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Infant Sleep and Obstructive Sleep Apnoea Syndrome

Infant Sleep and Obstructive Sleep Apnoea Syndrome. Albert M. Li Department of Paediatrics Prince of Wales Hospital Chinese University of Hong Kong. Infant sleep - normal sleep pattern - contrast with sleep of children and adults Touch / Massage - evidence of benefits

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Infant Sleep and Obstructive Sleep Apnoea Syndrome

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  1. Infant Sleep and Obstructive Sleep Apnoea Syndrome Albert M. Li Department of Paediatrics Prince of Wales Hospital Chinese University of Hong Kong

  2. Infant sleep - normal sleep pattern - contrast with sleep of children and adults • Touch / Massage - evidence of benefits - possible mechanisms • Childhood obstructive sleep apnoea

  3. Effects of massage and use of oil on growth, blood flow and sleep pattern in infants. Agarwal KN, Gupta A, Pushkarna R, et al. Indian J Med Res 2000;112:212-217

  4. Full term born healthy infants, n =125 • Age 6 +/- 1 weeks, weight > 3kg • Five groups; herbal oil, sesame oil, mustard oil or mineral oil for massage daily for 4 weeks, and a control group • Anthropometric measurements, femoral artery blood flow and sleep pattern • Sesame oil group had significant increase in length, midarm and midleg circumferences by 1.0, 0.9 and 0.7cm respectively, p < 0.05 • Significant increase in femoral flow in the sesame group • Massage improved post massage sleep duration

  5. Massage for preterm and / or low birth-weight infants – improved daily weight gain by 5.1g (95% CI 3.5, 6.7), reduced length of stay in hospital by 4.5 days (95% CI 2.4, 6.5), positive effects on postnatal complications and weight at 4 – 6 months. Vickers A, Ohlsson A, Lacy JB, et al. Cochrane Database Syst Rev. 2004;(2):CD000390 • Greater bone mineralisation and more optimal behavioural and motor responses for infants given massage compared to controls. Moyer-Mileur L, Luetkemeier M, Boomer L, et al. J Pediatr 1995;127:620-625 Field T, Schanberg SM, Scafidi F, et al. Pediatrics 1986;77:654-658 Scafidi F, Field T, Schanberg S. J Dev Behav Pediatr 1993;14:176-180 Ottenbacher K, Muller L, Brandt D, et al. J Dev Behav Pediatr 1987;8:68-77

  6. Mechanisms of action • Massage increases activity of the vagus nerve which may lead to an increase in food absorption hormones such as insulin. Diego MA, Field T, Hernandez-Rief M. J Pediatr 2005;147:50-55

  7. Massage promotes the quiet alert state and it during the quiet alert state that infants learn best and start to communicate.35 • An increase in the number and cytoxicity of natural killer cells in the massaged group.

  8. Massage enhances bonding and the release of oxytocin which has been shown to promote maternal well behaviour. Glover V, Onozawa K, Hodgkinson A. Semin Neonatol 2002;7:495-500

  9. Epidemiology • Prevalence of childhood OSAS reported to range from 0.7% to 10.3%. Ali et al, Arch Dis Child 1993 Gislason et al, Chest 1995 Redline et al, Am J Respir Crit Care Med 1999 Brunetti et al, Chest 2001 Rosen et al, J Pediatr 2003

  10. Childhood OSAS and even snoring are associated with behavioural, learning problems, poor attention span, hyperactivity and even lower than average intelligent quotient. • Evidence to suggest reversibility of such neuro-cognitive dysfunction following treatment.      Halbower AC, Mark Mahone E. Sleep Med Rev 2006;10:97-107   Row BW, Kheirandish L, Neville JJ, et al. Pediatr Res 2002;52:449-453       Macey PM, Henderson LA, Macey KE, et al. Am J Respir Crit Care Med 2002;166:1382-1387    Gozal D, Kheirandish L. Am J Respir Crit Care Med 2005;17:1325-1327

  11. 297 first-grade children whose school performance was in the lowest10th percentile • underwent assessment and overnight sleep study.

  12. Gozal, D. Pediatrics 1998;102:616-620

  13. Gozal, D. Pediatrics 1998;102:616-620

  14. Adjusted odds ratios for the presence of incident hypertension at 4-year follow-up according to the apnea-hypopnea index (AHI) at baseline. P for trend=0.002. Based on data from Peppard PE et al

  15. Marcus CL, Greene MG, Carroll JL. Am J Respir Crit Care Med. 1998;157:1098-1103

  16. Chan JYS, Li AM, Lo AFC, et al. (submitted for publication)

  17. Less commonly seen nowadays.

  18. Gold standard for diagnosis is overnight sleep study. • One-night sleep study is cost effective and able to correctly identify over 80% of positive cases. Li AM, Wing YK, Cheung A, et al. Chest 2004;226:1467-1472

  19. Treatment • Adenotonsillectomy offers cure in up to 85% of cases. • Medical treatments may be indicated for mild cases. • NIPPV recognised therapy for childhood OSAS especially for obese children.

  20. Li AM, Tsang TWT, Chan DFY, et al. (submitted for publication)

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