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

儿童手术前和术后大脑和睡眠相关事件的差异

• 批准号: 7679999
• 负责人: MARIA E BARNES-DAVIS
• 金额: $ 3.74万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-15 至 2011-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7679999
• 关键词: Academy; Address; Adult; Affect; Aftercare; Aggressive behavior; American; Apnea; Area; Arousal; Attention; Attention deficit hyperactivity disorder; Auditory; Awareness; Behavior; Behavioral; Brain; Caregivers; Child; Childhood; Chronic; Clinical; Cognition; Cognitive; Cognitive deficits; Communities; Development; Diagnosis; EP300 gene; Event; Event-Related Potentials; Exhibits; Functional disorder; Goals; Hygiene; Hyperactive behavior; Hypoxia; Impaired cognition; Individual; Instruction; Intervention; Knowledge; Laboratories; Language; Learning; Learning Disorders; Link; Measures; Medical; Medicine; Memory; Modeling; National Institute of Mental Health; Neurocognitive; Obstructive Sleep Apnea; Operative Surgical Procedures; Outcome; Oxygen; Pathology; Pediatrics; Performance; Physiological; Polysomnography; Population; Postoperative Period; Problem behavior; Process; Public Health; Quality of life; Questionnaires; Relative (related person); Reporting; Research; Schedule; Schools; Science; Severities; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Speech Discrimination; Symptoms; Techniques; Testing; Theoretical model; Time; Training; Treatment outcome; United States National Institutes of Health; Visual; Visuospatial; Work; Writing; base; behavior measurement; brain electrical activity; cognitive function; density; executive function; experience; frontal lobe; frontal lobe function; improved; inattention; indexing; insight; language processing; member; millisecond; neurobehavioral; neuropsychological; psychologic; respiratory; response; skills; vigilance

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.

描述（由申请人提供）：估计有 1-3% 的儿科人群患有阻塞性睡眠呼吸暂停 (OSA)，这可能是导致许多行为和神经认知功能障碍的原因。最近，美国儿科学会强调有必要研究手术干预后儿科 OSA 的进展情况。在之前的研究中，神经认知功能的测量是基于行为任务或护理人员完成的调查问卷。需要更客观和可靠的措施来衡量腺样体扁桃体切除术 (AT) 对 OSA 的疗效。我推测，通过夜间多导睡眠图 (PSG) 诊断患有 OSA 的儿童在接受涉及大脑额叶认知功能的听觉和视觉任务时，会表现出事件相关电位 (ERP) 的差异。高密度 ERP 技术对于儿童来说是安全有效的，并且可以在毫秒级别上深入了解大脑的电活动。这些时间锁定波形还可用于形成空间模型，帮助定位大脑中的电活动。童年时期的 ERP 差异与行为观察到的认知障碍和学习障碍有关。提案后面讨论的峰值幅度降低和特定波形延迟增加等差异可能会成为与睡眠呼吸障碍相关的认知缺陷的标志。 AT 之后，这些措施应该正常化。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 ERP 测量 OSA 儿童手术前后的认知和电生理变化； （2）通过行为任务、标准神经心理学评估和生理测量（例如PSG）检查术后临床症状的变化； (3) 获得成为科学界有效成员所需的经验、指导和写作技能。该提案与 NIH 和 NIMH 的目标相关，旨在进一步了解神经行为发育过程，重点关注儿童期（大脑特别敏感的快速变化时期），并采用多种技术来评估 OSA 以及伴随的行为或心理病理学的严重程度。这项拟议的研究将测试 OSA 等睡眠障碍对孩子功能的影响程度，并评估常见的手术是否能真正解决认知和行为问题，从而对公共健康产生积极影响。非常需要提高人们对睡眠重要性的认识以及儿童时期睡眠障碍的治疗。这项研究将进一步向科学界和公众通报睡眠卫生的保护以及儿科睡眠障碍的后果和治疗。