Idiopathic Scoliosis Progression and Sleep-disordered Breathing in Children
Idiopathic Scoliosis Progression and Sleep-disordered Breathing in Children
This study aimed to investigate the prevalence and clinical significance of sleep-disordered
 breathing (SDB) in children with mild-moderate idiopathic scoliosis (IS).
Idiopathic scoliosis (IS) is the most common pediatric musculoskeletal disorder that causes a
 three-dimensional spinal deformity affecting 2 to 4% of adolescent subjects. It can be
 progressive (in 3 out of 10 cases) and severe involving serious effects (spine pain,
 cardiopulmonary compromise, deformed torso, psychosocial issues) and heavy treatments
 (corset, surgery). However, there is still no reliable criteria to predict the occurrence and
 progression of IS, while the etiology of IS remains unclear.

 Sleep-disordered breathing (SDB) in children is a common condition characterized by recurrent
 events of upper airway obstruction during sleep. The major symptom is snoring or noisy
 breathing. Preliminary evidence suggests that SDB in children is associated with low bone
 mass and postural stability, which might be mechanisms in the development of scoliosis.
 However, the influence of SDB on the progression of IS remains unknown.

 To fill those gaps, investigators will perform a prospective, unrandomized, observational
 cohort study to determine the prevalence and significance of SDB in children with
 mild-moderate IS. All subjects will be screened with a designated sleep questionnaire (PSQ),
 and children with either severe daytime sleepiness or frequent snoring or any degree of sleep
 pause will be requested to undergo further evaluation and an overnight polysomnography (PSG).
 Routine follow-up visits will be scheduled 6 months apart up to 24 months to assess the curve
 progression of scoliosis.
Inclusion Criteria:

 -  Diagnosis of idiopathic scoliosis

 -  Skeletally immature (Risser Sign 0-3)

 -  Cobb angle between 11-40 degrees

 -  Age between 5 and 16

 -  Patients can understand and complete the revised Pediatric Sleep Questionnaire at
 baseline and follow-up visits

 -  Patients with symptoms suspicious of SDB agree to undergo clinical evaluation and an
 overnight polysomnogram

 -  Informed Consent Form signed by subject or the guardian

 Exclusion Criteria:

 -  Patients with scoliosis other than idiopathic, or with other musculoskeletal or
 neurodevelopmental conditions that might be responsible for the scoliosis

 -  History of previous spine surgery or spinal injury

 -  Tumor or malignant tumor in the spine

 -  Leg length discrepancy more than 20 mm

 -  Previous diagnosis or treatment of SDB more than 6 months ago

 -  Fail to fulfill the questionnaire or refuse to attend any further evaluation

 -  Severe obstructive sleep apnea syndrome (OSAS) or significant hypoxemia requiring
 Continuous Positive Airway Pressure treatment

 -  A guardian who cannot accompany the child on the night of PSG

 -  Plans to relocate within the next 24 months