Regional brain tissue changes and associations with disease severity in children with sleep-disordered breathing.

Children with sleep-disordered breathing (SDB) exhibit behavioral, cognitive, and autonomic deficits, suggestive of neural injury. We assessed whether the tissue alterations resulted from acute or chronic processes, and whether alterations correlated with disease severity. Brain tissue integrity was examined with mean diffusivity (MD) (3.0 T scanner) in 20 nonsnoring controls (mean age ± SEM, 12.2 ± 0.6 years; 10 males) and 18 children with SDB (12.3 ± 0.7 years; 11 males). Sleep, cognitive, and behavioral measures were compared between groups following overnight polysomnography using Student's t tests. Whole-brain MD maps were realigned and averaged, normalized, smoothed, and compared between groups using ANCOVA (covariates: age, gender, and socioeconomic status). Partial correlations were calculated between whole-brain smoothed MD maps and obstructive apnea-hypopnea indices (OAHIs). Age, gender, and sleep variables did not differ between groups. The SDB group showed higher OAHIs, body mass indices, and systolic blood pressure. Significantly reduced MD values (acute changes) appeared in the hippocampus, insula, thalamus, temporal and occipital cortices, and cerebellum, but were increased (chronic damage) in the frontal and prefrontal cortices in the SDB group over controls. Both positive and negative correlations appeared with extent of tissue changes and disease severity. Externalizing and Total Problem Behaviors were significantly higher in children with SDB. Verbal, performance, and total IQ scores trended lower, and behavioral scores trended higher. Pediatric SDB is accompanied by predominantly acute brain changes in areas that regulate autonomic, cognitive, and mood functions, and chronic changes in frontal cortices essential for behavioral control. Interventions need to be keyed to address acute vs chronic injury

Regional brain tissue changes and associations with disease severity in children with sleep-disordered breathing.

STUDY OBJECTIVES:Children with sleep-disordered breathing (SDB) exhibit behavioral, cognitive, and autonomic deficits, suggestive of neural injury. We assessed whether the tissue alterations resulted from acute or chronic processes, and whether alterations correlated with disease severity. METHODS:Brain tissue integrity was examined with mean diffusivity (MD) (3.0 T scanner) in 20 nonsnoring controls (mean age ± SEM, 12.2 ± 0.6 years; 10 males) and 18 children with SDB (12.3 ± 0.7 years; 11 males). Sleep, cognitive, and behavioral measures were compared between groups following overnight polysomnography using Student's t tests. Whole-brain MD maps were realigned and averaged, normalized, smoothed, and compared between groups using ANCOVA (covariates: age, gender, and socioeconomic status). Partial correlations were calculated between whole-brain smoothed MD maps and obstructive apnea-hypopnea indices (OAHIs). RESULTS:Age, gender, and sleep variables did not differ between groups. The SDB group showed higher OAHIs, body mass indices, and systolic blood pressure. Significantly reduced MD values (acute changes) appeared in the hippocampus, insula, thalamus, temporal and occipital cortices, and cerebellum, but were increased (chronic damage) in the frontal and prefrontal cortices in the SDB group over controls. Both positive and negative correlations appeared with extent of tissue changes and disease severity. Externalizing and Total Problem Behaviors were significantly higher in children with SDB. Verbal, performance, and total IQ scores trended lower, and behavioral scores trended higher. CONCLUSIONS:Pediatric SDB is accompanied by predominantly acute brain changes in areas that regulate autonomic, cognitive, and mood functions, and chronic changes in frontal cortices essential for behavioral control. Interventions need to be keyed to address acute vs chronic injury

Comparison between pulsed and continuous radiofrequency delivery

Das paroxysmale Vorhofflimmern (AF) wird zu 94% aus Foci aus dem Bereich von 2 bis 4 cm innerhalb der Pulmonalvenen getriggert [20]. Ein Ziel der Studie war die Klärung der Frage, inwieweit die Lokalisation der Ablationsnarbe im Bereich der Pulmonalvenen für einen Ablationserfolg ausschlaggebend ist. Als weiteres Studienziel galt es, die kontinuierliche Radiofrequenz-(RF)-Katheterablation mit der gepulsten Katheterablation zu vergleichen. Im Tierexperiment wurden Schweine lege artis anästhesiert und intubiert beatmet. Für jede Pulmonalvene wurden drei verschiedene anatomische Lokalisationen randomisiert ausgewählt: intraatrial, am Ostium der Pulmonalvene und innerhalb der Pulmonalvene selbst. Für die Ablation wurden drei verschiedene Energieeinstellungen verwendet: 30, 40 und 50 Watt (bei 55º C als Voreinstellung). Die Ablationen wurden mit einem zirkumferentiellen Ablationskatheter durchgeführt. Die Energiezufuhr zum Katheter wurde gepulst oder kontinuierlich gewählt. Die gepulste Katheterablation war bezüglich des Zeitmanagements sowie der Qualität der Homogenität und Transmuralität der kontinuierlichen Katheterablation überlegen. Bei der gepulsten Katheterablation traten weniger Komplikationen (PE, VT) auf als bei der kontinuierlichen Katheterablation. Die ostiale Pulmonalvenenisolation erwies sich als beste anatomische Lokalisation. Im Gegensatz dazu wiesen die intraatrialen Läsionen eine inhomogenere und eine weniger transmurale Ablation auf. Die Ablation innerhalb der Pulmonalvenen war signifikant häufiger mit einer Pulmonalvenenstenose (> 50% des Durchmessers) assoziiert. Die tierexperimentelle AF-Katheterablation im Bereich des Ostiums der Pulmonalvenen erzielte in Bezug auf die Homogenität der Ablationsnarbe und der Transmuralität der Läsion die besten Resultate. Des Weiteren wies die Ablation im Bereich des Ostiums ein geringeres Risiko hinsichtlich der Komplikation für eine Pulmonalvenenstenose auf. Die gepulste Katheterablation kann in signifikant kürzerer Zeit durchgeführt werden als die kontinuierliche Katheterablation. Bezüglich der Transmuralität und Homogenität der Läsionen konnte mit der gepulsten Katheterablation ein besseres Ergebnis erzielt werden als mit der kontinuierlichen Katheterablation.Atrial fibrillation is characterized by uncoordinated atrial activation often with irregular and high ventricular frequencies. Catheter ablation of the pulmonary veins (PV) has revolutionized treatment for invasive treatment of atrial fibrillation. The PV are often a trigger for the development of atrial fibrillation [20]. The aim of our study was first to evaluate different anatomical sites for PV-isolation: intraartial, ostial of the pulmonary veins or in the pulmonary veins it selves. The exact target for ablation is still unknown. The second aim of the study was to compare continuous radiofrequency (RF) delivery with pulsed RF. The animal experiments were performed in 8 anaesthetized and ventilated pigs. For each pulmonary vein three different anatomical sites for RF catheter ablation were selected: left atrial, the ostia of the PV or in the PV. In addition three different energy settings were used: 30, 40 and 50 Watts (55°C temperature presetting). The ablations were performed with an octapolar circumferential ablation catheter, either with continuous RF-energy delivery or with pulsed RF-energy delivery. The pulsed RF-energy delivery revealed the best results regarding transmurality (yes/no) and homogeneity (scaled). The best results for PV-isolation was the ostial of the PV. Intraatrial lesions were less homogenous and less transmural. Intrapulmonary vein ablation was associated with significant (> 50% diameter) stenosis of the PV (5/32). Ostial ablation of the PV may have the best results regarding homogeneity and transmurality with a low risk of PV stenosis. Pulsed energy delivery revealed the fastest way to create linear circumferential ostial lesions

Mean domain scores on CBCL (3A) and BRIEF (3B) at baseline (black bars) and follow-up (white bars) for the Control, Resolved and Unresolved groups.

<p>The dotted line represents the population mean. The solid lines represent the between group differences. *<i>p</i><0.05, **<i>p</i><0.01, ***<i>p</i><0.001.</p

Profile of SDB cohort at baseline and follow-up.

<p>At follow-up 16 children originally diagnosed with PS, 11 with Mild OSA and 8 with MS OSA returned. Of these, 18 had resolved and 17 had ongoing SDB. Twelve children who had resolved received treatment. Eight children who were unresolved also received treatment.</p