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Developing a Predictive Model of the Outcomes of Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome

开发小儿阻塞性睡眠呼吸暂停综合征腺样体扁桃体切除术结果的预测模型

基本信息

批准号：
10438448
负责人：
Derek J Lam
金额：
$ 4.63万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-01-01 至 2022-01-09
项目状态：
已结题

项目摘要

Project Summary/Abstract Recent evidence has demonstrated that up to 30% of children undergoing adenotonsillectomy (AT) for pediatric obstructive sleep apnea syndrome (OSAS) will have significant residual disease. Although most patients will experience some benefit from AT, the ability to reliably predict the outcome of AT for any individual patient has not been demonstrated. The candidate's long-term goal is to become a leading expert in developing and critically evaluating treatments for pediatric OSAS. To help achieve this goal, the candidate's specific training objectives for this career development award include 1) obtaining advanced biostatistics and outcomes research training, 2) gaining experience in developing and validating a predictive model of surgical outcomes, and 3) developing further clinical expertise in the diagnosis and treatment of pediatric OSAS. These training objectives will be achieved by pursuing advanced biostatistical coursework and training through the Oregon Clinical and Translational Research Institute (OCTRI) Scholars Program as well as clinical and research collaboration with the OHSU Sleep Disorders Program. The overall research objective of this proposal is to develop a comprehensive predictive model for the outcomes of AT for OSAS that includes anatomic and dynamic functional risk factors determined by sleep endoscopy. It is our central hypothesis that a composite predictive model that includes sleep endoscopy findings will accurately predict the outcome of AT and allow estimation of the likelihood of surgical success. The specific aims of this study are to 1) determine the associations between a validated sleep endoscopy rating scale and post AT outcomes, and 2) develop and validate a composite predictive model of the outcomes of AT incorporating sleep endoscopy ratings and other baseline factors. These aims will be achieved through a prospective cohort study of children aged 2-18 years who are undergoing AT for a diagnosis OSAS. Other inclusion criteria will include risk factors predisposing to residual OSAS after AT: obesity, severe preoperative OSAS, African American race, and age greater than 7 years. Patients will undergo sleep endoscopy prior to AT. Outcome measures include apnea-hypopnea index, generic and OSAS-specific quality of life, and validated caregiver ratings of executive function. A composite predictive model using presence of post-AT OSAS as the primary outcome variable will be developed and validated. Such a model will allow more accurate and reliable prognostication of AT outcomes and will help to inform the need for postoperative follow-up and possibly suggest strategies for further intervention. 6

项目概要/摘要最近的证据表明，高达 30% 的儿童接受腺样体扁桃体切除术 (AT) 小儿阻塞性睡眠呼吸暂停综合征 (OSAS) 会有明显的残留病灶。虽然大多数患者将从 AT 中获益，能够可靠地预测任何个体的 AT 结果患者尚未得到证实。候选人的长期目标是成为开发和批判性评估治疗方法的领先专家用于儿科 OSAS。为了帮助实现这一目标，候选人针对该职业的具体培训目标发展奖包括 1) 获得高级生物统计学和成果研究培训，2) 获得开发和验证手术结果预测模型的经验，以及 3) 进一步开发儿科 OSAS 诊断和治疗的临床专业知识。这些培训目标将实现通过俄勒冈州临床和转化中心进行高级生物统计课程和培训研究所 (OCTRI) 学者计划以及与 OHSU 的临床和研究合作睡眠障碍计划。本提案的总体研究目标是开发一个全面的预测模型 AT 治疗 OSAS 的结果，包括由睡眠决定的解剖学和动态功能风险因素内窥镜检查。我们的中心假设是，包含睡眠内窥镜检查的复合预测模型研究结果将准确预测 AT 的结果并可以估计手术成功的可能性。本研究的具体目的是 1) 确定经过验证的睡眠内窥镜检查之间的关联评级量表和 AT 后结果，以及 2) 开发并验证结果的综合预测模型 AT 纳入睡眠内窥镜检查评级和其他基线因素。这些目标将通过针对因诊断 OSAS 而接受 AT 的 2-18 岁儿童的前瞻性队列研究。其他纳入标准将包括 AT 后易发生残余 OSAS 的危险因素：肥胖、术前严重 OSAS，非裔美国人，年龄大于 7 岁。患者将在术前接受睡眠内窥镜检查在。结果测量包括呼吸暂停-呼吸不足指数、一般和 OSAS 特定的生活质量，以及验证护理人员执行功能的评级。使用后 AT 存在的复合预测模型将开发和验证 OSAS 作为主要结果变量。这样的模型将能够更加准确以及 AT 结果的可靠预测，并将有助于告知术后随访的需要和可能会提出进一步干预的策略。 6