Automated screening of children with obstructive sleep apnea using nocturnal oximetry: An alternative to respiratory polygraphy in unattended settings

Producción CientíficaStudy Objectives: Nocturnal oximetry has emerged as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was two-fold: (1) to design and assess a novel methodology for pediatric OSAHS screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. Methods: SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression (LR) models were optimized using genetic algorithms (GAs) for 3 cutoffs for OSAHS: 1, 3, and 5 events per hour (e/h). The diagnostic performance of LR models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥3% (ODI3) were assessed. Results: For a cutoff of 1 e/h, the optimal LR model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% Accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 AUC (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 e/h, the LR model achieved 83.4% Accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 e/h, oximetry reached 82.8% Accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). Conclusions: Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pre-test probability of OSAHS. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings.This research has been partially supported by the project 153/2015 of the Sociedad Española de Neumología y Cirugía Torácica (SEPAR), the project RTC-2015-3446-1 from the Ministerio de Economía y Competitividad and the European Regional Development Fund (FEDER), and the project VA037U16 from the Consejería de Educación de la Junta de Castilla y León and FEDER. L. Kheirandish-Gozal is supported by NIH grant 1R01HL130984-01. D. Álvarez was in receipt of a Juan de la Cierva grant from the Ministerio de Economía y Competitividad

Inflammatory Markers and Obstructive Sleep Apnea in Obese Children: The NANOS Study

Introduction: Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim: To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4-15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results: 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). Conclusion: IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763

Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study

The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ?3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up

Metabolic biomarkers in community obese children: effect of obstructive sleep apnea and its treatment

Objective: Obesity and obstructive sleep apnea in children have been associated with metabolic morbidities. The present study aimed to evaluate the presence of metabolic alterations among obese children recruited from the community, with and without obstructive sleep apnea syndrome (OSAS), and the impact of treatment of OSAS on metabolic profiles. Methods: A cross-sectional, prospective, multicenter study of Spanish children aged 3-14 years with a body mass index (BMI) ?95th percentile for age and sex were randomly selected in the first phase. Four groups emerged for follow-up: (1) no treatment; (2) dietary intervention; (3) surgical treatment of OSA; and (4) continuous positive airway pressure (CPAP) treatment of OSA. Fasting blood tests were performed at baseline (T0) and approximately one year after the intervention (T1). Results: A total of 113 obese children with a mean age of 11.3 ± 2.9 years completed T0 and T1 assessments. Their mean BMI z-score at T1 was 1.34 ± 0.59, and mean Respiratory Disturbance Index was 8.6 ± 13.0 at T0 and 3.3 ± 4.0/hour total sleep time at T1. Only glucose fasting levels differed among metabolic parameters in obese children with OSAS and without OSAS at baseline (T0) (p = 0.018). There were statistically significant differences between surgically treated OSAS (p = 0.002), and CPAP-treated OSAS (p = 0.024) versus the non-OSAS group in the glucose levels between baseline (T0) and follow-up (T1) after controlling for age and change in BMI. Significant univariate associations between BMI and C-reactive protein, insulin, and homeostasis model assessment of insulin resistance emerged at both T0 and T1. Conclusions: Concurrent obesity and OSAS could promote metabolic and inflammatory alterations, and the latter appeared to be sensitive to OSAS treatment outcomes. ClinicalTrials.gov Identifier: NCT01322763

Nocturnal Oximetry-based Evaluation of Habitually Snoring Children

Rationale: The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea–hypopnea syndrome (OSA) are not objectively diagnosed by nocturnal polysomnography because of access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could potentially provide a reliable and convenient diagnostic approach for pediatric OSA. Methods: DeidentifiednSpO2 recordings froma total of 4,191 children originating from13 pediatric sleep laboratories around the worldwere prospectively evaluated after developing and validating an automated neural network algorithm using an initial set of single-channel nSpO2 recordings from 589 patients referred for suspected OSA. Measurements and Main Results: The automatically estimated apnea–hypopnea index (AHI) showed high agreement with AHI from conventional polysomnography (intraclass correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the widely used AHI cutoff points of 1, 5, and 10 events/h revealed an incremental diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and 0.913 area under the receiver operating characteristic curve, respectively). Conclusions: Neural network–based automated analyses of nSpO2 recordings provide accurate identification of OSA severity among habitually snoring children with a high pretest probability of OSA. Thus, nocturnal oximetry may enable a simple and effective diagnostic alternative to nocturnal polysomnography, leading to more timely interventions and potentially improved outcomes.Supported in part by project VA037 U16 from the Consejer´ıa de Educacio´ n de la Junta de Castilla y Leo´ n and the European Regional Development Fund (FEDER), project RTC-2015-3446-1 from the Ministerio de Econom´ıa y Competitividad and FEDER, and project 153/2015 of the Sociedad Espan˜ ola de Neumolog´ıa y Cirug´ıa Tora´ cica (SEPAR). L.K.-G. is supported by NIH grant 1R01HL130984. M.F.P. was supported by a Fellowship Educational grant award from the Kingdom of Saudi Arabia. D.´A. was in receipt of a Juan de la Cierva grant from the Ministerio de Econom´ıa y Competitividad. The funders played no role in the study design, data collection, data analysis, interpretation, and writing of the manuscript

Nocturnal Oximetry-based Evaluation of Habitually Snoring Children

Rationale: The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea–hypopnea syndrome (OSA) are not objectively diagnosed by nocturnal polysomnography because of access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could potentially provide a reliable and convenient diagnostic approach for pediatric OSA. Methods: DeidentifiednSpO2 recordings froma total of 4,191 children originating from13 pediatric sleep laboratories around the worldwere prospectively evaluated after developing and validating an automated neural network algorithm using an initial set of single-channel nSpO2 recordings from 589 patients referred for suspected OSA. Measurements and Main Results: The automatically estimated apnea–hypopnea index (AHI) showed high agreement with AHI from conventional polysomnography (intraclass correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the widely used AHI cutoff points of 1, 5, and 10 events/h revealed an incremental diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and 0.913 area under the receiver operating characteristic curve, respectively). Conclusions: Neural network–based automated analyses of nSpO2 recordings provide accurate identification of OSA severity among habitually snoring children with a high pretest probability of OSA. Thus, nocturnal oximetry may enable a simple and effective diagnostic alternative to nocturnal polysomnography, leading to more timely interventions and potentially improved outcomes.Supported in part by project VA037 U16 from the Consejer´ıa de Educacio´ n de la Junta de Castilla y Leo´ n and the European Regional Development Fund (FEDER), project RTC-2015-3446-1 from the Ministerio de Econom´ıa y Competitividad and FEDER, and project 153/2015 of the Sociedad Espan˜ ola de Neumolog´ıa y Cirug´ıa Tora´ cica (SEPAR). L.K.-G. is supported by NIH grant 1R01HL130984. M.F.P. was supported by a Fellowship Educational grant award from the Kingdom of Saudi Arabia. D.´A. was in receipt of a Juan de la Cierva grant from the Ministerio de Econom´ıa y Competitividad. The funders played no role in the study design, data collection, data analysis, interpretation, and writing of the manuscript

Experiencias educativas en el marco de un proyecto de extensión

La presente comunicación describe el modo de trabajo del Proyecto de extensión “La Facultad va a la Escuela”, perteneciente a la Universidad Nacional de La Plata, y las experiencias interactivas entre diferentes niveles educativos que éste ofrece. En particular se exponen tres situaciones educativas: el taller “Uso y Aplicaciones del Microscopio”; una Jornada de Evaluación Conjunta entre les extensionistas y destinataries y una Jornada de Talleres realizada en el edificio Karakachoff. A partir de ellas concluimos que es necesario no solo generar propuestas centradas en espacios presenciales de trabajo conjunto, sino también ampliar el alcance de las intervenciones, permitiendo una interacción continua entre docentes de escuela primaria y extensionistas en pos de fortalecer la articulación entre estes. Frente a esto proponemos la implementación de tecnologías de la información y comunicación (TICs), de acuerdo a lo impulsado desde la Dirección General de Cultura y Educación de la provincia de Buenos Aires.Facultad de Humanidades y Ciencias de la Educació

Experiencias educativas en el marco de un proyecto de extensión

La presente comunicación describe el modo de trabajo del Proyecto de extensión “La Facultad va a la Escuela”, perteneciente a la Universidad Nacional de La Plata, y las experiencias interactivas entre diferentes niveles educativos que éste ofrece. En particular se exponen tres situaciones educativas: el taller “Uso y Aplicaciones del Microscopio”; una Jornada de Evaluación Conjunta entre les extensionistas y destinataries y una Jornada de Talleres realizada en el edificio Karakachoff. A partir de ellas concluimos que es necesario no solo generar propuestas centradas en espacios presenciales de trabajo conjunto, sino también ampliar el alcance de las intervenciones, permitiendo una interacción continua entre docentes de escuela primaria y extensionistas en pos de fortalecer la articulación entre estes. Frente a esto proponemos la implementación de tecnologías de la información y comunicación (TICs), de acuerdo a lo impulsado desde la Dirección General de Cultura y Educación de la provincia de Buenos Aires.Facultad de Humanidades y Ciencias de la Educació

Experiencias educativas en el marco de un proyecto de extensión

La presente comunicación describe el modo de trabajo del Proyecto de extensión “La Facultad va a la Escuela”, perteneciente a la Universidad Nacional de La Plata, y las experiencias interactivas entre diferentes niveles educativos que éste ofrece. En particular se exponen tres situaciones educativas: el taller “Uso y Aplicaciones del Microscopio”; una Jornada de Evaluación Conjunta entre les extensionistas y destinataries y una Jornada de Talleres realizada en el edificio Karakachoff. A partir de ellas concluimos que es necesario no solo generar propuestas centradas en espacios presenciales de trabajo conjunto, sino también ampliar el alcance de las intervenciones, permitiendo una interacción continua entre docentes de escuela primaria y extensionistas en pos de fortalecer la articulación entre estes. Frente a esto proponemos la implementación de tecnologías de la información y comunicación (TICs), de acuerdo a lo impulsado desde la Dirección General de Cultura y Educación de la provincia de Buenos Aires.Facultad de Humanidades y Ciencias de la Educació

ESPAÇOS EDUCATIVOS: OPORTUNIDADE DE UMA PRÁTICA EDUCATIVA PROBLEMATIZADORA

Science teaching exceeds the assimilation of scientific terms and concepts, in order to establish learning conditions to the students, thus to contribute to students’ knowledge construction. Our objective was to reflect on this process, based on Freire’s perspective and other authors who worked with science education in educational spaces. We carried out readings and recordings of the work of Paulo Freire, aiming to lend a new meaning to the Freire’s ideas. We also conducted research readings on science education in non-formal spaces. All facts points to the use of non-formal educational spaces, those located beyond the school walls and considered as complementary environments to formal education, due to facilitate the dynamics of learning to learn. Based on the analysis, we envision a formative education, in which the subject is able to dialogue with the scientific information that guides his life context.Compreende-se que ensinar ciências ultrapassa a assimilação de conceitos e termos científicos, oferecendo condições de aprendizagem para os alunos, contribuindo assim para a construção do conhecimento. O nosso objetivo foi refletir sobre esse processo baseado no ponto de vista Freireano e de autores que pesquisam a educação em ciências em espaços educativos. Para construí-lo realizamos leituras e fichamentos das obras de Paulo Freire objetivando ressignificar as ideias deste autor. Também realizamos leituras de pesquisas sobre a educação em Ciências em espaços não formais. Os fatos apontam para o uso de espaços educativos não formais que são considerados como ambientes complementares à educação formal, por facilitar a dinâmica de aprender a aprender. Com base na análise, vislumbramos uma educação formativa, na qual o sujeito é capaz de dialogar com as informações científicas que norteiam seu contexto de vida