Riva Tauman - Academia.edu (original) (raw)

Papers by Riva Tauman

The Open Sleep Journal, 2013

European Journal of Gastroenterology & Hepatology, 2016

To investigate fractional exhaled nitric-oxide (FeNO) levels in children with Crohn&a... more To investigate fractional exhaled nitric-oxide (FeNO) levels in children with Crohn's disease (CD) and ulcerative colitis (UC) and their correlation to disease activity. Children with CD and UC (aged 8-18 years) and age-matched healthy controls without respiratory symptoms were recruited. Disease activity was assessed using validated scores. All children performed spirometry and FeNO tests and the association between intestinal disease parameters and pulmonary functions was studied. Thirty-five children with CD, nine with UC, and 24 healthy controls were enrolled. The mean FeNO level was higher in children with CD compared with the controls. Increased FeNO levels (>23 parts per billion) were more common among CD and UC compared with healthy children (46, 33, and 0%, respectively, P<0.05). Nevertheless, FeNO levels did not correlate with disease activity. There were no significant differences between CD, UC patients, and healthy controls in any of the spirometric variables. FeNO level, a marker of airway inflammation, is elevated in children with inflammatory bowel diseases irrespective of their intestinal disease activity. Increased FeNO levels are not associated with respiratory symptoms, suggesting a latent pulmonary involvement in the systemic disease.

Sleep, Apr 1, 2004

Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, unde... more Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, undergoes dynamic changes that exhibit significant correlation with severity of sleep-disordered breathing. A sleep pressure score (SPS) with a cutoff value of 0.25 was derived from analysis of a large cohort of snoring and control children. Neurocognitive batteries were applied to examine the potential effect of SPS. Prospective study. 199 children who underwent a battery of neurobehavioral tests following an overnight sleep study were assigned to SPSHigh (> or = 0.25) or SPSLow (< 0.25) groups, and their neurocognitive performances were compared. Children in the SPSHigh group were significantly more likely to have deficits in memory, language abilities, verbal abilities, and some visuospatial functions than were children in the SPSLow group. These effects remained highly significant after adjusting for confounding variables and exhibited small to moderate effect sizes. We conclude that a sleep-pressure numerical factor derived from the overnight polysomnogram in snoring children is associated with deficits in neurobehavioral daytime functions that is independent of respiratory disturbance and hypoxemia and suggests a significant role for disturbed sleep homeostasis in pediatric sleep-disordered breathing.

Clinical Pediatrics, Sep 1, 2004

This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography... more This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography (PSG) in 41 infants with unexplained sleep disordered breathing. The relationships of respiratory events to episodes of gastroesophageal reflux (GER) were analyzed. The major causes for referring the infants were cyanotic episodes (22%), apneas (20%), and choking events (15%). PSG was abnormal in 8/41 (20%). Abnormal pH studies were observed in 12/41 (29%) infants. In 4/12 (33%), respiratory events correlated with GER episodes. Adding simultaneous pH monitoring to PSG may identify associated conditions and thus focus treatment.

European Respiratory Journal, Sep 1, 2012

Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keywor... more Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keyword 1: Children Keyword 2: Congenital lesion/malformation Keyword 3: Sleep disorders Title: Sleep-disordered breathing in children with craniofacial anomalies Prof. Yakov 29127 Sivan sivan@post.tau.ac.il MD 1 , Prof. Shlomi 29128 Constantini sconsts@netvision.net.il MD 2 , Dr. Michal 29129 Greenfeld michalgr@tasmc.health.gov.il MD 1 and Riva 29130 Tauman tauman@tasmc.health.gov.il MD 1 .

European Respiratory Journal, 2015

Sleep Medicine, 2016

Primary snoring (PS) is considered as the most benign form of sleep-disordered breathing (SDB), a... more Primary snoring (PS) is considered as the most benign form of sleep-disordered breathing (SDB), and treatment is usually not prescribed. Studies suggest that PS may not be as benign as had formerly been considered. We aimed to investigate the natural history of PS in children with adenotonsillar hypertrophy, and compare those who underwent adenotonsillectomy (AT) with those who did not. Children diagnosed with PS based on polysomnographic findings were included in the study. Information retrieved from their medical records, including medical history, physical examination, anthropometric measures, and polysomnography (PSG) results, was reviewed. A telephone interview was conducted 4-6 years following the PSG evaluation. The interview included the Pediatric Sleep Questionnaire Sleep-related Breathing Disorder (PSQ-SRBD) scale, demographics, anthropometric measures, and history of AT. A total of 248 children (56% males) were studied (mean age: 5.4 ± 3.4 years). Telephone interviews were conducted 5.3 ± 1.1 years following PSG. Sixty-four children (26%) underwent AT/adenoidectomy (A) following PSG. Of the 184 children who did not undergo surgery, 62 (34%) had positive PSQ-SRBD scores five years after diagnosis. Children with PS who underwent AT had better PSQ-SRBD scores at five years post diagnosis than the nonoperated children. A significant proportion of children with PS persist with SDB symptoms even five years following the diagnosis. In our cohort, a considerable percentage of children with a PSG diagnosis of PS underwent AT despite non-supportive sleep study results. Surgical intervention may have beneficial effects on some children with PS. Further studies using objective measures of sleep and incorporating the effect of SDB duration are required.

Sleep & breathing = Schlaf & Atmung, Jan 7, 2015

Inflammation plays a role in the pathogenesis and consequences of sleep-disordered breathing (SDB... more Inflammation plays a role in the pathogenesis and consequences of sleep-disordered breathing (SDB). The nasal mucosa and paranasal sinuses produce high levels of nitric oxide (NO). In asthma, exhaled NO is a marker of airway inflammation. There is only limited information whether nasal NO (nNO) accompanies also chronic upper airway obstruction, specifically, SDB. The objective of this study was to investigate nNO levels in children with SDB in comparison to healthy non-snoring children. Nasal NO was measured in children who underwent overnight polysomnographic studies due to habitual snoring and suspected SDB and in healthy non-snoring controls. One hundred and eleven children participated in the study: 28 with obstructive sleep apnea (OSA), 60 with primary snoring (PS), and 23 controls. Nasal NO levels were significantly higher in children with OSA and PS compared to controls (867.4 ± 371.5, 902.0 ± 330.9, 644.1 ± 166.5 ppb, respectively, p = 0.047). No difference was observed betw...

D107. PEDIATRIC SLEEP DISORDERS, 2012

Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keywor... more Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keyword 1: Children Keyword 2: Congenital lesion/malformation Keyword 3: Sleep disorders Title: Sleep-disordered breathing in children with craniofacial anomalies Prof. Yakov 29127 Sivan sivan@post.tau.ac.il MD 1 , Prof. Shlomi 29128 Constantini sconsts@netvision.net.il MD 2 , Dr. Michal 29129 Greenfeld michalgr@tasmc.health.gov.il MD 1 and Riva 29130 Tauman tauman@tasmc.health.gov.il MD 1 .

Sleep Disordered Breathing in Children, 2012

Lee-Chiong/Sleep: A Comprehensive Handbook, 2005

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2006

Sleep-disordered breathing (SDB) is a prevalent condition in children and is associated with incr... more Sleep-disordered breathing (SDB) is a prevalent condition in children and is associated with increased cardiovascular morbidity. Circulating levels of C-reactive protein (CRP), a proinflammatory protein, are associated with increased risk for atherosclerosis. Plasma CRP levels in snoring children have yielded conflicting results, such that it remains unclear whether OSA is mechanistically involved in such elevations of CRP. Consecutive nonobese children with polysomnographically demonstrated obstructive sleep apnea underwent blood draws in the morning after their corresponding sleep studies on 2 occasions, namely at diagnosis of obstructive sleep apnea and 10 to 14 weeks after adenotonsillectomy. High-sensitivity CRP serum concentrations were determined within 2 to 3 hours after collection, using a particle-enhanced turbidimetric immunoassay technique. Twenty children with obstructive sleep apnea (mean age 7.3 +/- 1.9 years; 55% boys; relative body mass index: 88% +/- 12.0%) with a ...

Sleep, Jan 15, 2004

Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, unde... more Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, undergoes dynamic changes that exhibit significant correlation with severity of sleep-disordered breathing. A sleep pressure score (SPS) with a cutoff value of 0.25 was derived from analysis of a large cohort of snoring and control children. Neurocognitive batteries were applied to examine the potential effect of SPS. Prospective study. 199 children who underwent a battery of neurobehavioral tests following an overnight sleep study were assigned to SPSHigh (> or = 0.25) or SPSLow (< 0.25) groups, and their neurocognitive performances were compared. Children in the SPSHigh group were significantly more likely to have deficits in memory, language abilities, verbal abilities, and some visuospatial functions than were children in the SPSLow group. These effects remained highly significant after adjusting for confounding variables and exhibited small to moderate effect sizes. We conclude th...

The Israel Medical Association journal : IMAJ, 2002

The role of continuous renal replacement therapy in patients with acute renal failure is well rec... more The role of continuous renal replacement therapy in patients with acute renal failure is well recognized. CRRT has also become an important modality of treatment in various acute situations without renal failure. To describe our experience with CRRT in acutely ill infants and children without renal failure. We analyzed all infants and children who underwent CRRT during the years 1998-2000 in the pediatric intensive care unit and we focus our report on those who were treated for non-renal indications. Fourteen children underwent 16 sessions of CRRT. The indications for CRRT were non-renal in 7 patients (age range 8 days to 16 years, median = 6.5). Three children were comatose from maple syrup urine disease, three were in intractable circulatory failure secondary to septic shock or systemic inflammatory response, and one had sepsis with persistent lactic acidosis and hypernatremia. Three children underwent continuous hemodiafiltration and four had continuous hemofiltration. The mean l...

American Journal of Obstetrics and Gynecology, 2015

We sought to examine the effect of maternal sleep-disordered breathing (SDB) on infant general mo... more We sought to examine the effect of maternal sleep-disordered breathing (SDB) on infant general movements (GMs) and neurodevelopment. Pregnant women with uncomplicated full-term pregnancies and their offspring were prospectively recruited from a community and hospital low-risk obstetric surveillance. All participants completed a sleep questionnaire on second trimester and underwent ambulatory sleep evaluation (WatchPAT; Itamar Medical, Caesarea, Israel). They were categorized as SDB (apnea hypopnea index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5) and controls. Infant GMs were assessed in the first 48 hours and at 8-11 and 14-16 weeks of age. At 12 months of age the Infant Developmental Inventory and the Brief Infant Sleep Questionnaire were administered. In all, 74 women and their full-term infants were studied. Eighteen (24%) women had SDB. Mean birthweight was 3347.1 ± 423.9 g. Median Apgar score at 5 minutes was 10 (range, 8-10). In adjusted comparisons, no differences were found between infants born to mothers with SDB and controls in GM scores in all 3 evaluations. Low social developmental score was detected at 12 months in 64% of infants born to SDB mothers compared to 25% of infants born to controls (adjusted P = .036; odds ratio, 16.7). Infant snoring was reported by 41.7% of mothers with SDB compared to 7.5% of controls (P = .004). Our preliminary results suggest that maternal SDB during pregnancy has no adverse effect on neonatal and infant neuromotor development but may affect social development at 1 year.

Journal of Maternal-Fetal and Neonatal Medicine, 2012

A small number of studies have, thus far, evaluated the association between maternal snoring and ... more A small number of studies have, thus far, evaluated the association between maternal snoring and fetal growth revealing conflicting results. No study has compared fetal growth between women with habitual snoring who snored before pregnancy and women with habitual snoring that started to snore during pregnancy. To examine the effect of maternal snoring on fetal outcome and to investigate the differences between &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;chronic snorers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new-onset snorers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Women of singleton, uncomplicated, full-term pregnancies completed a questionnaire. Obstetric and labor records were reviewed. Newborn records were reviewed for gestational age, birth weight, Apgar score and gender. 246 low risk women were studied. Mean BMI at the beginning of pregnancy was 22.3 ± 3.5 kg/m(2). 32% reported habitual snoring. Of those, 26% were chronic snorers and 74% were new-onset snorers. Neither significant difference in fetal growth was found between snorers and non-snorers nor between chronic snorers and new-onset snorers. Increased rate of nulliparous women was found in new-onset snorers compared with both chronic snorers and non-snorers (54 vs. 25 and 29% respectively; p = 0.001). In pregnant women with no apparent risk factors, maternal snoring does not affect fetal growth. No differences in maternal characteristics or fetal outcome were found between chronic snorers and new-onset snorers.

Sleep Medicine, 2013

To investigate (1) maternal cognitions regarding infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more To investigate (1) maternal cognitions regarding infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sleep and feeding and maternal depression among mothers of children with behavioral insomnia, feeding disturbances and healthy controls, and (2) the association between maternal cognitions about sleep and those about feeding. Children 6-36 months of age with either behavioral insomnia or feeding disorders were recruited. Children 6-36 months of age who attended the well-baby clinics were recruited and served as controls. The participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; mothers completed three questionnaires on their cognitions/perceptions of their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sleep and feeding habits and about their own feelings of depression. A total of 230 children (31 with behavioral insomnia, 29 with feeding disorders, 170 controls) were enrolled. Their mean age was 16.1 ± 7.6 months. Maternal cognitions/perceptions about sleep (maternal cognition infant sleep questionnaire, MCISQ) did not differ significantly between the behavioral insomnia group and the feeding disorders group. The MCISQ score was significantly higher in the behavioral insomnia group compared with controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .02). Mothers of children with feeding disorders reported being significantly more frustrated or anxious when they fed their child (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0005), less confident about their child getting enough food (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0005), and less confident in their ability to manage their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s behavior at mealtime (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .02) compared to the controls. Significant positive correlations were found between the MCISQ scores and the Beck Depression Inventory scores (r = 0.29, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0002), and between the MCISQ scores and the maternal cognitions of their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s feeding scores (r = 0.26, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0002). The latter remained significant after controlling for maternal depression (r = 0.25, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .002). Mothers of children with either behavioral insomnia or feeding disorders differ significantly from mothers of controls regarding their cognitions about sleep and feeding. Maternal cognitions about infant sleep behavior correlated with their cognitions about infant feeding. Maternal cognitions are a modifiable factor that may serve as a target for intervention in both sleep and feeding disorders in children.

Sleep Medicine, 2013

Objective: Sleep-disordered breathing (SDB) is a common disorder associated with substantial morb... more Objective: Sleep-disordered breathing (SDB) is a common disorder associated with substantial morbidity that occurs in otherwise healthy children. Atopy, asthma, and viral upper respiratory tract infections are known risk factors for pediatric SDB that exhibit seasonal variability. The aim of our study was to investigate the effect of seasonality on SDB severity in children and adolescents referred for polysomnographic evaluation for suspected SDB and to examine the effect of atopy/asthma on this variability. Methods: The medical records of all children and adolescents referred for a polysomnography (PSG) for suspected SDB between 2008 and 2010 were retrospectively assessed for seasonal patterns. The effect of atopy/asthma, age, and obesity on seasonal variability was investigated. Results: A total of 2178 children and adolescents (65% boys) were included. The mean age of the cohort was 4.9 ± 3.5 years (range, 3 months-18 years). Eighteen percent of patients had a history of asthma/ atopy. The mean obstructive apnea-hypopnea index (OAHI) in the winter was significantly higher compared to the summer (9.1 ± 9.6 vs 7.5 ± 7.0; P = .01; Cohen d = 0.19), particularly in children younger than the age of 5 years (10.2 ± 10.5 vs 7.9 ± 7.3; P = .008; Cohen d = 0.25). Asthma/atopy had no significant effect on seasonal variability. Conclusions: SDB severity alters in a season-dependent manner in children and adolescents referred for polysomnographic evaluation for suspected SDB. These alterations are more prominent in children younger than the age of 5 years. The presence of asthma/atopy does not contribute to this seasonal variability. These findings suggest that viral respiratory infections are most likely the major contributor for the seasonal variability observed in pediatric SDB; additionally, the time of the year when a child is evaluated for suspected SDB may affect the clinical management and outcome in borderline cases.

The Journal of Pediatrics, 2011

To identify the prevalence of long-term sleep disturbances in children successfully treated for c... more To identify the prevalence of long-term sleep disturbances in children successfully treated for central nervous system tumors by use of subjective and objective tools. Children diagnosed and treated for central nervous system tumors and age-matched control subjects were studied. Information on demographics, tumor type, location, and therapies were collected. Parents completed a 28-item sleep questionnaire. Sleep was also evaluated with a sleep-log and actigraphy. Forty patients (52% males) and 61 matched control subjects (48% males) were evaluated. The mean ages were 9.9 ± 3.8 and 11.4 ± 3.8 years, respectively (P = NS). The mean time from diagnosis to participation was 4.1 ± 1.4 years. Children in the study group reported longer nighttime sleep compared with control subjects (572 ± 66 minutes vs 519 ± 79 minutes, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; respectively). This was confirmed by actigraphy. These differences disappeared when comparison by age groups was performed. Two patients compared with none in the control subjects resumed daytime napping. No significant sleep disturbances were observed in the study group. No effect was found for tumor type, anatomic site, or adjuvant therapy. Recovered children with a history of brain tumor do not have significant sleep disorders. Their sleep is generally well preserved years after diagnosis and treatment. The possibility that excessive daytime somnolence affects a minority of these children needs further investigation.

Clinical Pediatrics, 2004

This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography... more This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography (PSG) in 41 infants with unexplained sleep disordered breathing. The relationships of respiratory events to episodes of gastroesophageal reflux (GER) were analyzed. The major causes for referring the infants were cyanotic episodes (22%), apneas (20%), and choking events (15%). PSG was abnormal in 8/41 (20%). Abnormal pH studies were observed in 12/41 (29%) infants. In 4/12 (33%), respiratory events correlated with GER episodes. Adding simultaneous pH monitoring to PSG may identify associated conditions and thus focus treatment.

The Open Sleep Journal, 2013

European Journal of Gastroenterology & Hepatology, 2016

To investigate fractional exhaled nitric-oxide (FeNO) levels in children with Crohn&amp;amp;a... more To investigate fractional exhaled nitric-oxide (FeNO) levels in children with Crohn&amp;amp;amp;amp;#39;s disease (CD) and ulcerative colitis (UC) and their correlation to disease activity. Children with CD and UC (aged 8-18 years) and age-matched healthy controls without respiratory symptoms were recruited. Disease activity was assessed using validated scores. All children performed spirometry and FeNO tests and the association between intestinal disease parameters and pulmonary functions was studied. Thirty-five children with CD, nine with UC, and 24 healthy controls were enrolled. The mean FeNO level was higher in children with CD compared with the controls. Increased FeNO levels (&amp;amp;amp;amp;gt;23 parts per billion) were more common among CD and UC compared with healthy children (46, 33, and 0%, respectively, P&amp;amp;amp;amp;lt;0.05). Nevertheless, FeNO levels did not correlate with disease activity. There were no significant differences between CD, UC patients, and healthy controls in any of the spirometric variables. FeNO level, a marker of airway inflammation, is elevated in children with inflammatory bowel diseases irrespective of their intestinal disease activity. Increased FeNO levels are not associated with respiratory symptoms, suggesting a latent pulmonary involvement in the systemic disease.

Sleep, Apr 1, 2004

Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, unde... more Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, undergoes dynamic changes that exhibit significant correlation with severity of sleep-disordered breathing. A sleep pressure score (SPS) with a cutoff value of 0.25 was derived from analysis of a large cohort of snoring and control children. Neurocognitive batteries were applied to examine the potential effect of SPS. Prospective study. 199 children who underwent a battery of neurobehavioral tests following an overnight sleep study were assigned to SPSHigh (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 0.25) or SPSLow (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.25) groups, and their neurocognitive performances were compared. Children in the SPSHigh group were significantly more likely to have deficits in memory, language abilities, verbal abilities, and some visuospatial functions than were children in the SPSLow group. These effects remained highly significant after adjusting for confounding variables and exhibited small to moderate effect sizes. We conclude that a sleep-pressure numerical factor derived from the overnight polysomnogram in snoring children is associated with deficits in neurobehavioral daytime functions that is independent of respiratory disturbance and hypoxemia and suggests a significant role for disturbed sleep homeostasis in pediatric sleep-disordered breathing.

Clinical Pediatrics, Sep 1, 2004

This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography... more This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography (PSG) in 41 infants with unexplained sleep disordered breathing. The relationships of respiratory events to episodes of gastroesophageal reflux (GER) were analyzed. The major causes for referring the infants were cyanotic episodes (22%), apneas (20%), and choking events (15%). PSG was abnormal in 8/41 (20%). Abnormal pH studies were observed in 12/41 (29%) infants. In 4/12 (33%), respiratory events correlated with GER episodes. Adding simultaneous pH monitoring to PSG may identify associated conditions and thus focus treatment.

European Respiratory Journal, Sep 1, 2012

Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keywor... more Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keyword 1: Children Keyword 2: Congenital lesion/malformation Keyword 3: Sleep disorders Title: Sleep-disordered breathing in children with craniofacial anomalies Prof. Yakov 29127 Sivan sivan@post.tau.ac.il MD 1 , Prof. Shlomi 29128 Constantini sconsts@netvision.net.il MD 2 , Dr. Michal 29129 Greenfeld michalgr@tasmc.health.gov.il MD 1 and Riva 29130 Tauman tauman@tasmc.health.gov.il MD 1 .

European Respiratory Journal, 2015

Sleep Medicine, 2016

Primary snoring (PS) is considered as the most benign form of sleep-disordered breathing (SDB), a... more Primary snoring (PS) is considered as the most benign form of sleep-disordered breathing (SDB), and treatment is usually not prescribed. Studies suggest that PS may not be as benign as had formerly been considered. We aimed to investigate the natural history of PS in children with adenotonsillar hypertrophy, and compare those who underwent adenotonsillectomy (AT) with those who did not. Children diagnosed with PS based on polysomnographic findings were included in the study. Information retrieved from their medical records, including medical history, physical examination, anthropometric measures, and polysomnography (PSG) results, was reviewed. A telephone interview was conducted 4-6 years following the PSG evaluation. The interview included the Pediatric Sleep Questionnaire Sleep-related Breathing Disorder (PSQ-SRBD) scale, demographics, anthropometric measures, and history of AT. A total of 248 children (56% males) were studied (mean age: 5.4 ± 3.4 years). Telephone interviews were conducted 5.3 ± 1.1 years following PSG. Sixty-four children (26%) underwent AT/adenoidectomy (A) following PSG. Of the 184 children who did not undergo surgery, 62 (34%) had positive PSQ-SRBD scores five years after diagnosis. Children with PS who underwent AT had better PSQ-SRBD scores at five years post diagnosis than the nonoperated children. A significant proportion of children with PS persist with SDB symptoms even five years following the diagnosis. In our cohort, a considerable percentage of children with a PSG diagnosis of PS underwent AT despite non-supportive sleep study results. Surgical intervention may have beneficial effects on some children with PS. Further studies using objective measures of sleep and incorporating the effect of SDB duration are required.

Sleep & breathing = Schlaf & Atmung, Jan 7, 2015

Inflammation plays a role in the pathogenesis and consequences of sleep-disordered breathing (SDB... more Inflammation plays a role in the pathogenesis and consequences of sleep-disordered breathing (SDB). The nasal mucosa and paranasal sinuses produce high levels of nitric oxide (NO). In asthma, exhaled NO is a marker of airway inflammation. There is only limited information whether nasal NO (nNO) accompanies also chronic upper airway obstruction, specifically, SDB. The objective of this study was to investigate nNO levels in children with SDB in comparison to healthy non-snoring children. Nasal NO was measured in children who underwent overnight polysomnographic studies due to habitual snoring and suspected SDB and in healthy non-snoring controls. One hundred and eleven children participated in the study: 28 with obstructive sleep apnea (OSA), 60 with primary snoring (PS), and 23 controls. Nasal NO levels were significantly higher in children with OSA and PS compared to controls (867.4 ± 371.5, 902.0 ± 330.9, 644.1 ± 166.5 ppb, respectively, p = 0.047). No difference was observed betw...

D107. PEDIATRIC SLEEP DISORDERS, 2012

Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keywor... more Number: 4713 Publication Number: P3847 Abstract Group: 4.2. Sleep and Control of Breathing Keyword 1: Children Keyword 2: Congenital lesion/malformation Keyword 3: Sleep disorders Title: Sleep-disordered breathing in children with craniofacial anomalies Prof. Yakov 29127 Sivan sivan@post.tau.ac.il MD 1 , Prof. Shlomi 29128 Constantini sconsts@netvision.net.il MD 2 , Dr. Michal 29129 Greenfeld michalgr@tasmc.health.gov.il MD 1 and Riva 29130 Tauman tauman@tasmc.health.gov.il MD 1 .

Sleep Disordered Breathing in Children, 2012

Lee-Chiong/Sleep: A Comprehensive Handbook, 2005

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2006

Sleep-disordered breathing (SDB) is a prevalent condition in children and is associated with incr... more Sleep-disordered breathing (SDB) is a prevalent condition in children and is associated with increased cardiovascular morbidity. Circulating levels of C-reactive protein (CRP), a proinflammatory protein, are associated with increased risk for atherosclerosis. Plasma CRP levels in snoring children have yielded conflicting results, such that it remains unclear whether OSA is mechanistically involved in such elevations of CRP. Consecutive nonobese children with polysomnographically demonstrated obstructive sleep apnea underwent blood draws in the morning after their corresponding sleep studies on 2 occasions, namely at diagnosis of obstructive sleep apnea and 10 to 14 weeks after adenotonsillectomy. High-sensitivity CRP serum concentrations were determined within 2 to 3 hours after collection, using a particle-enhanced turbidimetric immunoassay technique. Twenty children with obstructive sleep apnea (mean age 7.3 +/- 1.9 years; 55% boys; relative body mass index: 88% +/- 12.0%) with a ...

Sleep, Jan 15, 2004

Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, unde... more Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, undergoes dynamic changes that exhibit significant correlation with severity of sleep-disordered breathing. A sleep pressure score (SPS) with a cutoff value of 0.25 was derived from analysis of a large cohort of snoring and control children. Neurocognitive batteries were applied to examine the potential effect of SPS. Prospective study. 199 children who underwent a battery of neurobehavioral tests following an overnight sleep study were assigned to SPSHigh (> or = 0.25) or SPSLow (< 0.25) groups, and their neurocognitive performances were compared. Children in the SPSHigh group were significantly more likely to have deficits in memory, language abilities, verbal abilities, and some visuospatial functions than were children in the SPSLow group. These effects remained highly significant after adjusting for confounding variables and exhibited small to moderate effect sizes. We conclude th...

The Israel Medical Association journal : IMAJ, 2002

The role of continuous renal replacement therapy in patients with acute renal failure is well rec... more The role of continuous renal replacement therapy in patients with acute renal failure is well recognized. CRRT has also become an important modality of treatment in various acute situations without renal failure. To describe our experience with CRRT in acutely ill infants and children without renal failure. We analyzed all infants and children who underwent CRRT during the years 1998-2000 in the pediatric intensive care unit and we focus our report on those who were treated for non-renal indications. Fourteen children underwent 16 sessions of CRRT. The indications for CRRT were non-renal in 7 patients (age range 8 days to 16 years, median = 6.5). Three children were comatose from maple syrup urine disease, three were in intractable circulatory failure secondary to septic shock or systemic inflammatory response, and one had sepsis with persistent lactic acidosis and hypernatremia. Three children underwent continuous hemodiafiltration and four had continuous hemofiltration. The mean l...

American Journal of Obstetrics and Gynecology, 2015

We sought to examine the effect of maternal sleep-disordered breathing (SDB) on infant general mo... more We sought to examine the effect of maternal sleep-disordered breathing (SDB) on infant general movements (GMs) and neurodevelopment. Pregnant women with uncomplicated full-term pregnancies and their offspring were prospectively recruited from a community and hospital low-risk obstetric surveillance. All participants completed a sleep questionnaire on second trimester and underwent ambulatory sleep evaluation (WatchPAT; Itamar Medical, Caesarea, Israel). They were categorized as SDB (apnea hypopnea index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5) and controls. Infant GMs were assessed in the first 48 hours and at 8-11 and 14-16 weeks of age. At 12 months of age the Infant Developmental Inventory and the Brief Infant Sleep Questionnaire were administered. In all, 74 women and their full-term infants were studied. Eighteen (24%) women had SDB. Mean birthweight was 3347.1 ± 423.9 g. Median Apgar score at 5 minutes was 10 (range, 8-10). In adjusted comparisons, no differences were found between infants born to mothers with SDB and controls in GM scores in all 3 evaluations. Low social developmental score was detected at 12 months in 64% of infants born to SDB mothers compared to 25% of infants born to controls (adjusted P = .036; odds ratio, 16.7). Infant snoring was reported by 41.7% of mothers with SDB compared to 7.5% of controls (P = .004). Our preliminary results suggest that maternal SDB during pregnancy has no adverse effect on neonatal and infant neuromotor development but may affect social development at 1 year.

Journal of Maternal-Fetal and Neonatal Medicine, 2012

A small number of studies have, thus far, evaluated the association between maternal snoring and ... more A small number of studies have, thus far, evaluated the association between maternal snoring and fetal growth revealing conflicting results. No study has compared fetal growth between women with habitual snoring who snored before pregnancy and women with habitual snoring that started to snore during pregnancy. To examine the effect of maternal snoring on fetal outcome and to investigate the differences between &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;chronic snorers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new-onset snorers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Women of singleton, uncomplicated, full-term pregnancies completed a questionnaire. Obstetric and labor records were reviewed. Newborn records were reviewed for gestational age, birth weight, Apgar score and gender. 246 low risk women were studied. Mean BMI at the beginning of pregnancy was 22.3 ± 3.5 kg/m(2). 32% reported habitual snoring. Of those, 26% were chronic snorers and 74% were new-onset snorers. Neither significant difference in fetal growth was found between snorers and non-snorers nor between chronic snorers and new-onset snorers. Increased rate of nulliparous women was found in new-onset snorers compared with both chronic snorers and non-snorers (54 vs. 25 and 29% respectively; p = 0.001). In pregnant women with no apparent risk factors, maternal snoring does not affect fetal growth. No differences in maternal characteristics or fetal outcome were found between chronic snorers and new-onset snorers.

Sleep Medicine, 2013

To investigate (1) maternal cognitions regarding infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more To investigate (1) maternal cognitions regarding infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sleep and feeding and maternal depression among mothers of children with behavioral insomnia, feeding disturbances and healthy controls, and (2) the association between maternal cognitions about sleep and those about feeding. Children 6-36 months of age with either behavioral insomnia or feeding disorders were recruited. Children 6-36 months of age who attended the well-baby clinics were recruited and served as controls. The participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; mothers completed three questionnaires on their cognitions/perceptions of their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sleep and feeding habits and about their own feelings of depression. A total of 230 children (31 with behavioral insomnia, 29 with feeding disorders, 170 controls) were enrolled. Their mean age was 16.1 ± 7.6 months. Maternal cognitions/perceptions about sleep (maternal cognition infant sleep questionnaire, MCISQ) did not differ significantly between the behavioral insomnia group and the feeding disorders group. The MCISQ score was significantly higher in the behavioral insomnia group compared with controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .02). Mothers of children with feeding disorders reported being significantly more frustrated or anxious when they fed their child (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0005), less confident about their child getting enough food (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0005), and less confident in their ability to manage their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s behavior at mealtime (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .02) compared to the controls. Significant positive correlations were found between the MCISQ scores and the Beck Depression Inventory scores (r = 0.29, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0002), and between the MCISQ scores and the maternal cognitions of their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s feeding scores (r = 0.26, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0002). The latter remained significant after controlling for maternal depression (r = 0.25, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .002). Mothers of children with either behavioral insomnia or feeding disorders differ significantly from mothers of controls regarding their cognitions about sleep and feeding. Maternal cognitions about infant sleep behavior correlated with their cognitions about infant feeding. Maternal cognitions are a modifiable factor that may serve as a target for intervention in both sleep and feeding disorders in children.

Sleep Medicine, 2013

Objective: Sleep-disordered breathing (SDB) is a common disorder associated with substantial morb... more Objective: Sleep-disordered breathing (SDB) is a common disorder associated with substantial morbidity that occurs in otherwise healthy children. Atopy, asthma, and viral upper respiratory tract infections are known risk factors for pediatric SDB that exhibit seasonal variability. The aim of our study was to investigate the effect of seasonality on SDB severity in children and adolescents referred for polysomnographic evaluation for suspected SDB and to examine the effect of atopy/asthma on this variability. Methods: The medical records of all children and adolescents referred for a polysomnography (PSG) for suspected SDB between 2008 and 2010 were retrospectively assessed for seasonal patterns. The effect of atopy/asthma, age, and obesity on seasonal variability was investigated. Results: A total of 2178 children and adolescents (65% boys) were included. The mean age of the cohort was 4.9 ± 3.5 years (range, 3 months-18 years). Eighteen percent of patients had a history of asthma/ atopy. The mean obstructive apnea-hypopnea index (OAHI) in the winter was significantly higher compared to the summer (9.1 ± 9.6 vs 7.5 ± 7.0; P = .01; Cohen d = 0.19), particularly in children younger than the age of 5 years (10.2 ± 10.5 vs 7.9 ± 7.3; P = .008; Cohen d = 0.25). Asthma/atopy had no significant effect on seasonal variability. Conclusions: SDB severity alters in a season-dependent manner in children and adolescents referred for polysomnographic evaluation for suspected SDB. These alterations are more prominent in children younger than the age of 5 years. The presence of asthma/atopy does not contribute to this seasonal variability. These findings suggest that viral respiratory infections are most likely the major contributor for the seasonal variability observed in pediatric SDB; additionally, the time of the year when a child is evaluated for suspected SDB may affect the clinical management and outcome in borderline cases.

The Journal of Pediatrics, 2011

To identify the prevalence of long-term sleep disturbances in children successfully treated for c... more To identify the prevalence of long-term sleep disturbances in children successfully treated for central nervous system tumors by use of subjective and objective tools. Children diagnosed and treated for central nervous system tumors and age-matched control subjects were studied. Information on demographics, tumor type, location, and therapies were collected. Parents completed a 28-item sleep questionnaire. Sleep was also evaluated with a sleep-log and actigraphy. Forty patients (52% males) and 61 matched control subjects (48% males) were evaluated. The mean ages were 9.9 ± 3.8 and 11.4 ± 3.8 years, respectively (P = NS). The mean time from diagnosis to participation was 4.1 ± 1.4 years. Children in the study group reported longer nighttime sleep compared with control subjects (572 ± 66 minutes vs 519 ± 79 minutes, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; respectively). This was confirmed by actigraphy. These differences disappeared when comparison by age groups was performed. Two patients compared with none in the control subjects resumed daytime napping. No significant sleep disturbances were observed in the study group. No effect was found for tumor type, anatomic site, or adjuvant therapy. Recovered children with a history of brain tumor do not have significant sleep disorders. Their sleep is generally well preserved years after diagnosis and treatment. The possibility that excessive daytime somnolence affects a minority of these children needs further investigation.

Clinical Pediatrics, 2004

This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography... more This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography (PSG) in 41 infants with unexplained sleep disordered breathing. The relationships of respiratory events to episodes of gastroesophageal reflux (GER) were analyzed. The major causes for referring the infants were cyanotic episodes (22%), apneas (20%), and choking events (15%). PSG was abnormal in 8/41 (20%). Abnormal pH studies were observed in 12/41 (29%) infants. In 4/12 (33%), respiratory events correlated with GER episodes. Adding simultaneous pH monitoring to PSG may identify associated conditions and thus focus treatment.