PREVALENCE OF SLEEP DISORDERED BREATHING IN CHILDREN

简介(申请人提供)：本建议书的目的如下：1) 确定不同类型睡眠障碍呼吸(SDB)的患病率 在大范围随机抽样的儿童中；2)识别重要风险 (3)建立各种危险因素的家族史 (4)评估SDB对临床的影响， 心理测量和行为/学业结果；以及5)确定特征 这将有助于识别那些有可能患上青春期糖尿病的儿童 早期干预。几项评估选定人群的研究已经 提示儿童的SDB与各种严重后果有关。 这些后果包括：心血管并发症，如肺部并发症 高血压、肺心病和心律失常；行为异常，如 白天过度困倦，学习成绩不佳，多动症， 攻击性行为和社交退缩；以及成长障碍 成功的治疗逆转了时代。到目前为止，只有四个 使用客观睡眠评估睡眠呼吸暂停患病率的研究 评价方法一般在随机抽样的儿童中进行。三项研究 评估的有限年龄范围为6个月至6岁，而第四个评估的年龄范围为 2-18年的范围。这些研究在其研究中使用了相对较小的样本 睡眠实验室阶段(N分别为10、11、132和126)。因此，他们可以 没有充分评估临床意义。这些研究中没有一项进行评估： 一般发育(如身高、体重、年龄调整的BMI)；SDB的影响 身体健康(如血压)；学习成绩；或 电生理学将睡眠阶段定义为可能的结果衡量标准。只有一个 研究报告称，这可能与白天的嗜睡和行为有关。 因此，学龄儿童中SDB的患病率和临床影响是 未知。目的：明确SDB的患病率及临床意义 对于有合理精确度的6-12岁儿童，我们建议采用 类似于用于确定患病率和临床的方案 在美国国立卫生研究院以前支持的两项成年人方案中的意义。建议数 研究将采用两个阶段的方案：1)由 在当地小学注册的每一个孩子的父母将评估 一般睡眠、行为和学习问题；2)随机抽样(n=1,000) 根据SDB的风险从第一个样本中选择，并在睡眠中进行评估 实验室确定是否存在SDB。第二阶段将收到一个 全面的儿科耳鼻喉科和肺部评估以及学习成绩和行为 将会被评估。这群人的父母将为这个家庭接受采访 儿童SDB相关危险因素病史。这一战略将 产生足够的力量来确定糖尿病的患病率和临床意义 儿童中的SDB。

DESCRIPTION (provided by applicant): The objectives of this proposal are to: 1) establish the prevalence of different types of sleep disordered breathing (SDB) in a large general random sample of children; 2) identify important risk factors of SDB; (3) establish the family history of various risk factors associated with children with SDB; (4) assess the impact of SDB on clinical, psychometric and behavioral/academic outcomes; and 5) identify characteristics which will assist in identifying those children at risk for SDB for possible early intervention. Several studies evaluating select populations have suggested that various severe consequences are associated with SDB in children. These consequences include: cardiovascular complications such as pulmonary hypertension, cor pulmonale, and arrhythmia; behavioral abnormalities such as excessive daytime sleepiness, poor school performance, hyperactivity, aggressive behavior, and social withdrawal; and growth disturbances which at times are reversed by successful treatment. To date, there have been only four studies evaluating the prevalence of sleep apnea using objective sleep evaluation methods in general random samples of children. Three studies evaluated a limited age range of 6 mos to 6 yrs, while the fourth assessed a range of 2-18 years. These studies employed relatively small samples in their sleep laboratory phase (N=lO, 11, 132, and 126, respectively). Thus, they could not adequately assess clinical significance. None of these studies evaluated: general development (eg height, weight, age adjusted BMI); the effects of SDB on physical health (eg blood pressure); academic achievement; or electrophysiologic defined sleep stages as possible outcome measures. Only one study reported a possible association with daytime sleepiness and behavior. Thus, the prevalence and clinical impact of SDB in school age children is unknown. In order to establish the prevalence and clinical significance of SDB in children aged 6 - 12 years with reasonable precision, we propose to employ a protocol similar to that used to establish the prevalence and clinical significance in two previously NIH supported protocols in adults. The proposed study will employ a two-phase protocol: 1) questionnaire completed by the parents of every child enrolled in local elementary school which will assess general sleep, behavior and learning problems; 2) a random sample (n= 1,000) selected from the first sample based on risk for SDB and evaluated in the sleep laboratory to determine the presence of SDB. The second phase will receive a thorough pediatric ENT and pulmonary evaluation and school records and behavior will be assessed. The parents of this group will be interviewed for the family history of risk factors associated with SDB in children. This strategy will yield adequate power to establish the prevalence and clinical significance of SDB in children.