PREVALENCE OF SLEEP DISORDERED BREATHING IN CHILDREN

描述（由申请人提供）：本提案的目标是：1） 确定不同类型的睡眠呼吸障碍（SDB）的患病率 在大规模随机抽样儿童中; 2）识别重要风险 建立各种危险因素的家族史 与SDB儿童相关;（4）评估SDB对临床， 心理测量和行为/学术成果;以及5）确定特征 这将有助于识别那些有可能患上性别歧视的儿童， 早期干预。几项评估选定人群的研究 提示各种严重后果与儿童SDB相关。 这些后果包括：心血管并发症，如肺部感染， 高血压、肺心病和心律失常;行为异常， 白天过度嗜睡，学习成绩差，多动， 攻击性行为和社交退缩;以及生长障碍， 成功的治疗扭转了局面。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 评价方法一般为随机抽样儿童。三项研究 评估了6个月至6岁的有限年龄范围，而第四个评估了 2-18岁。这些研究采用了相对较小的样本， 睡眠实验室阶段（分别为N= 10、11、132和126）。因此可以 未充分评估临床意义。这些研究均未评价： 一般发育（如身高、体重、年龄校正BMI）; SDB的影响 身体健康（如血压）;学业成绩;或 电生理学将睡眠阶段定义为可能的结果测量。只有一 一项研究报告说，白天嗜睡和行为可能有联系。 因此，SDB在学龄儿童中的患病率和临床影响是 未知为了确定SDB的患病率和临床意义， 在6至12岁的儿童中，我们建议使用 与用于确定患病率和临床 在两个以前NIH支持的成人方案中具有显著性。拟议 研究将采用两阶段方案：1）由 每一个孩子的父母都在当地的小学就读， 一般睡眠、行为和学习问题; 2）随机样本（n= 1，000） 根据SDB风险从第一个样本中选择，并在睡眠中评估 实验室以确定SDB的存在。第二阶段将获得 全面的小儿耳鼻喉科和肺部评估以及学校记录和行为 将被评估。本组家长将接受家庭采访 与儿童SDB相关的危险因素史。这一战略将 产生足够的把握度来确定以下疾病的患病率和临床意义 儿童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.