Sleep Apnea Syndromes: Zucconi M

Villa MP, Brunetti L, Bruni O, Cirignotta F, Cozza P, Donzelli G, Ferini Strambi L, Levrini L, Mondini S, Nespoli L, Nosetti L, Pagani J, Zucconi M, Anonymous00069. · Gruppo di Studio interdisciplinare disturbi respiratori nel sonno, Società Italiana di Pediatria, Rome, Italy. · Minerva Pediatr. · Pubmed #15252374 links to  free full text

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Caprioglio A, Zucconi M, Calori G, Troiani V. · School of Specialization in Orthognathodontics, Faculty of Medicine and Surgery, University of Insubria, Varese. · Minerva Stomatol. · Pubmed #10431534 No free full text.

Abstract: BACKGROUND: This research aims to analized the clinical and diagnostic aspects of OSA in the orthodontic research field. METHODS: Through a case control study, the presence of early craniofacial modifications in a study group constituted of 13 children with long history of habitual snoring and obstructive sleep apnea syndrome (mean age 54 months, range 36-103) and in a control group constituted of 13 children with no history of snoring (mean age 60 months, range 55-67), is analyzed. Clinical neurological and orthodontic examination, cefalometrics analysis and MESAM 4 has been performed to each single child. RESULTS: Neurological clinical examination and diurnal polysomnography or nocturnal ambulatory monitoring of snoring (MESAM 4) showed that this pathology started very early in the childhood: snoring onset was 22.7 months, the apnea onset was 34.7 months. Moreover 23% of the children showed a failure to thrive. The cephalometric results revealed that OSA children showed different cranio-facial features: a maxillo-mandibular micrognathia and or retrognathia, an increment of divergency associated with an increase in the vertical development of the face and a reduced perviety of the upper airway space caused by a mechanical obstruction due to enlarged adenoids. The orthodontic clinical examination revealed that OSA patients showed posterior cross-bite, anterior open-bite and lip-incompetence. CONCLUSIONS: These results suggest that oral breathing, that is present in sleep apnea patients, is responsible of different cranio-facial anomalies. For this reason these features must be recognized, as soon as possible, in order to start an early treatment of this pathology.

Zucconi M, Calori G, Castronovo V, Ferini-Strambi L. · Sleep Disorders Center, Department of Neurology, and Statistic Unit, IRCCS H San Raffaele, Milan, Italy. · Chest. · Pubmed #12907549 links to  free full text

Abstract: STUDY OBJECTIVE: To compare an unattended device for cardiorespiratory monitoring (POLY-MESAM; MAP; Martinsried, Germany) [P-M] with classic nocturnal polysomnography (PSG) for diagnosis of obstructive sleep apnea (OSA) in children. DESIGN: Clinical setting. PATIENTS: Twelve children (age range, 3 to 6 years) with highly suspected uncomplicated OSA who underwent PSG and P-M on 2 consecutive laboratory nights in a balanced manner. MEASUREMENTS: Respiratory indexes were compared for P-M (automated analysis), hand-scored revised P-M (P-Mrev), and PSG. Analysis of contingency for cutoff levels of respiratory disturbance index (RDI) of 5 and 10 and level of agreement between P-M, P-Mrev, and PSG by the concordance method were evaluated. RESULTS: Nine of twelve children (75%) had a PSG RDI > 5, while 41.7% had an RDI > 10, indicating moderate-to-severe OSA. P-M sensitivity (78%) increased with the increase of the RDI cutoff, and P-Mrev sensitivity reached 100% at the cutoff of 10. The specificity was low for RDI > 5 and increased only modestly at RDI > 10 (P-Mrev, 57%). Seven of 12 children (increasing to 9 children with P-Mrev) and 9 of 12 children (increasing to 11 children with P-Mrev) were correctly classified by the P-M unit when cutoffs of 5 and 10 were considered, respectively. As far as the agreement level is concerned, P-M underestimated the incidence of obstructive hypopnea and overestimated the number of central apnea cases. P-Mrev improved the latter measure. CONCLUSION: Based on these data, the P-M device cannot be advocated for common use in a clinical setting, but it may have a role in urgent screening for highly suspected moderate-to-severe OSA.

Ferini-Strambi L, Baietto C, Di Gioia MR, Castaldi P, Castronovo C, Zucconi M, Cappa SF. · Sleep Disorders Center, Università Vita-Salute San Raffaele, Via Stamira d'Ancona 20, 20127 Milano, Italy. · Brain Res Bull. · Pubmed #12788211 No free full text.

Abstract: The aims of this study were to assess cognitive function in obstructive sleep apnea (OSA) patients and to evaluate the effect of short- and long-term treatment with continuous positive airway pressure treatment (CPAP). A battery of neuropsychological tests, the Epworth Sleepiness Scale (ESS), and the Beck Inventory Scale were administered to 23 patients with severe OSA (age: 56.5+/-6.13; AHI: 54.9+/-13.37) and to 23 age- and education-matched controls. The OSA patients were evaluated in a baseline condition and in two follow-up treatment sessions (after 15 days and 4 months of CPAP, respectively). At baseline, OSA patients had a significant impairment, compared to controls, in tests of sustained attention, visuospatial learning, executive function, motor performance, and constructional abilities. The longitudinal evaluation showed that after a 15-days CPAP treatment attentive, visuospatial learning, and motor performances returned to normal levels. A 4-months CPAP treatment did not result in any further improvement in cognitive tests. Performance on tests evaluating executive functions and constructional abilities was not affected by short- and long-term treatment with CPAP. The findings of this study confirm the hypothesis of partial reversibility of cognitive dysfunction in OSA patients after CPAP.

Castronovo V, Zucconi M, Nosetti L, Marazzini C, Hensley M, Veglia F, Nespoli L, Ferini-Strambi L. · Sleep Disorders Center, IRCCS H San Raffaele, Milano, Italy. · J Pediatr. · Pubmed #12712054 No free full text.

Abstract: OBJECTIVE: To measure the prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children. STUDY DESIGN: Cross-sectional survey with parental report and overnight ambulatory monitoring of children 3 to 6 years of age in 8 kindergartens (n = 604). Parents reported the child's information through an interviewer-based questionnaire or by a brief telephone interview. Snoring, oxygen saturation, body position, and heart rate were recorded for 1 night at home. RESULTS: Data were obtained on 98.5% of 604 children (447 questionnaires, 74%; 148 telephone interviews, 24.5%); groups were similar for sex and age. Two hundred sixty-five children had ambulatory monitoring at home. Habitual snoring (always and often) was reported in 34.5% and breathing cessation in 18.6%. Habitual snoring was associated with parental report of daytime symptoms (P =.001) and daytime somnolence (P =.032). Pathologic snoring was present in 12% of children (95% CI, 7.9-16.1). On multivariate analysis, parental report of habitual snoring was the strongest determinant of pathologic snoring (OR, 12.23; 95% CI, 3.56-41.94). Oxygen desaturation index > or =5 per hour was found in 13% of children (95% CI, 8.7-17.3). CONCLUSIONS: Parental report of habitual snoring is very common. Children with habitual snoring are more likely to have objectively measured snoring and daytime morbidity.

Ferini-Strambi L, Zucconi M, Castronovo V, Garancini P, Oldani A, Smirne S. · Sleep Disorders Center, State University and IRCCS H San Raffaele, Milan, Italy. · Sleep. · Pubmed #10566904 No free full text.

Abstract: The aim of this cross-sectional study was to evaluate the prevalence of sleep-disordered breathing by means of a validated portable instrument (MESAM IV) and to investigate the relationship between snoring and sleep apnea in a sample of Italian middle-aged female population. We randomly chose 750 subjects aged 40 to 65 years and 365 agreed to participate to the study. In this group, 19.7% of subjects were every-night snorers according to the questionnaire; when recorded, 54.2% snored for more than 10% of the night, and 7.1% for more than 50% of the night. Sleep apnea was also common: 10.7% of subjects had a respiratory disturbances per hour (RDI) between 5 and 9, 7.7% an RDI between 10 and 19, and 2.2% had an RDI > or =20. Snoring percentage and RDI were significantly correlated. However, 50% of subjects who snored for more than half the night had no evidence of sleep apnea. Snoring amount >50% resulted influenced by body mass index, while RDI>10 was influenced by neck diameter. We concluded that in middle-aged women, both snoring and sleep apnea are very common. A high percentage of snoring is not essential for the occurrence of sleep apnea, nor it necessarily indicates the presence of sleep apnea.

Zucconi M, Caprioglio A, Calori G, Ferini-Strambi L, Oldani A, Castronovo C, Smirne S. · Sleep Disorders Center, Dept of Neurology, State University and IRCCS H San Raffaele, Milan, Italy. · Eur Respir J. · Pubmed #10065690 links to  free full text

Abstract: Habitual snoring and obstructive sleep apnoea in children, which are frequently associated with adenotonsillar hypertrophy, may begin early in life and in relation with orocraniofacial features. The aim of this study was to detect the presence of early bone craniofacial modifications in young children with a long history of habitual snoring. Twenty-six habitually snoring children (mean age 4.6 yrs) were studied by nocturnal portable recording or diurnal polysomnography, cephalometry and orthodontic evaluation. A comparison of cephalometric findings was made between the studied group and 26 age-matched children (mean age 5.1 yrs) with no history of snoring or respiratory problems during sleep. The cephalometric analyses showed a significant increase in craniomandibular intermaxillar, lower and upper goniac angles with a retroposition and posterior rotation of the mandible (high angle face) and a reduction in the rhinopharynx space caused by higher thickness of adenoids in habitually snoring children compared with controls. Cross-bites and labial incompetence as well as daytime symptoms and familiarity for habitual snoring were found in most of the studied group of snorers compared with controls. The results indicate that upper airway obstruction during sleep is associated with mild but significant cephalometric and craniofacial modifications in children complaining of habitual snoring. Whether this skeletal conformation is genetically determined or influenced by the early onset of habitual snoring remains to be assessed.