Showing papers by "Susan Redline published in 1999"

Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems.

Abstract: This study examined risk factors for sleep-disordered breathing (SDB) in children and adolescents; specifically, quantifying risk associated with obesity, race, and upper and lower respiratory problems. Subjects were participants in a genetic-epidemiologic study of SDB and included 399 children and adolescents 2 to 18 yr of age, recruited as members of families with a member (a proband) with known sleep apnea (31 index families) or as members of neighborhood control families (30 families). SDB was assessed with home overnight multichannel monitoring and SDB was defined based on an apneahypopnea index >/= 10 (moderately affected) or < 5 (unaffected). SDB of moderate level was significantly associated with obesity (odds ratio, 4.59; 95% confidence interval [CI], 1.58 to 13.33) and African-American race (odds ratio, 3.49; 95% CI, 1.56 to 8.32) but not with sex or age. After adjusting for obesity, proband sampling, race and familial clustering, sinus problems and persistent wheeze each independently (of the other) predicted SDB. These data suggest the importance of upper and lower respiratory problems and obesity as risk factors for SDB in children and adolescents. Increased risk in African Americans appears to be independent of the effects of obesity or respiratory problems.

Executive Functions in Persons with Sleep Apnea.

Abstract: Seventeen patients with sleep apnea syndrome [SAS, Respiratory Disturbance Index (RDI) = 12−85] were compared with 16 normal controls (RDI < 7) on neuropsychological tests of executive functions, a domain in which SAS patients have been suggested to have deficits. SAS patients demonstrated greater deficits in the retrieval of information from semantic memory (Controlled Oral Word Association task) and in shifting responses in the face of error (Wisconsin Card Sort Test), but differences in working memory were not observed. Eliciting deficits in cognitive executive functions in SAS may require more sensitive measures than are typically used in neuropsychiatric research.

Obstructive sleep apnea/ hypopnea syndrome

Abstract: Obstructive sleep apnea/hypopnea (OSA/H) is a common disorder for which there are a variety of therapeutic options. All patients should make appropriate alterations in lifestyle and habits to reduce the risk of upper airway instability during sleep. The aggressiveness of additional treatment should be dictated by the severity of OSA/H, as measured by the condition’s physiologic and clinical impact. At this time, the most compelling reason to treat patients with OSA/H is to reverse daytime sleepiness, functional or performance impairments, and clinically significant hypoxemia. Given data that suggest strong associations between vascular diseases and OSA/H, however, it may be prudent to use a relatively low threshold when deciding whether to treat patients at high risk for hypertension and cardiovascular diseases. Although we do not completely understand the extent to which any given derangement in sleep architecture or sleep-associated gas exchange leads to short-or long-term morbidity, such an abnormality should alert the clinician to the possible need for intervention and the need for careful follow-up. In general, all patients with OSA/H who require treatment should have a trial of continuous positive airway pressure (CPAP), the medical therapy of choice. This approach provides rapid and assured alleviation of OSA/H. Once CPAP therapy is under way, the patient and clinician can evaluate other options if the patient does not wish to continue long-term positive-pressure therapy. It is essential that patients and their caregivers understand the nature of OSA/H and its risk factors and realize that successful upper airway stabilization by means of medical and surgical interventions other than positive pressure or tracheostomy cannot be guaranteed. Surgical techniques cannot guarantee cure and can cause notable adverse consequences. Although it is almost invariably successful in maintaining upper airway patency during sleep, positive-pressure therapy may also have side effects. These generally are not lasting or severe, but they may nonetheless affect patient comfort. Measures are available to address these side effects. Increasing amounts of information support the importance to clinical care of patient education about both OSA/H and its therapy. Such education enhances the likelihood of successful treatment, improved quality of life, and improved long-term outcome.

Screening for SIDS: A neonatal perspective.

Abstract: * Abbreviations: SIDS = : sudden infant death syndrome • ECG = : electrocardiogram The good news is that the incidence of sudden infant death syndrome (SIDS) is steadily decreasing. Preliminary available US data reveal a SIDS rate of 0.74 per 1000 live births in 1996, down from a rate of 1.5 per 1000 live births over the last 20 years.1 In low and very low birth weight infants the SIDS rate has consistently been three- to fourfold higher than that in term infants.2 Whether this low birth weight population is exhibiting a similar decline in SIDS rate is unclear. Therefore, neonatologists who spend most of their time taking care of preterm infants remain wary about the high-risk status of this population, especially because the mechanism underlying the high incidence of SIDS in preterm infants is unclear. Any rational way to screen such infants (and others) for SIDS risk status would be very welcome. Historically, neonatal apnea screening via diagnostic pneumograms seemed a good place to begin. Persistence of …

A quagmire for clinicians: When technological advances exceed clinical knowledge

Abstract: Obstructive sleep apnoea hypopnoea syndrome (SAHS) is currently estimated to affect between 2% and 25% of the adult population.1 2 Increasingly, data indicate that obstructive SAHS, if untreated, may result in both short and long term sequelae including daytime sleepiness, poor quality of life, neuropsychological impairment, hypertension, and cardio-cerebrovascular diseases.3 Its high prevalence and potentially substantial morbidity present challenges to the health care system and to individual care providers to diagnose and identify those individuals at greatest risk of obstructive SAHS related complications and those most likely to benefit from specific interventions. On the one hand, the costs associated with evaluation with the “gold standard” (overnight laboratory based multichannel polysomnography) could exceed $1500/patient. In the USA this cost alone could result in annual health care expenditures of >$18 billion if all adults with suspected SAHS were tested.4 On the other hand, the economic costs of untreated SAHS are substantial. These, however, are more difficult to estimate since they may include the costs associated with loss of work productivity, occupational and vehicular accidents, and potentially preventable hypertension and cardio-cerebrovascular diseases. Regarding the latter alone, it has been estimated that between $3 million and $2 billion spent on treatment of hypertension and cardiovascular diseases annually in the USA may be reduced by effective treatment of SAHS (estimates varying according to the estimated attributable risk).4 In times of escalating aggregate health care costs, how should the appropriate balance between costs and benefits be achieved? One strategy to reduce the costs associated with using complex expensive technology to diagnose a condition associated with common symptoms (snoring and daytime sleepiness, found in >50% to >20% of the population, respectively3) is to use screening tests and/or diagnostic tests that are simpler and less costly than overnight laboratory based polysomnography. When using …

Finding genetic mechanisms in syndromes of sleep disordered breathing: Report to the RNS assembly and the ATS board from the ad hoc committee on inheritance and ventilatory control approved by the ATS board of directors July 11, 1999

Abstract: for monogenic disorders but also for illnesses with complex pathophysiology. Finding genes for the disorders of respiratory control will permit new use of physiologicand organ-based knowledge and complements studies of environmental and pharmacologic factors operating to produce respiratory disorders of sleep and of hypoventilation during wakefulness. Furthermore, risk factor identification and modification, if viewed within a molecular framework, will facilitate insight into the influence of development, growth, and exposure history of the expression of disease. RATIONALE