTHOR]

Purpose: Untreated obstructive sleep apnea (OSA) in patients with acute ischemic stroke (AIS) is associated with increased morbidity and mortality. However, diagnosing and treating OSA in AIS is challenging. We aimed to determine the feasibility of portable monitoring (PM) for diagnosis and positive airway pressure therapy for treatment of OSA in an inpatient stroke population. Methods: We recruited inpatients with AIS from Cleveland Clinic. Those who consented underwent PM; participants with a respiratory event index (REI) ≥ 10 were offered auto-titrating positive airway pressure therapy (APAP). Ease-of-use questionnaires were completed. We summarized categorical variables using n(%) and continuous variables using mean ± SD or median [IQR]. Results: 27 participants (age 59.8 ± 11.8, 51.9% female, 51.9% Black, BMI 33.4 ± 8.5) enrolled. The study ended early due to Medicare contracting that forced most patients to complete stroke rehabilitation outside the Cleveland Clinic health system. 59.3% had large vessel occlusions and 53.8% had moderate/severe disability (Modified Rankin score ≥ 2). PM was attempted in 21 participants, successful in 18. Nurses and patients rated the PM device as highly easy to use. 13 of 18 (72%) patients who had an REI ≥ 10 consented to APAP titration, but only eight (61.5%) of those 13 used APAP for more than one night, and only five (27.8%) used APAP up to 90 days with data captured for only one participant. Five required troubleshooting at titration, and only one had adherent APAP usage by objective assessment after discharge. Conclusions: This study demonstrates the real-world challenges of assessing and treating OSA in an AIS population, highlighting the necessity for further research into timely and feasible screening and treatment. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to validate the new DormoTech Vlab device’s performance, usability, and validity as a sleep test and physiological data recorder. The novel device has been designed for patient comfort, ease of use, and home-based assessment of sleep disordered breathing and other sleep-related measurements. Methods: Forty-seven adults (mean age = 52 years, 42% female, body mass index 29.4 kg/m2) underwent simultaneous testing with the DormoTech Vlab device and routine full polysomnography (PSG) using the Nox A1 system (K192469, Nox Medical). The sleep studies were manually and independently scored according to recommended guidelines. The primary outcome measure was the apnea-hypopnea index (AHI) and its corresponding conventional severity level (i.e., normal, mild, moderate, severe). Secondary endpoints included other standard PSG parameters. Results: The AHI was 21.7 ± 24.2 events/h (mean ± standard deviation) using the Vlab device versus 21.5 ± 23.9 events/h for gold standard PSG Nox A1 (p = 0.7). When AHI was grouped by severity, inter-test agreement was high (Cohen’s kappa = 0.97). Results between the two systems were largely similar in the secondary endpoints, with high correlation between the two systems, and statistically significant (p < 0.05) differences only in REM latency measurements. The Vlab device provides similar sleep study data to conventional gold standard PSG and clinically near-identical test interpretation in almost all cases. Conclusion: Based on these results, the Vlab device can be considered substantially equivalent to the reference Nox A1 system in terms of usability, efficacy, and validity. Clinical Trial Registration: Trial name: Evaluation of the Usability and Performance Assessment of the DormoTech VLAB Device as a Home Sleep Test Identification number: NCT06224972. Date of Registration: 2023-12-06. [ABSTRACT FROM AUTHOR]

Purpose: Conventional obstructive sleep apnea (OSA) diagnosis via polysomnography can be costly and inaccessible. Recent advances in artificial intelligence (AI) have enabled the use of craniofacial photographs to diagnose OSA. This meta-analysis aims to clarify the diagnostic accuracy of this innovative approach. Methods: Two blinded reviewers searched PubMed, Embase, Scopus, Web of Science, and IEEE Xplore databases, then selected and graded the risk of bias of observational studies of adults (≥ 18 years) comparing the diagnostic performance of AI algorithms using craniofacial photographs, versus conventional OSA diagnostic criteria (i.e. apnea-hypopnea index [AHI]). Studies were excluded if they detected apneic events without diagnosing OSA. AI models evaluated with a random split test set or k-fold cross-validation were included in a Bayesian bivariate meta-analysis. Results: From 5,147 records, 6 studies were included, containing 10 AI models trained/tested on 1,417/983 participants. The risk of bias was low. AI trained on craniofacial photographs achieved a pooled 84.9% sensitivity (95% credible interval [95% CrI]: 77.1–90.7%) and 71.2% specificity (95% CrI: 60.7–81.4%). Bayesian meta-regression identified deep learning (convolutional neural networks) as the most accurate AI algorithm (91.1% sensitivity, 79.2% specificity) comparable to home sleep apnea tests. AHI cutoffs, OSA prevalence, feature engineering, input data, camera type and informativeness of Bayesian prior did not alter diagnostic accuracy. There was no substantial publication bias. Conclusion: AI trained on craniofacial photographs have high diagnostic accuracy and should be considered as a low-cost OSA screening tool. Future work focused on deep learning using smartphone images could improve the feasibility of this approach in primary care. [ABSTRACT FROM AUTHOR]

Abstract Background Endothelial dysfunction is an integral pathophysiologic mechanism in sickle cell disease (SCD), and can lead to many complications. Sleep-disordered breathing (SDB) is a SCD complication with diverse incidence and pathophysiology. This study aimed to determine the prevalence of SDB in children with SCD and to assess its relation to endothelial dysfunction. Methods Sixty children with SCD and 60 healthy controls were enrolled. The levels of TNF-α, IL-6, and IL-17A were evaluated in the entire cohort using enzyme-linked immunosorbent assay (ELISA) kits. Polysomnography (PSG) was performed for all SCD patients after completion of the Pediatric Sleep Questionnaire (PSQ). Results TNF-α, IL-6, and IL-17A levels were significantly greater in children with SCD than in controls (p-values

Background: This study examines the relationship between obstructive sleep apnea severity, sleep position, and body weight, particularly focusing on the negative impact of sleeping in a supine position combined with being overweight in a population-based sample. Methods: The Apnea-Hypopnea Index (AHI) was utilized as a marker of OSA severity and sleep position from a standardized overnight polysomnography. Participants were categorized by body mass index (BMI) (kg/m2) into normal weight/underweight (<25) and overweight (≥25). Results and Conclusions: The results indicated a higher mean Apnea-Hypopnea Index for those sleeping in the supine position compared to other positions, with overweight individuals experiencing a proportionally greater impact from sleep position than their normal-weight counterparts. [ABSTRACT FROM AUTHOR]

Introduction: There is a high prevalence of sleep disturbances and disorders such as obstructive sleep apnea (OSA) in children with attention-deficit hyperactivity disorder (ADHD), though this relationship remains poorly characterized by objective measures. Polysomnographic studies (PSGs) on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated vs. non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA. Methods: Medical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019 to 2022. ADHD diagnosis was determined by ICD code F90, andOSA was defined by apnea-hypopnea indices (AHI)≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA alone, children with ADHD alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest. Results: 4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA alone (29.8%), 333 with ADHD alone (8.3%), and 111 with ADHD and OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD alone. However, they exhibited significantly better sleep efficiency (SE), than children with OSA alone, and SE did not significantly differ from the other groups. No significant difference in periodic limbmovements (PLMs) was found across all groups. The above results held true even after correcting for stimulant prescription. Conclusion: The increased frequency of clinical insomnia diagnoses in children with ADHD is not associated with any traditional parameters on polysomnogram. Innovative subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with both ADHDandOSA, PSG results do not reveal any distinctive sleep disturbances which cannot be better explained by OSA alone. These findings underscore the importance of screening for OSA in patients with ADHD and clinically assessing for other sleep concerns. [ABSTRACT FROM AUTHOR]

Despite disease modifying treatments (DMT), assisted ventilation is commonly required in children with Spinal Muscular Atrophy (SMA). Guidelines suggest screening with oximetry and transcutaneous carbon dioxide (TcCO 2) for sleep disordered breathing (SDB). To determine the utility of pulse oximetry and TcCO 2 as a screen for SDB and the need for Non-Invasive Ventilation (NIV) in children with SMA type 1–3. A prospective cohort study was conducted in Queensland, Australia. Full diagnostic PSG was completed in DMT naïve children with SMA. Pulse oximetry and TcCO 2 were extracted from PSG. Apnoea-hypopnoea indices (AHI) criteria were applied to PSG results to define the need for NIV. Abnormal was defined as: ≤3 months of age [mo] AHI≥10 events/hour; >3mo AHI ≥5 events/hour. Receiver operating characteristic curves were calculated for abnormal PSG and pulse oximetry/TcCO 2 variables, and diagnostic statistics were calculated. Forty-seven untreated children with SMA were recruited (type 1 n = 13; 2 n = 21; 3 n = 13) ranging from 0.2 to 18.8 years old (median 4.9 years). Oxygen desaturation index ≥4 % (ODI4) ≥20events/hour had sensitivity 82.6 % (95 % CI 61.2–95.0) and specificity of 58.3 % (95 % CI 36.6–77.9). TcCO 2 alone and combinations of oximetry/TcCO 2 had low diagnostic ability. The same methodology was applied to 36 children who were treated (type 1 n = 7; type 2 n = 17; type n = 12) and oximetry±TcCO2 had low diagnostic ability. ODI4 ≥20events/hour can predict the need for NIV in untreated children with SMA. TcCO2 monitoring does not improve the PPV. If normal however, children may still require a diagnostic PSG. Neither oximetry nor TcCO 2 monitoring were useful screening tests in the children treated with DMT. • Emerging data suggest ongoing respiratory muscle weakness and ventilatory requirements (e.g non-invasive ventilation [NIV]) are common despite disease modifying treatments. • Ccurrent consensus statements for SMA suggest using pulse oximetry and transcutaneous carbon dioxide monitoring (TcCO 2) for screening for sleep disordered breathing, given the resource limitation of full polysomnography (PSG), however the usefulness of these methods has not been assessed. • We assessed the utility of Oximetry and TcCO 2 as a screen for sleep disordered breathing in children with SMA by comparing them with the gold standard full level 1 diagnostic PSG. • ODI4 ≥20events/hour can predict need for NIV in untreated children with SMA; neither oximetry nor TcCO2 are useful in DMT treated SMA. • An elevated TcCO 2 would indicate the need for NIV, however this was not observed any child in our group. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is identified by instances of either full or partial collapse of the airway during sleep, leading to reduced oxygen levels or awakening from sleep. This disruption causes interrupted and insufficient sleep, impacting cardiovascular well-being, mental health, and overall quality of life. Pediatric OSA is more challenging to diagnose and a single apnoea is considered to be significant in this age group. A hospital based prospective study with 100 children between the ages of 4 and 12 years with sleep disordered breathing. Evaluated for the severity of obstructive sleep apnea and also assessed if surgery was beneficial to treat OSA in mild cases. General physical examination, evaluation of facial/oral features were conducted to rule out adenoid facies. Additionally, ENT examination was conducted. Medical history and lateral neck radiographs were reviewed, and the paediatric sleep questionnaire was administered to evaluate neurobehavioral morbidities associated with OSA. These children were evaluated for sleep disorders by conducting the polysomnography. Pediatric sleep questionnaire was also administered. The scoring and results analysis were conducted according to standardised guidelines provided by the American association for sleep medicine. Furthermore, medical management protocols were outlined, including a 6-week course of intranasal steroids and leukotriene receptor antagonist therapy, with consideration of adenotonsillectomy for patients failing medical therapy. In our study on paediatric obstructive sleep apnea (OSA), medical treatment significantly reduced clinical symptom scores in cases of mild OSA, as evidenced by pre- and post-parental sleep questionnaire scores of 23.62 ± 8.24 and 13.55 ± 6.05, respectively (paired samples test, P = 0.00). Similarly, both the pre- and post-Apnoea/Hypopnoea Index (AHI) scores (2.278 ± 1.5658 and 1.19 ± 1.420) and central sleep apnea index scores (1.252 ± 0.8972 and 0.61 ± 0.815) significantly improved post-treatment (paired samples test, P = 0.03, respectively). Additionally, significant changes were observed in tonsillar grade after the 12-week medication course, and sleep architecture showed notable improvement during the repeat follow-up study. These findings highlight the efficacy of treatment interventions in alleviating symptoms and enhancing sleep efficiency in paediatric OSA. The findings of this study underscore the efficacy of a medical management using intranasal corticosteroids and oral montelukast in mitigating the severity of mild obstructive sleep apnea (OSA) in children. This research substantiates the therapeutic value of corticosteroids and oral montelukast in paediatric patients with mild OSA, offering compelling evidence for their use as beneficial interventions in this population. [ABSTRACT FROM AUTHOR]

Summary: This cross‐sectional study aimed to assess the prevalence of atypical deglutition (tongue thrust) in children diagnosed with moderate to severe obstructive sleep apnea syndrome (OSAS) and to explore its associations, particularly in relation to the type of dentition (mixed or permanent). The study was conducted over a 5 year period at a paediatric hospital in Paris, France. Children aged 6–18 years with moderate to severe OSAS (apnea–hypopnea index ≥5/h) underwent a comprehensive evaluation, including the recording of demographic data, symptoms of snoring and breathing issues, and otolaryngology examination. The swallowing pattern was assessed and orthodontic evaluations were performed. Cephalometric radiography and pharyngometry tests (pharyngeal collapsibility was computed) were conducted. The study found a high prevalence of atypical deglutition in children with mixed 74% [56–87] or permanent 38% [25–51] dentition. In children with mixed dentition and atypical deglutition, the pharyngeal compliance and lower facial dimensions were increased. In children with permanent dentition, atypical deglutition was associated with more severe OSAS and a lower hyoid bone position. Independent of the type of dentition, atypical deglutition was associated with an increase in the apnea–hypopnea index, an increase in the lower facial dimension, increased pharyngeal compliance, and a more caudal hyoid bone position. Atypical deglutition was strongly associated with increased pharyngeal collapsibility, more severe OSAS and altered facial measurements in children. The findings suggest that identifying atypical deglutition in children with OSAS could help to guide a personalised therapeutic approach, including myofunctional therapy. [ABSTRACT FROM AUTHOR]

Purpose: The sleep disturbance scale for children (SDSC) is a well-regarded tool for assessing pediatric sleep disorders, covering areas such as sleep initiation, breathing issues, and arousal disorders. The SDSC, known for its reliability and validity, has been adapted for various age groups and languages and aligns with the Association of Sleep Disorders Centers classification system. This study aimed to translate and culturally adapt the SDSC into Malayalam language for use in Kerala, conducting a test with parents from the Trivandrum district. Materials and Methods: The SDSC was translated from English to Malayalam language through a systematic process involving bilingual experts, synthesis, back-translation, and expert review. Cognitive interviews refined the translation, which was then tested for reliability with 103 parents. Internal consistency was assessed using Cronbach's alpha, while test-retest reliability was evaluated with Cohen's kappa, utilizing the SPSS version 20 for data analysis. Results: The translated SDSC showed strong internal consistency, with an overall Cronbach's alpha of 0.827 and domain-specific values between 0.7 and 0.8. Test-retest reliability was high, with correctness above 90% for all items and a Kappa statistics ranging from 0.66 to 0.88. Conclusion: The SDSC was successfully translated and culturally adapted into Malayalam language, demonstrating strong internal consistency and high test-retest reliability. This indicates that the Malayalam language version of the SDSC is a reliable tool for assessing pediatric sleep disorders among children in Kerala, making it applicable for use in this specific cultural context. [ABSTRACT FROM AUTHOR]

Background: Endothelial dysfunction is an integral pathophysiologic mechanism in sickle cell disease (SCD), and can lead to many complications. Sleep-disordered breathing (SDB) is a SCD complication with diverse incidence and pathophysiology. This study aimed to determine the prevalence of SDB in children with SCD and to assess its relation to endothelial dysfunction. Methods: Sixty children with SCD and 60 healthy controls were enrolled. The levels of TNF-α, IL-6, and IL-17A were evaluated in the entire cohort using enzyme-linked immunosorbent assay (ELISA) kits. Polysomnography (PSG) was performed for all SCD patients after completion of the Pediatric Sleep Questionnaire (PSQ). Results: TNF-α, IL-6, and IL-17A levels were significantly greater in children with SCD than in controls (p-values < 0.001, < 0.001, and 0.006, respectively). The PSQ revealed symptoms suggestive of SDB in 50 children with SCD (83.3%), and PSG revealed obstructive sleep apnea (OSA) in 44 children with SCD (73.3%); 22 patients had mild OSA, and 22 had moderate-to-severe OSA according to the apnea–hypopnea index (AHI). TNF-α was significantly greater in SCD children who reported heavy or loud breathing, trouble breathing or struggle to breathe, and difficulty waking up in the morning (p-values = 0.002, 0.002, and 0.031, respectively). The IL-6 levels were significantly greater in SCD children who stopped growing normally (p-value = 0.002). The levels of IL-6 and IL-17A were significantly greater in SCD children with morning headaches (p-values = 0.007 and 0.004, respectively). Conclusion: Children with SCD showed a high prevalence of SDB with significantly elevated levels of markers of endothelial function, highlighting the interplay of SDB and endothelial dysfunction in SCD. [ABSTRACT FROM AUTHOR]

Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure and cognitive function has become an essential focus in the heart-brain axis, given its potential role in developing neurocognitive abnormalities. In this review, we found that OSA plays a significant role in the cardio-neural pathway that leads to the development of cerebral small vessel disease and neurocognitive decline. Although data is still limited on this topic, understanding the critical role of OSA in the heart-brain axis could lead to the utilization of imaging modalities to simultaneously identify early signs of pathology in both organ systems based on the known OSA-driven pathological pathways that result in a disease state in both the cardiovascular and cerebrovascular systems. This narrative review aims to summarize the current link between OSA and neurocognitive disorders, cardio-neural pathophysiology, and the treatment options available for patients with OSA-related neurocognitive disorders. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD in children and adolescents is primarily centred on daytime functioning and the associated impairment of academic performance, although disrupted and restless sleep have been frequently reported in individuals with ADHD. Further, it has been recognised that sleep disorders not only intensify existing ADHD symptoms but in some cases can also mimic ADHD symptoms in the paediatric population with primary sleep disorders. Under the title 'The blind spot: sleep as a child's right issue?', professionals from diverse disciplines, including medicine and social sciences as well as individuals with an interest in ADHD and sleep medicine, including laypeople, have initiated a unifying discourse. The objective of this discourse is to improve our understanding of the diagnosis and treatment of ADHD and disruptive behaviours and to develop personalised and precision medicine. Research has shown that the existing, primarily descriptive and categorical diagnostic systems do not capture the heterogeneous nature of youth with attentional and behavioural difficulties and the phenotypic expressions thereof, including nighttime behaviours and sleep. New strategies for clinical phenotyping and the exploration of patient-reported behaviours are necessary to expand our understanding and develop personalised treatment approaches. In this position paper, we outline gaps in the clinical care of ADHD and related sleep disturbances, review strategies for closing these gaps to meet the needs of individuals with ADHD, and suggest a roadmap for escaping the one-size-fits-all approach that has characterised ADHD treatment algorithms to date. [ABSTRACT FROM AUTHOR]

BACKGROUND: The impact of sleep disordered breathing (SDB) on heart failure (HF) is increasingly recognized. However, limited data exist in support of quantification of the clinical and financial impact of SDB on HF hospitalizations. METHODS: A sleep-heart registry included all patients who underwent inpatient sleep testing during hospitalization for HF at a single cardiac center. Readmission data and actual costs of readmissions were obtained from the institutional honest broker. Patients were classified based on the inpatient sleep study as having no SDB, obstructive sleep apnea (OSA), or central sleep apnea (CSA). Cumulative cardiac readmission rates and costs through 3 and 6 months post-discharge were calculated. Unadjusted and adjusted (age, sex, body mass index, and left ventricular ejection fraction) modeling of cost was performed. RESULTS: The cohort consisted of 1547 patients, 393 (25%) had no SDB, 438 (28%) had CSA, and 716 (46%) had OSA. Within 6 months of discharge, 195 CSA patients (45%), 264 OSA patients (37%), and 109 no SDB patients (28%) required cardiovascular readmissions. Similarly, 3- and 6-month mortality rates were higher in both SDB groups than those with no SDB. Both unadjusted and adjusted readmission costs were higher in the OSA and CSA groups compared to no SDB group at 3 and 6 months post-discharge with the CSA and OSA group costs nearly double (~ $16,000) the no SDB group (~ $9000) through 6 months. INTERPRETATION: Previously undiagnosed OSA and CSA are common in patients hospitalized with HF and are associated with increased readmissions rate and mortality.

Myofunctional therapy is a specialized treatment aimed at correcting orofacial myofunctional disorders (OMDs), addressing muscle dysfunction and improper oral habits. Myofunctional therapy (MT) has emerged as a critical intervention in pediatric dentistry, particularly in addressing sleep disordered breathing (SDB) and non-nutritive sucking habits (NNSH), and their impact on growth and development. This article reviews the role of myofunctional therapy in pediatric dentistry, focusing on its mechanisms, benefits, and the interdisciplinary approach required for optimal oral health and function in children.

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

INTRODUCTION: Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). We aimed to examine the burden of SDB in infants with DS referred to tertiary sleep center. METHODS: Infants (≤12 months old) with DS who underwent consecutive polysomnography (PSG) at a single academic sleep center over a 6-year period were included. obstructive sleep apnea (OSA) (obstructive apnea hypopnea index [oAHI]>1/hr), central sleep apnea (central apnea index > 5/h) and the presence of hypoventilation (% time spent with CO2  > 50 mmHg either by end-tidal or transcutaneous> 25% of total sleep time) and hypoxemia (time spent with O2 saturation 5 min) were ascertained. RESULTS: A total of 40 infants were included (Mean age 6.6 months, male 66%). PSGs consisted of diagnostic (n = 13) and split night (n = 27, 68%) studies. All met criteria for OSA with mean oAHI 34.6/h (32.3). Central sleep apnea was present in 11 (27.5%) of infants. A total of 11 (27.5%) had hypoxemia. Hypoventilation was present in 10 (25%) infants. CONCLUSION: This study highlights the high prevalence of SDB in infants with DS referred to a sleep center, and supports early PSG assessment in this patient population.

In the Chilean pediatric population, to date, there is no validated screening instrument for sleep-related breathing disorders (SRBD). Objective: to develop and validate a cross-cultural adaptation of the Pediatric Sleep Questionnaire - sleep-related breathing disorder scale (PSQ-SRBD), by creating the Chilean Spanish version (PSQ-CL). Patients and Method: The PSQ-SRBD was translated from English into Chilean Spanish, obtaining the PSQ-CL, which was subsequently validated. Internal consistency was determined through Cronbach's alpha coefficient in 26 children with obstructive sleep apnea confirmed by polysomnography and in 112 controls. Reliability was obtained through the test-retest method. Results: In the pilot group, the overall internal consistency of the PSQ-CL through Cronbach's alpha was 0.71 and the internal consistency was 0.653, 0.566, and 0.808 in subscales A, B, and C, respectively. The discrimination capacity of the PSQ-CL questionnaire established through ROC analysis was 81%, determining a cut-off score of 0.227 with a sensitivity of 73.08% and a specificity of 77.68%. Conclusions: The PSQ-CL is a suitable instrument for screening sleep-disordered breathing in Chilean children. This instrument may be useful in clinical practice and epidemiological research in the Chilean pediatric population and could be used for multicenter studies. [ABSTRACT FROM AUTHOR]

Several pivotal differences in sleep and sleep disorders are recognized between women and men. This is not only due to changes in hormonal balance during women's reproductive life, such as in pregnancy and menopause. Women are more likely to report insomnia and non-specific symptoms of apneas, such as fatigue or mood disturbance, compared to men. Thus, it is important for clinicians and researchers to take sex and gender differences into account when addressing sleep disorders in order to acknowledge the biology unique to women. We present a narrative review that delves into the primary sleep disorders, starting from basic science, to explore the impact of gender differences on sleep and the current status of research on women's sleep health. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnoea syndrome is a respiratory sleep disorder that affects 1-5% of children. It occurs equally in males and females, with higher incidence in school age and adolescence. OSAS may be caused by several factors, but in children, adenotonsillar hypertrophy, obesity, and maxillo-mandibular deficits are the most common. In general, there is a reduction in the diameter of the airway with reduced airflow. This condition worsens during sleep due to the muscular hypotonia, resulting in apnoeas or hypoventilation. While snoring is the primary symptom, OSAS-related manifestations have a wide spectrum. Some of these symptoms relate to the nocturnal phase, including disturbed sleep, frequent changes of position, apnoeas and oral respiration. Other symptoms concern the daytime hours, such as drowsiness, irritability, inattention, difficulties with learning and memorisation, and poor school performance, especially in patient suffering from overlapping syndromes (e.g., Down syndrome). In some cases, the child's general growth may also be affected. Early diagnosis of this condition is crucial in limiting associated symptoms that can significantly impact a paediatric patient's quality of life, with the potential for the condition to persist into adulthood. Diagnosis involves evaluating several aspects, beginning with a comprehensive anamnesis that includes specific questionnaires, followed by an objective examination. This is followed by instrumental diagnosis, for which polysomnography is considered the gold standard, assessing several parameters, including the apnoea-hypopnoea index (AHI) and oxygen saturation. However, it is not the sole tool for assessing the characteristics of this condition. Other possibilities, such as night-time video recording, nocturnal oximetry, can be chosen when polysomnography is not available and even tested at home, even though with a lower diagnostic accuracy. The treatment of OSAS varies depending on the cause. In children, the most frequent therapies are adenotonsillectomy or orthodontic therapies, specifically maxillary expansion. [ABSTRACT FROM AUTHOR]

Background: The conventional measure of sleep fragmentation is via polysomnographic evaluation of sleep architecture. Adults with OSA have disruption in their sleep cycles and spend less time in deep sleep stages. However, there is no available evidence to suggest that this is also true for children and published results have been inconclusive. Objective: To determine polysomnographic characteristics of sleep architecture in children with OSA and investigate effects relative to OSA severity. Methods: Overnight polysomnograms (PSG) of children referred for suspected OSA were reviewed. Subjects were classified by apnea hypopnea index (AHI). PSG parameters of sleep architecture were recorded and analyzed according to OSA severity. Results: Two hundred and eleven children were studied (median age of 7.0 years, range 4-10 years) Stage N1 sleep was longer while stage N2 sleep and REM sleep was reduced in the OSA group when compared to those without OSA (6.10 vs 2.9, P <.001; 42.0 vs 49.7, P <.001; 14.0 vs 15.9, P =.05). The arousal index was also higher in the OSA group (12.9 vs 8.2, P <.001). There was a reduction in sleep efficiency and total sleep time and an increase in wake after sleep onset noted in the OSA group (83.90 vs 89.40, P =.003; 368.50 vs 387.25, P =.001; 40.1 ± 35.59 vs 28.66 ± 24.14, P =.007; 29.00 vs 20.50; P =.011). No significant difference was found in N3 sleep stage (33.60 vs 30.60, P =.14). Conclusion: We found evidence that children with OSA have a disturbance in their sleep architecture. The changes indicate greater sleep fragmentation and more time spent in lighter stages of sleep. Future research is needed and should focus on more effective methods to measure alterations in sleep architecture. [ABSTRACT FROM AUTHOR]

Purpose: The detection of obstructive sleep apnoea (OSA) in pregnant women in early-mid gestation is logistically difficult. Accurate alternates to polysomnography (PSG) in early pregnancy are not well identified. We compared the agreement between Apnealink Air (AL) and existing screening questionnaires to PSG in pregnant women ≤ 24-week gestation. Methods: Pregnant women (≤ 24-week gestation) underwent AL at home plus attended PSG in any order, completed within 7 days where practicable. AL was manually scored (AL(M)) and automatically scored (AL(A)). An apnoea-hypopnea index (AHI) ≥ 5 was considered diagnostic of OSA and an AHI ≥ 15 considered at least moderate OSA. Diagnostic analysis was undertaken (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)) by generating receiver operating characteristic (ROC) curves and an area under the curve (AUC) (95% CI). Bland–Altman plots were used to plot agreement. Screening questionnaires (Epworth sleepiness score (ESS), STOP-BANG, calculated pregnancy-specific screening tool) were compared to PSG. Results: A total of 49 participants successfully completed both tests at around 14-weeks gestation (IQR 12.9, 17.1). The time interval between AL and PSG was a median of 2 days (IQR 1, 5 (range 1–11)). A total of 14 (29%) participants had OSA. The median AHI of AL(A) (3.1(IQR 0.85,4.6)) and AL(M) (IQR2.4(0.65,4.8)) did not differ from PSG (1.7(IQR1.0,6.1)). AL(A) and AL(M) compared to PSG demonstrated diagnostic test accuracy (area under curve (ROC)) of 0.94(95% CI 0.87–1.0) and 0.92(95% CI 0.85–1.0) respectively. Apnealink Air outperformed screening questionnaires tested. Conclusion: The findings suggest that Apnealink may provide a substitute to attended PSG identification of OSA in pregnant women in early-mid gestation using both manual and auto-scoring methods. [ABSTRACT FROM AUTHOR]

Patients with obstructive sleep apnea (OSA) show autonomic, mood, cognitive, and breathing dysfunctions that are linked to increased morbidity and mortality, which can be improved with early screening and intervention. The gold standard and other available methods for OSA diagnosis are complex, require whole-night data, and have significant wait periods that potentially delay intervention. Our aim was to examine whether using faster and less complicated machine learning models, including support vector machine (SVM) and random forest (RF), with brain diffusion tensor imaging (DTI) data can classify OSA from healthy controls. We collected two DTI series from 59 patients with OSA [age: 50.2 ± 9.9 years; body mass index (BMI): 31.5 ± 5.6 kg/m2 ; apnea-hypopnea index (AHI): 34.1 ± 21.2 events/h 23 female] and 96 controls (age: 51.8 ± 9.7 years; BMI: 26.2 ± 4.1 kg/m2 ; 51 female) using a 3.0-T magnetic resonance imaging scanner. Using DTI data, mean diffusivity maps were calculated from each series, realigned and averaged, normalised to a common space, and used to conduct cross-validation for model training and selection and to predict OSA. The RF model showed 0.73 OSA and controls classification accuracy and 0.85 area under the curve (AUC) value on the receiver-operator curve. Cross-validation showed the RF model with comparable fitting over SVM for OSA and control data (SVM; accuracy, 0.77; AUC, 0.84). The RF ML model performs similar to SVM, indicating the comparable statistical fitness to DTI data. The findings indicate that RF model has similar AUC and accuracy over SVM, and either model can be used as a faster OSA screening tool for subjects having brain DTI data.

Objectives: Intracapsular tonsillectomy and adenoidectomy (iTA) has become a popular alternative to extracapsular tonsillectomy and adenoidectomy (TT) for the treatment of pediatric obstructive sleep apnea (OSA) due to improved recovery and fewer complications. The objective of this study was to compare surgical recovery and impact on OSA of iTA versus TT in patients with Trisomy 21 (T21). Methods: This is a case series with chart review of all T21 patients who underwent iTA or TT at our institution between July 1, 2015 and August 15, 2022. Data collected included demographics, comorbidities, preoperative sleep studies, intraoperative data, complications and recovery, postoperative sleep studies, and follow‐up data. Results: There were 62 (21.7%) patients who underwent iTA and 224 (78.3%) patients who underwent TT. The iTA group had significantly lower pain scores (p < 0.001), decreased use of narcotics (p < 0.001), shorter length of stay (p = 0.003), and faster return to oral intake (p = 0.01) during their postoperative hospital admission, and fewer 30‐day complications (p = 0.009) compared to the TA group. Both groups showed significant improvements in their sleep studies. For 41 (66.1%) of iTA patients who had follow‐up, median follow‐up was 1.8 years and for 169 (75.4%) TT patients, median follow‐up was 2.6 years. At follow‐up, 21 of 41 (51.2%) iTA patients and 83 of 169 (49.1%) TT patients exhibited OSA symptoms (p = 0.084) and tonsillar regrowth was not significantly different between the two groups (p = 0.12). Conclusion: Patients with T21 experience less pain and fewer postoperative respiratory complications from iTA than from TT. The short‐term impact of iTA versus TT on OSA, as measured by poysomnography, does not differ between the two techniques. Level of Evidence: 3 Laryngoscope, 134:2430–2437, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. Methods: A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. Results: Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p <.00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p >.05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p <.001). Conclusions: A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSA) has been associated with increased cancer incidence and aggressiveness. One hypothesis to support this association is the implication of immune response, particularly the programmed cell death pathway, formed by the receptor PD-1 and its ligand PD-L1. Recent studies have shown dysregulation of this pathway in severe OSA patients. It has also been shown that small extracellular vesicles (sEVs) carrying PD-L1 induce lymphocyte dysfunction. Thus, the aim of our study was to analyze the expression of PD-L1 on sEVs of OSA patients and to evaluate the role of sEVs on lymphocyte activation and cytotoxicity. Circulating sEVs were isolated from OSA patients and the control group. Lymphocytes were isolated from the control group. Circulating sEVs were characterized by western blot, nanotracking analysis, and flow cytometry and were incubated with lymphocytes. Our results show no differences in the quantity and composition of sEVs in OSA patients and no significant effects of sEVs in OSA patients on lymphocyte activation and cytotoxicity. These results suggest that OSA does not modify PD-L1 expression on sEVs, which does not contribute to dysregulation of cytotoxic lymphocytes. [ABSTRACT FROM AUTHOR]

Obstructive sleep disordered breathing (SDB) is prevalent in patients with Spinal Muscular Atrophy (SMA) and possibly reduced by disease modifying treatment (DMT) such as nusinersen. We hypothesized that some obstructive events may in fact be pseudo-obstructive, reflecting the imbalance of chest wall weakness with preserved diaphragmatic function, rather than true upper airway obstruction. If confirmed, these events could represent SMA-specific outcome measures. We aimed to report on the pattern observed in respiratory polygraphies (PG) in paediatric patients with SMA type 2 resembling obstructive SDB. We defined pseudo-obstructive SDB and assessed its changes throughout disease progression. Retrospective review of 18 PG of 6 SMA type 2 patients naïve from DMT across 3 timepoints (first study, one-year follow-up, latest study). At first study patients aged 3–13 years. Four patients were self-ventilating in room air and one of them required non-invasive ventilation (NIV) after the 1-year study. Two patients were on NIV since the first study. The features of pseudo-obstructive SDB included a. paradoxical breathing before, after, and throughout the event, b. the absence of increased respiratory rate during the event, c. the absence of compensatory breath after the event with a return to baseline breathing. Pseudo-obstructive events were progressively more prevalent over time. The derived pseudo-obstructive AHI increased at each timepoint in all patients self-ventilating, whilst it dropped after NIV initiation/adjustments. Pseudo-obstructive SDB is prevalent in SMA type 2. Its number progresses along with the disease and is treatable with NIV. Prospective studies in larger SMA cohorts are planned. • In Spinal Muscular Atrophy (SMA) pseudo-obstructive events reflect the imbalance of chest wall weakness with preserved diaphragmatic function. • Pseudo-obstructive events are characterised by paradoxical breathing in the absence of a raised respiratory rate and a subsequent compensatory breath. • The severity of pseudo-obstructive events progresses over the course of the disease in SMA if not treated with NIV. [ABSTRACT FROM AUTHOR]

Introduction: The Hypoglossal Nerve Stimulator (HNS) is a novel therapy that has been extensively studied in adults and more recently, it has been incorporated in children with Down Syndrome (DS) with persistent obstructive sleep apnea after adenotonsillectomy and trial of continuous positive airway pressure treatment. This systematic review article aims to examine the existing literature on HNS use in children to explore the benefits, efficacy, and parental experiences. Methods: MEDLINE, Web of Science and EMBASE were searched to include all studies published up to March 2nd, 2023, on the topic of HNS use in pediatric population under 21 years old. Results: A total of 179 studies were initially identified from which 10 articles were consistent with the inclusion criteria. Nine articles addressed outcomes after implantation of the HNS device in children with DS and 1 article explored the parental experiences. Findings were similar across studies where after implantation of HNS, there was marked improvement in polysomnographic outcomes and quality of life scores with high level of compliance. Conclusions: HNS holds promise as an effective treatment option for pediatric patients with DS and persistent OSA after AT and CPAP trials. It significantly improves sleep-disordered breathing, quality of life, and neurocognitive measures, leading to substantial and sustained benefits for these children. While the findings are encouraging, further research is needed to explore the potential of HNS in other pediatric populations without DS and to raise awareness among healthcare providers about this treatment option. Overall, HNS may offer significant long-term benefits for the overall well-being and health of pediatric patients with DS and persistent OSA. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence suggests that sleep disordered breathing (SDB) is under-recognized in youth and adults with ADHD. SDB may contribute to exacerbating pre-existing ADHD symptoms and may play a role in the development of cognitive deficits that may mimic ADHD symptoms. Method: We conducted a focused review of publications on cross-prevalence, overlapping clinical and neurobiological characteristics and possible mechanisms linking SDB and ADHD. Results: Exiting studies suggest that co-occurrence of SDB and ADHD is as high as 50%, with frequent overlap of clinical symptoms such as distractibility and inattention. Mechanisms linking these conditions may include hypoxia during sleep, sleep fragmentation and activation of inflammation, all of which may affect brain structure and physiology to produce disturbances in attention. Conclusions: The relationship between SDB and ADHD symptoms appear well-supported and suggests that more research is needed to better optimize procedures for SDB assessment in youth being evaluated and/or treated for ADHD. [ABSTRACT FROM AUTHOR]

Background: The presence of sleep-disordered breathing (SDB) in congestive heart failure (CHF) is associated with poor prognosis and is underdiagnosed despite advances in CHF management. The prevalence of SDB in CHF remains understudied in South East Asia. Methods: A prospective, observational single-centre study was conducted where 116 consecutive patients in a specialised heart failure clinic underwent level 1, attended polysomnography (PSG). Results: The prevalence of SDB was 78% using the apnoea-hypopnea index (AHI), AHI ⩾ 5/h threshold, and 59% with the AHI ⩾ 15/h threshold. Obstructive sleep apnoea (OSA) was the predominant type of SDB and was associated with increased body mass index and neck circumference. STOP-BANG was predictive of SDB, especially in men. Central sleep apnoea (CSA) patients had worse sleep indexes and lower awake arterial carbon dioxide. SDB was also homogenously present in preserved ejection fraction (EF) CHF. Conclusion: Most of the CHF patients were found to have SDB with the utility of PSG. Local CHF guidelines should include sleep testing for all patients with CHF. The study is registered on ClinicalTrials.gov (NCT05332223) as 'The Epidemiological Characteristics of SDB in Patients with Reduced or Preserved EF CHF'. [ABSTRACT FROM AUTHOR]