It's been said before, but it warrants reminding that when it comes to sleep disorders, children are not little adults.  Pediatric sleep medicine is a highly specialized field where the specialties of pediatric pulmonology and neurology intersect to help address problems unique to children.  Although polysomnnography, or "sleep studies" are very similar to adults.  The techniques, equipment, scoring methods , and even personnel are highly specialized.

 A long overdue update to the American Academy of Pediatrics Recommendations was recently published specifically addressing the problem of childhood obstructive sleep apnea.  This guideline discusses important symptoms for parents and physicians such as chronic snoring, mouth breathing, and pauses in breathing during sleep.  But it also discusses less recognized features of sleep disorders such as inattentiveness and hyperactivity which can also result from disrupted sleep.  Talk to your pediatrician if you suspect a sleep problem in your child.  Dr. Susarla

AAP Recommendations for Childhood Sleep Disorders

Sleep disturbances, including obstructive sleep apneasyndrome (OSAS), are common in children and can result in significant health problems if left untreated.

In a revised clinical practice guideline, “Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome,” published in the September 2012 Pediatrics (published online August 27), the American Academy of Pediatrics (AAP) recommends that all children or adolescents who snore regularly be screened for OSAS.

Additional symptoms can include labored breathing during sleep, disturbed sleep with frequent gasps, snorts or pauses, and daytime learning problems. It is important for children exhibiting signs of OSAS to get a comprehensive diagnosis by having an overnight, in-laboratory sleep study done.

If left untreated, OSAS can result in problems such as behavioral issues, cardiovascular problems, poor growth and developmental delays. Treatments are available that can result in significant improvements in these complications. Adenotonsillectomy is effective in treating OSAS and is recommended as the first line of therapy. Obesity can be a risk factor, so physicians may recommend weight loss in addition to other therapies in overweight or obese children. Post-operatively, physicians should be aware of the criteria suggesting which patients should be admitted and when other treatment should be considered, such as CPAP.

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I love good iconoclastic research that blows up our entire way of thinking about disease. -JR

New Genetic Pathway Behind Neurodevelopmental Disorders Discovered

ScienceDaily (Dec. 6, 2012) — Researchers at the Douglas Mental Health University Institute, have discovered a new genetic process that could one day provide a novel target for the treatment of neurodevelopmental disorders, such as intellectual disability and autism.

The research study, which appears in the December issue of the American Journal of Human Genetics, was led by Carl Ernst, a Douglas Institute researcher, an assistant professor in McGill's Department of Psychiatry and a Canada Research Chair in Psychiatric Genetics. Ernst and his colleagues found that genetic mutations that negatively affect brain development can occur in a gene family of previously unknown function in the human genome.

According to the World Health Organization, neurodevelopmental disorders affect one in six children in industrialized countries. Impairing the growth and development of the brain or central nervous system, neurodevelopmental disorders encompass a broad range of conditions, including developmental delay, autism spectrum disorders and cerebral palsy. People with neurodevelopmental disorders can experience difficulties with language, speech, learning, behaviour, motor skills and memory.

Mutations in genes are thought to underlie many neurodevelopmental disorders, but all genes important for brain development found to date are in a single pathway. Genes are coded in DNA that gives way to RNA, which gives way to protein. Proteins form the functional unit of the body and are the major players in all biological activity. Prior to the current study, all genetic mutations important for neurodevelopmental disorders, occurred in genes that make protein.

The work of Ernst and his research team identified an important shortcut in the process of making functional molecules for brain development. By sequencing the genomes of 200 people with neurodevelopmental disorders and chromosomal abnormalities, and comparing the results to more than 15,000 control samples, the researchers made a surprising discovery: some individuals had mutations in a gene that did not make protein.

"Our discovery tells us that mutations in genes that code only for RNA and do not make protein can have a functional impact and lead to neurodevelopmental abnormalities," Ernst says. "In previous studies of brain development, RNA was just considered a middle player -- one that only served as a template for the production of proteins." ....

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Does IVF Increase Risk for Asthma?

The cause of this association is not clear, but premature infants especially under 30 weeks gestation seem to be more prone to develop asthma symptoms like recurrent wheezing.  Dr. Susarla

Fertility treatment 'asthma link'

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In a study of more than 13,000 UK children, five-years-olds were about twice as likely to have asthma if they were not conceived naturally.Children born after fertility treatments, such as IVF, may have a slightly higher chance of developing asthma, research suggests.

The children were also more likely to need medication, which could be an indication of more severe asthma.

The findings were published in the journal Human Reproduction.

The researchers, at the Universities of Oxford and Essex, analysed data from children born between 2000 and 2002.

Researcher Dr Claire Carson said 15% of all the children in the study had had asthma at the age of five, but this proportion had risen to 24% among the 104 of them born through assisted-reproduction technologies.

She said it was interesting that the pattern had emerged, but far too soon to say if IVF treatment resulted in higher rates of asthma. Other explanations, such as genetics, may explain the association.

Dr Carson told the BBC that parents should not be put off IVF.

"Assisted reproduction technologies offer a chance to become a parent when there isn't another option," she said.

"For the majority of children asthma is quite manageable."

Malayka Rahman, from the charity Asthma UK, said: "This study suggests that there might be an association between IVF treatment and asthma developing in children, but the sample size for this study is small and currently the research in this area generally is not conclusive.

"Those considering IVF should speak to their GP about the benefits and health risks in order to make an informed decision."

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