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Biomedical subjects

Ann C Halbower

Publications and source records attributed to Ann C Halbower.

10 recordsLinked to original sources
PubMed2006

Neuropsychological morbidity linked to childhood sleep-disordered breathing.

Understanding the long-term neuropsychological consequences of sleep disorders in children poses a significant challenge to researchers. Since children are in a state of rapidly changing cognition and neurobehavioral function, impacts on development may have profound consequences. Recent studies now demonstrate that mild sleep apnea and snoring, once considered within the spectrum of normal sleep patterns, are associated with deficits of neuropsychological function. Preliminary data suggest that some of these cognitive deficits may be reversible following treatment of mild sleep apnea in children; however, factors such as age at treatment, duration of sleep disordered breathing, pre-morbid intellectual level, socioeconomic status, or the effectiveness of treatment may adversely affect long-term outcome. Furthermore, it is imperative that researchers determine whether the developing brain exhibits critical periods of plasticity during which episodes of sleep-disordered breathing might cause long-term or permanent neuropsychological effects.

Child↗
PubMed2006

Relief of upper airway obstruction with mandibular distraction surgery: Long-term quantitative results in young children.

OBJECTIVE: To evaluate the long-term benefits of mandibular distraction on sleep-related upper airway obstruction in young children with mandibular hypoplasia. DESIGN: Cross-sectional study. Subjects were examined for sleep-disordered breathing using medical history, physical examination results, and a written questionnaire. Subjects underwent standard overnight polysomnography, during which measures of sleep-disordered breathing were collected. SETTING: Tertiary care hospital. PATIENTS: Five children with upper airway obstruction from craniofacial anomalies treated with mandibular distraction, with a minimum follow-up of 12 months. MAIN OUTCOME MEASURES: Apnea-hypopnea index, oxygen saturation nadir, and peak end-tidal carbon dioxide value. RESULTS: Of the 5 children, 3 were cured of upper airway obstruction as documented by polysomnography, with an apnea-hypopnea index of less than 1.5 and no snoring. The fourth child had primary snoring without apnea. The fifth child had severe obstructive sleep apnea, with an apnea-hypopnea index of 20.2. CONCLUSIONS: Most children who undergo mandibular distraction for upper airway obstruction associated with mandibular hypoplasia demonstrate significant clinical improvement of obstructive sleep apnea. However, those children who continue to have symptoms of sleep-disordered breathing after surgery should undergo polysomnography for evaluation of persistent obstructive sleep apnea.

Craniofacial Abnormalities↗
PubMed2006

The trial of infant response to diphenhydramine: the TIRED study--a randomized, controlled, patient-oriented trial.

OBJECTIVE: To determine if infants aged 6 to 15 months with frequent parent-reported nighttime awakenings require reduced parental aid during a week of diphenhydramine hydrochloride treatment and 2 and 4 weeks after its discontinuation. DESIGN: Double-blind, randomized, controlled clinical trial. SETTING: The study was conducted from May 1, 2004, through May 1, 2005; patients were recruited nationally. PARTICIPANTS: Forty-four participants aged 6 to 15 months. INTERVENTIONS: Placebo or diphenhydramine was administered in infants 30 minutes before anticipated bedtime. MAIN OUTCOME MEASURES: The primary outcome was dichotomous: a parental report of improvement in the number of night awakenings requiring parental assistance during the intervention week, which ended on day 14. Secondary outcomes were improved sleep during the 2 weeks before days 29 and 43, parental overall happiness with sleep, and improved sleep latency. RESULTS: On June 6, 2005, the data safety monitoring board voted unanimously to stop the trial early because of lack of effectiveness of diphenhydramine over placebo. Only 1 of 22 children receiving diphenhydramine showed improvement compared with 3 of 22 receiving placebo. To reach the a priori determined sample size and have a positive outcome (ie, rejecting the null hypothesis), the trial would have needed to enroll 16 more participants in each arm, with 15 of the 16 in the diphenhydramine group and 0 of 16 in the placebo group improving. CONCLUSION: During 1 week of therapy and at follow-up 2 and 4 weeks later, diphenhydramine was no more effective than placebo in reducing nighttime awakening or improving overall parental happiness with sleep for infants.

Diphenhydramine↗
PubMed2006

Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury.

BACKGROUND: Childhood obstructive sleep apnea (OSA) is associated with neuropsychological deficits of memory, learning, and executive function. There is no evidence of neuronal brain injury in children with OSA. We hypothesized that childhood OSA is associated with neuropsychological performance dysfunction, and with neuronal metabolite alterations in the brain, indicative of neuronal injury in areas corresponding to neuropsychological function. METHODS AND FINDINGS: We conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6-16 y) group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared. Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency). Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001) and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03). CONCLUSIONS: Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.

Adolescent↗
PubMed2006

Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea.

OBJECTIVES: Positive airway pressure therapy (PAP) is frequently used to treat children who have obstructive sleep apnea syndrome and do not respond to adenotonsillectomy. However, no studies have evaluated objectively adherence to PAP in children, and few studies have evaluated objectively the effectiveness of PAP. The objective of this study was to determine adherence and effectiveness of PAP (both continuous [CPAP] and bilevel [BPAP] pressure) in children with obstructive apnea. METHODS: A prospective, multicenter study was performed of children who were randomly assigned in a double-blind manner to 6 months of CPAP versus BPAP. Adherence was measured objectively using the equipment's computerized output. Effectiveness was evaluated using polysomnography. RESULTS: Twenty-nine children were studied. Approximately one third of children dropped out before 6 months. Of the 21 children for whom 6-month adherence data could be downloaded, the mean nightly use was 5.3 +/- 2.5 (SD) hours. Parental assessment of PAP use considerably overestimated actual use. PAP was highly effective, with a reduction in the apnea hypopnea index from 27 +/- 32 to 3 +/- 5/hour, and an improvement in arterial oxygen saturation nadir from 77 +/- 17% to 89 +/- 6%. Results were similar for children who received CPAP versus BPAP. Children also had a subjective improvement in daytime sleepiness. CONCLUSIONS: Both CPAP and BPAP are highly efficacious in pediatric obstructive apnea. However, treatment with PAP is associated with a high dropout rate, and even in the adherent children, nightly use is suboptimal considering the long sleep hours in children.

Adolescent↗
PubMed2004

Sleep disturbance after rapid ascent to moderate altitude among infants and preverbal young children.

Rapid ascent to high altitude is known to result in sleep disturbances among adults. No data exist regarding the effects of altitude exposure on sleep in children. The objective of this study was to determine the effect of rapid ascent to moderate altitude on sleep in infants and young children. In this prospective study, each child served as his or her own control. Each subject was studied over 7 days and nights. On days 1 and 2, children were studied at home (1601 m), day 3 at a hotel without ascent (travel control), day 4 at home, days 5 and 6 at a hotel after ascent (3109 m), and day 7 at home. Since increased motion is a characteristic of sleep disturbance among infants and young children, continuous measurements of motion were made using an ankle-mounted Actigraph. Thirty children, 17 girls and 13 boys, with a median age of 16.5 months (range = 4 to 33 months) participated in the study. Significant changes in the activity counts, reflecting a sleep disturbance during nocturnal sleep, were noted between the travel control night (20.9 +/- 1.9) and the first night at altitude (29.4 +/- 2.5): p < 0.01. This sleep disturbance is most significant during the first night at altitude and may be similar to sleep disturbance with altitude exposure seen in adults.

Altitude↗
PubMed2003

Sleep disorders in children.

PURPOSE OF REVIEW: Childhood sleep disorders are one of the most prevalent complaints in the pediatrician's office. Infant sleep rhythm complaints from new mothers reach 46%, while childhood obstructive sleep apnea has a prevalence of 2% and adolescent insomnia with daily consequences surpasses that percentage. RECENT FINDINGS: Each sleep disorder must be considered in context of age, as age influences the presentation and impact on the developing child or adolescent. For example, sleep-disordered breathing resulting in adult sleepiness can contribute to death in infants. The symptoms of narcolepsy are often masked until after adolescence, resulting in psychologically costly misdiagnoses. SUMMARY: There are no outcome studies that track the long-term consequences of pediatric sleep disorders or their contribution to adult sleep problems, but this is an area of increasing research interest. This review assesses the most recent literature on pediatric sleep disorders from May 1, 2002, until April 30, 2003.

Adolescent↗
PubMed2002

Secondary narcolepsy in children with brain tumors.

We report two cases of children with disabling daytime sleepiness associated with suprasellar tumors and hypothalamic obesity. Multiple sleep latency testing demonstrated features consistent with severe narcolepsy, with sleep latencies of 0.25 and 0.75 minutes, and REM latencies of 2.1 and 1.5 minutes, respectively. An additional patient with hypothalamic damage secondary to a brain tumor, who was thought to be in a vegetative state, had features of narcolepsy on polysomnography. All children responded well to treatment with stimulants. We speculate that secondary narcolepsy associated with hypothalamic tumors is due to damage or loss of hypothalamic hypocretin-containing neurons. In view of the good response to treatment, we recommend that all children with excessive daytime sleepiness and hypothalamic damage be evaluated for narcolepsy.

Adolescent↗
PubMed2002

Food dye use in enteral feedings: a review and a call for a moratorium.

Pulmonary aspiration of gastric contents is common in enterally fed patients. Tinting enteral feedings with blue dye is thought to aid the early detection of aspiration in hospitalized patients. The blue-dye method is popular despite evidence that it is not sensitive. Reports of absorption of blue dye from enteral feedings in patients with sepsis and other critical illnesses are increasing. The presence of blue and green skin and urine, and serum discoloration has been linked with death. FD&C Blue No.1 and related dyes have toxic effects on mitochondria, suggesting that dye absorption is harmful. This study reviews the literature on the dye method and dye pharmacology, reports the results of a survey of current dye use, and describes 2 recent deaths associated with blue-dye absorption. We concluded that the use of blue dye in enteral feedings should be abandoned and replaced by evidence-based methods for the prevention of aspiration.

Journal Article↗