Sleeping for Better Cardiovascular Health in Children and Adolescents

There is a reason why personal sleep monitoring devices have proliferated in the wearable technology space.  Poor sleep health is linked to reduced cognitive function, quality of life, and cardiovascular outcomes.  Children are not immune to these complications, but they may present differently.  Obesity, hypertension, insulin resistance, and dyslipidemia have all been correlated in some form to obstructive sleep apnea or sleep disordered breathing.

Be on the lookout for the any of the following:

1) Chronic snoring, mouth breathing, pauses in breathing during sleep especially when associated with tonsillar enlargement

2) Signs of daytime sleepiness despite adequate sleep time.  Sleep needs in children vary by age, so it is important that sleep times reflect that.  Also, it is common for sleepiness to look completely different in children.  Problems with focus, attention and labile emotions and irritability in the second half of the day are quite common.

3) Special risk populations, including children that are obese, or those that have other medical disorders known to predispose to sleep apnea, such as Down Syndrome or other craniofacial abnormalities.

Any of the above warrants evaluation with a pediatric sleep specialist to discuss testing.

AHA Releases Scientific Statement on Obstructive Sleep Apnea and Cardiovascular Health in Children and Adolescents

 In a recent scientific statement, the American Heart Association (AHA) outlined evidence highlighting the effect of obstructive sleep apnea (OSA) on the cardiovascular health of children and adolescents. The full statement was published in Journal of the American Heart Association.

The AHA noted that this statement may be used to develop future guidelines in managing OSA with regard to cardiovascular disease (CVD) risk in the pediatric population.

Epidemiology and Risk Factors

Patients with OSA experience disruption during sleep caused by upper airway obstruction. In children and adolescents, the clinical presentation of the condition can vary by age, but it is generally characterized by habitual snoring, labored breathing, gasps/snorting noises, and daytime sleepiness. According to the AHA, 1% to 6% of children and adolescents have OSA. Current evidence suggests that the OSA prevalence in a pediatric population peaks between 2 and 8 years of age and corresponds to a peak in adenotonsillar hypertrophy prevalence.

Primary risk factors for OSA in the pediatric population include obesity, allergic rhinitis, upper and lower airway disease, enlarged tonsils and adenoids, low muscle tone, neuromuscular disorders, and craniofacial malformations. In addition, sickle cell disease (SCD) may be an independent risk factor for OSA. Premature birth, or birth that occurs prior to 37 weeks’ gestation, may also be associated with an increased risk for sleep-disordered breathing among children, partially because of delayed development of respiratory control.

Read article here.

Saharan dust is headed to Texas, bringing gorgeous sunsets and allergies

Summer is not the season we typically associate with asthma control problems.  The fluctuating temperature, seasonal allergens, and the respiratory viruses are typically more associated with asthma exacerbations in the fall through spring seasons.   

 

However, the Saharan dust approaching this weak does underscore that air quality issues can be a significant problem in the summer.  With this dust comes a higher concentration of airborne particulate matter that can worsen allergies and asthma. 

 

Listed below, are 3 ways to reduce the likelihood of dust and other environmental factors worsening your child’s asthma control: 

 

1. Don’t’ forget your controllers 

 

Missing asthma controller doses during the school season is clearly a problem.  It’s easy to underestimate risk in the summer since most of the conventional triggers are not there.  Don’t do it!  If you have not been advised to stop or reduce controller medication, be sure to continues as instructed.   

2. Monitor the air quality 

 

Just like allergen monitoring, air quality reports are also available and are included in many online weather forecasts and weather smartphone apps.  Airnow.gov provided zip code specific air quality risk.  A recommendation for people with sensitive lung conditions, or an AQI score of 100 or above is usually a good indication to reduce time outdoors.  

 

3. Check with your asthma specialist 

 

If you are overdue for a visit with your asthma specialist, follow up to make sure your asthma is currently controlled.  Absence of symptoms is reassuring, but it is important to have some routine assessment of lung function to confirm this. 

HOUSTON — Saharan dust is headed to Texas! It sounds ominous, right? However, it's a weather phenomenon that happens every year around this time.

In the late spring and through the summer, plumes of dust from the Saharan Desert 5,000-miles away travel across the Atlantic, spanning into the Caribbean and as far as the Gulf of Mexico.

It's called the Saharan Air Layer, or more formally, Aerosol Optical Thickness. Experts say these plumes can dump up to 60 million tons of dust into the atmosphere. 

Satellites pick it up when the dust layer is thick, and this year it's thick enough to track. We're better at it now because of advanced satellites that can tell how much power is lost as sunlight passes through the atmosphere.  

From more intensely colored sunsets to altering air quality, there are some positive and negative impacts that come with these.

Saharan dust is filled with nutrient rich minerals that has played a role in fertilizing the Amazon Rainforest for thousands of years. The dust does sometimes travel far enough inland in the United States that it can cause unhealthy air quality. 

If you notice skies looking a hazy brown color or a pale blue, you may be dealing with Saharan dust in your forecast. If the layer is thin enough, it also creates more intense fiery sunsets.

Impact on hurricane season

These dust plumes can also impact our hurricane season. 

Tropical systems need warmth from the oceans and enough moisture high in the atmosphere to form. These dust layers are very hot and super dry, which will hinder tropical development if it’s dense enough. They also produce strong wind shear that could break apart a storm. 

Sometimes, Saharan dust can suppress thunderstorm development causing the sky to remain hazy for days and can lead to hotter days.

Last June, a massive dust layer dubbed a “Godzilla” dust plume blanketed the Caribbean. 

It was considered the largest dust storm in two decades, according to NASA scientists. 

In a recent study, they are predicting that these annual dust plumes will decrease over the next century as a result of climate change and ocean warming. 

Read article here.

Philips-Respironics CPAP and Ventilator Device Recall, What to Know

 Philips-Respironics, a medical device manufacturer for home ventilator and CPAP/BIPAP machines used to treat sleep apnea, recently announced a recall for many of their medical devices due to concerns that a sound reducing foam may degrade over time and enter into a patient's airway and lungs, posing severe medical risk.

Philips Respironics announced a voluntary recall notification (U.S. only) / field safety notice (International Markets) for Continuous and Non-Continuous Ventilators (certain CPAP, BiLevel PAP and Ventilator Devices) due to two issues related to the polyester-based polyurethane (PE-PUR) sound abatement foam used in these devices: 1) PE-PUR foam may degrade into particles which may enter the device’s air pathway and be ingested or inhaled by the user, and 2) the PE-PUR foam may off-gas certain chemicals. The foam degradation may be exacerbated by use of unapproved cleaning methods, such as ozone (see FDA safety communication on use of ozone cleaners), and off-gassing may occur during initial operation and may possibly continue throughout the device’s useful life.

Advice for Patients and Customers

Philips advises patients and customers to take the following actions:

• For patients using affected BiLevel PAP and CPAP devices: Discontinue use of your device and work with your physician or durable medical equipment (DME) provider to determine the most appropriate options for continued treatment. To continue use of your device due to lack of alternatives, consult with your physician to determine if the benefit of continuing therapy with your device outweighs the risks identified in the recall notification.
• For patients using affected life-sustaining mechanical ventilator devices: Do not stop or alter your prescribed therapy until you have talked to your physician. Philips recognizes that alternate ventilator options for therapy may not exist or may be severely limited for patients who require a ventilator for life-sustaining therapy, or in cases where therapy disruption is unacceptable. In these situations, and at the discretion of the treating clinical team, the benefit of continued usage of these ventilator devices may outweigh the risks identified in the recall notification.

Patients, physicians and DME suppliers can call Philips at 877-907-7508 for additional support.

Read article here.

Recall letter here.

Treating Sleep Apnea without CPAP

We care about the adults too.  Not all sleep apnea is the same, join us to learn about a treatment alternative.

Click HERE to register

COVID 19 Vaccination - Why, When, and Where?

 

The SARS-COV2 virus is known to be very dangerous if not deadly to high risk populations.  Common severe complications from this virus include a life threatening pneumonia requiring hospital care.  

Two highly effective mRNA vaccines are now available (Pfizer and Moderna) in limited quantities and should become increasingly available to high risk individuals before it becomes generally available to the public.  These vaccinations DO NOT contain live virus and therefore CANNOT cause infection.  They are primarily approved for prevention of a severe COVID 19 related illness.  The Pfizer vaccination is approved for 16 and up and the Moderna vaccine is approved for 18 and up.  Both vaccination require 2 doses to be effective. We are currently in phased 1A and 1B in Texas.

Because of limited vaccine availability, CDC and many public health agencies and hospital systems are providing vaccine in a phased manner as indicated below:

Healthcare personnel and residents of long-term care facilities should be offered the first doses of COVID-19 vaccines (1a)

CDC recommends that initial supplies of COVID-19 vaccine be allocated to healthcare personnel and long-term care facility residents. This is referred to as Phase 1a. Phases may overlap. CDC made this recommendation on December 3, 2020.

Groups who should be offered vaccination next (1b and 1c)

CDC recommends that in Phase 1b and Phase 1c, which may overlap, vaccination should be offered to people in the following groups. CDC made this recommendation on December 22, 2020.

Phase 1b

• Frontline essential workers such as fire fighters, police officers, corrections officers, food and agricultural workers, United States Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those who work in the educational sector (teachers, support staff, and daycare workers.)
• People aged 75 years and older because they are at high risk of hospitalization, illness, and death from COVID-19. People aged 75 years and older who are also residents of long-term care facilities should be offered vaccination in Phase 1a.

Phase 1c

• People aged 65—74 years because they are at high risk of hospitalization, illness, and death from COVID-19. People aged 65—74 years who are also residents of long-term care facilities should be offered vaccination in Phase 1a.
• People aged 16—64 years with underlying medical conditions which increase the risk of serious, life-threatening complications from COVID-19.
• Other essential workers, such as people who work in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health.

Texas Department of State Health Services has provided state specific guidance about who is eligible for vaccination now.  

It includes peoples age 16 and above who may have certain underlying conditions.  Those recommendations are listed here:

Texas DSHS recommendations

People 16 years of age and older with at least one chronic medical condition that puts them at increased risk for severe illness from the virus that causes COVID-19, such as but not limited to:

• Cancer
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Heart conditions, such as heart failure, coronary artery disease or cardiomyopathies
• Solid organ transplantation
• Obesity and severe obesity (body mass index of 30 kg/m2 or higher)
• Pregnancy
• Sickle cell disease
• Type 2 diabetes mellitus

There are a variety of other chronic medical conditions that are considered possibly higher risk that may be indication for vaccination as well. That comprehensive list is here:

CDC recommendations about chronic medical conditions

Below is a link from the Texas DSHS website to help identify a vaccine provider here you:

Vaccine provider locations can be found here

It's Here! Home Monitoring For Asthma

 During a period where office visits are reduced when possible and safe, and when some lung function testing maneuvers are avoided (spirometry) because of increased risk for asymptomatic infection spread, it is a great advantage to have quality home monitoring options.  The Capmedic device does this and provides the additional benefit of coaching asthma patients through proper lung function and allowing your asthma doctor to monitor compliance.  Dr. Susarla

CapMedic Measures Lung Function, Makes Sure Inhalers Used Correctly

The FDA has cleared the CapMedic device that helps to make sure that metered dose inhalers (MDIs) are properly used, even by young patients.

MDIs are most commonly employed to deliver asthma medications deep into the lungs, but to work effectively they have to be used correctly and on a consistent schedule.

The CapMedic snaps onto the top of many inhalers and, using built-in lights and a tiny speaker, it works to nudge users to inhale the medication correctly and at the right time. When a person is ready, the device talks them through all the steps, like shaking the inhaler, properly squeezing it while keeping it upright, and timing the inhalation just right.

The same device can snap onto an accompanying plastic adapter to turn it into an accurate at-home spirometer for lung function measurement. It can now measure FEV1, the maximum amount of air that the patient can push in a second, and PEF, the maximum flow one can generate at a steady rate.

Readings about usage and spirometer data are stored on an accompanying smartphone, helping patients, parents, and caretakers, make sure that the inhaled medication regimen is adhered to.

“Decades of studies have shown that almost 90% of patients are unable to use MDIs correctly – a result of their complex, multi-step usage requirements. The Cognita team has conducted drug deposition studies showing a tenfold improvement in the delivery of medication from just 4-5% to 45% when inhalers are used correctly,” said Rajoshi Biswas, Ph.D., Chief Scientific Officer and co-founder at Cognita Labs, in the announcement. “Getting an effective daily dose means patients are more likely to avoid costly, life-threatening hospitalizations.”

Read article here.

COVID-19 Infection and Transmission in Children

Are children at significant risk for a COVID-19 infection?  Although there may certainly be high risk groups, the data do not seem to support this.

Age-dependent effects in the transmission and control of COVID-19 epidemics

The COVID-19 pandemic has shown a markedly low proportion of cases among children1,2,3,4. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from China, Italy, Japan, Singapore, Canada and South Korea. We estimate that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years, and that clinical symptoms manifest in 21% (95% credible interval: 12–31%) of infections in 10- to 19-year-olds, rising to 69% (57–82%) of infections in people aged over 70 years. Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low. Our age-specific clinical fraction and susceptibility estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings. In countries with younger population structures—such as many low-income countries—the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.

Read article here.