Impact of Childhood Sleep Disordered Breathing

描述（由申请人提供）：越来越多的证据表明，儿童的睡眠呼吸障碍（SDB）与行为障碍以及在学校和神经认知测试中的较差表现有关。然而，SDB的自然历史和长期影响仍有待确定。这项竞争性更新的主要目的是确定青春期前SDB对随后的学业和神经认知表现的影响，评估影响儿童SDB自然史的因素，并确定这些因素在白种人和西班牙裔之间是否存在差异。另一个目的是评估先前确定的通气驱动变化是否在后续评估中持续存在。因此，本项目建议对图森儿童睡眠呼吸暂停评估（TuCASA）队列进行重新评估。该队列最初招募的儿童年龄从6岁到11岁，旨在分析儿童SDB的患病率及其相关因素，具有良好的特征，是实现以下具体目标的理想工具：1)确定青春期前儿童SDB是否会在大约4年后对这些儿童的学习和神经认知表现、生长和血压产生不利影响，并比较白种人和西班牙裔儿童的研究结果；2)计算6 - 11岁儿童SDB的4年发病率、缓解率和当前患病率，并评估是否存在种族和/或青春期前的人体特征影响这些发病率；3)评估先前观察到的通气驱动异常是否在数年后持续存在；4)采用一种新的工作记忆和持续注意测试方法，结合任务执行过程中获得的脑电图（EEG）测量结果，确定是否可以在4年前患有SDB的儿童中检测到执行和额叶功能的细微变化。在TuCASA队列中，大约425名儿童将接受无人照看的重复家庭多导睡眠图、神经认知测试、完整的睡眠相关问卷，并在他们最初招募后大约4年进行了选择的人体测量。此外，在最初的TuCASA评估中进行了通气驱动研究的50名儿童的子集将重复这些研究。第二个子研究将采用50对TuCASA队列的病例对照子集，这些患者在4年前被发现患有或未患SDB，但在年龄、性别、种族和智力上相匹配。这些儿童将接受持续工作记忆任务，评估工作记忆和持续注意力，同时记录脑电图。这些数据将为SDB对儿童生长发育的长期影响提供重要证据。

DESCRIPTION (provided by applicant): Increasing evidence links sleep disordered breathing (SDB) in children to behavioral disturbances, and to poorer performance in school and on neurocognitive tests. However, the natural history and long-term impact of SDB remains to be determined. The primary objectives of this competitive renewal are to determine the impact of SDB identified in preadolescents on subsequent school and neurocognitive performance, to assess factors, which influence the natural history of SDB in children and to ascertain whether these elements differ between Caucasians and Hispanics. An additional objective is to assess whether previously identified changes in ventilatory drive persist on subsequent evaluation. This project thus proposes a reevaluation of the Tucson Children's Assessment of Sleep Apnea (TuCASA) cohort. This cohort of children initially recruited from ages 6 through 11 years to analyze the prevalence and correlates of childhood SDB, is well characterized, and is an ideal vehicle to achieve the following specific aims: 1) to determine whether SDB in preadolescent children adversely impacts school and neurocognitive performance, growth and blood pressure in these same children approximately 4 years later, and to compare findings between Caucasians and Hispanics; 2) to calculate the 4- year incidence and remission rates and current prevalence of SDB in children who were initially studied from ages 6 through 11 years, and to assess whether there are ethnic and/or anthropometric characteristics in preadolescence that influence these rates; 3) to assess whether abnormalities previously observed in ventilatory drive persist several years later; 4) to determine whether subtle changes in executive and frontal-lobe function can be detected in children who had SDB 4 years previously using a novel test of working memory and sustained attention which incorporates electroencephalographic (EEG) measures obtained during task performance. Approximately 425 children in the TuCASA cohort will undergo a repeat unattended home polysomnogram, neurocognitive test battery, complete questionnaires related to sleep and have selected anthropometric measurements taken approximately 4 years after their initial recruitment. In addition, a subset of 50 children who had ventilatory drive studies during their initial TuCASA evaluation will have these studies repeated. A second sub study will employ a 50 pair case control subset of the TuCASA cohort who were found to have, or not have SDB 4 years previously, but who are matched on age, gender, ethnicity and intelligence. These children will undergo the Sustained Working Memory Task that assesses working memory and sustained attention with concurrent recording of EEG. These data will provide important evidence concerning the long-term impact of SDB on growth and development in children.