IDENTIFICATION OF SLEEP DISORDERED BREATHING IN CHILDREN

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。睡眠呼吸障碍，即喉咙在睡眠中反复完全或部分关闭，据信影响了1%至3%的儿童。其中最突出的后果是注意力不集中和多动行为，破坏性行为障碍，如注意力缺陷/多动障碍，认知缺陷和白天过度嗜睡。儿童睡眠呼吸障碍的通常治疗方法是腺扁桃体切除术，这是该年龄组最常见的外科手术之一。睡眠专家经常建议怀疑患有睡眠呼吸障碍的儿童在腺扁桃体切除术前进行睡眠实验室研究，以确定是否真的存在睡眠呼吸障碍。然而，在实践中，耳鼻喉科医生很少获得这些研究。睡眠实验室测试，即多导睡眠图，在多大程度上提供了预测手术后儿童的行为或嗜睡是否会改善的信息，目前还不确定。研究人员的初步数据表明，标准的多导睡眠图测量，如夜间呼吸停止的频率，并不能可靠地预测手术后的行为反应。然而，在临床实践中很少使用的两种新技术却显示出独特的预测价值。第一种技术是用电脑评估睡眠中脑电波随每次呼吸同步变化的程度。一些证据表明，在睡眠呼吸紊乱的情况下，即使呼吸没有完全受阻，呼吸所需的额外努力也可能导致部分觉醒，这反映在脑电波模式中。第二种方法是监测食道内的压力。这种压力随着每次呼吸而变化，当喉咙部分闭合时压力更大。吸气时的最大负压提供了增加呼吸努力的黄金标准，这是睡眠呼吸紊乱的基本特征。因此，本研究项目的主要目标是改进识别儿童睡眠呼吸障碍的方法，这种呼吸障碍会影响儿童的行为、认知和白天嗜睡。研究人员将使用夜间多导睡眠描记术，详细评估100名儿童的行为、精神状态、认知和嗜睡，这些儿童因临床适应症而计划接受腺扁桃体切除术。研究人员还将按照相同的方案，研究50名匹配的对照受试者。所有评估将在6个月后重复，以完成这项对照、非随机随访研究。对脑电波随呼吸周期变化程度的计算机分析，将与标准的睡眠唤醒（通过脑电波的视觉检查确定）进行比较，以确定哪些预测在手术前的认知和行为问题，以及手术后这些问题的解决。将食道压力与睡眠呼吸障碍的标准多导睡眠图测量方法进行比较，以预测相同结果的能力。这项研究可能会从根本上改善用于识别儿童睡眠呼吸障碍的方法，这种方法带有重大的、可治疗的行为疾病。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Sleep-disordered breathing, in which the throat closes completely or partially in a repeated manner during sleep, is believed to affect 1% to 3% of children. Among the most prominent consequences are inattentive and hyperactive behavior, disruptive behavior disorders such as attention-deficit/hyperactivity disorder, cognitive deficits, and excessive daytime sleepiness. The usual treatment for sleep-disordered breathing in children is adenotonsillectomy, which is one of the most frequent surgical procedures performed in this age group. Sleep specialists often recommend that children suspected to have sleep-disordered breathing undergo sleep laboratory studies before adenotonsillectomy to determine whether sleep-disordered breathing is truly present. However, in practice otolaryngologists rarely obtain these studies. Uncertainty exists about the extent to which the sleep laboratory tests, called polysomnograms, provide information that predicts whether or not a child s behavior or sleepiness will improve after surgery. Preliminary data from the investigators suggests that standard polysomnographic measures, such as the rate at which breathing stops during the night, do not reliably predict behavioral response after surgery. In contrast, however, two newer techniques rarely used in clinical practice do show unique predictive value. The first technique involves computerized assessment of the degree to which brain waves vary in synchrony with each breath during sleep. Some evidence suggests that the extra effort required to breathe in sleep-disordered breathing, even when breathing is not completely obstructed, may cause partial arousal that is reflected in brain wave patterns. The second technique involves monitoring pressure within the esophagus. This pressure changes with each breath, and more when the throat is partially closed. The maximum negative pressure during inspiration provides a gold-standard measure of increased respiratory effort, a fundamental feature of sleep-disordered breathing. The main goal of this research project, therefore, is to improve methods for identification of childhood sleep-disordered breathing that affects behavior, cognition, and daytime sleepiness. The investigators will use nocturnal polysomnography and detailed assessments of behavior, psychiatric status, cognition, and sleepiness, in 100 children who are scheduled to undergo adenotonsillectomy for clinical indications. The investigators also will study, in an identical protocol, 50 matched control subjects. All assessments will be repeated six months later to complete this controlled, non-randomized follow-up study. The computerized analysis, of the degree to which brain waves change with the respiratory cycle, will be compared with standard sleep arousals (determined by visual inspection of brain waves) to see which predicts cognitive and behavioral problems before surgery and their resolution after surgery. Esophageal pressures will be compared to standard polysomnographic measures of sleep-disordered breathing in their ability to predict the same outcomes. This investigation could lead to fundamental improvement in methods used to identify childhood sleep-disordered breathing that carries significant, treatable behavioral morbidity.