Introduction Objectives Fibromyalgia (FM) is a common rheumatic disorder characterized by chronic, widespread pain associated with several not painful symptoms. The contribution of gender to the manifestation of the disease may influence the higher prevalence of FM among women. In spite of this, how patients’ gender influences the clinical manifestation of FM is still not well understood. The frequent association with neuropsychiatric symptoms raised the attention on the role of neurotrophins, including the brain-derived neurotrophic factor (BDNF) as potential biomarkers of the condition. Aims of the study were to evaluate the influence of gender on clinical manifestations and to investigate BDNF serum levels as a potential biomarker of FM. Methods We consecutively enrolled 201 adult patients of both sexes diagnosed with FM. For each patient, we collected clinical and clinimetric data and, in a subgroup of 40 patients, we measured serum BDNF levels. BDNF levels have been measured also in 40 matched healthy controls (HC). Results Several symptoms were significantly higher in women compared with men, including pain, fatigue, memory problems, tenderness, balance problems and sensitivity to environmental stimuli. On the contrary, men reported a significant higher frequency of coexisting depressive symptoms. BDNF levels were significantly lower in FM patients compared with HC, discriminating with good accuracy the condition. Conclusion Gender influences FM clinical manifestations, with a higher prevalence of pain, fatigue and other common FM symptoms among women while higher frequency of neuropsychiatric symptoms among men. BDNF offers promises as a potential biomarker of the disease. Key Points • Gender-related differences in the clinical manifestations of FM may contribute to the higher prevalence of FM among females. Indeed, women show higher levels of pain and symptoms traditionally associated to FM, which are evaluated to establish the diagnosis according to the clinical criteria. • The new insights into the pathogenesis of the disease raised the attention on the role of brain mediators in FM. Among these, BNDF shows potential as a diagnostic biomarker.

This study aims at determining serum levels of tryptophan and other metabolites of the kynurenine pathway in children with attention deficit hyperactivity disorder (ADHD) compared to healthy controls. Such metabolites interact with glutamate receptors in the central nervous system, potentially modulating mechanisms that are pivotal in ADHD and thus potentially representing peripheral biomarkers of the disorder. We measured serum levels of tryptophan and some metabolites of the kynurenine pathway in 102 children with ADHD and 62 healthy controls by liquid chromatography–tandem mass spectrometry (LC–MS/MS). As compared to healthy controls, children with ADHD showed a reduction in serum levels of anthranilic acid (−60%), kynurenic acid (−11.2%), and xanthurenic acid (−12.5%). In contrast, serum levels of tryptophan (+11.0%) and kynurenine (+48.6%) were significantly enhanced, and levels of quinolinic acid were unchanged in children with ADHD. In a logistic regression model, the presence of ADHD was predicted by low anthranilic acid and high tryptophan levels. These findings support the involvement of the kynurenine pathway in the pathophysiology of ADHD and suggest that anthranilic acid and tryptophan levels should be investigated as potential peripheral biomarker for ADHD.

Objectives: To detect and raise the attention to the problem of obstructive sleep apnea (OSA) among the school-age children presented with nocturnal enuresis (NE). Methods: Sixty-three children >5 years presented with NE were enrolled in the study (35 Egyptian and 28 Italian). Children with evidence of urinary tract infection or anatomical abnormalities, intellectual disabilities, psychological issues and diabetes mellitus were excluded. All the children were clinically examined and scored using sleep clinical record score (SCR) adapted by Villa et al in 2013 (Eur Respir J 2013;41:55–61) as SCR ≥ 6.5 is considered positive. Then the patients were subjected for full night polysomnogram (PSG). Children with apnea/hypopnea index (AHI) ≥1 events/hour were considered as OSA. Results: Twelve Egyptian children refused to undergo the PSG. Fifty-one children aged 8.2±2.8 years underwent the PSG where 87.5% had OSA with AHI of 9.2±11.8 events/hour. Fifty-seven percent had OSA≥3 events/hour. The average oxygen saturation was 96.6±1.6% and nadir was 86.2±8.2%. SCR score correlated significantly with AHI (p=0.004) with mean SCR score of 7.44±2.78 points with 75% sensitivity in detecting OSA≥3. Thirty-one percent were obese with significantly higher AHI (12.2±15.9 vs. 6.1±8.6; p=0.035) that positively correlated with AHI (r= 0.301,p=0.035). Dental/skeletal malocclusions, arched palate and nasal obstruction were more prevalent with OSA (60.8%, 51% & 51% respectively) rather than tonsillar hypertrophy and oral breathing (19.6% & 27.5% respectively). Conclusions: NE is commonly associated with OSA especially in the obese children. Skeletal malocclusions and nasal obstruction were commonly associated with OSA and NE.

The sleep clinical record (SCR) may be a valid method for detecting children with obstructive sleep apnoea (OSA). This study aimed to evaluate whether there were differences in SCR depending on age and to identify the possible risk factors for OSA development. We enrolled children with sleep disordered breathing between 2013 and 2015, and divided them according to age into preschool- and school-age groups. All patients underwent SCR and polysomnography. OSA was detected in 81.1% and 83.6% of preschool- and school-age groups, respectively. Obesity, malocclusions, nasal septal deviation and inferior turbinate hypertrophy were significantly more prevalent in school-age children (p<0.05); however, only tonsillar hypertrophy had significant hazard ratio (2.3) for OSA development. Saddle nose, nasal hypotonia, oral breathing and tonsillar hypertrophy were significantly more prevalent for development of OSA in preschoolers (p<0.03). The SCR score was significantly higher among preschool children than in school-age children (8.4±2.22 versus 7.9±2.6; p=0.044). Further, SCR score >6.5 had a sensitivity of 74% in predicting OSA in preschool children with positive predictive value of 86% (p=0.0001). Our study confirms the validity of the SCR as a screening tool for patient candidates for a PSG study for suspected OSA, in both school and preschool children.

Background: Obesity is an important risk factor for obstructive sleep apnea syndrome (OSAS), and obese children with OSAS have frequently shown oxygen desaturations when compared with normal-weight children. The aim of our study was to investigate the oximetry characteristics in children with obesity and sleep-disordered breathing (SDB).Methods: Children referred for suspected OSAS were enrolled in the study. All children underwent sleep clinical record (SCR), pulse oximetry, and polysomnography (PSG).Results: A total of 248 children with SDB were recruited (128 obese and 120 normal-weight children). Obese children showed higher oxygen desaturation index (ODI) and lower nadir oxygen saturation (nadir SaO(2)) compared to non-obese children (p < 0.05). ODI and nadir SaO2 correlated with obesity (p < 0.05). The SCR evaluation showed that deep bite and overjet were more common among obese children (p < 0.05), whereas habitual nasal obstruction and arched palate were more common among non-obese children (p < 0.05). Furthermore, skeletal malocclusion and tonsillar hypertrophy were significant risk factors in obese children associated with severe desaturation (p < 0.05).Conclusion: Obese children with SDB have a more significant oxygen desaturation; adeno-tonsillar hypertrophy is not the only important risk factor for its development but also the presence of malocclusions. (C) 2016 Elsevier B.V. All rights reserved.

INTRODUCTION:Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life. MATERIALS AND METHODS:We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR). RESULTS:In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05). CONCLUSIONS:Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.

OBJECTIVES:To investigate the activity of the autonomic nervous system (ANS) during sleep in children with obstructive sleep apnea (OSA), in order to detect a possible cardiac ANS imbalance analyzing heart rate variability (HRV). METHODS:43 subjects between 4 and 12 years of age (7.26 ± 2.8 years), undergoing a diagnostic assessment for OSA were evaluated. A time domain index (R-apnea index) was developed to evaluate HRV strictly related to obstructive events during sleep. Poincaré plot of RR intervals during the whole night was calculated. RESULTS:R-apnea index was negatively correlated with apnea hypopnea index (AHI) (r=-0.360, p=0.028). AHI and the duration of the disease were the only variables that were significantly correlated with R-apnea index. Three groups were subsequently created according to polysomnographic findings considering AHI. R-apnea index resulted significantly lower in patient with severe OSA compared to primary snoring/mild OSA subjects (p<0.05). Looking at Poincaré plot, SD1 showed a diminishing trend with severity of OSA, however not reaching statistical significance. CONCLUSIONS:Our findings suggest an autonomic impairment in OSA children evidenced by the altered HRV both in the very short term (R-apnea index) and in short term (SD1). SIGNIFICANCE:R-apnea index is an easy and cheap method to undelay early ANS imbalance.

Objective: To evaluate the phenotypic characteristics and presence of sleep disorders in a group of pre-school children who presented in the first year of life at least one episode of Apparent life threating event (ALTE) compared with a control group. Study design: We analysed a group of pre-school children who referred for an ALTE (mean age 5.21 ± 0.90 years) between 2008 and 2010. Personal and family history was obtained for all the participants. All the children underwent a general clinical examination. Children with no history of ALTE were recruited as a control group. Results: One-hundred and seven ALTE children and 115 controls were enrolled. In ALTE group a higher frequency of snoring (25.2% vs 6.1%, p < 0.05), apnoeas (19.6% vs 4.3%, p< 0.05), restless sleep (31.7% vs 6.1%, p< 0.05) and night sweating (42.1% vs 24.3%, p< 0.05) compared with control group was reported. Thirty eight out of 107 (35.5%) of ALTE children showed a positive Brouillette score compared to controls (8/115, 7%) (p <0.05). Children in ALTE group vs controls showed a higher frequency of Angle class II (27.1% vs 15.7%, p <0.05), narrow palate (72.9% vs 51.3%, p <0.05) and Friedman palate position (grade III-IV) (31.7 % vs 16.6 %, p <0.05) Conclusions: Higher frequency of OSA symptoms and craniofacial abnormalities in children at pre-school age with previous ALTE were present. These findings support the hypothesis that ALTE occurrences could be suggestive of future development of OSA and underline the importance of a long-term follow-up.

Background: The sleep clinical record (SCR) is a rapid and valid method for detect children with OSAS. The aim of our study was to evaluate if there were differences in SCR depending on age. Methods: We enrolled children who referred to our pediatric sleep centre from September 2013 to January 2015. All patients underwent SCR, Polysomnography (PSG) and nocturnal oximetry. Results: We studied 351children (mean age 5,7 ± 2,8 years, male 235, PSG data: AHI 7,1± 9,2 ev/h, mean SpO2 97,0± 4,9%). The SCR mean value was 8,4± 2,3 (310 children with an SCR > 6,5). We divided the children into 2 groups depending on age, group 1 (234 pre-school children <6 years, mean age 4,0 ±1,1 years,155 male) and group 2 (117 school children, mean age 8,9± 2,3 years, 80 male) and we founded statistical significant differences in prevalence of obesity (BMI cent >95°, group 1: 15% vs group 2: 40%, p=0,001), in SCR values (group 1: 8,6±2,2 vs group 2: 8,0 ± 2,5, p=0,03), oxygen desaturation index (ODI, group 1: 6,5±3,9 vs group 2: 4,8 ± 3,3, p=0,001) and in some SCR parameters in term of alar cartilage hypotonia (group 1: 35% vs group 2: 23%, p=0,03), lip orbicular muscles hypotonia (group 1: 33% vs group 2: 22%, p=0,04), saddle nose (group 1: 33% vs group 2: 14%, p=0,001), nasal obstruction (group 1: 77% vs group 2: 57%, p=0,001), and severe tonsillar hypertrophy (group 1: 73% vs group 2: 33%, p=0,001). Conclusions: The SCR score is higher in children under 6 years of age and our study confirm that pre-school children had more structural orofacial alterations and severe tonsillar hypertrophy than school children who presented more obesity as a risk factor of OSAS.

This study evaluated the efficacy of oropharyngeal exercises in children with symptoms of obstructive sleep apnea syndrome (OSA) after adenotonsillectomy.

OBJECTIVES:The objective of this study was to evaluate the impact of obesity on cognitive impairment, in children with obstructive sleep apnoea (OSA), children with OSA and obesity, and in normal controls. METHODS:Thirty-six children with OSA (group 1), 38 children with OSA and obesity (group 2) and 58 normal controls (group 3) were studied. The Total intelligence quotient (T-IQ), Verbal IQ (V-IQ) and the Performance IQ (P-IQ) scores were obtained using the Wechsler Intelligence Scale for Children - Third Edition Revised. All participants' parents filled out the questionnaire containing the attention deficit and hyperactive disorder rating scale to investigate symptoms of hyperactivity and attention deficit. Obese and non-obese children with sleep-disordered breathing (SDB) underwent polysomnography. RESULTS:T-QI and P-QI scores were significantly lower in group 2 with higher performance impairment at the subtest compared to other groups. In obese children, V-IQ was significantly correlated with age of onset (r = 0.335, p = 0.05) and duration of SDB (r = -0.362, p = 0.02), while P-IQ and T-IQ were correlated with body mass index (BMI) percentile (r = -0.341, p = 0.03) and respiratory disturbance index (RDI) (r = -0.321, p = 0.05), respectively. RDI and BMI negatively influenced T-IQ in obese children with OSA. No correlation was found between sleep parameters and IQ scores or subtest scores in all groups. CONCLUSIONS:Obese children with OSA showed higher cognitive impairment. Obesity has an additive and synergic action with that exerted by OSA, speeding up the onset of complications.

IMPORTANCE Although polysomnographic (PSG) testing is the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children, the number of pediatric sleep laboratories is limited. Developing new screening methods for identifying OSAS may reduce the need for PSG testing.OBJECTIVE To evaluate the combined use of the sleep clinical record (SCR) and nocturnal oximetry testing for predicting PSG results in children with clinically suspected OSAS.DESIGN, SETTING, AND PARTICIPANTS Prospective study over 10 months. A cohort of 268 consecutive children (mean [SD], age 6 [3] years) referred for clinically suspected OSAS was studied at a pediatric sleep center at a university hospital. Children with disorders other than adenotonsillar hypertrophy or obesity were excluded.MAIN OUTCOMES AND MEASURES Mild OSAS (obstructive apnea-hypopnea index [AHI], 1-5 episodes/h) and moderate-to-severe OSAS (AHI, >5 episodes/h) were the main outcome measures. Sleep clinical record scores greater than or equal to6.5 were considered positive, as were McGill oximetry scores (MOS) greater than 1, and these positive scores were the main explanatory variables in our study. Each participant was evaluated by the SCR, followed by pulse oximetry test the first night and PSG test in the sleep laboratory the second night.RESULTS Of the total participants, 236 (88.1%) were diagnosed with OSAS, 236 (88.1%) had a positive SCR score, and 50 (18.7%) had a positive MOS. Participants with positive SCR scores had significantly increased risk of an AHI greater than or equal to 1 (adjusted odds ratio [AOR], 9.3; 95% CI, 3.7-23.2; P < .001). Children with an MOS greater than 1 were significantly more likely to have an AHI greater than 5 episodes/h than children with an MOS equal to 1 (AOR, 26.5; 95% CI, 7.8-89.2; P < .001). A positive SCR score had satisfactory sensitivity (91.9%) and positive predictive value (91.9%) but limited specificity (40.6%) and negative predictive value (40.6%) for OSAS. An MOS greater than 1 had excellent specificity (97.4%) and positive predictive value (94%) but low sensitivity (39.2%) and fair negative predictive value (60.8%) for moderate-to-severe OSAS among children with a positive SCR score. The combination of SCR scores and MOS correctly predicted primary snoring, mild OSAS, or moderate-to-severe OSAS in 154 of 268 (57.4%) participants.CONCLUSIONS AND RELEVANCE The combined use of the SCR score and nocturnal oximetry results has moderate success in predicting sleep-disordered breathing severity when PSG testing is not an option.

OBJECTIVES:The objectives of this study were to confirm the efficacy of rapid maxillary expansion in children with moderate adenotonsillar hypertrophy in a larger sample and to evaluate retrospectively its long-term benefits in a group of children who underwent orthodontic treatment 10 years ago. METHODS:After general clinical examination and overnight polysomnography, all eligible children underwent cephalometric evaluation and started 12 months of therapy with rapid maxillary expansion. A new polysomnography was performed at the end of treatment (T1). Fourteen children underwent clinical evaluation and Brouilette questionnaire, 10 years after the end of treatment (T2). RESULTS:Forty patients were eligible for recruitment. At T1, 34/40 (85%) patients showed a decrease of apnea-hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined responders. Only 6/40 (15%) showed a decrease <20% of AHI at T1 and were defined as non-responders (ΔAHI -53.47% ± 61.57%). Moreover, 57.5% of patients presented residual OSA (AHI > 1 ev/h) after treatment. Disease duration was significantly lower (2.5 ± 1.4 years vs 4.8 ± 1.9 years, p <0.005) and age at disease onset was higher in responder patients compared to non-responders (3.8 ± 1.5 years vs 2.3 ± 1.9 years, p <0.05). Cephalometric variables showed an increase of cranial base angle in non-responder patients (p <0.05). Fourteen children (mean age 17.0 ± 1.9 years) who ended orthodontic treatment 10 years previously showed improvement of Brouilette score. CONCLUSION:Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.

Aim: Aim of our study was to evaluate the role of Anterior Active Rhinomanometry (RAA) in the diagnosis of Obstructive Sleep Apnea Syndrome (OSAS) in children with sleep disordered breathing (SDB) in order to avoid the overuse of Polysomnography (PSG) Methods: Children with SDB,referred to our Pediatric Sleep Centre, underwent Sleep Clinical Record (SCR), Nocturnal Pulsossimetry, PSG and RAA. RAA was performed 3 times for each patient and the mean value of Total Nasal Resistance and Nasal Respiratory Flow has been recorded. A group of patients without a history of SDB and respiratory diseases was evaluated with SCR and RAA and considered as a control group. Results: A group of 29 children (55,2% male, age 4-16, mean age 7,0±2,9) with SDB was enrolled and compared with a control group of 16 patients (43,8% male, age 4-16, mean age 6,9±2,22). Significant differences in term of SCR (mean value 6,18±2 vs 9,18±2,45; p Children with SDB were divided in two groups depending from the Apnea-Hypopnea Index (AHI): group 1 (AHI Conclusions: RAA if associated with SCR and nocturnal pulsossimetry could improve the diagnosis of OSAS when PSG is not available.

The aim of our study was to evaluate the utility of the sleep clinical record (SCR) in the follow-up of children with obstructive sleep apnea (OSA) after treatment.

The purposes of this study were to assess cognitive functions in preschool children with sleep-disordered breathing (SDB) and to compare them with matched control children.

F2-isoprostanes are considered to be a reliable standard biomarker of oxidative stress in vivo because they are not influenced by the intake of lipids in the diet, and they are chemically stable molecules and easily detected. This study aimed to test the hypothesis that 8-isoprostane level is a useful marker to valuate the severity of pediatric obstructive sleep apnea (OSA).

Introduction Sleep-disordered breathing (SDB) has been associated with impaired cognitive and behavioural function in school children; little is known about younger children, although the age of 3 to 5 years is more affected and it is particularly important to further neurobehavioral development. Aim and objectives To assess cognitive functions in preschool children affected by SDB. Methods We enrolled 58 preschool children (age ranged 3-6 years; mean age 4.36 ± 0.97; 50% male) attending our Paediatric Sleep Centre and receiving a polysomnographic diagnosis of Primary Snoring (PS) or Obstructive Sleep Apnea Syndrome (OSA). Children with psychiatric disorders, EEG abnormalities, epilepsy, genetic syndromes and unable to speak fluent Italian were excluded. All children underwent a neurocognitive assessment using the Wechsler Preschool and Primary Scale of Intelligence- Third Edition (WPPSI-III). Results 28 children received diagnosis of PS or mild OSA (mean Apnea-Hypopnea Index (AHI) 2.56 ± 1.21) and 30 moderate-severe OSA (mean AHI 14.49 ± 11.7). In both groups, the cognitive assessment showed high scores on Verbal IQ (109.24 ± 11.78 vs 111.55 ± 12.25), Performance IQ (111.2 ± 10.75 vs 111.38 ± 11.01), and Full IQ (111.68 ± 11.06 vs 113.55 ± 12.88), without any statistical differences. Conclusions SDB of any severity in preschool children is not associated with poorer cognitive performance; therefore it could be argued that short duration of SDB don't cause neurocognitive damage. Further studies on larger series of children are warranted to confirm our preliminary data and to compare our results with cognitive assessment in a control group.

Introduction Polysomnography (PSG) is the gold standard for the diagnosis of Obstructive Sleep Apnea (OSA). However, it is expensive and not available everywhere. For these reasons, alternatives to full PSG for the evaluation of suspected OSAS are often sought. The aim of our study is to develop a simple tool to screen OSA, thus reducing the use of PSG. Methods Children with suspected OSA referred to our Pediatric Sleep Centre from September 2012 to September 2013 were included. Each patient underwent Sleep Clinical Record (SCR), full PSG, and nocturnal pulse oximetry. A diagnosis of OSA was made in children with an Apnea/Hypopnea Index (AHI) ≥1 ev/h. A SCR score ≥ 6.5 and a McGill Oximetry Score (MOS) ≥ 2 were considered positive. Results We enrolled 285 children, mean age 6.2 ± 3.1, 187 (65.6%) male. 52 children (18.2%) showed MOS ≥ 2 with a sensitivity of 20.5% and specificity of 97.2%. 227 children (79.6%) had SCR score ≥ 6.5 with a sensitivity of 81.1% and specificity of 30.5%. 48 children (16.8%) showed positive SCR and MOS; all of them received a diagnosis of OSA at the PSG, reaching a specificity of 100%. Sensitivity was 52%; positive and negative predictive value were respectively 100% and 18.5%. Conclusion The combined use of SCR and nocturnal pulse oximetry with MOS may represent a valid alternative to full PSG.

The aim of this prospective study was to investigate the activity of the autonomic nervous system (ANS) during sleep in children with obstructive sleep apnea (OSA), in order to detect a precocious imbalance of ANS. Materials and methods: A total of 43 subjects between 4 to 15 years of age (7.26 ± 2.8 years), undergoing a diagnostic assessment for OSA in our Paediatric Sleep Centre (Rome, Italy), for habitual snoring and apnea were enrolled.A time domain index (the R-apnea index) was developed to evaluate heart rate variability (HRV) strictly related to obstructive events during sleep. Moreover Poincare plot of RR intervals during the whole night was calculated. Results: The R-apnea index was negatively correlated with apnea hypopnea index (AHI) (r = -0.360, p = 0.028). Furthermore AHI and the duration of the disease have been identified as the only variables that were significantly correlated with the R-apnea index. Three groups were subsequently created on the basis of polysomnographic findings according to AHI. The R-apnea index resulted significantly lower in patient with severe OSA compared to primary snoring/mild OSA subjects (p Looking at Poincare plot, SD1 (short term variability) showed a diminishing trend with severity of OSA, although not reaching statistical significance. Conclusions: Our findings suggest that an early autonomic impairment was present in children with OSA since HRV was altered in the very short term (R-apnea index) and in short term (SD1).