The correlation between obesity and severity of obstructive sleep apnea (OSA) is well established in adults, but data are inconsistent in children. We hypothesized that there is a significant ...correlation between the degree of obesity and the severity of OSA in children.
We retrospectively reviewed records of weight, height, history, and polysomnography of all 1-to 15-year-old children referred to our sleep laboratory. Children with known anomalies and repeated polysomnography were excluded from this study. Obesity was defined as body mass index z score (BMI Z score) > 1.96. The correlation between BMI Z score and apnea-hypopnea index (AHI) was assessed. Possible confounding factors, ie, age, gender, and tonsil size, were adjusted by multiple linear regression.
Four hundred eighty-two children were included in this study. Obese children had a significantly higher AHI (median, 1.5; interquartile range IQR, 0.2 to 7.0) than the AHI of nonobese children (median, 0.7; IQR, 0.0 to 2.5). BMI Z score was significantly correlated with log-transformed AHI (LnAHI) r = 0.156, p = 0.003. BMI Z score and tonsil size were still correlated with Ln(AHI) even after adjusted for other confounding factors (p = 0.001).
Degree of obesity as measured by BMI Z score and tonsil size are significantly related to severity of OSA as reflected by the AHI, although the correlation is mild.
Highlights • There was significant improvement in ACT™ score in aYPFS group but not in the control group. • aYPFS added on to montelukast improved Asthma Control Test Score in children with asthma. • ...There were no significant differences between groups in other primary and secondary outcome parameters.
To compare active acupuncture with sham acupuncture for the treatment of persistent allergic rhinitis among children.
Subjects with persistent allergic rhinitis were recruited from the pediatric ...outpatient clinic. They were randomized to receive either active acupuncture or sham acupuncture. Main outcome measures included daily rhinitis scores, symptom-free days, visual analog scale scores for immediate effects of acupuncture, daily relief medication scores, blood eosinophil counts, serum IgE levels, nasal eosinophil counts, patients' and parents' preferences for treatment modalities, and adverse effects.
Eighty-five patients were recruited from the pediatric outpatient clinic at Kwong Wah Hospital, in Hong Kong. Thirteen patients withdrew before randomization; 35 patients (mean age: 11.7 +/- 3.2 years) were randomized to receive active acupuncture for 8 weeks, and 37 patients (mean age: 11 +/- 3.8 years) were randomized to receive sham acupuncture for 8 weeks. Acupuncture was performed twice per week for both groups. Both the assessing pediatricians and the patients were blinded. There were significantly lower daily rhinitis scores and more symptom-free days for the group receiving active acupuncture, during both the treatment and follow-up periods. The visual analog scale scores for immediate improvement after acupuncture were also significantly better for the active acupuncture group. There was no significant difference in the following outcome measures between the active and sham acupuncture groups: daily relief medication scores, blood eosinophil counts, serum IgE levels, and nasal eosinophil counts, except for the IgE levels before and 2 months after acupuncture in the sham acupuncture group. No severe adverse effects were encountered. Numbness, headache, and dizziness were found in both the active and sham acupuncture groups, with no difference in incidence, and the effects were self-limiting.
This study showed that active acupuncture was more effective than sham acupuncture in decreasing the symptom scores for persistent allergic rhinitis and increasing the symptom-free days. No serious adverse effect was identified. A large-scale study is required to confirm the safety of acupuncture for children.
To estimate the prevalence of snoring, witnessed sleep apnea, teeth grinding, primary and secondary nocturnal enuresis, and sleep duration in Hong Kong primary school children.
Cross-sectional ...telephone questionnaire survey in a community.
A total of 3,047 6- to 12-year-old apparently healthy children.
Those who agreed to the study were contacted by telephone. Survey questions were asked about the symptoms of the different sleep disorders, and the frequency of each positive symptom was noted for the preceding 1 week.
Prevalence and risk factors of sleep disorders in Hong Kong primary school children.
The prevalence of the following sleep symptoms was listed as follows: habitual snoring (10.9%), witnessed sleep apnea (1.5%), nocturnal enuresis (5.1%), and sleep teeth grinding (20.5%). Significant risk factors for habitual snoring included witnessed sleep apnea, mouth breathing during sleep, snoring in first-degree relatives, headache on rising, male gender, allergic rhinitis, and sleep teeth grinding. Significant risk factors for witnessed sleep apnea included habitual snoring, allergic rhinitis, tiredness on rising, and excessive daytime sleepiness. Poor academic results were associated with present of witnessed sleep apnea and absence of sleep teeth grinding. None of the sleep problem was associated with poor conduct results. The mean sleep duration was 8.79 h (SD 0.96).
This study provides epidemiologic data of sleep-disordered breathing, enuresis, sleep teeth grinding, and duration of sleep in Chinese primary school children in Hong Kong.
Atopic dermatitis (AD) is a common chronic, multisystem inflammatory skin disease in pediatric patients. There has been an increase in the incidence of AD in the pediatric population of the ...Asia–Pacific region. Studies have shown that genetic, epigenetic, environmental and cultural factors may lead to differences in the clinical manifestation and prevalence of AD between races. Early treatment of AD is necessary to prevent the atopic march leading to comorbidities such as asthma and allergic rhinitis. Topical corticosteroids (TCS) are used as first-line therapy for the treatment of AD, but their long-term usage poses a risk to the patient’s health. Pimecrolimus (1%) is a topical calcineurin inhibitor (TCI) that is indicated for the treatment of mild to moderate AD. Pimecrolimus has no apparent increase in adverse events compared to TCS, and it causes less of a burning sensation than tacrolimus. The safety and efficacy of pimecrolimus has been established through various clinical trials; yet, in many Asian countries, the use of pimecrolimus in infants is still restricted due to safety concerns. Based on the available evidence, the expert panel recommends pimecrolimus in infants between 3 months and 2 years of age in the Asian population.
Background: The aim of this study was to compare the effectiveness of an intensive asthma education program (group B) with that of a standard asthma education program (group A).
Methods: A ...prospective randomized single blinded study was conducted in the pediatric department of a public hospital in Hong Kong. Children aged 2–15 years admitted to the pediatric department with an acute attack of asthma were recruited. A standard asthma education program (group A) or an intensive asthma education program (group B) for children were offered. The main outcome measures include the number of visits to the emergency department and the number of hospitalization for asthma during the 3 month follow‐up period.
Results: A total of 45 children were in group A and 55 in group B. Group B had statistically significant reductions in the number of visits to the emergency department and the number of hospitalizations. Drug compliance was also significantly improved in group B. Parents’ satisfaction rate was also higher in group B.
Conclusion: The intensive asthma education program might be more cost effective than the standard asthma education program in the management of asthmatic children admitted to hospital in Hong Kong.
An update on childhood snoring Ng, Daniel K.; Chow, Pok-Yu; Chan, Chung-Hong ...
Acta Paediatrica,
September 2006, Letnik:
95, Številka:
9
Journal Article
Recenzirano
Habitual snoring or daily snoring is a symptom of sleep‐disordered breathing (SDB) in children and it is reported in about 10% of children. SDB includes primary snoring, upper airway resistance ...syndrome (UARS), obstructive hypoventilation syndrome and obstructive sleep apnea syndrome (OSAS). Classification of SDB in a particular snoring child requires an overnight polysomnography (PSG). Manual scoring of PSG is mandatory in children. Risk factors for SDB include allergic rhinitis, passive smoking, obesity, dysmorphic syndromes and neuromuscular disorders. Conclusion: Treatment includes general measures like treatment of allergic rhinitis, weight reduction in obese children, and avoidance of sleep deprivation. Specific measures include removal of adenoid and tonsils. Complications of SDB include neurocognitive impairment, hypertension and failure to thrive.
Background and objective
The purpose of this study is to assess whether
Chinese
children with high apnea–hypopnea index (AHI) are sleepier by a modified Epworth Sleepiness Scale (ESS).
Materials and ...methods
Records were retrospectively reviewed. We included children who were between 3 and 12 years old, admitted for overnight polysomnogram because of suspected obstructive sleep apnea syndrome (OSAS). A modified ESS was used to assess excessive daytime sleepiness (EDS) of the children.
Results
One hundred ninety-two
Chinese
children were included. Children with high AHI, defined as AHI > 5.0, were sleepier than children with AHI less than or equal to 5. After adjustment by age, gender, and obesity, children with high AHI remained significantly sleepier. Modified ESS was significantly correlated with AHI (rho = 0.124, 95% CI = 0.004–0.281). Modified ESS score of >8 was the best cutoff point with the sensitivity and specificity of 0.29 and 0.91, respectively. The odds ratio of children with modified ESS > 10 having high AHI was 4.231 (95%CI = 1.248 to 14.338) and children with modified ESS > 8 had the highest odds ratio, 4.295(95%CI = 1.66 to 11.1), of having high AHI.
Conclusion
Chinese
children with high AHI appear to be sleepier than children with low AHI. Children with suspected OSAS and high modified ESS, i.e., ESS > 8, had significantly higher odds ratio of having high AHI. Increased sleepiness is a specific but not a sensitive symptom in snoring children with high AHI. Screening for EDS in snoring children may help us identify those with high AHI and prioritize the management of those children.
The aim of this study was to review the literature to evaluate the association between allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) in childhood. A PubMed literature search ...(January 1970 to February 2005) was conducted using the following key words: obstructive sleep apnea, allergic rhinitis, and mouth breathing. The retrieved articles were reviewed and the levels of evidence were assessed. AR affected approximately 40% of children and OSAS occurred in 2% of children. AR is a risk factor for OSAS because AR is associated with nasal obstruction, enlargement of tonsils and adenoids, and an elongated face, which, taken together, constitute a smaller upper airway size. Adequate treatment of AR is helpful to decrease the severity of OSAS and prevent emergence of an elongated face, which predispose for OSAS. There is convincing evidence that AR increases the risk of OSAS in children. Appropriate treatment of AR regularly could prevent the occurrence of OSAS and reduce the severity of existing OSAS.
Noncontact forehead temperature measurement by handheld infrared thermometer was used as a screening tool for fever. However, the accuracy data and normal range of forehead temperature determined by ...this method were not available.
The temperature readings from 3 handheld infrared thermometers were validated against an electronic thermometer. Normal range of forehead temperature was determined by measuring the forehead temperature in 1000 apparently healthy subjects.
Significant differences were detected in readings obtained by the 3 different handheld infrared thermometers (analysis of covariance,
P < .001) The most accurate one was chosen, and the normal range of forehead temperature in 1000 subjects detected by this method was 31.0°C to 35.6°C.
Our study shows that commercially available, handheld infrared thermometers require individual validation. Forehead temperature in excess of 35.6°C is suggestive of fever. Further studies are required to confirm accuracy of this value in detecting fever.
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