Obstructive sleep apnea syndrome in the pediatric age: The role of the pneumologist

OBJECTIVE: This review paper aims to summarize the current state of knowledge on the role of the pneumologist in the diagnosis and respiratory treatment of children affected by obstructive Sleep Disordered Breathing (SDB). MATERIALS AND METHODS: A literature review has been performed on the following topics: obstructive SDB and its clinical entities, indications for respiratory treatment of pediatric SDB, and Continuous Positive Airway Pressure (CPAP) and Noninvasive Positive Pressure Ventilation (NIPPV) treatment approach to obstructive SDB. RESULTS: OSDB is related to obesity, craniofacial pathologies, neuromuscular disorders and, most commonly, adenotonsillar hypertrophy. Adenotonsillectomy is the first-choice treatment in children with obstructive apnea secondary to adenotonsillar hypertrophy. CPAP and NIPPV are recommended in cases where Obstructive Sleep Apnea (OSA) persists after surgery or when surgery is contraindicated. Treatment interventions are usually implemented gradually by separately addressing each abnormality that would predispose to obstructive SDB, then reevaluating after each intervention to detect any residual disease and to assess the need for additional treatment. CONCLUSIONS: Many pediatric patients continue to experience problems and symptoms such as hypersomnia and apnea after adenotonsillectomy and need CPAP/NIPPV treatment. Current knowledge is still incomplete, especially with regard to the mechanisms of pathogenesis of pediatric OSA, the factors affecting pediatric OSA, and the phenotypic variability of the disease. A better understanding of these aspects would contribute to the development of new therapies

Obstructive sleep apnea syndrome in the pediatric age: the role of the otorhinolaryngologist

OBJECTIVE: Obstructive sleep apnea (OSA) is the primary indication for tonsillectomy, one of the most common pediatric surgical procedures, commonly performed in association with adenoidectomy. The objective of this review article is to evaluate the role of the otorhinolaryngologist in pediatric OSA. MATERIALS AND METHODS: A literature review has been performed on the following topics: peculiarities of sleep-disordered breathing in pediatric age; discrimination of sleep disorders; adenotonsillar hypertrophy; surgical techniques; adjuvant surgical procedures. RESULTS: The role of the otorhinolaryngologist in pediatric OSA is important for the evaluation of the upper airways and of essential biometric and polysomnographic data and for indication and execution of appropriate surgical treatment. In the majority of healthy children, adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography. When post-surgical residual OSA occurs, it is essential to monitor patients by means of drug-induced sleep endoscopy (DISE). CONCLUSIONS: Otolaryngologic assessment is of paramount importance to correctly classify a child with OSA. Correct inspection of the upper airway and quantification of the quality of sleep through polysomnography lead to the right therapeutic choice. Knowledge of different surgical techniques helps to deal with residual OSA after studying the obstruction sites by drug-induced sedation endoscopy

The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment

none7noAbstract: Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI++D+), severe OSA nondesaturators (AHI++D−), and moderate OSA nondesaturators (AHI+D−). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients.openAngelelli P., Macchitella L., Toraldo D.M., Abbate E., Marinelli C.V., Ariglian M., De Benedetto M.Angelelli, P.; Macchitella, L.; Toraldo, D. M.; Abbate, E.; Marinelli, C. V.; Ariglian, M.; De Benedetto, M

Gravitational diffraction radiation

We show that if the visible universe is a membrane embedded in a higher-dimensional space, particles in uniform motion radiate gravitational waves because of spacetime lumpiness. This phenomenon is analogous to the electromagnetic diffraction radiation of a charge moving near to a metallic grating. In the gravitational case, the role of the metallic grating is played by the inhomogeneities of the extra-dimensional space, such as a hidden brane. We derive a general formula for gravitational diffraction radiation and apply it to a higher-dimensional scenario with flat compact extra dimensions. Gravitational diffraction radiation may carry away a significant portion of the particle's initial energy. This allows to set stringent limits on the scale of brane perturbations. Physical effects of gravitational diffraction radiation are briefly discussed.Comment: 5 pages, 2 figures, RevTeX4. v2: References added. Version to appear in Phys. Rev.

Circularly Symmetric Apodization via Starshaped Masks

Recently, we introduced a class of shaped pupil masks, called spiderweb masks, that produce point spread functions having annular dark zones. With such masks, a single image can be used to probe a star for extrasolar planets. In this paper, we introduce a new class of shaped pupil masks that also provide annular dark zones. We call these masks starshaped masks. Given any circularly symmetric apodization function, we show how to construct a corresponding starshaped mask that has the same point-spread function (out to any given outer working distance) as obtained by the apodization.Comment: Paper also at: http://www.orfe.princeton.edu/~rvdb/tex/starshape/ms.pdf Updated to clarify misleading statements regarding total throughput for apodizations and their corresponding starshaped mask

Temporary Acceleration of Electrons While Inside an Intense Electromagnetic Pulse

A free electron can temporarily gain a very significant amount of energy if it is overrun by an intense electromagnetic wave. In principle, this process would permit large enhancements in the center-of-mass energy of electron-electron, electron-positron and electron-photon interactions if these take place in the presence of an intense laser beam. Practical considerations severely limit the utility of this concept for contemporary lasers incident on relativistic electrons. A more accessible laboratory phenomenon is electron-positron production via an intense laser beam incident on a gas. Intense electromagnetic pulses of astrophysical origin can lead to very energetic photons via bremsstrahlung of temporarily accelerated electrons

Cost-effectiveness strategies in OSAS management: a short review

Lapnea ostruttiva del sonno (OSAS) è una malattia cronica eccessivamente sotto-diagnosticata con unalta prevalenza negli adulti. LOSAS sta diventando un problema sociale significativo perché associata ad un peggioramento della qualità della vita ed un aumento della mortalità. Il rapporto costo-efficacia nella gestione diagnostica e terapeutica dellOSAS è un problema strategico per contrastare la crescente domanda di test oggettivi. I pazienti OSAS che non presentano comorbilità clinicamente evidenti devono essere studiati utilizzando un sistema semplificato e poco costoso, come lHome Sleep Testing (HST). Al contrario, la Sleep Laboratory Polisomnography (PSG) rimane il gold standard per la gestione dei pazienti con OSAS in presenza di comorbidità. Occorre sottolineare che luso di HST potrebbe portare ad una diagnosi errata in soggetti OSAS non ben selezionati. Questa breve rassegna si propone di offrire argomenti di riflessione sulla corretta diagnosi e trattamento dellOSAS, in rapporto ai dati di prevalenza e alle ricadute sui costi/benefici sociali della malattia. Attualmente non può essere solo il rapporto costo/efficacia a definire il modello organizzativo adottato per la gestione dellOSAS, in quanto si rendono necessari ulteriori studi prospettici a lungo termine, volti a validare in maniera definitiva tale rapporto nonché il confronto tra il trattamento con modelli di gestione ospedaliera versus lassistenza domiciliare

Perceived Hospital Preparedness Is Negatively Associated With Pandemic-Induced Psychological Vulnerability in Primary Care Employees: A Multicentre Cross-Sectional Observational Study.

The COVID-19 pandemic had a profound negative impact on the psychological wellbeing of healthcare providers (HPs), but little is known about the factors that positively predict mental health of primary care staff during these dire situations. We conducted an online questionnaire survey among 702 emergency department workers across 10 hospitals in Switzerland and Belgium following the first COVID-19 wave in 2020, to explore their psychological vulnerability, perceived concerns, self-reported impact and level of pandemic workplace preparedness. Participants included physicians, nurses, psychologists and nondirect care employees (administrative staff). We tested for predictors of psychological vulnerability through both an exploratory cross-correlation with rigorous correction for multiple comparisons and model-based path modelling. Findings showed that the self-reported impact of COVID-19 at work, concerns about contracting COVID-19 at work, and a lack of personal protective equipment were strong positive predictors of Depression, Anxiety, and Stress, and low Resilience. Instead, knowledge of the degree of preparedness of the hospital/department, especially in the presence of a predetermined contingency plan for an epidemic and training sessions about protective measures, showed the opposite effect, and were associated with lower psychological vulnerability. All effects were confirmed after accounting for confounding factors related to gender, age, geographical location and the role played by HPs in the hospital/department. Difficult working conditions during the pandemic had a major impact on the psychological wellbeing of emergency department HPs, but this effect might have been lessened if they had been informed about adequate measures for minimizing the risk of exposure

'From mosh pit to posh pit': Festival imagery in the context of the boutique festival

This paper addresses market-based cultural production in the context of the UK festival field, with a focus on the framing of the festival experience through anticipation. In particular, boutique festivals are discussed as examples of a contemporary cultural ?product category? which has emerged and proliferated in the last decade. Through discourse analysis of media representations of boutique festivals, we situate the boutique festival in a broader sociocultural discourse of agency and choice, which makes it meaningful and desirable, and outline the type of consumer it is meant to attract. For the contemporary consumer, the boutique festival is presented as an anticipated experience based on countercultural festival imagery, while simultaneously framing cultural participation through consumption. The paper contributes to a wider debate on the construction of the consumer in the cultural economy