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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). [...]

Arousal from sleep in healthy adults is associated with a large, transient increase in heart rate (HR). Individuals with Down syndrome (DS) have attenuated cardiovascular responses to autonomic tests during wakefulness. We tested the hypothesis that the HR response to arousal from sleep is reduced in children with DS and obstructive sleep apnea (OSA) compared with healthy children. Twenty children aged 3-17 yr referred for investigation of sleep-disordered breathing (10 DS, and l0 OSA controls) matched for age and obstructive apnea/hypopnea index underwent routine overnight polysonmography. In addition, 10 non-snoring controls from the general community were studied. Beat-by-beat HR was analyzed from 15 s pre- to 15 s post-spontaneous arousals and compared between groups using two-way ANOVA with repeated measures. Data are presented as means [+ or -] SE. For both rapid eye movement (REM) and non-REM (NREM), arousals were associated with a significant increase in HR in all groups (peak response NREM: DS, 118 [+ or -] 1% at 3 s; OSA controls, 124 [+ or -] 2% at 4 s; and healthy controls, 125 [+ or -] 3% at 4 s; and peak response REM: DS, 116 [+ or -] 2% at 4 s; OSA controls, 123 [+ or -] 3% at 4 s; and healthy controls, 125 [+ or -] 4 at 4 s; P < 0.001 for all). Post hoc analysis revealed that HR in the DS group was significantly lower than both control groups at 1-4 s in NREM and at 4 to 5 s in REM (P < 0.05 for all). In conclusion, the HR response to spontaneous arousal from sleep is reduced in children with DS and OSA compared with healthy children. This attenuated cardiovascular response could be due to reduced sympathetic activation or blunted vagal withdrawal and may have implications for the child with DS and OSA. autonomic control; pediatric doi: 10.1152/ajpheart.00701.2009.

Objective: Diagnosis of obstructive sleep apnoea (OSA) is made on overnight polysomnography (PSG). Given the widespread availability of smartphone video technology, we aimed to develop and test a standardised scoring system for smartphone videos and compare these scores to PSG results.Methods: Children aged 1-16 years undergoing PSG for suspected OSA were included. Parents were asked to take 1-2 min videos of the breathing they were concerned about. Videos were scored using a newly developed and tested tool on five components: inspiratory obstructive noises (1-4), presence of obstructive events (0-1), increased work of breathing (0-1), mouth breathing (0-1) and neck extension (0-1). Video scores and the Obstructive Apnoea Hypopnoea Index (OAHI) were compared using Spearman correlation. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for different cut-off scores to achieve the best results.Results: Videos from 43 children (28 men (65.1%), median age 5.7 years (range 2.6-14.0 years), median OAHI 3.8/hour (range 0-82 events/hour) were included. Nine children (20.9%) had a video score of <3, all of whom had an OAHI of ≤5 events/hour. For a video score of ≥3, sensitivity was 100%; specificity was 36%; positive predictive value was 53%; and negative predictive value 100% for moderate to severe OSA (OAHI>5 events/hour) .Conclusion: We have developed and validated a simple clinical tool (the Monash Obstructive Sleep Apnoea Video Score) to quantify abnormalities in breathing seen on short video recordings made on a smartphone. A low score rules out moderate-severe OSA and may be valuable in the triage of children with symptoms of OSA. [ABSTRACT FROM AUTHOR]

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This article discusses the use of overnight oximetry as a diagnostic tool for sleep apnea and other respiratory and sleep conditions. The study compares the success of a new "drive-through" model of home oximetry with the previous face-to-face model. The results show that there was no difference in failure rates between the two models, and the drive-through model was found to be more efficient and convenient for both staff and families. The authors recommend the use of the drive-through model for routine care and plan to continue this service even after pandemic-related restrictions are eased. [Extracted from the article]