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Childhood OSA is increasingly recognized to be associated with a variety of complications including neurocognitive and cardiovascular diseases. The intermediate link between OSA and end organ damage has been suggested to be inflammation, and both local airway and systemic inflammation have been described in adults with OSA. A non-invasive technique of sputum induction was utilised to show that children with OSA also have airway inflammation, as characterized by a significant increase in neutrophils, and the severity of OSA also correlated significantly with the degree of neutrophilic inflammation (Chapter 7). This finding may lead to research on the use of anti-inflammatory therapeutic agents or antibiotics for the treatment of childhood OSA. Another marker of inflammation, C-reactive protein (CRP) was measured in a cohort of children with OSA before and after treatment (Chapter 8). Children with OSA had higher CRP levels compared to their non-OSA counterparts, and the raised CRP decreased significantly following treatment suggesting that the inflammatory response is potentially reversible. The cardiovascular risk factors of insulin levels and blood pressure (BP) were evaluated and children with OSA had higher serum insulin and greater systolic and diastolic BP compared to healthy controls (Chapters 9 and 10). These findings suggest that children with OSA may be at risk of developing metabolic syndrome and its devastating consequence. (Abstract shortened by UMI.), The original research studies undertaken were based on nocturnal sleep examinations to explore childhood OSA in two main aspects, namely its assessment, and a better understanding of its complications in children. The gold standard for diagnosing OSA is overnight polysomnography (PSG), which is an expensive investigation that is not routinely available at all public hospitals in Hong Kong. Alternative valid assessment tools for OSA that are more cost-effective are needed. The feasibility of using radiographic techniques to assess severity of OSA was explored, and the size of the upper airway, as reflected by the tonsillar pharyngeal (TP) ratio obtained from lateral neck radiograph, correlated well with the severity of OSA (Chapter 4). A defined TP cutoff could accurately predict moderate-to-severe OSA with high sensitivity and specificity. This method could be used in clinical practice to prioritize patients with suspected OSA for further evaluation. A locally applicable questionnaire scale was examined for its validity and accuracy in diagnosing children with OSA (Chapter 5). The presence of three symptoms (snoring, mouth breathing and nocturnal sweating) was found to have high predictive value in correctly identifying children with the condition. The question of whether a single night PSG study is adequate in diagnosing OSA was examined together with the assessment for the presence of night-to-night variability in PSG and respiratory parameters in childhood sleep (Chapter 6). Forty-four obese children and 43 age and sex-matched healthy controls underwent two consecutive nights PSG examination. Although a first night effect was clearly documented, a single night PSG study would have correctly identified over 80% of children with OSA. This finding has significant resource implications., Albert Martin Li., Adviser: Tony Nelson., Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3420., Thesis (M.D.)--Chinese University of Hong Kong, 2008., Includes bibliographical references (leaves xxxv-lxxx)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., in English only., School code: 1307., isbn: 9781109224986, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Le traumatisme crânien léger (TCC) est produit par un coup à la tête ou à l'application des forces d'accélération et de décélération ayant comme résultat une altération des processus cognitifs. Les critères diagnostiques du TCC léger sont les suivants : une altération de la conscience de moins de 30 minutes, un résultat à l'échelle de coma de Glasgow entre 13 et 15, une tomographie axiale couplée avec ordinateur (SCAN) négative et une imagerie par résonance magnétique (IRM) parfois négative. L'amnésie post-traumatique peut varier mais ne doit pas dépasser 24 heures. Les études sont parfois contradictoires concernant les séquelles résiduelles suite à un traumatisme crânien léger. Cependant, selon certains auteurs, 10 à 15 % des victimes seront au prise avec des symptômes qui limiteront la reprise des activités normales. C'est pourquoi il s'avère pertinent de cerner le plus exactement possible le profil des jeunes victimes d'un TCC léger afin de prévenir les difficultés associées. Les objectifs de la présente étude sont d'évaluer si les traumatismes crâniens légers ont une incidence sur le sommeil, la mémoire auditive et le comportement des jeunes âgés entre 7 et 15 ans. Quinze jeunes avec TCC léger ont été recrutés à partir des dossiers médicaux du Complexe Hospitalier de la Sagamie (CHS). Quinze autres jeunes n'ayant jamais subi ce type de traumatisme, recrutés dans deux écoles de la commission scolaire des Rives-du-Saguenay forment le groupe contrôle. Chaque participant et ses parents ont rencontré un évaluateur afin de répondre à des questionnaires et des tests concernant le sommeil, la mémoire et le comportement du jeune. Les résultats obtenus démontrent que le groupe de jeunes avec TCC légers présentent plus de troubles de comportement de type «délinquant», ont des performances scolaires plus faibles et participent moins à des activités sportives, culturelles et sociales que le groupe contrôle sans TCC léger. Les résultats concernant le sommeil et la mémoire ne