OBJECTIVETo explore the diagnostic value of pulse transit time (PTT) in children with sleep disordered breathing(SDB).

METHODSForty eight randomly selected snorers (2 - 13 years) with SDB were examined by PSG and PTT in the same time. Data obtained were analyzed by different technicians respectively. Statistics and analysis of the data were performed.

RESULTSApnea hypopnea index (AHI), obstructive apnea index (OAI), the lowest oxygen and micro-arousal index were obtained by PSG and PTT. The results was described as M [25 percentile; 75 percentile]: 4.9[1.3;10.1], 4.6[1.5;11.8]; 1.2[0.7;4.9], 1.3[0.6;5.0]; 0.93[0.85;0.95], 0.93[0.84;0.95]; 14.5[12.6;16.4], 26.0[17.4;30.6]. The difference of AHI, OAI, and the lowest oxygen were not significant (P > 0.05), while the PTT arousal index detection rate was higher than PSG (Z = -5.19, P < 0.01). There was no significant difference in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) and determination of degree of patient's condition (P > 0.05). PTT could identify upper airway resistance syndrome in children without OASHS.

CONCLUSIONSBoth methods can be used to diagnose SDB. However, PTT is easy to use and suitable for the diagnosis of SDB in children, especially for UARS.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Polysomnography ; Pulse ; Sleep Apnea Syndromes ; diagnosis ; physiopathology

OBJECTIVETo analyse the clinical features of children with obstructive sleep apnea-hypopnea syndrome (OSAHS), accompanying with risk factors.

METHODSThe clinic data of 19 patients treated in the Department of Otorhinolaryngology of Guangzhou Children's Hospital between January 2005 to January 2008 were investigated retrospectively. Among them, 5 were < 2 years old, 6 with craniofacial deformity: small mandible and (or) mandibular retrusion (5 cases), transverse facial cleft (1 case), Down's syndrome (2 cases), cerebral palsy (2 cases), chronic bronchitis (3 cases) and mucopolysaccharidoses (1 case). Nineteen patients with symptoms of snoring, mouth breathing, were diagnosed as OSAHS by polysomnography (PSG) and treated by tonsillectomy and (or) adenoidectomy in hospital. All patients were closely followed-up.

RESULTSFourteen patients underwent PSG 6 months to 1 year after operation, 11 patients recovered, the median [percentiles 25; percentiles 75] apnea-hypopnea index (AHI) decreased from the pre-operative 22.5 [16.5; 24.3] times/h to 2.0 [1.5; 4.3] times/h, and the lowest oxygen saturation (LSaO(2)) before operation was 0.63, and was higher than 0.92 after operation, 1 case accompanying with chronic bronchitis, the pulmonary hypertension was improved after operation. One case with Down's syndrome was not significantly improved, preoperative AHI and LSaO(2) was 22.4 times/h and 0.67, and after operation was 14.2 and 0.84; 2 cases accepted adenoidectomy only, snoring, mouth breathing reappeared 3 months after operation, pre-operative PSG results showed AHI 24.6 times/h and 26.6 times/h, LSaO(2) was 0.69 and 0.73, after operation the AHI was 10.6 times/h and 8.5 times/h, LSaO(2) was 0.90 and 0.88, the symptoms disappeared after adenotonsillectomy. Five cases did not have PSG because they lived far away in the other cities, their pre-operative PSG showed AHI 16.4 to 26.2 times/h, LSaO(2) was 0.65 to 0.76. One year after operation, these patients were followed-up by telephone, 4 children were significantly improved, 1 case with mandibular symptoms showed no improvement.

CONCLUSIONSFor OSAHS children accompanying with risk factors, if they have adenoid and tonsil hypertrophy, adenotonsillectomy is the major treatment. Because of the existence of risk factors, perioperative risk increased, even the failure of operation. so these patients must be comprehensively assessed before operation. Satisfied results can be achieved by close observation after operation and management of complications as soon as possible.

Adenoidectomy ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Risk Factors ; Sleep Apnea, Obstructive ; complications ; surgery ; Tonsillectomy

OBJECTIVETo analyze the similarities and differences of the clinical manifestations between the children with upper airway resistance syndrome (UARS) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the clinical features and characteristics of sleep respiratory parameters.

METHODSUsing the double-blind method, all children were diagnosed as UARS or OSAHS through the polysomnography test and the results of all children were analyzed by a sleep technician and an otolaryngologist. Another ENT doctor recorded their clinical and physical examination in detail.

RESULTSPolysomnography showed that the apnea-hypopnea index (AHI) and the lowest oxygen in 253 children with OSAHS were 3.60[2.00;7.55] times/h and 0.90[0.85;0.91], and were 0.90[0.50;1.10] times/h and 0.95[0.92;0.96] in 102 children with UARS, the difference of the two groups by rank test was statistically significant. The proportion of UARS and OSAHS was more common during preschool period than during school-age period. The chief complaint in two groups was sleep snoring, and the main symptoms were sleep restless, attention deficit/hyperactivity and breath with mouth open. The incidence rate of above symptoms were as follows, 94.1%, 72.5%, 62.7% and 37.3% in children with UARS, 92.9%, 78.7%, 57.7% and 45.5% in children with OSAHS. The difference was not significant by chi-square test (P>0.05). Tonsil and adenoid hypertrophy were also observed in the two groups, the difference was not significant (chi2 = 0.27, P= 0.87). However, the children with OSAHS were more apt to have the sleep apnea than with UARS, the difference was statistically significant (chi2 = 34.07, P<0.001).

CONCLUSIONSThe clinical manifestations of two groups are similar, the difference between UARS and OSAHS can not be determined by the patient's clinical performance. Sleep apnea can be more easily observed in children with OSAHS than that in UARS, the final diagnosis is based on polysomnography.

Adolescent ; Airway Resistance ; Child ; Child, Preschool ; Double-Blind Method ; Female ; Humans ; Male ; Polysomnography ; Sleep Apnea, Obstructive ; epidemiology ; physiopathology

OBJECTIVETo explore the correlation between periodic limb movement index (PLMI) and the apnea-hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and lowest oxygen saturation (LSaO₂) in sixty-four children with sleep-disordered breathing (SDB).

METHODSBetween March 2008 and May 2009, sixty-four children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion. Sixty-four children were divided into two groups. Thirty children were diagnosed as OSAHS and 34 children were diagnosed as primary snoring (PS, 32 children) or upper airway resistance syndrome (UARS, 2 children). The difference of PLMI and periodic limb movement index during sleep associated with arousals (PLMI-arousal) were compared between the two groups. Besides this, the correlation between PLMI, periodic limb movement index during sleep associated with arousals and AHI, AI, HI and LSaO₂ were also analyzed in all SDB children. Furthermore, all SDB children were divided into two groups according to PLMI (< 5 events/h vs ≥ 5 events/h). AHI, AI, HI, LSaO₂ and sleep structure were compared between the two groups.

RESULTS(1) The difference of PLMI and PLMI-arousal between the children with OSAHS and children with other SDB types (PS and UARS) were not significant (z value, -1.279, -1.490; P value, 0.201, 0.136, respectively). (2) The increased sleep stage I was significant as being compared between the two groups (< 5 events/h vs ≥ 5 events/h, t = -2.16, P < 0.05). However, other sleep stages and sleep efficiency were not significantly different (P value, all > 0.05). (3) The difference of HI, AI, AHI, arousals index (ArI) and LSaO₂ were not significant between the two groups (< 5 events/h vs ≥ 5 events/h, P value, all > 0.05). (4) PLMI and PLMI-arousal were not correlated with AHI, HI, AI, AHI and LSaO₂ (Spearman rank correlation analysis).

CONCLUSIONSPLMS may be independent of SDB and PLMS had a little influence on sleep structure.

Adolescent ; Child ; Child, Preschool ; Extremities ; physiopathology ; Female ; Humans ; Male ; Movement ; Polysomnography ; Sleep ; Sleep Apnea Syndromes ; physiopathology

OBJECTIVE: To investigate the effect of form-deprivation on level of gelatinase in the posterior sclera in chicks. METHODS: Fifty 1-day-old chicks were monocularly deprived to establish the animal model of form-deprivation myopia (FDM). According to the duration of form-deprivation the experimental chicks were divided randomly and equivalently into 5 groups, which were deprived for 3, 7, 14, 21 and 30 days respectively. Meanwhile the other eyes of the deprived chicks were used as self-control groups and chicks of the same days were chosen randomly as the normal control groups for each FDM group. At each form-deprivation point the changes of degree of diopters and axial length of chicks in each group were recorded. The levels of gelatinase in posterior sclera of the experimental eyes were measured by gelatin enzymography. RESULTS: Compared with the normal and self-control groups, the levels of MMP-2 activity in FDM groups were much higher (P <0.01). With the increase of the time of monocular deprivation these changes became more significant and reached the top after 14 days' deprivation with an inter-group statistical difference (P <0.01). The dynamic changes of MMP-2 activity were the same as those of axial length and degree of diopters in each experimental groups. There was positive correlation between the MMP-2 activity and axial length (r = 0.989, P < 0.01). But there was a negative correlation between the MMP-2 activity and refractive degree. CONCLUSION Increase of MMP-2 activity in the posterior sclera of chicks would be a direct key factor to trigger sclera ECM remodeling process in chick FDM.
Animals ; Chickens ; Gelatinases ; metabolism ; Matrix Metalloproteinase 2 ; metabolism ; Myopia ; enzymology ; etiology ; Sclera ; enzymology

Objective To analysis the etiology and molecular classification of brucella strains isolated in Guangdong province in 2010.Methods The strains of 19 brucella were verified and identified by some methods including traditional biology phenotype confirmation,PCR amplification and pulsed field gel electrophoresis (PFGE).Results On phenotype level,4 strains were brucella melitensis biovar 1,2 strains were brucella suis biovar 3,and the rest were brucella melitensis biovar 3,which were specific B genes positive strains,and the PFGE typing similar values ranging from 67.9％ to 100％.In addition to the four strains from Zhuhai for the outbreak,the homology was 100％,and the rest were sporadic cases.Conclusions Brucella cases,in Guangdong province,are highly sporadic and dispersed outbreaks.Compared with a few years ago,it shows species diversification,and brucella melitensis biovar 3 is still the dominant serotype.PFGE can be used to distinguish the three species of brucella,but it can't effectively distinguish the allotypes.

OBJECTIVETo explore the reasons of multiple operations in children with airway foreign body through analyzing the clinical data of children who received two or more operations.

METHODSFrom 2003 to 2009, all children with airway foreign body who received two or more operations in hospital were enrolled. The clinical manifestations, image before and after operation and intraoperative conditions were retrospectively analyzed, in order to find the reasons of multiple operations.

RESULTSAll children fully recovered, no serious complications or death. The reasons of two or more operations were multiple: 21 cases (42.8%) were related to the factor of apparatus, 20 (40.8%) cases were related to the quality, surrounding conditions and location of the foreign body and experience and surgical skills of operator, 4 (8.2%) cases were due to incarceration of foreign body, another 4 (8.2%) cases were due to unstable intraoperative oxygen saturation.

CONCLUSIONSBoth subjective and objective factors (quality, surrounding conditions or location of foreign body, et al) were related to multiple operations. To reduce the chance of multiple operations, careful preoperative assessment and preparation are necessary.

Child ; Child, Preschool ; Female ; Foreign Bodies ; surgery ; Humans ; Infant ; Male ; Reoperation ; Respiratory System ; Retrospective Studies

OBJECTIVETo explore the level of serum uric acid (UA) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS).

METHODBetween Sep. 2008 and Mar. 2010, 138 children with OSAHS were enrolled in study group. Sixty-five children with accessory auricle or ptosis of upper lid were enrolled into the control group. Furthermore, according to apnea/hypopnea index (AHI) or obstructive apnea index (OAI) the study group was further divided into three subgroups (mild, moderate and severe group). At last, the study group and control group were divided into two groups according to the body mass index (BMI), separately. The fasting serum UA level was compared among the different groups. Then the correlation between the serum UA level and AHI, BMI, oxygen desaturation index, least arterial oxygen saturation (LSaO(2)) and the percentage of total sleep time with arterial oxygen saturation < 0.92 was also analyzed in OSAHS children with or without overweight and obesity respectively.

RESULTThe difference of serum UA level between the study group and control group (z = -0.443), and the difference among the three groups (χ(2) = 1.241) was not significant(P > 0.05). The serum UA level in overweight and obese children [study group, 273.0 (238.3 - 357.3); control group, 298.0 (253.0 - 336.0)] was significantly higher than that in children with normal BMI [study group, 246.5(215.8 - 300.0); control group, 266.0 (224.0 - 303.3)] (z = -2.084, -2.214, P < 0.05). That serum UA level did not correlate with the above index of OSAHS was observed in children with or without overweight and obesity in study group (P > 0.05).

CONCLUSIONFindings of higher serum UA level were not observed in children with OSAHS. There was no correlation between serum UA level and the above indices of OSAHS. The serum UA level in overweight and obese children was significantly higher than that in children with normal BMI.

Case-Control Studies ; Child ; Child, Preschool ; Humans ; Sleep Apnea, Obstructive ; blood ; Uric Acid ; blood

OBJECTIVETo observe the symptoms of inattention, hyperactivity among obstructive sleep apnea hypopnea syndrome (OSAHS) children, also to investigate the effects of surgery (tonsillectomy and adenoidectomy or adenoidectomy alone) on the changes of sleep architecture and inattention-hyperactivity score (IHS).

METHODSBetween June 2004 and may 2007, eighty children diagnosed as OSAHS with overnight polysomnography (PSG) were included in this study, only sixteen children had complete pre-op and post-op PSG data. Thirty children with vocal cord nodules were selected as control group. DSM-IV-derived IHS was evaluated by neurologist. All OSAHS children accepted surgery (tonsillectomy and adenoidectomy or adenoidectomy alone) and IHS evaluation. The pre-op and post-op sleep architecture and IHS were compared with that of control group.

RESULTS(1) The median IHS 80 OSAHS children was higher than that it in control group (0.89 vs 0.17) and the difference was significant (Z = -4. 276, P < 0.05). After surgery, it showed a significant reduction in IHS (0.44 vs 0.89, t = 6.219, P < 0.05). (2) Twenty-five OSAHS children had pre-op IHS greater than 1.25 and nine had post-op IHS greater than 1.25, while only three children in control group had IHS greater than 1.25. The difference was statistically significant (chi2 = 5.192, 9.56 respectively, P < 0.05). (3) For sixteen OSAHS children who had both pre-op and post-op PSG data, a decrease in the percentage of phase 1 sleep and an increase in the percentage of phase 2 sleep, slow wave sleep (SWS) and rapid eye movement (REM) sleep were observed in six months after surgery and the difference was significant (t = 12.2, -5.4, -6.3, - 8.1 respectively, P < 0.001). After surgery, apnea-hypopnea index (AHI) decreased from 13.9 times/h to 1.5 times/h while lowest saturation of blood oxygen (LSaO2) increased from 0.855 to 0.940 (t = 5.3, - 3.7 respectively, P < 0.01). REM sleep percentage and LSaO2 was still lower than that of control group six months after surgery.

CONCLUSIONSChildren with OSAHS showed significantly impaired attention and hyperactivity as compared with control group. Improvement of behavior and sleep architecture were observed after adenoidectomy and tonsillectomy.

Attention Deficit Disorder with Hyperactivity ; complications ; diagnosis ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Humans ; Intraoperative Period ; Male ; Sleep Apnea, Obstructive ; complications ; surgery

OBJECTIVETo explore the difference of arousal index between the children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and children with primary snoring. Furthermore, to explore the correlation between the above mentioned arousals and the apnea-hypopnea index (AHI) and lowest oxygen saturation (LSaO(2)).

METHODSBetween March 2007 and February 2008, 102 children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion [Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi) which was published in Chin J Otorhinolaryngol Head Neck Surg in February, 2007]. One-hundred and two children were divided into two groups according to the guidelines. Sixty six children [56 boys, 10 girls; aged 4 - 17 years, (7.01 +/- 2.24) years (x(-) +/- s)] who were diagnosed as OSAHS were enrolled in study group and 36 children [29 boys, 7 girls; aged 4 - 13 years, (7.44 +/- 2.68) years] who were diagnosed as primary snoring made up control group. The difference of spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared between the two groups. Besides this, the correlation between spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement and AHI and LSaO(2) were also analyzed. Furthermore, the study group were divided into three subgroups according to AHI (< or = 10 times/h, 10 times/h < AHI < or = 20 times/h, > 20 times/h). Spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared among the three groups.

RESULTSThe increased total arousal index and arousal index related to respiratory stimuli and the decreased spontaneous arousal index of study group were significant as compared to those of control group (Mann-Whitney U, z value, -3.148, -3.866, -2.791; P value, 0.002, 0.000, 0.005, respectively). The increased arousal index related to respiratory stimuli were significant as being compared among the three groups. Arousal index related to respiratory stimuli was correlated with AHI (coefficient correlation: 0.734, P = 0.000). Other kinds of arousals and arousal index related to respiratory stimuli were not correlated with LSaO(2) (Spearman rank correlation analysis). When compared to control group, stage I increased and stage REM decreased and the difference was significant (z were -2.423, -3.519; P were 0.015, 0.000).

CONCLUSIONSThe arousal index related to respiratory stimuli were increased and spontaneous arousal index were decreased in children with OSAHS. Arousal index related to respiratory stimuli is more suitable to show the degree of sleep fragment than other arousal index.

Adolescent ; Arousal ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Humans ; Male ; Polysomnography ; Sleep Apnea, Obstructive ; physiopathology ; Snoring