Sleep-disordered breathing is associated with impaired attention and neurocognitive deficits. We assessed the association of snoring and intermittent hypoxia with poor academic performance in third grade school children (1,144 children). Snoring frequency and intermittent hypoxia were investigated using parental questionnaire and nocturnal home pulse oximetry. Intermittent hypoxia was specified as desaturation events of 90% or less pulse oximeter saturation. Poor academic performance was defined as grade 4-6 on a six-point scale (i.e., approximately the lowest quintile grades) in mathematics, science, reading, spelling, and/or handwriting in the most recent school report. Snoring "always" was significantly associated with poor academic performance in mathematics (odds ratio; 95% confidence interval: 3.6; 1.3-10.1), science (4.3; 1.3-14.6), and spelling (3.5; 1.2-10.3). Snoring "frequently" was also significantly associated with poor academic performance in mathematics (2.4; 1.3-4.7) and spelling (2.0; 1.04-3.8). A significant relationship between snoring and poor academic performance was also found in children without intermittent hypoxia, whereas intermittent hypoxia did not show an independent association with poor academic performance. Thus, habitual snoring (i.e., snoring frequently or always) was associated with poor academic performance in these primary school children.

WHAT'S KNOWN ON THIS SUBJECT: In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often difficult and time consuming, which may increase the risk of complications. We developed a system for automatic oxygen control and proved its efficacy in the past. WHAT THIS STUDY ADDS:A multicenter study adds evidence for the proposed automatic oxygen control system to significantly improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload compared with routine manual oxygen control. abstract BACKGROUND AND OBJECTIVE: In preterm infants receiving supplemental oxygen, routine manual control (RMC) of the fraction of inspired oxygen (FIO 2 ) is often difficult and time consuming. We developed a system for closed-loop automatic control (CLAC) of the FIO 2 and demonstrated its short-term safety and efficacy in a single-center study. The objective of this study was to test the hypothesis that this system is more effective than RMC alone in maintaining arterial oxygen saturation within target levels when evaluated over 24 hours under routine conditions and with different target levels. METHODS:We performed a multicenter, randomized controlled, crossover clinical trial in 34 preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure and supplemental oxygen. Twenty-four-hour periods with RMC were compared with 24-hour periods of RMC supported by CLAC. RESULTS:The median (range) percentage of time with arterial oxygen saturation levels within target range was 61.4 (31.5-99.5) for RMC and 71.2 (44.0-95.4) for CLAC (P , .001). The median (range) number of manual FIO 2 adjustments was reduced from 77.0 (0.0-224.0) for RMC to 52.0 (10.0-317.0) for CLAC (P = .007).CONCLUSIONS: CLAC may improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload related to RMC. Pediatrics 2014;133:e379-e385 Preterm infants frequently require supplemental oxygen (O 2 ). The goal of this therapy is to deliver sufficient O 2 to the tissues while minimizing O 2 toxicity and oxidative stress, which may result from too high or too widely fluctuating O 2 levels. Although the optimal level of arterial pulse oximeter saturation (SpO 2 ) is still debated, there is evidence that wide fluctuations in SpO 2 should in any case be avoided. [1][2][3] This may be difficult to achieve, however, under routine clinical conditions. 4 Thus, automatic titration of the fraction of inspired oxygen (FIO 2 ) by using a closedloop FIO 2 controller (FIO 2 C) seems attractive. The first attempts at automating O 2 delivery to patients date back to the 1970s, but only recently, with the advance of motion-resistant pulse oximetry, sophisticated systems have been developed that seem to be suitable for clinical use in preterm infants requiring respiratory support. 5,6 In a group of preterm infants receiving nasal continuous posit...

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In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often time-consuming and inappropriate. We developed a system for automatic oxygen control and hypothesized that this system is more effective than routine manual oxygen control in maintaining target arterial oxygen saturation levels. We performed a randomized controlled crossover clinical trial in 12 preterm infants receiving nasal continuous positive airway pressure and supplemental oxygen. Periods with automatic and routine manual oxygen control were compared with periods of optimal control by a fully dedicated person. The median (range) percentage of time with arterial oxygen saturation levels within target range (87-96%) was 81.7% (39.0-99.8) for routine manual oxygen control, 91.0% (41.4-99.3) for optimal control, and 90.5% (59.0-99.4) for automatic control (ANOVA: p = 0.01). Pairwise post hoc comparisons revealed a statistically significant difference between automatic and routine manual oxygen control (Dunnett's test: p = 0.02). The frequency of manual oxygen adjustments was lowest in automatic control (Friedman's test: p < 0.001). Automatic oxygen control may optimize oxygen administration to preterm infants receiving nasal continuous positive airway pressure and reduce nursing time spent with oxygen control.

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We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.

In order to study the prevalence of habitual snoring (HS), obstructive sleep apnoea (OSA), other aspects of sleep-disordered breathing (SDB), and their determinants, we enrolled a cross-section of children from the population of third graders attending regular primary schools in Hannover, Germany. The recruitment strategy followed a multistage, probability-clustered design. Selected schools were compared with eligible schools regarding the percentage of children with low socio-economic status (SES). The recruitment process was analysed and response proportions calculated. Study subjects were compared with their school enrolment cohort based on anonymous data provided by school authorities. Habitual snoring and OSA were investigated using parental questionnaires and all children underwent nocturnal home pulse oximetry. There was a good overall representativeness of sampled schools with regard to the percentage of children with low SES. In total, 1760 children were contacted and 1144 (65.0%) agreed to participate. The whole process of self-selection of study subjects was not differential by gender.Compared with their school enrolment cohort, study subjects had slightly higher educated parents. The prevalence of HS was estimated to be 10.1% [95% CI 8.3, 11.9%]; and 3.2% [2.2, 4.2%] and 3.9% [2.8, 4.2%] had an abnormally high OSA or SDB score respectively. Based on pulse oximetry, 2.4% [95% CI 1.5, 3.4%] had 3 D 90 and 3 D C , 1.0% [0.4, 1.6%] had the DI 90 > 0.6, and 3.3% [2.2, 4.4%] had the DI 4 > 3.9 and the DI C > 0.4. This study sample appears to be highly representative with regard to all available data from the population, and therefore suitable to study the prevalence of HS and OSA. Our prevalence estimates are in the range of other studies.