A Trial of Intranasal Corticosteroids to Treat Childhood OSA Syndrome.

Background: Intranasal corticosteroids (INCS) are frequently used to treat OSA syndrome (OSAS) in children. However, their efficacy has not been rigorously tested.

Research Question: Do INCS result in improved OSAS symptoms, polysomnography findings, behavior, and quality of life compared with placebo?

Study Design And Methods: In this randomized, double-blind, placebo-controlled trial, children with OSAS aged 5 to 12 years (N = 134) were randomized 2:1 to receive 3 months of INCS or placebo.

The obstructive sleep apnoea syndrome in adolescents.

Background: The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromotor factors; however, the relative contributions of these factors have not been studied during the important developmental phase of adolescence. We hypothesised that adenotonsillar volume (ATV), nasopharyngeal airway volume (NPAV), upper airway critical closing pressure (Pcrit) in the hypotonic and activated neuromotor states, upper airway electromyographic response to subatmospheric pressure and the ventilatory response to CO during sleep would be major predictors of OSAS risk.

Methods: 42 obese adolescents with OSAS and 37 weight-matched controls underwent upper airway MRI, measurements of Pcrit, genioglossal electromyography and ventilatory response to CO during wakefulness and sleep.

Evolution of Obstructive Sleep Apnea in Infants with Cleft Palate and Micrognathia.

Study Objectives: Children with craniofacial anomalies are a heterogeneous group at high risk for obstructive sleep apnea (OSA). However, the prevalence and structural predictors of OSA in this population are unknown. We hypothesized that infants with micrognathia would have more significant OSA than those with isolated cleft palate ± cleft lip (ICP), and those with ICP would have more significant OSA than controls.

Relationship between obstructive sleep apnea cardiac complications and sleepiness in children with Down syndrome.

Objective/background: Children with Down syndrome (DS) have a high rate of pulmonary hypertension and sleepiness. They also have a high prevalence of obstructive sleep apnea syndrome (OSAS). We hypothesized that OSAS was associated with cardiovascular dysfunction and sleepiness in children with DS, and that this dysfunction was partly reversible.

Understanding the anatomic basis for obstructive sleep apnea syndrome in adolescents.

Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children.

Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI).

Neurobehavioral functioning in adolescents with and without obesity and obstructive sleep apnea.

Study Objectives: Children and adults with obstructive sleep apnea syndrome (OSAS) exhibit neurobehavioral abnormalities, but few studies have evaluated the transitional stage of adolescence. Obesity is also associated with neurobehavioral abnormalities, and many patients with OSAS are obese. However, the confounding effect of obesity on neurobehavioral abnormalities in adolescents with OSAS has not been evaluated.

Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age.

Rationale: Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain.

Objectives: We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep.

Feasibility of comprehensive, unattended ambulatory polysomnography in school-aged children.

Study Objectives: Although unattended ambulatory polysomnography (PSG) is frequently performed in adults, few studies have been performed in children. The objective of this study was to evaluate the feasibility of comprehensive, ambulatory PSG, including electroencephalography, in school-aged children in the home environment.

Methods: A total of 201 children, born premature with birth weights of 500-1,250 grams, currently aged 5-12 years and living in Canada and Australia, underwent unattended ambulatory PSG.

Investigating reasons for CPAP adherence in adolescents: a qualitative approach.

Study Objectives: Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers.

Methods: Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20).

Relationship between body fat distribution and upper airway dynamic function during sleep in adolescents.

Introduction: The obstructive sleep apnea syndrome (OSAS) is associated with increased visceral adipose tissue (VAT) in adults; however, few studies have evaluated VAT in relation to upper airway function in adolescents. We hypothesized that increased neck circumference (NC) and VAT would be associated with increased upper airway collapsibility.

Methods: Adolescents (24 obese patients with OSAS, 22 obese control patients, and 29 lean control patients) underwent abdominal magnetic resonance imaging, and measurement of upper airway pressure-flow relationships in the activated and hypotonic upper airway states.

Anthropometric predictors of visceral adiposity in normal-weight and obese adolescents.

Background: Obesity and fat distribution patterns [subcutaneous vs. visceral adipose tissue (VAT)] are important predictors of future cardiometabolic risk. As accurate VAT measurement entails imaging, surrogate anthropometric measurements that would be cheaper and quicker to obtain would be highly desirable.

Ventilatory responses to hypercapnia during wakefulness and sleep in obese adolescents with and without obstructive sleep apnea syndrome.

Study Objectives: Abnormal ventilatory drive may contribute to the pathophysiology of the childhood obstructive sleep apnea syndrome (OSAS). Concomitant with the obesity epidemic, more adolescents are developing OSAS. However, few studies have specifically evaluated the obese adolescent group.

Effects of race on upper airway dynamic function during sleep in children.

Study Objective: Studies in adults and children have shown that African American race is a risk factor for the obstructive sleep apnea syndrome (OSAS). Therefore, we hypothesized that non-obese, non-snoring African American children would have a more collapsible upper airway during sleep than age-, gender-, and size-matched Caucasians.

Design: Upper airway dynamic function was measured during sleep in normal African American and Caucasian children.

Cortical processing of respiratory occlusion stimuli in children with central hypoventilation syndrome.

Rationale: The ability of patients with central hypoventilation syndrome (CHS) to produce and process mechanoreceptor signals is unknown.

Objectives: Children with CHS hypoventilate during sleep, although they generally breathe adequately during wakefulness. Previous studies suggest that they have compromised central integration of afferent stimuli, rather than abnormal sensors or receptors.

Effect of sleep stage on breathing in children with central hypoventilation.

The early literature suggests that hypoventilation in infants with congenital central hypoventilation syndrome (CHS) is less severe during rapid eye movement (REM) than during non-REM (NREM) sleep. However, this supposition has not been rigorously tested, and subjects older than infancy have not been studied. Given the differences in anatomy, physiology, and REM sleep distribution between infants and older children, and the reduced number of limb movements during REM sleep, we hypothesized that older subjects with CHS would have more severe hypoventilation during REM than NREM sleep.