Sleep disturbances in children with multiple disabilities.

Sleep Med Rev. 2011 May 25;

Authors: Tietze AL, Blankenburg M, Hechler T, Michel E, Koh M, Schlüter B, Zernikow B

INTRODUCTION: Although sleep disturbances in disabled children are of central clinical importance, there is little research on that topic. There are no data available on frequency, severity or aetiology of sleep disturbances and related symptoms in this specific patient group. OBJECTIVE: To review the current state of research and outline future research objectives. METHODS: We searched international scientific databases for relevant publications from 1980-2009. From all papers qualifying for further analysis we retrieved systematic information on sample characteristics, sleep assessment tools and their test quality criteria, and core findings. RESULTS: 61 publications including 4392 patients were categorized as "mixed" (reporting on heterogeneous diagnoses), or "specified" papers (specific diagnoses) based on international classification of diseases (ICD) 10 classification. To assess sleep disturbances, most authors relied on subjective instruments with poor psychometric quality. Mean prevalence of sleep disturbances was 67% (76%,"mixed" group; 65%, "specified" group). In children suffering severe global cerebral injury, the prevalence of sleep disturbances was even higher (>90%). The most frequent symptoms were insomnia and sleep-related respiratory disorders. Some of these symptoms were closely associated with specific medical syndromes. CONCLUSION: There is an urgent need for sleep disturbance assessment tools evaluated for the patient group of interest. By use of validated assessment tools, patient factors, which may be crucial in causing sleep disturbances, may be investigated and appropriate treatment strategies may be developed.

PMID: 21620745 [PubMed - as supplied by publisher]

Exhaled breath temperature in healthy children is influenced by room temperature and lung volume.

Pediatr Pulmonol. 2011 May 27;

Authors: Logie KM, Kusel MM, Sly PD, Hall GL

BACKGROUND: Exhaled breath temperature (EBT) has been proposed for the non-invasive assessment of airway inflammation. Previous studies have not examined the influence of room temperature or lung size on the EBT. OBJECTIVE: This study aimed to address these issues in healthy children. METHODS: We assessed the effects of room temperature and lung volume in 60 healthy children aged 9-11 years (mean age 10.3 years, 33 male). Static lung volumes were assessed using multiple breath nitrogen washout. Questionnaire and skin prick tests were also used to establish respiratory health in the children. We obtained the EBT parameters of slope, end plateau temperature (PLET) and normalized plateau temperature (nPLET; plateau temperature minus inspired air temperature), and ascertained physiological factors influencing EBT. RESULTS: End plateau temperature was shown to be proportionally affected by room temperature (r = 0.532, P < 0.001) whereas slope and nPLET decreased with increasing room temperature (r = -0.392 P < 0.02 and r = -0.507 P = 0.002). After adjusting for room temperature, height and age, the total lung capacity (r(2)  = 0.435, P = 0.006) and slow vital capacity (SVC; r(2)  = 0.44, P = 0.005) were found to be the strongest predictors of end PLET in healthy children. When all factors were included in a multiple regression model, SVC and room temperature were the only predictors of plateau and nPLET. Slope was only influenced by room temperature. CONCLUSIONS: Exhaled breath temperature measurements are highly feasible in children with a 95% success rate in this healthy population. Room temperature and SVC significantly influence EBT variables in healthy children. Further studies are required to investigate the ability of EBT to assess airway inflammation in children with respiratory disease. Pediatr Pulmonol. © 2011 Wiley-Liss, Inc.

PMID: 21626714 [PubMed - as supplied by publisher]

Abstract  Breathing difficulty and respiratory distress is the most common cause of admission to the Pediatric Emergency. Respiratory distress presents as altered breathing pattern, forced breathing efforts or obstructed breathing, and chest indrawing; respiratory failure is defined as paCO2 >50 mmHg (inadequate ventilation) and/or a paO2 < 60mmHg (inadequate oxygenation). Rapid assessment is aimed to ascertain adequacy of airway patency, breathing, and circulation. Immediate care is directed at (a) restoration of airway patency- by positioning (head tilt –chin lift), cleaning the oropharynx, and/or insertion of oropharyngeal airway; (b) supporting breathing- with high flow oxygen and assisted ventilation (with bag and mask or endotracheal intubation and ven...

Conclusion: PCT values in CF children are not different from values reported in healthy children. In CF children, PCT values do not rise significantly at the onset of a respiratory exacerbation and thus hold no promise as an early marker to identify a pulmonary exacerbation. Content Type Journal ArticlePages 1-4DOI 10.1007/s00431-011-1502-xAuthors Jacoba Johanna Louw, Division Woman and Child, University Hospitals Leuven, Faculty of Medicine, Catholic University of Leuven, Leuven, BelgiumJaan Toelen, Division Woman and Child, University Hospitals Leuven, Faculty of Medicine, Catholic University of Leuven, Leuven, BelgiumMarijke Proesmans, Cystic Fibrosis Reference Centre, University Hospitals Leuven, Catholic University of Leuven, Leuven, BelgiumFrançois Vermeulen, Cystic Fibrosi...