Biomedical subjects

Robert A Weatherly

Publications and source records attributed to Robert A Weatherly.

6 recordsLinked to original sources

PubMed2006

Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy.

OBJECTIVES: Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care. METHODS: We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children. RESULTS: Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales, inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness. CONCLUSIONS: Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.

Adenoidectomy↗

PubMed2006

Subjective sleepiness and polysomnographic correlates in children scheduled for adenotonsillectomy vs other surgical care.

STUDY OBJECTIVE: To compare a validated subjective measure of childhood sleepiness to an objective determination, assess the frequency of problematic sleepiness among children with suspected sleep-disordered breathing (SDB), and examine what standard or investigational polysomnographic measures of SDB predict subjective sleepiness. DESIGN: Prospective, cross-sectional. SETTING: University-based sleep disorders laboratory. PARTICIPANTS: Washtenaw County Adenotonsillectomy Cohort. INTERVENTION: Polysomnography followed by Multiple Sleep Latency Tests (MSLTs) in 103 children aged 5 to 12 years old: 77 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 26 for unrelated surgical care. Parents completed the previously validated, 4-item Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS). RESULTS: Thirty-three (43%) of the children scheduled for adenotonsillectomy had high PSQ-SS scores, in comparison with only 3 (12%) of the controls (p = .004). The PSQ-SS scores correlated inversely with mean sleep latencies on the MSLTs (rho = -0.23, p = .006). The obstructive apnea index, apnea-hypopnea index, and respiratory disturbance index (which included respiratory event-related arousals identified by esophageal pressure monitoring) each correlated similarly with PSQ-SS scores, as did investigational quantification of esophageal pressures and respiratory cycle-related electroencephalographic changes (each rho approximately 0.30, p < .02). A stepwise regression identified sigma-frequency respiratory cycle-related electroencephalographic changes as the strongest independent predictor of subjective sleepiness among all subjects and particularly among those without obstructive sleep apnea. CONCLUSIONS: Sleepiness is a frequent problem among children with suspected SDB. Subjective sleepiness (PSQ-SS) reflects MSLT results to a limited extent, as in adults. Standard polysomnographic measures of SDB predict subjective sleepiness, but respiratory cycle-related electroencephalographic changes may offer additional clinical utility.

Adenoidectomy↗

PubMed2004

Tracheal reconstruction using tissue-engineered cartilage.

OBJECTIVES: To determine whether rabbit cartilage can be tissue engineered using a polyglycolic acid (PGA) construct composed of PGA mesh, autologous chondrocytes, and alginate covalently linked with the cell adhesion sequence arginine-glycine-aspartic acid (RGD), and to investigate the feasibility of reconstructing tracheal defects using the PGA construct in conjunction with a bioabsorbable intratracheal stent. METHODS: Nineteen New Zealand White rabbits were used. Nine rabbits underwent subcutaneous implantation of 3 different PGA construct combinations: (1) PGA, autologous chondrocytes, and RGD-modified alginate; (2) PGA, autologous chondrocytes, and unmodified alginate; and (3) PGA and RGD-modified alginate. The remaining 10 animals underwent anterior tracheal reconstruction using fascia lata grafts and the complete PGA construct (PGA, autologous chondrocytes, and RGD-modified alginate). At the time of tracheal reconstruction, a poly-l-lactic acid intratracheal stent was placed in 5 of these latter animals. Rates of tracheal stenosis and mortality were compared with those of historical control animals. Histologic analysis was performed on the PGA constructs. RESULTS: In the subcutaneous implants, the PGA constructs made with chondrocytes (with and without RGD) demonstrated mature cartilage formation in 7 (78%) of the 9 animals. No cartilage was seen in PGA constructs made without chondrocytes. Two of the 10 animals that underwent tracheal reconstruction with the complete PGA construct survived to 20 weeks and demonstrated patent airways, 1 with a stent and 1 without a stent (80% overall mortality). Histologic analysis showed mature cartilage formation at the tracheal reconstruction site. Historical control animals that underwent reconstruction with fascia lata alone demonstrated the lowest overall mortality. CONCLUSIONS: Cartilage can be tissue engineered in rabbits using PGA mesh embedded with alginate-encapsulated autologous chondrocytes. It is also possible to reconstruct tracheal defects with this method of cartilage engineering, although the mortality rate in this study is high.

Alginates↗

PubMed2004

Polysomnography in children scheduled for adenotonsillectomy.

OBJECTIVE: Several studies suggest that a reliable diagnosis of childhood sleep-disordered breathing (SDB) requires polysomnography (PSG). We compared clinical and PSG-based diagnoses in children scheduled for adenotonsillectomy (AT). Parent responses on a validated Pediatric Sleep Questionnaire were used to determine which symptoms could help identify children with clinical diagnoses of SDB but normal PSG. STUDY DESIGN AND SETTING: Thirty-four children aged 5.0 to 12.9 years and scheduled for AT to treat clinically diagnosed sleep-disordered breathing underwent laboratory-based PSG. Results were scored by 3 different criteria: 1) >1 obstructive apnea (2 breaths or longer) per hour of sleep; 2) >5 apneas or hypopneas per hour of sleep; or 3) >1 apnea, hypopnea, or respiratory event-related arousal per hour of sleep. RESULTS: Depending on the criterion used, the PSG documented SDB from a minimum of 18/34 subjects (53%, for criterion I) to as many as 30/34 subjects (88%, for criterion III). Among symptoms studied, absence of daytime mouth breathing and habitual snoring were most helpful in identification of children who had no evidence of SDB on PSG, by criterion I (Chi-square, P < 0.05). The absence of other common symptoms, such as "loud snoring" or "trouble breathing" at night, were not helpful. CONCLUSION: Children with clinical diagnoses of SDB may not consistently meet PSG criteria for this disorder. Questions about daytime mouth breathing and habitual snoring might help clinicians recognize children who would not have SDB on objective testing. SIGNIFICANCE: Clinical identification of SDB confirmable on PSG could be improved. However, available outcome data do not yet clarify whether clinical or PSG criteria best identify children likely to suffer morbidity from SDB. EBM RATING: C.

Adenoidectomy↗

PubMed2003

Tolerance of esophageal pressure monitoring during polysomnography in children.

OBJECTIVES: To assess tolerance of esophageal pressure monitoring (EPM) among 5- to 13-year-old children during research polysomnography at study entry and again 1 year later. DESIGN: Prospective, observational study. SETTING: University-based sleep laboratory. PARTICIPANTS: Children scheduled for adenotonsillectomy or hernia repair. INTERVENTIONS: None; all operations were performed for clinical indications only. RESULTS: Forty-two of 336 families approached about the study declined to participate mainly to avoid EPM. The EPM was usually the main concern for the 47 adenotonsillectomy and 7 hernia-repair patients and families who did participate. Among 54 enrolled subjects, 51 allowed attempts at insertion of the esophageal catheter, and insertion was successful in all cases; 38 tolerated EPM for at least 2 hours; 33 maintained EPM for the entire night; and 36 had repeat EPM 1 year later for at least 2 hours. Reasons for EPM failure included crying at insertion, vomiting, pain, and inadvertent catheter removal during sleep. The children who tolerated EPM for at least 2 hours did not differ from other subjects based on age, sex, presence of a disruptive behavior disorder, anxiety, tonsil size, history of tonsillitis, or body mass index (all P > .05). CONCLUSIONS: The EPM was well tolerated in most school-aged volunteers, but many families did not volunteer, and some children were not able to endure EPM for at least 2 hours. Although better success might be achieved in clinical settings if EPM is medically indicated and not part of voluntary research, EPM is still likely to create significant concern, for children and parents, that must be weighed against anticipated benefits.

Adenoidectomy↗

PubMed2003

Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns.

OBJECTIVES: Some data suggest that the clinical diagnosis of obstructive sleep apnea (OSA) in a child should be confirmed by polysomnography before adenotonsillectomy (AT), but otolaryngology literature generally does not agree and few studies have examined surgical practice patterns. METHODS: We mailed, to 603 members of two North American otolaryngology societies, surveys about children aged 5.0-12.9 years upon whom they performed ATs in the previous year. RESULTS: A total of 183 otolaryngologists estimated that they had performed 24,000 ATs. Reported major surgical indications, not mutually exclusive, included recurrent throat infections (for 42% of procedures), obstructed breathing of any type (59%), OSA (39%), poor school performance (17%), and poor attention (11%). Pre-operative evaluations included an office-based, sleep-related history in 93% of children, any objective testing for OSA in <10%, and laboratory-based polysomnography in <5%. Surgeons with academic affiliations, higher volumes of ATs, and pediatric specialization reported lower percentages of ATs performed for recurrent tonsillitis as opposed to other indications. CONCLUSIONS: As a common indication for AT, OSA now rivals recurrent throat infection. No more than 12% of school-aged children who undergo AT for OSA have polysomnography prior to the procedure. Indications for AT may depend, in part, on practice settings and otolaryngologists' backgrounds.

Adenoidectomy↗