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Sleep Apnea Syndromes: HELP
Articles from Chicago
Based on 701 articles published since 2010

These are the 701 published articles about Sleep Apnea Syndromes that originated from Chicago during 2010-2020.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
151 Review Congenital central hypoventilation syndrome and sudden infant death syndrome: disorders of autonomic regulation. 2013

Rand, Casey M / Patwari, Pallavi P / Carroll, Michael S / Weese-Mayer, Debra E. ·Center for Autonomic Medicine in Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. ·Semin Pediatr Neurol · Pubmed #23465774.

ABSTRACT: Long considered a rare and unique disorder of respiratory control, congenital central hypoventilation syndrome has recently been further distinguished as a disorder of autonomic regulation. Similarly, more recent evidence suggests that sudden infant death syndrome is also a disorder of autonomic regulation. Congenital central hypoventilation syndrome typically presents in the newborn period with alveolar hypoventilation, symptoms of autonomic dysregulation and, in a subset of cases, Hirschsprung disease or tumors of neural crest origin or both. Genetic investigation identified PHOX2B, a crucial gene during early autonomic development, as disease defining for congenital central hypoventilation syndrome. Although sudden infant death syndrome is most likely defined by complex multifactorial genetic and environmental interactions, it is also thought to result from central deficits in the control of breathing and autonomic regulation. The purpose of this article is to review the current understanding of these autonomic disorders and discuss the influence of this information on clinical practice and future research directions.

152 Review The more the merrier? Working towards multidisciplinary management of obstructive sleep apnea and comorbid insomnia. 2013

Ong, Jason C / Crisostomo, M Isabel. ·Rush University Medical Center. ·J Clin Psychol · Pubmed #23382086.

ABSTRACT: OBJECTIVES: The goal of this article was to provide an overview of the diagnostic considerations, clinical features, pathophysiology, and treatment approaches for patients with obstructive sleep apnea (OSA) and comorbid insomnia. METHOD: We begin with a review of the literature on OSA and comorbid insomnia. We then present a multidisciplinary approach using pulmonary and behavioral sleep medicine treatments. RESULTS: OSA and insomnia co-occur at a high rate and such patients have distinct clinical features. Empirically supported treatments are available for OSA and insomnia independently but there are no standards or guidelines for how to implement these treatments for patients who suffer from both disorders. CONCLUSIONS: Multidisciplinary treatment holds promise for patients with comorbid sleep disorders. Further research should be aimed at optimizing treatments and developing standards of practice for this population.

153 Review Poor sleep, hazardous breathing: an overview of obstructive sleep apnea. 2013

Carlucci, Melissa / Smith, Maureen / Corbridge, Susan J. ·Department of Biobehavioral Health Science at the University of Illinois at Chicago College of Nursing in Chicago, IL, USA. ·Nurse Pract · Pubmed #23361374.

ABSTRACT: Obstructive sleep apnea is a chronic disorder resulting from upper airway collapse during sleep. It is linked to a variety of health and safety risks but can often be effectively treated. This article provides an overview of the disorder, including an evidence-based approach to diagnosis and management.

154 Review Diagnostic value of the Friedman tongue position and Mallampati classification for obstructive sleep apnea: a meta-analysis. 2013

Friedman, Michael / Hamilton, Craig / Samuelson, Christian G / Lundgren, Mary E / Pott, Thomas. ·Section of Sleep Surgery, Rush University Medical Center, Chicago, Illinois 60602, USA. mfriedmanmd@gmail.com ·Otolaryngol Head Neck Surg · Pubmed #23322629.

ABSTRACT: OBJECTIVE: To assess the association between the Mallampati classification and Friedman tongue position for obstructive sleep apnea severity as determined by apnea-hypopnea index and to determine which method is most closely correlated with prediction of obstructive sleep apnea severity. DATA SOURCES: English-language searches of PubMed, MedLine, and the Cochrane database. Reference sections of identified studies were examined for additional articles. REVIEW METHODS: Databases through December 2011 were searched, combined with review of relevant article bibliographies, and assessed by 4 reviewers. Systematic review and random-effects meta-analysis of studies evaluating tongue position and obstructive sleep apnea severity were performed. Outcomes were reported as correlations. RESULTS: Ten studies met inclusion criteria and had data for pooling (2513 patients). Friedman tongue position and Mallampati classification were significantly associated with obstructive sleep apnea severity, with a correlation of 0.351 (0.094-0.564, P = .008). Analysis of the correlation of tongue position with obstructive sleep apnea severity reveals correlations of 0.184 (0.052, 0.310, P = .006) and 0.388 (0.049, 0.646, P = .026) for the Mallampati classification and Friedman tongue position, respectively. Publication bias does not yield a significant Egger regression intercept; however, 4 imputed values to the right of the mean were found using Duval and Tweedie's trim-and-fill method, yielding an overall correlation of 0.498 (confidence interval = 0.474-0.521). CONCLUSION: The Mallampati classification and Friedman tongue position assessment techniques are significantly correlated with predicting obstructive sleep apnea severity. Publication bias does not significantly affect our results. The strength of this correlation is higher for Friedman tongue position, although 95% confidence intervals for the respective correlation coefficients overlap.

155 Review What happens to glaucoma patients during sleep? 2013

Aref, Ahmad A. ·University of Illinois Eye and Ear Infirmary, Chicago, IL, USA. ahmadaref@gmail.com ·Curr Opin Ophthalmol · Pubmed #23262987.

ABSTRACT: PURPOSE OF REVIEW: To summarize the findings of the recent reports on nighttime events that may lead to the development or progression of glaucomatous optic neuropathy. RECENT FINDINGS: Peak intraocular pressure (IOP) likely occurs at night because of the head and body positions assumed during sleep. Sleeping in a 30° head-up position leads to IOP lowering during this time period. Laser trabeculoplasty and glaucoma-filtering surgery are efficacious in controlling IOP over a 24-h period, although most medical therapies may be inadequate. The Sensimed Triggerfish (Sensimed AG, Lausanne, Switzerland) device is capable of recording IOP fluctuations over a 24-h period. A nocturnal increase in IOP and decrease in blood pressure leads to lower ocular perfusion pressure (OPP), which may significantly increase the risk of glaucomatous visual field progression. Prospective case-control studies report a positive association between obstructive sleep apnea (OSA) and glaucoma; larger, retrospective cohort studies report no association. SUMMARY: Several nighttime events including increased IOP, decreased OPP, and possibly OSA contribute to the development and progression of glaucomatous optic neuropathy. These events may explain the occurrence and progression of glaucomatous disease in the setting of seemingly controlled office-measured IOP.

156 Review Novel pharmacological approaches for treatment of obstructive sleep apnea in children. 2013

Kheirandish-Gozal, Leila / Kim, Jinkwan / Goldbart, Aviv D / Gozal, David. ·University of Chicago, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, Department of Pediatrics, Chicago, IL 60637, USA. ·Expert Opin Investig Drugs · Pubmed #23126687.

ABSTRACT: INTRODUCTION: The lymphadenoid tissues in the upper airway are sparse and organized lympho-epithelial structures playing an important role against foreign pathogens, with the palatine tonsils being the major components of the lymphoid tissues contained in the Waldeyer's ring. Obstructive sleep apnea (OSA) has emerged as a very frequent condition in the pediatric age range that is associated with substantial neurobehavioral, cardiovascular and metabolic morbidities. Adenotonsillar hypertrophy is the major pathophysiological contributor to OSA occurrence in children. AREAS COVERED: Here, the authors provide a systematic review and summary of some of the known histological and pathological features of human lymphadenoid tissues and their fundamental immunological functions, provide insights into the pathophysiology of pediatric OSA, particularly focusing on inflammatory pathways and the available outcomes associated with targeting such pathways with compounds such as corticosteroids and leukotriene modifiers. Furthermore, they present findings from an unbiased approach to discovery of therapeutic targets and formulate constructs toward putative future interventional approaches for this highly prevalent condition. EXPERT OPINION: Surgical approaches for pediatric OSA may not be as effective as previously anticipated. Accordingly, expanded use of existing systemic or topical anti-inflammatory agents or development of novel compounds targeting selected immune cell populations underlying pathophysiological determinants of OSA is needed.

157 Review Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea. 2013

Gozal, David / Hakim, Fahed / Kheirandish-Gozal, Leila. ·Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL, USA. dgozal@peds.bsd.uchicago.edu ·Respir Physiol Neurobiol · Pubmed #22954503.

ABSTRACT: Obstructive sleep apnea (OSA) is highly prevalent sleep disorder of breathing in both adults and children that is fraught with substantial cardiovascular morbidities, the latter being attributable to a complex interplay between intermittent hypoxia (IH), episodic hypercapnia, recurrent large intra-thoracic pressure swings, and sleep disruption. Alterations in autonomic nervous system function could underlie the perturbations in cardiovascular, neurocognitive, immune, endocrine and metabolic functions that affect many of the patients suffering from OSA. Although these issues have received substantial attention in adults, the same has thus far failed to occur in children, creating a quasi misperception that children are protected. Here, we provide a critical overview of the evidence supporting the presence of autonomic nervous system (ANS) perturbations in children with OSA, draw some parallel assessments to known mechanisms in rodents and adult humans, particularly, peripheral and central chemoreceptor and baroreceptor pathways, and suggest future research directions.

158 Review Pathological consequences of intermittent hypoxia in the central nervous system. 2012

Zhang, Shelley X L / Wang, Yang / Gozal, David. ·Department of Pediatrics, University of Chicago, Chicago, Illinois, USA. ·Compr Physiol · Pubmed #23723023.

ABSTRACT: Intermittent hypoxia (IH) is a frequent occurrence in clinical settings. In the last decades, evidence has emerged implicating the gas exchange alterations and sleep disruption associated with those disorders in the high prevalence of cognitive and behavioral deficits afflicting these patients. In an effort to better characterize the role of IH, and to identify potential mechanisms of IH-induced central nervous system (CNS) dysfunction, a large number of rodent models have been recently developed. The cumulative evidence confirms that IH indeed induces a heterotopic pattern of injury in the brain, particularly affecting cortical, subcortical, and hippocampal regions, ultimately leading to neuronal apoptosis and activation of microglia. These IH-induced deleterious processes exhibit substantial variability across the lifespan, are under substantial modulatory influences of diet, physical or intellectual activity, and genetic factors, and preferentially recruit oxidative stress and inflammatory pathways.

159 Review Serum, urine, and breath-related biomarkers in the diagnosis of obstructive sleep apnea in children: is it for real? 2012

Gozal, David. ·Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637, USA. dgozal@uchicago.edu ·Curr Opin Pulm Med · Pubmed #22965273.

ABSTRACT: PURPOSE OF REVIEW: The scarcity of pediatric sleep laboratories has thus far precluded timely diagnosis and treatment of pediatric obstructive sleep apnea (OSA), thereby increasing the risk for residual OSA-associated morbidities. Recent developments in transcriptomics, proteomics, and exhaled condensate biomarker discovery will be reviewed in the context of exploring the validity of such methods towards development of reliable and validated diagnostic approaches for pediatric OSA. RECENT FINDINGS: Gene expression arrays have revealed significant and reproducible changes in a restricted number of genes that should enable discriminatory ability in the recognition of OSA in children. Similarly, a number of urinary proteins have been identified that display outstanding receiver-operator properties towards the diagnosis of pediatric OSA. The technological improvements in both exhaled breath online high-pressure fast chromatography and biosensor surfaces with affinity for volatile compounds should also permit noninvasive diagnosis of pediatric OSA when combined and integrated with computational methods. SUMMARY: It is likely that the modest efforts thus far realized in the context of biomarker discovery for the diagnosis and clinical monitoring of OSA in children will experience major acceleration in the upcoming years and lead to a completely novel paradigm in the screening and diagnosis of this disease.

160 Review Update in pediatric lung disease 2011. 2012

McColley, Susanna A / Morty, Rory E. ·Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA. smccolley@northwestern.edu ·Am J Respir Crit Care Med · Pubmed #22753687.

ABSTRACT: -- No abstract --

161 Review C-reactive protein and obstructive sleep apnea syndrome in children. 2012

Gozal, David / Kheirandish-Gozal, Leila / Bhattacharjee, Rakesh / Kim, Jinkwan. ·Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA. dgozal@uchicago.edu ·Front Biosci (Elite Ed) · Pubmed #22652648.

ABSTRACT: Obesity has emerged as one of the most important epidemics in the western hemisphere, and as its prevalence continues to increase in children, the associated risk for cardiovascular and metabolic complications follows parallel increases in prevalence, and reflects activation of underlying inflammatory pathways. The obstructive sleep apnea syndrome (OSAS) is a frequent condition in children associated with intermittent upper airway obstruction during sleep, its prevalence is markedly increased in the presence of obesity, and is associated with activation of similar inflammatory mechanisms as those activated by obesity, suggesting that the 2 disorders may reciprocally contribute to their adverse consequences. C-reactive protein (CRP) is a prototypic marker of inflammation that has repeatedly shown promise as a potentially reliable biomarker of cardiovascular morbidity. In addition, under certain circumstances CRP may enhance inflammation, oxidative stress, and pro-coagulant activity and thus promote atherogenesis. In this paper, we will critically review the available evidence linking OSAS to systemic inflammation in children using CRP levels as the reporter biomarker.

162 Review Otolaryngologic manifestations of craniofacial syndromes. 2012

Swibel Rosenthal, Laura H / Caballero, Nadieska / Drake, Amelia F. ·Division of Neurosciences, Department of Otolaryngology - Head and Neck Surgery, Stritch School of Medicine, Loyola University Hospital, 2160 South First Avenue, Maywood, IL 60153-5500, USA. LHRosenthal@lumc.edu ·Otolaryngol Clin North Am · Pubmed #22588037.

ABSTRACT: This review describes important aspects of the most commonly encountered craniofacial syndromes. The goal is to provide otolaryngologists and other health care providers with critical information necessary to manage these patients appropriately. The algorithm provided in this article should be helpful in guiding the treatment of craniofacial patients based on their unique otolaryngologic characteristics. The principles highlighted in the algorithm can be applied to other craniofacial syndromes not addressed here, including Pierre Robin sequence and Down syndrome.

163 Review Acute cardiopulmonary failure from sleep-disordered breathing. 2012

Carr, Gordon E / Mokhlesi, Babak / Gehlbach, Brian K. ·Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson AZ. · Section of Pulmonary and Critical Care, Sleep Disorders Center, University of Chicago Pritzker School of Medicine, Chicago, IL. · Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: brian-gehlbach@uiowa.edu. ·Chest · Pubmed #22396567.

ABSTRACT: Sleep-disordered breathing (SDB) comprises a diverse set of disorders marked by abnormal respiration during sleep. Clinicians should realize that SDB may present as acute cardiopulmonary failure in susceptible patients. In this review, we discuss three clinical phenotypes of acute cardiopulmonary failure from SDB: acute ventilatory failure, acute congestive heart failure, and sudden death. We review the pathophysiologic mechanisms and recommend general principles for management. Timely recognition of, and therapy for, SDB in the setting of acute cardiopulmonary failure may improve short- and long-term outcomes.

164 Review Metabolic dysfunction in pcos: Relationship to obstructive sleep apnea. 2012

Ehrmann, David A. ·Section of Endocrinology, Diabetes, and Metabolism, The University of Chicago, 5841 S. Maryland Ave., Mail Code 1027, Chicago, IL 60637, USA. dehrmann@medicine.bsd.uchicago.edu ·Steroids · Pubmed #22178788.

ABSTRACT: Polycystic ovary syndrome (PCOS) affects between 5% and 8% of women, making it one of the most common endocrinopathies in women. The disorder typically has its onset at puberty with evidence of excessive androgen production, obesity, and insulin resistance. Women with PCOS are more insulin resistant than weight-matched controls and have an exceptionally high prevalence of early-onset impaired glucose tolerance (30-40%), and type 2 diabetes (up to 10%). Over the past several years, chronic decreases in sleep duration and/or quality have been identified as a risk for the development of a number of metabolic derangements that are strikingly similar to those seen in PCOS. Specifically, decreased sleep quality due to obstructive sleep apnea (OSA) has been causally linked to insulin resistance, glucose intolerance, dyslipidemia and hypertension independent of body mass index (BMI). Until recently, however, it had not been recognized that OSA is present in a disproportionate number of women with PCOS: the risk for OSA is at least 5- to 10-fold higher compared to the risk in similarly obese women without PCOS. The causes and consequences of OSA in women with PCOS are addressed in this manuscript.

165 Review Sleep and metabolic function. 2012

Morselli, Lisa L / Guyon, Aurore / Spiegel, Karine. ·Department of Medicine, University of Chicago, Chicago, IL, USA. ·Pflugers Arch · Pubmed #22101912.

ABSTRACT: Evidence for the role of sleep on metabolic and endocrine function has been reported more than four decades ago. In the past 30 years, the prevalence of obesity and diabetes has greatly increased in industrialized countries, and self-imposed sleep curtailment, now very common, is starting to be recognized as a contributing factor, alongside with increased caloric intake and decreased physical activity. Furthermore, obstructive sleep apnea, a chronic condition characterized by recurrent upper airway obstruction leading to intermittent hypoxemia and sleep fragmentation, has also become highly prevalent as a consequence of the epidemic of obesity and has been shown to contribute, in a vicious circle, to the metabolic disturbances observed in obese patients. In this article, we summarize the current data supporting the role of sleep in the regulation of glucose homeostasis and the hormones involved in the regulation of appetite. We also review the results of the epidemiologic and laboratory studies that investigated the impact of sleep duration and quality on the risk of developing diabetes and obesity, as well as the mechanisms underlying this increased risk. Finally, we discuss how obstructive sleep apnea affects glucose metabolism and the beneficial impact of its treatment, the continuous positive airway pressure. In conclusion, the data available in the literature highlight the importance of getting enough good sleep for metabolic health.

166 Review Obstructive sleep apnea and atrial fibrillation: a call for increased awareness and effective management. 2012

Loomba, Rohit Seth / Arora, Rohit. ·Chicago Medical School, Naperville, IL 60540, USA. rohit.loomba@my.rfums.edu ·Am J Ther · Pubmed #21403470.

ABSTRACT: Many studies have noted a correlation between obstructive sleep apnea (OSA) and atrial fibrillation (AF). Although there is a need for large randomized control trials, the present data are quite convincing and can be used to improve current treatment procedures. Reviews, randomized control trials, and meta-analyses were obtained using electronic search strategies such as Medline and Cochrane Library. References of electronically obtained studies were then used to conduct hand searches for additional relevant studies. Sources were deemed relevant if they discussed the relationship between AF and OSA in respect to incidence, mechanism, recurrence, or treatment. Selected sources were then stratified on the basis of quality. Correlations between OSA and AF are present, and OSA seems to lend itself to the development, progression, and post-ablation recurrence of AF. Treatment of OSA before ablation can help reduce AF recurrence, allowing for more efficient treatment of AF. It is thus important for physicians to monitor AF patients for OSA and monitor those with OSA for AF.

167 Review Polycystic ovary syndrome in 2011: Genes, aging and sleep apnea in polycystic ovary syndrome. 2011

Dunaif, Andrea. ·Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 15-745, Chicago, IL 60611, USA. a-dunaif@northwestern.edu ·Nat Rev Endocrinol · Pubmed #22183129.

ABSTRACT: Polycystic ovary syndrome (PCOS) is a complex genetic disease that affects approximately 7% of women of reproductive age worldwide. From novel pathways implicated in the etiology of PCOS through genome-wide association to characterization of the reproductive and metabolic changes that occur in ageing women with PCOS, the year 2011 has seen a number of studies published that highlight the intricacies of this condition.

168 Review Sleep disturbances and insulin resistance. 2011

Van Cauter, E. ·Sleep, Metabolism and Health Center, Department of Medicine, University of Chicago, Chicago, IL 60637, USA. evcauter@medicine.bsd.uchicago.edu ·Diabet Med · Pubmed #21950773.

ABSTRACT: The causes and risk factors of insulin resistance remain insufficiently understood. After taking into account the important roles of adiposity, age, sex and race/ethnicity, up to 50% of the individual variability in insulin resistance remains unexplained. In recent years, evidence has accumulated to support a role for sleep disturbances, including insufficient sleep, poor sleep quality and insomnia, and obstructive sleep apnoea, as independent risk factors for the development and exacerbation of insulin resistance. The present review summarizes the evidence. We will start with a brief introduction to sleep and its disorders and then examine in succession the role of the three major types of sleep disturbances of modern society, namely insufficient sleep, poor sleep quality and/or insomnia and obstructive sleep apnoea. Insulin resistance is a hallmark of the polycystic ovary syndrome, the most common endocrine pathology in women, and the last section of this review will discuss the role of obstructive sleep apnoea in the insulin resistance and metabolic disturbances of polycystic ovary syndrome.

169 Review Does lack of sleep cause diabetes? 2011

Touma, Carol / Pannain, Silvana. ·Department of Medicine, Section of Endocrinology, The University of Chicago, IL 60637, USA. ·Cleve Clin J Med · Pubmed #21807927.

ABSTRACT: Several lines of evidence indicate that chronic lack of sleep may contribute to the risk of type 2 diabetes mellitus. Adequate sleep and good sleep hygiene should be included among the goals of a healthy lifestyle, especially for patients with diabetes. We urge clinicians to recommend at least 7 hours of uninterrupted sleep per night as part of a healthy lifestyle.

170 Review Sleep and obesity. 2011

Beccuti, Guglielmo / Pannain, Silvana. ·Department of Medicine, University of Chicago, Chicago, IL 60637, USA. ·Curr Opin Clin Nutr Metab Care · Pubmed #21659802.

ABSTRACT: PURPOSE OF REVIEW: This review summarizes the most recent evidence linking decreased sleep duration and poor sleep quality to obesity, focusing upon studies in adults. RECENT FINDINGS: Published and unpublished health examination surveys and epidemiological studies suggest that the worldwide prevalence of obesity has doubled since 1980. In 2008, 1 in 10 adults was obese, with women more likely to be obese than men. This obesity epidemic has been paralleled by a trend of reduced sleep duration. Poor sleep quality, which leads to overall sleep loss has also become a frequent complaint. Growing evidence from both laboratory and epidemiological studies points to short sleep duration and poor sleep quality as new risk factors for the development of obesity. SUMMARY: Sleep is an important modulator of neuroendocrine function and glucose metabolism and sleep loss has been shown to result in metabolic and endocrine alterations, including decreased glucose tolerance, decreased insulin sensitivity, increased evening concentrations of cortisol, increased levels of ghrelin, decreased levels of leptin, and increased hunger and appetite. Recent epidemiological and laboratory evidence confirm previous findings of an association between sleep loss and increased risk of obesity.

171 Review Update in sleep medicine 2010. 2011

Mokhlesi, Babak / Gozal, David. ·Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. bmokhles@medicine.bsd.uchicago.edu ·Am J Respir Crit Care Med · Pubmed #21642256.

ABSTRACT: -- No abstract --

172 Review Inflammatory pathways in children with insufficient or disordered sleep. 2011

Kim, Jinkwan / Hakim, Fahed / Kheirandish-Gozal, Leila / Gozal, David. ·Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL 60637, USA. ·Respir Physiol Neurobiol · Pubmed #21569868.

ABSTRACT: Sleep is not only an essential physiological function, but also serves important roles in promoting growth, maturation, and overall health of children and adolescents. There is increasing interest regarding the impact of sleep and its disorders on the regulation of inflammatory processes and end-organ morbidities, particularly in the context of metabolic and cardiovascular diseases (CVD) and their complications. Obstructive sleep apnea syndrome (OSAS) is an increasingly common health problem in children, and in the last decade, the emergence of increasing obesity rates has further led to remarkable increases in the prevalence of OSAS, along with more prominent neurocognitive, behavioral, cardiovascular and metabolic morbidities. Although the underlying mechanisms leading to OSAS-induced morbidities are likely multi-factorial, and remain to be fully elucidated, activation of inflammatory pathways by OSAS has emerged as an important pathophysiological component of the end-organ injury associated with this disorder. To this effect, it would appear that OSAS could be viewed as a chronic, low-grade inflammatory disorder. Furthermore, the concurrent presence of obesity and OSAS poses a theoretically increased risk of OSAS-related complications. In this review, we will critically review the current state of research regarding the impact of insufficient and disrupted sleep and OSAS on the immune processes and inflammatory pathways that underlie childhood OSAS as a distinctive systemic inflammatory condition in children, and will explore potential interactions between OSAS and obesity.

173 Review Sleep disturbances in children with attention-deficit/hyperactivity disorder. 2011

Spruyt, Karen / Gozal, David. ·Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637, USA. ·Expert Rev Neurother · Pubmed #21469929.

ABSTRACT: In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities.

174 Review Pediatric obstructive sleep apnea: an update. 2010

Loghmanee, Darius A / Sheldon, Stephen H. ·Northwestern University Feinberg School of Medicine, USA. dloghmanee@childrensmemorial.org ·Pediatr Ann · Pubmed #21162487.

ABSTRACT: -- No abstract --

175 Review Anaesthetic considerations with the metabolic syndrome. 2010

Tung, A. ·Department of Anesthesia and Critical Care, University of Chicago, 5841 S. Maryland Avenue MC4028, Chicago, IL 60637, USA. atung@dacc.uchicago.edu ·Br J Anaesth · Pubmed #21148652.

ABSTRACT: The rising incidence of obesity has led to increased prevalence of a distinct, obesity-related metabolic syndrome. This syndrome is characterized by truncal obesity, insulin resistance, altered lipid levels, and hypertension. Definition of the metabolic syndrome rests on a set of clinical criteria instead of a single diagnostic test. It carries a different risk profile than obesity alone, and poses special challenges for the anaesthesiologist. These include preoperative risk stratification for common comorbidities, identifying reasonable thresholds for implementing preoperative risk reduction, overcoming obesity-related issues in intraoperative management, and delivering safe postoperative care. The metabolic syndrome predisposes to coronary artery disease, congestive heart failure, obstructive sleep apnoea, pulmonary dysfunction, and deep venous thrombosis. Because its different presentations can have different risk profiles, anaesthesiologists should assess the cumulative risk of each component of the metabolic syndrome separately, which significantly complicates preoperative management. Since obesity itself is difficult to treat, preoperative risk reduction can be difficult. Few data exist to inform best practice as to the anaesthetic care of patients with metabolic syndrome. This review evaluates and synthesizes current evidence regarding perioperative care for patients with the metabolic syndrome, including indications for preoperative testing; use of aspirin, β-blockers, statins, heparin, and angiotensin-converting enzyme inhibitors; anaesthetic strategies including regional anaesthesia; and postoperative management including continuous positive pressure ventilation by mask, prevention of pulmonary embolism, and indications for advanced respiratory monitoring.

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