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Sleep Apnea Syndromes: HELP
Articles from Norfolk, VA
Based on 30 articles published since 2010
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These are the 30 published articles about Sleep Apnea Syndromes that originated from Norfolk, VA during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Managing the Child with Persistent Sleep Apnea. 2019

Bluher, Andrew E / Ishman, Stacey L / Baldassari, Cristina M. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA. · Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC# 2018, Cincinnati, OH 45229-2018, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC# 2018, Cincinnati, OH 45229-2018, USA. · Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA; Departments of Pediatric Otolaryngology and Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, 601 Children's Lane, 2nd Floor, Norfolk, VA 23507, USA. Electronic address: baldassc@gmail.com. ·Otolaryngol Clin North Am · Pubmed #31301824.

ABSTRACT: Pediatric obstructive sleep apnea (OSA) affects 2% to 4% of American children, and is associated with metabolic, cardiovascular, and neurocognitive sequelae. The primary treatment for pediatric OSA is adenotonsillectomy. Children with obesity, craniofacial syndromes, and severe baseline OSA are at risk for persistent disease. Evaluation of persistent OSA should focus on identifying the causes of upper airway obstruction. Interventions should be tailored to address the patient's symptomatology, sites of obstruction, and preference for surgical versus medical management. Further research is needed to identify management protocols that result in improved outcomes for children with persistent OSA.

2 Review Mild Obstructive Sleep Apnea in Children: What is the Best Management Option? 2018

Baldassari, Cristina M / Choi, Sukgi. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A. · Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A. · Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A. ·Laryngoscope · Pubmed #29521427.

ABSTRACT: -- No abstract --

3 Review Systematic Review of Drug-Induced Sleep Endoscopy Scoring Systems. 2018

Amos, Janine M / Durr, Megan L / Nardone, Heather C / Baldassari, Cristina M / Duggins, Angela / Ishman, Stacey L. ·1 Otolaryngology and Facial Plastic Surgery, McLaren Oakland Hospital, Pontiac, Michigan, USA. · 2 Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA. · 3 Division of Otolaryngology, Nemours/AI DuPont Hospital for Children, Wilmington, Delaware, USA. · 4 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. · 5 Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. · 6 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA. · 7 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #29064308.

ABSTRACT: Objective To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.

4 Review Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. 2016

Camacho, Macario / Li, Dongcai / Kawai, Makoto / Zaghi, Soroush / Teixeira, Jeffrey / Senchak, Andrew J / Brietzke, Scott E / Frasier, Samuel / Certal, Victor. ·Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii. · Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, California. · Shenzhen Key Laboratory of ENT, Institute of ENT & Longgang ENT hospital, Shenzhen, China, Stanford, California. · Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, California. · Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California. · Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. · Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland. · Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA. · Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF & CHEDV Porto, University of Porto, Porto, Portugal. · CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. ·Laryngoscope · Pubmed #27005314.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine if sleepiness and sleep study variables (e.g., Apnea-Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA). STUDY DESIGN: Systematic review and meta-analysis. METHODS: Nine databases (PubMed/MEDLINE included) were searched through November 24, 2015. RESULTS: Seventeen studies (n = 216 patients, 34.4 ± 10.0 years and body mass index: 29.0 ± 6.1 kg/m(2) ) met criteria. Tonsils sizes were hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by 65.2% (from 40.5 ± 28.9/hour to 14.1 ± 17.1/hour) (n = 203). The AHI mean difference (MD) was -30.2 per hour (95% confidence interval [CI] -39.3, -21.1) (P value < 0.00001). The AHI SMD was -1.37 (-1.65, -1.09) (large effect). Lowest oxygen saturation improved from 77.7 ± 11.9% to 85.5 ± 8.2% (n = 186). Lowest oxygen saturation MD was 8.5% (95% CI 5.2, 11.8) (P value < 0.00001). The Epworth Sleepiness Scale decreased from 11.6 ± 3.7 to 6.1 ± 3.9 (P value < 0.00001) (n = 125). Individual patient outcomes (n = 54) demonstrated an 85.2% success rate (AHI < 20/hour and ≥ 50% reduction) and a 57.4% cure rate. Individual patient data meta-analysis showed preoperative AHI < 30 per hour to be a significant predictor of surgical success (P value < 0.001) and cure (P value = 0.043); among patients with preoperative AHI < 30 per hour, tonsillectomy success rate was 100% (25 of 25) and cure rate was 84% (21 of 25) with a mean postoperative AHI of 2.4 ± 2.1 per hour; this compares to tonsillectomy success rate of 72.4% (21 of 29), cure rate of 10 of 29 (34.4%), and mean postoperative AHI of 14.3 ± 13.9 per hour for patients with preoperative AHI ≥ 30 per hour. CONCLUSION: Isolated tonsillectomy can be successful as treatment for adult OSA, especially among patients with large tonsils and mild to moderate OSA (AHI < 30/hour). Laryngoscope, 2016 Laryngoscope, 126:2176-2186, 2016.

5 Article Pediatric Adenotonsillectomy Trial for Snoring (PATS): protocol for a randomised controlled trial to evaluate the effect of adenotonsillectomy in treating mild obstructive sleep-disordered breathing. 2020

Wang, Rui / Bakker, Jessie P / Chervin, Ronald D / Garetz, Susan L / Hassan, Fauziya / Ishman, Stacey L / Mitchell, Ron B / Morrical, Michael G / Naqvi, Syed K / Radcliffe, Jerilynn / Riggan, Emily I / Rosen, Carol L / Ross, Kristie / Rueschman, Michael / Tapia, Ignacio E / Taylor, H Gerry / Zopf, David A / Redline, Susan. ·Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA rwang@hsph.harvard.edu. · Department of Biostatistics, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA. · Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. · Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA. · Sleep Disorders Center and Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA. · Sleep Disorders Center and Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA. · Divisions of Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. · Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA. · Department of Otolaryngology, Head and Neck Surgery, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA. · Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. · Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, USA. · Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. · Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. · Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA. ·BMJ Open · Pubmed #32179560.

ABSTRACT: INTRODUCTION: Mild obstructive sleep-disordered breathing (oSDB), characterised by habitual snoring without frequent apnoeas and hypopnoeas on polysomnography, is prevalent in children and commonly treated with adenotonsillectomy (AT). However, the absence of high-level evidence addressing the role of AT in improving health and behavioural outcomes has contributed to significant geographical variations in care and potential for surgery to be both overused and underused. METHODS AND ANALYSIS: The Pediatric Adenotonsillectomy Trial for Snoring (PATS) is a single-blinded, multicentre randomised controlled trial designed to evaluate the effect of AT in treating mild oSDB. Four hundred sixty eligible children, aged 3.0-12.9 years old, will be randomised to either early adenotonsillectomy or to watchful waiting with supportive care (WWSC) with a 1:1 ratio. The study's coprimary endpoints are (1) change from baseline in executive behaviour relating to self-regulation and organisation skills as measured by the Behavioural Rating Inventory of Executive Function (BRIEF) Global Composite Score (GEC); and (2) change from baseline in vigilance as measured on the Go-No-Go (GNG) signal detection parameter (d-prime). A mixed effects model will be used to compare changes in the BRIEF GEC score and GNG score at 6 and 12 months from baseline between the AT arm and the WWSC arm. ETHICS AND DISSEMINATION: The study protocol was approved by the institutional review board (IRB) at Children's Hospital of Philadelphia (CHOP) on 3 October 2014 (14-0 11 214). The approval of CHOP as the central IRB of record was granted on 29 February 2016. The results will be published in peer-reviewed journals and presented at academic conferences. The data collected from the PATS study will be deposited in a repository (National Sleep Research Resource, sleepdata.org) after completion of the study to maximise use by the scientific community. TRIAL REGISTRATION NUMBER: NCT02562040; Pre-results.

6 Article The generalizability of the clinical assessment score-15 for pediatric sleep-disordered breathing. 2019

Goldstein, Nira A / Friedman, Norman R / Nardone, Heather C / Aljasser, Abdullah / Tobey, Allison B J / Don, Debra / Baroody, Fuad M / Lam, Derek J / Goudy, Steven / Ishman, Stacey L / Arganbright, Jill M / Baldassari, Cristina / Schreinemakers, J B S / Wine, Todd M / Ruszkay, Nicole J / Alammar, Ahmed / Shaffer, Amber D / Koempel, Jeffrey A / Weedon, Jeremy. ·Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York. · Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado. · Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware. · Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia. · Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh. · Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California. · Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Comer Children's Hospital, Chicago, Illinois. · Division of Pediatric Otolaryngology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon. · Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia. · Division of Pediatric Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. · Department of Pediatric Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri. · Department of Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, Virginia, U.S.A. · Drexel University College of Medicine, Philadelphia, Pennsylvania. · Research Division, State University of New York Downstate Medical Center, Brooklyn, New York. ·Laryngoscope · Pubmed #31782808.

ABSTRACT: OBJECTIVE: The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assessment for pediatric sleep-disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS-15 in a multi-institutional fashion. METHODS: Five hundred and thirty children from 13 sites with suspected sleep-disordered breathing were recruited, and the investigators completed the CAS-15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty-seven subjects had a follow-up CAS-15. RESULTS: Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS-15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS-15 and the initial apnea-hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver-operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1. CONCLUSION: This study establishes the generalizability of the CAS-15 as a useful office tool for the evaluation of pediatric sleep-disordered breathing. LEVEL OF EVIDENCE: 2B Laryngoscope, 2019.

7 Article Sleep apnea and kidney transplant outcomes: findings from a 20-year (1997-2017) historical cohort study. 2019

Lubas, Margaret M / Ware, J Catesby / Szklo-Coxe, Mariana. ·School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA. · Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA. · School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA; Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: mszklo@odu.edu. ·Sleep Med · Pubmed #31669818.

ABSTRACT: OBJECTIVE/BACKGROUND: A historic cohort single-center study of kidney transplant recipients with graft loss examined the associations between sleep apnea and two transplant outcomes, death with a functioning graft (DWFG), and graft survival time. PATIENT/METHODS: Adult patients who received transplants and experienced graft failure or DWFG from January 1, 1997 to January 1, 2017 constituted the cohort (n = 322). Data for the study were obtained by merging two secondary data sources: the Organ Procurement and Transplantation Network (OPTN) database and the transplant center's medical records. A Cox regression modeled the association of diagnosed sleep apnea, stratified by year-of transplant surgery, with graft survival time. Using backward elimination, this model was adjusted for recipient age, race/ethnicity, gender, functional status, donor age, and antigen mismatch. RESULTS: No statistically significant differences were found for proportions of DWFG in those with, versus without, sleep apnea, informing our censoring approach. When examining graft survival time, the Cox regression model was stratified given a sleep apnea and year-of-transplant interaction (p < 0.01, adjusted model). For patients transplanted between 1997 and 2008, sleep apnea was statistically significantly associated with a decreased risk of graft failure or cardiovascular-related DWFG [adjusted Hazard Ratio (aHR) = 0.63, 95%CI, 0.42-0.94]. For patients transplanted between 2009 and 2017, sleep apnea statistically significantly increased the risk of graft failure or cardiovascular-related DWFG (aHR = 2.61, 95%CI, 1.13-6.00). CONCLUSIONS: In a cohort of transplant recipients with graft loss, sleep apnea increased the risk of graft loss nearly three-fold among patients transplanted between 2009 and 2017. Similar DWFG proportions by sleep apnea presence indicate this risk is likely driven by renal failure, not mortality. Further research on whether treatment of sleep apnea can improve graft survival is warranted.

8 Article Impact of montelukast and fluticasone on quality of life in mild pediatric sleep apnea. 2019

Bluher, Andrew E / Brawley, Craig C / Cunningham, Tina D / Baldassari, Cristina M. ·Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: andrew.bluher@childrens.harvard.edu. · Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · Healthcare Delivery Science Program, Eastern Virginia Medical School, Norfolk, VA, USA. · Department of Pediatric Otolaryngology, Children's Hospital of the King's Daughters, Norfolk, VA, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #31260810.

ABSTRACT: OBJECTIVES: Research has shown improvement in apnea-hypopnea index in children with mild obstructive sleep apnea treated with anti-inflammatory medications. Data on quality of life outcomes in children receiving these medications is lacking. We aim to assess quality of life in children with mild obstructive sleep apnea treated with montelukast and fluticasone. METHODS: Children between 3 and 16 years old with mild sleep apnea (apnea-hypopnea index > 1 and ≤ 5) presenting to a pediatric otolaryngology clinic were recruited prospectively and treated with 4 months of montelukast and fluticasone. Subjects' caregivers completed the OSA-18, a validated quality of life survey, at baseline and 4 months. Children with ongoing obstruction at follow-up underwent adenotonsillectomy. RESULTS: Thirty-one patients were included. Mean (SD) age was 6.8 (3.9) years. Most subjects (54.8%) were black and 48% were obese. Mean (SD) apnea-hypopnea index of the subjects was 2.8 (1.0). The mean (SD) baseline OSA-18 score was 60.2 (18.5), indicating a moderate impact of sleep disturbance on quality of life. Following treatment, there was significant improvement (p < 0.005) in mean OSA-18 score. Four children discontinued montelukast due to behavioral side effects. Seven children (22%) underwent adenotonsillectomy after failing medical therapy. Demographic factors such as obesity [OR 0.63 (0.11, 3.49)] and apnea hypopnea index [OR 1.38 (0.59, 3.66)] failed to predict which children would respond to anti-inflammatory medications. CONCLUSIONS: Children with mild obstructive sleep apnea treated with montelukast and fluticasone experience significant improvements in quality of life. Further research is needed to determine optimal duration of therapy.

9 Article The effect of treating obstructive sleep apnea with continuous positive airway pressure on posttraumatic stress disorder: A systematic review and meta-analysis with hypothetical model. 2019

Zhang, Ye / Ren, Rong / Yang, Linghui / Zhou, Junying / Sanford, Larry D / Tang, Xiangdong. ·Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. · Laboratory of Anaestheisa & Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. · Sleep Research Laboratory, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: SanforLD@evms.edu. · Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. Electronic address: 2372564613@qq.com. ·Neurosci Biobehav Rev · Pubmed #31042558.

ABSTRACT: The present study explored whether continuous positive airway pressure (CPAP) treatment impacts nightmare and overall posttraumatic stress disorder (PTSD) symptoms in patients with PTSD and obstructive sleep apnea (OSA). The meta-analysis for six eligibile studies indicates that CPAP can significantly improve nightmare (standardized mean differences (SMD) = -0.778; 95% confidence interval (CI) = -1.228 to -0.327) and overall PTSD symptoms (SMD = -1.298; 95% CI = -2.128 to -0.468) in these patients. A subgroup analysis revealed that the effects of CPAP on improvements of nightmare and overall PTSD symptoms varied across CPAP treatment duration (3 and 6 months), but did not reach a statistically significant level. Furthermore, improvements in overall PTSD symptoms were associated with CPAP adherence. This review emphasizes the importance of the need for a multidisciplinary approach in treating patients with PTSD and OSA, and proposes a hypothetical model of how CPAP improves posttraumatic stress symptoms in patients with PTSD and OSA.

10 Article Worldwide and regional prevalence rates of co-occurrence of insomnia and insomnia symptoms with obstructive sleep apnea: A systematic review and meta-analysis. 2019

Zhang, Ye / Ren, Rong / Lei, Fei / Zhou, Junying / Zhang, Jihui / Wing, Yun-Kwok / Sanford, Larry D / Tang, Xiangdong. ·Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. · Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. · Sleep Research Laboratory, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: SanforLD@evms.edu. · Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. Electronic address: 2372564613@qq.com. ·Sleep Med Rev · Pubmed #30844624.

ABSTRACT: Recent investigations have established that patients with obstructive sleep apnea (OSA) and insomnia have greater daytime impairments and reduced quality of life compared to those with either disorder alone. The present study reviewed current data on the co-occurrence prevalence of insomnia and insomnia symptoms with OSA and assessed its worldwide and regional prevalence based on World Health Organization (WHO) regions. A total of 37 studies were included in the analysis. The overall prevalence rates of insomnia, any insomnia complaints, difficulty falling asleep (DFA), difficulty maintaining sleep (DMS) and early morning awakening (EMA) found in OSA patients were 38%, 36%, 18%, 42%, and 21%, respectively. According to the regional classification of the WHO, the rates of DFA, DMS and EMA in OSA patients in the Western Pacific Region were lower than those in the European Region and the Region of the Americas. We also analyzed the pooled prevalence rates of OSA based on different apnea-hypopnea index (AHI) criteria in insomnia patients. The rates were 35% (AHI≥5) and 29% (AHI≥15), respectively. Regional differences of DFA, DMS and EMA in OSA patients may be related to sex, age and body mass index.

11 Article Urinary Leukotriene E4 Levels in Children with Sleep-Disordered Breathing. 2018

Biyani, Sneh / Benson, M Jedorah / DeShields, Sarah C / Cunningham, Tina D / Baldassari, Cristina M. ·1 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. · 2 Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, Virginia, USA. · 3 Department of Pediatric Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA. ·Otolaryngol Head Neck Surg · Pubmed #29484947.

ABSTRACT: Objective Due to limitations of polysomnography (PSG), novel ways to evaluate pediatric obstructive sleep apnea (OSA) are needed. Urinary leukotriene E4 (LTE4), an inflammatory marker, has been identified as a potential biomarker for pediatric OSA. The objective of the study was to assess whether urinary LTE4 levels correlate with OSA severity, as determined by obstructive apnea-hypopnea index (AHI) and nadir oxygen saturation. Study Design Prospective trial. Setting Tertiary care children's hospital. Subjects and Methods Children (age, 3-16 years) with sleep-disordered breathing (SDB) who were referred for PSG were included. Urine samples were obtained the morning following PSG, and urinary LTE4 levels were quantified with enzyme-linked immunoassay kits. Results A total of 113 children were enrolled, and the mean age was 7.3 years. Thirty-nine percent (n = 44) were obese, and the majority were white (53%, n = 58). Seventy-eight percent (n = 88) were diagnosed with OSA (AHI >1), with 27% (n = 30) having severe disease (AHI >10). The mean urinary LTE4 level was 91.3 ng/mM. Urinary LTE4 levels did not correlate with AHI ( P = .77) or nadir oxygen saturation ( P = .64). There was a significant difference in urinary LTE4 levels between patients with mild SDB and those with moderate to severe OSA ( P = .03). Conclusion Urinary LTE4 levels do not correlate with AHI in children with SDB. Compared with children with severe OSA, children with mild SDB have higher urinary LTE4 levels. Further research is needed determine whether urinary LTE4 is a satisfactory biomarker for pediatric OSA.

12 Article Changes in Transcranial Ultrasound Velocities in Children with Sickle Cell Disease Undergoing Adenotonsillectomy. 2018

Santarelli, Griffin / DeShields, Sarah C / Ishman, Stacey L / Randall, Michael / Cunningham, Tina D / Baldassari, Cristina M. ·1 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School and the Children's Hospital of The King's Daughters, Norfolk, Virginia, USA. · 2 Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, Virginia, USA. · 3 Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #29405840.

ABSTRACT: Objectives (1) To assess for changes in cerebral blood flow velocity in children with sickle cell disease and obstructive sleep apnea (OSA) following adenotonsillectomy. (2) To determine if clinical factors such as OSA severity affect cerebral blood flow velocity values. Study Design Case series with chart review over 10 years. Settings Two tertiary children's hospitals. Subjects and Methods Children aged 2 to 18 years with a history of sickle cell disease and OSA, as defined by an apnea hypopnea index (AHI) >1 on polysomnography, were eligible for inclusion. Transcranial Doppler ultrasonography was used to assess cerebral blood flow velocity before and after adenotonsillectomy. Results Fifteen patients met inclusion criteria; 73% (n = 11) were female. The mean preoperative AHI was 8.9 (range, 1.2-22.2). Six (40%) patients had severe OSA (AHI >10). Following adenotonsillectomy, there was a significant reduction in mean (95% CI) cerebral blood flow velocities of the left terminal internal cerebral artery, 91.2 (79.4-103.1) to 75.7 (61.7-89.8; P = .018), and the right middle cerebral artery, 134.3 (119.2-149.3) to 116.5 (106.5-126.5; P = .003). There was not a significant correlation between baseline AHI and change in cerebral blood flow velocities. Conclusion Adenotonsillectomy may result in a reduction in some cerebral blood flow velocities. Further research is needed to determine if changes in cerebral velocities as assessed by transcranial Doppler ultrasonography translate into a reduced risk of stroke for children with sickle cell disease and OSA.

13 Article Adenotonsillectomy outcomes in children with sleep apnea and narcolepsy. 2017

Biyani, Sneh / Cunningham, Tina D / Baldassari, Cristina M. ·Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: biyanis@evms.edu. · Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA, USA. · Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA; Department of Pediatric Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, VA, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #28802388.

ABSTRACT: OBJECTIVE: To identify improvements in daytime sleepiness following adenotonsillectomy in children with non-severe obstructive sleep apnea and narcolepsy. STUDY DESIGN: Case series with chart review over 15 years. SETTING: Tertiary Children's Hospital. SUBJECTS AND METHODS: Children between 6 and 17 years of age with narcolepsy that underwent adenotonsillectomy for non-severe obstructive sleep apnea (OSA) were included. Narcolepsy was diagnosed based on clinical assessment and the Multiple Sleep Latency Test (MSLT) results. A standardized instrument, the pediatric Epworth Sleepiness Scale (ESS), was used to assess daytime sleepiness before and after adenotonsillectomy. RESULTS: Nine children with a mean age of 12.1 years were included. The majority of the subjects (78%, n = 7) were African American and six children (66.7%) were obese. Four children (44%) were treated with wake promoting agents during the study. The mean preoperative apnea hypopnea index on polysomnography was 4.89 (SD 1.86), while the mean sleep latency on MSLT was 6.32 min (SD 3.14). The mean preoperative ESS was 16.10 and the postoperative ESS was 10.80 (SD 3.96). There was significant improvement (p = 0.02) in the ESS following adenotonsillectomy with seven children (78%) reporting diminished daytime sleepiness. CONCLUSIONS: Children with non-severe OSA and narcolepsy experience significant improvement in daytime sleepiness following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of non-severe OSA in children with narcolepsy.

14 Article The deterioration of driving performance over time in drivers with untreated sleep apnea. 2016

May, Jennifer F / Porter, Bryan E / Ware, J Catesby. ·Old Dominion University, Department of Psychology, Norfolk, VA, United States; Sentara Healthcare, Sleep Centers, Norfolk, VA, United States. Electronic address: jlfreema@sentara.com. · Old Dominion University, Department of Psychology, Norfolk, VA, United States. · Eastern Virginia Medical School, Division of Sleep Medicine, Norfolk, VA, United States. ·Accid Anal Prev · Pubmed #26851617.

ABSTRACT: Sleep apnea increases risk of driving crashes when left untreated. This study examined the driving performance decrements of untreated, undiagnosed sleep apnea drivers compared with healthy controls in a monotonous highway driving simulator task. It was hypothesized that the sleep apnea group would perform worse during a driving simulator test compared with the control group. A significant group by time interaction occurred indicating that sleep apnea participants' performance degraded more quickly over the course of the drive. In contrast with previous studies, this sleep apnea group did not include sleep disorder center patients, but rather community volunteers whose screening indicated a significant apnea/hypopnea index of 15 or greater. There may be inherent differences between patients and nonpatients with sleep apnea, as patients may have a more significant impact on their quality of life, causing them to seek treatment. Still, the results are clear that although the sleep apnea group drove similarly to the control group at the start of the drive, they are sensitive to time on task effects. These results support the need to diagnose and treat sleep apnea.

15 Article Is MRI Necessary in the Evaluation of Pediatric Central Sleep Apnea? 2015

Woughter, Meghan / Perkins, Amy M / Baldassari, Cristina M. ·Eastern Virginia Medical School, Norfolk, Virginia, USA. · Department of Pediatrics, Division of Biostatistics and Innovation in Research Design, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, USA. · Department of Otolaryngology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA baldassc@gmail.com cristina.baldassari@chkd.org. ·Otolaryngol Head Neck Surg · Pubmed #26227470.

ABSTRACT: OBJECTIVES: (1) To determine the prevalence of central nervous system (CNS) pathology identified on head magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA); (2) to assess the yield of MRI in evaluation of CSA; and (3) to identify factors that predict CNS pathology in children with CSA. STUDY DESIGN: Case series with chart review. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: A chart review was conducted over 12 years. Patients 6 months to 18 years of age who underwent head MRI for evaluation of CSA were included. CSA was diagnosed on polysomnogram as central apnea index >1. RESULTS: Forty children were included in the CSA group. Twenty-two patients were male, and the mean age was 60 ± 41.5 months. The mean central apnea index was 3.8 ± 1.9, while the mean obstructive apnea hypopnea index was 3.4 (interquartile range, 0.7-3.8). Eighteen percent (7 of 40) of children with CSA had evidence of CNS pathology on MRI, with the most common finding (n = 3) being arachnoid cyst. Children with CSA who had gastroesophageal reflux disease or abnormal neurologic examinations were more likely to have CNS pathology. Other factors, such as prematurity, did not improve the yield of MRI in children with CSA. CONCLUSIONS: While routine evaluation of children with elevated central apnea index by MRI is not indicated, providers should consider neuroimaging in children with CSA and abnormal neurologic examination findings or gastroesophageal reflux disease. Further research is necessary to identify other tests with improved diagnostic yield for evaluation of pediatric CSA.

16 Article A 44-year-old woman with excessive sleepiness. Opioid-induced central sleep apnea. 2014

Tovar-Torres, María Paula / Bodkin, Cynthia / Sigua, Ninotchka L. ·Department of Medicine, Eastern Virginia Medical School, Norfolk, VA. · Department of Neurology, Indiana University School of Medicine, Indianapolis, IN. · Department of Medicine, Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, IN. Electronic address: nsigua@iu.edu. ·Chest · Pubmed #25451363.

ABSTRACT: -- No abstract --

17 Article Self-reported sleep bruxism and nocturnal gastroesophageal reflux disease in patients with obstructive sleep apnea: relationship to gender and ethnicity. 2014

Hesselbacher, Sean / Subramanian, Shyam / Rao, Shweta / Casturi, Lata / Surani, Salim. ·Sentara Healthcare, Virginia Beach, VA, USA ; Eastern Virginia Medical School, Norfolk, VA, USA. · Mercy Health System, Cincinnati, Ohio, USA. · Baylor College of Medicine, Houston, Texas, USA. · Texas A&M University, Texas, USA. ·Open Respir Med J · Pubmed #25352924.

ABSTRACT: STUDY OBJECTIVES: Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity. METHODS: A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a sleep questionnaire prior to undergoing polysomnography. Patients with confirmed OSA were evaluated based on gender and ethnicity. Associations were determined between sleep bruxism and nocturnal GERD, and daytime sleepiness, insomnia, restless legs symptoms, and markers of OSA severity in each group. RESULTS: In these patients with OSA, the prevalence of nocturnal GERD (35%) and sleep bruxism (26%) were higher than the general population. Sleep bruxism was more common in Caucasians than in African Americans or Hispanics; there was no gender difference. Nocturnal GERD was similar among all gender and ethnic groups. Bruxism was associated with nocturnal GERD in females, restless legs symptoms in all subjects and in males, sleepiness in African Americans, and insomnia in Hispanics. Nocturnal GERD was associated with sleepiness in males and African Americans, insomnia in females, and restless legs symptoms in females and in Caucasians. CONCLUSION: Patients with OSA commonly have comorbid sleep bruxism and nocturnal GERD, which may require separate treatment. Providers should be aware of differences in clinical presentation among different ethnic and gender groups.

18 Article Polysomnographic results of prone versus supine positioning in micrognathia. 2014

Kimple, Adam J / Baldassari, Cristina M / Cohen, Aliza P / Landry, April / Ishman, Stacey L. ·Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, United States. · Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States; Department of Pediatric Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, VA, United States. · Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. · Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Pediatric Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: stacey.ishman@cchmc.org. ·Int J Pediatr Otorhinolaryngol · Pubmed #25282304.

ABSTRACT: BACKGROUND: Children with micrognathia commonly present with upper airway symptoms and are at risk for developing obstructive sleep apnea (OSA). Prone positioning is widely used as first-line management for micrognathic children with obstructive symptoms. The aim of the present study was to document the effect of positioning on oxygenation and upper airway obstruction as measured by polysomnography (PSG). METHODS: Three children with micrognathia from two institutions underwent PSG in both the prone and supine position. RESULTS: Patient ages were 1 week, 3 months, and 7 months. Supine obstructive apnea-hypopnea indices (oAHI) were severe for all 3 children, with a mean of 21.9 events/hour (range 16.8 to 26.3). In the prone position, the oAHI significantly improved in 2 of 3 children, with a mean of 5.1 events/hour (range 0.3 to 10.3). The frequency of central apnea events increased in 1 child following supine positioning. Nadir oxygen saturation improved in 2 of 3 children and remained within normal limits in the third. CONCLUSIONS: This is the first report of the effect of positioning on changes in PSG indices of micrognathic children. Improvement in obstructive PSG indices occurred with prone positioning, though OSA persisted in 2 of 3 children. The effect of positioning on central apnea was unclear. In light of these findings, we recommend that routine PSG be considered in micrognathic children undergoing prone positioning for definitive therapy of upper airway obstruction.

19 Article Correlation between REM AHI and quality-of-life scores in children with sleep-disordered breathing. 2014

Baldassari, Cristina Marie / Alam, Lyla / Vigilar, Maria / Benke, James / Martin, Charley / Ishman, Stacey. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, and Department of Pediatric Otolaryngology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA cristina.baldassari@chkd.org baldassc@gmail.com. · Eastern Virginia Medical School, Norfolk, Virginia, USA. · Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Eastern Virginia Medical School, Graduate Program in Public Health, Norfolk, Virginia, USA. · Departments of Pediatric Otolaryngology-Head & Neck Surgery & Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, and Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #25164468.

ABSTRACT: OBJECTIVES: Prior research has demonstrated poor correlation between the obstructive apnea-hypopnea index (AHI) on full-night polysomnogram (PSG) and quality-of-life (QOL) scores. We aim to examine the association between rapid eye movement (REM) AHI and QOL scores in children with sleep-disordered breathing (SDB). STUDY DESIGN: Prospective trial. SETTING: Two tertiary children's hospitals. SUBJECTS AND METHODS: Children between 3 and 16 years of age with suspected SDB who were undergoing PSG were eligible. Children with craniofacial anomalies were excluded. Subjects' caregivers completed the Obstructive Sleep Apnea-18 (OSA-18), a validated QOL survey. Power analysis determined a group size of 34. RESULTS: One hundred twenty-seven patients were enrolled. The mean (SD) age was 6.3 (3.3) years. Most subjects (52%) were black and 26% were obese. The mean (SD) obstructive AHI of the subject population was 5.4 (11.9), while the mean (SD) REM AHI was 13.1 (23.7). The mean total OSA-18 score was 65.2, indicating a moderate impact of SDB on QOL. Neither the obstructive AHI (P = .73) nor the REM AHI (P = .49) correlated with total OSA-18 scores. However, lower nadir oxygen saturation was associated with significantly poorer QOL (P = .02). The sleep disturbance OSA-18 subset score significantly correlated with both the obstructive AHI (r (2) = 0.22; P = .01) and the REM AHI (r (2) = 0.22; P = .01); the remaining 4 subset scores did not correlate with either factor. CONCLUSION: Neither obstructive AHI nor REM AHI correlates with total OSA-18 QOL scores. With the exception of nadir oxygen saturation, PSG parameters do not reflect the burden of SDB on QOL in children.

20 Article Is cardiology evaluation necessary in children with electrocardiogram abnormalities noted on polysomnogram? 2014

Baldassari, Cristina M / Beydoun, Hind A / Peak, Jessica / Reed, John H. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. ·Otolaryngol Head Neck Surg · Pubmed #24493790.

ABSTRACT: OBJECTIVES: (1) To determine the prevalence of cardiac disease in children with electrocardiogram (ECG) abnormalities on polysomnogram (PSG). (2) To assess whether factors such as family history of heart disease and severity of sleep apnea are associated with cardiac disease. STUDY DESIGN: Case series with chart review from 2002 to 2012. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: Children between 1 and 16 years of age with ECG abnormalities on PSG who were referred to cardiology for evaluation were included. Children with a known history of cardiac disease were excluded. RESULTS: Sixty-one children had ECG abnormalities on PSG and were subsequently referred to cardiology. The mean age was 6.5 years (SD, 4.5), and 64% (n = 39) of subjects were African American. The mean obstructive apnea hypopnea index (AHI) was 8.8 (SD, 13.3), and 26% of the children had severe obstructive sleep apnea (AHI >10). The most common ECG abnormality (n = 52) recorded on PSG was premature ventricular contractions. Thirty percent (n = 18) of children had marked arrhythmias noted on their PSG ECG. Most children referred to cardiology underwent echocardiogram (45/61) and 24-hour arrhythmia monitoring (42/61). Five children (8%) had cardiac pathology, including atrial and ventricular ectopy, tuberous sclerosis, mitral regurgitation, and aortic insufficiency. Factors such as family history of heart disease (P = .40) and severe OSA (P = .74) were not associated with cardiac pathology. CONCLUSION: Cardiac pathology in children with abnormal ECGs on PSG is common. Cardiology referral in such patients should be considered. Further research is needed to determine the appropriate cardiac workup.

21 Article Adenotonsillectomy vs observation for management of mild obstructive sleep apnea in children. 2014

Volsky, Peter G / Woughter, Meghan A / Beydoun, Hind A / Derkay, Craig S / Baldassari, Cristina M. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. ·Otolaryngol Head Neck Surg · Pubmed #24170659.

ABSTRACT: OBJECTIVE: To determine the impact of adenotonsillectomy vs observation on quality of life (QOL) in children with mild obstructive sleep apnea (OSA). STUDY DESIGN: Prospective, nonrandomized trial. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: Sixty-four children (ages 3-16 years) with mild OSA (apnea hypopnea index between 1 and 5 on polysomnogram) completed the study. Caregivers chose between management options of adenotonsillectomy and observation and completed validated QOL instruments (OSA-18 and Children's Health Questionnaire) at baseline, early, and late follow-ups. The primary outcome measure was QOL. RESULTS: Thirty patients chose adenotonsillectomy, while 34 were observed. Total OSA-18 scores at baseline were significantly poorer (P = .01) in the surgery group (72.3) compared with the observation group (58.5). Four months following surgery, OSA-18 scores improved by 39.1 points over baseline (P = .0001), while there was no change for the observation group (P = .69). After 8 months, OSA-18 scores remained improved in the surgery group, and observation group scores improved by 13.4 points over baseline (P = .005). While OSA-18 scores at the late follow-up visit were poorer in the observation group, the difference was not statistically significant (P = .05). Six observation patients opted for adenotonsillectomy during the study. CONCLUSION: Quality of life significantly improves in children with mild OSA after adenotonsillectomy. In children with mild OSA who are observed, QOL improvements at early follow-up are less pronounced, but significant improvements in QOL are evident after 8 months. QOL instruments may be useful tools to help providers determine which children with mild OSA may benefit from early intervention.

22 Article The otolaryngologic manifestations of Sotos syndrome. 2013

Gaudreau, Philip / Zizak, Vincent / Gallagher, Thomas Q. ·Naval Medical Center, Portsmouth, VA, United States. Electronic address: pgaudreau164@gmail.com. ·Int J Pediatr Otorhinolaryngol · Pubmed #24060089.

ABSTRACT: OBJECTIVE: Soto's syndrome is a genetic disorder caused by mutations in the NSD1 gene. It is characterized by excessive growth in early life. It features craniofacial abnormalities, developmental delay, hypotonia and advanced bone age. A review of the current literature reveals only chronic otitis media and conductive hearing loss as otolaryngologic manifestations of Soto's syndrome. Our objective was to determine if there are additional manifestations relevant to the otolaryngologist. METHODS: We performed a retrospective case series in which the Department of Defense electronic medical record was searched for ICD 9 code 253.0 (acromegaly/gigantism). Records were reviewed for genetic testing indicative of Soto's syndrome. These records were further analyzed for evidence of otolaryngologic problems. RESULTS: Seventeen patients were identified with five having confirmed NSD1 mutations consistent with Soto's syndrome. Of these, 4/5 had otolaryngologic problems such as conductive hearing loss, aspiration, laryngomalacia, obstructive sleep apnea and sensorineural hearing loss. CONCLUSIONS: Currently there is no description in the literature of these additional manifestations of Soto's syndrome. We present this case series to support the idea that an otolaryngologist should be involved in the multidisciplinary care required for these patients.

23 Article Nocturnal diaphoresis secondary to mild obstructive sleep apnea in a patient with a history of two malignancies. 2013

Vorona, Robert Daniel / Szklo-Coxe, Mariana / Fleming, Mark / Ware, J Catesby. ·Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23510, USA. voronard@evms.edu ·J Clin Sleep Med · Pubmed #23853568.

ABSTRACT: Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom.

24 Article Characteristics of patients with the "malignant obesity hypoventilation syndrome" admitted to an ICU. 2013

Marik, Paul E / Desai, Himanshu. ·Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA. marikpe@evms.edu ·J Intensive Care Med · Pubmed #22564878.

ABSTRACT: BACKGROUND: The incidence of obesity in westernized nations is increasing at an alarming rate. We have noted an increasing number of patients admitted to our intensive care unit (ICU) with hypercapnic respiratory failure and multisystem organ dysfunction related to obesity. We have coined the term the malignant obesity hypoventilation syndrome (MOHS) to describe this entity. METHODS: We reviewed the hospital records of all patients who were admitted to our ICU over an 8-month period, with a body mass index (BMI) greater than 40 kg/m² and a PaCO₂ greater than 45 mm Hg. We excluded patients with musculoskeletal disease, intrinsic lung disease, and those with >20 pack-year smoking history. RESULTS: Sixty-one patients (8% of all admissions) met the inclusion criteria for our study. The patients' mean BMI was 48.9 ± 8.6 kg/m². The patients' mean age was 59 ± 11; 47 (77%) were female and 56 (92%) were black. All patients were admitted to the ICU with hypercapnic respiratory failure. The patients had been admitted to our hospital on average 6 times over the previous 2 years; 75% had been erroneously diagnosed and treated for chronic obstructive pulmonary disease (COPD)/asthma and 86% had been treated with diuretics for congestive cardiac failure. All patients had type 2 diabetes and the metabolic syndrome. Three patients had a tracheotomy in place at admission and required mechanical ventilation. All of the remaining patients were treated with noninvasive bilevel positive airway pressure (BiPAP), with 23 patients failing BiPAP and requiring mechanical ventilation. Seven patients had a tracheotomy performed. On the basis of unexplained abnormalities of liver function tests, 39 patients (64%) were presumptively diagnosed with nonalcoholic steatohepatitis (NASH). Pulmonary function tests were suggestive of a restrictive pattern in all patients tested. By echocardiography 43 (71%) patients had left ventricular hypertrophy and 37 (61%) patients had features of left ventricular diastolic dysfunction. Forty-seven (77%) patients had pulmonary hypertension, which was moderate to severe (pulmonary systolic pressure >45 mm Hg) in 25 cases. All patients had an elevated C-reactive protein (9.4 ± 6.9 mg/dL), and all but 1 were vitamin D deficient (13.5 ± 8.5 ng/mL). Eleven patients (18%) died during the index hospitalization. CONCLUSIONS: MOHS is a serious multisystem disorder with a high mortality that appears to be relatively common, frequently misdiagnosed, and inadequately treated.

25 Article Changes in central apnea index following pediatric adenotonsillectomy. 2012

Baldassari, Cristina M / Kepchar, Jessica / Bryant, Lucas / Beydoun, Hind / Choi, Sukgi. ·Department of Otolaryngology--Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia 23507, USA. cristina.baldassari@chkd.org ·Otolaryngol Head Neck Surg · Pubmed #22075072.

ABSTRACT: OBJECTIVES: To determine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA). STUDY DESIGN: Case series with chart review. SETTING: Two tertiary children's hospitals. SUBJECTS AND METHODS: Children between 1 and 16 years of age who underwent adenotonsillectomy for OSA and had both preoperative and postoperative full-night polysomnography (PSG) with CAI greater than 1 on preoperative PSG were eligible for inclusion. Central apnea was defined as the absence of both inspiratory effort and chest wall movement lasting longer than 20 seconds. Criteria for diagnosis of central sleep apnea (CSA) was CAI greater than 1. RESULTS: A total of 101 children with OSA had preoperative and postoperative PSG. Fifteen of these patients had a preoperative CAI greater than 1. The mean age was 67.7 months (SD, 62.7 months). The CAI ranged from 1.1 to 11.1. The mean preoperative CAI was 3.9 (SD, 2.9), while the mean postoperative CAI was 1.9 (SD, 4.8). There was significant improvement (P = .008) of the CAI following adenotonsillectomy. Ninety percent of subjects with mild CSA (CAI between 1 and 5) had postoperative resolution of their disease. There was also significant improvement (P = .004) in the obstructive apnea hypopnea index (AHI), with the mean preoperative AHI of 22.8 (SD, 19.8) decreasing to an AHI of 5.5 (SD, 6.5) postoperatively. CONCLUSIONS: Children with OSA and mild CSA on preoperative PSG showed significant improvement in CAI following adenotonsillectomy. Future studies are needed to determine the clinical significance of CSA in children with OSA and to identify treatment strategies.

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