Sunday, August 09, 2015

Identification of Sleep Disorders in Infants of the Houston Area with Medical, Pediatric Neurology, Pulmonary Problems

Who would argue that normal oxygenation and sleep is important for development?

I came across these articles recently and wanted to share. 

Dr Susarla and I want to do as much as possible to improve the lives of our patients. Sometimes we see patients who have had unrecognized sleep problems for years. Sometimes we see patients who failed adenotonsillectomy and never followed up. 

Sleep apnea is highly prevalent in infants with complex health care needs. It is treatable...if recognized

Take some time to ask about your patient/client's sleep.  Do they look tired? Are they "over-tired" at times? Are they in a high risk group? 

Please let us know how we can help. 

Josh Rotenberg MD

J Clin Sleep Med. 2014 Nov 15;10(11):1213-6. doi: 10.5664/jcsm.4204.

Comorbidities in infants with obstructive sleep apnea.



The clinical characteristics of obstructive sleep apnea (OSA) in infants have been insufficiently characterized. Our aim was to describe identifiable comorbidities in infants with obstructive sleep apnea, which may assist in recognizing these patients earlier in their disease course and help improve management.


This was a single-center, retrospective study involving infants 0-17 months of age with a diagnosis of OSA on the basis of clinical features and nocturnal polysomnography (PSG) at the Mayo Clinic Center for Sleep Medicine between 2000 and 2011. Patients were excluded if they had central apnea accounting for greater than 50% of respiratory events. OSA severity was determined by the apnea-hypopnea index (AHI).


One hundred thirty-nine patients were included. Based upon the AHI, they were subdivided into mild (AHI <5 30="" 5-9="" moderate="" or="" severe="">10; 40%) categories. Comorbidities included:
  • gastroesophageal reflux in 95/139 (68%), 
  • periodic limb movements in sleep in 59/139 (42%), 
  • craniofacial abnormalities in 52/139 (37%), 
  • neuromuscular abnormalities in 47/139 (34%), 
  • prematurity in 41/139 (29%), 
  • geneticsyndromes in 41/139 (29%), 
  • laryngomalacia / tracheomalacia in 38/139 (27%), and 
  • epilepsy in 23/139 (17%) of subjects.

 Severity of OSA correlated with prematurity, having a genetic syndrome, or neuromuscular abnormality. 

Multispecialty evaluation was needed for 119/139 (86%).


Comorbidities in infants with OSA differ from those of older children. Based upon the comorbidities identified in our study population, it appears that appropriate management of infants with OSA requires a multidisciplinary approach involving genetics, gastroenterology, pulmonology, otolaryngology, neurology, and general pediatrics.
© 2014 American Academy of Sleep Medicine.


Infant; obstructive sleep apnea; polysomnography; sleep disordered breathing; sleep disorders

J Plast Reconstr Aesthet Surg. 2014 Nov;67(11):1475-80. doi: 10.1016/j.bjps.2014.07.026. Epub 2014 Jul 31.

Screening for obstructive sleep apnea in children with syndromic cleft lip and/or palate.
Silvestre J1, Tahiri Y1, Paliga JT1, Taylor JA2.

Author information
Craniofacial malformations including cleft lip and/or palate (CL/P) increase risk for obstructive sleep apnea (OSA). While 30% of CL/P occurs in the context of underlying genetic syndromes, few studies have investigated the prevalence of OSA in this high-risk group. This study aims to determine the incidence and risk factors of positive screening for OSA in this complex patient population.
The Pediatric Sleep Questionnaire (PSQ) was prospectively administered to all patients cared for by the cleft lip and palate clinic at the Children's Hospital of Philadelphia between January 2011 and August 2013. The PSQ is a 22-item, validated screening tool for OSA with a sensitivity and specificity of 0.83 and 0.87 in detecting an apnea-hypopnea index (AHI) >5/hour in healthy children. The Fisher exact and Chi-square tests were used for purposes of comparison.
178 patients with syndromic CL/P completed the PSQ. Mean cohort age was 8.1 ± 4.4 years. Patients were predominately female (53.9%), Caucasian (78.1%), and had Veau Class II cleft (50.6%). Craniofacial syndromes included isolated Pierre Robin Sequence (PRS) (29.8%), 22q11.2 deletion syndrome (14.6%), Van der Woude syndrome (6.7%), and other rare genetic abnormalities (28.8%). The overall incidence of positive OSA screening was 32.0%. Males were at increased risk for positive OSA screening (P = 0.030), as were non-Caucasians (P = 0.044). Symptoms with the highest positive predictive value for OSA were "others comment on child appearing sleepy" (76.2%) and "stops breathing during the night" (75.0%). Notably, patients with 22q11.2 deletion syndrome were at highest risk for positive screens (50.0%, P = 0.042).

Nearly a third of our patients with syndromic CL/P screened positively for OSA (32.0%), highlighting the importance of screening in this at-risk population. Future work will correlate screening results with polysomnograms to help validate these findings.

Diagnostic, III.
Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Cleft lip and palate; Obstructive sleep apnea; Pediatric; Questionnaire; Screening

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