IDENTIFICATION OF SLEEP DISORDERED BREATHING IN CHILDREN

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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.