Biomedical subjects

Yu-Shu Huang

Publications and source records attributed to Yu-Shu Huang.

11 recordsLinked to original sources

PubMed2006

Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study.

BACKGROUND: Children diagnosed with attention-deficit/hyperactivity disorder (ADHD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) criteria, may also have obstructive sleep apnea (OSA), but it is unclear whether treating OSA has similar results as methylphenidate (MPH), a commonly used treatment for ADHD. METHODS: This study enrolled 66 school-age children, referred for and diagnosed with ADHD, and 20 healthy controls. Polysomnography (PSG) performed after ADHD diagnosis showed the presence of mild OSA. After otolaryngological evaluation, parents and referring physicians of the children could select treatment of ADHD with MPH, treatment of OSA with adenotonsillectomy or no treatment. Systematic follow-up was performed six months after initiation of treatment, or diagnosis if no treatment. All children had pre- and post-clinical interviews; pediatric, neurologic, psychiatric and neurocognitive evaluation; PSG; ADHD rating scale, child behavior checklist (CBCL) filled out by parents and teacher; test of variables of attention (TOVA); and the quality of life in children with obstructive sleep disorder questionnaire (OSA-18). RESULTS: ADHD children had an apnea-hypopnea index (AHI)>1<5 event/hour; 27 were treated with MPH, 25 had adenotonsillectomy, and 14 had no treatment. The surgical and MPH groups improved more than the non-treatment group. When comparing MPH to post-surgery, the PSG and questionnaire sleep variables, some daytime symptoms (including attention span) and TOVA subscales (impulse control, response time and total ADHD score) improved more in the surgical group than the MPH group. The surgical group had an ADHD total score of 21.16+/-7.13 on the ADHD rating scale (ADHD-RS) post-surgery compared to 31.52+/-7.01 pre-surgery (p=0.0001), and the inattention and hyperactivity subscales were also significantly lower (p=0.0001). Finally, the results were significantly different between surgically and MPH-treated groups (ADHD-RS p=0.007). The surgical group also had a TOVA ADHD score lower than -1.8 and close to those obtained in normal controls. CONCLUSION: A low AHI score of >1 considered abnormal is detrimental to children with ADHD. Recognition and surgical treatment of underlying mild sleep-disordered breathing (SDB) in children with ADHD may prevent unnecessary long-term MPH usage and the potential side effects associated with drug intake.

Adenoidectomy↗

PubMed2006

A common haplotype of the dopamine transporter gene associated with attention-deficit/hyperactivity disorder and interacting with maternal use of alcohol during pregnancy.

CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) is a common heritable childhood behavioral disorder. Identifying risk factors for ADHD may lead to improved intervention and prevention. The dopamine transporter gene (DAT1) is associated with ADHD in several studies, with an average 1.2 odds ratio and evidence of heterogeneity across data sets. OBJECTIVE: To investigate sources of heterogeneity by refining the DAT1 association using additional markers and investigating gene-environment interaction between DAT1 and maternal use of alcohol and tobacco during pregnancy. DESIGN: Prospective study. SETTING AND PATIENTS: Children with ADHD from child behavior clinics in the southeast of England and in the Taipei area of Taiwan. INTERVENTIONS: Within-family tests of association using 2 repeat polymorphisms in the 3' untranslated region and intron 8 plus additional markers in the English sample. MAIN OUTCOME MEASURES: Transmission ratios of risk alleles from heterozygote parents to affected offspring and comparison of the transmission ratios in high- and low-exposure groups for the environmental variables. RESULTS: A novel association was identified between ADHD, the intron 8 polymorphism, and a specific risk haplotype in both English and Taiwanese samples. The risk haplotype showed significant interactions with maternal use of alcohol during pregnancy. CONCLUSIONS: The identification of a common haplotype in 2 independent populations is an important step toward identifying functionally significant regions of DAT1. Interaction between DAT1 genotypes and maternal use of alcohol during pregnancy suggests that DAT1 moderates the environmental risk and has implications for the prevention of ADHD. Further studies are required to delineate the precise causal risk factor involved in this interaction.

Alcohol Drinking↗

PubMed2006

Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing.

OBJECTIVES/HYPOTHESIS: Children with sleep-disordered breathing may experience behavioral and learning problems such as inattentiveness and hyperactivity. The aim of this study was to measure the impact of adenotonsillectomy on sleep-related adverse events and behavioral problems in children with sleep-disordered breathing. METHOD: This prospective and interventional study enrolled 40 sleep-disordered breathing children (mean age, 8.4+/-1.6 years) with hypertrophic tonsils and adenoids. All patients completed two polysomnographies, tests of variables of attention (TOVAs), and Child Behavior Checklists, one at baseline and the other 6 months after adenotonsillectomy. RESULTS: The apnea-hypopnea index (P<.001), TOVA scores (P<.001), and 8 of 9 individual domains of the Child Behavior Checklist scores (P<.05) significantly improved after surgery. However, the change in the apnea-hypopnea index was not negatively correlated with TOVA score (r=-0.17, P=.38). CONCLUSION: Adenotonsillectomy could significantly improve behavior (TOVA) scores, but the improvement may not simply be attributable to changes in sleep apnea events.

Adenoidectomy↗

PubMed2005

No evidence for the association of DRD4 with ADHD in a Taiwanese population within-family study.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent and highly heritable childhood disorder. The dopamine D4 receptor (DRD4) gene has shown a genetic association with ADHD in Caucasian populations with meta-analysis indicating a small but significant effect across datasets. It remains uncertain whether this association can be generalised to non-Caucasian ethnic groups. Here we investigate two markers within the DRD4 gene in a Taiwanese population, the exon 3 variable number tandem repeat (VNTR) and a 5' 120 base-pair duplication. METHODS: Within-family transmission disequilibrium tests of association of the 5' 120 base-pair duplication, and exon 3 VNTR in a Taiwanese population. RESULTS: No evidence of association of ADHD with either polymorphism in this population was observed. CONCLUSION: The DRD4 gene markers investigated were not found to be associated with ADHD in this Taiwanese sample. Further work in Taiwanese and other Asian populations will therefore be required to establish whether the reports of association of DRD4 genetic variants in Caucasian samples can be generalised to Asian populations.

Adolescent↗

PubMed2005

SPECT findings in the Kleine-Levin syndrome.

STUDY OBJECTIVES: The Kleine-Levin Syndrome, is a rare disorder with onset during teenage years, but little is known on etiopathogenesis. Seven subjects with Kleine-Levin Syndrome accumulated over time had systematic SPECT studies during (n=5) and out (n=7) of the symptomatic period. SUBJECTS: Seven boys with symptom onset between 11 and 17 years of age and at least 2 episodes per year were followed for a mean of 6 years. METHODS: Electroencephalogram awake-asleep, computed tomography scan, and magnetic resonance imaging studies were performed before Tc-99m ECD single photon emission tomography (SPECT) obtained during day 4 or 5 (n=5) and at least 1 month away from the symptomatic period (n=7). RESULTS: All imaging tests except SPECT were normal. Hypoperfusion of both thalami were seen during the symptomatic period that completely disappeared during the asymptomatic period. Hypoperfusion in other regions were also noted in some, but not all subjects. They persisted during the asymptomatic period in 2 cases over the temporal lobe (2/7 cases), frontal lobe (1/7 cases), and basal ganglia (1/7 cases). The largest amount of persistent hypoperfusion was seen in the subject with longest clinical evolution. CONCLUSION: Hypoperfusion of the thalamus is a consistent finding during the symptomatic period, but perfusion abnormalities may persist even during the asymptomatic period. The longer the duration of the syndrome, the more extended the hypoperfusion regions during the asymptomatic period.

Adolescent↗

PubMed2005

Is obstructive sleep apnea syndrome a neurological disorder? A continuous positive airway pressure follow-up study.

Abnormal sensory responses have been found in the upper airway of obstructive sleep apnea patients, but no long-term study has been published previously regarding the evolution of obstructive sleep apnea syndrome and persistence of abnormal pharyngeal sensory evaluation in response to continuous positive airway pressure (CPAP) treatment. Over 5 years, we managed healthy, nonobese subjects compliant with nasal CPAP. Only 47 subjects completed this prospective study, due to protocol requirements. They underwent regular clinical evaluation, subjective scales, four polysomnographies without nasal CPAP, recalibration of nasal CPAP with polysomnography, regular downloading of home data, and a palatal two-point discrimination study. None of the subjects presented normal results at any checkpoint when they had been without CPAP for two or three nights. By the completion of the study, all subjects required an increase in nasal CPAP (1-7 cm H(2)O) and demonstrated abnormal two-point palatal discrimination compared with control subjects. Despite initial control of clinical symptoms with regular usage of nasal CPAP in subjects without weight change, abnormal sensory palatal evaluation was present at the conclusion of the study. Obstructive sleep apnea syndrome involves abnormal upper airway sensory input, which may be responsible for the development of apneas and hypopneas. These neurological lesions are persistent despite nasal CPAP treatment.

Adult↗

PubMed2005

Insomnia.

The pathogenesis of insomnia in an individual usually is multifaceted. Effective treatments require a thorough evaluation to determine the factors that need to be addressed. Pharmacologic treatments generally are safe and effective for short-term use. Long-term hypnotic use remains controversial because of the potential risk of tolerance and dependency. Various cognitive and behavioral treatments for insomnia have been shown to be effective in the management of insomnia. For long-term follow-up, multicomponent cognitive behavioral therapy, alone or in combination with hypnotic use, has been shown to be superior to hypnotic use alone.

Journal Article↗

PubMed2005

Heart rate variability, sympathetic and vagal balance and EEG arousals in upper airway resistance and mild obstructive sleep apnea syndromes.

BACKGROUND AND PURPOSE: We questioned the role of respiratory events in obstructive sleep apnea syndrome (OSAS) and of upper airway resistance syndrome (UARS) on heart rate (HR) during sleep, paying specific attention to the termination of the abnormal breathing events and examining the presence of arousals or termination with only central nervous system (CNS) activation. PATIENTS AND METHODS: Twenty patients, 10 with UARS and 10 with mild OSAS, were studied. A nocturnal polysomnogram was performed including measurement of respiratory variables and pulse transit time (PTT). According to the presence or absence of a PTT event indicative of autonomic nervous system (ANS) activation, 148 events were extracted after having been randomly chosen in each represented sleep stage, with or without an electroencephalogram (EEG) arousal >1.5s. RR interval (RRI) in electrocardiogram (ECG) recordings, as well as heart rate variability, was calculated during 60 and 120s, respectively. Period amplitude analysis (PAA) was applied for RR-interval analysis, and fast Fourier transformation (FFT) was applied to perform HR variability analysis. RESULTS: Visually scored EEG arousal was significantly associated with an increase in sympathetic index of heart rate, while PTT was associated with a drop in parasympathetic index, after the respiratory events. Patients with mild OSAS presented persistently shorter RRI when compared to patients with UARS. The latter also exhibited a significant decrease in parasympathetic index (High Frequency (HF)) at the termination of a respiratory event. CONCLUSION: The HF component was only significantly decreased in patients with UARS, which indicates a predominant involvement of the parasympathetic tone in patients with UARS in comparison to those with OSAS.

Adult↗

PubMed2004

Mood improvement after surgery for obstructive sleep apnea.

OBJECTIVE: Patients with obstructive sleep apnea (OSA) may experience unfavorable psychologic symptoms such as depression and anxiety. The aim of this study was to confirm this hypothesis and to investigate whether the psychologic symptoms among OSA patients can be relieved by surgical intervention. STUDY DESIGN: Prospective, longitudinal intervention study. METHODS: The 5-Item Mental Health scale (MH-5) was used to evaluate the postoperative changes of mood after extended uvulopalatal flap (EUPF) surgery on 84 Taiwanese patients with OSA. The preoperative and postoperative MH-5 data obtained from these patients were compared with a Taiwanese population norm. RESULTS: Before surgery, the MH-5 scores of the OSA patients were significantly worse than the Taiwanese population norm of 72.8 (P <.0001). Postoperatively, mean MH-5 scores significantly increased from 61.8 +/- 16.0 to 70.0 +/- 15.8 (P =.0006). The effect size of this score change was 0.51, indicating a moderate degree of mood improvement. However, this score was still inferior to that of the population norm (P =.0045). The mood improvement was not significantly associated with the changes in either sleep apnea events or the level of sleepiness. Neither the changes in respiratory disturbance index (P =.4382), maximum arterial oxygen saturation (P =.4866), nor the change in Epworth Sleepiness Scale scores (P =.4951) were predictive of the MH-5 score improvement (R = 0.07). CONCLUSIONS: This study demonstrated that patients with OSA had a higher level of anxiety, depression, and probable behavior or personality changes than the population norm. EUPF surgery could significantly improve the mood status among OSA patients; the effect of surgery was mild but clinically relevant. However, the extent of mood improvement experienced by OSA patients receiving operations may not simply be attributable to the changes in sleep apnea events or a reduced level of sleepiness.

Adult↗

PubMed2004

Sleep disorders in Taiwanese children with attention deficit/hyperactivity disorder.

To assess obstructive sleep apnea syndrome (OSAS) and periodic limb movement disorder (PLMD) in children with attention deficit/hyperactivity disorder (ADHD) compared with a control group. The ADHD was diagnosed based on Diagnostic and Statistical Manual, version IV (DSM-IV) criteria on successively seen elementary school children aged 6-12 years referred to a psychiatric clinic for suspected ADHD. A standardized interview (Kiddie-SADS-E), parents and teacher questionnaires, neuropsychological testing, and nocturnal polysomnography were completed for each child. Eighty-eight children (77 boys) with ADHD and 27 controls were involved in the study. Fifty children with ADHD (56.8%) had an apnea-hypopnea index (AHI) >1 event h(-1) and 17 (19.3%) had an AHI >5 event h(-1). Nine children (10.2%) had a periodic limb movement index (PLMI) >5 events h(-1). There is one child with AHI >1 and none with a PLMI > 5 in the control group. In the test of variables of attention (TOVA), the response time was significantly worse in ADHD with sleep disorders than those without them. The child behavior checklist (CBCL) showed a significant difference between groups in the hyperactivity subscale. The diagnostic criteria for ADHD based on DSM-IV do not differentiate between children with or without sleep disorders. Evaluation of sleep disorders should be considered before starting drug treatment for ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

A family-based association study of attention-deficit hyperactivity disorder and dopamine D2 receptor TaqI A alleles.

BACKGROUND: Over the past 5 years, considerable progress has been made in the identification of polymorphic variation within monoamine system genes that are associated with the attention-deficit hyperactivity disorder (ADHD) phenotype. In this study, we investigated the association of the dopamine D2 receptor (DAD2) TaqI A and ADHD in a Taiwanese sample. METHODS: The sample consisted of 98 children with ADHD and 154 of their parents. ADHD cases were ascertained from the Child Psychiatric Clinics at Chang Gung Memorial Hospital in the Taipei area, Taiwan. A diagnosis of ADHD was made following clinical interviews plus completion of a standard maternal interview and Conner's revised rating scales by a parent and teacher. Association of DRD2 TaqI A polymorphism in this sample was investigated using a haplotype-based haplotype relative-risk method. RESULTS: Among our subjects, there was no significant difference in transmission rates between DRD2 TaqI A1 and A2 alleles. CONCLUSION: The results of this study do not support DRD2 playing a major role in Taiwanese children with ADHD.

Attention Deficit Disorder with Hyperactivity↗