Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.

The Scope of Body Image Disturbance - the Big Picture An Overview of Assessment and Treatment Strategies Sociocultural Theory - the Media and Society Social Comparison Processes Appearance-Related Feedback Interpersonal Factors Peers, Parents and Perfect Strangers Feminist Perspectives Sexual Abuse and Sexual Harassment Behavioural Aspects of Disturbance - Conditioning, Context and Avoidance Cognitive Processing Models Future Directions - Integrative Theories, Multidimensional Assessment and Multicomponent Interventions

Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance

OBJECTIVES: This revised clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of the obstructive sleep apnea syndrome (OSAS) in children and adolescents. This practice guideline focuses on uncomplicated childhood OSAS, that is, OSAS associated with adenotonsillar hypertrophy and/or obesity in an otherwise healthy child who is being treated in the primary care setting. METHODS: Of 3166 articles from 1999–2010, 350 provided relevant data. Most articles were level II–IV. The resulting evidence report was used to formulate recommendations. RESULTS AND CONCLUSIONS: The following recommendations are made. (1) All children/adolescents should be screened for snoring. (2) Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered. (3) Adenotonsillectomy is recommended as the first-line treatment of patients with adenotonsillar hypertrophy. (4) High-risk patients should be monitored as inpatients postoperatively. (5) Patients should be reevaluated postoperatively to determine whether further treatment is required. Objective testing should be performed in patients who are high risk or have persistent symptoms/signs of OSAS after therapy. (6) Continuous positive airway pressure is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists postoperatively. (7) Weight loss is recommended in addition to other therapy in patients who are overweight or obese. (8) Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated or for mild postoperative OSAS.

/pdf/diagnosis-and-management-of-childhood-obstructive-sleep-2wes17zrfk.pdf

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Pediatric obstructive sleep apnea (OSA) has become widely recognized only in the last few decades as a likely cause of significant morbidity among children. Many of the clinical characteristics of pediatric OSA, and the determinants of its epidemiology, differ from those of adult OSA. We systematically reviewed studies on the epidemiology of conditions considered part of a pediatric sleep-disordered breathing (SDB) continuum, ranging from primary snoring to OSA. We highlight a number of methodologic challenges, including widely variable methodologies for collection of questionnaire data about symptomatology, definitions of habitual snoring, criteria for advancing to further diagnostic testing, and objective diagnostic criteria for SDB or OSA. In the face of these limitations, estimated population prevalences are as follows: parent-reported “always” snoring, 1.5 to 6%; parent-reported apneic events during sleep, 0.2 to 4%; SDB by varying constellations of parent-reported symptoms on questionnaire, 4 to 11%; OSA diagnosed by varying criteria on diagnostic studies, 1 to 4%. Overall prevalence of parent-reported snoring by any definition in meta-analysis was 7.45% (95% confidence interval, 5.75–9.61). A reasonable preponderance of evidence now suggests that SDB is more common among boys than girls, and among children who are heavier than others, with emerging data to suggest a higher prevalence among African Americans. Less convincing data exist to prove differences in prevalence based on age. We conclude by outlining specific future research needs in the epidemiology of pediatric SDB.

/pdf/epidemiology-of-pediatric-obstructive-sleep-apnea-aypunpylsd.pdf

Epidemiology of pediatric obstructive sleep apnea

Background Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. Methods We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. Results The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was ...

/pdf/a-randomized-trial-of-adenotonsillectomy-for-childhood-sleep-3mkppgy40q.pdf

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

https://www.nationaljewish.org/NJH/media/pdf/Meltzer%20References/Chervin-(2000)-Pediatric-Sleep-Questionnaire-validity-and-reliability.pdf

Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems.

Clinical prediction of periodic leg movements during sleep in children.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/69216/Body%20Weight%20and%20Shape%20Self-Cognitions,%20Emotional%20Distress,%20and%20Disordered%20Eating%20in%20Middle%20Adolescent%20Girls.pdf;sequence=1

Body weight and shape self-cognitions, emotional distress, and disordered eating in middle adolescent girls

Tend to breathe through the mouth during the day? Have a dry mouth on waking up in the morning? Occasionally wet the bed? Wake up feeling un-refreshed in the morning? Have a problem with sleepiness during the day? Has a teacher or other supervisor commented that your child appears sleepy during the day? Is it hard to wake your child up in the morning? Does your child wake up with headaches in the morning? Did your child stop growing at a normal rate at any time since birth? Is your child overweight? This child often... Does not seem to listen when spoken to directly Has difficulty organizing tasks Is easily distracted by extraneous stimuli Fidgets with hands or feet or squirms in seat Is “on the go” or often acts as if “driven by a motor” Interrupts or intrudes on others (e.g. butts into conversations or games)

Kristen M. Hedger

Papers

Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems.

Clinical prediction of periodic leg movements during sleep in children.

Body weight and shape self-cognitions, emotional distress, and disordered eating in middle adolescent girls

Pediatric Sleep Questionnaire