Does nocturnal sweating suggest sleep apnea?

Does nocturnal sweating suggest sleep apnea?

This was the question of

today about sweating in sleep...

In clinical context, nocturnal sweating can be a  sensitive sign of sleep apnea.  But, its not specific.

Sweating often improves with OSA treatment.

 JR


Infants

Sleep. 1993 Aug;16(5):409-13.

Clinical symptoms associated with brief obstructive sleep apnea in normal infants.

Kahn A1, Groswasser J, Sottiaux M, Rebuffat E, Sunseri M, Franco P, Dramaix M, Bochner A, Belhadi B, Foerster M.

Author information

Abstract

Relatively little data exist concerning the manifestations of repeated obstructive sleep apnea in normal infants. A questionnaire concerning daytime and sleep habits was completed by the parents of 4,100 healthy infants before they underwent a 9-hour night monitoring study. One hundred infants with an obstructive apnea index above 1.2 were randomly selected. They formed the "apnea" group. From the initial population, 300 infants with noapnea were also selected to form the "no-apnea" group. Both groups were matched for sex, gestational age, post conceptional age, birth weight, mother's age, parity and a family history of sudden infant death. Five variables from the questionnaires significantly differentiated the two groups of infants. When awake, the infants with apnea were characterized by a greater frequency of breathholding spells (22% of apnea infants) and episodes of fatigue during feeding (28%) than the non-apnea infants. During sleep, they exhibited a greater frequency of profuse sweating (15%), snoring (26%) or noisy breathing (44%). Multiple symptoms were present in some infants. A stepwise logistic regression resulted in two significant independent variables: profuse sweating during sleep (p = 0.008) and noisy breathing (p = 0.002). The predictive value of these two symptoms was tested on a new group of 650 healthy infants. The two independent variables led to the correct classification of 60 of the 67 infants with apnea (89.67%) and 382 of the 583 non-apnea infants (65.5%). A positive history alone had a positive predictive value of 0.21.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID:

 

8378681

 

[PubMed - indexed for MEDLINE]

Children

Arch Dis Child. 2012 May;97(5):470-3. doi: 10.1136/adc.2010.199638. Epub 2011 Mar 22.

Night sweats in children: prevalence and associated factors.

So HK1, Li AM, Au CT, Zhang J, Lau J, Fok TF, Wing YK.

Author information

Abstract

OBJECTIVE:

The authors aimed to examine the prevalence and factors associated with night sweats (NS) in primary school children.

STUDY DESIGN:

Cross-sectional design.

RESULTS:

Among 6381 children (median age 9.2 (7.7-10.7) years) with complete information on NS, 3225 were boys (50.5%). 747 children (11.7%) were reported to have weekly NS in the past 12 months. Boys were more likely than girls to have NS (p<0 .0001="" children="" class="highlight" have="" likely="" more="" nbsp="" ns="" span="" to="" were="" with="">sleep

-related symptoms and respiratory and atopic diseases. In addition, they were more likely to be hyperactive and have frequent temper outbursts. Using an ordinal regression model, NS was found to be significantly associated with male gender, younger age, allergic rhinitis, tonsillitis and symptoms suggestive of obstructive sleep apnoea, insomnia and parasomnia.

CONCLUSION:

NS is prevalent among school-aged children and is associated with the presence of sleep-related symptoms and respiratory and atopic diseases.

Adults

• Respiratory medicine

Nocturnal sweating—a common symptom of obstructive sleep apnoea: the Icelandic sleep apnoea cohort

1. Erna Sif Arnardottir1,2, 
2. Christer Janson3, 
3. Erla Bjornsdottir1,2, 
4. Bryndis Benediktsdottir1,2,
5. Sigurdur Juliusson4, 
6. Samuel T Kuna5,6, 
7. Allan I Pack5, 
8. Thorarinn Gislason1,2

+Author Affiliations

1. ¹Department of Respiratory Medicine and Sleep, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
2. ²Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
3. ³Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala Universitet, Uppsala, Sweden
4. ⁴Department of Otolaryngology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
5. ⁵Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
6. ⁶Department of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA

1. Correspondence toDr Thorarinn Gislason; thorarig@landspitali.is

• Received 26 February 2013
• Accepted 10 April 2013
• Published 14 May 2013

Abstract

Objectives To estimate the prevalence and characteristics of frequent nocturnal sweating in obstructive sleep apnoea (OSA) patients compared with the general population and evaluate the possible changes with positive airway pressure (PAP) treatment. Nocturnal sweating can be very bothersome to the patient and bed partner.

Design Case–control and longitudinal cohort study.

Setting Landspitali—The National University Hospital, Iceland.

Participants The Icelandic Sleep Apnea Cohort consisted of 822 untreated patients with OSA, referred for treatment with PAP. Of these, 700 patients were also assessed at a 2-year follow-up. The control group consisted of 703 randomly selected subjects from the general population.

Intervention PAP therapy in the OSA cohort.

Main outcome measures Subjective reporting of nocturnal sweating on a frequency scale of 1–5: (1) never or very seldom, (2) less than once a week, (3) once to twice a week, (4) 3–5 times a week and (5) every night or almost every night. Full PAP treatment was defined objectively as the use for ≥4 h/day and ≥5 days/week.

Results Frequent nocturnal sweating (≥3× a week) was reported by 30.6% of male and 33.3% of female OSA patients compared with 9.3% of men and 12.4% of women in the general population (p<0 .001="" 11.5="" 33.2="" adjustment="" after="" age="" and="" cardiovascular="" change="" compared="" decreased="" demographic="" difference="" disease="" factors.="" for="" frequent="" from="" full="" hypertension="" in="" insomnia="" nocturnal="" non-users="" of="" p="" pap="" prevalence="" related="" remained="" significant="" sleepiness="" sweating="" symptoms.="" the="" this="" to="" treatment="" was="" with="" younger="">

Conclusions The prevalence of frequent nocturnal sweating was threefold higher in untreated OSA patients than in the general population and decreased to general population levels with successful PAP therapy. Practitioners should consider the possibility of OSA in their patients who complain of nocturnal sweating.

Article summary

Article focus

• Previous studies have suggested a possible relationship between obstructive sleep apnoea and frequent nocturnal sweating. However until now, studies comparing the prevalence of frequent nocturnal sweating in untreated sleep apnoea patients compared with the general population as well as changes with sleep apnoea treatment have been lacking. Our study focuses on the role of nocturnal sweating in sleep apnoea.

Key messages

• Our study indicates a possible role of frequent nocturnal sweating as a marker for untreated sleep apnoea. One-third of adults with sleep apnoea experience this symptom and they are three times more likely to report it compared with adults in the general population. The symptom is responsive to treatment in the majority of sleep apnoea patients.
• Clinicians should include sleep apnoea in the differential diagnosis of patients presenting with a complaint of nocturnal sweating and further investigate that possibility.

Strengths and limitations of this study

• The strengths of this study include the detailed assessment of a large number of sleep apnea patients studied with a two year follow-up and the comparison with a general population cohort.
• Our study was an observational study, not a randomised controlled trial, which may be considered a limitation. Other limitations include the use of subjective measures of sweating and the smaller number of women with sleep apnea than men, due to lower prevalence.

Ways to get children to sleep more

This article discusses why children may not be sleeping much and how to get them to sleep more.

Asking sleep experts for advice on how to put children to bed often feels like an exercise in futility. The standard tips are banal and predictable: avoid caffeine; remove the TV from their bedroom; don’t sleep on a full stomach; put up dark blinds. You have the feeling the experts are holding out on us—there has to be something more. And there is. Here’s the stuff they’d love to tell you, if they weren’t afraid of overwhelming you with science.

• Ever wonder why most people sleep better when their bedrooms are cool? It’s because the circadian rhythm system that helps regulate sleep cycles is not just light sensitive, it’s temperature sensitive. Anything above a neutral air temperature both slows the body’s initiation of sleep and changes sleep patterns—a hotter room means an increase in non-REM sleep.

• 77 percent of children use television as part of their pre-bedtime routine. Sitting still and vegging out for half an hour should, theoretically, help a child unwind, as long as they’re not watching a show that excites them too much. However, the brightness of the screen undermines the theory. The light from a television or computer can delay both the necessary drop in core body temperature and melatonin production—and thus delaying sleep onset—by two hours.

• We’re all familiar with the agony of being super exhausted, yet not being able to fall asleep for hours. What gives? It’s because after just a few days of shortened sleep, the brain starts making extra stress hormone cortisol. It takes six times as long for this stress hormone to drop to a low-enough level that sleep is possible.

• In one study of 170 children, those in white-collar families tended to be in bed later and get up earlier than those in working-class families. Yet they actually got more actual sleep. How is that possible? It’s because their bedtimes and wake-times were more consistent; they stuck to their routine. This made their sleep more efficient—they rolled around in bed far less.

• Inconsistent bedtimes are, for all practical purposes, homemade jet lag—the desynchronization of the two systems that regulate sleep, the circadian rhythm and the homeostatic pressure system. Staying up three hours later on weekends is equivalent to flying across three time zones every weekend.

• With children averaging three hours of television per day, it’s hard to make the case children are universally overscheduled. But the most driven children are the most overscheduled—and the most sleep deprived. In some ways, these busy overachievers are those who concern the experts the most. According to University of Minnesota’s Dr. Kyla Wahlstrom, a motivated student can sacrifice sleep to maintain high GPAs, but she may pay for that success with higher levels of depression and stress. Teen boys who have a high number of extracurriculars are significantly more likely to be involved in a fall-asleep car crash. And those with part-time jobs both sleep less and have lower grades.

• For the majority of kids, rather than thinking it’s a choice between sleep and activities, the opposite is true: Students who sleep more are involved in more afterschool activities—with no detriment to their grades. They have the energy to be involved. Schools that have delayed start times have seen their students sleep more and increase their participation in sports and extracurriculars.

• Naps are not quite the salve we imagine. They appease the homeostatic pressure system, but not the circadian. You wake up feeling better—a two-hour nap is equivalent to 150 mg of caffeine—but naps do nothing to repair diminished cognitive functioning. The intellect is just as dulled after the nap as before. Kindergartners who take long naps, for instance, do worse on puzzle-solving.

• 16 percent of kids snore a few times a week. As recently as 2002, the American Academy of Pediatrics opined that children’s snoring was a benign condition not warranting treatment. Just five years later, researchers now caution that kids’ snoring is not like adult snoring at all—even a little snoring is a major cause for concern, because their developing brains can be deprived of oxygen.

• Common sleep disorders such as nightmares, restless leg syndrome, and frequent night waking can have a startlingly negative impact on children’s development—from using drugs at 14 to having clinical-level anxiety as adults. Research by University of Michigan’s Dr. Ronald Chervin indicates as many as 25 percent of kids diagnosed with ADHD have an underlying sleep disorder causing their symptoms. If treated for their sleep disorder, the ADHD would magically disappear. Despite the risks posed by sleep disturbance, the number of children treated for them is “vanishingly small.” Parents should consult a qualified sleep specialist—few pediatricians have expertise with sleep problems. Waiting to see if a child grows out of a sleep problem isn’t the answer.

Read more here

Sleep disorders in children can hurt their development

This article discusses how detrimental sleep disorders can be to children and their development.

Sleep behaviors are one of the most common concerns parents of young children discuss with their pediatricians. In infancy and early childhood, the developing brain requires more time asleep than it does awake.As a result, sleep quality is extremely important in the overall well-being of a child. Children suffering from lack of quality sleep or sleep-related disorders can jeopardize their cognitive, emotional and physical development. Pediatric sleep problems don’t just affect the child - they often have a negative impact on other siblings’ quality of sleep and the entire family dynamic.

Sleep disturbances are diagnosed in 25 to 30 percent of infants and children. Causes can include an inconsistent bedtime routine, sleepwalking, sleep apnea, narcolepsy and epilepsy. Not surprisingly, pediatric sleep disorders are often overlooked because presenting symptoms of negative behavior, moodiness, irritability, lack of motivation, inability to focus, lethargy are misdiagnosed as behavioral or emotional problems, not a physical, medical condition. Severe or chronic sleep disorders can even cause adverse cardiovascular and metabolic effects as well as failure to thrive.

Common pediatric symptoms

Symptoms of sleep disorders in children can be obvious or subtle and often present with one or more of these symptoms on a regular basis:

 ongoing bedtime resistance

 nightly awakenings

 sleepwalking

 nightmares

 bedwetting

 insomnia

 chronic snoring/breathing difficulties

How to proceed if you suspect a sleep disorder

First, consult with your pediatrician to rule out any acute or chronic medical conditions. Once medically cleared, it may be helpful to clinically observe and monitor your child in a sleep center that offers pediatric diagnosis and treatment services. These centers offer comfortable bedroom like settings where sleep patterns are evaluated and diagnosed during an overnight stay.A parent accompanies the child during the stay to provide comfort and alleviate anxiety.A sleep technologist applies small painless sensors designed to monitor your child’s brainwaves, muscle activity, heart rhythms, respiratory activity and oxygen saturation levels throughout the night. The results are then analyzed by a pediatric sleep medicine physician, who will determine a diagnosis and recommend the most appropriate treatment for your child, if necessary. Once properly diagnosed, this and other sleep-related medical conditions can be successfully treated to restore and continue the child’s normal development process. If you suspect your child may have a sleep issue, see your pediatrician and discuss a sleep study evaluation.

Read more here

Sleep Disordered Breathing in Children and its Risks

This article discusses signs of sleep disordered breathing in children, its prevalence and other statistics on sleep disordered breathing, and the risks it poses to the child's health.

Does your child snore? Does he breathe through his mouth when he sleeps? Do you ever notice pauses in your child's breathing while she's asleep? If you've answered yes to any of these questions, your child may be suffering from sleep-disordered breathing.

Sleep-disordered breathing in children is disruptive to their nightly rest, which can result in other health problems. Scientists are still working to get a sense of how prevalent the disorder is among children. We're also still learning about the risk factors that contribute to sleep-disordered breathing in children, as well as the health consequences for kids who suffer from it. Increasingly, it appears that both the risks and the health effects of sleep-disordered breathing are different in children than they are in adults. A new study examines both the prevalence of sleep disordered breathing in children, and the particular risk factors they face.

Researchers in Finland examined sleep-disordered breathing in 491 children ages 6-8. Their study, which was part of a larger research project on child health, analyzed the prevalence of sleep-disordered breathing among the children. The study also examined risk factors that might contribute to the sleep disorder, including tonsil size, jaw position and facial proportions. For the purpose of this study, sleep-disordered breathing was defined as frequent or loud snoring, mouth breathing during sleep and sleep apnea.

Here are some important highlights of their results:

• 9.9% of children had some type of sleep-disordered breathing. This rate was the same for both boys and girls in the study
• Average body-fat percentage was 20.6 for girls and 15.0 for boys
• 11.4% of boys and 15.6% of girls were overweight or obese
• Body fat was not associated with an increased risk of sleep-disordered breathing. Sleep-disordered breathing was no more frequent among obese and overweight children in this study than among children at normal weight

Several craniofacial features were associated with elevated risk for sleep-disordered breathing: 

• Children with enlarged tonsils were 3.7 times as likely to experience symptoms of sleep-disordered breathing


• Children with cross bite were 3.3 times a likely to have sleep-disordered breathing. Cross bite is a dental condition where teeth are out of alignment with corresponding teeth above or below.


• Children with convex facial profiles were 2.6 times as likely to suffer from sleep-disordered breathing as children with other facial types. Convex facial features include prominent forehead and brow line and receding chin.

These results suggest that the risk factors for sleep-disordered breathing in children may be very different than those for adults. The most significant risk factor of sleep-disordered breathing in adults is excess body weight. Research indicates that 70% of people who are morbidly obese have obstructive sleep apnea. This study indicates that excess weight may not be a risk factor for children. For them, features of the head, neck and throat, as well as certain dental conditions, may be more significant indicators of risk for sleep-disordered breathing.

The health problems for children who develop sleep-disordered breathing also appear to be different than those for adults. A growing body of research indicates that children who experience sleep-disordered breathing are at greater risk for problems with behavioral, emotional and cognitive development: 

• This large-scale study of more than 11,000 children found that kids with sleep-disordered breathing were significantly more likely to exhibit behavioral and emotional problems, including hyperactivity, anxiety, depression, social issues with peers, and conduct problems including aggressiveness.


• Children who exhibit aggressive and bullying behavior in school were twice as likely to have some form of sleep-disordered breathing, according to this research


• Children with sleep-disordered breathing demonstrated lower intellectual abilities than those without, in this study. This cognitive impairment existed regardless of the degree of severity of the sleep disorder. Even children with mild forms of sleep-disordered breathing experienced cognitive difficulties.

A recent large-scale study in the United States examined the prevalence for sleep disordered breathing among children. Researchers evaluated more than 12,000 children between the ages 6 months and 6.75 years, and found: 

• 1-2% of children across all ages suffer from chronic sleep apnea


• As many as 21% of children in this age range snore habitually


• Children ages 1.5-2.5 years are especially vulnerable to snoring: researchers found a significant increase in rates of snoring among children at this age


• By the age of six, 25% of children are mouth breathing during sleep

These latest results from Finnish scientists add to the body of research that indicates how significant an issue sleep-disordered breathing is for children. We need to know more about the prevalence of the disorder among children, as well as the risk factors and health consequences. We also need to further explore how the risks to children may differ from adults.

To avoid the behavioral, cognitive and emotional problems associated with sleep-disordered breathing, we also need to get better at identifying the problem. Early intervention can help avoid more serious problems that can occur if the disorder is left untreated. The most effective treatment strategy will involve the cooperation among doctors and dentists. But the process starts with parents. Paying attention to your child's breathing during sleep, and bringing attention to any signs of irregular breathing, is the first and critical step.

Read more here

How successful is tonsillectomy for treating sleep apnea in children? Only 25% are normalized!

J Pediatr. 2006 Dec;149(6):803-8.

Parents and patients often assume that they are "cured" after tonsillectomy. JR

Persistence of obstructive sleep apnea syndrome 

in children after adenotonsillectomy.

Tauman R, Gulliver TE, Krishna J, Montgomery-Downs HE, O'Brien LM, Ivanenko A, Gozal D.

Source

Kosair Children's Hospital Research Institute and the Department of Pediatrics, Division of Pediatric Sleep Medicine, University of Louisville, Louisville, Kentucky, USA.

Abstract

OBJECTIVE:

To investigate the relative contribution of various risk factors to the surgical outcome of adenotonsillectomy for obstructive sleep apneasyndrome in children.

STUDY DESIGN:

Children (n = 110; mean age, 6.4 +/- 3.9 years) underwent two polysomnographic evaluations before and after adenotonsillectomy. In addition, 22 control children were studied. History for allergy and family history of sleep-disordered breathing was taken before each polysomnographic evaluation.

RESULTS:

Significant changes in sleep stage percentages and sleep fragmentation were found in the postsurgery study compared with the presurgery study; 25% of the children had apnea/hypopnea index (AHI) </=1, 46% had AHI >1 and <5 29="29" ahi="ahi" and="and" had="had">/=5 in the postsurgery study. The frequency of subjects with AHI </=1 after surgery was significantly lower among obese subjects (P < .05). Comparison between the children who had AHI </=1 after surgery and 22 control children showed complete normalization of sleep architecture after surgery.

CONCLUSIONS:

Adenotonsillectomy yields improvements in respiratory abnormalities in children with obstructive sleep apnea syndrome. Complete normalization occurs in only 25% of the patients. Obesity and AHI at diagnosis are the major determinant for surgical outcome. When normalization of respiratory measures occurs after surgery, normalization of sleep architecture will also ensue.