Pre- and Post-operative Differences in Brain and Sleep-related Events in Children

描述（由申请人提供）：在估计1-3%的儿科人群中，阻塞性睡眠呼吸暂停（OSA）可能导致许多行为和神经认知功能障碍。最近，美国儿科学会强调需要研究手术干预后儿童OSA的进展。在以前的研究中，神经认知功能的测量是基于行为任务或由照顾者完成的问卷。需要一个更客观和可靠的措施的疗效腺样体扁桃体切除术（AT）的OSA。我假设，儿童诊断为阻塞性睡眠呼吸暂停综合征的夜间多导睡眠图（PSG）将表现出不同的事件相关电位（ERP）时，提出了听觉和视觉任务，挖掘大脑额叶的认知功能。高密度ERP技术在儿童中是安全有效的，它们提供了对毫秒级大脑电活动的洞察。这些时间锁定的波形还可以用于形成空间模型，其帮助定位大脑中的电活动。儿童时期的ERP差异与行为上观察到的认知障碍和学习障碍有关。差异，如在提案中稍后讨论的特定波形的峰值振幅降低和延迟增加，可能作为与睡眠呼吸障碍相关的认知缺陷的标志。AT后，这些措施应正常化。本研究拟通过以下三个方面的研究来促进目前的研究：（1）用事件相关电位（ERPs）测量OSA患儿手术前后的认知和电生理变化;（2）用行为任务、标准神经心理学评估和生理测量（如PSG）检查术后临床症状的变化;（3）获得经验，指导，和写作技能需要成为科学界的功能成员。该提案与NIH和NIMH的目标有关，因为它旨在进一步了解神经行为发育的过程，重点是儿童期（大脑特别敏感的快速变化时期），并采用几种技术来评估OSA的严重程度以及伴随的行为或心理病理学。这项拟议中的研究将对公共卫生产生积极影响，测试像OSA这样的睡眠障碍对儿童功能的影响程度，并评估通常进行的手术是否真的能解决认知和行为问题。提高对睡眠的重要性的认识和治疗儿童睡眠障碍是非常必要的。这项研究将进一步向科学界和公众提供有关睡眠卫生保护以及儿童睡眠障碍的后果和治疗的信息。

DESCRIPTION (provided by applicant): In an estimated 1-3% of the pediatric population, Obstructive Sleep Apnea (OSA) is likely responsible for many behavioral and neurocognitive dysfunctions. Recently the American Academy of Pediatrics highlighted the need to study the progression of pediatric OSA after surgical intervention. In previous studies, measures of neurocognitive function were based on behavioral tasks or questionnaires completed by the caregiver. A more objective and reliable measure of the efficacy of adenotonsillectomy (AT) for OSA is needed. I hypothesize that children diagnosed with OSA by overnight polysomnography (PSG) will exhibit differences in event-related potentials (ERPs) when presented with auditory and visual tasks that tap the cognitive functions of the brain's frontal lobes. High-density ERP techniques are safe and effective in children, and they provide insight into the electrical activity of the brain at the millisecond level. These time- locked waveforms can also be used to form spatial models which help localize electrical activity in the brain. ERP differences in childhood have been linked to behaviorally observed cognitive impairment and learning disorders. Differences, such as decreased peak amplitudes and increased latencies of specific waveforms discussed later in the proposal, might serve as markers for the cognitive deficits associated with sleep- disordered breathing. After AT, these measures should normalize. I propose to contribute to the current research by accomplishing three aims: (1) measuring cognitive and electrophysiological changes in children with OSA before and after surgery using ERPs; (2) examining the postoperative changes in clinical symptoms with behavioral tasks, standard neuropsychological assessments, and physiological measures, such as PSG; (3) obtaining the experience, instruction, and writing skills needed to become a functioning member of the scientific community. This proposal relates to the goals of NIH and NIMH in that it seeks to further understanding of the processes of neurobehavioral development with a focus on childhood (a period of rapid change during which the brain is particularly sensitive) and to employ several techniques to assess the severity of OSA and accompanying behavioral or psychological pathology. The proposed study will have a positive impact on public health by testing the extent to which sleep disorders like OSA affect the functioning of our children and assessing whether the commonly performed surgery actually resolves cognitive and behavioral problems. Increased awareness of the importance of sleep and treatment of sleep disorders in childhood is greatly needed. This study will further inform the scientific community and the public on the protection of sleep hygiene and the consequences and treatment of pediatric sleep disorders.