Literature Review: A Roundup of Important Recent Studies

Bottom line: Knowing these factors, physicians should have clear conversations with patients regarding complications and outcomes, and may want to consider out-of-court settlements when adverse factors to judgments in favor of defendants are present.

Citation: Svider PF, Sunaryo PL, Keeley BR, Kovalerchik O, Mauro AC, Eloy JA. Characterizing liability for cranial nerve injuries: a detailed analysis of 209 malpractice trials. Laryngoscope. 2013;123:1156-1162.

—Reviewed by Amy Eckner

Obesity in Children with OSA can Lead to Depression, Withdrawal

Is there a correlation between obstructive sleep apnea (OSA), obesity, behavior and quality of life in children?

Background: Obesity in children has greatly increased over the last 30 years. Previous studies have not found a linear correlation between obesity degree and OSA severity. In this study, caregivers were asked to complete the OSA quality of life questionnaire (OSA-18) and Behavior Assessment System for Children (BASC-2). All children underwent complete head and neck examinations to include tonsillar size assessments. Children were divided into Groups 1 (OSA-obese), 2 (OSA-normal weight) and 3 (primary snoring-normal weight with sleep-disordered breathing, but no OSA).

Study design: Case-control study of 73 children with pediatric OSA aged 2 to 18 years; the study was conducted between 2006 and 2009. Children with significant comorbidities, and those who were underweight or overweight but not obese, were excluded.

Setting: Cardinal Glennon Children’s Medical Center, St. Louis, Mo.

Synopsis: Mean ages of Groups 1, 2 and 3 were 9.5, 7.2 and 7.5 years, respectively. There were no gender, ethnicity, family income or family education differences between Groups 1 and 2. There were no age, BMI z score, ethnicity, family income or family education differences between Groups 2 and 3. The apnea-hypopnea index (AHI) was significantly higher for Group 1 than Group 2; there were no differences in tonsillar size. Group 1 had a worse mean total OSA-18 score than Group 2, with significant differences in emotional distress and daytime problems. Group 1 also had worse scores than Group 2 on BASC-2 for depression, withdrawal and internalizing problems. Groups 2 and 3 did not differ for any BASC-2 results. There was no correlation between BMI z score and OSA severity as measured by AHI; AHI correlated with OSA-18 scores but not with the behavioral symptoms index (BSI). There was a positive correlation between OSA-18 total scores and BSI. For Groups 1 and 2, AHI correlated with OSA-18 but not BSI; for Group 3, AHI did not correlate with either OSA-18 or BSI, but there was a correlation between OSA-18 and BSI. Limitations included the small size of individual subgroups, polysomnography behavior and quality of life issues, possibly related to poor age matching, lack of a true control population and parental bias.