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。相关的发病包括注意力不集中和多动行为、破坏性行为障碍、认知缺陷和白天过度嗜睡。睡眠专家建议儿童接受多导睡眠检查以确认SDB，特别是在腺扁桃体切除术之前，这是最常见的治疗方法。然而，耳鼻喉科医生很少在手术前或手术后进行此类检测。已发表的报告显示，SDB的临床诊断并不能可靠地预测多导睡眠图的结果，但多导睡眠图本身预测发病率的程度，特别是可治疗的发病率，尚不清楚。研究人员的初步数据表明，标准的SDB测量，如呼吸暂停率和呼吸不足率，从睡眠中唤醒率和氧饱和度，并不能可靠地预测神经行为的发病率或其改善。相比之下，在临床实践中很少使用的两种新技术确实显示出独特的预测价值。第一个是由研究人员开发并验证的一种创新信号处理算法，用于评估SDB患儿大脑皮层脑电图活动与非呼吸暂停呼吸周期同步变化的程度。第二项是食道压力监测，这是衡量SDB特征的呼吸努力增加的金标准。

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.