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Obstructive sleep apnea (OSA) is a fairly common nocturnal breathing disorder, affecting 2-4% of individuals. Although OSA is associated with medical morbidity, its most functionally disruptive effects in adults appear to be neuropsychological in nature. Research on the neuropsychological effects of pediatric OSA has been limited. This study compared the neuropsychological functioning of school-aged children with OSA to that of healthy children. The primary goal was to clarify the presence and pattern of neuropsychological morbidity associated with pediatric OSA. Sleep was assessed with parent-report questionnaires and laboratory sleep studies. Neuropsychological functioning was assessed by formal tests and parent-and teacher-report questionnaires. Data indicated OSA-related cognitive and behavioral impairment that was particularly marked on measures of behavior regulation and some aspects of attention and executive functioning. Minimal effects were observed on measures of intelligence, verbal memory, or processing speed. Exploratory analyses failed to indicate any clear relationship between neuropsychological functioning and objective indexes of hypoxia or sleep disruption, though the sample was small. These data add to a growing literature which suggests that significant neuropsychological deficits are associated with pediatric OSA. Findings suggest a pattern of neuropsychological morbidity that is similar but not identical to that seen in adult OSA. (JINS, 2004, 10, 962-975.)

In 2001, the Muscular Dystrophy Community Assistance, Research and Education Amendments (MD-CARE Act) was enacted, which directed federal agencies to coordinate the development of treatments and cures for muscular dystrophy. As part of the mandate, the Centers for Disease Control and Prevention (CDC) initiated surveillance and educational activities, which included supporting development of care considerations for Duchenne muscular dystrophy (DMD) utilizing the RAND/UCLA Appropriateness Method (RAM). This document represents the consensus recommendations of the project's 10-member Respiratory Panel and includes advice on necessary equipment, procedures and diagnostics; and a structured approach to the assessment and management of the respiratory complications of DMD via assessment of symptoms of hypoventilation and identification of specific thresholds of forced vital capacity, peak cough flow and maximum expiratory pressure. The document includes a set of Figures adaptable as "pocket guides" to aid clinicians. This article is an expansion of the respiratory component of the multi-specialty article originally appearing in Lancet Neurology, comprising respiratory recommendations from the CDC Care Considerations project.

Rationale: Adenotonsillectomy, the first line of treatment of sleepdisordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified. Objectives: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy. Methods: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year. Measurements and Main Results: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence. Conclusions: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension. Keywords: growth velocity; adenotonsillectomy; sleep-disordered breathingOne of the most frequently encountered conditions associated with obesity is sleep-disordered breathing (SDB). In adults, the risk of SDB increases by 1.14 for every unit increase in body mass index (BMI) (1). In the pediatric population, the risk for developing SDB is fourfold greater in obese children than in children who are not obese (2). Although the prevalence of SDB in all children is believed to range from 2 to 3% (3-5), the prevalence in adolescents who are morbidly obese exceeds 50% (6, 7). Obesity is therefore strongly associated with abnormal upper airway control during sleep across all age groups.Adenotonsillectomy, the first line of treatment in the management of childhood SDB, is the most commonly performed surgical procedure in children. The annual rate of adenotonsillectomy in children aged 0 to 14 years ranges from 19 per 10,000 in Canada to 115 per 10,000 in the Netherlands (8). At least half of these procedures are performed to relieve symptoms of SDB. In the first few weeks after adenotonsillectomy, obese children with SDB have a less favorable response to surgery than lean children. However, neither the long-term outcome nor the factors that contribute to recurrence of the disorder after adenotonsillectomy are clearly understood. Moreover, the impact of recurrence of SDB on important cardiovascular risk factors, such as blood pressure (BP), has never been examined.Research investigating the relationship between adiposity and SDB h...

Repeat polysomnograms were performed after significant weight loss. Comparisons were made between pre-and postoperative polysomnographic data. Results: Nineteen of 34 patients (55%) who underwent bariatric surgery were diagnosed with OSA. Subsequent to surgery, 10 of these patients returned for follow-up polysomnographic testing. After significant weight loss (mean, 58 kg), OSA severity markedly decreased in all patients (median apnea-hypopnea index at baseline vs. after weight loss, 9.1 vs. 0.65). Discussion: Our study indicated that OSA was highly prevalent in extremely overweight adolescents meeting eligibility criteria for bariatric surgery. The significant weight loss after gastric bypass was associated with a marked reduction in OSA severity.

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To determine, in a series of children younger than 6 years undergoing adenotonsillectomy for treatment of clinical obstructive sleep apnea syndrome (OSAS), the effect of age on prevalence of postoperative respiratory complications. The primary objective was to define a practice standard for postoperative hospital admission.

More than 20 million adults and 2 million children and teenagers in the USA have extreme obesity (body mass index ≥ 40 kg/m 2 ), a condition associated with premature morbidity and mortality (1,2). In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities (3). Bariatric surgery performed late in the course of comorbid conditions may not be as effective as surgery performed earlier. Based on these factors, we proposed that surgery for extreme adolescent obesity may be a beneficial option for highly selected teenagers (4), but large-scale prospective studies using reliable and valid measures that are systematic assessed are still lacking.To facilitate and accelerate data collection and research in bariatric surgery, the National Institute of Diabetes & Digestive, and Kidney Diseases established the Longitudinal Assessment of Bariatric Surgery (LABS) consortium, a prospective observational study of adults undergoing bariatric surgery. Teen-LABS, an ancillary study to LABS, is also a prospective observational cohort study with the goal of collecting coordinated clinical, epidemiological and behavioral data in adolescent bariatric surgical patients (5). The design of Teen-LABS is patterned from the second phase of LABS, using similar research methodology and data collection instruments. The detailed methodology of the LABS study is now published (6) and available in a public access domain (7). The LABS and Teen-LABS studies will afford the first opportunity to understand broad ranging outcomes of bariatric