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5. Regional brain tissue changes and associations with disease severity in children with sleep-disordered breathing.

Author

Horne, Rosemary SC, Roy, Bhaswati, Walter, Lisa M, Biggs, Sarah N, Tamanyan, Knarik, Weichard, Aidan, Nixon, Gillian M, Davey, Margot J, Ditchfield, Michael, Harper, Ronald M, and Kumar, Rajesh

Subjects
autonomic, cognition, diffusion tensor imaging, magnetic resonance imaging, mood, Magnetic resonance imaging, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Neurology & Neurosurgery
Abstract

Study objectivesChildren with sleep-disordered breathing (SDB) exhibit behavioral, cognitive, and autonomic deficits, suggestive of neural injury. We assessed whether the tissue alterations resulted from acute or chronic processes, and whether alterations correlated with disease severity.MethodsBrain tissue integrity was examined with mean diffusivity (MD) (3.0 T scanner) in 20 nonsnoring controls (mean age ± SEM, 12.2 ± 0.6 years; 10 males) and 18 children with SDB (12.3 ± 0.7 years; 11 males). Sleep, cognitive, and behavioral measures were compared between groups following overnight polysomnography using Student's t tests. Whole-brain MD maps were realigned and averaged, normalized, smoothed, and compared between groups using ANCOVA (covariates: age, gender, and socioeconomic status). Partial correlations were calculated between whole-brain smoothed MD maps and obstructive apnea-hypopnea indices (OAHIs).ResultsAge, gender, and sleep variables did not differ between groups. The SDB group showed higher OAHIs, body mass indices, and systolic blood pressure. Significantly reduced MD values (acute changes) appeared in the hippocampus, insula, thalamus, temporal and occipital cortices, and cerebellum, but were increased (chronic damage) in the frontal and prefrontal cortices in the SDB group over controls. Both positive and negative correlations appeared with extent of tissue changes and disease severity. Externalizing and Total Problem Behaviors were significantly higher in children with SDB. Verbal, performance, and total IQ scores trended lower, and behavioral scores trended higher.ConclusionsPediatric SDB is accompanied by predominantly acute brain changes in areas that regulate autonomic, cognitive, and mood functions, and chronic changes in frontal cortices essential for behavioral control. Interventions need to be keyed to address acute vs chronic injury.

Published
2018

9. Core outcomes and factors influencing the experience of care for children with severe acute exacerbations of asthma: a qualitative study

Author

Craig, Simon, primary, Xu, Yao, additional, Robas, Kael, additional, Iramain, Ricardo, additional, Yock-Corrales, Adriana, additional, Soto-Martinez, Manuel E, additional, Rino, Pedro, additional, Belen Alvarez Ricciardi, Maria, additional, Piantanida, Sofia, additional, Mahant, Sanjay, additional, Ubuane, Peter Odion, additional, Odusote, Olatunde, additional, Kwok, Maria, additional, Johnson, Michael D, additional, Paniagua, Natalia, additional, Benito Fernandez, Javier, additional, Ong, Gene Y, additional, Lyttle, Mark D, additional, Gong, Jin, additional, Roland, Damian, additional, Dalziel, Stuart R, additional, Nixon, Gillian M, additional, Powell, Colin V E, additional, Graudins, Andis, additional, and Babl, Franz E, additional

Published
2023
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17. Sleep-disordered breathing in Australian children with Prader-Willi syndrome following initiation of growth hormone therapy

Author

Caudri, Daan, Nixon, Gillian M., Nielsen, Aleisha, Mai, Linda, Hafekost, Claire R., Kapur, Nitin, Seton, Chris, Tai, Andrew, Blecher, Greg, Ambler, Geoff, Bergman, Philip B., Vora, Komal A., Crock, Patricia, Verge, Charles F., Tham, Elaine, Musthaffa, Yassmin, Lafferty, Antony R., Jacoby, Peter, Wilson, Andrew C., Downs, Jenny, Choong, Catherine S., Caudri, Daan, Nixon, Gillian M., Nielsen, Aleisha, Mai, Linda, Hafekost, Claire R., Kapur, Nitin, Seton, Chris, Tai, Andrew, Blecher, Greg, Ambler, Geoff, Bergman, Philip B., Vora, Komal A., Crock, Patricia, Verge, Charles F., Tham, Elaine, Musthaffa, Yassmin, Lafferty, Antony R., Jacoby, Peter, Wilson, Andrew C., Downs, Jenny, and Choong, Catherine S.

Abstract

Aim: In children with Prader-Willi syndrome (PWS), growth hormone (GH) improves height and body composition; however, may be associated with worsening sleep-disordered breathing (SDB). Some studies have reported less SDB after GH initiation, but follow-up with polysomnography is still advised in most clinical guidelines. Methods: This retrospective, multicentre study, included children with PWS treated with GH at seven PWS treatment centres in Australia over the last 18 years. A paired analysis comparing polysomnographic measures of central and obstructive SDB in the same child, before and after GH initiation was performed with Wilcoxon signed-rank test. The proportion of children who developed moderate/severe obstructive sleep apnoea (OSA) was calculated with their binomial confidence intervals. Results: We included 112 patients with available paired data. The median age at start of GH was 1.9 years (range 0.1–13.5 years). Median obstructive apnoea hypopnoea index (AHI) at baseline was 0.43/h (range 0–32.9); 35% had an obstructive AHI above 1.0/h. Follow-up polysomnography within 2 years after the start of GH was available in 94 children who did not receive OSA treatment. After GH initiation, there was no change in central AHI. The median obstructive AHI did not increase significantly (P = 0.13), but 12 children (13%, CI95% 7–21%) developed moderate/severe OSA, with clinical management implications. Conclusions: Our findings of a worsening of OSA severity in 13% of children with PWS support current advice to perform polysomnography after GH initiation. Early identification of worsening OSA may prevent severe sequelae in a subgroup of children.

Published
2022

19. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study

Author

Craig, Simon, primary, Powell, Colin V E, additional, Nixon, Gillian M, additional, Oakley, Ed, additional, Hort, Jason, additional, Armstrong, David S, additional, Ranganathan, Sarath, additional, Kochar, Amit, additional, Wilson, Catherine, additional, George, Shane, additional, Phillips, Natalie, additional, Furyk, Jeremy, additional, Lawton, Ben, additional, Borland, Meredith L, additional, O’Brien, Sharon, additional, Neutze, Jocelyn, additional, Lithgow, Anna, additional, Mitchell, Clare, additional, Watkins, Nick, additional, Brannigan, Domhnall, additional, Wood, Joanna, additional, Gray, Charmaine, additional, Hearps, Stephen, additional, Ramage, Emma, additional, Williams, Amanda, additional, Lew, Jamie, additional, Jones, Leonie, additional, Graudins, Andis, additional, Dalziel, Stuart, additional, and Babl, Franz E, additional

Published
2022
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21. Additional file 2 of Hospital revisits after paediatric tonsillectomy: a cohort study

Author

Tran, Aimy H. L., Chin, Ken L., Horne, Rosemary S. C., Liew, Danny, Rimmer, Joanne, and Nixon, Gillian M.

Subjects
humanities
Abstract

Additional file 2. Risk factors for emergency department presentation and hospital readmission involving haemorrhage. Univariate and multivariable regression analysis of the risk factors for emergency department presentation and hospital readmission involving haemorrhage

Published
2022
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24. Bacterial causes of empyema in children, Australia, 2007-2009

Author

Strachan, Roxanne E., Cornelius, Anita, Gilbert, Gwendolyn L., Gulliver, Tanya, Martin, Andrew, McDonald, Tim, Nixon, Gillian M., Roseby, Rob, Ranganathan, Sarath, Selvadurai, Hiran, Smith, Greg, Soto-Martinez, Manuel, Suresh, Sadasivam, Teoh, Laurel, Thapa, Kiran, Wainwright, Claire E., and Jaffe, Adam

Subjects
Bacterial pneumonia -- Diagnosis -- Research, Bacteria -- Causes of -- Research, Empyema -- Diagnosis -- Care and treatment -- Research, Children -- Health aspects, Pneumonia -- Diagnosis -- Research, Health
Abstract

Empyema in children is a relatively uncommon disease that occurs in 0.7% of children with pneumonia (1). Many organisms cause empyema in children; Streptococcus pneumoniae is the most common (2-6). [...]

Published
2011
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38. Sleep disordered breathing in children disrupts the maturation of autonomic control of heart rate and its association with cerebral oxygenation.

Author

Walter, Lisa M, Tamanyan, Knarik, Weichard, Aidan J, Davey, Margot J, Nixon, Gillian M, and Horne, Rosemary S. C.

Subjects
SLEEP disorders in children, CEREBRAL circulation, HEART beat, SLEEP disorders
Abstract

Key points: Sleep disordered breathing (SDB) affects 4–11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control.The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non‐snoring control children was absent during sleep in children with SDB.Age significantly predicted increasing cerebral oxygenation during wake in non‐snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation.Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep.SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non‐snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. The repetitive episodes of hypoxia that are features of sleep disordered breathing (SDB) in children are associated with alterations in autonomic control of heart rate in an age‐dependent manner. We aimed to relate heart rate variability (HRV) parameters to age and measures of cerebral oxygenation in children (3–12 years old) with SDB and non‐snoring controls. Children (SDB, n = 117; controls, n = 42; 3–12 years) underwent overnight polysomnography. Total (TP), low‐ (LF) and high‐frequency (HF) power, tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) were analysed during wake and sleep. Pearson's correlations determined the association between age and HRV parameters, and multiple linear regressions between HRV, age and cerebral oxygenation parameters. During wake, age had a positive association with LF power, reflecting increased parasympathetic and sympathetic activity with increasing age for both control and SDB groups. This association was also evident during sleep in controls, but was absent in children with SDB. In controls, during wake TOI had a positive, and FTOE a negative association with age. During sleep, TP, LF and HF power were significant, negative determinants of TOI and positive determinants of FTOE. These associations were not seen in children with SDB during wake or sleep. SDB disrupts the normal maturation of the autonomic control of heart rate and the association between HRV and cerebral oxygenation exhibited by non‐snoring control children of primary school age. These results highlight the impact SDB has on cardiovascular control and the potential impact on adverse cardiovascular outcomes. Key points: Sleep disordered breathing (SDB) affects 4–11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control.The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non‐snoring control children was absent during sleep in children with SDB.Age significantly predicted increasing cerebral oxygenation during wake in non‐snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation.Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep.SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non‐snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. [ABSTRACT FROM AUTHOR]

Published
2019
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46. Feasibility of Comprehensive, Unattended Ambulatory Polysomnography in School-Aged Children

Author

Marcus, Carole L., primary, Traylor, Joel, additional, Biggs, Sarah N., additional, Roberts, Robin S., additional, Nixon, Gillian M., additional, Narang, Indra, additional, Bhattacharjee, Rakesh, additional, Davey, Margot J., additional, Horne, Rosemary S.C., additional, Cheshire, Maureen, additional, Gibbons, K. Jeremy, additional, Dix, Joanne, additional, Asztalos, Elizabeth, additional, Doyle, Lex W., additional, Opie, Gillian F., additional, D'ilario, Judy, additional, Costantini, Lorrie, additional, Bradford, Ruth, additional, and Schmidt, Barbara, additional

Published
2014
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48. Urgent Adenotonsillectomy

Author

Brown, Karen A., primary, Morin, Isabelle, additional, Hickey, Chantal, additional, Manoukian, John J., additional, Nixon, Gillian M., additional, and Brouillette, Robert T., additional

Published
2003
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50. Reply.

Author

Nixon, Gillian M and Davey, Margot J

Published
2015

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