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Available from: Manisha Witmans, Jun 16, 2015
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    ABSTRACT: To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA). At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Pre- and post-surgery OPSG indices were compared. We defined cure as an apnea hypopnea index (AHI) <1.5/h on the post-surgery OPSG, and we compared the cure rates of different surgeries. A total of 143 children, median age 12.4 y (IQR 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 [IQR 9-15] years) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT +turbinate trim± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor. Surgery improved OPSG indices in the majority of obese children with OSA. © 2014 American Academy of Sleep Medicine.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 02/2015; DOI:10.5664/jcsm.4608 · 2.83 Impact Factor
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    ABSTRACT: 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. We hypothesized that obese adolescents with OSAS would exhibit more neurobehavioral abnormalities than obese and lean adolescents without OSAS.
    Sleep 10/2014; DOI:10.5665/sleep.4498 · 5.06 Impact Factor
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    ABSTRACT: Children with the obstructive sleep apnea syndrome (OSAS) have impaired respiratory afferent cortical processing during sleep that persists after treatment of OSAS. However, it is unknown whether this impairment is present during wakefulness and if so, whether it improves after OSAS treatment. We hypothesized that children with OSAS, during wakefulness, have abnormal cortical processing of respiratory stimuli manifested by blunted respiratory-related evoked potentials (RREP) and that this resolves after OSAS treatment. We measured RREP during wakefulness in 26 controls and 21 children with OSAS before and after treatment. 13 participants with OSAS repeated testing 3-6 months after adenotonsillectomy. RREP were elicited by interruption of inspiration by total occlusion, and 30 and 20 cm H2O/L/s resistances. Nf at Fz latency elicited by occlusion was longer in children with OSAS at baseline compared to controls (78.8±24.8 vs. 63.9±19.7 ms, p = 0.05). All other peak amplitudes and latencies were similar between the two groups. After OSAS treatment, Nf at Fz latency elicited by 30 cm H2O/L/s decreased significantly (before, 88±26 vs. 71±25 ms after, p =0.02) as did that elicited by 20 cm H2O/L/s (85±27 vs. 72±24 ms, p= 0.004). The amplitude of N1 at Cz elicited by occlusion increased from -3.4±5.6 to -7.4±3 µV (p=0.049) after treatment. We concluded that children with OSAS have partial delay of respiratory afferent cortical processing during wakefulness that improves after treatment. Copyright © 2014, Journal of Applied Physiology.
    Journal of Applied Physiology 12/2014; 118(4):jap.00582.2014. DOI:10.1152/japplphysiol.00582.2014 · 3.43 Impact Factor