Is a 2-Night Polysomnographic Study Necessary in Childhood Sleep-Related Disordered Breathing?

Li, Albert M.; Wing, Yun Kwok; Cheung, Asy; Chan, Daniel; Ho, Crover Kwok Wah; Hui, Shuk Yi Annie; Fok, Tai Fai

doi:10.1378/chest.126.5.1467

Cited by 99 publications

(67 citation statements)

References 23 publications

(26 reference statements)

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“…Evidence from a variety of patient populations and studies of healthy children suggest that children, much like adults, show improvements in sleep quality from the first to second night in the sleep laboratory, 3,[5][6][7][8][9][10]19 with some measures of sleep quality continuing to improve when data from subsequent nights are collected. 3 The most consistently reported changes are in TST, SE, WASO, and REM parameters.…”

Section: Discussion and Limitationsmentioning

confidence: 99%

“…7 The groups were later further broken down for the presence or absence of SDB, and sleep architecture was examined using a 2-night, laboratory-based study. Children with and without SDB had increased TST and greater sleep effi ciency on the second night.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…5 The work concluded that 6 Li et al compared 46 obese children to 44 normal weight children between the ages of 7 and 15 years. 7 The groups were later further broken down for the presence or absence of SDB, and sleep architecture was examined using a 2-night, laboratory-based study. Children with and without SDB had increased TST and greater sleep effi ciency on the second night.…”

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confidence: 99%

“…Children without SDB were found to have more REM, decreased REM latency, and decreased stage 2 on the second night. 7 Several studies have used the FNE principle to compare children with mood disorders or ADHD with typical controls as a way to interrogate sleep as a proxy for optimal mental health. For instance, Bertocci et al examined 51 children between the ages of 8 and 17 years with a diagnosis of major depressive disorder (MDD) for three consecutive nights in the lab.…”

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First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

Buckley

Wingert

Swedo

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: To evaluate for the fi rst night effect (FNE) in a group of young children with autism. Design: Analysis of polysomnographic data from a 2-night sleep laboratory study. Setting: Clinical Center of the National Institutes of Health. Patients or Participants: 15 children (aged 2-10 years) with a diagnosis of an ASD. Interventions: None. Measurements and Results: Polysomnographic analysis showed the presence of a FNE for wake after sleep onset minutes, stage 2, and sleep effi ciency, but not for REM sleep parameters or TST. Conclusions S C I E N T I F I C I N V E S T I G A T I O N ST he fi rst night effect (FNE) refers to the well-accepted phenomenon of a poorer quality of sleep on the fi rst night when subjects undergo two or more consecutive nights in the sleep lab. Typically, FNE effects include lower sleep effi ciency, less total sleep time, less REM sleep, longer latency to REM sleep, and more intermittent awake time on night one.1,2 While this phenomenon is well recognized among adult populations, there are few exclusively pediatric studies that have examined FNE, and fewer still that have included young children with disorders affecting development.The largest pediatric study examining the FNE was performed in 1984. It was a laboratory-based evaluation of 87 healthy children between the ages of 6 and 15 years. This experiment reported an increase in TST and a decrease in sleep latency for night two. It also revealed similar second night fi ndings as had been seen in adult cohorts, namely, better sleep effi ciency, fewer wake after sleep onset (WASO) minutes, decreased REM latency, and increased REM percentage.3 Palm et al. conducted a 2-night at home study in 1989 on 18 healthy children between 8 and 12 years and did not fi nd such an effect. 4 Instead, there was an increase in sleep latency, an increase in percentage of stage 1 sleep, and an increase in REM latency, all on the second night.The majority of FNE data in children have come from studies using patient populations that frequently undergo overnight polysomnography (PSG) as part of a routine diagnostic assessment. Several studies have examined the FNE among children with suspected sleep disordered breathing (SDB) and obese children who are at risk for developing SDB. Scholle et al. evaluated 131 children between the ages of 2 and 17 years with suspected SDB for 2 nights in the laboratory. 5 The work concluded that while there was a FNE effect for WASO and REM percentage, a second night was not needed for pertinent respiratory parameters. Similarly, Verhulst et al. examined 70 children between the ages of 2 and 17 years, also referred for SDB, and found a FNE for REM sleep parameters but not for respiratory measures.6 Li et al. compared 46 obese children to 44 normal weight children between the ages of 7 and 15 years. 7 The groups were later further broken down for the presence or absence of SDB, and sleep architecture was examined using a 2-night, laboratory-based study. Children with and without SDB had increased TST and greater ...

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Section: Discussion and Limitationsmentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

Buckley

Wingert

Swedo

et al. 2013

Journal of Clinical Sleep Medicine

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“…The so-called "first-night effect," which has been seen in individuals of all ages (Aber, Block, Hellard, & Webb, 1989;Carvalhaes-Neto et al, 2003;Scholle et al, 2003), might represent an adaptation burden to the sleep laboratory. Since Agnew, Webb, and Williams (1966) reported and defined the first-night effect, several researchers have described its association with reduced TST, poor SE, less REM sleep, increased SL, and increased WASO (Aber et al, 1989;Curcio, Ferrara, Piergianni, Fratello, & De Gennaro, 2004;Le Bon et al, 2000;Li et al, 2004;Scholle et al, 2003;Toussaint et al, 1997 Acute experimental psychological stress in healthy participants had a consistent effect on REM sleep in early studies. In the 1960s and 1970s, many researchers reported that presleep stimulation influenced REM activity and awakenings (Baekeland, Koulack, & Lasky, 1968;Cluydts & Visser, 1980;Cohen, 1975;Goodenough, Witkin, Koulack, & Cohen, 1975).…”

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The Effect of Psychosocial Stress on Sleep: A Review of Polysomnographic Evidence

Kim

Dimsdale

2007

Behavioral Sleep Medicine

345

250

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This systematic review examines the effect of diverse psychosocial stressors on polysomnographic measures of sleep. Sixty-three articles were located and categorized in terms of the types of stressors imposed. Experimental stress resulted in fairly consistent changes: decreases in slow wave sleep, REM sleep, and sleep efficiency (SE), as well as increases in awakenings. Data were limited in terms of response to non-experimental stressors, except for the case of post-traumatic stress disorder (PTSD) on sleep, where a number of reports suggest that PTSD patients have increased awakenings and decreased SE. Future research needs to define stress more precisely in terms of duration and severity and to measure its impacts on sleep in populations that differ in terms of age, comorbid illness, gender, and so forth. Without such fine-grained analyses, it is difficult to draw definitive conclusions about this important area.Sleep researchers traditionally have focused on primary sleep disorders such as sleep apnea, narcolepsy, or periodic limb movement disorder; but common knowledge has it that the stresses of daily life can perturb even healthy sleep. As Mason (1968) described, psychological stressors are potent stimuli for physiological stress responses. Most studies on psychosocial stress and its physiological effects on sleep are based solely on subjective reports. However, these subjective reports of sleep are not sufficient to evaluate physiological sleep changes as measured by polysomnography (PSG; Akerstedt, Hume, Minors, & Waterhouse, 1994;Schneider-Helmert & Kumar, 1995). What really happens in sleep physiology after exposure to stressors? Although the gold standard of measurement of sleep is PSG, there are relatively little data concerning the effects of ordinary or severe stress on polysomnographically examined sleep. This article systematically reviews the diverse literature in this area.Stress is notorious for being difficult to define. It encompasses all kinds of stimuli of varying amounts of aversiveness and duration (Dimsdale, Irwin, Keefe, & Stein, 2005). Kecklund and Akerstedt (2004b) grouped stressors conceptionally into physical versus psychological or social, acute versus chronic, and high intensity versus low intensity.Copyright © Lawrence Erlbaum Associates, Inc. Correspondence should be addressed to Joel E. Dimsdale, University of California, San Diego, 9500 Gilman D., La Jolla, CA 92093-0804. jdimsdale@ucsd.edu. NIH Public Access Author ManuscriptBehav Sleep Med. Author manuscript; available in PMC 2014 December 15. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAlthough there are numerous animal models of social stress, it is still challenging to generalize psychosocial stress responses in animals to those in humans. This review focuses on psychosocial stressors; other types of stressors such as environmental manipulations (e.g., temperature), exercise, or intentionally imposed sleep disruption are not covered in this article.It is possible that different types...

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Validation of a questionnaire instrument for prediction of obstructive sleep apnea in Hong Kong Chinese children

Cheung

Chan

et al. 2006

Pediatr. Pulmonol.

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To develop and validate a questionnaire scale that can be used as a screening tool to investigate for the presence of childhood obstructive sleep apnea syndrome (OSAS) in Hong Kong Chinese children. Subjects suspected to have OSAS and controls were recruited. Parents completed a Hong Kong children sleep questionnaire (HK-CSQ) and all recruited subjects underwent at least one overnight polysomnographic study (PSG). An obstructive apnea index (OAI) >or= 1/h was diagnostic of OSAS. Receiver-operating characteristics (ROC) curve was constructed to determine optimal sensitivity and specificity. Reliability and validity of the questionnaire scale were also assessed. Two hundred twenty-nine children (149 boys and 80 girls) with a mean age of 10.0 years (SD = 2.1) were recruited. Their mean body mass index (BMI) and OAI were 19.8 (SD = 5.1) and 2.6 (SD = 7.6), respectively. Fifty-four boys and 12 girls were found to have OSAS. Three questions were found to be highly significant in predicting for the presence of OSAS-snoring, nocturnal mouth breathing, and sweating. A composite score of 7 from the three questions (range 0-12) was found to discriminate the OSAS cases best [ROC curve, AUC = 0.8 (95% CI = 0.8-0.9)]. The sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were 75.4, 80.5, 61.3, and 88.9%, respectively. Test-retest reliability was undertaken in 51 subjects and the measurement of agreement (Kappa value) was 0.6. This HK-CSQ is a useful, valid, and reliable screening instrument for the presence of OSAS in children.

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Is a 2-Night Polysomnographic Study Necessary in Childhood Sleep-Related Disordered Breathing?

Cited by 99 publications

References 23 publications

First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

The Effect of Psychosocial Stress on Sleep: A Review of Polysomnographic Evidence

Validation of a questionnaire instrument for prediction of obstructive sleep apnea in Hong Kong Chinese children

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