Hasnaa E. Jalou

Morning Blood Pressure Is Associated with Sleep Quality in Obese Adolescents

OBJECTIVE To examine relationships among blood pressure (BP), adiposity, and sleep quality with the use of overnight polysomnography in obese adolescents. STUDY DESIGN Overnight polysomnogram and morning BP measurements were performed in obese (body mass index [BMI] >95th percentile) nondiabetic adolescents (eligible age range 12-18 years, n = 49). Subjects were stratified into 2 groups, one with normal BP, and one with elevated BP, and demographic and clinical characteristics were compared between the groups. Multiple linear regression analysis was used to assess the effects of sleep quality on BP. RESULTS Participants (n = 27) had a normal morning BP, and 22 (44.9%) had elevated morning BP. There were no differences in age (P = .53), sex (P = .44), race (P = .58), or BMI (P = .56) between the 2 BP groups. The group with elevated BP spent shorter percentages of time in rapid eye movement (REM; P = .006) and slow-wave sleep (SWS; P = .024). Multiple linear regression analysis showed that a lower percentage of both REM and SWS was associated with increased morning BP after we adjusted for pubertal stage, sex, race, and BMI. CONCLUSION Lack of deeper stages of sleep, REM sleep, and SWS is associated with greater morning BP in obese adolescents, independent of BMI. Poor sleep quality should be considered in the work-up of obese youth with hypertension. Intervention studies are needed to evaluate whether improving the quality of sleep will decrease BP elevation.

Obstructive sleep apnoea in obese adolescents and cardiometabolic risk markers

In paediatric patients, obstructive sleep apnoea is associated with adiposity, especially visceral adiposity. In adults, obstructive sleep apnoea is also associated with a higher prevalence of cardiovascular disease and type 2 diabetes. There are limited and conflicting paediatric studies examining the association between obstructive sleep apnoea and biomarkers of risk for cardiovascular disease and type 2 diabetes in youth.

Use of polysomnography to assess safe decannulation in children

Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process.

Characteristics of obstructive sleep apnea across the spectrum of glucose tolerance in obese adolescents

Background It is not known if dysglycemia and sleep-disordered breathing are linked in adolescents, as in adults. Objective To perform a pilot study evaluating measures of sleep-disordered breathing across the spectrum of glucose tolerance in obese adolescents. We hypothesized that dysglycemia would be associated with sleep-disordered breathing. Participants/methods This was a prospective, cross-sectional clinical pilot study that included 57 adolescents [body mass index (BMI) 38.9 ± 8.4 kg/m2] aged 12–18 years (14.5 ± 1.6) with normal glucose tolerance (NGT), or dysglycemia [impaired glucose tolerance (IGT) or type 2 diabetes (T2D)]. Measures Anthropometrics, overnight polysomnogram, and oral glucose tolerance tests were performed. Participant characteristics and outcome measures were compared by glucose tolerance status. Correlational analyses were conducted to assess the associations between variables of interest. Results Participants with dysglycemia (n = 21) were not different from those with NGT (n = 36) for BMI, waist circumference, body fat, or sleep characteristics. Nocturnal oxygen desaturation was associated with higher BMI (r = −0.334, p = 0.012). The apnea–hypopnea index (AHI) was not associated with physical and metabolic parameters. Although participants with dysglycemia tended to have higher AHIs (median 3.2, 2.2, and 1.6 events/h for T2D, IGT, and NGT, respectively), there was not a linear relationship between measures of glycemia and AHI. Conclusion Further study with a larger proportion of youth with prediabetes and T2D is necessary to determine whether evaluation for sleep-disordered breathing is uniformly warranted.

Endoscopic Airway Findings in Infants with Obstructive Sleep Apnea

Objectives: This study describes the un-sedated endoscopic airway findings in infants with obstructive sleep apnea confirmed by polysomnography (PSG). Methods: A retrospective chart review was performed on infants who had undergone both a documented airway endoscopy and PSG from 2006 to 2015 at our center. Demographics, comorbidities, findings of airway endoscopy and findings on PSG were extracted from the electronic medical record. Regression analyses were performed to determine the relationship between AHI, endoscopic airway findings and gestational age. Results: We identified 39 patients with PSG in room air and confirmed obstructive sleep apnea (Apnea Hypopnea Index (AHI) >1/hour) who had undergone unsedated airway endoscopy. The median gestational age at time of PSG was 40 weeks and for endoscopy was 40 weeks. Median AHI on PSG was 17.2/hour. Laryngomalacia [87.2%], pharyngomalacia [33.3%] and tracheomalacia [10.3%] were the three most prevalent findings on endoscopy. Surgically correctable fixed airway obstruction was uncommon. Prevalence of pharyngomalacia decreased with increased gestational maturity (p=0.05). As the postmenstrual age at PSG completion increased, there was a trend towards a decline of the AHI (p=0.087). Twenty-two (56.4%) patients had a follow up PSG performed. Using paired t test, there was a significant decrease in AHI (Δ13.41: -40.9, 15.8, 15.8) from 23.4/hour (1.3-62) to 10.0/hour (0-32), despite no interim surgical intervention. Conclusions: Dynamic airway collapse, including laryngomalacia and pharyngomalacia, were the most common findings in obstructive sleep apnea during infancy. The decreased prevalence of pharyngomalcia and trend towards improvement of AHI with time suggests airway immaturity contributes to obstructive sleep apnea observed during infancy and improves with age.