SUMMARY The all‐night polysomnographic findings of nine patients with spastic quadriparesis (mean age 36‐7 months) were analysed retrospectively and compared with those of nine age‐matched controls (rnean age 37‐4 months). The cerebral palsy group had significantly more respiratory disturbances per hour of sleep, with five of nine being diagnosed as having obstructive sleep apnea. They also had fewer changes in body position during the night. Interictal epileptiform discharges averaged 23‐3 per cent of the total arousals in the cerebral palsy group. Obstructive apnea, decreased ability to change body position, and interictal epileptiform discharges are prevalent in the sleep of patients with severe cerebral palsy, and contribute towards its disruption. RÉSUMÉ Troubles du sommeil dans les formes graves d' IMC Les enregistrements polysomnographiques continus de deux patients presentant une quadriplégic spastique (âge moyen de 36‐7 mois) ont été analysés rétrospectivement et comparés à ceux de neuf contrôles appariés (âge moyen de 37‐4 mois). Le groupe IMC présentait significativement plus de perturbations respiratoires par heure de sommeil, dont cinq cas diagnostiquées comme apnée obstructive de sommeil. Us avaient également moins de changement de position durant le sommeil. Des décarges épileptiformes intercritiques furent observées dans 23‐3 pour cent du total des périodes d'éveil dans le groupe IMC. L'apnée obstructive, une incapacité accrue à changer la position du corps et les décharges épileptiformes intercritiques prédominent durant le sommeil des patients avec IMC grave, et contribuent à l'incapacite globale. ZUSAMMENFASSUNG Schlafstörungen bei Patienten mil schwerer Cerebralparese Von neun Patienten mit schwerer Tetraplegie (mittleres Alter 36‐7 Monate) wurden retrospektiv die Befunde der nächtlichen Schlafpolygraphie analysiert und mit den Befunden von neun altersentsprechenden Kontrollen verglichen (mittleres Alter 37‐4 Monate). Bei den Patienten mit Cerebralparese traten pro Stunde Schlaf signifikant häufiger Schlafstörungen auf, fünf von neun hatten eine obstruktive Schlafapnoe. Außerdem veränderten sie im Verlauf der Nacht seltener ihre Körperposition. 23‐3 Prozent der Schlafunterbrechungen wurden bei der CP Gruppe durch interiktale epileptiforme Entladungen hervorgerufen. Auffällige Faktoren für Schlafunterbrechungen bei Patienten mit schwerer Cerebralparese sind obstruktive Apnoe, eingeschränkte Fähigkeit, die Körperposition zu verändern, und interiktale epileptiforme Entladungen. RESUMEN Anomalias del suefio en niños con grave parálisis cerebral Los hallazgos polisonográficos obtenidos durante toda la noche en nueve pacientes con cuadriparesia espástica (promedio de edad 36,7 meses) fueron analizados retrospectivamente y comparados con los de nueve controles de la misma edad (promedio 37,4 meses). El grupo con parálisis cerebral tenía significativamente más alteraciones respiratorias por cada hora de sueño; cinco de ellos habian sido diagnosticados de apnea de sueño. También presentaban menos cambi...

Among 145 patients treated with recombinant human growth hormone (GH), four developed sleep apnea (two obstructive, two mixed) associated with tonsillar and adenoidal hypertrophy in three. These four patients had no local risk factors predisposing to upper airway obstruction (i.e., frequent pharyngitis or sinusitis). Clinical and/or polysomnographic features of sleep apnea improved following cessation of GH therapy in one patient, and following tonsillectomy and adenoidectomy in all patients. The present observations indicate that, albeit rarely, obstructive and/or central sleep apnea may occur in children treated with GH. Polysomnography should be considered if symptoms of snoring, interrupted sleep, daytime somnolence-particularly if associated with tonsillar hypertrophy-appear in children during GH therapy.

Objectives/Hypothesis: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.Study Design: Delphi method-based survey series. Methods: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up.Results: The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics ( 22), and Prior Workup Characteristics (18).Conclusion: This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes.

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