PREVALENCE OF SLEEP DISORDERED BREATHING IN CHILDREN

描述（由申请人提供）：该提案的目标是：1) 确定不同类型睡眠呼吸障碍 (SDB) 的患病率 在大量儿童的一般随机样本中； 2）识别重要风险 SDB因素； (3)建立各种危险因素的家族史 与患有 SDB 的儿童有关； (4)评估SDB对临床、 心理测量和行为/学业成绩； 5) 识别特征 这将有助于识别那些可能患有 SDB 风险的儿童 早期干预。几项评估特定人群的研究表明 表明儿童 SDB 与各种严重后果有关。 这些后果包括： 心血管并发症，如肺 高血压、肺心病和心律失常；行为异常，例如 白天过度嗜睡、学习成绩不佳、多动、 攻击性行为和社交退缩；和生长障碍 成功的治疗可以逆转时代。迄今为止，只有四 使用客观睡眠评估睡眠呼吸暂停患病率的研究 一般儿童随机样本的评价方法。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 范围为2-18岁。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=10、11、132和126）。这样，他们就可以 没有充分评估临床意义。这些研究都没有评估： 总体发育（例如身高、体重、年龄调整后的体重指数）； SDB的影响 身体健康（例如血压）；学术成就；或 电生理学将睡眠阶段定义为可能的结果测量。只有一个 研究报告可能与白天的嗜睡和行为有关。 因此，学龄儿童 SDB 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 对于 6 - 12 岁的儿童，我们建议采用合理的精度 类似于用于确定患病率和临床情况的方案 NIH 之前支持的两个成人方案的重要性。拟议的 研究将采用两阶段方案：1）由研究人员完成调查问卷 每个在当地小学就读的孩子的家长都会评估 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进行评估 实验室确定 SDB 的存在。第二阶段将获得 彻底的儿科耳鼻喉科和肺部评估以及学校记录和行为 将被评估。该群体的家长将接受家庭采访 儿童 SDB 相关危险因素史。这一战略将 产生足够的力量来确定患病率和临床意义 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.