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

描述(申请人提供)：据估计，在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，美国儿科学会强调了研究手术干预后儿童阻塞性睡眠呼吸暂停的进展的必要性。在以前的研究中，神经认知功能的测量是基于照顾者完成的行为任务或问卷。对腺扁桃体切除术(AT)治疗阻塞性睡眠呼吸暂停综合征(OSA)的疗效需要一个更客观、更可靠的衡量标准。我假设，夜间多导睡眠图(PSG)诊断为阻塞性睡眠呼吸暂停综合征(OSA)的儿童，在接受利用大脑额叶认知功能的听觉和视觉任务时，事件相关电位(ERPs)会有所不同。高密度的ERP技术对儿童是安全有效的，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也可以用来形成空间模型，帮助定位大脑中的电活动。儿童时期的事件相关电位差异与行为观察到的认知障碍和学习障碍有关。差异，如峰值幅度降低和特定波形潜伏期延长，可能会作为与睡眠障碍呼吸相关的认知缺陷的标志。在AT之后，这些措施应该会正常化。我建议通过实现三个目标来为当前的研究做出贡献：(1)使用ERPS测量阻塞性睡眠呼吸暂停儿童手术前后的认知和电生理变化；(2)通过行为任务、标准的神经心理评估和生理测量(如PSG)检查术后临床症状的变化；(3)获得成为科学界正常成员所需的经验、指导和写作技能。这项建议与NIH和NIMH的目标有关，因为它寻求进一步了解神经行为发展的过程，重点是儿童时期(在此期间大脑特别敏感的快速变化时期)，并使用几种技术来评估OSA的严重性和伴随的行为或心理病理。这项拟议中的研究将通过测试阻塞性睡眠呼吸暂停等睡眠障碍对儿童功能的影响程度，以及评估通常进行的手术是否真的解决了认知和行为问题，对公共健康产生积极影响。提高对睡眠的重要性和儿童时期睡眠障碍治疗的认识是非常必要的。这项研究将进一步告知科学界和公众有关睡眠卫生的保护以及儿童睡眠障碍的后果和治疗。

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.