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Article ; Online: The clustering of disorders related to childhood sleep-disordered breathing: are they related to a single mechanism?

Halbower, Ann C

2010 Volume 138, Issue 3, Page(s) 469–471

MeSH term(s)	Adult ; Child ; Cluster Analysis ; Humans ; Risk Factors ; Sleep Apnea Syndromes/complications ; Sleep Apnea Syndromes/epidemiology ; Sleep Apnea Syndromes/psychology
Language	English
Publishing date	2010-09
Publishing country	United States
Document type	Comment ; Editorial ; Research Support, N.I.H., Extramural
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1378/chest.10-0786
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Article: Pediatric home apnea monitors: coding, billing, and updated prescribing information for practice management.

Halbower, Ann C

Chest

2008 Volume 134, Issue 2, Page(s) 425–429

Abstract: A series of new current procedural terminology codes have been created that allow health-care providers to code and bill for pediatric home apnea monitoring in the United States. Apnea monitors have been used at home on pediatric patients at risk for ... ...

Abstract	A series of new current procedural terminology codes have been created that allow health-care providers to code and bill for pediatric home apnea monitoring in the United States. Apnea monitors have been used at home on pediatric patients at risk for sudden death for > 30 years without the benefit of evidence-based efficacy studies. Nevertheless, new apnea monitor devices with expanded capability have been developed. Recommended indications for pediatric home apnea monitors are outdated and vague. It is important for the prescribing health-care provider to understand device function, as well as the pathophysiology of cardiorespiratory events in different disease states in order to make logical decisions about which monitor to prescribe, or whether to prescribe one at all. This article will review what apnea monitors are designed to do, common misperceptions about device indications vs device capability, and updated suggestions regarding the prescription, billing, and coding of pediatric apnea monitors for pediatric practice management.
MeSH term(s)	Apnea/diagnosis ; Child ; Current Procedural Terminology ; Home Care Services ; Humans ; Infant ; Monitoring, Ambulatory/instrumentation ; Patient Selection ; Practice Patterns, Physicians' ; Sudden Infant Death/prevention & control ; United States
Language	English
Publishing date	2008-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1378/chest.08-0538
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Article ; Online: The Impact of Altitude on Sleep-Disordered Breathing in Children Dwelling at High Altitude: A Crossover Study.

Hughes, Benjamin H / Brinton, John T / Ingram, David G / Halbower, Ann C

Sleep

2017 Volume 40, Issue 9

Abstract: Study objectives: Sleep-disordered breathing (SDB) is prevalent among children and is associated with adverse health outcomes. Worldwide, approximately 250 million individuals reside at altitudes higher than 2000 meters above sea level (masl). The ... ...

Abstract	Study objectives: Sleep-disordered breathing (SDB) is prevalent among children and is associated with adverse health outcomes. Worldwide, approximately 250 million individuals reside at altitudes higher than 2000 meters above sea level (masl). The effect of chronic high-altitude exposure on children with SDB is unknown. This study aims to determine the impact of altitude on sleep study outcomes in children with SDB dwelling at high altitude. Methods: A single-center crossover study was performed to compare results of high-altitude home polysomnography (H-PSG) with lower altitude laboratory polysomnography (L-PSG) in school-age children dwelling at high altitude with symptoms consistent with SDB. The primary outcome was apnea-hypopnea index (AHI), with secondary outcomes including obstructive AHI; central AHI; and measures of oxygenation, sleep quality, and pulse rate. Results: Twelve participants were enrolled, with 10 included in the final analysis. Median altitude was 1644 masl on L-PSG and 2531 masl on H-PSG. Median AHI was 2.40 on L-PSG and 10.95 on H-PSG. Both obstructive and central respiratory events accounted for the difference in AHI. Oxygenation and sleep fragmentation were worse and pulse rate higher on H-PSG compared to L-PSG. Conclusions: These findings reveal a clinically substantial impact of altitude on respiratory, sleep, and cardiovascular outcomes in children with SDB who dwell at high altitude. Within this population, L-PSG underestimates obstructive sleep apnea and central sleep apnea compared to H-PSG. Given the shortage of high-altitude pediatric sleep laboratories, these results suggest a role for home sleep apnea testing for children residing at high altitude.
MeSH term(s)	Altitude ; Arousal/physiology ; Child ; Child, Preschool ; Cross-Over Studies ; Female ; Heart Rate ; Humans ; Male ; Oxygen/metabolism ; Polysomnography ; Prevalence ; Respiratory Physiological Phenomena ; Sleep/physiology ; Sleep Apnea Syndromes/complications ; Sleep Apnea Syndromes/diagnosis ; Sleep Apnea Syndromes/physiopathology ; Sleep Apnea, Central/complications ; Sleep Apnea, Central/diagnosis ; Sleep Apnea, Central/physiopathology ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/physiopathology ; Sleep Deprivation/complications ; Sleep Deprivation/physiopathology ; Wakefulness/physiology
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2017-11-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	424441-2
ISSN	1550-9109 ; 0161-8105
ISSN (online)	1550-9109
ISSN	0161-8105
DOI	10.1093/sleep/zsx120
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Article ; Online: Using a Home Ventilator with a Child.

Baker, Christopher D / Halbower, Ann C / Sterni, Laura M / Sockrider, Marianna

American journal of respiratory and critical care medicine

2016 Volume 194, Issue 12, Page(s) P21–P22

MeSH term(s)	Child ; Humans ; Pamphlets ; Patient Education as Topic/methods ; Respiration, Artificial/methods ; Self Care/methods ; Ventilators, Mechanical
Language	English
Publishing date	2016-12-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.19412P21
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Article ; Online: What do ovaries have to do with sleeping?

Sundaram, Shikha S / Halbower, Ann C

The Journal of pediatrics

2011 Volume 159, Issue 4, Page(s) 526–527

MeSH term(s)	Disorders of Excessive Somnolence/complications ; Female ; Humans ; Polycystic Ovary Syndrome/complications ; Sleep Apnea Syndromes/complications
Language	English
Publishing date	2011-10
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2011.06.043
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Article ; Online: Burden of disease in pediatric narcolepsy: a claims-based analysis of health care utilization, costs, and comorbidities.

Carls, Ginger / Reddy, Sheila Reiss / Broder, Michael S / Tieu, Ryan / Villa, Kathleen F / Profant, Judi / Halbower, Ann C

Sleep medicine

2019 Volume 66, Page(s) 110–118

Abstract: Background: This study analyzed a privately insured pediatric population with and without narcolepsy to determine the impact of pediatric narcolepsy on comorbidities, health care utilization, and cost. Additional analyses compared narcolepsy type 1 and ... ...

Abstract	Background: This study analyzed a privately insured pediatric population with and without narcolepsy to determine the impact of pediatric narcolepsy on comorbidities, health care utilization, and cost. Additional analyses compared narcolepsy type 1 and type 2. Methods: This retrospective cross-sectional study identified US patients with narcolepsy <18 years of age with ≥2 claims with a diagnosis code of narcolepsy using Truven MarketScan® data 2011 to 2015. Patients were matched to controls without narcolepsy. Comorbid conditions, health care utilization, and costs were measured by calendar year. P values are nominal, and no adjustments for multiplicity or multiple comparisons were made. Results: A total of 1427 pediatric patients with narcolepsy were identified and matched with 4281 controls from 2011 to 2015. Patients with narcolepsy had more comorbid conditions (mean 5.8 vs 2.4, nominal P < 0.001). Respiratory diseases and mood disorders were more common in patients with narcolepsy than controls (57% vs 32% and 56% vs 14%, respectively; both nominal P < 0.001). Compared to controls, patients with narcolepsy underwent more diagnostic tests (electroencephalogram, EEG [0.13 vs 0.0053]) and brain computed tomography, CT/magnetic resonance imaging, MRI (0.26 vs 0.022; both nominal P < 0.001). Mean annual inpatient days (0.71 vs 0.15), emergency department visits (0.51 vs 0.15), and outpatient office visits (8.6 vs 2.3) were higher for patients with narcolepsy than controls (all nominal P < 0.001). Annual mean health care costs were higher for patients with narcolepsy versus controls ($15,797 vs $2449, nominal P < 0.001). Conclusion: Pediatric patients with narcolepsy had greater comorbidity, higher health care utilization, and higher costs than patients without narcolepsy.
MeSH term(s)	Adolescent ; Cataplexy ; Child ; Child, Preschool ; Comorbidity ; Cost of Illness ; Cross-Sectional Studies ; Female ; Health Care Costs ; Humans ; Insurance Claim Review/statistics & numerical data ; Male ; Narcolepsy/economics ; Patient Acceptance of Health Care/statistics & numerical data ; Pediatrics ; Retrospective Studies ; United States
Language	English
Publishing date	2019-08-26
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2012041-2
ISSN	1878-5506 ; 1389-9457
ISSN (online)	1878-5506
ISSN	1389-9457
DOI	10.1016/j.sleep.2019.08.008
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Article ; Online: Family Chaos and Child Functioning in Relation to Sleep Problems Among Children at Risk for Obesity.

Boles, Richard E / Halbower, Ann C / Daniels, Stephen / Gunnarsdottir, Thrudur / Whitesell, Nancy / Johnson, Susan L

Behavioral sleep medicine

2016 Volume 15, Issue 2, Page(s) 114–128

Abstract: This study evaluated the influence of child and family functioning on child sleep behaviors in low-income minority families who are at risk for obesity. A cross-sectional study was utilized to measure child and family functioning from 2013 to 2014. ... ...

Abstract	This study evaluated the influence of child and family functioning on child sleep behaviors in low-income minority families who are at risk for obesity. A cross-sectional study was utilized to measure child and family functioning from 2013 to 2014. Participants were recruited from Head Start classrooms while data were collected during home visits. A convenience sample of 72 low-income Hispanic (65%) and African American (32%) families of preschool-aged children were recruited for this study. We assessed the association of child and family functioning with child sleep behaviors using a multivariate multiple linear regression model. Bootstrap mediation analyses examined the effects of family chaos between child functioning and child sleep problems. Poorer child emotional and behavioral functioning related to total sleep behavior problems. Chaos associated with bedtime resistance significantly mediated the relationship between Behavioral and Emotional Screening System (BESS) and Bedtime Resistance. Families at high risk for obesity showed children with poorer emotional and behavioral functioning were at higher risk for problematic sleep behaviors, although we found no link between obesity and child sleep. Family chaos appears to play a significant role in understanding part of these relationships. Future longitudinal studies are necessary to establish causal relationships between child and family functioning and sleep problems to further guide obesity interventions aimed at improving child sleep routines and increasing sleep duration.
MeSH term(s)	African Americans/psychology ; Child Behavior/psychology ; Child, Preschool ; Cross-Sectional Studies ; Emotions/physiology ; Family Relations ; Female ; Hispanic Americans/psychology ; Humans ; Longitudinal Studies ; Male ; Minority Health ; Obesity/physiopathology ; Obesity/psychology ; Poverty/psychology ; Sleep/physiology ; Sleep Wake Disorders/physiopathology ; Sleep Wake Disorders/psychology
Language	English
Publishing date	2016-01-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2099743-7
ISSN	1540-2010 ; 1540-2002
ISSN (online)	1540-2010
ISSN	1540-2002
DOI	10.1080/15402002.2015.1104687
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Article ; Online: Knowledge, Attitudes, and Risk for Sudden Unexpected Infant Death in Children of Adolescent Mothers: A Qualitative Study.

Caraballo, Michelle / Shimasaki, Suzuho / Johnston, Katherine / Tung, Gregory / Albright, Karen / Halbower, Ann C

The Journal of pediatrics

2016 Volume 174, Page(s) 78–83.e2

Abstract: Objective: To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the ... ...

Abstract	Objective: To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. Study design: Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. Results: Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate sleep space. The most common justifications for blankets were infant comfort and concern that babies were cold. Participants' decision making was often influenced by their own mothers, with whom they often resided. Participants felt that their instincts trumped professional advice, even when in direct contradiction to safe sleep recommendations. Conclusions: Among focus group participants, adherence with safe sleep practices was poor despite awareness of the American Academy of Pediatrics recommendations. Many mothers expressed beliefs and instincts that infants were safe in various unsafe sleep environments. Future study should investigate the efficacy of alternative educational strategies, including education of grandmothers, who have significant influence over adolescent mothers.
MeSH term(s)	Adolescent ; Bedding and Linens ; Female ; Focus Groups ; Health Knowledge, Attitudes, Practice ; Humans ; Infant Equipment ; Infant, Newborn ; Maternal Age ; Qualitative Research ; Risk Factors ; Sleep ; Sudden Infant Death/prevention & control
Language	English
Publishing date	2016-04-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2016.03.031
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Article ; Online: Treating Obstructive Sleep Apnea and Chronic Intermittent Hypoxia Improves the Severity of Nonalcoholic Fatty Liver Disease in Children.

Sundaram, Shikha S / Halbower, Ann C / Klawitter, Jelena / Pan, Zhaoxing / Robbins, Kristen / Capocelli, Kelley E / Sokol, Ronald J

The Journal of pediatrics

2018 Volume 198, Page(s) 67–75.e1

Abstract: Objective: To determine the effects of treating obstructive sleep apnea/nocturnal hypoxia on pediatric nonalcoholic fatty liver disease (NAFLD) severity and oxidative stress.: Study design: Biopsy proven participants (n = 9) with NAFLD and ... ...

Abstract	Objective: To determine the effects of treating obstructive sleep apnea/nocturnal hypoxia on pediatric nonalcoholic fatty liver disease (NAFLD) severity and oxidative stress. Study design: Biopsy proven participants (n = 9) with NAFLD and obstructive sleep apnea/hypoxia were studied before and after treatment with continuous positive airway pressure (CPAP) for sleep disordered breathing, including laboratory testing and markers of oxidative stress, urine F(2)-isoprostanes. Results: Adolescents (age 11.5 ± 1.2 years; body mass index, 29.5 ± 3.8 kg/m Conclusions: This study provides strong evidence that treatment of obstructive sleep apnea/nocturnal hypoxia with CPAP in children with NAFLD may reverse parameters of liver injury and reduce oxidative stress. These data also suggest CPAP as a new therapy to prevent progression of NAFLD in those children with obesity found to have obstructive sleep apnea/nocturnal hypoxia.
MeSH term(s)	Adolescent ; Biomarkers/metabolism ; Body Mass Index ; Child ; Chronic Disease ; Cohort Studies ; Continuous Positive Airway Pressure ; F2-Isoprostanes/urine ; Female ; Humans ; Hypoxia/complications ; Hypoxia/therapy ; Male ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/therapy ; Oxidative Stress ; Pilot Projects ; Severity of Illness Index ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/therapy
Chemical Substances	Biomarkers ; F2-Isoprostanes
Language	English
Publishing date	2018-05-08
Publishing country	United States
Document type	Controlled Clinical Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2018.03.028
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Article ; Online: Randomized, Placebo-Controlled Trial of Ferrous Sulfate to Treat Insomnia in Children With Autism Spectrum Disorders.

Reynolds, Ann M / Connolly, Heidi V / Katz, Terry / Goldman, Suzanne E / Weiss, Shelly K / Halbower, Ann C / Shui, Amy M / Macklin, Eric A / Hyman, Susan L / Malow, Beth A

Pediatric neurology

2019 Volume 104, Page(s) 30–39

Abstract: Background: Insomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance.: Methods: We performed a randomized placebo-controlled trial of oral ferrous sulfate to ... ...

Abstract	Background: Insomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance. Methods: We performed a randomized placebo-controlled trial of oral ferrous sulfate to treat insomnia in children with autism spectrum disorders and low normal ferritin levels. Twenty participants who met inclusion criteria and whose insomnia did not respond to sleep education were randomized to 3 mg/kg/day of ferrous sulfate (n = 9) or placebo (n = 11) for three months. Results: Iron supplementation was well tolerated, and no serious adverse events were reported. Iron supplementation improved iron status (+18.4 ng/mL active versus -1.6 ng/mL placebo, P = 0.044) but did not significantly improve the primary outcome measures of sleep onset latency (-11.0 minutes versus placebo, 95% confidence interval -28.4 to 6.4 minutes, P = 0.22) and wake time after sleep onset (-7.7 minutes versus placebo, 95% confidence interval -22.1 to 6.6 min, P = 0.29) as measured by actigraphy. Iron supplementation was associated with improvement in the overall severity score from the Sleep Clinical Global Impression Scale (-1.5 points versus placebo, P = 0.047). Changes in measures of daytime behavior did not differ between groups. Conclusion: This trial demonstrated no improvement in primary outcome measures of insomnia in subjects treated with ferrous sulfate compared with placebo. Interpretation was limited by low enrollment.
MeSH term(s)	Autism Spectrum Disorder/blood ; Autism Spectrum Disorder/complications ; Child ; Child, Preschool ; Double-Blind Method ; Female ; Ferritins/blood ; Ferrous Compounds/administration & dosage ; Ferrous Compounds/pharmacology ; Humans ; Male ; Outcome Assessment, Health Care ; Sleep Initiation and Maintenance Disorders/blood ; Sleep Initiation and Maintenance Disorders/drug therapy ; Sleep Initiation and Maintenance Disorders/etiology
Chemical Substances	Ferrous Compounds ; ferrous sulfate (39R4TAN1VT) ; Ferritins (9007-73-2)
Language	English
Publishing date	2019-08-02
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	639164-3
ISSN	1873-5150 ; 0887-8994
ISSN (online)	1873-5150
ISSN	0887-8994
DOI	10.1016/j.pediatrneurol.2019.07.015
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