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Biomedical subjects

Timothy F Hoban

Publications and source records attributed to Timothy F Hoban.

9 recordsLinked to original sources
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↗
PubMed2005

Obstructive sleep apnea in children.

Despite increasing recognition of childhood obstructive sleep apnea syndrome (OSAS) as a significant public health problem, treatment of the condition remains inconsistent. Some children are screened using polysomnography and treated only when objective respiratory disturbances are identified. Many others receive adenotonsillectomy based only on signs and symptoms of upper airway obstruction without ever having a formal sleep study. Outcome-based data regarding the effectiveness of adenotonsillectomy, continuous positive airway pressure, and other treatments for childhood OSAS remain extremely limited. In this article, the major therapeutic options for treatment of childhood OSAS are reviewed. Adenotonsillectomy remains the most frequently used treatment for uncomplicated OSAS in children, but residual airway obstruction persists in a notable minority of patients. Nasal continuous positive airway pressure is used for children who are not good surgical candidates or who have failed previous surgical treatment, but is sometimes not tolerated by young children or their parents. Various alternative treatments are used on an individualized basis for children who cannot use the two first-line therapies for sleep apnea.

Journal Article↗
PubMed2005

Pediatric sleep-related breathing disorders and restless legs syndrome: how children are different.

Sleep-related breathing disorders and restless legs syndrome have traditionally been felt to affect primarily adults. Recent research suggests that these conditions are surprisingly common in children as well, and that clinical manifestations may differ considerably from those seen in adults. This review summarizes the clinical characteristics, epidemiology, pathophysiology, and treatment of sleep-related breathing disorders and restless legs syndrome in children. Particular emphasis is placed on recent research and on how the presentation and treatment of these conditions are different in children compared with adults.

Adolescent↗
PubMed2004

Sleep and its disorders in children.

Although the physiological mechanisms that underlie sleep disorders in children differ little from those seen in adults, the clinical manifestations may differ considerably between the two. For example, sleep apnea in adults affects men more than women, is more prevalent in the obese, and presents with symptoms of snoring and excessive somnolence. In preadolescent children, sleep apnea affects both sexes equally, is more closely correlated with adenotonsillar enlargement than obesity, and may be more likely to present with daytime inattention and learning problems rather than frank somnolence. Likewise, the insomnia and associated bedtime struggles of a 3-year-old bear little resemblance to the insomnia of a mature adult apart from the fact that both individuals are unable to easily fall asleep. Sleep disorders in children are reviewed with particular focus on age-related changes in normal sleep and on sleep disorders that primarily or exclusively affect children. Pediatric aspects of other sleep disorders will be reviewed in more limited detail, with examination of how age, developmental level, and comorbid conditions cause clinical presentation and treatment to differ from that of adults.

Child↗
PubMed2004

Assessment and treatment of disturbed sleep in attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder affects 3-5% of children in the USA, and is commonly accompanied by disrupted sleep in the form of insomnia, restless sleep or excessive daytime tiredness. In addition, daytime inattention and hyperactivity which mimicks attention deficit hyperactivity disorder can result from intrinsic sleep disorders such as obstructive sleep apnea or periodic limb movement disorder. In most cases, the correct clinical evaluation permits appropriate diagnosis and management. Current research investigating the relationship between attention deficit hyperactivity disorder and sleep, as well as general precepts of clinical assessment and treatment are reviewed.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study.

OBJECTIVE: To determine the effect of treating obstructive sleep apnea (OSA) on seizure frequency in adults and children with epilepsy in a prospective study. Several case series documented an improvement in seizure control with treatment of coexisting OSA, but published series did not sample a clinic population, were not prospective in design, and did not account for concurrent changes in antiepileptic drug (AED) doses or levels. PATIENTS AND METHODS: Adult patients and the parents of pediatric patients seen in the University of Michigan Epilepsy and Pediatric Neurology Clinics were given validated questionnaires. Thirteen adults (aged 20-56) and 5 children (aged 14-17) were selected for polysomnography (PSG) based on frequency of seizures and risk for OSA. Seizure frequency was compared during 8-week baseline and treatment phases and AED levels were done to document stability in medication levels. RESULTS: Six of 13 adults and 3 of 5 children met PSG criteria for OSA. Three adults and 1 child were treated with continuous positive airway pressure (CPAP), were tolerant of the device, and had no change in AED doses; all four had at least a 45% reduction in seizure frequency during CPAP treatment. One adult was treated with an oral appliance with a reduction in nocturnal seizures only, and 2 adults and 2 children were intolerant of CPAP. CONCLUSIONS: Treatment of OSA in patients with epilepsy may improve seizure control and a large randomized placebo-controlled trial appear warranted.

Adolescent↗
PubMed2003

Rhythmic movement disorder in children.

How should sleep-related rhythmic movements in children be assessed and treated? Rhythmic movement disorder (RMD) represents an unusual variety of childhood parasomnia characterized by repetitive motion of the head, trunk, or extremities, which usually occurs during the transition from wakefulness to sleep or arises during sustained sleep. Although the condition most often affects infants and toddlers in a transient and self-limited fashion, the condition occasionally persists in a problematic fashion, which may nevertheless be amenable to treatment. Since RMD may occasionally cause injury or resemble nocturnal seizure, prompt recognition, and appropriate management on the part of the clinician is essential. This article will examine the spectrum of RMD in children, including their common clinical manifestations; data regarding their epidemiology and natural history; the role of polysomnography, electroencephalography; and other diagnostic testing. Potential causes of the condition and available methods of treatment are also examined.

Child↗
PubMed2002

Transient central nervous system white matter abnormality in X-linked Charcot-Marie-Tooth disease.

X-linked Charcot-Marie-Tooth disease (CMTX) is a hereditary demyelinating neuropathy caused by mutations in the connexin 32 (Cx32) gene. Cx32 is widely expressed in brain and peripheral nerve, yet clinical manifestations of CMTX mainly arise from peripheral neuropathy. We have evaluated two male patients with CMTX who on separate occasions developed transient ataxia, dysarthria, and weakness within 3 days of returning from ski trips at altitudes above 8,000 feet. Magnetic resonance imaging studies in both patients showed nonenhancing, confluent, and symmetrical white matter abnormalities that were more pronounced posteriorly and that resolved over several months. Magnetic transfer images in one patient demonstrated increased magnetization transfer ratios distinct from that seen in demyelination or edema. Both patients returned to their normal baseline within 2 to 3 weeks. These cases suggest that CMTX patients are at risk for developing an acute, transient, neurological syndrome when they travel to places at high altitudes and return to sea level. Cx32 mutations may cause central nervous system dysfunction by reducing the number of functioning gap junctions between oligodendrocytes and astrocytes, making both cells more susceptible to abnormalities of intercellular exchange of ions and small molecules in situations of metabolic stress.

Adolescent↗