Ignacio E. Tapia’s research while affiliated with University of Miami and other places

Study objectives: In-laboratory polysomnography is recommended for the evaluation of obstructive sleep apnea (OSA) in children, but availability is limited. We hypothesized that home sleep apnea testing including electroencephalogram (HSAT) could accurately detect OSA in children and be an alternative to polysomnography. Methods: Children clinically referred for polysomnography underwent testing with the HSAT device twice: once in their home as well as concurrently with in-lab polysomnography (portable lab testing [PLT]). HSAT and PLT were compared to reference polysomnography for OSA diagnosis using an obstructive apnea-hypopnea index (OAHI) greater than 2 events/hour. OAHI cutoffs of 1 and 5 events/hour were explored. The diagnostic accuracy was further analyzed using the area under the receiver operating characteristics curve (AUC ROC). Results: All 15 participants, median (range) age 8.1 (2.9-17.1) years completed in-lab testing and HSAT. OSA was identified by polysomnography in 7 (47%) participants. HSAT correctly identified OSA status from polysomnography in 14 (93%). OAHI was similar between polysomnography [1.7 (0, 26) events/hour] and PLT [1.6 (0.3, 24.4)] and HSAT [1.8 (0.3, 23)], p=0.98. HSAT OAHI showed strong correlation with polysomnography OAHI (Spearman's r = 0.8, p=0.0001). AUC ROC referenced with polysomnography were excellent using OAHI threshold values of 1,2, and 5 compared with PLT (AUC ROC=0.96, 0.96, 1) and HSAT (AUC ROC= 0.79, 0.95, 0.98 respectively). Conclusions: HSAT with EEG was accurate compared to polysomnography for the diagnosis of pediatric OSA. Electroencephalography may improve the diagnostic accuracy of HSAT in children, particularly for mild OSA and younger children.

Introduction Sleep deficiencies, such as sleep disordered breathing (SDB) and insufficient sleep, are linked to adverse health outcomes. These sleep deficiencies are more common in racial and ethnic minoritised children and have significant negative impacts on neurobehavioural and social-emotional development. Non-Latine Black/African American children are 4–6 times more likely than non-Latine White children to experience both SDB and short sleep duration. Although SDB and insufficient sleep often co-occur in young children, there is a paucity of research considering the potential unique and additive impacts of SDB and insufficient sleep on child outcomes, as well as racial disparities in these outcomes, thus hindering comprehensive interventions. Our study objectives are to (1) examine racial disparities in the neurobehavioural and social-emotional impacts of early childhood SDB and/or insufficient sleep and (2) identify proximal and distal socioecological factors linked to these sleep disparities and outcomes. Methods and analysis A cross-sectional observational study comparing neurobehavioural (executive functioning, attention, vigilance) and social-emotional functioning (social skills, emotion regulation) in 400 dyads consisting of caregivers and their otherwise healthy Black and White 3–5 year-old children and divided into four groups: (A) preschoolers with SDB; (B) preschoolers with insufficient sleep; (C) preschoolers with both SDB and insufficient sleep and (D) matched controls. Child SDB, insufficient sleep, neurobehavioural skills and social-emotional functioning are measured using validated objective and subjective assessment tools, with a subset of caregivers completing qualitative interviews. Primary outcomes include individual differences in neurobehavioural and social-emotional functioning in these groups of Black and White preschoolers, and multilevel socioecological factors associated with variation in outcomes. Quantitative data will be analysed using descriptive analyses, linear regression and comparison of model coefficients. Qualitative data will be coded using thematic analysis and a joint display to stratify qualitative themes by child race and sleep deficiencies. Ethics and dissemination The study protocol has been approved by the institutional review board of the Children’s Hospital of Philadelphia and the University of Oregon. Results will be disseminated through peer-reviewed publications and conferences.

Importance The literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated. Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB). Objective To determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions. Design, Setting, and Participants This randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index z score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024. Intervention Early adenotonsillectomy. Main Outcomes and Measures Evaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed. Results Among 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system. The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, −1.25 per participant per year; 95% CI, −1.96 to −0.53) and a 48% reduction in prescriptions (mean difference, −2.53 per participant per year; 95% CI, −4.12 to −0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits. Conclusions and Relevance This study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT02562040

Study objectives: Nasopharyngeal inflammation contributes to pediatric obstructive sleep apnea syndrome (OSAS). Intranasal corticosteroids (INCS) are used to treat pediatric OSAS; a randomized controlled trial (RCT) showed an improvement in OSAS symptoms but without polysomnography or neurobehavioral outcome differences. There is a lack of data demonstrating an objective decrease in the nasal inflammatory biomarker profile (NIBP) associated with INCS. Hence, we evaluated the association of NIBP and response to INCS. Methods: Secondary analysis of a RCT of INCS versus placebo in pediatric OSAS (n=134). The difference in intranasal biomarkers (IL-4, IL-13, TNF-alpha) between the groups after 3 and 12 months was evaluated. The association of the NIBP and response to INCS was assessed. Multiple regression analysis was performed to identify clinical predictors of response to INCS. Results: There were no statistically significant differences in the nasal IL-4, IL-13 and TNF-alpha levels between INCS and placebo groups after 3 and 12 months of treatment. Within the INCS group, there was no statistically significant change in the nasal IL-4, IL-13 and TNF-alpha levels after 3 months of therapy based on responder status. However, among those who received INCS, obesity and a higher obstructive apnea-hypopnea index (OAHI) at baseline were clinical predictors of greater OAHI after three months (p = 0.038 and 0.002, respectively). Conclusions: INCS did not affect the NIBP in children with OSAS, including the responders. In addition, INCS is not recommended as a treatment option in children with obesity or high OAHI at baseline. Clinical trial registration: Name: Steroids for Pediatric Apnea Research in Kids (SPARK); URL: https://clinicaltrials.gov/study/NCT02180672; Identifier: NCT02180672.

The growing impact of climate change and escalating wildfire seasons has led to heightened ambient air pollution, potentially affecting children's sleep health. However, current epidemiological research often relies on outdoor weather data to model the environmental impacts on sleep health, potentially mischaracterizing the actual bedroom environment. To address these challenges, we conducted experiments to investigate the relationships among ambient, indoor, and personal exposure to PM2.5 concentrations and obstructive sleep apnea (OSA) in children. We employed computational fluid dynamics (CFD) simulations to assess how personal exposures are influenced by factors such as air distribution design, supply air temperature (Tsa), body shape, and sleep position. Our statistical analysis revealed notable associations between OSA severity as measured by obstructive apnea-hypopnea index (OAHI) and indoor PM2.5 concentrations (β: 11.52; 95% CI: 5.07 to 17.96; p < 0.01) and personal PM2.5 exposures (β: 18.92; 95% CI: 9.80 to 28.04; p < 0.001), with personal exposure demonstrating a stronger relationship. Our findings highlighted the critical role of Tsa and body shape in exacerbating personal exposure, as they could modify the bedding microenvironment around children's breathing zone during sleep. We assessed the effect of air filtration interventions on mitigating personal PM2.5 exposure and modulating OSA severity in children. Higher air filter efficiencies such as MERV14 or above can modulate severe OSA for more than 80% of the year. However, during wildfire episodes, because air filtration interventions alone may be insufficient, comprehensive strategies, including the potential use of air cleaners and personal protective equipment (PPE), are necessary to ensure children's health. Our research demonstrated that quantifying personal exposure is a more informative predictor than solely relying on ambient or indoor measures for estimating OSA in children.

Introduction Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction. Objective To assess associations among executive function, QOL, and symptom burden in children with mSDB. Design, Setting, and Participants This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024. Exposure Pediatric mSDB. Main Outcomes and Measures Quality of life was assessed using the Obstructive Sleep Apnea–18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire–Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function. Results The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 ( r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = −0.04 [95% CI, −0.08 to −0.01]) and sustained attention (β = −0.05 [95% CI, −0.10 to −0.01]). Conclusions and Relevance In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.