Background
Long‐term home noninvasive ventilation (NIV) is increasingly employed in children with sleep‐disordered breathing and chronic respiratory failure. While studies suggest its successful ...implementation in tertiary care centers, little is known about the situation in a general care setting. Hence, we aim to evaluate the clinical profiles of these children in a general pediatric unit over the past two decades.
Methods
Data collected retrospectively on patients younger than 18 years old receiving long‐term home NIV from January 1, 1997 to December 31, 2017 in a Hong Kong regional general pediatric unit were reviewed.
Results
The number of children on home NIV increased more than 10‐fold over the past two decades. In total, 114 children were commenced on NIV during the 21‐year period. Upper airway obstruction was the most common cause (77%), followed by neuromuscular diseases (16%), pulmonary disorders (4%), and abnormal ventilatory control (3%). Continuous positive airway pressure was the most common NIV type (59%). To date, 46% of the children remained in our NIV program, while 18% discontinued NIV support. NIV adherence increased significantly with follow‐up (median of 78.6% and 82.5% at baseline and last follow‐up, respectively). Sixty‐five percent of the children used NIV for at least 4 h on 70% of the days monitored. Higher body mass index was associated with lower adherence.
Conclusion
Pediatric home NIV is feasible in the general care setting with good outcomes and adherence. As the demand for NIV service grows, input from local hospitals will be of increasing importance and should be considered upon healthcare planning.
Heated humidified high flow nasal cannula (HHHFNC) has gained popularity in the treatment of children with respiratory distress and bronchiolitis in the past decade. Its efficacy as a mode of ...non-invasive respiratory support has been demonstrated in both adults and children. However, reports on its use in the treatment of obstructive sleep apnea (OSA) in infants are limited. We aimed to evaluate the efficacy of HHHFNC therapy as treatment in infants with OSA.
A retrospective analysis of OSA infants who had undergone polysomnographic titration between 2015 and 2017 was undertaken. Data about the age, gender, AHI, co-morbid conditions and flow used for each patient were retrieved.
Ten infants were included in this study (median age 34 weeks; IQR 27–38 weeks). The median optimal HHHFNC flow rate was 8.0 L/min (IQR 6.7–8.0 L/min). HHHFNC significantly reduced median obstructive apnea–hypopnea index (OAHI) from 9.1 (IQR 5.1–19.3) to 0.9 (IQR 0–1.6; P = 0.005) events/h; median obstructive apnea index (OAI) from 5.8 (IQR 1.1–13.4) to 0 (IQR 0–0.9; P = 0.021) events/h; median obstructive hypopnea index (OHI) from 4.1 (IQR 0.9–6.8) to 0.1 (0–0.9; P = 0.017) events/h; and median oxygen saturation (SpO2) nadir increased from 88% (IQR 83–94%) to 94% (IQR 93–96%; P = 0.040).
HHHFNC significantly reduced respiratory events and improved oxygenation in infants with OSA.
•Heated humidified high flow can be used to treat obstructive sleep apnea in infants.•HHHFNC is an alternative to CPAP in treating OSA in infants.•Malacic airway is a cause of OSA in both preterm and term infants.
The utilization of FFR remains low. Our study evaluated the per-vessel prognostic value of computational pressure-flow dynamics-derived FFR (caFFR) among patients with stable coronary artery disease. ...A total of 3329 vessels from 1308 patients were included and analysed. They were stratified into ischaemic (caFFR ≤ 0.8) and non-ischaemic (caFFR > 0.8) cohorts, and the associations between PCI and outcomes were evaluated. The third cohort comprised all included vessels, and the associations between treatment adherent-to-caFFR (PCI in vessels with caFFR ≤ 0.8 and no PCI in vessels with caFFR > 0.8) and outcomes were evaluated. The primary outcome was VOCE, defined as a composite of vessel-related cardiovascular mortality, non-fatal myocardial infarction, and repeat revascularization. PCI was associated with a lower 3-year risk of VOCE in the ischaemic cohort (HR, 0.44; 95% CI, 0.26–0.74;
P
= 0.002) but not in the non-ischaemic cohort. The risk of VOCE was lower in the adherent-to-caFFR group (
n
= 2649) (HR, 0.69; 95% CI, 0.48–0.98;
P
= 0.039).
Graphical Abstract
A novel index that uses coronary angiography images to estimate FFR may have substantial clinical value in guiding management among patients with stable coronary artery disease.
IntroductionProtein malnutrition is associated with higher risks of postoperative complications, mortality, prolonged postoperative stays in hospital, slower physical and mental recovery after ...surgery and lower subsequent health-related quality of life. To reduce the risk of postoperative morbidity and mortality, nutritional prehabilitation programmes have been developed recently to build up patient’s nutritional reserve to withstand the stress of surgery. The intervention involves nutritional screening and counselling, and increasing dietary protein intake in protein-malnourished patients in the several weeks before surgery. However, there are few well-conducted preoperative studies to examine the effect of increasing dietary protein intake on the quality of recovery of malnourished patients after elective cardiac surgery.Method and analysisThis randomised controlled trial of malnourished patients undergoing major elective cardiac surgery will compare the quality of postoperative recovery in patients with or without nutritional prehabilitation. One hundred and thirty-two patients will be randomised to receive nutritional prehabilitation (target-adjusted whey protein powder supplementation and an individualised 1 hour session/week counselling by a dietician 1 month before operation date) or standard care (no nutritional prehabilitation). Primary outcomes will be the quality of recovery after surgery (15-item Quality of Recovery) on the third postoperative day. Secondary outcomes will include days (alive and) at home within 30 days, changes in the WHO Disability Assessment Schedule 2.0, changes in health-related quality of life (EQ-5D) and Cardiac Postoperative Morbidity Survey. An outcomes assessor will be blinded to the treatment allocation. Appropriate univariate analyses, generalised estimating equations and multiple regressions will be performed for intention-to-treat and per-protocol analyses.Ethics and disseminationThe Joint CUHK-NTEC Clinical Research Ethics Committee approved the study protocol (CREC Ref. No.: 2021.703 T). The findings will be presented at scientific meetings, peer-reviewed journals and to study participants.Trial registration numberChiCTR2200057463.
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.
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.
Abstract Introduction Hypertension is found to be associated with obstructive sleep apnea (OSA) in both children and adults. But data on the effect of blood pressure after adenotonsillectomy (AT) for ...children with OSA are limited and controversial. Objective To assess the impact of AT on different parameters of 24-h ambulatory blood pressure monitoring in children with OSA. Methods We retrospectively reviewed records of OSA children who had undergone AT and a repeated sleep polysomnography after AT from 2001 to 2008. Results Forty-four children were identified and included in the analysis. The mean apnea-hypopnea index (AHI) dropped from 14.14 ± 15.9 to 3.3 ± 7.1. ( p < 0.001). Twenty (45%) were cured of OSA. After AT, the diastolic BP load decreased significantly. Six out of eight (75%) hypertensive children became normotensive after surgery. For the pre-AT hypertensive group, both systolic and diastolic blood pressure decreased significantly during sleep after AT. However, eight children who were normotensive before AT became hypertensive after AT. These 10 post-AT hypertensive patients were more likely to have post-AT AHI > 1 than the post-AT normotensive group, although the difference did not reach statistical significance. Conclusion In the current cohort of OSA children, 44% were cured of OSA and a significant decrease in overall diastolic blood pressure load in 24-h ambulatory blood pressure was achieved after adenotonsillectomy for children with OSA. But hypertension may persist or even occur in those previously normotensive children despite the improvement in AHI. Persistence of OSA may be a risk factor and further study is required. Cure of OSA should not be assumed after AT and follow-up PSG should be performed together with 24-h ambulatory blood pressure monitoring. In light of the current findings, long term study of the blood pressure is warranted for children with OSA.
Background Acupuncture combined with auricular acupressure has been used as a complementary and alternative treatment for smoking cessation in Hong Kong for over 10 years. This study aimed to ...investigate the success rates of smoking cessation posttreatment, and to evaluate treatment effects on tobacco dependence, smoking behavior, anxiety levels, and sleep disturbances between successful and unsuccessful quit smokers in Hong Kong. Methods This prospective, multicenter clinical study conducted between September 2020 and February 2022 in Hong Kong was part of the Guangdong-Hong Kong-Macau Greater Bay Area project on smoking cessation. Thirty eligible current smokers (mean age 47.10 years; 40% female) were recruited and received a combination of standardized acupuncture and auricular acupressure treatments twice weekly for 8 weeks. The primary outcome was the success rate of smoking cessation at week 24. The secondary outcomes were the success rates of smoking cessation at weeks 8 and 16, exhaled carbon monoxide (CO) levels, and changes in scores on the Fagerström Test for Nicotine Dependence (FTND), Autonomy Over Smoking Scale (AUTOS), Hamilton Anxiety Rating Scale (HAM-A), Self-rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI). Adverse events were also recorded. Results Of 30 eligible participants, 28 completed 6 or more treatment sessions; all completed follow-up assessments. At week 24, the success rate of smoking cessation was 46.67%. The successfully quit rates at weeks 8 and 16 were 36.67% and 43.33%, respectively. The overall change in mean FTND scores from baseline improved significantly from weeks 2 to 24 (P < 0.05), with the successful quit group showing significantly greater improvement between weeks 8 and 24 (P < 0.01). Compared with baseline values, there were significant reductions in mean AUTOS scores from weeks 6 to 24 (P < 0.001), with the successful quit group showing greater improvement at weeks 16 (P = 0.04) and 24 (P < 0.001). No significant changes were detected in exhaled CO levels or HAM-A, SAS, and PSQI scores. No study-related adverse events were observed. Conclusions Acupuncture combined with auricular acupressure could be an effective alternative treatment for smoking cessation and reduction of tobacco dependence among Hong Kong smokers. Trial registration Chinese Clinical Trial Registry, No. ChiCTR2000033650. Registered on June 7, 2020. Keywords: Acupuncture, Auricular acupressure, Clinical trial, Smoking cessation, Tobacco dependence
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.
