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IPSA CONGRESS.   
IPSA Congress 2014 - Porto Alegre - Brazil - Sunday, September 29, 2013

It is my pleasure to present the
III Congress of the International Pediatric Sleep Association (IPSA) - Porto Alegre (Brazil) 3-5 December 2014.

The importance of sleep for health, learning and psychomotor development in infancy, childhood and adolescence has been emphasized in the pediatric research in the last two decades and it has become more and more evident that ensuring a good sleep during development is of key importance for a later healthy life.
The IPSA Congress is an influential forum for sleep practitioners from around the world to network and exchange views, whilst learning from world-class researchers about the latest scientific and clinical developments in the field.
The success of the last two Congresses in Rome 2010 and Manchester 2012 has highlighted the magnitude of Pediatric Sleep Medicine in the scientific community and we hope that the 2014 Congress will provide a perfect balance between didactic and practical needs, in order to provide the technical knowhow and up-to-date knowledge that will enable participants to improve their practice.
As traditional for IPSA, the most renowned International opinion leaders in the field of Pediatric Sleep Medicine speakers will join the Congress and will highlight the recent significant advances in both basic science and clinical sleep medicine during development.
I hope that the world paediatric sleep community will gather together in the lively city of Porto Alegre to celebrate the best clinical practice and the latest advances in Pediatric Sleep Medicine.

Oliviero Bruni
President of the International Pediatric Sleep Association

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IPSA Congress 5-7 december 2012 - Manchester City (UK)

IPSA Congress 5-7th December 2012 - Manchester (UK)   read more...

ABSTRACT BOOK OF THE IPSA CONGRESS, Rome 3-5 December 2010

IPSA 2010 - Abstract Book

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 Announcements

Guia SAOS Infantil Espanola

New guidelines on the diagnosis and treatment of OSA in children published by the Spanish Pediatric Sleep Group. (available only in Spanish)

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RECENT LITERATURE HIGHLIGHTS   
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Testing for pediatric obstructive sleep apnea when health care resources are rationed.
Related Articles

Testing for pediatric obstructive sleep apnea when health care resources are rationed.

JAMA Otolaryngol Head Neck Surg. 2014 Jul;140(7):616-23

Authors: Horwood L, Brouillette RT, McGregor CD, Manoukian JJ, Constantin E

Abstract
IMPORTANCE: Evaluation of pediatric obstructive sleep apnea in resource-limited health care systems necessitates testing modalities that are accurate and more cost-effective than polysomnography.
OBJECTIVE: To trace the clinical pathway of children referred to our sleep laboratory for possible obstructive sleep apnea who were evaluated using nocturnal pulse oximetry and the McGill Oximetry Score.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study of children 2 to 17 years old with suspected obstructive sleep apnea due to adenotonsillar hypertrophy, conducted at a Canadian pediatric tertiary care center.
INTERVENTIONS: Nocturnal pulse oximetry studies scored using the McGill Oximetry Score.
MAIN OUTCOMES AND MEASURES: For children who underwent adenotonsillectomy we determined the length of time from oximetry to surgery, postoperative length of stay, postoperative readmissions, and emergency department visits in the month following surgery and major surgical complications. We analyzed these outcomes by oximetry result. We compared the cost savings of our diagnostic approach with those of other diagnostic models.
RESULTS: Among 362 children, the median age was 4.8 years (interquartile range, 3.3-6.7), and 61% were male. Two-hundred-sixty-six (73%) and 96 (27%), respectively, had inconclusive and abnormal oximetry results. Eighty of 96 of children with abnormal oximetry results (83%) and 81 of 266 children with inconclusive oximetry results (30%) underwent adenotonsillectomy. Thirty-three of 266 children (12%) underwent further evaluation with polysomnography; of 14 diagnosed as having OSA, 12 underwent adenotonsillectomy. Children with abnormal oximetry results were operated on soonest after testing and triaged based on oximetry results. No child with an inconclusive oximetry result required hospitalization for more than 1 night postoperatively; 14% of children (11 of 80) with an abnormal oximetry result required hospitalization for 2 or 3 nights (χ2 = 12.0; P = .001). Rates of readmissions and emergency department visits were low, irrespective of oximetry results (whether inconclusive or abnormal). We show that our oximetry-based diagnostic approach results in considerable cost savings compared with a polysomnography-for-all approach.
CONCLUSIONS AND RELEVANCE: Oximetry studies evaluated with the McGill Oximetry Score expedite diagnosis and treatment of children with adenotonsillar hypertrophy referred for suspected sleep-disordered breathing. When resources for testing for sleep-disordered breathing are rationed or severely limited, our proposed diagnostic approach can help maximize cost-savings and allows sleep laboratories to focus resources on medically complex children requiring polysomnographic evaluation of suspected sleep disorders.

PMID: 24851855 [PubMed - indexed for MEDLINE]


A new scoring system for upper airway pediatric sleep endoscopy.
Related Articles

A new scoring system for upper airway pediatric sleep endoscopy.

JAMA Otolaryngol Head Neck Surg. 2014 Jul;140(7):595-602

Authors: Chan DK, Liming BJ, Horn DL, Parikh SR

Abstract
IMPORTANCE: Sleep-associated upper-airway obstruction in children is a significant cause of morbidity. Development of a simple, standardized, quantitative technique to assess anatomic causes of sleep-related breathing disorder is important for surgical planning, clinical communication, and research.
OBJECTIVE: To design, implement, and evaluate a scoring system to quantify airway obstruction in pediatric drug-induced sleep endoscopy.
DESIGN, SETTING, AND PARTICIPANTS: This study was a retrospective case series conducted at a tertiary pediatric hospital. The patients were children with sleep-related breathing disorder who underwent polysomnography and drug-induced sleep endoscopy.
INTERVENTIONS: Flexible fiber-optic laryngoscopy was performed. Endoscopic examinations were recorded on video and assessed by 4 independent raters based on a scoring template.
MAIN OUTCOMES AND MEASURES: Five locations in the upper aerodigestive tract (adenoid, velum, lateral pharyngeal wall, tongue base, and supraglottis) were evaluated on a 4-point scale for minimum and maximum obstruction. Internal reliability was assessed by calculating interrater and intrarater intraclass correlation coefficients (ICCs). For external validation, aggregate and site-specific scores were correlated with preoperative polysomnographic indices.
RESULTS: Videos recorded of sleep endoscopies from 23 children (mean age, 2.2 years) were reviewed and rated. Children had an average apnea-hypopnea index of 24.8. Seventy percent of interrater and intrarater ICC values (7 of 10 for each set) were above 0.6, demonstrating substantial agreement. Higher total obstructive scores were associated with lower oxygen saturation nadir (P = .04). The scoring system was also used to quantitatively identify children with multilevel airway obstruction, who were found to have significantly worse polysomnographic indices compared with children with single-level obstruction (P = .02).
CONCLUSIONS AND RELEVANCE: The proposed scoring system, which is designed to be easy to use and allow for subjectivity in evaluating obstruction at multiple levels, nonetheless achieves good internal reliability and external validity. Implementing this system will allow for standardization of reporting for sleep endoscopy outcomes, as well as aid the practicing clinician in the interpretation of sleep endoscopy findings to inform site-directed surgical intervention in cases of complicated obstructive sleep apnea.

PMID: 24810174 [PubMed - indexed for MEDLINE]


Associations between sleep habits and mental health status and suicidality in a longitudinal survey of monozygotic twin adolescents.
Related Articles

Associations between sleep habits and mental health status and suicidality in a longitudinal survey of monozygotic twin adolescents.

J Sleep Res. 2014 Jun;23(3):290-4

Authors: Matamura M, Tochigi M, Usami S, Yonehara H, Fukushima M, Nishida A, Togo F, Sasaki T

Abstract
Several epidemiological studies have indicated that there is a relationship between sleep habits, such as sleep duration, bedtime and bedtime regularity, and mental health status, including depression and anxiety in adolescents. However, it is still to be clarified whether the relationship is direct cause-and-effect or mediated by the influence of genetic and other traits, i.e. quasi-correlation. To examine this issue, we conducted a twin study using a total of 314 data for monozygotic twins from a longitudinal survey of sleep habits and mental health status conducted in a unified junior and senior high school (grades 7-12), located in Tokyo, Japan. Three-level hierarchical linear model analysis showed that both bedtime and sleep duration had significant associations with the Japanese version of the 12-item General Health Questionnaire (GHQ-12) score, suicidal thoughts and the experience of self-harm behaviours when genetic factors and shared environmental factors, which were completely shared between co-twins, were controlled for. These associations were statistically significant even after controlling for bedtime regularity, which was also associated significantly with the GHQ-12 score. These suggest that the associations between sleep habits and mental health status were still statistically significant after controlling for the influence of genetic and shared environmental factors of twins, and that there may be a direct cause-and-effect in the relationship in adolescents. Thus, late bedtime and short sleep duration could predict subsequent development of depression and anxiety, including suicidal or self-injury risk. This suggests that poor mental health status in adolescents might be improved by health education and intervention concerning sleep and lifestyle habits.

PMID: 24456111 [PubMed - indexed for MEDLINE]


The impact of daytime sleepiness on the school performance of college students with attention deficit hyperactivity disorder (ADHD): a prospective longitudinal study.
Related Articles

The impact of daytime sleepiness on the school performance of college students with attention deficit hyperactivity disorder (ADHD): a prospective longitudinal study.

J Sleep Res. 2014 Jun;23(3):318-25

Authors: Langberg JM, Dvorsky MR, Becker SP, Molitor SJ

Abstract
This prospective longitudinal study evaluated the impact of daytime sleepiness on the school performance of 62 college students diagnosed comprehensively with attention deficit hyperactivity disorder. The primary goal of the study was to determine if self-reported daytime sleepiness rated at the beginning of the academic year could predict academic and overall functioning at the end of the academic year while also considering potentially important covariates, including symptoms of inattention, hyperactivity and impulsivity, medication status and whether or not students lived at home or on-campus. Self-reported daytime sleepiness predicted longitudinally school maladjustment, overall functional impairment and the number of D and F grades (i.e. poor and failing) students received in courses above and beyond both self- and parent-report of symptoms, but did not predict overall grade point average. Living at home served as a protective factor and was associated with less school maladjustment and overall impairment. Gender was the only significant predictor in the overall grade point average model, with female gender associated with higher overall grades. The implications of these findings for monitoring and treatment of sleep disturbances in college students with attention deficit hyperactivity disorder are discussed.

PMID: 24372786 [PubMed - indexed for MEDLINE]


Relations between daytime pre-ejection period reactivity and sleep in late childhood.
Related Articles

Relations between daytime pre-ejection period reactivity and sleep in late childhood.

J Sleep Res. 2014 Jun;23(3):335-8

Authors: Bagley EJ, El-Sheikh M

Abstract
The sympathetic nervous system and children's sleep serve critical arousal regulation functions. Shortened pre-ejection period, a reliable indirect index of greater sympathetic nervous system activity, has been associated with reduced sleep duration and quality in adults, but limited evidence exists in children regarding associations between pre-ejection period and sleep. We examined relations between pre-ejection period reactivity in response to a laboratory-based stressor and multiple parameters of actigraphy-based sleep duration and quality in children. The sample included 123 boys and 112 girls [mean age = 11.31 years, standard deviation (SD) = 0.63 years]. Controlling for body mass index, sex and pre-ejection period baseline, increased sympathetic nervous system reactivity, indexed by a lower level of pre-ejection period during the challenge than the baseline, was associated with worse sleep quality indicated by lower sleep efficiency, greater sleep activity and greater long wake episodes. The findings add to a small literature on relations between sympathetic nervous system functioning and children's sleep, suggesting that poor sleep quality is related to dysregulation of this stress response system.

PMID: 24372764 [PubMed - indexed for MEDLINE]


Sleep enhances memory consolidation in children.
Related Articles

Sleep enhances memory consolidation in children.

J Sleep Res. 2014 Jun;23(3):302-8

Authors: Ashworth A, Hill CM, Karmiloff-Smith A, Dimitriou D

Abstract
Sleep is an active state that plays an important role in the consolidation of memory. It has been found to enhance explicit memories in both adults and children. However, in contrast to adults, children do not always show a sleep-related improvement in implicit learning. The majority of research on sleep-dependent memory consolidation focuses on adults; hence, the current study examined sleep-related effects on two tasks in children. Thirty-three typically developing children aged 6-12 years took part in the study. Actigraphy was used to monitor sleep. Sleep-dependent memory consolidation was assessed using a novel non-word learning task and the Tower of Hanoi cognitive puzzle, which involves discovering an underlying rule to aid completion. Children were trained on the two tasks and retested following approximately equal retention intervals of both wake and sleep. After sleep, children showed significant improvements in performance of 14% on the non-word learning task and 25% on the Tower of Hanoi task, but no significant change in score following the wake retention interval. Improved performance on the Tower of Hanoi may have been due to children consolidating explicit aspects of the task, for example rule-learning or memory of previous sequences; thus, we propose that sleep is necessary for consolidation of explicit memory in children. Sleep quality and duration were not related to children's task performance. If such experimental sleep-related learning enhancement is generalizable to everyday life, then it is clear that sleep plays a vital role in children's educational attainment.

PMID: 24329882 [PubMed - indexed for MEDLINE]


Mother-reported sleep, accelerometer-estimated sleep and weight status in Mexican American children: sleep duration is associated with increased adiposity and risk for overweight/obese status.
Related Articles

Mother-reported sleep, accelerometer-estimated sleep and weight status in Mexican American children: sleep duration is associated with increased adiposity and risk for overweight/obese status.

J Sleep Res. 2014 Jun;23(3):326-34

Authors: Martinez SM, Greenspan LC, Butte NF, Gregorich SE, De Groat CL, Deardorff J, Penilla C, Pasch LA, Flores E, Tschann JM

Abstract
We know of no studies comparing parent-reported sleep with accelerometer-estimated sleep in their relation to paediatric adiposity. We examined: (i) the reliability of mother-reported sleep compared with accelerometer-estimated sleep; and (ii) the relationship between both sleep measures and child adiposity. The current cross-sectional study included 303 Mexican American mother-child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration using maternal report and accelerometry and child anthropometrics. Concordance between sleep measures was evaluated using the Bland-Altman method. We conducted zero-ordered correlations between mother-reported sleep, accelerometer-estimated sleep and child BMI z-scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother-reported sleep (model 1), accelerometer-estimated sleep (model 2) and both sleep measures (model 3). Children had an average age of 8.86 years (SD = 0.82). Mothers reported that their child slept 9.81 ± 0.74 h [95% confidence interval (CI): 9.72, 9.89], compared to 9.58 ± 0.71 h (95% CI: 9.50, 9.66) based on accelerometry. Mother-reported sleep and accelerometer-estimated sleep were correlated (r = 0.33, P < 0.001). BMIz outcomes were associated negatively with mother-reported sleep duration (model 1: β = -0.13; P = 0.02) and accelerometer-estimated sleep duration (model 2: β = -0.17; P < 0.01). Accounting for both sleep measures, only accelerometer-measured sleep was related to BMIz (model 3: β = -0.14, P = 0.02). Each sleep measure was related significantly to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children's sleep than maternal report, yet maternal report may be sufficient to examine the sleep-adiposity relationship when resources are limited.

PMID: 24329818 [PubMed - indexed for MEDLINE]


Epileptic seizures as condensed sleep: an analysis of network dynamics from electroencephalogram signals.
Related Articles

Epileptic seizures as condensed sleep: an analysis of network dynamics from electroencephalogram signals.

J Sleep Res. 2014 Jun;23(3):268-73

Authors: Gast H, Müller M, Rummel C, Roth C, Mathis J, Schindler K, Bassetti CL

Abstract
Both deepening sleep and evolving epileptic seizures are associated with increasing slow-wave activity. Larger-scale functional networks derived from electroencephalogram indicate that in both transitions dramatic changes of communication between brain areas occur. During seizures these changes seem to be 'condensed', because they evolve more rapidly than during deepening sleep. Here we set out to assess quantitatively functional network dynamics derived from electroencephalogram signals during seizures and normal sleep. Functional networks were derived from electroencephalogram signals from wakefulness, light and deep sleep of 12 volunteers, and from pre-seizure, seizure and post-seizure time periods of 10 patients suffering from focal onset pharmaco-resistant epilepsy. Nodes of the functional network represented electrical signals recorded by single electrodes and were linked if there was non-random cross-correlation between the two corresponding electroencephalogram signals. Network dynamics were then characterized by the evolution of global efficiency, which measures ease of information transmission. Global efficiency was compared with relative delta power. Global efficiency significantly decreased both between light and deep sleep, and between pre-seizure, seizure and post-seizure time periods. The decrease of global efficiency was due to a loss of functional links. While global efficiency decreased significantly, relative delta power increased except between the time periods wakefulness and light sleep, and pre-seizure and seizure. Our results demonstrate that both epileptic seizures and deepening sleep are characterized by dramatic fragmentation of larger-scale functional networks, and further support the similarities between sleep and seizures.

PMID: 24329723 [PubMed - indexed for MEDLINE]

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