Effect of adenotonsillectomy for childhood obstructive sleep apnea on nocturnal heart rate patterns

Liu, Xiao; Immanuel, Sarah A.; Kennedy, Declan; Martin, James; Pamula, Yvonne; Baumert, Mathias

doi:10.1093/sleep/zsy171

Cited by 11 publications

(4 citation statements)

References 35 publications

(47 reference statements)

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“…Too high or low variability may be pathologic, while children with OSA have lower HRV. Liu et al demonstrated a greater reduction in monotonous increases or decreases in heart rate in the eAT group, suggesting its positive association with autonomic cardiovascular control.…”

Section: Observations and Discussionmentioning

confidence: 94%

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Decuzzi

Redline

Isaiah

2022

JAMA Otolaryngol Head Neck Surg

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ImportanceAdenotonsillectomy, performed for approximately 500 000 children annually in the US alone, is the first line of treatment of pediatric obstructive sleep apnea (OSA). The Childhood Adenotonsillectomy Trial (CHAT), the first randomized clinical trial to test the efficacy of adenotonsillectomy, compared the management of pediatric nonsevere OSA by early adenotonsillectomy (eAT) vs watchful waiting with supportive care. Since the publication of the primary article in 2013, the CHAT study data set were made available via the National Sleep Research Resource, which allowed researchers to address a range of additional clinical questions relevant to the care of children with OSA. This review focuses on secondary analyses associated with the CHAT data set as grouped by the outcome of interest.ObservationsThe results of most secondary analyses suggest that children who underwent eAT experienced the greatest improvements in symptom burden, sleepiness, parent-reported behavior, and quality of life. Changes in other domains, such as cognition, cardiovascular physiology, and metabolic indicators, were modest and selective. The associations between most treatment outcomes and polysomnographic parameters were weak. Symptoms were poor predictors of OSA severity. The results from these secondary analyses benefitted from the rigor of multicenter design and centralized polysomnography interpretation in CHAT. However, the exclusion of younger preschool-aged children and children with primary snoring limited the generalizability of findings. In addition, because caregivers were not masked, some of the parent-reported outcomes may have been inflated.Conclusions and RelevanceThe results of this narrative review suggest that CHAT provides a model for future OSA-related studies in children for design, conduct, and subsequent reuse of the study data set, and its findings have advanced our understanding of the pathophysiology and management of pediatric nonsevere OSA. Directions for future research include whether the findings from this landmark study are generalizable to younger children and children with primary snoring and severe OSA. Similar studies may help address practice variability associated with pediatric OSA and help identify children who are most likely to benefit from undergoing eAT.

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Section: Observations and Discussionmentioning

confidence: 94%

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Decuzzi

Redline

Isaiah

2022

JAMA Otolaryngol Head Neck Surg

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“…Obstructive sleep apnea has a detrimental impact on health sequelae such as cognitive behavioural deficits, growth retardation, and CVD, particularly in untreated childhood OSA (Beebe, 2006;Ehsan et al, 2017;Gozal, 2008). Abnormal autonomic control has been reported in children with OSA (Aljadeff et al, 1997;Liu et al, 2018;Martín-Montero et al, 2023;Teo & Mitchell, 2013). A crosssectional case-control study showed that compared to non-OSA controls, children with OSA showed a larger pharyngeal compliance associated with an increased AHI, possibly as consequence of decreased sympathetic tone (reduced LF and LF/HF) in NREM sleep but decreased parasympathetic tone (reduced HF) in REM sleep (Bokov et al, 2021).…”

Section: Upper Airway Surgical Proceduresmentioning

confidence: 99%

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

Qin,

Fietze,

Mazzotti

et al. 2023

Journal of Sleep Research

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SUMMARYObstructive sleep apnea is a highly prevalent sleep‐related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter‐individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea–Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea–Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea–Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.

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“…Berbagai penelitian sebelumnya telah mengkaji pendidikan seks pada anak antara lain: Mukti (2016), Rusydi (2012), Maulana (2018), Hakiki (2015), Liu X, (2018), Solihin (2015), Jatmikowati, dkk (2015) dan Tirtawinata (2016). Beberapa penelitian terdahulu tersebut menyebutkan bahwa terjadinya kejahatan seksual dan penyimpangan prilaku seks sebagai akibat kurangnya pendidikan seks yang benar yang diterima anak sejak dini dalam keluarga dan sekolah.…”

Section: Pendahuluanunclassified

Pendidikan Seks Bagi Anak Usia Dini Menurut Hadist Nabi

Bakhtiar

Nurhayati

2020

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Early age (0-6 years) is the golden age. This period is the formation period that determines adolescence and adulthood. Islam as a perfect religion has governed all lines, one of which is about educating young children, especially related to sex education. This study aims to explore how sex education for early childhood in the explanation of the Prophet's hadith. This type of research used by researchers is library research (library research) by tracing various hadith books and the work of scholars and experts related to early childhood sex education. As a qualitative study, the data analysis is used in three stages (data reduction, data display, and concluding). The results of this study state that sex education for young children does not explain sex itself to children, but means: first, explain and introduce their identity as men or women through differences in genitalia. Second, it teaches children moral values and character and politeness of decency. Third, provide a warning for parents to educate their children at an early age following the religious directions contained in the Koran and Hadith.

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Effect of adenotonsillectomy for childhood obstructive sleep apnea on nocturnal heart rate patterns

Cited by 11 publications

References 35 publications

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

Pendidikan Seks Bagi Anak Usia Dini Menurut Hadist Nabi

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