bluuebunny/crossref_metadata_2025_split huggingface dataset:
0521 Prevalence and Characteristics of Sleep Disordered Breathing in 12-24 Month Old Children: A Single Center Study
Authors: SurVance Emilee , Nguyen Quang , Betz Kelly , El-Kersh Karim , Senthilvel Egambaram 
Published: May 2022

Abstract

Introduction
To evaluate the prevalence and characteristics of obstructive sleep apnea (OSA) in children with ages between 12 to 24 months.

Methods
This was a single center, retrospective study that included children with ages 12-24 months who were evaluated for suspected sleep disordered breathing and underwent a full overnight polysomnography in an academic sleep disorders center over a period of 7 years. An apnea hypopnea index (AHI) &gt;1 was used to define OSA, &gt;5 was used to define moderate OSA, and &gt;10 was used to define severe OSA.

Results
A total of 232 children with ages between 12-24 months were included in this study. The majority (66.4%) were noted to be males, and 56.9% were Caucasian. Snoring (90.1%) and witnessed apnea (53.3%) were the most common presenting symptoms for sleep evaluation. History of prematurity (18.2%) and gastroesophageal reflux (20.2%) were common co-morbidities. OSA was diagnosed in about 79% of the children and it was categorized as mild in 53.5%, moderate in 16.4 % and severe in 30.1%, respectively. There were no statistically significant differences in total sleep time, sleep efficiency, or the stages among these groups. However, statistical significant differences among the groups were noted in median REM% (Q1-Q3) (normal 19.3 (15-22.2) vs. mild 22.2 (18-26.6) vs. moderate 23.1(16-28) vs. severe 21(15-24.6) p=0.013), median REM AHI (normal 1.6 (1-2.8) vs. mild 7.5 (5-10.8) vs. moderate19.4 (12-23.6) vs. severe 51.2 (37-73.4) p&lt;0.001), median OAHI (normal 0.3 (0-0.5) vs. mild 1.1 (1-2.6) vs. moderate 5.5 (4-7.5) vs. severe 20.7 (13-31.9) p&lt;0.001), median supine AHI (normal-0.3 (0.0.6) vs. mild 1.7 (1-3.4) vs. moderate 6.3 (3-8.1) vs. severe 24.3(12-40.4) p&lt;0.001), median SaO2 nadir (normal 94 (90-96) vs. mild 89 (84-91) vs. moderate 86.5 (82-91) vs. severe 80 (73-84) p&lt;0.001), median arousal index (normal 8.9 (7-11.8) vs. mild 11.3 (9-13.5) vs. moderate 13.2 (11-18.6) vs. severe 16.8 (14-23.6) p&lt;0.0001). Surgical treatment was performed in 98 children (53.5% of the children diagnosed with OSA) of which 76 surgeries were adenotonsillectomy.

Conclusion
In children with ages 12-24 months with suspected sleep disordered breathing, OSA was diagnosed in 79% with moderate to severe OSA in 46.5%.

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0525 The Effects of the COVID-19 Pandemic on Continuous Positive Airway Pressure (CPAP) Adherence in Pediatric Patients with Obstructive Sleep Apnea (OSA)
Authors: Cole Melissa , Mullen Lisa , Tiemeyer Karin , Gurbani Neepa , Huang Guixia , Hossain Md , Simakajornboon Narong 
Published: May 2022

Abstract

Introduction
CPAP Adherence in children with OSA is often sub-optimal and there is concern for worsening during the COVID-19 pandemic. Although telehealth has been used in sleep clinics during the pandemic, there is little known about telemedicine’s effectiveness in specialized care. The purpose of this study is to compare CPAP adherence and related outcome metrics in pediatric OSA patients seen before and during the COVID-19 pandemic and between those seen in person and by telemedicine.

Methods
This retrospective cohort consisted of patients who were diagnosed with OSA, prescribed CPAP, and were seen in a CPAP clinic between 1/1/2018 and 9/31/2021. CPAP adherence data and outcome metrics including the Epworth Sleepiness Scale (ESS), Michigan Sleep-disordered Breathing (PSQ) and Pediatric Quality of Life questionnaires (Ped-QOL) were collected. Only patients with one pre-pandemic and at least one post-pandemic visit were included. All variables were reported as mean± SD. Statistical comparison was performed using the mixed-effects model.

Results
147 patients met criteria with 353 total visits. 147 were before the pandemic (pre) and 206 were during the pandemic (post). Demographic data indicated 57% male, 82% white, and 63% 12 years and older. Post-pandemic visits consisted of 78% telemedicine. Comparison between pre and post pandemic data demonstrated no statistically significant differences in % CPAP usage&gt;4hrs (71±31% [pre] vs 73±33% [post], p=0.95), ESS (6.4±5.5 [pre] vs 5.9±5.8 [post], p=0.27), or PSQ (0.38±0.22 [pre] vs 0.36±0.22 [post] p=0.90). However, there was a significant difference in Psychosocial Health domain of Ped-QOL (68.6±19.4 [pre] vs 74.5±17.9 [post], p=0.012). Comparison between telemedicine and in-person visits during the pandemic showed no differences in %CPAP usage&gt;4hrs (73±31% [Tele] vs 73±37%, p=0.73), ESS, PSQ, or Ped-QOL.

Conclusion
In our cohort, children with OSA had no significant changes in CPAP adherence, sleepiness, or OSA symptoms during the COVID-19 pandemic. CPAP telehealth visits provided the same effectiveness as in-person visits, as evidenced by similar adherences and outcome metrics. Interestingly, patients reported higher psychosocial health during the pandemic despite no difference in CPAP adherence. Factors not related to OSA management may contribute to the improvement of quality of life in this population.

Support (If Any)
Cincinnati Children’s Research Fund
0526 Utility of polysomnography in tracheostomy decannulation process in children
Authors: Gurbani Neepa , Knollman Phillip , Heubi Christine , Huang Guixia , Hossain Md , Simakajornboon Narong 
Published: May 2022

Abstract

Introduction
Different approaches have been used to assess decannulation readiness including clinical observation with gradual tracheostomy downsizing, capping, and microlaryngoscopy and bronchoscopy. Polysomnograms with tracheostomy capping are being used at some centers prior to decannulation. We have previously shown that polysomnography is an important additional tool to predict successful decannulation. However, this study was based on a relatively small number of children. Thus the aim of this study is to review the polysomnographic features that predict decannulation outcomes in a large cohort of children with various conditions.

Methods
A retrospective chart review of polysomnography and medical records was performed for children 0-18 years of age preparing for tracheostomy decannulation from Feb. 2005 to June 2019 at Cincinnati Children’s Hospital Medical Center. Subjects with less than four hours of sleep time were excluded from the study.

Results
A total of 128 subjects were included in the study with 74 in the successful decannulation group (SD), 48 in the no decannulation group (ND) and 6 in the unsuccessful decannulation group. Underlying diagnosis included history of prematurity 41 (32%), genetic disorders 39 (30.5%), neurological disorders 17 (13.3%), airway abnormalities 108 (84.4%), and cardiac disease 24 (18.8%). Average age at the time of tracheostomy was 1.8±3.4 years and at decannulation was 5.7±3.6 years in the SD group. Favorable microlaryngoscopy/bronchoscopy (MLB) was significantly higher in SD group 73.8% vs. ND group 26.2% (p&lt;0.001). Comparing polysomnographic respiratory sleep parameters showed significant differences between ND and SD groups for apnea hypopnea index (AHI)&gt;10/h (88% [ND] vs. 12% [SD]; p&lt;0.001) and obstructive apnea hypopnea index (OAHI)&gt; 5/h (75.6% [ND] vs. 24.4% [SD]; p&lt;0.001). Alveolar hypoventilation (CO2&gt;50 for &gt;25% of TST) was also significantly higher in the ND group (70.6%) vs. SD group (29.4%) (p&lt;0.009).

Conclusion
In our large cohort of children undergoing decannulation, there were several differences in polysomnographic characteristics including AHI, obstructive AHI and CO2 parameters between those who were and were not successfully decannulated. In addition to unfavorable findings on airway evaluation, children who did not undergo decannulation were more likely to have moderate to severe degree of sleep disordered breathing and alveolar hypoventilation.

Support (If Any)
This study was supported by Cincinnati Children’s Hospital Research Fund.
0533 Age-related changes in sleep disordered breathing in pediatric Prader Willi Syndrome patients
Authors: Patel Neha , Gustavo Nino , Lew Jenny , Weiss Miriam , Aziz Julia 
Published: May 2022

Abstract

Introduction
Prader Willi Syndrome (PWS) is a rare genetic disorder characterized by infantile hypotonia, hyperphagia leading to early childhood obesity, and multiple sleep abnormalities including increased risk of obstructive sleep apnea, central sleep apnea, and excessive daytime sleepiness. PWS patients have been reported to have a shorter lifespan with respiratory related causes as a common cause of death. Limited data exists on PSGs in pediatric PWS patients. Our aim was to compare respiratory parameters in different age groups.

Methods
We conducted a retrospective chart review of pediatric patients with a genetically confirmed diagnosis of Prader Willi Syndrome from 2007 to 2015. In lab polysomnograms were scored using the AASM criteria for pediatric sleep studies. As central apneas are more commonly seen in infancy with PWS, we categorized patients into &lt; 1 years old and 1-19 years old for comparison.

Results
Fifty-one PSGs were reviewed of which 31 (60.7%) were males and 20 (39.3%) were females. Forty-one PSGs were initial studies and 11 were repeat studies. Age at time of sleep study ranged from 11 days-19 years old. 8 (15%) subjects were &lt; 1 years old and 44 (84%) were 1-19 years old. For patients &lt; 1 year old, mean obstructive hypopnea index (OAHI) was 5.65±3.7, central index (CI)2.2±2.5, mean SpO2(%) 98±.4, SpO2 nadir 86±5.8, and % of time with SpO2 &lt; 90% .16±.314. For patients 1-19 years old, mean (OAHI) was 8.7±13.4, (CI) 0.8±1.25, mean SpO2 96±3.0, SpO2 nadir 81±.10, and % of time with SpO2 &lt; 90% .03±.10. The OAHI trended up in the 1-19 year old group but results were not significant, CI decreased in the 1-19 year old group 2.2 vs 0.8 p &lt; .04.

Conclusion
Our study demonstrated similar results to prior studies in pediatric PWS with an increase in OAHI and decrease in CI with age. SPO2 nadir decreased in the 1-19 year old group but these results were not significant. Ongoing research at our center is looking at possible contributing factors including BMI percentile, GH therapy, and adenotonsillectomy to better understand our findings.

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0536 Association of a Novel EEG Biomarker of Sleep Depth with Sleep Disordered Breathing in Adolescents
Authors: Ricci Anna , He Fan , Calhoun Susan , Fang Jidong , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Younes Magdy , Fernandez-Mendoza Julio 
Published: May 2022

Abstract

Introduction
The odds ratio product (ORP) provides a standardized, continuous measure of sleep depth that ranges from 0 (deep sleep) to 2.5 (full wakefulness). ORP has been shown to increase during adolescence, representing the decline in sleep depth that occurs during this developmental period. In adults, higher ORP has been associated with sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), while there have been no studies in youth. We aimed to determine the association of ORP with SDB in adolescents.

Methods
We extracted ORP from the sleep EEG of 261 typically developing adolescents aged 12-23y (median 16y) from the Penn State Child Cohort. Higher ORP during rapid eye movement (REM) and non-REM sleep indicates less deep sleep, while higher ORP-9 (i.e., average ORP in the 9-seconds following non-REM cortical arousals) indicates greater arousability. We used general linear models, adjusted for sex, age and race/ethnicity, to examine mean differences in ORP metrics among clinically meaningful groups of SDB based on the apnea/hypopnea index (AHI) consisting of no SDB (AHI&lt;2 and no snoring, n=100), primary snoring (AHI&lt;2 and snoring, n=75), 2≤AHI&lt;5 (n=64), and AHI≥5 (n=22).

Results
Adolescents with primary snoring or 2≤AHI&lt;5 did not significantly differ in ORP metrics from those without SDB (all p≥0.12). Adolescents with AHI≥5 had higher ORP-NREM compared to those without SDB, with primary snoring or with 2≤AHI&lt;5 (all p≤0.01), while ORP-REM was significantly higher compared to those without SDB (p=0.02). ORP-9 was significantly greater in adolescents with AHI≥5 compared to those with no SDB (p&lt;0.01) and those with primary snoring (p=0.02), but not when compared to those with 2≤AHI&lt;5 (p=0.07).

Conclusion
Our data suggest that adolescents with OSA experience lower REM and non-REM sleep depth/intensity (higher ORP) compared to those without SDB. In addition, these adolescents experience a slower progression back to deep sleep following cortical arousals (higher ORP-9), which suggests they remain in a high arousability state and, thus, are more likely to repeat arousals. Commensurate with previous studies in adults, our data show that ORP is a useful sleep EEG biomarker able to capture decreased sleep depth in adolescents with OSA.

Support (If Any)
National Institutes of Health (R01MH118308, UL1TR000127)
0544 Polysomnography characteristics of children with obesity: A single center retrospective study
Authors: Rao Harish , Bandyopadhyay Anuja , Slaven James , Saliba Gabriel , Jalou Hasnaa 
Published: May 2022

Abstract

Introduction
The constellations of symptoms known as obstructive sleep apnea (OSA) results from either partial or complete airway obstruction during sleep. This affects effective gas exchange and disrupts sleep architecture resulting in sleep fragmentation with downstream immediate and long-term adverse effects. Obesity is a significant risk factor in childhood OSA, especially in post-pubertal children. Obese/overweight children have been found to have significantly higher rates of OSA than their normal-weight counterparts, independent of tonsillar size. Polysomnography characteristics (PSG) comparing children with obesity with and without comorbidities (Hypertension, Diabetes or Pre-diabetes) has not been previously described.

Methods
Retrospective analysis of 190 obese children (BMI&gt;95th centile), age between 7-18 years with AHI ≥5/hour met the criteria for the data analysis. Clinical, demographic and PSG parameters of children with obesity with and without co-morbidities were compared using Wilcoxon rank sum test. Correlation (Spearman non-parametric) and regression model was employed to explore associations between demographic and PSG characteristics.

Results
Majority of the obese children (mean BMI 33.2) had mild OSA, with no significant difference in AHI between the two groups. Children with obesity and comorbidities were older with higher BMI. There was no difference in BMI between the two groups after adjusting for BMI z scores. AHI increased with increasing BMI centiles. In our regression model, peak ETCO2 was associated with Black race, AHI, rhinitis and inversely associated with asthma. Peak ETCO2 increased with BMI. Oxygen at baseline, nadir and desaturation duration inversely correlated with BMI-centiles. Older children had lower O2 nadir. Black race was associated with higher desaturation, supine AHI, and arousal index. Supine AHI was higher with rhinitis. Average heart rate when awake, NREM and REM increased with higher BMI.

Conclusion
In our study, majority of the children had mild OSA with no significant difference in AHI between obese children with and without comorbidities. AHI, average heart rate and peak ETCO2 increased with BMI. O2 nadir was lower in older children and with higher BMI. Black race was associated with higher peak ETCO2, higher desaturation and supine AHI. Children with obesity and comorbidities were older with higher BMI suggesting synergistic effect of BMI and duration of obesity.

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0545 Metabolic Variables and the severity of Obstructive Sleep Apnea in non-obese children
Authors: Bhushan Bharat , Maddalozzo John , Johnston Douglas , Yasuda Mayuri , Billings Kathleen 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) can be associated with abnormal metabolic variables that may impact the overall health of the child into adulthood. Prior studies have focused on understanding the relationship of obesity, OSA, and metabolic alterations. Understanding the relationship of OSA and metabolic alterations in normal-weight children would improve understanding of the health impact of OSA in and of itself. The Objective of this study was to evaluate the association of OSA and metabolic variables, including lipid levels, blood glucose, and HbA1c in normal-weight children with OSA.

Methods
Prospective, case-control study performed at a tertiary care children’s hospital. Normal-weight children, aged 2-12 years, undergoing overnight polysomnography (PSG) for assessment of sleep disordered breathing were selected for participation in the study. Laboratory testing for lipid levels, fasting glucose, HbA1c were completed and analyzed relative to the PSG findings.

Results
A total of 61 patients with a mean age of 4.7±2.5 years were analyzed. Thirty-four (55.7%) patients were male, and 27 (44.3%) were female. The mean body mass index (BMI) z score was 0.5±1.2, and all patients were non-obese (BMI z score &lt;85th percentile). Total cholesterol, fasting blood glucose, HbA1c levels were significantly higher in patients with OSA when compared to those with No-OSA (p&lt;0.01). There was incremental worsening of blood glucose and HbA1c levels with greater severity of OSA. The apnea-hypopnea index (AHI) was positively and significantly correlated with blood glucose and HbA1c (p&lt;0.001). Multiple linear regression analysis showed that the AHI was a predictor of blood glucose (p&lt;0.001) and HbA1c (p&lt;0.001) levels independent of age, gender, total sleep time, and BMI z score.

Conclusion
Increasing severity of OSA in non-obese children was associated with worsening levels of cholesterol, blood glucose, and HbA1c. This points to the importance of addressing the issue of OSA in children given the potential impact of these elevated levels on the overall health of the child.

Support (If Any)
None
0549 Prevalence and Impact of Muscle Cramps in Patients with Restless Legs
Authors: Albazli Khaled , Walters Arthur S , Karroum Elias G 
Published: May 2022

Abstract

Introduction
Recent studies have shown alterations in Vitamin D binding protein in RLS, and Vitamin D is intimately related to calcium metabolism, while hypocalcemia is a well-known trigger for muscle cramps. The presence and consequences of muscle cramps in RLS has never been systematically studied. Therefore, the aim of this study was to determine the prevalence and impact of muscle cramps in RLS patients.

Methods
An email was sent to 4222 active members of the RLS foundation (RLSF) with a link to survey adult RLS patients. The survey included demographic information, questions on muscle cramps (including a visual analogue scale rating intensity), the Pittsburgh Sleep Quality Index assessing sleep disturbances, the 36-Item Short Form Survey Instrument (SF-36) evaluating health status, the 13-item short-form Cambridge-Hopkins diagnostic questionnaire (CH-RLSq13) for diagnosing RLS, and the International RLS Severity Scale measuring RLS severity. Patients who answered “yes” to the question “In the last 3 months have you experienced muscle cramps (defined as involuntary painful muscle contraction occurring at rest, not associated with exercise)?” were considered to have muscle cramps.

Results
A total of 509 RLSF members completed the whole electronic survey, while 317 participants (Age: 68.9±10.2; 73.1% Women; 97.8% White/Caucasian; BMI: 27.4±5.8) qualified as RLS patients and were included in further analysis. The prevalence of muscle cramps in RLS patients was 60.3%. RLS patients with (versus without) muscle cramps were more overweight (p=0.0119) and had lower scores (more disability) on several SF-36 health concepts including physical functioning (p=0.0093), role limitations due to emotional problems (p=0.0429), social functioning (p=0.0017), and more pain (p=0.0387). In addition, there was a weak (Spearman coefficient ρ=0.253) but significant positive correlation (p=0.0004) between intensity of muscle cramps and severity of RLS symptoms.

Conclusion
Muscle cramps were present in almost two-third of RLS patients and were associated with a negative impact on health status and severity of RLS. Therefore, from a clinical practice point of view, it seems warranted to screen for muscle cramps in RLS patients. RLS and leg cramps may theoretically be related to each other through calcium metabolism and/or through inflammatory mechanisms.

Support (If Any)
This study was not funded.
0550 Health-Economic Implications of Defined Improvements in Restless Leg Syndrome Severity: A Model-Based Exploratory Analysis based on Prior Publication Data
Authors: Cao Khoa , Winkelman John , Pietzsch Jan 
Published: May 2022

Abstract

Introduction
Restless leg syndrome (RLS) is a debilitating condition associated with reduced health-related quality of life (HRQoL) and increased resource utilization. Our objective was to provide model-based estimates of quality-adjusted life year (QALY) gain and reduction in healthcare utilization that might be expected for changes in symptom severity.

Methods
We identified two health-economic studies which reported severity-specific quality-of-life and resource utilization. Happe et al. 2009 reported HRQoL using EQ-5D measurements stratified by International Restless Legs Scale (IRLS) severity (n=519, 63.6% female, 64.2 years) and Durgin et al. 2015 reported healthcare utilization stratified by RLS severity (no/mild/moderate/severe RLS) (n=2,392, 56.9% female, 56.0 years). We fitted regression models to support IRLS-specific estimates of EQ-5D and healthcare resource utilization. These models (polynomial for EQ-5D, linear for resource utilization) were applied to calculate QALY gain, and events avoided for ER visits, hospitalizations, and healthcare provider (HCP) visits over 5 years for IRLS improvement of 1-10 points, from a baseline of 30, 25, and 20.

Results
At five years, a 1, 3, 5, 7, and 10-point IRLS reduction corresponded to a QALY gain of 0.09, 0.25, 0.40, 0.52, and 0.69 for a baseline of 30, 0.07, 0.19, 0.29, 0.37, and 0.47 for a baseline of 25, and 0.04, 0.12, 0.18, 0.22, and 0.26 for a baseline of 20. The events avoided over 5 years with an IRLS reduction of 1, 3, 5, 7, and 10 points respectively were 1.12, 3.37, 5.62, 7.87, and 11.25 HCP visits, 0.09, 0.26, 0.43, 0.61, and 0.87 ER visits, and 0.04, 0.11, 0.18, 0.26, and 0.36 hospitalizations.

Conclusion
This exploratory analysis based on two health-economic studies confirms the substantial quality-of-life and healthcare cost burden associated with RLS. The data provide guidance on the magnitude of potential quality-of-life improvement and cost reduction that might be associated with defined improvement in RLS severity. Further investigation may be warranted for the factors that link change in IRLS and healthcare resource utilization, such as sleep deficits or cardiovascular risks.

Support (If Any)
Funding was provided by Noctrix Health