Ekkehart Paditz

Obstructive Sleep Apnea Syndrome in Children

Snoring and obstructive sleep apnea are a frequent problem not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. The epidemiology, etiology, diagnosis, and management of obstructive sleep apnea syndrome (OSAS) in adults have been adequately established on the basis of evidential data. As a result of this, both physicians and the public are increasingly aware of OSAS in adults. Although there are numerous parallels between pediatric and adult OSAS, the situation in children differs that in adults. There is a greater variety of symptoms in children with OSAS, diagnosis is often more difficult with serious consequences for growth and development of children. Treatment of OSAS in children is also different from that of the adult patient.There are many possible causes for the development of obstructive sleep apnea in children. These include hypertrophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. OSAS can, however, also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy.Epidemiological data presented in the literature concerning the incidence of OSAS in children is extremely varied. This wide range is probably due to the fact that snoring may be misdiagnosed as OSAS.The diagnosis of OSAS in children may only be made by considering clinical history (such as rate of growth, tendency to fall asleep during the day, sleep disturbances, susceptibility to infection, etc.), polysomnography (if possible during several nights) and accompanying instrumental diagnosis including cephalometry or laryngoscopy. One of the problems of polysomnography in childhood is that performance and interpretation of the results have not yet been standardized or evaluated for different age groups.Treatment depends on the cause of OSAS and require multidisciplinary management involving the pediatrician, pediatric or adolescent psychiatrist, ear, nose, and throat specialist, maxillofacial surgeons, and neurosurgeons. Adenotonsillectomy (ATE) is the therapy generally chosen if the child has adenoidal vegetations and/or tonsillar hypertrophy. Corrective surgery is possible for rare malformation syndromes. Nocturnal masks for continuous positive airway nasal pressure or procedures for mask respiration are effective in children, but are only used in exceptional cases, such as when ATE is contraindicated or when symptoms of OSAS remain after surgery. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials.

Compound effect of PHOX2B and RET gene variants in congenital central hypoventilation syndrome combined with Hirschsprung disease

Guido Fitze,* Inke R. König, Ekkehart Paditz, Alexandre Serra, Marianne Schläfke, Dietmar Roesner, Andreas Ziegler, and Hans K. Schackert Department of Pediatric Surgery, University of Technology Dresden, Dresden, Germany Department of Pediatrics, University of Technology Dresden, Dresden, Germany Department of Surgical Research, University of Technology Dresden, Dresden, Germany Institute of Medical Biometry and Statistics, University at Lübeck, Lübeck, Germany Department of Applied Physiology, Ruhr-University Bochum, Bochum, Germany

Diagnostik von Schlafstörungen und schlafbezogenen Atmungsstörungen im Kindes- und Jugendalter im Schlaflabor

ZusammenfassungSchlafstörungen und schlafassoziierte Störungen stellen im Kindesalter ein häufiges Problem dar. Die Zuweisung an ein pädiatrisches Schlaflabor wie auch die Diagnostik und Einleitung von Therapiemaßnahmen werden uneinheitlich gehandhabt. In diesem Konsensuspapier werden daher Empfehlungen formuliert, wann pädiatrische Patienten einem Kinderschlaflabor zugewiesen werden sollten und welche Voruntersuchungen notwendig sind. Des Weiteren wird erläutert, für wie viele Nächte der Patient untersucht und welche Parameter ermittelt werden sollten.Die Polysomnographie (PSG), der diagnostische Goldstandard bei den schlafbezogenen Atmungsstörungen, den Hypersomnien und den schlafbezogenen Bewegungsstörungen, ist im Kindesalter in der Regel eine stationäre Leistung. Die Beobachtung der Kinder während der PSG muss durch geschultes Personal erfolgen. Die Durchführung und Auswertung der Diagnostik im Schlaflabor sollte durch einen pädiatrischen Schlafmediziner bzw. Somnologen überwacht werden.Aufgrund des deutlichen Mehraufwands für eine PSG im Kindesalter wird eine adäquate Vergütung gefordert.AbstractSleep disorders and sleep-related disorders are a common problem in childhood. The referral to a pediatric sleep laboratory as well as the diagnostics and introduction of therapeutic measures are inconsistently applied. Therefore, in this consensus paper recommendations are formulated for when pediatric patients should be referred to a sleep laboratory and which preliminary examinations are necessary. Furthermore, recommendations are given on how many nights are necessary for a patient to be examined and which parameters should be investigated. Polysomnography (PSG), the gold standard for sleep-associated respiratory disorders, hypersomnia and sleep-related movement disorders, should normally be performed in pediatric cases as an inpatient. Observation of children during PSG must also be carried out by trained personnel. The examination and evaluation of the diagnostics in a sleep laboratory should be supervised by a pediatric sleep doctor or somnologist. Due to the much higher labor and cost-intensive procedure involved for a PSG in childhood, an adequate reimbursement is necessary.

Untersuchung zur Genauigkeit der Abtastung von EKG-Signalen für eine nachfolgende Spektralanalyse kontinuierlich gemessener RR-Intervalle im Schlaflabor@@@Assessment of Accuracy of ECG signal sampling for spectral analysis of beat-to-beat recorded R-R intervals in a sleep laboratory

ZusammenfassungFragestellungZur erforderlichen Genauigkeit der automatisierten Registrierung der RR-Intervalle gibt es unterschiedliche Aussagen. Es soll gezeigt werden, dass Abtastfrequenzen von 100 Hz bis zu 40 Hz keine signifikanten Beeinträchtigungen der Spektralanalysen von RR-Intervallen darstellen.Patienten und MethodikEs wurden 30 Patienten im Schlaflabor mit einer EKG-Abtastung von 100 Hz mit dem Alice 3.0 System untersucht. Da mit diesem System auch Abtastfrequenzen von 40 Hz möglich sind, wurden die Auswirkungen beider unterschiedlichen Abtastfrequenzen auf eine nachfolgende Spektralanalyse untersucht. Die Untersuchung wurde für die Gesamtpopulation (N=30) sowie für zwei unterschiedliche Mittelwertgruppen (RR>900 ms; n=15 und RR<900 ms; n=15) durchgeführt. Die Abtastwiederholung erfolgte mittels Simulationstechnik.ErgebnisseDie mittlere Länge der RR-Intervalle wirkt sich auf die spektralen Parameter unterschiedlich aus. Zeitbereichsparameter wurden kaum verändert. Unterschiede > 5 % zwischen beiden Abtastfrequenzen gab es nur im sehr hohen Frequenzband > 0.40 Hz (UHF) für kurze mittlere RR-Intervalle. Alle anderen Abweichungen waren in der Größenordnung von 1–3%.SchlussfolgerungMittels Simulation konnten nur geringe Beeinträchtigungen von Spektralanalysen gefunden werden. Entscheidend ist eine mathematisch korrekte Analysemethodik. Weitere Vergleiche mit gleichzeitig unterschiedlichen Abtastfrequenzen sind notwendig um die Ergebnisse dieser mathematischen Simulationen unter echten Ableitungsbedingungen zu bestätigen.SummaryQuestion of the studyThere are differing opinions regarding the accuracy required of sampling frequencies in ECG signals. The question of this study was whether sampling frequencies of 100 Hz or 40 Hz would significantly influence the results of spectral analysis of R-R intervals.Patients and methodsThirty subjects underwent polysomnographic recordings in the sleep laboratory, sampled at a frequency of 100 Hz using the Alice 3.0 system. Two different sampling frequencies were used to assess the effects on a subsequent spectral analysis of R-R intervals. Repetition using a different sampling frequency was performed with a simulation technique. The study was performed on the total group (N=30) and on two different subgroups (mean R-R>900 ms; n=15 and mean R-R<900 ms; n=15), respectively.ResultsAlthough different means of R-R intervals influence the following spectral parameters in different ways, there are only small changes in the time domain. Differences >5% in analyses using two different sampling frequencies was found only in the UHF band (very high frequency band >0.40 Hz) in time series with short R-R intervals. In LF band and HF band, the differences varied between 1% and 3%.ConclusionsUsing the simulation technique, we found only small changes in the spectral analysis parameters. The selection of a correct mathematical approach seems to be an important precondition. Additional comparative studies using different sampling frequencies for the same data segment are necessary to confirm these results in real-time conditions.