Felipe Damiani

Sleep-Disordered Breathing in Adolescents and Younger Adults: A Representative Population-Based Survey in Chile

BACKGROUND Prevalence and potential risk contributors of sleep-disordered breathing (SDB) in adolescents and younger adults remain unclear. We hypothesized that SDB prevalence in younger Hispanic adults is higher than the limited evidence indicates. METHODS This is a population-based study of Hispanic subjects surveyed as part of the Chilean National Health Survey database. For this study, only subjects aged 15 to 40 years were included. Sleep and demographic questionnaires were used to assess SDB prevalence and its risk factors. Anthropometric measurements were performed in each subject. Prevalence was calculated for each SDB-related symptom. A regression model was constructed to investigate demographic risk factors of SDB. RESULTS A total of 2,147 subjects were included. Mean age (± SD) was 27.2 ± 7.2 years, n = 899 (42%) were men. Habitual snoring was highly prevalent, with an average of 53.8% in men and 38.3% in women. Snoring, witnessed apneas, and daytime somnolence increased continuously with age, with an abnormal SDB questionnaire score detected in 2.5%. Reported sleep duration was 7.61 ± 1.67 hours during weekdays and 8.27 ± 2.11 hours during weekends. Snoring frequency was significantly higher in men than women at nearly all age groups, and an adjusted regression model (OR [95% CI]) identified male sex (2 [1.6-2.5]; P < .001) and BMI (1.08 [1.03-1.12]; P < .001) as independent risk factors for snoring. CONCLUSION The risk of SDB is highly prevalent in younger adults, even in females, and increases with age and BMI. The high prevalence and low awareness justify active screening and treatment of SDB in this population.

Sleep-disordered breathing in children with Down syndrome: Usefulness of home polysomnography

OBJECTIVE To investigate the technical feasibility of unattended home polysomnography (HPSG) in children with Down syndrome. METHODS Data from children with Down syndrome under 10 years of age referred to a diagnostic sleep study was analyzed. A full sleep-lab based polysomnography (PSG) or a HPSG with a portable device was performed. Uninterpretable HPSGs were defined as: recordings with (i) loss of ≥2 of the following channels: nasal flow, or thoracoabdominal sensors, or (ii) HPSG with less than 4h of artifact-free recording time or (iii) less than 4h SpO2 (peripheral capillary oxygen saturation) signal. RESULTS A total of 44 children (68% males) were included in the study, with a mean age of 3.6 (0.1-10) years. PSG was performed in 8 cases and HPSG in 36 cases. Six HPSG recordings were classified as uninterpretable and had to be repeated. Age, gender and BMI were no significant predictors of uninterpretability of the HPSG. Obstructive sleep apnea (OSA) was present in 61% (n=27) of all subjects, and classified as mild, moderate, and severe in 43% (n=19), 11% (n=5), and 7% (n=3) of cases, respectively. Interpretable and technically acceptable HPSGs were obtained in 30 subjects (83%). Age, gender and BMI were no significant predictors for interpretability of the HPSG. DISCUSSION This study demonstrates that a portable polysomnographic home device may be helpful for diagnosing OSA in children with Down syndrome. Considering the potential consequences of untreated OSA, this screening test may be helpful for early diagnosis of OSA in children with Down syndrome.

Geographic latitude and sleep duration: A population-based survey from the Tropic of Capricorn to the Antarctic Circle

ABSTRACT The impact of latitude on sleep duration remains virtually unexplored, even though latitude exerts profound influences on daylight duration. Using Chile as a one-country model, we explored on the potential associations between sleep duration and latitude. Based on the 2nd Chilean Health Survey, we identified reported sleep data during spring of people living from north to south in Chilean cities, located between 18°29ʹS to 53°18ʹS (4329 km distance at same longitude). A total of n = 2493 participants were included (mean age 45.3 ± 18.4 years, 41.8% males). Mean sleep duration on workdays and weekends was 7.42 ± 1.71 h, and 7.91 ± 2.13 h, respectively, ranging from 7.91 ± 1.92 h in the north to 8.33 ± 1.89 h in the south, such that more northern latitudes (i.e., 18°29ʹS to 39°50ʹS) slept less compared to more southern latitudes (i.e., 51°43ʹS–53°18ʹ), even after controlling for age, gender, and socioeconomic status. In the logistic regression models, men residing at northern latitudes exhibited an odds ratio of 3.348 [95% CI: 1.905–5.882; p < 0.0001] for having shorter sleep on weekends than their southern counterparts. Latitude appears to strongly affect reported sleep patterns, leading to longer sleep duration with increasing latitude, particularly in men during weekends. Whether environmental factors such as photoperiod are causally involved in theses associations needs to be elucidated in future studies.

Long-term effects of adenotonsillectomy in children with obstructive sleep apnoea: protocol for a systematic review

Introduction Adenotonsillar hypertrophy is the most important anatomical factor associated with obstructive sleep apnoea syndrome in children. The American Academy of Pediatrics recommends adenotonsillectomy as the first line of treatment. AT can reduce the apnoea hypopnoea index; however, its effect on long-term outcomes remains unclear. Methods and analysis We will conduct an electronic search for randomised controlled trials in MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. We will also identify literature by reviewing the references included in the selected studies and relevant reviews, screening through important scientific conferences, and searching for ongoing trials in the WHO International Clinical Trials Registry Platform. Two researchers will independently undertake selection of studies, data extraction and assessment of the risk of bias of included studies. We will estimate pooled risk ratios for dichotomous data, and mean difference or standardised mean difference for continuous outcomes. A random-effects model will be used for meta-analyses. Data synthesis and other analyses will be conducted using RevMan V.5.3 software. Ethics and dissemination No ethics approval is considered necessary. The results of this study will be disseminated via peer-reviewed publications and social networks. Trial registration number CRD42015022102.

Effect of a Lung Rest Strategy During Ecmo in a Porcine Acute Lung Injury Model

ECMO is used to treat patients who develop refractory hypoxemia and to provide a more protective ventilation. Several guidelines recommend “lung rest” strategies based on variable ventilatory parameters. However, there is limited evidence to support this strategy.