Upper Airway Motor Control during Sleep in Children

儿童睡眠期间的上呼吸道运动控制

• 批准号: 6906453
• 负责人: ELIOT S KATZ
• 金额: $ 12.58万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6906453
• 关键词: REM sleep; chemoreceptors; clinical research; elasticity; electromyography; human subject; hypocapnia; mechanical pressure; mechanoreceptors; middle childhood (6-11); neuromuscular function; patient oriented research; pharynxs; polysomnography; preschool child (1-5); psychic activity level; psychomotor function; respiratory airflow disorder; respiratory airway pressure; respiratory muscles; respiratory reflex; sleep apnea

DESCRIPTION (provided by applicant): Obstructive sleep apnea syndrome (OSAS) is a common and serious cause of morbidity during childhood OSAS is characterized by recurrent episodes of partial or complete airway obstruction resulting in hypoxemia hypercapnea, and/or respiratory arousal. The sleep fragmentation and gas exchange abnormalities observed with OSAS may produce serious cardiovascular and neurobehavioral impairment. Habitual snoring is reported in 3-12% of the general pediatric population, although only 1-3% will have OSAS. The anatomical and/ol neuromuscular basis of the primary snoring (PS) and OSAS phenotype has not been elucidated. Upper airway patency is maintained by an intricate balance between the static pharyngeal mechanics, neuromuscular activity, and luminal pressure. A prominent role for upper airway neuromuscular control mechanisms in the pathophysiology of OSAS is hypothesized to explain the observation that obstruction does not occur while awake and is infrequently seen during NREM sleep. Using a validated intra-oral surface electrode to record genioglossus activity (EMGgg) and a nasal mask technique for measuring airway collapsibility (Pcrit), we will assess children with OSAS, PS and normal controls, awake and asleep, for the following; 1) Basal tonic and phasic EMGgg activity as a percentage of maximal; 2) Muscle and airway mechanical responses to hypercapnea (chemoresponsiveness); 3) Muscle and airway mechanical responses to continuous positive airway pressure (CPAP) and pulses of negative airway luminal pressure (mechanoresponsiveness); 4) Muscle and airway mechanical responses to inspiratory resistance loading. These studies address the role of neuromuscular compensatory mechanisms in the maintenance of airway patency during wakefulness and sleep in children. This proposal for a Mentored Patient-Oriented Research Career Development Award will permit the applicant to pursue his goal to become a clinical scientist. This training is set in the rich intellectual environment provided by the airway physiology laboratory of Dr. David P. White at Brigham and Women's Hospital, the Division of Respiratory Diseases at Children's Hospital Boston and the Harvard School of Public Health.

描述（由申请人提供）： 阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）是儿童期常见的严重疾病，其特征是反复发作的部分或完全气道阻塞，导致低氧血症、高碳酸血症和/或呼吸觉醒。OSAS患者的睡眠片段化和气体交换异常可能导致严重的心血管和神经行为损害。据报道，一般儿童人群中有3-12%的人习惯性打鼾，但只有1-3%的人患有OSAS。原发性打鼾（PS）和OSAS表型的解剖学和/或神经肌肉基础尚未阐明。上呼吸道通畅是由静态咽力学、神经肌肉活动和管腔压力之间的复杂平衡来维持的。上呼吸道神经肌肉控制机制在OSAS的病理生理学中的突出作用被假设来解释阻塞在清醒时不发生并且在NREM睡眠期间很少见到的观察结果。使用经验证的口内表面电极记录颏舌肌活动（EMGgg）和鼻罩技术测量气道可吸收性（Pcrit），我们将评估OSAS、PS和正常对照儿童清醒和睡眠时的以下指标：1）基础紧张性和阶段性EMGgg活动占最大值的百分比; 2）肌肉和气道对高碳酸血症的机械反应（化学反应性）; 3）对持续气道正压（CPAP）和气道腔负压脉冲的肌肉和气道机械反应（机械反应性）; 4）对吸气阻力负荷的肌肉和气道机械反应。这些研究探讨了神经肌肉代偿机制在儿童清醒和睡眠期间维持气道通畅中的作用。这一指导以患者为导向的研究职业发展奖的建议将允许申请人追求他的目标，成为一名临床科学家。本培训的背景是由布莱根妇女医院的大卫P.白色博士气道生理学实验室、波士顿儿童医院呼吸疾病科和哈佛公共卫生学院提供的丰富知识环境。