Identification of Sleep-Disordered Breathing in Children

描述（由申请人提供）：睡眠呼吸障碍（SDB）影响至少1%至3%的儿童。相关的发病率可能包括注意力不集中和过度活跃的行为，破坏性行为障碍，认知缺陷和白天过度嗜睡。睡眠专家建议儿童进行多导睡眠描记术以确认SDB，特别是在最常见的治疗方法--扁桃体切除术之前。然而，耳鼻喉科医生很少在手术前或手术后进行这种测试。已发表的报告表明，SDB的临床诊断不能可靠地预测多导睡眠图结果，但多导睡眠图测量本身预测发病率，特别是可治疗的发病率的程度尚不清楚。来自研究者的初步数据表明，标准的SDB指标，如呼吸暂停和呼吸不足的发生率、睡眠觉醒的发生率和氧饱和度下降的程度，不能可靠地预测神经行为的发病率或改善。相比之下，两种在临床实践中很少使用的新技术确实显示出独特的预测价值。第一个是一个创新的信号处理算法，由研究人员开发和验证，以评估在何种程度上皮层EEC活动的变化与SDB儿童的非呼吸暂停呼吸周期同步。第二，食管压力监测，是一个金标准的增加呼吸努力的特点SDB措施。 因此，修订后的竞争性更新申请的主要目标是研究和改进识别携带可逆性发病的儿童SDB的方法。研究者将对100名计划进行临床适应性腺样体扁桃体切除术的儿童和50名匹配的对照受试者进行夜间多导睡眠描记术和行为、精神状态、认知和嗜睡的有效评估。所有评价将在6个月后重复进行，以完成本对照、非随机随访试验。具体目标1是确定术前呼吸周期相关的EEC变化（RCREC），而不是标准的多导睡眠图觉醒，是否可以预测神经行为发病率及其手术后的改善。目的2是评估食管压力，而不是标准SDB措施，是否可以预测相同的结果。目的3是评价新的标准测量方法在识别临床相关残留SDB中的术后效用。对SDB的两个基本特征-呼吸努力增加及其与儿童SDB的皮质识别和神经行为影响活动风险的相关性-的研究可能会导致儿童SDB识别和神经行为影响风险的根本改善。

DESCRIPTION (provided by applicant): Sleep-disordered breathing (SDB) affects at least 1 to 3% of children. Associated morbidity can include inattentive and hyperactive behavior, disruptive behavior disorders, cognitive deficits, and excessive daytime sleepiness. Sleep specialists recommend that children undergo polysomnography to confirm SDB, especially before adenotonsillectomy, which is the most common treatment. However, otolaryngologists rarely obtain such testing either before or after surgery. Published reports show that a clinical diagnosis of SDB does not predict polysomnographic results reliably, but the extent to which bolysomnographic measures themselves predict morbidity, and especially treatable morbidity, is not well known. Preliminary data from the investigators suggest that standard SDB measures, such as rates of apneas and hypopneas, rates of arousals from sleep, and the extent of oxygen desaturation, do not reliably predict neurobehavioral morbidity or its improvement. In contrast, two newer techniques, rarely used in clinical practice, do show unique predictive value. The first is an innovative signal processing algorithm developed and validated by thfe investigators to assess the extent to which cortical EEC activity changes in synchrony with non-apneic respiratory cycles in children with SDB. The second, esophageal pressure monitoring, is a gold-standard measure of the increased respiratory effort that characterizes SDB. The main goal of this revised competitive renewal application, therefore, is to study and improve methods for identification of childhood SDB that carries reversible morbidity. The investigators will administer nocturnal polysomnography and well-validated assessments of behavior, psychiatric status, cognition, and sleepiness to 100 children scheduled for clinically-indipated adenotonsillectomy, and to 50 matched control subjects. All evaluations will be repeated 6 months later to complete this controlled, non-randomized follow-up trial. Specific Aim 1 is to determine whether pre-operative respiratory cycle-related EEC changes (RCREC), rather than standard polysomnographic arousals, can predict neurobehavioral morbidity and its improvement after surgery. Aim 2 is to assess whether esophageal pressure', rather than standard SDB measures, can predict the same outcomes. Aim 3 is to evaluate the post-operative utility of the newer and standard measures in identification of clinically-relevant residual SDB. This investigation of two fundamental SDB characteristics -increased respiratory effort arid its correlation with cortical identification of childhood SDB and risk for neurobehavioral impact activity - may well lead to fundamental improvement in identification of childhood SDB and risk for neurobehavioral impact.